Dr. Nir Uriel: Elevating Progress in Advanced Heart Failure
Nir Uriel, MD, MSc, an internationally recognized leader in heart failure, mechanical circulatory support, and heart transplantation, has been named to the newly created position of Director, Advanced Heart Failure and Cardiac Transplantation at NewYork-Presbyterian. In this new role, Dr. Uriel will oversee heart failure programs at NewYork-Presbyterian’s campuses in Manhattan, Queens, Brooklyn, and Westchester, with a goal to increase accessibility of care for those with advanced heart failure throughout the New York area.
Born and raised in Israel, Dr. Uriel earned his medical degree at the Ben Gurion University of the Negev. After completing his internship in internal medicine at Assaf Harofeh Medical Center, he served for four years in the Israeli Defense Force, initially as a combat battalion physician and then as a clinical study supervisor in the Army’s medical research corps. Returning to Assaf Harofeh Medical Center to complete his residency and a cardiology fellowship, he then moved to New York in 2008 to pursue fellowships at NewYork-Presbyterian/Columbia University Irving Medical Center in cardiology, heart failure, transplant, and mechanical circulatory support, remaining here as a faculty member for five years.
“I came to Columbia 11 years ago to do my fellowship and it was one of the best years of my training, if not the best,” says Dr. Uriel. “That’s the reason I decided to stay at Columbia and had an amazing five years as an attending.”
Dr. Uriel took a particular interest in high-risk heart transplant populations, including patients with HIV and those who had undergone chemotherapy. “When you deal with advanced heart failure in which life is on the line all the time, and there is only a slight gap between being alive or dead, you find yourself asking a lot of questions along the way that may help the next patient,” says Dr. Uriel. “I began to develop algorithms to try to help those patients live a much better and normal life. We started transplanting patients with HIV and learned that we can do it as successfully as transplanted patients without HIV.”
Dr. Uriel also conducted research in heart failure, developing and validating a set of decision-making tools now used to guide the treatment of patients with mechanical assist devices, and he was one of the first to determine the prevalence of acquired Type II von Willebrand’s disease in such patients.
In 2014, he was offered the position of Director of Heart Failure, Transplant and Mechanical Circulatory Support at the University of Chicago Medicine, where he also served as the Louis Block Professor of Medicine. “The opportunities were great, and I left taking the knowledge and the experience that I had gained here at Columbia,” he says.
A Burgeoning Career
The next five years served as another period of significant professional growth for Dr. Uriel. “I had the opportunity to run the largest mechanical circulatory support study in history and will be publishing a paper about it in The New England Journal of Medicine,” he says. Dr. Uriel was also among the physician leaders of the University of Chicago Medicine transplant care team that made history in December 2018 after performing two triple-organ transplants within 27 hours, replacing the failing hearts, livers, and kidneys of 29-year-olds Sarah McPharlin and Daru Smith.
“Sarah came to my office after multiple institutions told her that she needed hospice because she had come to the end of her life,” recalls Dr. Uriel. “I didn’t think so, and I told her, ‘Sarah, we’re going to try to do everything we can. I can’t promise you anything, but we are going to try to do it.’ She not only needed a heart transplant, but her liver and kidney were also already destroyed due to heart failure. So, we set up the plan, designed what we were going to do, and just two days before Christmas, we did a triple-organ transplant.”
Shortly thereafter, Daru Smith arrived at the hospital emergency department requiring a triple-organ transplant due to multisystem sarcoidosis. “Our team was already in the mindset that the triple-organ transplant can be doable and that we could help Daru, too,” says Dr. Uriel. The back-to-back surgeries marked the first time a U.S. hospital had ever performed more than one of these most challenging and complex cases within one year, much less within 27 hours.
Targeting Heart Failure in a Big Way
In discussions with Allan Schwartz, MD, Chief of Cardiology at NewYork-Presbyterian/Columbia, about the prospect of returning to NewYork-Presbyterian, Dr. Uriel points to some of the reasons that led him to accept. “What amazed me when I was working here is that NewYork-Presbyterian is all about the patient,” he says. “Returning to the place where you were trained, you want to do something special. I thought it would be wonderful to increase the accessibility of care to all people with advanced heart failure. With a hospital network that is sitting in Manhattan, in Brooklyn, in Queens, and in Westchester, we have an opportunity to provide care to millions of people in the New York area.”
“There are a lot of treatment options today that will change people’s lives, increase their longevity, and give them a good life and another holiday to celebrate with their grandchildren, children, and spouses.”
— Dr. Nir Uriel
According to the American Heart Association, of the more than 6 million Americans living with heart failure, about 10 percent have advanced heart failure, a field that has grown dramatically in the last two years. “The problem is that most of the people are not diagnosed with this condition, and many of them do not achieve the level of care that they require,” says Dr. Uriel. “There are a lot of treatment options today that will change people’s lives, increase their longevity, and give them a good life and another holiday to celebrate with their grandchildren, children, and spouses.”
Investigations to Help a Failing Heart
Dr. Uriel has published more than 200 original peer-reviewed articles in the Journal of American College of Cardiology, Circulation, and the Journal of Heart and Lung Transplantation, among others. “One aspect of my research continues to focus on how we can help a failing heart with mechanical circulatory support,” he says. “It challenges us because we are creating something that is hybrid – half human and half machine. We need to understand how this interaction between the machine and the human body, specifically the blood, leads to something that will allow the patient to live and with a good quality of life. We call this condition hemocompatibility, but it is much more than that.”
“Our original study, which began at Columbia, looked at the effect of what happened to the patient’s blood with mechanical circulatory support,” continues Dr. Uriel. “Blood doesn’t like metal, blood likes tissue.”
“This led us eventually to require changes in the medical therapy,” adds Dr. Uriel. “And slowly we have built medical algorithms on how to treat those patients so that the body will not be bothered by the presence of a mechanical component inside of it.”
Dr. Uriel also collaborated on and studied the HeartMate3™ Left Ventricular Assist System, serving as principal investigator in the multicenter MOMENTUM 3 trial. “MOMENTUM 3 was an important step forward for patients living with advanced heart failure,” says Dr. Uriel. “The study results will allow for wider use of the technology thanks to a significantly improved adverse event profile.” Among patients with advanced heart failure, this fully magnetically levitated centrifugal-flow left ventricular assist device was associated with less frequent need for pump replacement than an axial-flow device and was superior with respect to survival free of disabling stroke or reoperation to replace or remove a malfunctioning device.
Dr. Uriel will also continue research in heart transplantation. “The quality of a patient’s life after heart transplant is amazing. And we always try to push the envelope,” he says. “So, another huge focus of my research is how to improve and reduce adverse events associated with medications given to patients going to heart transplantation. At the end of the day, you’re trying to find a solution for people that have a deadly disease.”
Reflecting on his passion for medicine and for helping his patients, Dr. Uriel is clear on what it means to him on a personal level. “I think what drives me is something very simple,” he says. “When you believe that life is the most precious thing, our highest priority is to try to preserve our patients’ lives and give them the opportunity to enjoy life.”
Mehra MR, Uriel N, Naka Y, et al. A fully magnetically levitated left ventricular assist device — final report. The New England Journal of Medicine. 2019 Apr 25;380(17):1618-27.