Five Questions with William Prabhu, MD, Interventional Cardiologist
We spoke with William Prabhu, MD, about his experience as a faculty member at Columbia—including his role in expanding interventional cardiology services in the Hudson Valley.
Can you tell us about your path to Columbia?
I went to medical school at SUNY Syracuse, did my residency and chief residency at the University of Vermont, and my cardiology, interventional cardiology, structural cardiology, and peripheral fellowships all at Brown University. I spent four years working at Westchester Medical Center, and then the last four and a half years here at Columbia.
I knew I wanted to be an interventional cardiologist when I first observed the people who are now my senior partners perform a transcatheter aortic valve replacement or TAVR, almost 20-something years ago, back when they first started doing that procedure. Columbia, of course, helped develop the device, along with so many others; pioneers like Dr. Martin B. Leon and Dr. Kodali, who are now my senior partners. I saw the third TAVR procedure in the country when they did it all those years ago. When I saw that, I said, I have to do this.
To be fair, I don't think I would've been in the starting lineup in center field for the New York Yankees. <laugh> Those are probably the two best jobs in the world. I go back and forth on which is better, but most of the time, it's interventional cardiology. We get to get up in the middle of the night at the drop of a hat and come in and save a neighbor's life.
What is your clinical role here at Columbia?
I'm an interventional cardiologist working at Hudson Valley Hospital and here at the Columbia University Irving Medical Center main campus in upper Manhattan. I perform coronary interventions for heart attacks and chest pain at both places. We have a comprehensive structural heart team, which includes things like transcatheter aortic valve replacement, or TAVR. Patients can be evaluated in Westchester, but procedures are performed at the main campus. We're hoping to expand our care in Westchester, including our peripheral vascular disease services. We also have a robust pulmonary embolism program, where we treat lots of patients.
I think the cath lab opened about 4 years ago. There are actually two locations: we have the Bronxville location and the Peekskill on Croton location. I mainly work at the Peekskill location.
We have a fully functioning cath lab treating heart attacks and cardiogenic shock patients, and we have resources at our disposal to take care of quite a few patients.
It is a beautiful facility. We can provide one-on-one care from our nursing staff, which you won't find at a larger institution. We have the same capabilities, technologies, and techniques that would be used at Columbia University, but closer to home. This is an enormous benefit to the community. Before this effort, advanced interventional cardiology techniques in Westchester were not readily available. There are a million patients in Westchester County, which is obviously a big metro area. They deserve the same kind of care that you would get in any other major metropolitan area. And I'm one of the folks bringing that care to Westchester.
What procedures are now available in Westchester?
We do coronary artery stenting, which is mostly for heart attacks or chest pain. We have full ventricular assist device pumps for emergencies. We have multiple capabilities for pulmonary embolism care, which is the third-highest cause of death from cardiovascular causes. And we hope to start doing carotid artery stenting to prevent the second most common cause of cardiovascular death, which is stroke. And there's new data to show it's superior to the traditional vascular surgery approach. That still has to go through a couple of layers for approval, but I've been trained in it and have done it before.
The carotid artery stenting is huge. The left ventricular cyst devices are huge. We’ll hopefully start doing things like Watchman devices for left atrial appendage closure, which aren't that new, but folks won't have to go all the way down to New York for the procedure.
At Columbia, we are constantly driving new breakthroughs. Practically any transcatheter cardiovascular device that gets approved in this country goes through the interventional cardiology department at Columbia. Before it's seen by a physician in the United States, it's seen by our group and goes into our hands for evaluation. So we have access to almost all cutting-edge technologies through our leadership roles in interventional cardiology.
What are some unmet needs in the Westchester area that you'd like to highlight?
I can give you two of them. One is high-quality percutaneous coronary intervention. This field has developed relatively recently; it's probably only 40 years old. So there are some people who came in at the beginning who are still doing the stuff they did 30 years ago. Because we are constantly up to date with the latest technologies, this makes a difference in how long a stent lasts and the results the patient achieves. So that's really important to us, and it's something we're passionate about in our group.
For example, intravascular ultrasound, or any intracoronary imaging, is performed at a rate of about 10-15% across the country. We're doing it 95-100% of the time because intracoronary imaging during stent placement has been proven to reduce heart attacks and adverse events. Radial access is kind of old news, but we do over 90% of procedures via radial access because it’s more comfortable for patients.
And stroke reduction is the other need. Carotid artery stenting is something I really want to focus on, again, because it has now been shown to be superior to the old surgical standard. So that’s really a huge unmet need across the country that we're just starting to pursue at Columbia in Manhattan, and hopefully at Hudson Valley, as well.
Ever have an experience that made you realize you were doing what you should be doing?
I can remember having to do a TAVR for a vet and him asking if we could put it off until later. When I asked why, he said he couldn't get there that early; he had to take three buses to the hospital.
I just said, "Where do you live?” And I picked him up that morning and drove him to the hospital. We did his TAVR valve, and he was ready to go home the following day, so on the way home from work, I just dropped him back at his house. He did great.
Everybody kind of made fun of me for that one, but it's just, you do what you have to do. So we just did what we had to do for this guy, who was just the nicest guy.
A family friend we ski with was getting increasingly short of breath. She came in critically ill with aortic stenosis that had been misdiagnosed. We got her in, put her new valve in, and I've got tons of pictures of her skiing afterward. We still see each other all the time.
My wife's a physician; she's been a pediatric ER physician at Columbia for the last 10 years, and now she works predominantly at NYP Westchester. We live in Westchester. We've got four kids. We're part of the community; this is where we live and where our friends live. It’s our job to take care of all the folks around us. We get to make a difference.
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