Q: What attracts you to working with the
A DOCTOR WITH HEART
Dr. Adams, co-author of Carpentier’s Reconstructive Valve Surgery, also initiated the creation of the Mitral Valve Repair Reference Center Web site to help educate patients about their hearts. “Our goal is to provide patients a valuable, robust resource,” said Dr. Adams. He cites the Web expertise and vision of Gideon Sims, director of cardiothoracic IT at Mount Sinai, as indispensable in building and maintaining the site. Visit mitralvalverepair.org.
Heart surgery is fascinating. It’s highly technical—it demands precision and an incredible working knowledge of how to manage a complex system, the heart and lungs. There’s also a really unique team model in heart surgery because of the complexity of the surgery. It takes about ten people working together and everyone has their own responsibilities. It’s quite interesting to be the quarterback of such an amazing team. And there’s the physiology of putting the heart to sleep and waking it up again. It’s a rewarding experience each and every time.
Q: Next to Dr. Alain Carpentier, you’ve been one of the most pioneering figures in the field of mitral valve repair. Why is it so important to repair rather than replace? Well, valve repair is really the gold standard. An animal valve won’t last the rest of your life, and metal valves commit a patient to a lifetime of anticoagulation. The emerging data tell us that intervening early—in patients who are often young, healthy, and asymptomatic— improves their chances of staying healthy over the long term. Of course, that means the stakes for them, and for us, are higher, and the native valve must be preserved to get the real long term benefit.
Q: That’s a lot of responsibility to shoulder. Does it ever get to you? I keep a box of tissues on my desk because invariably patients or family members get emotional every week facing the prospect of heart surgery; these are younger patients, many with young children of their own, in the middle of their lives. Physiology is on your side with younger patients, but there’s an inherent pressure to be perfect when you’re intervening in low risk patients.
Q: Your work starts with a hyper-focus on each patient but you seem equally passionate about educating physicians and patients. What are you most proud of in your role as educator?
Q: Your educational mission frequently takes you around the world to perform surgeries and educate physicians, particularly in developing nations. To give you some perspective, more than eight hundred surgeons from sixty-six countries attended the 2011 American Association for Thoracic Surgery Mitral Conclave, which I directed. There’s a lot of interest in this field and our team is committed to leading this educational effort internationally. We are establishing relationships in developing countries and helping them develop high level skills by making repeat visits to the same institutions. The goal is to raise the skill level of a group of surgeons and their teams. We do as many surgeries as we can on these visits, too. Last year we operated on ten patients in Thailand and the Dominican Republic. There’s a high burden of rheumatic mitral valve disease in young children in developing countries. It really touches your heart to see them. We teach the surgeons and their teams how to do these complex operations in young people with end stage diseases, how to care for them around surgery.
Q: What does “Mission Accomplished” look
MOUNT SINAI SURGERY MILESTONES
Richard Stock, K. Chan and M. Terk et al. devise a new technique for performing interstitial implants in the treatment of gynecologic malignancies.
like to you? The goal is for Mount Sinai to be a leader in the field and to expand our valve reference center model across the country. Over the next ten years we have an opportunity to really establish ourselves as a visionary center in this field. With the recruitment of Dr. Jagat Narula as director of Cardiovascular Imaging, one of our main goals is to build a 21st century valve center for diagnosis and total care of patients with mitral valve disease. This isn’t something you win overnight. We’re just getting started.
Warren Sherman and Valentin Fuster (co-PIs): first cellular transplant for congestive heart failure (autologous skeletal myoblast transplantation) in US done by Sherman; a new approach to heart failure treatment, trying to replace non-functional heart tissue with actively contracting muscle; retrieve immature cells from the leg.
Well, I can’t overemphasize that Carpentier’s Reconstructive Valve Surgery—the textbook I co-wrote with Dr. Carpentier and Dr. Farzan Filsoufi—is the world reference book in the field of mitral valve disease. The three of us handwrote the book during three-day sessions over almost eight years and about fifty international flights between Paris and New York. The first edition sold out on pre-release on Amazon—that’s how high the demand is for knowledge in this field. We’re also extremely proud of our Mitral Valve Repair Reference Center Web site; it is recognized by peers around the world as an educational source.
We wanted to educate the patients, not talk down to them; we simplified the language a bit, but we used our own medical texts and papers and drawings to put it together. We wanted to make our own bodies of work available to patients, whether they come to Mount Sinai for treatment or not.
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Magazine of Mount Sinai Medical Center