Washington University cardiac surgeons are widely recognized as national surgical leaders. As part of the highest-ranked heart program in Missouri by U.S. News & World Report, they have a long history of performing adult cardiac surgeries and fostering innovation in the field of cardiac medicine. Working with cardiologists, vascular surgeons, anesthesiologists, intensivists and a highly qualified, experienced nursing staff, cardiac surgeons offer the latest advances in technology and innovative therapies. They employ practices supported by scientific evidence to achieve the best possible outcomes for patients and strive to further advance the field through a longstanding dedication to quality research and education.
For the second consecutive year, Washington University cardiac surgeons at Barnes-Jewish Hospital received the Mitral Valve Repair Reference Center Award from the American Heart Association and Mitral Foundation. Barnes-Jewish Hospital is the only center in the state of Missouri and one of a select few in the Midwest to receive the award, which recognizes high volume of procedures, availability of resources and clinical performance measures. Ralph Damiano Jr., MD, division chief of cardiothoracic surgery and Evarts A. Graham Professor of Surgery, was selected as a mitral reference surgeon. Damiano notes that the expertise in minimally invasive procedures offered at Washington University and Barnes-Jewish Hospital contributes significantly to the success of the mitral program.
The Cox-Maze procedure for atrial fibrillation was first developed and performed at Washington University in 1987. The less invasive Cox-Maze IV was later pioneered by chief of cardiothoracic surgery Ralph Damiano Jr., MD. A recent study, published in the Journal of Thoracic and Cardiovascular Surgery, reported longterm outcomes and durability of the Cox-Maze IV. The investigators demonstrated the effectiveness of the procedure in patients with life-threatening heart arrhythmia by studying long-term rhythm and survival outcomes in patients who underwent the concomitant Cox-Maze IV procedure for atrial fibrillation. These findings were presented by postdoctoral research scholar Tari-Ann Yates, MD, at the 2022 Nicholas T. Kouchoukos Research Day, an event that celebrates research accomplishments within the division.
Washington University cardiothoracic trainees benefit from experience with the nation’s leading surgeons in complex cardiac procedures. Puja Kachroo, MD, surgical director of aortic surgery, serves as a mentor to trainees in the repair of challenging thoracoabdominal aortic aneurysms. At the 102nd Annual Meeting of the American Association for Thoracic Surgery, Kachroo presented her strategy for teaching these procedures, from preoperative planning to operative experience and review after each case. Trainees, including Lauren Barron, MD, who completed her cardiothoracic surgery fellowship this year, and current fellow Linda Schulte, MD, finish the program prepared for careers at the forefront of cardiothoracic surgery.
Building on a Legacy in Cardiac Surgery
Tsuyoshi Kaneko, MD, a leading cardiac surgeon with expertise in transcatheter therapeutics and minimally invasive surgery, has joined the Department of Surgery as new section chief of cardiac surgery.
“It is very exciting to join an institution with such a rich tradition and history, and to be part of the legacy,” says Kaneko. “There are multiple exciting innovations that are occurring in the field of cardiac surgery. My goal is for WashU to lead these innovations in cardiac surgery.”
Kaneko specializes in transcatheter and endovascular approaches to cardiac surgery, including transcatheter aortic valve repair (TAVR), transcatheter mitral and tricuspid valve repair and replacement, and endovascular thoracic aortic aneurysm repair. Moreover, he specializes minimally invasive and complex valvular and aortic surgery.
“Dr. Kaneko has proven himself to be a world-renowned leader in the field of cardiac surgery,” says Department of Surgery Chair John Olson Jr., MD, PhD. “His clinical Tsuyoshi Kaneko, MD. skill in complex valvular heart disease, his commitment to patient outcomes, and his dedication to training future cardiothoracic surgeons align with the core mission of the Department of Surgery at Washington University.”
Kaneko earned his medical degree and trained in general and cardiac surgery programs at Keio University School of Medicine in Tokyo, Japan. Kaneko finished his general surgery training at the University of Texas Health Science Center in Houston and his cardiothoracic surgery residency at Brigham and Women’s Hospital. He then spent one year in the Brigham catheterization laboratory to gain expertise in transcatheter valve therapies.
Kaneko led the largest structural heart program in New England through numerous clinical innovations. He initiated several new techniques in valve and cardiovascular surgery and the first enhanced recovery after surgery programs for cardiac surgery at Brigham. Kaneko spent eight years at Brigham as well as Harvard Medical School, where he held multiple director positions. Kaneko’s primary research interest focuses on clinical outcomes of surgical and transcatheter valvular and aortic disease. He has been a site PI or sub-PI on over 20 clinical trials, has over 200 peer reviewed publications and book chapters and has held leadership roles in many national organizations for cardiothoracic surgery.
