Matthew Czarny, MD

Following an atypical career path, Czarny currently serves as an attending interventional cardiologist while completing a structural fellowship.

Featured Fellow: Matthew Czarny, MDMatthew Czarny, MD, is currently completing a fellowship in structural and vascular interventions at Johns Hopkins Hospital (Baltimore, MD), where he also serves as an attending interventional cardiologist. He was educated at the University of Wisconsin, Madison and earned his MD from Johns Hopkins University School of Medicine. Czarny trained in internal medicine at Brigham and Women’s Hospital (Boston, MA) and returned to Johns Hopkins to train in cardiology and interventional cardiology. In July, Czarny will be a full-time structural interventional cardiology attending at Johns Hopkins, and he looks forward to combining his passions for clinical work, teaching, and research throughout his career.

Most fellows don’t have the experience of also being an attending at the same time. Can you tell us a little about what that has been like?

My position is somewhat atypical but exciting. I spend most of my time as the fellow for structural procedures, but I also participate in the attending daytime cath lab coverage and the interventional call schedule. There’s a need in the structural fellowship curriculum to continue to hone your coronary skills; it’s not ideal to not do any coronary work the first year out of interventional cardiology training. This “hybrid” year allows me to continue to develop my coronary skills as I would in my first attending position, while I also learn the structural skill set. Several of my mentors told me that there’s an incredible amount of learning that goes on during the first few years as an attending interventional cardiologist, and that has certainly rung true for me. Being the structural fellow and an interventional attending simultaneously has allowed me to develop my skills in a way that wouldn’t have been possible for me had I been solely in either role.

What has surprised you most about becoming an interventional cardiologist?

In becoming an attending, I’ve found that the ups and downs of my work have become more pronounced. As a fellow, you talk with patients and their families prior to the procedures, but a lot of times you’re not the one that goes out to the waiting room and talks with a patient’s family immediately after, for instance, a STEMI. As a result, I didn’t fully appreciate how incredibly grateful patients and their families are in those moments. On the other hand, it’s also much more difficult when there are poor outcomes or complications.

How do you see the field changing in the next 5 years?

Certainly, there is currently a major focus in structural interventional cardiology on the low-risk TAVR trials. Based on what we’ve seen in all the prior TAVR trials, I think there’s a high likelihood that TAVR is going to be shown to be at least equivalent to surgical aortic valve replacement in low-risk patients. There are already a lot of TAVRs being done, and approval for low-risk patients will really open the floodgates. In addition, I think we’re on the verge of major advances in transcatheter mitral interventions, which will further increase structural volumes. With that, I suspect the format of interventional cardiology fellowship will change. When structural fellowships first started maybe 5 or 6 years ago, case volumes at most places were such that only one fellow could be supported. There were always more interventional fellows than there were structural fellows. But I think as procedural volumes and the scope of transcatheter structural interventions increase, structural training is going to become more integrated into interventional fellowships. I wouldn’t be surprised if most programs transition to 2 years in length and combine coronary and structural training.

What is the biggest challenge facing interventional and structural cardiology fellows today?

As case volumes increase and as medicine in general is tilted more toward throughput, a major challenge for fellows is making sure that they don’t lose sight of the subtle but important details of each patient’s presentation and care. With the sheer number of patients we’re expected to see and the large volume of clinical data generated for each patient, it’s easy to know each case in less than perfect detail. This temptation is even stronger in interventional cardiology, where many encounters are limited to a procedure and the immediate pre- and postprocedure care. Knowing every detail of every patient I care for has been stressed through all of my interventional and structural cardiology training, and I think I’m a better doctor because of that.

What is the best piece of advice your mentor has given you?

The best piece of advice I received was to always keep my eyes open for clinical questions that need to be addressed. It’s easy to ignore small inconsistencies in medicine, but sometimes those are clues to new avenues of investigation. I’ve tried to approach my research that way—many of my research ideas have come from the difficulties we experience in clinical practice or tough cases that lead to a recognition of the lack of evidence in a particular area.

What is something that people might not know about you?

Most people don’t know that I was a drummer from grade school all the way through college. I was in a band in college; we would occasionally play at local bars, and it was a lot of fun.

What his nominator, Jon Resar, MD (Johns Hopkins Hospital), says:

I nominated Matt because he is the consummate cardiologist and interventional cardiologist. He has superb clinical decision-making and procedural skills in the cath lab, and he is an innovative thinker and researcher.

*To nominate a stellar cardiology fellow for the Featured Fellow section of TCTMD’s Fellows Forum, click here.