Dr. Luciana Da Silva
Cardiothoracic Surgeon
UPMC Children’s Hospital of Pittsburgh
Advancing Heart and Lung Care in 2025
E t s ‘ N o t e
Natalie May
Natalie May
Pulse of Progress
The Vanguard of Heart and Lung Care
Theheartandlungsaretherhythmandbreathoflife, andthemaestroswhokeeptheminsyncare cardiothoracicsurgeons.Weat ,are InsightsCare delightedtodedicateourlatesteditiontotheTrailblazing CardiothoracicSurgeonsAdvancingHeartandLung Carein2025.Whattheydo—conductingdelicate proceduressuchascoronaryarterybypassgraftingandlung transplantation—saveslives,yes,butitpushesthelimitsof contemporarymedicinewithprecision,innovation,and empathy
Cardiothoracicsurgeonsarethebackboneofthehealthcare system,combiningart,science,andhumanityineach surgery.Fromembracinginnovativetechnologiessuchas roboticsurgeriestoguidingthenextgenerationthrough intensive,decade-longprograms,theyrepresent commitment.Theircommitmentguaranteesthatnovice surgeonsexcelnotjustintechnicalknowledge,butalsoin thecompassionatecarepatientsrightfullyexpect.This editionhonorstheirunrelentingcommitmenttohealand
inspire,guidingeachheartbeatandbreathtowarda healthier,fullerlife.
Foryoungmedicalprofessionalslookingtoleavethemark theyweremeanttoleave,thisissueisvaluablesource, providinginformationonthemostrecenttrendsand advancementsincardiothoracicsurgery.Fromminimally invasiveprocedurestopioneeringresearch,wedelveinto howthesesurgeonsareleadingthewaytowardsthefuture ofheartandlungtreatment.Aschallengeschange,their determinationtomoveforwarddoesnot,andthusthis disciplineisaguidinglightofhopeandopportunity
Weencourageyoutoturnthepageforaninspiringwalk throughthelivesoftheseincrediblesurgeons.Wehope theirexperienceswillinspireyouasmuchastheyhave inspiredus.
Have an enlightening read ahead!
CO NTE NT S
Cover Story
Global Expert Bringing Breakthroughs to Tiny Hearts
TRAILBLAZING CARDIOTHORACIC SURGEONS
ADVANCING HEART AND LUNG CARE IN 2025
Brief Featuring Person
Alec Akbarov
Cardiothoracic Surgeon
Dr. Luciana Da Silva
Cardiothoracic Surgeon
Harrell Ligh oot
Cardiothoracic Surgeon
Kenny Cheng
Cardiothoracic Surgeon
Dr. Shreekumar Subramanian
Cardiothoracic Surgeon
Organiza on
CaroMont Health. caromonthealth.org
UPMC Children’s Hospital of Pi sburgh chp.edu
Cone Health. conehealth.com
SJP Medical Centres Sdn. Bhd. subangjayamedicalcentre.com
HCA Healthcare, Inc. hcahealthcare.com
Alec is an expert cardiothoracic surgeon with a focus on minimally invasive heart and thoracic surgeries, commi ed to advancing pa ent recovery and quality of life.
Dr. Luciana, a compassionate cardiothoracic surgeon, transforms lives by expertly trea ng children with complex heart defects, par cularly Ebstein’s anomaly, offering hope and innova ve care.
Harrell is an experienced cardiothoracic surgeon proficient in heart and lung opera ons, emphasizing compassionate care, cu ng-edge methods, and op mal pa ent health and recovery.
Kenny is a skilled cardiothoracic surgeon specializing in complex heart and lung procedures, dedicated to pa ent care, innova ve techniques, and improving surgical outcomes with precision.
Dr. Shreekumar, a skilled cardiothoracic surgeon, blends advanced technology with personalized care, enhancing pa ent outcomes through exper se, empathy, and innova ve surgical techniques.
Dr.
A Global Expert Bringing Breakthroughs to Tiny Hearts
Cardiothoracic Surgeon
UPMC Children’s Hospital of Pittsburgh
LUCIANA
UCIANA D SILVA
E V E R Y Y E A R ,
thousandsofchildrenaroundtheworldarebornwithheart defectsthatneedcomplexsurgeriesandlifelongcare.For theirfamilies,it’sahardandemotionaljourneyfullof questions,fears,andhopeforwhatliesahead.Intimeslike these,havingaskilled,compassionatesurgeonbytheirside cantrulychangeeverything.That’swhereDr.Lucianada Silvacomesin.SheisaCardiothoracicSurgeonat UPMCChildren’sHospitalofPittsburgh,whohas dedicatedherlifetocaringforchildrenwithseriousheart conditions,especiallyarareonecalledEbstein’sanomaly. Duringhertimepracticingmedicine,shecontinuously improvessurgicalapproachesthatcanleadthesechildren towardafulllifeexpectancy.Hermedicalworkextends pasttreatmenttocreateopportunitiesforchildrenwhile providinghopetofamiliesduringdifficulttimes.
