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Heart to Heart with Jay S. Yadav MD, Founder and CEO MiRus

Jay Desk
by Jyothsna Hegde | July 2021

“The best things in life are somewhat accidental,” says Dr. Jay Yadav. He should know. From aspiring to study astronomy to choosing medicine to work on cancer and then opting for cardiology and then innovating cardiovascular medical devices to save lives which led to being a serial entrepreneur, Dr. Yadav admits his path of success is a summation of “serendipitous” happenings in his life and his spontaneous reactions to these situations. In fact, the trend seems to have applied to the way he met his better-half, Marshalla, he says “I only met her one time at the hospital when I was a resident at Duke. Our paths may never have crossed again if I had not immediately asked her to have dinner.”

An interventional cardiologist embracing elixir, engineering, entrepreneurship, excogitation and empathy in equal measure, Dr. Yadav is driven by a sincere desire to directly impact lives with effective use of science and novel technology. A fine testament for his love of innovation are the many firsts he has accomplished, including pioneering breakthrough treatment methodologies such as first angioplasty for the cerebral arteries (among many others) and medical devices and commercialization for the greater good. Currently the Founder and CEO of MiRus, Dr. Yadav, is the founder of several successful companies: CardioMEMS acquired by St. Jude Medical/Abbott; Angioguard, Inc. acquired by Johnson & Johnson; first investor and director of SMART Therapeutics acquired by Boston Scientific.

MiRus expanded its manufacturing capacity with the addition of a fully operational 50,000 sqft orthopedic, spine and cardiovascular manufacturing plant in Marietta, GA, which added to MiRus’ existing 20,000 sqft manufacturing facility. MiRus has intellectual property with over a 100 patents and very sophisticated technology with the R&D spend on the background technology being at least around $60-80M.

Dr. Yadav is also credited for having published over 200 scientific papers, two medical books and over 40 patents. His exhaustive list of distinguished accolades includes American Heart Association Top Ten Scientific Advances, 2003; Ellis Island Medal of Honor, 2004; 50 Best Doctors in the History of the Cleveland Clinic, 2011; Ernst and Young Entrepreneur of the Year (healthcare), 2011; Intel Innovation Award, 2011; his procedure for stroke treatment became a Class I recommendation of the American Heart Association and the American College of Cardiology, 2011; American Heart Association Honoree, 2016, Recognition of Being One of the Top Innovative Companies in Georgia.

Where does his love to steer science towards soothing suffering stem from? Dr. Yadav traces his roots to Meerut, India where he wasn’t exactly in the pink of his health. Hit with typhoid more than once, the prognosis of a local doctor was quite grim. With his father away in the US, Dr. Yadav credits his mother’s indomitable spirit that never let him down, even when the doctor declared the probability of brain damage should he in fact survive. Dr. Yadav and his mother now laugh about the fact that the only job the doctor said Dr. Yadav could sustain, if he survived, was being a grass cutter! Dr. Yadav recalls not liking and running away from schools except for St. Mary’s Academy that his mother chose for him. At age nine, Dr. Yadav and his motivational mother moved to Salisbury, North Carolina, where his father was a college professor and so was his mom. No grass cutter, Dr. Yadav later went on to Yale, at only fifteen!

“Actually, in our current company all the product names are on an astronomical theme so we’re having a little bit of fun with that,” muses Dr. Yadav on astronomy which was his original object of affection. Growing up in an academic atmosphere, the college observatory at a walking distance beckoned him. Drawn to astronomy at first, physics also held Dr. Yadav’s interest, to the extent that he majored in physics and biochemistry. Influenced by movement in physics in the late 60s and 70s to do something life enhancing, and reading Gandhi’s My Experiments in Truth, and having watched physicians in his immediate family save lives, led him to utilize science, medicine specifically, to directly impact the welfare of people.

Dr. Yadav opted to stay close to his parents and two brothers when the family moved to West Virginia. He enrolled at the WVU School of Medicine which led him to residency at Duke Hospital.

