Meet Christian F. Witzke, MD
Dr. Witzke is director of the Structural Heart Disease Program and director of the Latin-American Cardiovascular Program at Einstein Healthcare Network.
Dr. Witzke has a special interest in the field of structural heart disease. He focuses on percutaneous closure of heart defects, paravalvular leaks and management of various valvular heart diseases, including aortic stenosis and mitral valve disease. Dr. Witzke is a leading implanter of percutaneous aortic valve prosthesis—also known as TAVR—in patients with aortic stenosis. He also helped develop the Cardiogenic Shock Program at Einstein.
Here’s what he had to say about TAVR and aortic stenosis, along with reflections on his practice.
Q: What is TAVR?
A: TAVR is the acronym for a transcatheter aortic valve replacement. It is a relatively new technology that is being used for replacement of the aortic valve without the need for open heart surgery. I say “relatively new” because it was initially approved in 2011. The approval was for a very specific patient population, and that has evolved to a larger group of patients who could benefit from this procedure. It’s actually moving forward to expand to almost everybody with aortic stenosis, but this is for the future.
Q: That leads to a question about aortic stenosis. What is it, and what kind of impact does it have on a person’s life?
A: Aortic stenosis is a disease where the aortic valve becomes narrow. The disease progresses very slowly over years, creating stress to the heart muscle. Because the disease progresses so slowly, patients develop subtle changes in their life, which sometimes aren’t perceived as symptoms, including shortness of breath and fatigue. People think it’s just aging. “I’m not doing the things I used to be able to do because I’m just getting older.”
It’s so complex that sometimes even primary care physicians don’t recognize the symptoms. There’s also a group of primary care physicians who actually know that their patients have the disease, but they think their patient might be too old and too fragile to undertake any procedures and they don’t refer those patients to us.
We have a lot of outreach to primary care physicians about the importance of recognizing the subtle symptoms, and to not hesitate to refer them to our practice–stop thinking about age as a limiting factor. This procedure has become so straightforward nowadays with such a low risk for death and complications, even elderly patients can undertake this procedure very, very well.
Q: What causes aortic valve disease?
A: We don’t really understand or know how this disease occurs. What we know is that aortic stenosis is the most common valvular disease in the U.S.
Normally the aortic valve is made of three cusps, or three working components that allow blood to go in one direction and prevent the blood from coming in the opposite direction. In patients with aortic stenosis the valve becomes stiff, making it hard for the heart to pump blood to the body.
Typical risks that affect the arteries of the heart and body, like diabetes, high blood pressure, smoking and high cholesterol, seem to have a role in the development of aortic stenosis. The impact of each of them to this valve is unclear.
Q: What does valve replacement do for people?
A: The first thing it does is resolve the patient’s symptomatology. I remember doing these procedures early on in the research phases, 2008 and 2009, when I was in Boston. I remember vividly. I would talk to one of my patients and ask him if he felt any better two hours after the TAVR procedure. Patients would say, “Doctor, there is only one thing I can tell you. I used to feel like somebody was sitting on my chest, and I couldn’t take a deep breath. Now, I can breathe.” It’s just incredible.
Q: What led you down this path? Not everyone becomes a doctor, and not everyone does the kind of work you do.
A: It goes back to when I was a teenager. I went to a Catholic school, and I recall going to the hospital with one of my teachers who was very involved in helping people. It all came out of helping the sick. I remember going to University Hospital in Caracas, Venezuela, where I was born, to see these very ill patients. We would just go there to visit them and bring something to cheer them up. I think that’s the way it started. That led me to want to become a physician.
At some point late in my medical school years, I recognized that the heart was the organ I was passionate about. That become reinforced when I went for a research year at Massachusetts General Hospital after medical school, where I spent one year working on basic science. It was just unbelievable, the way the heart works. It was so tactile, you can actually see it in the basic research lab. That was an eye-opener for me. During my residency at Einstein, my passion was fueled by my teachers. I ultimately decided to do interventional cardiology, which to me is that portion of cardiology that gives rapid resolution of patients’ symptoms.
Q: You completed your Internal Medicine residency and Cardiovascular Medicine fellowship training at Einstein Medical Center, followed by two years of training in Interventional Cardiology and Structural Heart Disease at Massachusetts General Hospital. Why did you come back to Einstein?
A: I love this place. They trained me, and I knew the patient population. There’s a large Latino population, and I knew I could have a huge role taking care of Latino patients. Today, 60 to 70 percent of my patients are bilingual, bicultural, and most of them speak only Spanish. I also foresee a great opportunity to develop the Structural and Valvular Heart Disease Program, as Einstein did not have this specialty. This program involves working with patients with valve conditions like aortic stenosis and congenital heart disease like holes in their hearts.
Q: What is your favorite book?
A: I mainly read Spanish-written books. “Love in the Time of Cholera,” written by Nobel Prize-winner for language and literature Gabriel Garcia Marquez, is by far my favorite book. I’ve read it at least three times in my life.
Q: Do you have a favorite movie?
A: I’m a movie lover, but I would say, my favorite of all is Dead Poets Society. I love when Robin Williams takes his students to the school’s Hall of Fame to stress the importance of everyday life. He tells them to “Seize the day.”
Q: What is something that people might not know about you?
A: People don’t think I can relax. If you see me around, I am in a continuous state of motion. People think I’m always in a rush and always trying to get to the next thing on the list. But during a day of moving, there are also moments of peace and mindfulness. They just happen at home or my office during a coffee break.