Mahesh Anantha, MD
With a love of vascular medicine, this fellow took the unusual path of training in peripheral before coronary interventions.
Mahesh Anantha, MD, is an interventional cardiology fellow at the University of Arizona (Phoenix, AZ). He was educated at Madras Medical College (Chennai, India), then came to the United States to pursue research training at the Mayo Clinic School of Medicine (Rochester, MN), an internal medicine residency at Creighton University School of Medicine (Omaha, NE), and a cardiovascular disease fellowship at the University of Minnesota (MN). Last year, rather than starting with coronary interventions, he completed a fellowship in vascular medicine and endovascular interventions at Yale-New Haven Hospital (New Haven, CT). Anantha has had more than three dozen original research papers published in peer-reviewed journals and has presented findings at many large, international conferences. He plans to pursue additional training in statistics to aid his translational research goals and eventually would like to settle into a career balanced in both academic and clinical duties.
What has it been like to train and now envision your career in a country different from where you grew up?
Initially, when I moved to the United States in 2010, it was challenging. I wasn’t getting paid during my research time and I didn’t know anybody here, so the transition was very difficult. There were mornings when I thought that I should just go back and continue my training in India, but I kept myself motivated and just kept pushing through because I knew there were great opportunities and mentors here. The longer I stayed, the more confidence I gained and the more established I felt.
At this point, I’m here for good. Much of the training I’ve received reflects the practice here in the US more than in India. Interestingly, I went back to the Madras Medical Mission in India for a month of elective in a busy cath lab during my cardiology rotation, and I noted how incredibly different the practice was. They were very methodical despite having a very high volume of procedures, and it was a highly educational and enjoyable experience. However, mainly for doing long-term, data-driven research, it will be a great opportunity for me to stay in the United States and continue my training and eventually my career. I do hope to return to India annually and find opportunities to give back to the community.
Why did you choose to train in peripheral before coronary interventions—a path opposite from what others typically do?
I found out about peripheral interventions back in 2011 after completing an elective at Temple University—I knew that I wanted to learn more. I grew to develop a real passion for vascular medicine, especially when I realized that a lot of patients with peripheral arterial disease are undertreated. When I was at the University of Minnesota, my mentor Christina Fanola, MD, motivated me to do something different, gain extra skills, and not just follow the traditional path. When you complete a peripheral interventional fellowship, I feel that you get much better catheter skills because you are starting with larger arteries that don’t move, unlike the coronaries. Also, you learn how to manage your own complications, including big-bore femoral access techniques, in a way that you don’t always have time for during coronary training. However, there are only a few programs in the country that offer peripheral training prior to coronary training and none of them are ACGME-accredited, so finding and applying to them is not so straightforward.
How would you advise someone else who is considering taking this or a similar pathway?
I would definitely recommend completing peripheral fellowship before training in coronary intervention, mainly because when it comes to procedural skills, you’ll be better. We know that coronary artery disease often coexists with peripheral arterial disease, so you’ll be able to give comprehensive care to your patients. Applying for a peripheral fellowship is difficult because of the different timelines for application. You won’t go through the Electronic Residency Application Service (ERAS) system and you’ll likely have to reach out to programs individually, often finding out about them through word-of-mouth. I would advise applying during your second year of general cardiology training, similar to when your peers would begin applying for interventional cardiology fellowships.
My experience at Yale was amazing with excellent hands-on training with Carlos Mena-Hurtado, MD, who is a great mentor and a wonderful friend. The year was also academically very productive with research mentorship by Mena-Hurtado as well as Kim Smolderen, PhD, from the Vascular Medicine Outcomes (VAMOS) group.
What has surprised you most about becoming an interventional cardiologist?
As a general cardiology fellow, whenever I saw people doing interventional procedures, they made it look easy. But I’ve come to know that every time I step into the cath lab, every single day, it's very humbling. Even if you think about a very small procedure, things can take a different turn and you always have to be prepared for that. Every single day presents a new case and a new learning experience, even if it’s a procedure you’ve done 100 times before.
What has it been like for you to pursue your training during the COVID-19 pandemic?
Surprisingly, my training numbers did not take a hit and actually matched those of the previous year’s fellow. At Yale, we were doing a lot of peripheral procedures, especially critical limb ischemia (CLI) and acute limb ischemia. Mentally, however, it was very stressful. Although we were not deployed in the COVID-19 unit, we did operate on patients who subsequently turned out positive and with this, you risk introducing the infection to your family, those around you, and really everybody you contact. I would always feel guilty that I might be bringing the virus to an immunocompromised patient. Also, if I suddenly have some minor symptoms, like waking up with some congestion, I have to ask myself if I should consider this as COVID-19 and take off work. Then again, if I don't go, I'm putting more pressure on my peers to work. It was definitely a big mental pressure to find that balance, and we all went through a phase of depression at some point.
What do you like to do in your free time to balance out your work life?
I love playing chess. I play online and a quick blitz game is very refreshing. I also love watching movies, even if it means having them on in the background while I’m working on my research in the evenings. Also, I love yoga and practice once or twice a week. While I used to play field hockey and race motorcycles, I don’t do either of those anymore, but I have been learning guitar recently.
What his nominator Carlos Mena-Hurtado, MD (Yale University, New Haven, CT), says:
Mahesh is an incredible fellow. He did 1 year of endovascular fellowship with us at Yale and is currently doing his second year of interventional cardiology focusing on the coronaries. He is incredibly productive in terms of academic productivity having done more than 10 manuscripts during the year with us. He has published a lot. And he is finalist for a young investigator award for this upcoming American Heart Association Scientific Sessions for his work documenting trends in patients with CLI. Clinically, he is very skillful and able to do complex cases both endo and coronary. Given his academic and clinical output, I would feature him as future star in interventional cardiology.
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