ACC.19 in New Orleans can be summarized in one word: Innovative. The first-ever Vascular Shark Tank was perhaps the perfect epitome of this ethos. Conceived by vascular cardiologist Marc P. Bonaca, MD, MPH, the event, he said, was designed to "explore new ways to detect and reduce the burden of peripheral artery disease (PAD)." Judged by two famous sharks, David Harrison, MD, and Kenneth W. Mahaffey, MD, FACC, the audience was engaged throughout three pitches.

The first pitch, by Mary M. McDermott, MD, from Northwestern, was a home-based exercise program. Think trendy "Peloton for PAD" patients, whereby a virtual coach helps them access exercise from their homes, hopefully removing barriers to care. Along with the medical benefit to the patient, at a fraction of the cost for current hospital or clinic-based exercise programs, it's a cost saver for Medicare. Both sharks liked the idea but expressed cautious optimism about patient adherence and the ability to build a therapeutic relationship virtually.

The second pitch took me back to my MIT days, listening to Sreekanth Vemulapalli, MD, from Duke present his idea of using pre- and intra-procedural fractional flow reserve to predict success of revascularization in PAD. He proposed using a pre-intervention biplane angiogram with 3D reconstruction and a triangulated mesh with a fluid dynamic algorithm (nicknamed Harvey) to predict flow and pressure changes over the lower extremity arterial bed, postprocedural ankle-brachial index (ABI) and response to revascularization.

Despite my engineering background, I agree with shark Mahaffey who called the technology a "black box" and audience members who pointed out that a noninvasive test may be more appropriate than a technology based on angiograms to determine appropriateness of revascularization. The judges felt the idea was too early in its infancy for implementation.

Connie Ng Hess, MD, FACC, from the University of Colorado, pitched a platform to reduce disparities in care and lack of access to care for PAD patients – and won the competition! What I call "telemedicine for underserved patients," Hess's platform consists of a three-step process to: 1) identify disease in underserved communities, 2) characterize individual risk (using ABI, lipids, HbA1c, blood pressure, etc.) and 3) randomize patients to brick-and-mortar primary care physicians or a virtual care platform that provides access to medical care providers, a health care navigator and algorithms to manage risk. She'll test this hypothesis in existing underserved cohort communities in Colorado. Hess commented "all three ideas were innovative and would improve health care for PAD patients if implemented."

I left the session enthralled by what I felt was no doubt going to be the "shark tank effect" for these three young researchers. Just as with the television show, where simply appearing has the potential to boost sales and revenue for a company, I felt these three young cardiologists would have the same privilege. I caught up with shark Harrison afterwards who warned Mark Cuban, "Watch out! This is where the real innovation happens!"

We already have FIT Jeopardy and now Vascular Shark Tank. What will the ACC think of next? Clinical Trials Wheel of Fortune? Whatever the forum, please keep the innovation and fun coming as you always do ACC!

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Keywords: ACC Publications, Cardiology Magazine, Ankle Brachial Index, Peripheral Arterial Disease, Hemoglobin A, Hydrodynamics, Vulnerable Populations, Blood Pressure, Physicians, Primary Care, Lipids, Blood Pressure Determination, Imaging, Three-Dimensional, Lower Extremity, Arteries, Angiography, Coronary Angiography, Patient Compliance, Telemedicine, Exercise Therapy, Algorithms, Medicare, Auscultation, Cohort Studies

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