Pittsburgh
ButDr.daSilvadidn’talwaysplantobecomeaheart surgeon.Herpathintothisdemandingfieldwasn’texactlya straightline.ShegrewupinBrazil,andinthebeginning, sheactuallystartedoutinengineering.Shelovednumbers andsolvingproblemsandthoughtthatwouldbeherfuture. Butwhenthecountry’seconomyshiftedandengineering careersbecameuncertain,shemadeabigdecisionand switchedtomedicine.Thatchoice,guidedbyinstinctand resilience,endedupchangingherlifeandthelivesofso manychildrenandfamiliesalongtheway.
Dr. da Silva is using expertise to give children with heart defects a brighter future!
FromEngineeringtoMedicine
Dr.daSilvadidn’tfollowatraditionalrouteintomedicine; hercareerhasbeenshapedbyadaptabilityandchanging circumstances.“IstartedinCivilEngineeringschool becauseIlovedmathematicsandlikedconstructionvery much.ButIwaslivinginBrazil,andthecountrywasgoing throughaperiodofeconomicalstagnation,withlackofjob opportunitiesinthisfield.So,Idecidedtomoveto medicine.Thenextyear,Itookthetestsagainandwas
approvedformedicalschool.Iwas18yearsoldwhenI enteredmedicalschoolinBrazil,”sherecalls.
However,itwasn’tjusttheswitchfromengineeringto medicinethatdefinedhercareer;itwasthewaysheviewed thefieldofmedicineitself.Earlyinhermedicaltraining, Dr.daSilvanoticedadisconnectbetweenwhatshewas diagnosingandthetreatmentseffectiveness.Shewasn’t particularlydrawntotheclinicalareabecauseitoftentook alongtimetoseeresults,andsometimespatientsdidn’t complywiththetreatmentplans,whichleftherfeeling disappointed.
Atthatpoint,Dr.daSilvamadeadecisiveturntoward surgery,seekingafaster-paced,moreimmediateapproach topatientcare.Herdecisionwouldsoonleadherdowna pathwhereeverymomentcouldchangethetrajectoryofa younglife.
DiscoveringaPassionforHeartSurgery
Itwasn’tlongbeforeDr.daSilvadiscoveredhertrue passionwithintheworldofsurgery—heartsurgery The pivotalmomentcamewhensheobservedherfirstheart surgeryduringmedicalschool.“Oneofourteachersinvited metofollowhisprivatescheduleinanotherhospital.I beganfollowinghisworkintheORandemergencyroom, andthat’swhenIrealizedthat’swhatIwantedtodo.Atthat hospital,Isawmyfirstheartoperation,”sheshares.
ThemoreDr.daSilvaobserved,themorecaptivatedshe became,particularlybycongenitalheartsurgery.“Itruly fellinlovewithheartsurgery,especiallycongenitalheart surgery,”shesayswithpalpableenthusiasm.Butevenas shefelldeeperintoherpassionforheartsurgery,she encounteredchallengesalongtheway.“Oneofmyteachers casuallysaidthiswasanareaformenandsuggestedI pursuecardiologybecausethereweremorewomen.ButI saidno,Ireallylikesurgery,andIwoulddoheartsurgery.”
Determinedtopursueherdream,Dr.daSilvaappliedfora residencyincardiothoracicsurgeryandwasaccepted.She hasneverlookedbacksince,subsequentlyfinishinga specializationincongenitalheartsurgeryandlater achievingadoctoraldegreeincardiothoracicsurgeryatthe FederalUniversityofSaoPaulo.
JoiningUPMCandAdvancingTreatmentforEbstein’s Anomaly
Intheyearsfollowingherresidency,Dr.daSilvaandher husband—whoisalsoaheartsurgeon—wereinvitedto UPMCChildren’sHospitalofPittsburghbyDr Victor Morell.Theirexpertiseinanovelsurgicalprocedurefor Ebstein’sanomaly,ararecongenitalheartdefect,had caughttheattentionofthehospital.Thecouplehad developedaspecializedprocedurecalledtheConerepair fortreatingthisconditioninBrazil,andUPMCoffered themtheopportunitytofurtheradvancetheirworkinthe UnitedStates.