Why Cardiology? On rotations during his residency, cardiology specifically, Dr. Yadav recalls being impressed by Dr. Andreas Grüentzig’s then pathbreaking creation, angioplasty, which saved the life a dying man, by opening of an artery and had the patient leave the hospital quickly. “It was miraculous.” Dr. Yadav also recounts that the procedure was deemed controversial, yet Dr. Grüentzig was hired by Atlanta’s Dr. Spencer King at Emory. But his experience with a rotation in neurology for patients who came in with a stroke had not been that promising. “A heart attack is a clot blocking the artery. A stroke is a clot blocking the artery just in different locations, the processes are a little different but fundamentally similar.” Even though the mechanism is similar with blockage of blood flow, lack of oxygen, and tissue death, doctors at the time never opened up the blocked artery like in cardiology. Finding it ‘bizarre’, Dr. Yadav didn’t understand why similar technologies were not being applied. Oblivious to the politics of healthcare system and technical complexities ahead, the young doctor made a solemn decision. “I’m going to improve the treatment of stroke.”

And he did. Dr. Yadav conducted the first successful randomized trial of a less invasive treatment called carotid stenting, which he had developed, for patients with severe blockage of the arteries supplying the brain. This procedure is now a Class I recommendation of the American Heart Association and the American College of Cardiology and American Stroke Association. His Angioguard substantially improved the safety of balloon angioplasty to clean out the arteries in the neck by temporarily inserting a tiny filter to trap stirred-up gunk before it floats to the brain.

What was it like to use his creation on a patient for the very first time? “Back then, to do initial cases you couldn’t do it in the United States,” notes Dr. Yadav. So, he traveled to Siegburg, Germany for testing, and the rest, as they say, is history.

What fueled his transition from physician to entrepreneur? Dr. Yadav credits his wife Marshalla who extended unwavering support despite the obvious risks. The consensus in the field was that a filter couldn’t be made small enough so that it could go into an artery, go through a lesion, and be retrievable. Dr. Yadav knew how it could be done, but two large companies declined to make it for him as they didn’t feel there was a need for it. So, he decided to venture out and make it himself, with whatever the young couple had at the time. Dr. Yadav had the first prototype in 1997 and used it on a patient for the first time in 1998. His persistence paid off and upon successful launch, the very companies that refused to build his product ended up in a bidding war for the same! And not without reason. In 2002, his invention was proclaimed as a “watershed” advance in stroke prevention by medical experts. Johnson & Johnson ended up acquiring Angioguard.

“The first intracranial stent is a pretty meaningful event; they allow for treatment of stroke and aneurysms,” notes Dr. Yadav about his work at SMART Therapeutics that formed the basis for stent retrievers for stroke treatment, particularly of the fact that it helps people do much better with stroke. “It is very, very gratifying. “

“I noticed that many heart failure patients were being admitted to the CCU over and over again with pulmonary edema due to decompensation of their heart failure,” says Dr. Yadav about the origins of CardioMEMS. When patients with heart failure decompensate, they are often put on a ventilator, with a small tube (catheter) inserted into their hearts to get information about their cardiac function and heart failure medications are adjusted based upon their cardiac physiology measurements. Heart failure patients are often hospitalized many times per year which is very traumatic for them and their families. The anxiety associated with frequent hospitalizations has a severe psychological impact akin to PTSD. “I started thinking about the problem: is there an elegant way to get intracardiac information from the patient while they are still at home and transmit it to their physician or nurse on a daily basis so they can make medication adjustments that prevent the decompensation and hospitalization?” Dr. Yadav did not want to utilize traditional pacemaker type technology of using batteries and wires that lead to complications and require repeat surgery for batteries to be replaced. Multiple “physics” problems he notes, had to be solved while meeting FDA safety considerations. To address these issues, there was need for wireless energy transmission into the body and a stable sensor technology which does not require recalibration. CardioMEMS achieved both of these goals, turning out be the first medical implant to be wirelessly powered and also the first medical implant completely wafer fabricated. Acquired by St. Jude Medical /Abbott, also one of its investors, CardioMEMS is the winner of Top Ten of the Decade and Intel Innovation Awards. Dr. Yadav’s satisfaction comes from the fact that his “inventions are of real value” in terms of “saving lives and available throughout the world.”

“Much like many other things in life, MiRus was serendipitous, too.” When a highly successful industrialist from Boston was referred to Dr. Yadav, neither had anticipated the strong bond that would emerge from his visit. The patient, Saul Siegel, with a history of multiple cardiovascular and cerebrovascular surgeries had developed complications and was referred by the surgeons at Mass General referred to a “crazy, young guy at Cleveland Clinic.” Dr. Yadav was able successfully treat Mr. Siegel, who was much older than his physician, and a father-son relationship soon ensued. The relation grew stronger as he moved to Cleveland from Boston. It helped that he had businesses all over the world and had done business in India.” He was a wonderful friend and mentor.”

