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Featured Profile and Interview With Eduard Quintana MD, PhD, FECTS
Dr. Eduard Quintana is currently a consultant cardiovascular surgeon at Hospital Clínic de Barcelona and serves as director of the cardiovascular surgery residency and fellowship programs. As an associate professor of surgery at the University of Barcelona Medical School, he teaches fourth-year medical students and mentors final-year students in cardiovascular surgery. At the University of Barcelona, he also coordinates the issue of medical applications of engineering for final-year students in the biomedical engineering degree program.
Eduard is an active member of EACTS and is currently involved in a project leading the development and delivery of the European Board of Cardiovascular and Thoracic Surgery (EBCTS) MCQ examination, which is gaining momentum throughout Europe and beyond as a mandatory professional examination prior to entering independent practice.
Eduard’s clinical interests include hypertrophic obstructive cardiomyopathy (septal myectomy), surgery for infective endocarditis, surgery of the aorta at all levels, CABG, the Ross operation, as well as perioperative care management. When he is not working, he loves cooking, spending time with his family, and indulging in his passion for swimming.
CTSNet is excited to launch Dr. Quintana’s Guest Editor Series “Operative Management of Hypertrophic Obstructive Cardiomyopathy—Gold Standard Septal Myectomy to Stand the Test of Time.” Click here to learn more about the series, including registration details for the culminating live event on April 8, 2022 that will explore this important topic.
Featured Profile Interview
Mary Hammon for CTSNet
CTSNet: You received your medical degree in Spain and then completed your fellowship in the US. What was the most interesting or valuable aspect of pursuing training in a different country?
Dr. Quintana: Before moving to the US, I completed a five-year integrated program in cardiac, vascular surgery, and ICU care.
Different aspects led to that road to the US in a moment when I was younger, with fewer bonds. I felt the need to have professional experience from where we were told was the best hospital in the world: the Mayo Clinic in Rochester, Minnesota. Some of my senior mentors—Carlos Mestres, José Pomar, and Miguel Josa—made clear the necessity to advance my training abroad and supported the idea.
Living in another country, getting to know a completely different healthcare system, and working along so many US and international fellows was also a strong point. Of course, seeking a place with high surgical volume and the best surgeons to expedite and enhance my surgical experience was definitive. Rochester saw my growing interest in hypertrophic cardiomyopathy, complex aorta surgery, and CABG. For this, I am indebted to all the staff at the CVS Department, with special thanks to Hartzell Schaff, Joe Dearani, Alberto Pochettino, and Rocky Daly in these fields.
I also have to acknowledge the support of my wife, Anna Sabate-Rotes, who was willing to engage in that important move. In the end, it was a family project too. Anna greatly advanced her career in pediatric cardiology as a research fellow and completed a PhD with the experience attained at the Mayo Clinic. We made strong friendships with lots of fellows and their families that continue and remind us of those highly valued days. In Rochester, we also saw the birth of our first daughter, Cristina, during our fellowships. The whole experience rounded up perfectly.
CTSNet: What are your current research interests?
Dr. Quintana: Endocarditis is a line of work I inherited from Carlos Mestres upon my return to Barcelona. The endocarditis team had been already in place for more than thirty years and has been a true example of collaborative multidisciplinary work in a field where commercial conflicts of interest are, to the best of my knowledge, inexistent.
Each patient we treat is an opportunity to understand better this complex disease and improve care for the next one. We conduct research at multiple levels, from simple clinical outcome research to translational research. For example, samples obtained from patients with endocarditis treated surgically are stored in our bio bank, and the same microorganisms are used to test combinations of antibiotics in our animal model of endocarditis. In return, we have adopted combinations of antibiotics proven useful in the animal to treat very complex patients successfully ahead of contemporary guideline recommendations. Our colleagues José Miró, Cristina García de la María, and the team have been world leaders in this. Clinical research on the field of ambulatory treatment for endocarditis, duration of antibiotic treatment after surgery, and the safety/efficacy of oral antibiotic treatment in patients with endocarditis are examples of ongoing research.
Hypertrophic cardiomyopathy surgery is another growing line of research. In this field also, collaborative multidisciplinary has allowed multiple lines of research. As an example, patients and specimens from septal myectomy operations are being analyzed with multimodal imaging, including synchrotron tissular microstructural assessment, for better discrimination of etiology of hypertrophy. We hope to be able to better characterize disease noninvasively in the future through this research.
Other ongoing areas of research are related to aorta disease, CABG, and cardiopulmonary bypass.
CTSNet: If you had a magic wand to create the next innovation in CT surgery, what would it be?
Dr. Quintana: The ability to perform endovascular cardioscopic surgery (in a bloodless operative field) on the arrested heart.
CTSNet: What is the biggest challenge facing adult cardiac surgery right now?
Dr. Quintana: A big one is ensuring the training of the next generations of cardiovascular surgeons. When I look back at the practice, our generation grew up surgically through the guidance of our generous mentors. The field has changed enormously since then. Not only has the complexity increased brutally, but so has the scrutiny to which each operation is subjected, which puts training in a difficult spot.
The increasing adoption of thoracoscopic or robotically assisted procedures, the growing use of “artistic” valve sparing procedures, the refinement of CABG operations with the use of multiarterial grafting, prophylactic operations in young and asymptomatic patients, and procedures exposed to very long aortic occlusion times are just a few examples that do not leave room for imperfections.
To facilitate the maintenance of contemporary standards, we need to recapture the interest of our best students. This starts with mentoring medical students and attracting the talented like in the old times. Also, the role of high-fidelity simulation and preintervention training will need huge investment at institutional levels if we want to maintain both clinical safety and excellence in training. We should move away from operations carried for the first time by trainees in the operating room. Protected staff time for training residents outside the operating room seems like a must.
Luckily, many things fall in favor of our trainees now. I recall those inspiring initial videos posted at CTSNet by Prof. Sampath Kumar with classic background music. They were so helpful. Now the amount of high-quality academic free resources with operative videos and techniques exceeds what was imaginable fifteen years ago. CTSNet, MMCTS, and the Annals of Cardiothoracic Surgery are great initiatives with a direct impact on the training and care for patients. My CTSNet Guest Editor Series is another example of free learning opportunities.
CTSNet: Technical skill is obviously important for surgeons, but can you address the importance of leadership skills and the capacity to foster the surgical team’s success?
Dr. Quintana: A great team functions at its best when each member is allowed room to grow and the leaders are more focused on creating value rather than their career promotion. I am always very skeptical of surgical departments where you hear only one name. This usually translates into poor leadership. Those are places to stay away from, regardless of whether you are a trainee, a consultant, or a patient.
CTSNet: How important is the international exchange of ideas, information, and techniques in cardiothoracic surgery?
Dr. Quintana: The value of this has been well demonstrated along the history of our specialty. Surgical advances are possible when we keep an open mind, become critical of what we do, and pay attention to other’s ideas and experience. I would love to regularly visit far more practices, as I think this is a very healthy exercise.
The international surgical collaboration also allows for development of multicentric randomized studies, and that shall see its continued growth. This collaboration facilitates trainee exchange and the culmination of divulgation tools such as my CTSNet Guest Editor Series present here.