In an exclusive interview with ArabMedicare, Dr. Mirvat Alasnag, MD talks about the DynamX bioadaptor implant and what this innovation means for heart patients in Saudi Arabia.

ArabMedicare: Can you tell us about your role and journey to becoming the Head of the Catheterization Laboratory at King Fahd Armed Forces Hospital?

Alasnag: I trained in Clinical Cardiology and Interventional Cardiology at Loma Linda University Medical Center (California) and Harper University Hospital, Detroit Medical Center (Michigan). Since my graduation in 2009 till date, I have been practicing as an Interventional Cardiologist at the King Fahd Armed Forces Hospital (KFAFH). I was inspired to run a cath lab primarily to apply the organizational skills I acquired through the courses and bootcamp I attended under SCAI, a professional medical society in the United States dedicated solely to interventional cardiology. Algorithms and protocols permit us to update the cath lab team’s practices and trial novel technologies while maintaining patient safety.

ArabMedicare: Could you also highlight the impact of what it means to be the first woman interventional cardiologist in the Gulf region; and as a role model for women entering the medical profession?

Alasnag: Irrespective of gender; hard work, and dedication pay off eventually. Having said that, cardiology is still a male-dominated profession so a woman may have to deal with deep-seated perceptions and prejudices. This is why it is important to choose to work in an open-minded hospital that wants to empower talented individuals and serves as a benchmark for other centers. Throughout my career, I have strived to demonstrate that women can be successful leaders and managers while raising their families without compromising their quality of work.

ArabMedicare: What are the specific objectives or goals KFAFH aims to achieve by participating in the global BIO-RESTORE post-market registry?

Alasnag: I am delighted that King Fahd Armed Forces Hospital is the first in the Kingdom of Saudi Arabia to begin clinical research and offer a new type of angioplasty procedure with the DynamX bioadaptor implant, an innovation beyond stents designed to restore vessel function. We are pleased to offer this to patients suffering from coronary artery disease, and especially for those who are younger and seek to reclaim an active lifestyle. We are also participating in the global BIO-RESTORE post-market registry for bioadaptor to generate diverse, in-market experiences, specifically in Saudi patients.

ArabMedicare: Can you discuss why the DynamX bioadaptor is innovative beyond stents and how it is designed to restore vessel function?

Alasnag: DynamX bioadaptor is a coronary implant that is uniquely designed to not only restore blood flow but to also unlock and uncage the vessel, allowing the artery to return to its natural physiology, motion, and function while DynamX continues to provide dynamic support. The DynamX bioadaptor scaffold is comprised of three metallic helical strands that are linked together by unique unlocking elements. The helical strands separate following the natural resorption of the biodegradable polymer coating, allowing for the restoration of vessel motion and function.

ArabMedicare: What are the differences between bioadaptors and stents and their impact on patient outcomes?

Alasnag: As our heart beats, our blood vessels expand and contract. This is known as pulsatile motion. When metal stents are placed within vessels, the stents cage the vessels and prevent them from exhibiting pulsatile motion. Preventing this natural motion has been associated with poor outcomes including heart attack, the need for re-stenting, and even death.¹ The DynamX bioadaptor initially works similarly to a traditional metal stent, opening narrowed arteries and restoring good blood flow, but after several months its unique design allows for more normal vessel pulsatility and function in response to the needs for more oxygen demanded by your heart (such as during exercise).

The latest data on DynamX was presented at a late-breaking clinical session during the EuroPCR 2024 conference in Paris. This was based on the two-year results from the BIOADAPTOR Randomized Controlled (1:1) Trial (RCT), comparing the DynamX® bioadaptor system to standard of care Resolute Onyx™ Drug-Eluting Stent (DES) from 34 centers in Japan, Europe, and New Zealand. The results, for the first time, demonstrate a significant reduction in adverse events and clinical advantage of the DynamX bioadaptor in target lesion failure (TLF) and the secondary endpoint of target vessel failure (TVF) driven by sustained low event rates with DynamX compared to a two-fold increase in DES.

An earlier, single-arm, open-label mechanistic study included imaging analysis confirming vessel function and motion restoration. Notably, zero deaths were attributed to the device or procedure, and zero definite/probable stent thrombosis out to the final 3-year follow-up period.

ArabMedicare: Could you elaborate on the Saudi patient’s experience with the DynamX bioadaptor implant?

Alasnag: So far, we have used it in a dozen patients with varying pathologies and presentations including ACS (acute coronary syndrome), STEMI (ST-elevation myocardial infarction), and CCS (chronic coronary syndrome), and we are seeing good results. We are also currently recruiting for the BIO-RESTORE trial.

ArabMedicare: What unique challenges or opportunities do you see in providing this new procedure to Saudi patients?

Alasnag: The great long-term potential of the DynamX bioadaptor is to flatten and lower the MACE (major adverse cardiovascular events) curve over patients’ lifetimes. The unique restoration of vessel motion and function also allows for improved blood flow in response to cardiac exertion, so patients may experience fewer symptoms of their cardiac disease, engage in more of the activities they enjoy, and carry less of their constant anxiety burden.

ArabMedicare: What are your priorities and goals in fostering this innovation and medical advancement for Saudi Arabia?

Alasnag: At KFAFH we have always believed in offering the best medical care to our patients. We want to lead the way in exploring Saudi Arabia’s potential to provide the latest medical technologies to our patients. We are proud that KFAFH is the first hospital in the Kingdom of Saudi Arabia to offer an angioplasty procedure with the DynamX bioadaptor implant, an innovation beyond stents designed to restore vessel function. The bioadaptor is a transforming implant that, after a period of healing, unlocks and allows the artery to pulse and function more naturally in response to a patient’s exertion and the heart’s changing needs. More normal artery motion and expansion help the artery restore its healthy function and reduce the risks of secondary adverse events such as heart attacks or repeat procedures.

References:

1) Stone GW, Kimura T, Gao R, et al. JAMA Cardiol. 2019 Dec 1;4(12):1261-1269.

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