“Here,wefoundaplacefullofpeoplewithaveryhigh levelofknowledge,especiallyinthetreatmentof congenitalheartdiseases.Allthespecialtiesherearevery welldeveloped,andwehavealltheinstrumentsweneedto furtherdevelopourfieldofinterest,”sheexplains.The decisiontomovetoPittsburghwasaturningpointintheir careers.AtUPMC,theywereabletotaketheirresearchand clinicalpracticestonewheights,particularlyinthe treatmentofEbstein’sanomaly
Ebstein’sanomalyinvolvesthedisplacementofthe tricuspidvalveinsidetherightventriclemuscle,with enlargementoftherightventricleandrightatrium.Dueto involvementoftherightventriclemyocardium,this conditioncanleadtoseverecomplicationssuchasright heartfailureandarrhythmias.ShewasassistingDr.Jose PedrodaSilva,herhusband,whenthegroundbreaking techniquefortreatingthiscomplexcondition,the“Cone repair”wascreatedin1993,inSaoPaulo.Together,they expandeditsusetochallengingsituations,includingthe ConerepairafterTricuspidvalvereplacementand performingthefirstConerepairaftertheStarnesprocedure in2019atUPMCChildren’sHospitalofPittsburgh,an stagedapproachthatrevolutionizedthetreatmentofcritical illneonateswithEbstein’sanomaly
“
“AtUPMCalone,we’vedonemorethan150casessince 2016.Here,wefoundstrongsupportfromtheentireteam. TheDaSilvaCenterforEbstein’sAnomalywascreated, integratingspecialtieslikeadvancedcardiacimaging,fetal
I started in Civil Engineering school because I loved mathematics and liked construction very much. But I was living in Brazil, and the country was going through a period of economical stagnation, with lack of job opportunities in this field. So, I decided to move to medicine.
medicine,interventionalcardiology,adultcongenitalheart diseaseandelectrophysiology—allinoneplace,”she shares.Thiscollaborativeenvironmenthasallowedthemto notonlyrefineexistingtechniquesbutalsopushthe boundariesofmedicalresearchtobetterunderstandthe diseaseandimprovepatientoutcomes.
BalancingInnovationandPatientRisk
Asaleadingsurgeoninahighlyspecializedfield,Dr.da Silvafacestheever-presentchallengeofbalancingclinical innovationwithpatientsafety.“In2019,weperformedthe firststagedtreatmentonanewbornwithEbstein’sanomaly thatwasseverelysick,applyingtheStarnesprocedure, followedfewmonthslaterbytheConerepair Whatwedid wastosequentiallycombinethetwowell-known techniquestoimprovepatientsurvival,”sheexplains.The goal,sheemphasizes,isnotonlytocreateentirelynew proceduresbuttoenhanceexistingonestoensurethebest possibleoutcomesforpatients.
ThecombinationoftheconeandStarnesprocedures representsacarefullyconsideredevolutionofprevious treatments.
“TheStarnesprocedureisasimplerandreproducible techniquethatrescuesthenewbornfromacritical condition,butitwouldcommitthepatienttosingle ventriclepathway,withpossibleseverecomplicationsin longterm.Wechangedthisconceptbyremovingthe Starnespatchlateronandrehabilitatingtherightventricle, applyingtheConerepairinthetricuspidvalve.TheCone repairisacomplexprocedurethatfewspecializedcenters haveexpertiseandachievegoodresults.Wehavebeen successfulinallthecaseswehaveproposedthisapproach” shesays.Forher,patienteducationisparamount.By ensuringthatfamiliesfullyunderstandtherisksandbenefits ofthetreatmentplan,Dr.daSilvabuildstrustand confidence,allowingformoreinformeddecisionsinthe high-stakesenvironmentofcongenitalheartsurgery.
ThePowerofCross-DisciplinaryCollaboration
OneofthekeyreasonsforDr.daSilva’ssuccessatUPMC isthehospital’semphasisoncross-disciplinary collaboration.Sheandhercolleaguesworkcloselywith specialistsacrossmultiplefields,includinginterventional cardiology,electrophysiology,andresearch.This collaborativeapproachextendsbeyondjustpatientcare. Herteamalsoconductsgroundbreakingresearchtofurther understandthelong-termeffectsofcongenitalheart conditionsandrefinesurgicaltechniques.
“Wecanalsocollaboratewithnearbyacademicinstitutions liketheUniversityofPittsburghandCarnegieMellon.If wehaveanidea,wecanworkwithengineering departmentstocreatenewequipment.Thesewouldfirstbe testedinanimalsbeforeusinginhumans,”sheexplains. Thistypeofinterdisciplinaryworkishelpingpushthefield ofcongenitalheartsurgeryforward,ensuringthatUPMC remainsatthecuttingedgeofbothclinicalpracticeand innovation.
