Feb. 24, 2020
Keeping the beat
There are those who work to live and those who live to work. We often find the latter group to be peculiar, wondering what motivates them. Solidly in the live to work camp, Merril Knudtson would simply tell you he is curious by nature.
A 75-year-old mild mannered man, Knudtson recently retired from a medical career as an interventional cardiologist that spanned nearly 40 years in Calgary as both a professor and clinician. Now, he is being honoured by having a catheter lab named after him at the Foothills Medical Centre.
Perhaps Knudtson’s biggest accomplishment was his commitment to advance a craft that, at the time, was so new dictionaries didn’t even have a definition for it yet.
Knudtson began medical school at the University of Calgary in 1972, part of just the third class of aspiring physicians. Fascinated by the human heart, Knudtson later relocated to Emory University in Atlanta, Georgia, for three years to study at what was then North America’s preeminent cardiology program. It was there his future was unknowingly written for him.
He studied under the father of interventional cardiology, Dr. Andreas Gruentzig, a Swiss cardiologist who conducted the first-ever successful balloon angioplasty and was subsequently recruited to Emory.
“Through a stroke of fortune, I was able to work with Dr. Gruentzig for a six-month period, and that really shaped my career in a really major way,” says Knudtson.
Enrapt by the novel practice of interventional cardiology, Knudtson returned to Calgary and was one of a handful of doctors working in this specialized field, which he describes as an “electric environment in which to work.”
After convincing colleague Dr. David Roth to begin training new recruits, the two began the first-ever interventional cardiology residency program in 1983.
Sharp young talents from around the world began flashing passports destined for training in Calgary.
“We were able to develop this program and really have a profound influence. Being able to have your influence spread in that way was a real jolt,” says Knudtson.
To date, more than 75 physicians have completed the program and are practicing in locations around the world.
Knudtson made another critical choice that would codify heart patients not just in Alberta but across the country, thanks to a commonly shared database he termed APPROACH—Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease. Created in 1995, he offered APPROACH to every Canadian medical school and physician for free.
The database was still in its infancy and Knudtson took it upon himself to input every shred of detail related to coronary heart disease cases and add critical accountability to the resource-intensive procedure. It didn’t take long for other physicians to see the work Knudtson was establishing for Canadian medical perpetuity by promoting coronary artery disease research.
Today, every province and territory in Canada implements aspects, if not a carbon copy, of APPROACH.
“If APPROACH was good for Alberta, it should be good for Canada,” he says of the database.
“If any people contacted us with an interest in looking at what we were doing, we would strongly support their using those techniques. It literally happened from coast to coast. To see your colleagues buy into it and support it, I think it contributed in a very, very major way for momentum and my own personal commitment.”
In 2012, Knudtson was 30 years into his storied medical career when he received perhaps the most humbling shoulder tap of all time—a recipient’s notice of the Order of Canada—for his trailblazing work within interventional cardiology. Knudtson's work was recognized nationally, but perhaps the effects were realized most significantly at home. "It seemed really a bit of a dream," he says.
Dean Traboulsi studied under Knudtson before becoming his colleague in the ‘80s.
“Merril was an excellent cardiologist, teacher and a true leader, but more importantly a great innovator,” says Traboulsi. “We all learned together at that time of early days angioplasty, but he was clearly ahead of the game in many ways.”
Traboulsi remembers seeing Knudtson manually modifying catheters to fit aberrant arteries. Beyond that, he said Knudtson was adept at advancing medical science and patient care.
“There were all kinds of things he had to deal with in addition to dealing with patients with complex medical problems,” he says. “He was the whole package, really.”
Those comments are echoed by Dr. Bryan Har, another interventional cardiologist who worked with Knudtson for 11 years and received mentorship from him, as well.
“He’s incredibly patient, and from a procedure standpoint, he can talk you through very challenging cases,” says Har.“Even when you think you’ll fail, he can talk you through it and build that confidence rather than taking over.”