Following in the footsteps of some of the pioneers of cardiovascular surgery, Gustavo Oderich, MD, recently stepped into position as the Michael E. DeBakey distinguished chair in surgery, professor of surgery, chief of vascular and endovascular surgery and director for the Center for Aortic Surgery at Baylor College of Medicine and Texas Heart Institute in Houston. Steeped in history, the Baylor and Texas Heart Institute names add to an already illustrious career for Oderich that has crossed countries and climates.
From medical school in Brazil through the Mayo Clinic in Rochester, Minnesota, to his most recent post at the University of Texas (UT) Houston, Oderich has followed in the pioneering footsteps of some of vascular surgery’s most noted forefathers. Now he has landed at the place where two of its finest, Michael E. DeBakey, MD, the name behind his distinguished chairmanship, and Denton Cooley, MD, minted Houston’s status as a cardiovascular powerhouse.
In this interview, Oderich tells Vascular Specialist what the Baylor College of Medicine and Texas Heart Institute legacy means to him and the mark he hopes to make through his clinical and research endeavors.
Baylor represents the holy grail of U.S., if not world, cardiovascular surgery through its association with the likes of pioneers like DeBakey and Cooley. What does their legacy mean to you?
GO: It’s a privilege and honor to work at the Baylor College of Medicine and Texas Heart Institute. I’m very much attached to the legacy of these giants and what has been accomplished here during the last century. In terms of cardiovascular surgery, Baylor College of Medicine and Texas Heart Institute have consistently been a powerhouse, and a lot of the things we do nowadays started here in the late 1950s with the work of Drs. DeBakey and Cooley and, subsequently, Drs. Stanley Crawford and Joseph Coselli, among so many prominent surgeons. I am so grateful for the work of Dr. Joseph Mills, our immediate past chief of vascular surgery at Baylor, who successfully established the division at the institution. The aorta is where I spend most of my time clinically and is also the focus of my research, so working in the place where the first of these operations were performed, where modern aortic surgery was really invented, is an incredible honor. It is an honor beyond anything I could have imagined holding the title of inaugural Michael E. DeBakey distinguished chair in surgery. Dr. DeBakey was arguably one of the most accomplished and influential surgeons the world has ever seen.
What do you hope to bring to the Michael E. DeBakey Department of Surgery at Baylor?
GO: The department has 280 full-time faculty and 18 divisions or sections and, under the leadership of Dr. Todd Rosengart, has seen the number of clinical cases, research grants, scientists, and high-impact publications skyrocket over the last decade. Dr. Rosengart was able to show me a clear vision of what we could accomplish at Baylor College of Medicine and Texas Heart Institute, which I was most excited to learn in the interview process.
Baylor College of Medicine has played a leading role in contemporary complex open surgical aortic repair, largely due to the massive experience of Dr. Coselli and remarkable improvements in clinical outcomes. Yet, the endovascular aortic program had not yet been fully developed into a premier, advanced endovascular program capable of handling most complex cases and leading future developments in this field. That’s the know-how that I can bring to the department, in addition to continue to advance the work of Dr. Mills. The way I see it, Drs. DeBakey, Cooley, Crawford and Coselli climbed a huge mountain, they wrote many chapters and formed the foundations for what we do today; I’m here to continue this climb, write new chapters, as well as preserve, maintain and be loyal to the work that they
have done.
We have seen you go from the Mayo Clinic to UT Houston and now Baylor. Could you speak a bit about these career moves?
GO: I’m originally from Brazil and finished my medical school there in 1995. However, after completing two years of surgery in the country, it became clear to me that I wanted to advance my career and become involved in academic surgery and complex endovascular techniques. I realized this would be very difficult to accomplish in Brazil at that time.
I was very fortunate to be accepted for general surgery and vascular training at the Mayo Clinic in the late 1990s and to join the faculty in 2006. Becoming a Mayo surgeon was the highest accolade of my career. Only a few are cut out to meet the true Mayo surgeon definition. At Mayo, I was trained to be a “navy seal” of open surgical vascular surgery. Later, working with Drs. Roy Greenberg, Dan Clair and colleagues at the Cleveland Clinic, I perfected endovascular skills and broadened my horizons to complex endovascular work. At Mayo, I witnessed a place that went from offering traditional, classic open surgery, to a hub of advanced endovascular surgery. To give you an idea of the scale of the shift, when I started at Mayo, we were in one or two device trials; when I left, we were in 26. For most of those, we were the number one enroller.
Mayo is the best hospital in the world; it has mastered clinical practice and is very patient-focused. But I am a native of Brazil and, culturally, it was very difficult to live in the Midwest. And the weather… if you imagine cold, you don’t know what cold is. We had a polar vortex more than once, and it’s a very long winter. There are two seasons in Rochester: July and winter.
