Featured Profile: Gry Dahle

Gry Dahle, MD, PhD, is a consultant working in department of cardiothoracic and cardiovascular surgery at Oslo University Hospital in Norway. She is a transcatheter aortic valve implantation (TAVI) pioneer and implemented TAVI in Oslo University Hospital. Dr. Dahle is the executive secretary for ISMICS and the Editorial Board of Innovators. She is the chair of the transcatheter task force for EACTS and in the Board of EACTS Examination (EBCTS) as the chair of Level 2 exam.

Dr. Dahle has focused on transcatheter methods for valve replacement for most of her career and is always seeking out new minimally invasive methods and technologies. She also works with anesthetists and technological teams to implement artificial intelligence in their intensive care unit. She stresses using creativity to continue to innovate and discover the best and safest treatment options for patients. She is in the working group for innovation and a member of the Professional Board of the Norwegian Medical Association. Dr. Dahle is also interested in medical ethics and is the chair of the Norwegian National Ethical Committee for medical devices and research (REK KULMU). 

CTSNet spoke with Dr. Dahle about her prolific work in valve surgery, the emergence of artificial intelligence in medicine, and the importance of building in interdisciplinary surgical team. Read on for the full interview, which has been edited for length and clarity. 

For more from Dr. Dahle, check out her Guest Editor Series, 21 Years After First TAVI: Will the Pace of Innovations Continue for All Heart Valves?

CTSNet: What is the biggest advance you have seen in transcatheter therapies/surgical techniques recently?

Dr. Dahle: I still think the innovation of PCI, and later TAVI, is the biggest out-of-the-box thoughts and the mother of catheter treatment.

CTSNet: What is the biggest challenge facing transcatheter therapies/surgical techniques right now?

Dr. Dahle: The biggest challenge is to have the heart team and the collaboration between cardiologists and surgeons functioning to find the best treatment for the specific patient. It is important to think outside one’s own ego. The border between specialties should disappear, and treatment options should be found in collaboration centers—the valve center, coronary center, heart failure center, etc.—consisting of all kinds of specialists in the field. 

The technical challenges are in the mitral valve and tricuspid valve catheter treatment. Still, there are the issues of LVOT obstruction and device size—and, hence, the profile of the delivery system.

There is also the challenge of structural valve degeneration and choosing a lifelong treatment option for younger patients, as well as determining in young and low risk patients who will live longer—the valve or the patient.

CTSNet: If you had a magic wand to create the next innovation in CT surgery, what would it be?

Dr. Dahle: It would be a biocompatible mechanical valve with no need of anticoagulation, suitable for all valve positions, implantable with open surgery, endoscopically, or done via transcatheter procedure.

CTSNet: What are your current research interests and how do they complement or influence your approach to patient care?

Dr. Dahle: Artificial intelligence is an emerging innovation that we may use with success if we use it with care. It may help us to speed up procedure performance and reduce procedure time, and therefore radiation time. There is CT reconstruction software that predicts tissue deformity and helps to choose the right valve and size. Holography gives us true insight of the heart and thereby better opportunity to choose the best strategy. We can virtually place the valve in the patient’s specific heart and see how it will work. 

For hemodynamics, we have software that can predict hypotension before it comes and make suggestions for treatment. This may help to reduce or avoid kidney failure and delirium. We are working on implementing this.  

CTSNet: Technical skill is obviously important for surgeons, but can you address the importance of leadership skills and the capacity to foster the surgical team’s success?

Dr. Dahle: For sure, technical skills are important, but the team building is as important. You need a team to have success, and planning of the procedure is crucial. Leadership skills to involve everybody and make everybody feel useful and needed are essential.

CTSNet: What changes have you seen for women in cardiothoracic surgery in your time as a surgeon?

Dr. Dahle: The number of female cardiac surgeons has increased, and they are also more visible as key opinion leaders and thereby role models for young surgeons. The leadership style of these women may be a bit different from male surgeons as well.

CTSNet: How important is the international exchange of ideas, information, and techniques in cardiothoracic surgery?

Dr. Dahle: These days it has become even more important. We have to share experiences and new methods across the Atlantic. However, there are different regulations in Europe and United States. In past years the FDA was the most restrictive; now it is more difficult in Europe. The new MDR and CTR will try to make the process more transparent, but so far it is more difficult in Europe. 

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