Q&A With Cardiac Surgeon Jai Raman, MD

Jai Raman, MD, of Rush University Medical Center in ChicagoJaishankar Raman, MD, PhD, joined Rush University Medical Center last fall as the new surgical director of heart transplant and chief of the Section of Cardiac Surgery in the Department of Cardiovascular-Thoracic Surgery. Raman — who attended medical school in his native India and received surgi­cal training and his PhD in Australia — came to Rush after nine years at the University of Chicago Medical Center. He spoke recently to Rush writer Kevin McKeough.

Why did you decide to specialize in heart surgery?

When I finished medical school, I thought I wanted to be a plastic surgeon. Early on I got a chance to do a lot of micro­surgery, but I found it to be very boring and very repetitive. Then, while I was exploring jobs in Sydney, Australia, and I observed cardiac surgery — a beating heart that was being operated on. I’d never seen it before, and it was very compelling. It was love at first sight.

Why did you decide to come to Rush?

Rush is providing the opportunity to build a clinical program that could have a lasting legacy. One of the fortunate byproducts of my stay at U of C was that I was able to develop expertise in minimally invasive surgery, the largest amount of expe­rience of anyone in the region. One reason to come here was to try to expand that whole area and to help make Rush a regional center for minimally invasive surgery.

What kinds of procedures does cardiac surgery encompass?

It includes all the surgery on the heart — bypasses, valve replacements, valve repairs and transplants. The heart is a muscular pump with valves in it that has a blood supply. It has big blood vessels coming in and out of it, and it’s got an electrical sys­tem. If there are problems with the vessels that come in and out of it, we fix those. If we have to work on aortic aneurysms, we do that. If the valves are abnormal or leaking, we repair them. If there are abnormalities of the rhythm, we treat them. If there are problems with the rib cage, we do things to get the bone to heal better. If the pump is not working, we use a ventricular assist device, which is like an artificial heart, and failing that, we may perform a transplant.

How does the opening of the Tower support what you’re trying to accomplish?

Minimally invasive surgery is almost like a solo operation, because the room the surgeon has to work in is so limited. In each of the Tower operating rooms, however, we have these big, beautiful monitors. On one, we can show the image from a small video camera that’s mounted to a band around my head. On another, you can have the images from an echocardiograph, and on a third screen you can have the overhead camera. Everyone working in the OR knows what’s going on, and therefore there’s a lot more inclusiveness and participation.

How have you expanded the cardiac surgery program so rapidly?

We’ve lowered the risk profile for minimally invasive procedures, so we’re able to use them to treat lower-risk patients as well as high-risk patients who might not survive open-chest surgery. … We now are also able to treat heart failure with ventricular assist devices and heart transplantation.

You mentioned that you’re treating lower-risk patients with minimally invasive techniques. Tell us more about it.

When cardiac surgery first became a specialty in the 1950s, the traditional approach to most heart surgery was a big incision down the middle of the chest, through the breast bone, which is called stenotomy. That proce­dure was popularized by Dr. Ormand Julian, who at the time was a senior surgeon at Rush.

After the surgery was done, the breast bone was always lashed together with wire. That is still the accepted norm all over the world. One of my contributions is to see how we can use metal plates and screws to fix the bone back together. If you lash the bone together with wire, it still moves a little, so it takes a long time to heal. With plates, the bone doesn’t move and the healing is more effective.

Wires don’t work well with minimally invasive chest surgery, which has prevented surgeons from performing it widely. Now we’re able to use less invasive approaches because of these plating techniques. We started doing minimally invasive surgery in the extremely high-risk patient population, where any other approach would be deemed too dangerous, and then brought down the risk profile significantly.

What are your future goals for the program?

I want to make this a premier center for heart surgery, focusing significantly on two areas: minimally invasive aspects of all heart surgery and innovative therapies for heart failure and transplantation.

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