One of the companies Mr. Siegel owned was the former Westinghouse Nuclear Laboratory in Pittsburgh, which had made cutting edge materials including one for a nuclear rocket engine. During one of their fireside chats, Mr. Siegel offered his company’s expertise in discovering new alloys that would further the cause of medicine. With that support, Dr. Yadav’s team led by Noah Roth worked for over ten years towards developing a new alloy, Molybdenum Rhenium, for medical implants and successfully produced the world’s thinnest coronary stent. The molybdenum rhenium technology platform is the foundation MiRus, originating from Latin for “miraculous”, the pronunciation is similar with emphasis on “mi’. “It is also a play on our alloy molybdenum rhenium. One of my children came up with the name.”

“Molybdenum-Rhenium offers dramatically superior mechanical strength and fatigue properties over other approved biomaterials, such as cobalt-chrome, titanium, and stainless steel,” notes Dr. Yadav. It is two to three times stronger and four times more durable than the current alloys. These properties allow medical device implants to be made smaller and less disruptive to surrounding tissue and which leads to surgery being less invasive.

In addition to creating the world’s best spine and cardiovascular implants, MiRus also offers a suite of software and wearable technology allowing patients to be connected to their care providers and provides an early warning system to reduce emergency room visits and hospitalizations in the spine and orthopedic space. “MiRus technology is designed to benefit the patient by making surgery less invasive and improving outcomes as well as our healthcare system by reducing cost.”

Apart from saving lives, what else does the earnest cardiologist hold dear to his heart? His family! “We have dinner together almost every night. We are pretty old-fashioned in some ways,” says Dr. Yadav. The couple have three boys, Daven, Chethan and Nevin and a girl, Priya, whom he affectionately describes as “95 pounds of toughness”. Priya is a trained Bharatanatyam dancer. Dr. Yadav passionately believes in letting all his kids make their own life choices, much like his parents did. “My goal is to teach them good work habits and self-discipline.”

“I don’t have this sort of sense of obsession that medicine is the only pathway to making a contribution,” said Dr. Yadav about his advice for students considering medicine. For everyone else, he said he advises what he said at his son’s graduation get together -” Follow your heart, your passion, whatever makes you excited. Bring some intensity and passion to it. Have an ethical framework that will guide how you spend your time and life.”
“Vaccination is the key,” said Dr. Yadav addressing COVID. “We should reduce misinformation about the vaccines, in general these are some of the safest vaccines, certainly, that I’ve seen in my medical career. There is always a risk / benefit tradeoff, it is not humanly possible to develop treatments that are zero risk.”

Indian Americans are believed to have a genetic predisposition of diabetes and cardiovascular diseases. What can be done to address the issue? Meditation, exercise such as walking, working out with weights is very effective because increasing muscle mass helps with diabetes. As he mentioned protein intake, Dr. Yadav traveled back in time to the villages in India where even the staple food is well balanced with dal and vegetables. He also advices fermented food such as yogurt in a daily diet.

How can an organization such as IACA be more relevant for future generations? Dr. Yadav believes IACA can endeavor to provide identity for the Indian American community, and to provide a mechanism for interaction. The Indian American community needs representation in the political space, because, as he points out, “we have some interests that are specific to us, whether they are cultural in nature or political.” “This is a great country, but things happen. If our youngsters have a harder time getting into elite schools, if there’s discrimination on religious grounds or ethnic grounds, we do want an organization that is able to represent us.” Dr. Yadav also believes that IACA can potentially serve as a bridge to increase business and trade with India and encourage entrepreneurship. But, he adds, the cultural component is crucial. “And I am happy to help.”

Because he considers entrepreneurship such a crucial activity, Dr. Yadav has been involved with TiE (The Indus Entrepreneurs) for many years, serving on the Board and as Chairman. He particularly enjoyed his involvement with the high school entrepreneurship program that was initiated by Kanchana Raman. “We have some very talented young people, and it was very gratifying to see them develop their ideas over the course of the year long program.” MiRus also has an EB5 program which has been used by parents in India interested in ensuring that their children are able to remain in the USA after finishing their studies.

What drives someone like Dr. Yadav? Since the passing of his mentor Saul Siegel, who passed away after aortic valve surgery, Dr. Yadav is working towards making an aortic valve that is much better, which will be named the ‘Siegel valve’, of course. “That will be kind of completing the cycle. The proper homage to Saul is to solve the problem that took his life.” Dr. Yadav is one of those extraordinary humane healthcare warriors that strive to heal, with all his heart and a humble smile.