Five Questions with Michael Brener, MD, Interventional Cardiologist
We spoke with Michael Brener, MD, about joining the faculty at Columbia—including his hemodynamics research and his hobby of completing cardiology fellowships.
Can you tell us a little bit about your background?
I was born in Israel and came to the United States when I was two years old. My father is also an interventional cardiologist and came here to complete his internal medicine training. He was on the faculty of the Cleveland Clinic for 20 years.
So I grew up in Cleveland. What's there to say about Cleveland? [Laughs] It was a good place to grow up. I had a fairly nondescript childhood, and I came to New York the first time around for college.
I went to Columbia for undergrad and then briefly left the city for medical school and internal medicine residency at Johns Hopkins in Baltimore. I was asked to be a chief resident, which, at Hopkins, is a pretty involved role. I basically functioned as the attending physician for a group of medicine trainees for an entire year. I was basically on service the whole time. It was a very important part of my personal professional development.
I then came back to Columbia for my cardiology training, and I've been here ever since. I have done a few fellowships here: general cardiology for four years, interventional cardiology, and structural interventional cardiology. So, I've done a lot of training in my life, but I think I am finally done.
This is my first year as faculty. As part of my clinical role, I help the Columbia community practice. We have a variety of nurse practitioners who are part of the interventional cardiology section who see patients in the boroughs and they need to refer patients for procedures. I perform their standard right and left heart catheterizations and coronary interventions as needed.
I spend around 50% of my time focused on research, and I help the structural and valve team with procedures one day a week.
Is there any reason you gravitated toward the valve space?
My research drove me there. I always credit my cardiology fellowship program director, Dr. Steven Marx, because he connected me with a research mentor before I even started my fellowship here at Columbia. His name is Dan Berkoff. He is an adjunct faculty member here at Columbia, but he primarily works at the Cardiovascular Research Foundation. He is the guru of cardiovascular hemodynamics; if you ever have a question about hemodynamics, he's your guy.
So, I started to really get into hemodynamics with him. I learned a very specialized technique called pressure-volume analysis. He taught me how to do it, how to interpret it, and everything else I needed to know about it.
And the natural place to apply that technique in the field of cardiology, and interventional cardiology in particular, is in the valve space.
Patients with valvular heart disease have very interesting hemodynamics. Much of my research focuses on hemodynamics on the right side of the heart, specifically the right ventricle and pulmonary arterial circulation. So, I'm interested in emerging therapies for tricuspid regurgitation.
We now have two FDA-approved technologies, so it's great to have new ways to treat patients and make them feel better. We still haven't unlocked the answer of who will do better with a valve replacement. But I think that answer is in the hemodynamics.
I think we'll be able to use hemodynamics to figure out not just which patients need treatment, but also which kind of treatment.
What's a scenario where hemodynamics would be a determining factor between valve repair vs. valve replacement?
Right ventricular-pulmonary artery (RV-PA) coupling is the relationship between the contraction of the right ventricle and the resistance of the pulmonary arteries. When the right ventricle is coupled to the pulmonary artery, blood is very efficiently transferred forward in the right direction.
In simple terms, when you reduce regurgitation acutely, the heart must now pump all of the blood in one direction. It doesn't do that normally because it's very easy to pump it backwards in the wrong direction.
A helpful construct for thinking about hemodynamics in the heart is to view it like a pump with valves. If you think of it like a pump, it's just blood flowing down with gravity, right? It's going to take the path of least resistance. So when you eliminate the path of least resistance, which is blood going backward, now blood has to pump forward into the pulmonary arteries, which may be under high resistance, relatively speaking.
Looking at the hemodynamics, we can use an advanced test called pressure-volume analysis to determine which patients will have enough reserve and sufficient right ventricular contractile function to tolerate valve replacement. I think that will help us hone in on who will be a better replacement candidate.
And if they're not a good candidate for replacement, that doesn't mean that they're out of luck; it might mean that we need to emphasize valve repair for those patients.
If you could assess that with high fidelity before intervention, you could tailor therapy more accurately.
What do you do for fun when you're not being a doctor?
I have an 8-year-old son who occupies about 95% of my attention. He is an absolute blast. We both love baseball; that's our shared passion. Like I said, I grew up in Cleveland, so I'm a Guardians fan. My son is a die-hard Yankees fan; he knows the 40 man roster, knows all the stats. So I can't walk in the house and NOT be a Yankees fan.
So, I have to be a bit of a Yankees fan, and I do like the Orioles from my time in Baltimore; I have a lot of split allegiances. But I get around it by saying I love the game of baseball. This past summer, we went to the All-Star game. We also did a little tour of the country and visited a bunch of baseball stadiums. I will see a game pretty much anywhere.
I also like to cook a lot, and I'm pretty good at it.
So, between my son, baseball, cooking, and work, I don't have much time for anything else.
When did you know you made the right career choice?
I think back to the first time that I had my own STEMI patient—a life-threatening type of heart attack. I did it on my own, in the middle of the night. I thought, this is why I have trained for so many years. It was very affirming in the moment, to realize that this is what it's all for. You've trained for 10 years to be able to help them.
I just found that extremely exhilarating. I remember it was two in the morning, but I couldn't go back to sleep. It was summer, so the sunrise was around five in the morning. So I just enjoyed my New York moment, eating a bagel, egg, and cheese, sitting and enjoying the sunrise.
The patient did really well, and they left the hospital after a few days. Ultimately, that's why we do it: we want to help patients in their moment of need.