Professor Ali Dodge-Khatami is a leading surgeon in pediatric and congenital heart surgery, known for his work in minimally invasive techniques. As the Director at Uniklinikum Aachen, he has helped improve heart surgeries for children, making them safer and more effective. With over 25 years of experience, he is passionate about training young surgeons and working with medical teams to provide the best care.
Beyond the hospital, he travels to countries in need, performing life-saving surgeries for children. His dedication to innovation and helping others has made him a respected name in heart surgery around the world.
Let’s delve into the interview details below!
Professor Dodge-Khatami, could you share with us your journey into the field of pediatric and congenital heart surgery and what inspired you to pursue this specialization?
Landing into the highly specialized field of pediatric and congenital heart surgery happened really by a stroke of luck and the fortunate (for me) alignment of some unlikely stars. I was at the end of my residency training as a cardiac surgeon in Lausanne, Switzerland, and had the opportunity to finish up with a 2-year fellowship at RUSH in Chicago with the ultimate goal of going back home and doing the standard bread and butter acquired adult heart disease cardiac surgery.
As a visiting fellow from Switzerland, I was squeezed into the extant roster as the “add-on foreign guy” and was included in the mandatory 6-month rotation in pediatric and congenital heart surgery at Children’s Memorial Hospital, affiliated to Northwestern University. In 1998, this was a special place with a huge buzz about it, where my serendipitous timing of being there couldn’t have been better, and ended up becoming a life-changing experience: congenital heart surgery was led by Dr. Constantine Mavroudis together with Dr. Carl L. Backer, at the time the 2 hottest upcoming senior surgeons in the USA, authors of the go-to textbook for pediatric heart surgeons internationally, consistently presenting at national and international meetings, and being involved in the establishment of the new nomenclature for congenital heart defects, soon to be used by all. Both have ended up as Presidents of the prestigious Congenital Heart Surgeons Association.
Put that together with some of the field’s leading pediatric cardiologists, and an array of co-fellows in the intensive care unit who would ALL go into leading positions throughout the country amongst the nascent Pediatric Cardiac Intensive Care Society, there was a vibrant atmosphere of learning, collaborating, sometimes competing, and being part of something bigger that felt very special. It functioned like an extended family of role models and pursuers of excellence, many of whom have become friends since, with the 2 lead surgeons who became mentors and guides during my career. I can’t imagine how I would have chosen anything else than this whole new world of treating babies, children, adolescents and adults with congenital heart disease, which has become a true calling for me. It’s a real example of being at the right place at the right time: one thing led to another to solidify the choice I made, and one I’ve never regretted.
Pediatric and Congenital Heart Surgery is personally for me the highest art form in surgery, combining scientific knowledge and innovation, technical precision, grace, adaptability, stamina, improvisation, and 3-D mental vision: who wouldn’t want to try to be the best at it? Plus, it’s a never-ending process that will never bore you—you can always get better.
As the Director of Minimal Invasive Pediatric & Congenital Heart Surgery at Uniklinikum Aachen, what are the key advancements in minimally invasive techniques that have significantly impacted patient outcomes?
The minimal invasive approach to treating heart defects in children is not necessarily new, although it still feels like such to many. In fact, it has been around for more than 20 years, and therefore it is astounding that so many colleagues have not yet started and still have trepidations or wonder how difficult it may seem—actually, it’s not and can be learned quite easily.
Part of the explanation comes from the fact that our standard surgical training curriculum, which may be anywhere from 2-7 years, one that is taught very similarly all over the planet to aspiring adult and congenital cardiac surgeons, does not include any of the minimal invasive approaches. As such, if we’re not exposed to it through a formal teaching process, how can we expect to learn, perform, and perfect techniques? While some standardization and inclusion in the adult training programs has started, none is yet forthcoming in the pediatric domain.
