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Featured Profile and Interview With Marc W. Gerdisch, MD
Dr. Marc Gerdisch is the chief of cardiovascular and thoracic surgery and surgical director of the Heart Valve Center at Franciscan Health, Indianapolis, Indiana. He is also a senior partner with the Illinois-based Cardiac Surgery Associates specializing in complex heart valve surgery, as well as an associate clinical professor of thoracic and cardiovascular surgery at the Loyola University Medical Center in Chicago. Dr. Gerdisch earned his MD from the Loyola University Stritch School of Medicine in Illinois, after which he trained in both general surgery and cardiovascular and thoracic surgery at Loyola University Medical Center. During those years, he also undertook mitral valve repair and biomechanical assist device training at the L’Hospital Broussai in Paris, France.
Dr. Gerdisch’s research interests include surgical treatment of atrial fibrillation, management of the left atrial appendage, minimally invasive mitral valve surgery, aortic valve repair, alternative mechanical valve anticoagulation, transcatheter valve in valve therapy, and regenerative tissue valve technology. Dr. Gerdisch is currently a fellow of American College of Surgeons, American College of Cardiology, and the Heart Rhythm Society. In addition to being a founding board member of Enhance Recovery After Surgery – Cardiac Society, he is also a member of CTSNet, AATS, EACTS, HVS, ISMICS, STS, and AHA (past president of the Indianapolis chapter).
CTSNet is excited to launch Dr. Gerdisch’s Guest Editor Series “Surgical Atrial Fibrillation - What We Must Do and What We Can Do.” More information on this series will be released shortly, including registration details for the culminating live event that will explore this important topic.
Catherine Marcic Joyce for CTSNet:
CTSNet: How important is the international exchange of ideas, information, and techniques in cardiothoracic surgery?
Marc Gerdisch: Among the presenters for my Guest Editor Series on surgical treatment of atrial fibrillation is my dear friend from Belgium, Dr. Mark La Meir, whom I met while speaking in India and Malaysia. He was then early in his trajectory to forge a new path in minimally invasive arrythmia surgery. While in France, Poland, Japan, Germany, Slovenia, Italy, Croatia, and Cuba, I have had the pleasure of exchanging ideas with creative, dedicated surgeons. In fact, my choice to invest myself in valve surgery was in no small part inspired by time spent in Paris in 1993 with Dr. Alan Carpentier. Perhaps the journey of Dr. Niv Ad, also featured in my Guest Editor Series, serves well to describe the importance of ignoring borders when solving problems for patients. In 1998 Dr. Ad traveled from Jerusalem, Israel, to Washington, DC, to work with Dr. James Cox. During that time, they developed minimally invasive cryosurgical Maze. Dr. Cox himself has circled the globe numerous times, and he and Dr. Ralph Damiano, current chair at Washington University, the position occupied by Dr. Cox when he performed the first Cox Maze, have received visitors and fellows from around the world seeking to develop acumen and perform research in arrhythmia surgery.
CTSNet: What is your favorite procedure? Why is it your favorite?
MG: A favorite procedure is a moving target because we are always in the process of refining approaches and documenting efficacy. Germane to our current edition, the Cox Maze procedure stands as a constant favorite. I find it transformative for patients to be rid of atrial fibrillation. In addition to the constant threat of stroke, the negative impact of atrial fibrillation on a person’s aerobic capacity and general sense of well-being has long been underestimated, perhaps in part due to a sense of futility in its treatment. The Cox Maze brings us the closest to extinguishing atrial fibrillation. My practice is essentially all valve surgery, with an emphasis on minimally invasive techniques. I am enamored of any valve repair. During the past few years, my focus has been aortic valve repair. Pioneered by Dr. Hans-Joachim Schafers, this repair has gained momentum with the introduction by Dr. Scott Rankin, of an internal remodeling ring that allows technique standardization and wider application to various pathologies. It is among our newest vistas of progress toward abolishing limitations placed on people with valve disease, typically receiving prosthetic valves.
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?
MG: The “surgical team” comprises every person involved with a patient’s global experience. It is crucial to recognize the contribution of everyone from office to OR staff. Inherent in the focus required to learn and perform cardiac surgery is the tendency to emphasize those few hours in the operating room as the preponderance of value in the patient journey. It is in fact a necessity that the operation be ideal for the patient and crafted to their specific needs, but equally important are the process of readying the person to be a surgical patient and attention to detail to make recovery a positive and brief passage to a full life. Orchestration of a team sensibility that creates purpose for the group of care givers participating in the entire chain of events is the responsibility of the surgeon. At Franciscan, we hold monthly meetings with representatives from every branch of care for the cardiac patient, including anesthesia, ICU, step-down nursing, operating room, respiratory therapy, physical therapy, endocrine, social work, and pharmacy. During our time together, we review data and progress on multiple initiatives, all directed toward wholistic patient care, efficiency, and improved outcomes. Everyone has the opportunity to contribute and everyone is recognized for their care and effort. Excellent patient care and high staff morale are inextricably linked, and they are dependent on providing direction, support, and kindness from those of us fortunate enough to lead.
CTSNet: How does your clinical research complement or influence your approach to patient care?
MG: Data and research drive our patient care. Everything we innovate in our program is evaluated short and long term for patient benefit, with short loop feedback and trends in the literature keeping us nimble and fueling our direction forward. For the thirteen years I have been at Franciscan, we have followed every patient undergoing surgical ablation for atrial fibrillation perpetually. Patients are told before surgery about the plan, and it stands as a bond between us that we will attend to their arrhythmia. They will contribute to our understanding of the disorder and its effective treatment. We also maintain databases for minimally invasive valve surgery and aortic valve repair. Following a pilot randomization, we expanded the implementation of prophylactic closure of the left atrial appendage. We then gathered data with extended follow up for internal verification of outcomes and now have ongoing aggregation for publication. After participating in a randomized control trial revealing considerable improvement in recovery when sternotomy patients received rigid plate fixation, we extended the technique to every patient, engaged all of our staff, and created a rapid mobilization process that is revolutionary. Although we are not an academic center, Franciscan cardiac surgery is always participating in multiple multi-institutional studies, and typically we are among the highest enrollers. We owe our current patients the opportunity to participate in the evolution of heart surgery, and our future patients the possibility of an ever-brighter future.
CTSNet: Thank you, Dr. Gerdisch.