StayingAheadinaFast-EvolvingField
Theworldofheartsurgeryisconstantlyevolving,and stayingattheforefrontofnewresearch,technology,and techniquesisnoeasytask.“Artificialintelligenceis evolving,butforcongenitalheartdisease,wedon’tyet applyAItohelpinsidetheoperativefield,howeverit improvesthediagnosis,treatmentplanningandrisk assessment,”Dr.daSilvanotes.Andsheremains committedtointegratingthelatesttechnologyintoher practice.UPMCusesadvancedimagingequipmentto create3D-printedmodelsofpatients’hearts,enabling surgeonstobetterunderstandcomplexanatomybefore operating.
One of my teachers casually said this was an area for men and suggested I pursue cardiology because there were more women. But I said no, I really like surgery, and I would do heart surgery.
“Wecanalsouse3Dglassestovirtuallynavigateinsidethe heart,improvingunderstandingforcomplexcases,”she adds.Thisinnovativeuseoftechnologyishelpingherand herteamtacklesomeofthemostchallengingsurgeries, offeringalevelofprecisionthatwasn’tpossiblejustafew yearsago.
TheChallengesofInnovationandTrainingtheNext Generation
WhileDr.daSilva’sworkcontinuestoimpactthelivesof countlesschildren,shefacessignificantchallengesinher role.“Themainchallengeistimeandpersonnel.Asurgeon islikeanartist—especiallyincongenitalheartsurgery. Everybodyhasalimitedperiodofactivelife.Weneedto teachthenextgeneration,butit’sliketeachingsomeoneto paint,peoplehavedifferentskillsandstyle”sheexplains. Trainingnewsurgeonstohandletheintricaciesof congenitalheartsurgeryisalongandintensiveprocessthat requiresyearsofdedication.
“Congenitalcasesarecomplexandrare.First,weneedto centralizethesecasesinspecializedcenters—likewedid withEbstein’sanomaly.Fewcentersintheworldhavedone
asmanysurgeriesaswehave,andourresultsare distinguishable,”shesays.Thiscentralizationensuresthat newsurgeonsreceivethebestpossibletrainingwhilealso guaranteeingthatpatientshaveaccesstothehighestlevel ofcare.
MentoringFutureLeadersinHeartSurgery
Whenitcomestomentoringthenextgenerationofheart surgeons,Dr.daSilvaplacesastrongemphasisoncharacter andinterpersonalskills.“First,honesty,withthemselves andwithpatients.Theymusthaverealdedicationtothis life.It’snotjustaboutoperatingonaheart,it’sabout interactingwiththechildandtheirparents,”shesays.Inher view,theabilitytoformstrong,empatheticrelationships withbothpatientsandcolleaguesisessentialtosuccessin thisdemandingfield.
“Goodrelationshipsarekey—withfamiliesandwith colleagues.Noonecanbeagoodsurgeonalone.Werelyon anesthesiologists,nurses,intensivists—anentireteam.You canbeverysmartandskilled,butifyoucan’trelateto others,heartsurgeryisnottherightfield.”
ShapingtheFutureofHeartSurgery
Lookingahead,Dr.daSilvaenvisionsUPMCplayinga significantroleinshapingthefutureofheartsurgery
“We’rereceivingpatientsfromallover—Europeand Asia—becauseourcenterofferscomprehensivecareand follow-up.Wewanttobetterunderstandtheright ventricularfunctionandwhetherearliersurgerycould preventdysfunctionlater,”shesays.Throughinternational collaborationsandcontinuedresearch,UPMCaimsto furtherrefinesurgicaltechniquesandofferhopetoeven morepatientsaroundtheworld.
Dr.daSilva’sworkcontinuestohaveafar-reachingimpact, notonlythroughhersurgicalexpertisebutalsothroughher leadershipinadvancingthefieldofcongenitalheart surgery.Beingcommittedtoimprovingpatientoutcomes andmentoringthenextgenerationofsurgeons,sheremains adrivingforceintheworldofpediatricheartcare.
The Role of AI CARDIOTHORACIC
Cardiothoracicsurgery,aspecialtyofpractice
dealingwiththemanagementofheart,lung,and otherthoracicorgandiseases,hasalwaysbeenat theforefrontofmedicalinnovation.Fromthedevelopment ofopen-heartsurgerytotheestablishmentofminimally invasivetechnology,thespecialtyhasprogressively improvedtoimprovepatientoutcomes.Currently,artificial intelligence(AI)isusheringinanewageofprecision, transformingCardiothoracicSurgeryInnovationsthrough improveddiagnostics,surgicalplanning,intraoperative assistance,andpostoperativecare.
In this article, we will discuss the central role played by AI in changing cardiothoracic surgery and its power to reframe clinical practice.
