Five Questions with Dr. Mahesh Madhavan, Interventional Cardiologist

We spoke with Mahesh Madhavan, MD, MS, about joining the faculty at Columbia—including his role developing and expanding services for coronary and structural heart care in the Greater Hudson Valley Area.

Can you tell us about your background?

Dr. Mahesh Madhavan Profile Headshot

I've had a longstanding interest in science and research since growing up in Pittsburgh, Pennsylvania. My father is an interventional cardiologist and watching him be a part of the field for the last 40 years significantly influenced me. Hearing about the developments in the field, witnessing his dedication to patients and his work in the hospital, and joining him at the conferences that my current mentors and colleagues organize and lead really shaped my interest growing up. 

That interest in science and research is still motivating me today. I'm fascinated by applying what we know and adding to the knowledge base. Hopefully, that knowledge will help make patients feel better and do better. 

After graduating from high school, I moved to Philadelphia to attend the University of Pennsylvania for my undergraduate studies. I focused on a few things in college, but my interest in science led me to major in biology and biological sciences. I also minored in South Asian studies out of curiosity about my historical background and where my parents came from: South India. After college, I was interested in gaining more experience and training in research. I had done laboratory-based research at that time, and I wanted to pursue that further. I therefore joined a leading physician investigator at the Dana-Farber Cancer Institute in a lab focused on various DNA repair pathways pertinent to the field of radiation oncology. 

I subsequently came to Columbia for medical school in 2009, and I've been here ever since. Coming to Columbia, a place that has such a major impact on this field, only reiterated my interest in pursuing a career focused on cardiovascular patient care and research.

I've been so fortunate to have the opportunity to work with and learn from world leaders in the interventional cardiology space. And that naturally led to my continued interest in joining the team and hopefully making my own contributions to this field in the future. 

What's your role with Columbia?

I'm an interventional cardiologist focused on coronary and structural (or valvular) heart disease. I work at the main CUIMC campus at Milstein Hospital, performing procedures and treating patients with those diseases. In addition, I will work to help teach fellows and the next generation of interventional cardiologists in the cardiac Cath lab. 

I'm also part of a team at Columbia helping to bring interventional and structural heart therapies to Middletown and the Greater Hudson Valley area. We’re partnering with Garnet Health to offer patients in this area with what Columbia is known for: the very best cardiovascular care, whether it's related to coronary disease, valve disease, or other cardiac conditions. The goal is to perform many of these coronary or structural procedures there. We want to offer them the same high-quality care they would receive at our main campus, but closer to home.

Lastly, given my longstanding interest in helping advance care and in developing and providing novel therapies for patients, I am also very much involved in clinical research and the undertaking of clinical trials in interventional cardiology both at Columbia and CRF [Cardiovascular Research Foundation].

What role does research play in your career?

I am fortunate to have been exposed to many of the Columbia and CRF faculty during my time as a medical student, resident, and fellow. While early on I was involved with basic science research, my focus has since shifted to more patient-oriented and clinical research. A lot of the things we do are evaluating new devices and therapies in terms of their efficacy and safety and whether they will provide any benefit in terms of what they add to currently available treatments. We're also evaluating new devices or devices that have yet to be used in the United States. 

The hope is that, whether it's for coronary disease or in the structural space, we can improve on the available devices that are out there. In the coronary space, there's a lot of interest in improving the longevity of our treatments; one of the limitations of coronary stents is that, just like any other treatment, they don't necessarily last forever. And there are treatments available outside of the U.S. that might serve as a touch-up treatment. The specific kind of device is called a drug-coated balloon. One of the areas I've helped contribute towards is studying these drug-coated balloons under the leadership of Martin Leon, MD, and Ajay Kirtane, MD.

I'm fortunate in that the group here at Columbia is at the forefront of this type of work. Similarly, with regards to structural heart disease, there are a number of clinical investigations underway to help improve upon available treatments for mitral, tricuspid, and other disease processes. It will require a lot of thought, planning, and device development to make transcatheter therapies possible in these areas. My role at Columbia and CRF is to help design and undertake studies to study novel devices, with the ultimate hope of bringing such treatments to patients.

What has your experience been working at both Milstein and Middletown?

We're fortunate at Columbia to have several amazing operators who have helped shape the field in many ways. The opportunity to continue learning from some of the leading minds in the field is a unique one, and I am grateful for this. Continuing advancement—developing one's skills and having some of the most cutting-edge technologies available for patients—is an exciting part of being here at Columbia.

But there are strengths to working outside of the center, too. I enjoy collaborating with my colleagues in the Cath lab at the Garnet Hospital; many of them have provided valuable insights or suggestions, and that kind of working environment is exactly the type of place I want to be a part of. It's exciting to provide many of the services we offer at Milstein to patients who are now 60-plus miles away and who would otherwise not be able to get those types of treatments. It's also quite rewarding to know that we can help diagnose diseases that otherwise might not have been found as quickly. Bridging the treatment gap for those patients is a big draw for me.

We need to do more in terms of reaching out to patients, making them more aware to reach out to their primary care doctors, and, when appropriate, to cardiologists to get evaluated and screened. And letting them know about these diseases, whether it's coronary disease or valvular heart disease, what signs and symptoms to look for, and how they can impact you. When rounding on the wards or seeing patients in the clinic, I have noticed that these are areas that may not necessarily be as well-known or appreciated. That's an area we could do better at and an area I will take as a challenge and move forward with, especially as I continue to spend more time in that region.

What do you envision for the Columbia-Garnet partnership?

We hope to bring therapies such as valvular heart and structural interventions up there. That will be a joint effort between us and the cardiac surgeons. Columbia Cardiac Surgery, led by Michael Argenziano, MD, already has a presence there, and they'll be an instrumental partner in making this happen. In addition, Inderpal Singh, MD, has done a lot to help lay the groundwork of establishing the Columbia Cardiology footprint in the region.

The heart valve clinic is a joint effort between cardiac surgeons and interventional cardiologists, and I am looking forward to working closely with the surgical team. Specifically, when it comes to the valve program, I am especially excited about the idea of this opportunity to help build something from the start. I came to Columbia in 2009 at a time when the initial transcatheter valve replacement studies were being published; it was a pivotal moment in the field. Being exposed to studies like that and then having the opportunity first to rotate under and then work side-by-side with leaders in the field, like Dr. Leon and Susheel Kodali, MD, has been a truly unique opportunity. My ultimate hope is to help bring some of these cutting-edge therapies and advance care for patients with heart disease in the Greater Hudson Valley Area.