Remembering Domenico Pagano

Throughout his 30-year career as a first-class cardiothoracic surgeon, Domenico Pagano was driven by an unwavering commitment to improve patient outcomes. Renowned for his expertise in quality improvement, he was passionate about the importance of data to enhance patient care. This was evident in his work as consultant cardiothoracic surgeon at Queen Elizabeth University Hospital in Birmingham, where he established the award-winning Quality and Outcomes Research Unit, and his work at EACTS where he brought fresh energy to quality improvement.

Described by Rafa Sádaba, former EACTS Secretary General, as the ‘heart and soul’ of the QUIP database, Domenico channelled his energy and passion for evidence-based care into the development of a proper European Registry. EUROMACS is now considered the standard for Europe and several countries have mandated reporting outcome data to EUROMACS for ventricular assist device operations.

Born in Pompei in 1962, Domenico’s early years at school in Naples were instrumental in developing his sense of right and wrong. He was proud of the breadth of his education, which included studying Philosophy and Classics, subjects he was planning to return to by retracing the journey of Homer’s Odyssey in retirement.

He attended medical school at the University of Naples before graduating in 1987, writing his graduation thesis on ‘Echo Doppler evaluation of Cardiac Valvular Prostheses’. Whilst working in cardiovascular surgery in Bologna he met his future wife, Donna, and in 1989 they moved to the UK.

He began working at the Queen Elizabeth University Hospital in Birmingham in 1991, where his cardiothoracic career took off. He became a Research Fellow at the University of Birmingham, submitting his thesis on the ‘Identification of hibernating myocardium using PET scans’.

In 1998 he was made Hunterian Professor by the Royal College of Surgeons of England and two years later he was awarded the McCormack Medal for achieving the highest marks in the final cardiothoracic exam and the Ronald Edwards award for best presentation at SCTS.

Leading EACTS

In all aspects of his work, Domenico displayed passion and integrity, qualities that made him the “perfect choice” to become EACTS Secretary General in 2017, according to EACTS Past President Ruggero de Paulis. He describes how Domenico dedicated himself unreservedly to the role, using the platform to ‘raise the bar’ and drive important change both within the organisation and across the cardiothoracic community.

With his characteristic optimism and enthusiasm, Domenico set about professionalising the organisation, for instance bringing in external support to improve governance arrangements.

He guided EACTS through the COVID-19 pandemic which significantly impacted the Association’s flagship event, the EACTS Annual Meeting. Ruggero de Paulis says: “Even during difficult periods Domenico’s optimism was unwavering. He never complained and always had a solution.” Indeed, in 2020, the EACTS Annual Meeting went ahead when many other conferences were cancelled. It was held virtually for the first time, enabling the cardiothoracic community to learn and share experiences online because of COVID restrictions.

After three years in the role, Domenico had to take a step back due to acute health issues, and he later stood down as EACTS Secretary General before the same issue eventually got the better of him.

A strong surgical voice

Domenico’s strength of character and presence helped to bring the Association to the forefront of the cardiothoracic community and give a stronger voice to surgeons. Patrick Myers, EACTS Secretary General, remembers: “Domenico opened up the discussion about the design and interpretation of clinical trials. At the Clinical Trials Update session at the Annual Meeting he brought together diverse people from the heart team to review the data and present different viewpoints. Now, as surgeons, we feel it is normal to speak up if we don’t agree with trial design.” An avid reader and renaissance man, his favourite and oft repeated quote was from cardiologist and Nobel Peace prize laureate Bernard Lown: “Never whisper in the presence of wrong”.

In 2020, the Society of Thoracic Surgeons invited Domenico to give the prestigious Thomas B. Ferguson Lecture at its 56th Annual Meeting. Under the carefully chosen title, “M.E.G.A: Make Evidence Great Again,” he challenged cardiothoracic surgeons to critically appraise data and use evidence to improve patient outcomes and deliver guidelines we can trust.

Never one to shy away from a discussion, his passion for transparency led him to highlight the importance of full disclosure of conflicts of interest on guideline committees. This was controversial and divisive, driven by his determination to ensure heart teams could rely on trusted guidelines and advise their patients on the best treatment options.

Supporting the cardiothoracic community

Domenico was widely respected and admired across the cardiothoracic community and he drew on his own deeply competitive nature to instill nothing but excellence in those he mentored, expecting them always to give 100% to support their patients.

He was an active contributor to cardiothoracic research, publishing many papers during his career. His primary interest was in myocardial metabolism and outcomes.

His ability to apply the latest evidence and a human context to his work ensured he consistently achieved excellent surgical results for his patients. Domenico understood the human impact of his work and he challenged colleagues to always see patients as people with emotions, fears and families. His commitment and drive to enhance patient care and deliver improved outcomes was unwavering.

Domenico was not only a first-class cardiothoracic surgeon but also a supportive colleague, a generous friend and a great host and raconteur. He will be missed by his family, friends and the surgical community.

An edited version of this obituary will also be published in EJCTS.