As an educator, Kaneko has demonstrated a high level of commitment to training future leaders in cardiothoracic surgery. He has served as program director for multiple fellowships and associate program director for the cardiothoracic surgery residency at Brigham. His trainees have gone on to take positions at leading academic medical centers across the country and internationally.
“Dr. Kaneko will bring his superb clinical, research and leadership skills to Washington University/ Barnes-Jewish Hospital and build on our legacy as one of the top academic units in the world,” says Division Chief of Cardiothoracic Surgery Ralph Damiano Jr., MD.
Pulling Together: Scott’s Story
The Washington University and Barnes-Jewish Heart and Vascular Center is home to a team of world-renowned specialists dedicated to saving the lives of patients with the most severe cardiovascular diseases.
“The heart team at Washington University has a great collaborative spirit,” says Chief of Cardiothoracic Surgery Ralph Damiano Jr., MD. “We work together, we communicate, we collaborate. That’s the way to get the best care: having a team where everyone is invested in doing the best thing for the patient.
When Scott Pulley was diagnosed with severe coronary heart disease far from home in a Chicago hospital, he was told his only option was a heart transplant. His wife reached out to a friend of the family and cardiac specialist at Washington University, and was assured that the heart team would try everything at their disposal to find an alternative to transplantation.
Scott arrived at Barnes-Jewish Hospital late at night in seemingly stable condition. Only a few hours later, Scott suddenly arrested and went into ventricular fibrillation, but the heart team was prepared.
Matthew Schill, MD, performed CPR on Scott for over 30 minutes. A fellow at the time, Schill now serves as an instructor of surgery in the Division of Cardiothoracic Surgery. The heart team prepared Scott for ECMO treatment, which would give them time to develop and implement a treatment plan while Scott’s heart rested.
Amit Pawale, MD, surgical director of the Heart Transplant, VAD and ECMO Program, led Scott’s ECMO care. Jasvindar Signh, MD, an interventional cardiologist and associate professor of medicine in the Cardiovascular Division at Washington University, inserted an impella pump to decompress the left ventricle and placed stents to revascularize Scott’s heart. The entire team worked tirelessly to stabilize Scott and restored his heart to healthy function – both in a moment of emergency and without the need for a transplant.
“ECMO serves a critical bridge therapy for a patient like Scott, whose heart needs time to recover before we provide a more lasting solution,” says Pawale. “When it comes to ECMO, experience counts. We lead the highest volume ECMO program in the region and have the expertise to judge the most appropriate course of treatment for patients with heart failure, when every second counts.”
Thanks to the efforts and expertise of Schill, Pawale, Signh and the rest of the multidisciplinary heart team and nursing staff at Barnes-Jewish Hospital, Scott made an impressive recovery and continues to live a healthy and active life.
Fostering Interest in Cardiothoracic Surgery
Matthew Schill, MD, joined the faculty in the Section of Cardiac Surgery as an instructor of surgery in 2022, after completing extensive training at Washington University and Barnes-Jewish Hospital. Schill earned his medical degree at the School of Medicine in 2013 and went on to complete his general surgery residency and cardiothoracic surgery fellowship at Barnes-Jewish Hospital before joining the faculty.
Schill, who found his passion for cardiothoracic surgery while training at the medical school, aims to foster a similar interest in medical students today through the Cardiovascular Interest Group (CVIG). This program offers medical students early exposure to cardiology and cardiothoracic surgery and works to connect them with mentors and research opportunities.
Medical students in CVIG have the opportunity to participate in cardiothoracic surgery programming, including lectures, anastomosis labs and Q&A sessions with Washington University faculty. Schill, M. Faraz Masood, MD, and Chief of Cardiac Surgery Tsuyoshi Kaneko, MD, led a recent CVIG lab, during which 25 first and second-year medical students learned how to structure vascular anastomosis. Faculty and fellow mentors guided students through the procedure which was performed on vascular grafts donated specifically for the lab.
“I have been incredibly impressed by the quality and capability of Washington University trainees at every level, and look forward to seeing future leaders in the field come out of our programs,” says Kaneko, who is the John M. Shoenberg Chair in Cardiovascular Disease.
In addition to the technical skills needed to perform anastomoses, students focused on ergonomics, efficiency and teamwork needed to develop well-rounded surgical skills. “If you have a mentor who has invested time and energy into their students, that can go a long way towards inspiring you to pursue a career in that field,” says Masood, who leads CVIG. “That’s why we developed CVIG: we are here to reflect our passion for what we do so we can engage students in conversation and help them determine the next steps in their career.”
Schill, who sees patients at Barnes-Jewish Hospital and locations across the region, gained extensive experience in coronary artery bypass grafting, valve replacement and repair, complex aortic procedures and transcatheter aortic and mitral procedures while training at Washington University.
“Cardiac surgery is a technically challenging field, but also full of rewarding experiences,” says Schill. “There is a great need for a new generation of surgeons in our specialty, and there are incredible opportunities awaiting those who choose careers in cardiac surgery.”