AI-PoweredDiagnostics
AmongthemostsignificanttasksofAIincardiothoracic surgeryisenhancingtheaccuracyindiagnosis.Programs trainedonhugedatabasesofmedicalimagescandetect abnormalitieswithunbelievableprecision:theyareknown asmachinelearningprograms.Asanexample,artificial intelligencealgorithmsanalyzingcomputedtomography (CT)scansorechocardiogramsmaydetecttheearly manifestationsofsuchdiseasesascoronaryarterydisease, lungcancer,orvalvularheartdisease,andevenbeforethe onsetofsymptoms.
AIeliminatesfalsepositivesandnegatives,anditmeans thatitlowersthenumberofunnecessaryproceduresand makessurethatpatientsareprovidedwithpropercare, whichpreconditionsthesuccessofsurgery.
SurgicalPlanning
AIischangingsurgicalplanningwiththeprovisionofdatadriven,personalizedinsights.Surgicalproceduresthat involvethoracicsurgerysuchasthecoronaryarterybypass graftingorremovaloflungsrequireapreciseplanningdue tothecomplexnatureofthethoracicanatomy AI-driven platformscando3Dimageryofpatients,allowingsurgeons tobeabletolookandpracticeproceduresbeforegettingin theoperatingroom.
Suchcomputersimulationsenablesurgeonstoanticipate difficulties,optimizeincisionlocation,andcustomize interventiontoindividualpatientanatomy Asanexample, AI-poweredsoftwarelikeHeartFlowcancreateapatientspecificmodelofthecoronaryarteriesthatcanhelpa surgeonplanthestentsmoreaccurately.Thisaccuracy reducestheriskofanyoperation,savestimeandenhances theresults,whichisagiantleapinthefieldof CardiothoracicSurgeryInnovations.
IntraoperativeAssistance
AIisatimelyassistanttothesurgeonintheoperatingroom andhelpshim/hertoimprovehis/hercapability.RoboticassistedtechnologiessuchasthedaVinciSurgicalSystem integrateAItoenhancedexterityandprecisioninminimally invasiveprocedures.Theyusemachinelearningtofilterthe handtremors,understandthemovementsofthesurgeonas precisemovementsandprovidemagnifiedandhighresolutionviewsoftheoperationsite.
Intraoperativedecision-makingisalsomadewiththehelp ofAI.Asanexample,computervisionalgorithmsmaybe usedtoscanliveoperatingfeedsandidentifysignificant structures,suchasthebloodvesselsornerves,reducingthe chancesofaccidentallydamagingthem.
PostoperativeCare
TheeffectsofAIreachbeyondtheOR,maximizing postoperativecarethroughpredictivemodels.Machine learningalgorithmsreviewpatientinformation—vitalsigns, laboratorytests,andpastoutcomes—toforecastcomplicationssuchasinfections,arrhythmias,orrespiratory collapse.Clinicianscanpre-emptivelyintervenebasedon theseforecasts,enhancingrecoveryrates.
Forinstance,AI-facilitatedplatformssuchastheCleveland Clinic'sriskstratificationplatformutilizereal-time informationtopredictpostoperativeatrialfibrillation,a
frequentcardiacsurgerycomplication.Byidentifyinghighriskpatients,theplatformfacilitatestargetedprevention, includingmodifiedmedicationprotocols.Furthermore,AIfacilitatedremotemonitoringplatformsmonitorpatients afterdischarge,triggeringalertstohealthprofessionalsfor earlywarningsigns.Readmissionisminimized,andlongtermoutcomesareimproved.
EthicalandPracticalConsiderations
AlthoughAIhasgreatpotential,itsapplicationin cardiothoracicsurgeryisnotonlypracticalbutalsohas ethicalimplications.Themostimportantissuewithdata privacyissafeguardingpatients'confidentialitysinceAI dealswithsubstantialamountsofdatathatneedtobestored safely.Thereisalsoanissueofalgorithmicbiasinwhich themodelgiveswrongpredictionstominoritycommunities,andthisshouldneverhappensoastomakesurethere isfaircare.
SurgeonswillalsohavetoadapttothepositionofAI, dividingdependenceontechnologywithclinicaljudgment. OverdependenceonAIwouldreducesurgicalproficiency, andalackofusecouldlimititsbenefits.Residency programsareevolvingtoincludeAIliteracytoensure surgeonscanutilizethesetoolsproperly.Finally,regulatory frameworksmustcatchupwithinnovationtoensureAI systemsfunctionwellandsafely
TheFutureofAIinCardiothoracicSurgery
Lookingforward,theroleofAIincardiothoracicsurgeryis settogrow.Improvementsinnaturallanguageprocessing mayallowAItolearnfromunstructuredclinicalnotes, furtheroptimizingtreatmentplans.Autonomoussurgical robots,poweredbyAI,couldeventuallyconductmundane tasksunderthewatchfuleyeofahuman,allowingsurgeons toconcentrateonhigh-leveldecision-making.Further,the incorporationofAIintogenomicsmayenablepersonalized treatments,withinterventionskeyedtoapatient'sgenetic make-up.