The minimal invasive movement in treating children has only slowly advanced through isolated single-surgeon/center publications of techniques in journals, and slow sharing of knowledge through random site visits to colleagues and hospitals when asked to do so.
Progressively, by sharing of knowledge through a broader network, through multi-institutional gathering of data and publication of results, online communication of precise and didactical surgical videos, open access conferences, wet and dry laboratory simulation teaching workshops, the minimal invasive approach is gaining traction and reaching a much wider audience of surgeons potentially wanting to train and specialize in it.
Since this more coordinated movement, the key advancements have been broadening the spectrum of defects which may be treated, thereby offering the approach to a growing pediatric population, and streamlining techniques and protocols, which have made the approach a safe and reproducible routine in many hands.
With over two decades of experience in cardiac surgery, how do you envision the future of minimally invasive procedures in pediatric cardiac care?
As mentioned before, although the minimal invasive approach has been around for at least 2 decades, it’s only at the beginning of where it can go. There is so much to be gained from sharing individual surgeon and center expert experience, that we all unconsciously push each other to go further, and get better at this, which is happening as we speak: standardizing the approach and mindset, together with hopefully some technological refinements in equipment developed by the industry (surgical instruments, smaller cannulae for perfusion needed for the heart-and-lung bypass machine, amongst others), will inevitably lead to better outcomes for the children, more confidence gained by the surgical teams, and ultimately a wider acceptance for it to become mainstream.
It has only been recently that increased awareness, through online and published media, is reaching parents, patients, referring pediatric cardiologists and pediatricians, for the minimal invasive approach to be not just “on the horizon” and potentially available at certain centers in certain specialized hands, but actually demanded or expected by those seeking care, and this is one of the bigger steps forward.
Can you tell us about some of the most challenging cases you’ve encountered in your career, and how your team approached those complex surgeries?
There have been many, and there will always come new numerous challenging cases—they’re not the exception, but rather the rule (actually every so many days to weeks, quite often). While the vast majority go well, through a combination of your own luck, expertise and strength of your team, you never really remember them. Wisdom correctly says, “you learn nothing from success.” Therefore, not surprisingly, you really remember the ones that didn’t go so well, and you must find a way to learn, pick yourself up, and stand tall, from your failures or shortcomings. I could go on and on with anecdotal challenging great cases filling entire chapters, which wouldn’t really interest the readers, but probably more to the point is what I’ve learned, together with my team, from going through the tough experiences.
Taking care of challenging patients is a team sport, and everyone plays an important part. When things are rough, you have to stick together. Removing blame from the picture, completely and across the spectrum, is a first important step in establishing mutual respect and confidence amongst your team. Like you, they are trying to do their best for the patients, baby, child or adult, every single time, be it for a “simple” or complex procedure. The mirror image of this concept, by extension, is being painfully honest, and acknowledging responsibility for any mishap. I think striving for excellence is a daily goal for many, and realistically achieved by a sum of the great training one was lucky enough to have, being meticulously prepared, trying one’s utmost best every single time, and by learning from mistakes.
At Uniklinikum Aachen, how do you foster collaboration between various medical departments to ensure the best care for pediatric cardiac patients?
Much of this is covered by what I just mentioned for the former question. Team-building across multiple medical specialities involves meticulous organization without being overpowering or micromanaging into the domain and/or expertise of your colleagues. Give praise for performance and good attitude, prepare for all eventualities through anticipation and thorough communication, remove blame for mishaps, provide constructive feedback to enhance confidence, and go on some extracurricular people-bonding activities with your team once in a while; it goes a long way. It all sounds pretty cliché and easy, but implementing it on a regular basis actually defines excellence, which many teams including my own are still striving for. The culmination of these factors, in a sustained fashion over time, is what make great teams achieve great outcomes for their little heart patients.
You’ve been instrumental in shaping the landscape of congenital heart surgery—what is the most rewarding aspect of working with pediatric patients who require these life-saving procedures?
