Dr. Ali Dodge-Khatami, MD, PhD, is Professor and Director of Minimally Invasive Pediatric & Congenital Heart Surgery at RWTH Uniklinikum Aachen, Germany. He has been instrumental in advancing minimally invasive congenital heart repairs, which have existed for over two decades but were once limited to a small group of specialized surgeons and not mainstream. Through perseverance, dedication, and a focus on reproducible excellent outcomes, Dr. Ali Dodge-Khatami and fellow pioneers have helped these techniques gain wider acceptance.
At several centers where he introduced minimally invasive surgery, including RWTH Aachen, he witnessed a shift from initial skepticism and reluctance to routine acceptance and demand among colleagues. Increased awareness of the outstanding results has also led parents, patients, and referring cardiologists to actively seek these less invasive procedures. Dr. Dodge-Khatami’s leadership continues to shape the growth of minimally invasive pediatric heart surgery both within Germany and internationally.
Let’s delve into the interview details below!
What innovations or techniques have you pioneered or adopted that you believe are redefining success in congenital heart surgery today?
I’ve been privileged to surgically grow up during an incredible era of development and innovation within the congenital heart surgical community, leading to huge progress in surgical survival of previously fatal conditions and enhanced quality of life after successful repairs. Through refinements in technique and instruments, enhanced knowledge of physiology and anatomy, protocolization of critical care, advances in cardiopulmonary bypass technology, and the ability to share this knowledge, the quality of repairs and survival have risen to very high standards, reproducibly across many centers. I’ve been lucky to adopt and absorb this from many great surgeon pioneers of our time—we have all adopted techniques and knowledge from each other and aim to pass it on. I’m not sure “pioneering” is the right word, as many minimally invasive techniques are adopted from adult cardiac surgery, but I hope that my persistence over 20 years in advocating, refining techniques, troubleshooting, and publishing manuscripts and surgical videos on the minimally invasive experience in congenital heart defect repair in infants and children, is leading to wider acceptance.
In an era of fast-paced medical advancement, how do you integrate cutting-edge technology while preserving patient-centered care in pediatric cardiac surgery?
Optimal patient outcomes ultimately define excellence in medicine and surgery, which remain a patient care-centred issue. Integrating cutting-edge technology into your practice is essential in being up to date, connecting to your peers, and having access to the best/newest available, but is only significantly relevant if it results in better patient care and enhanced surgical outcomes. In other words, technology for the sake of technology isn’t progress unless it translates into tangible improvement in patient outcomes. While keeping eyes and ears open to the new advances in medical technology, you need to always ask yourself: how will it practically relate and truly enhance your performance to better help your patients?
Can you share a pivotal moment or breakthrough in your career that significantly influenced your approach to complex pediatric surgeries?
Mid-career, I spent 7 years in the southern USA, where perinatal medicine was highly advanced, among underserved populations with limited access to prenatal diagnosis or abortion. This led to a higher number of newborns surviving severe congenital heart defects—often with prematurity and co-morbidities—whose families simply wanted care. I hadn’t seen such volume or complexity in Europe: hundreds of newborns with severe, rare combinations of defects surviving high-risk pregnancies and awaiting surgery. This period, across two major hospitals, involved constant work with a multidisciplinary team, triage, ethical soul searching, surgical innovation in challenging anatomy, and complex post-operative care. It made us stronger together through difficult but rewarding times. I emerged a different – and I believe – a better surgeon and person, deeply grateful to my colleagues and patients.
What strategies do you employ to cultivate a high-performing surgical team in such a specialized and emotionally demanding field?
Leading by example is something I believe in and strive for. It seems intuitive that a leader would want his/her team to follow in their footsteps when they show high standards and integrity. The combination of demanding excellence through performance and discipline, together with rewarding the smallest of tasks with praise, is an important balance to strike. Probably the closest known analogy is Formula 1 car racing: yes, there is only one star pilot at the center of attention (equivalent to the pediatric cardiac surgeon), but what is required to actually win the race? What preparation and planning by THE WHOLE TEAM needs to fall into place to get the best start? What needs to happen AT EACH PIT STOP and throughout the competition to ensure the smoothest run? Each bolt needs to be unscrewed and retightened, each wheel needs to be taken off and put back on, petrol, air, cooling, brakes, etc…and EACH PERSON of that team needs to do it in synchrony and harmony, and needs to know, needs to FEEL, how important they are for the success of the race. The same applies to high-performing surgical teams: every surgical scrub nurse, anesthesia technician, perfusionist, intensive care nurse and physician, and resident aid on the ward need to feel how important they indeed are in whichever task they perform, no matter how “apparently small”, for the global well-being of the patient, leading to excellent outcomes.
As a global thought leader, how do you envision international collaboration shaping the future of congenital heart surgery in the next decade?
In congenital heart disease, many malformations are so rare that individual experience may be limited. Advancing diagnosis and treatment requires larger patient numbers, making international collaboration through multi-institutional studies essential. Pooling observations and experiences helps drive understanding and innovation. While scientific networking has made great strides, global integration still has room to grow.
Education and training have been positively transformed by telecommunications, webinars, simulation, and virtual technologies—enabling the sharing of critical information and even surgical experience across time and space. The rapid emergence of AI will further enhance this. Still, I believe nothing replaces in-person contact, face-to-face communication, or hands-on surgical experience. Developing virtual methods to replicate these when live participation isn’t possible is a crucial next-best alternative.
What are some of the most pressing challenges currently facing pediatric cardiac surgery, and how is your team addressing them through research or practice?
In developed nations, advancing technology allows earlier (prenatal) diagnosis and genetic discoveries, enabling prevention, medical treatment, and non-surgical catheter interventions—often avoiding surgery altogether. With rising socio-economic levels, parents now expect not only survival but enhanced quality of life. As a result, fewer babies are born with complex defects, and fewer are referred for surgery. This trend is ongoing, though its ultimate impact on the field remains uncertain.
At the same time, managing congenital cardiac care—from infancy through adulthood—has become highly scrutinized, with very high expectations. As one of the most resource-intensive specialties, it carries major stakes for physicians, hospitals, and healthcare systems. While high expectations drive excellence, they also create pressure on caregivers. Managing this performance pressure is a constant challenge requiring leadership that fosters not just standards, but also morale, confidence, fulfillment, and sustainable professional longevity. It may not be easy—but it demands daily passion, dedication, and giving your utmost, for both patients and colleagues.
Looking ahead, what legacy or long-term impact do you hope to leave on the next generation of heart surgeons and the broader medical community?
As mentioned, it’s uncertain how genetic discoveries, prevention, healthcare regulation, and rising quality-of-life expectations may reduce the number of babies born with complex congenital heart defects. The next generation of surgeons may encounter fewer high-risk cases. Fortunately, the most common “low risk” defects—often curable with one open-heart surgery—will likely remain and continue to require excellent care.
This allows us to shift focus from survival, which is now near 100%, to enhancing quality of care and quality of life. Early repair in infancy offers a unique window: infants heal quickly, won’t remember hospitalization, and can return to normal activities with high growth potential. These principles underpin my advocacy for minimally invasive approaches in infants and young children—low-risk surgeries through small, barely visible incisions, performed early (3–12 months), yielding excellent, possibly lifelong results. This movement, advanced by a core group of surgeons, is gaining momentum and may well become the new norm. If I can contribute significantly to that shift, I’d consider it a meaningful legacy.