TheconvergenceofAIandcardiothoracicsurgeryisanew eraofprecision,asdata-drivenknowledgeimproveseach stepofpatientcare.Fromenhanceddiagnostics,planning, intraoperativeaccuracy,andpostoperativerecovery,AInot onlyimprovesoutcomesbutredefinespossibilitiesinthis high-riskdomain.AsCardiothoracicSurgeryInnovations continuetoadvance,AIwillbeafoundation,propelling progressandchanginglives.
-Pearl Shaw
Dr.ShreekumarSubramanian
Trailblazing Cardiothoracic Surgeons Advancing Heart and Lung Care in 2025
Cardiovascularandpulmonarydiseasesarestillmajor
health problems around the world. Advances in medical technology integrated with personalized carearemakingapositivedifferenceinpatientoutcomesand life expectancy Physicians who recognize and solve the uniqueproblemsandgoalsofeachpatientarethemainreason for advancements in this area. Leading surgeons in this area usebothtraditionalandlessinvasivemethodstoadvancecare forcardiacandthoracicproblems.
Dr. Shreekumar Subramanian, Cardiothoracic Surgeon at TriStar Medical Center in Nashville, Tennessee, and affiliated with HCA Healthcare, Inc , exemplifies this approach With more than 25 years of experience and thousands of surgeries under his belt, Dr Subramanian is known not just for his skill but for his caring approach. He takes the time to listen to his patients, explains treatments clearly,andtreatseveryonewithrespect.Hisworkshowsthat heartandlungcaretodayisaboutsupportingeachpatientand theirfamilythrougheverystepoftheirjourney.
Let’s explore Dr Subramanian’s expert, personalized approachtransformingheartandlungcarein2025!
ACarePhilosophyRootedinEmpathyandRespect
What sets Dr. Subramanian apart is his commitment to placingpatientsattheheartofeverydecision.“Idon’toffera patient anything I wouldn’t offer my own family,” he explains. This principle guides all his interactions, ensuring honestyandcompassionthroughoutthecareprocess.
Rather than dictating a single course of action, Dr. Subramanian believes in presenting patients with clear options.“Whendealingwithpatients,Ipresenttheoperation or procedure as an option—it’s always up to the patient and
theirfamilytodecidewhatthey’dliketodo.”Thisapproach buildstrustandeasesanxiety,makingsurethattreatmentfits whattrulymatterstoeachindividual.
Moreover,heinsistsonmedicalreasonableness:“Ionlyoffer anoperationorprocedureifIbelieveitisreasonabletoexpect itwillimproveeithersurvivalorqualityoflife.”Inpractice, this means avoiding unnecessary surgeries and focusing on thoughtful,evidence-basedcare.
To achieve this, he spends considerable time understanding eachpatient’suniquesituation.“Mypracticeisreallyfocused onpatient-centeredcareandtailoringtherapies.Bytailoring therapies, I mean I adapt the treatment to the individual patientratherthanapplyingaone-size-fits-allapproach.”For some, this means traditional open surgery; for others, a minimally invasive procedure might be best, depending on theirhealthandlifestyle.
FromMilitaryServicetoMedicalMastery
Dr Subramanian’sjourneyisasremarkableashisapproachto patientcare.HeearnedaBachelorofScienceinBiologywith aminorinModernLanguagesfromUnionCollege,followed by a medical degree with honors from Albany Medical College in 1996. Instead of taking the traditional route, he chosetojointheU.S.AirForce,whereheservedfortenyears.
During his military career, he completed his internship, residency, and a clinical research fellowship at David Grant Medical Center, Travis Air Force Base, California His servicetookhimaroundtheglobe—deployedtoIraq,Libya, Kazakhstan, and serving as a combat trauma surgeon in Balad, Iraq, during Operation Iraqi Freedom. These experiencesdemandedquickdecision-makingandresilience inlife-or-deathsituations.
“ServingintheAirForcewastransformative,”hereflects.“It taught me how to make life-or-death decisions under stress, and how to care for patients in the most challenging conditions.” This foundation in discipline and empathy continuestoshapehisworktoday.
After his military service, he completed a Thoracic and Cardiovascular Surgery fellowship at the Cleveland Clinic Foundation,oneofthenation’stopprograms.Healsoearned atravelingfellowshiptotheArizonaHeartInstitutetofurther refine his skills. But it was his time in Germany that truly broadenedhisexpertise.