I’ve been privileged to be a part of the congenital heart surgery world for the last 25 years, through various countries I’ve worked in with their different medical systems, be it in advanced university teaching hospitals or during many humanitarian missions in emerging programs at various stages of their development—it has been and continues to be an awe-inspiring journey. No matter where I’ve been or what I’ve seen or participated in, there is a common thread, which is a humbling motivation to continue:
Parents trust us with the lives of their babies and children, most often with great chances for survival and improved quality of life, but also sometimes against difficult odds and uncertain outcomes. Always, there is hope and love. It is something I feel very strongly about and want to honour.
What advice would you offer to young surgeons aspiring to enter the field of pediatric and congenital heart surgery, particularly those interested in mastering minimal invasive techniques?
Maybe two seemingly opposite mindsets, although I would wager that they are complimentary:
Think outside the box, and keep a broad mind, by soaking up and incorporating as much as you can from the various surgeons and their teams who surround you. They may do things very differently, but all have the same goal, namely, to achieve excellent outcomes—there are indeed many different roads leading to Rome. I always say I’m a mix of 14 surgeons, including myself and the 13 others I’ve worked with, which is a rich recipe of dos and don’ts resulting in a unique combined flavour of surgery.
A quote from the late great Mr. Marc de Leval, one of the true masters in our field who led the team in Great Ormond Street Hospital for Sick Children in London, UK: “Attention to detail!”
Dig deep, never lose your focus on the end goal, never give up, but enjoy the journey, as you’ll only live through it once.
Looking ahead, what do you believe will be the next groundbreaking developments in pediatric and congenital heart surgery, and how can the next generation of surgeons prepare for these innovations?
There are still quite a few unanswered questions and lesions/physiology for which we don’t have good answers, with tremendous room for improvement. What to do with unrepairable valves which we do not want to replace in growing children, as all extant valve replacement options do not grow, i.e., when will tissue-engineered growing valves finally come into daily practice? What are the better solutions for end-stage heart failure which are currently managed by various mechanical assist-devices as a bridge to recovery, bridge to decision, bridge to transplant, or direct cardiac transplantation, i.e., will long-lasting myocardial cells/tissue finally incorporate the heart and last? We need better solutions to the Fontan-Kreutzer paradigm for single ventricle lesions, or really thinking out-of-the-box pathways not to land with this complex physiology to begin with. I’m not sure there is any way to “prepare for innovation.” Rather, I can only encourage the next generation to “Be the innovator” and make it happen.
You are involved in humanitarian efforts as part of The Global Cardiac Alliance. Can you tell us more about some of the challenges and successes you have encountered in these surgical missions abroad?
Global Cardiac Alliance was initiated by Dr. William Novick in 1993, under a different name at the time, but which continues under this current name since 2014. For the last 32 years, its mission has been to eradicate congenital heart disease in developing countries on all continents across the world, by establishing/performing cardiac surgery, diagnostics and post-operative care, while training and teaching local teams to eventually provide for their own children with congenital heart disease.
It is a humanitarian non-profit organization which has performed cardiac surgeries on more than 23,000 children since its inception and continues to organize multiple fully equipped cardiac surgical missions per year in host countries. I’ve been volunteering and performing surgeries with them since 2008, in a variety of countries such as Ukraine, Northern Macedonia, Georgia, Honduras, Lebanon, Libya, DR Congo, Kenya, Russia, and Vietnam.
There is still a lot of room on many continents to introduce, establish and improve on providing life-saving surgery and healthcare for children with congenital heart defects. Be it in countries during peacetime or in conflict zones, finding local teams who are willing and capable of learning and becoming independent to provide care for their own local pediatric population, while finding political stability and sound funding in a sustainable fashion remains a great challenge due to numerous potential obstacles.
These challenges can be overcome, and there is huge hope. On the bright side, saving the life/improving the health status of EACH CHILD, one at a time, is a SUCCESS, for each family and perhaps extended to its community.