UT offered a great opportunity, but there was not a complex endovascular program and so I had several concerns. One of them was whether I could reproduce our outcomes from Mayo at UT, but I soon learned that we could. And I learned that it’s not only about the surgeon, it’s about the team and the infrastructure. We created all that at UT and, in fact, recently published our outcomes, with a 1% mortality for thoracoabdominal aortic aneurysms [TAAAs], both at Mayo and UT, among more than 600 patients. I now have to reproduce that here at Baylor, but I’m confident we can do it.
Homing in on your current work, you are at the forefront of endovascular aneurysm repair (EVAR) advancements and pushing the envelope with complex devices through the U.S. Aortic Research Consortium (ARC). What is some of the key evidence that has been coming out of this project?
GO: I was part of the American Heart Association (AHA) writing committee for management of aortic diseases that was published in 2022. When we started discussions for how to treat TAAAs, complex endovascular repair was not even on the radar of several members of the writing committee. There were several reasons for this, mostly due to the fact that the body of literature was all single-center experiences, with short follow-up, plagued by reinterventions and by limited access to devices. In fact, there was no commercially approved device for TAAAs in the U.S. at the time. All that changed with ARC. Offering probably the highest level of evidence for complex aortic work, this is a prospective, monitored and adjudicated registry of 10 ongoing prospective non-randomized physician-sponsored investigational device exemption [IDE] studies that annually report outcomes to the Food and Drug Administration [FDA]. The 10 physicians involved are at the top of their game and have well overcome the learning curve. I think it shows the world what can be done when you have an experienced team, centralization, skill, access to technology and volume, and the work is remarkable.
Some of our most important work to date was published last year in Circulation. This was a series of over 1,100 elective TAAA repairs, with a mortality of 2.7%. That is a three-fold reduction in early mortality compared to the best open surgical series of a single center, and about a five-fold reduction on large data from Medicare.
What’s next on the horizon for U.S. ARC?
GO: There is a lot of room for improvement. There are still many patients who die from other, non-aortic diseases and reintervention rates remain an issue. That’s where I think new research has to focus.
Looking to the future, ARC 2.0 is going to be when we have all the digital and clinical data immediately available at our fingertips so that we can use artificial intelligence [AI] algorithms to look at phenotypes of patients to plan appropriate procedures and assess likely outcomes.
There will be several challenges when we reach this stage, including HIPAA [Health Insurance Portability and Accountability Act]. This currently prevents us from having access to many aspects of personalized data points, such as dates for example, which are needed for time-dependent outcomes. Also, we don’t have easy access to imaging or other personalized data, and, given we’re moving towards personalized medicine, that’s going to be a big challenge.
Can you talk a little more about some of the work that’s being done on the journey toward precision care?
GO: AI will be used in the entire patient experience, from preoperative diagnosis to treatment planning, operation, postoperative care and surveillance. We could talk about several examples. Randy Moore’s work with the ViTAA technology is certainly landmark, but it does involve access to very detailed imaging data from patients, which is something we have to work on—how we make data-sharing and image-sharing agreements between centers more streamlined. I’m working now with the International Multicenter Aortic Research Group [IMARG], which has 30 sites worldwide and is going to be the United Nations version of the U.S. ARC for the entire world, but it’s a mountain of work to make all the countries and regulatory agencies happy.
I’m also very enthusiastic about the work of Drs. David Murdock and Dianna Milewicz at UT with facial phenotypes. Basically, this would involve taking a photograph of the patient and knowing with extreme accuracy whether they have Loeys-Dietz or Marfan syndrome, or in fact any genetic disorder. That is going to be very important because these patients show up in the emergency department and you don’t have time to take the DNA and check whether they have a genetic condition. You need to know right away.
There’s lots of work being done with digital twins too to predict how the anatomy is going to relate to an outcome, which is similar to the work of Randy Moore [in Calgary with ViTAA Medical], but a little bit different.
Vascular surgery has been defined by several “revolutions.” What is the next one?
GO: I think that what we foresee in the future is a combination of a lot of work on AI algorithms that will make things more personalized, more accurate, faster, simpler, more efficient, and will allow us to better select patients and have better outcomes. I do think that there is going to be need for centralization because medicine is becoming hyper-specialized. Both the minimally invasive as well as the open surgical parts of it are becoming extremely difficult, and that means a
group of physicians must be able to do those procedures.
Also, we need to move away from using radiation, and I think that, hopefully, we’re going to see more options aside from this initial phase that we already have. We have Fiber Optic RealShape [FORS] technology [Philips], we have the IntraOperative Positioning System [IOPS; Centerline Biomedical], but we need to go to the next level where this is seamless, can be used in a larger portion of the procedure, and is more effective.