For two years, Dr. Subramanian worked independently as a cardiac surgeon at the Heart Center Leipzig, gaining experience with cutting-edge technologies like transcatheter aortic valve replacement (TAVR) and mitral valve therapies minimally invasive treatments that were just emerginginEurope.WhenhereturnedtotheU.S.,hehelped buildtheTAVRprogramattheUniversityofArizonaMedical Centerandservedasdirectorofthethoracicsurgeryresidency program.
In 2015, he was recruited to TriStar Centennial Medical Center to establish their minimally invasive mitral valve surgery program, bringing his international experience and advancedskillstopatientsinTennessee.
MasteringComplexCardiovascularConditions
Dr. Subramanian’s clinical expertise spans a wide range of cardiac and thoracic conditions, from emergencies to complexsurgeries:
• Acute myocardial infarction (heart attacks), where timelycaresaveslives
• Hypertrophic cardiomyopathy, a thickening of the heart muscle
• Infectiveendocarditis,adangerousheartvalveinfection
• Cardiactumors,rarebutseriousgrowths
• Arrhythmias and conduction disorders affecting heart rhythm
• Congenitalheartdefectsandvalvediseases
• Heart failure management, improving patients’ daily lives
• Minimallyinvasivetranscathetervalveproceduressuch asTAVRandMitraClip
• Thoracic aortic aneurysm repair, correcting dangerous bulgesintheaorta
Withover5,000cardiovascularoperationsandmorethan60 published scientific articles and abstracts, Dr. Subramanian combines hands-on experience with academic knowledge. This lets him provide care that is both cutting-edge and groundedinprovenscience.
BringingWorld-ClassCardiacCareClosertoHome
Accesstospecializedheartandlungcareisoftenachallenge formanypatientswholivefarfrommajorcenters.Toaddress this, Dr Subramanian sees patients not only at TriStar CardiovascularSurgeryinNashvillebutalsoattheT.J.Health Pavilion in Glasgow, Kentucky This makes expert consultations and follow-up visits easier for patients in smallerorruralcommunities.
While surgeries take place at TriStar Centennial Medical Center in Nashville, the convenience of the Glasgow clinic means fewer long trips for patients needing ongoing care. Thismodelblendsconveniencewithtop-qualitycare,making surepatientsgetthetreatmenttheyneedwithoutunnecessary burden.
InnovatingThroughResearchandEducation
Throughout his career, Dr. Subramanian has embraced innovation and teaching He has trained extensively in minimally invasive valve surgeries and helped launch new programslikeTAVRduringitsearlyFDAapprovalphase.
As a residency program director, he has mentored many young surgeons, emphasizing the balance of technical skill andempathy Hehasalsoledclinicalstudies,includingFDA trials on sutureless aortic valves, helping bring new technologiessafelytopatients.Hismorethan60publications show his commitment to advancing cardiovascular care worldwide.
AHumanTouchinHigh-TechMedicine
Despitehistechnicalexpertise,Dr Subramanianneverloses sight of the person behind the patient. “I spend a lot of time withpatients,understandingtheirspecificsituation,andthen craftatherapythatworksbestforthem,”hesays.
This focus on communication and trust means treatment decisionsconsidernotjustmedicalfacts,butpatients’values and fears too. This helps patients feel confident facing complexchoicesabouttheirhealth.
LifeBeyondtheOperatingRoom
Outside of surgery, Dr Subramanian is a family man, balancing his demanding career with life at home alongside his wife and two children. His military and global medical e
service—whethertohiscountry,patients,orfamily
TheFutureofCardiothoracicCare
As medicine continues to evolve, Dr. Subramanian stays at theforefront,blendingsurgicaltraditionwithinnovative,less invasiveoptions.HisworkwithHCAHealthcareandTriStar Medical Center means patients can access expert, personalized heart and lung care that is both advanced and compassionate.
Forthosefacingseriousheartorlungconditions,hisvisionis clear: care that is high-tech but also high-touch, tailored to eachindividual’sneedsandlife.
GENE THERAPY and the Future of CARDIAC CARE
Heartdiseaseremainstheleadingcauseofdeath
worldwide,claimingmillionsoflivesannually. Despiteadvancesinmedicine,symptom-based medicines,stents,andbypassprocedurescannotreachthe heartoftheissue.That'swheregenetherapyentersthe picture—thenextparadigmshiftthatwouldaltertheFuture ofCardiacCarebytargetingthegeneticrootsofheart disease.
In this article, we will explore how gene therapy is poised to transform cardiac treatment, its use today, challenges, and what it holds for patients.
GeneTherapyinCardiacCare
Genetherapypreventsortreatsthediseasewithamodificationoradditionofgeneticmaterialintothecellsofthe patient.Intheareaofheartdisease,itattemptstocorrect thegeneticabnormalities,enhancetheactivityofthecells, orinducethehealingofheartdamage.Theheartisa complexorganthathaslittleregenerativecapacity,making itparticularlyhardtotreat.Suchdamagemaybeirreversibleindisorderslikeheartfailure,coronaryarterydisease orgeneticcardiomyopathies,andconventionaltherapiesare oftenineffective.Genetherapyisthelateststrategytodeal withthesediseasesandapproachthematmolecularlevel.
CurrentApplicationsinCardiacCare
Cardiovasculardiseasegenetherapyisinitsearlyphase, yetclinicalandpreclinicaltrialsareencouraging.Heart failure,orfailureofthehearttopumpbloodeffectivelyis oneoftheareasofconcern.Scientistsarestudying treatmentusingthegenes,suchasSERCA2a,which regulateheartmusclecontractions,thatdealwithcalcium management.Inaninnovativeexperiment,genetherapy usingAAVwasintroducedinpatientswithadvancedheart failureinanattempttoimproveSERCA2aexpressionand improveheartperformanceandsymptomsinsomepatients.
Thealternativeapplicationisinthemanagementof inheritedcardiomyopathies,suchashypertrophic cardiomyopathy(HCM)becauseofmutationsofgenessuch asMYBPC3.CRISPR-Cas9,agene-editingtechnology,is beingconsideredtoreversesuchmutationandpreventthe onsetofthedisease.Inpreclinicalstudies,asanexample,it hasbeenestablishedthatinanimalmodels,CRISPRcanbe usedtoeditfaultygenesincardiaccells.
ChallengesinGeneTherapyforHeartDisease
Despiteitspromise,genetherapyhassignificantchallenges. Thelocation,complexity,andconstantmovementofthe heartmakesithardtotransducegenestoheart.Vectors mustbeprecise,inordertodelivergenestothetargetcells withoutcausingimmuneresponsesandoff-targetactivity EventhoughAAVsarebeneficialduetotheirlow immunogenicity,theycantriggerimmuneresponsesamong somepatients.
Anotherchallengeistheheart'slimitedcapacityfor regeneration.Incontrasttotheliverorskin, cardiomyocytesrarelydivide,whichlimitstheirrepairof widespreaddamage.Genetherapiesnotonlyhaveto introducefunctionalgenesbutalsohavetoprovide sustainedexpressionwithinnon-dividingcells.Moreover, mass-producingsafe,high-qualityvectorsforwidespread deploymentisstillexpensiveandchallenging.
Therearealsoethicalandregulatoryquestionsinthe balance.Geneediting,particularlybymeanslikeCRISPR, isanissuewithregardtolong-termsafetyandunforeseen geneticchange.AgenciesliketheFDAandtheEMA requireextensivetestingtoprovetherapiessafeand effective,whichcandelaydevelopment.Additionally, accessandaffordabilityarealsosignificantissues,asgene therapiesareoftenverycostly,renderingtheminaccessible topatientsfromlow-resourcesettings.
TheFutureofCardiacCare
Genetherapyinthefuturecouldrevolutionizecardiac treatmentwithlong-termandtailor-madeinterventions. Newgene-modifyingtechnologies,suchasbaseeditingand primeediting,aresaidtoimproveaccuracyinfixinggenetic defects.Suchmethodscouldidentifyspecificmutations withoutcausingwidespreadgeneticchanges,reducingrisks andmaximizingsuccess.
Anotherhighlypromisingareaisstemcellintegrationinto genetherapy.Combininggene-editedstemcellswith cardiactissueengineering,scientistsareworkingtoprovide functionalhearttissuefortransplantationortoenhancethe body'sownrepairmechanismsintheheart.Forexample, inducedpluripotentstemcells(iPSCs)canbegenetically engineeredtoproducehealthycardiomyocytesthatwould substitutedefectivetissueinheartfailuresufferers.
Deliverymethodsarealsobeingimproved.Technological advanceslikenanoparticle-basedvectorsandcatheter-based systemscanpotentiallyreducetheinvasivenessand increasetheeffectivenessofgenetherapy Thesetechnologiescouldallowtreatmentstobedeliveredtotheheart itselfduringroutineprocedureswithlessriskandmoregain tothepatient.
Artificialintelligence(AI)isbeingusedmoreandmoreto makegenetherapymoreefficient.AIcanpredictthebest targets,designbettervectors,andsortthroughpatient informationtogivepersonalizedtreatments.Thiscanmake drugdevelopmentfasterandtargetthedrugssothatthey arebettersuitedformanydifferentpatientpopulations.
-Natalie May
