Top Surgeons Making a Global Impact in Surgery

3. ‘‘ delivering it. The quality of healthcare delivery depends on the quality of the workforce

4. Note Et s ‘ Pearl Shaw Pearl Shaw

5. Masters of Modern Medicine S urgery is more than a procedure. It’s precision, courage, and trust—coming together to save lives. And behind every life changed is a surgeon who chose to go further. In this special edition of Insights Care, we proudly present the ‘Top Surgeons Making a Global Impact in Surgery.’ These are the changemakers, the innovators, and the quiet heroes pushing boundaries in modern medicine. These professionals do more than operate. They lead. They innovate. They stay calm in chaos and make tough calls with compassion. Every move they make carries the power to heal, and the weight of responsibility. Their stories remind us of what’s possible when passion meets purpose. And that healing doesn’t start with a tool—it starts with vision. We hope this edition leaves you informed, inspired, and in awe of what true leadership in surgery looks like. But today’s top surgeons go beyond the operating room. They share knowledge. They develop new techniques. They bring hope to places where resources are limited. They don’t just follow medical progress—they drive it. Happy Reading! Across the world, surgeons are creating impact that crosses borders. They are not just changing patients’ lives—they’re shaping the future of healthcare. Their work is proof that skill, heart, and purpose can truly make a global difference.

6. Contents Table of Cover Story 08 Dr. Lee Errett Pioneering a Future Where Quality Healthcare Knows No Borders

7. PROFILE 22 Professor Ali Dodge-Khatami A Global Leader in Minimally Invasive Congenital Heart Surgery Articles 16 28 How AI and Robotics Are Shaping the Future of Heart Surgery Precision, Innovation, and Care Next-Gen Cardiac Surgery Advancements

8. March 2025 2025

9. TOP SURGEONS MAKING A GLOBAL IMPACT IN SURGERY Featuring Person Organiza?on Brief Amer is an expert in cardiothoracic surgery, dedicated to enhancing pa?ent recovery through innova?ve approaches and comprehensive treatment of heart and lung diseases. Amer Harky Cardiothoracic Surgeon NHS nhsbsa.nhs.uk David is skilled in adult cardiac surgery, commi?ed to precision and excellence in managing intricate heart condi?ons with a focus on long-term pa?ent wellness. David Zapata Adult Cardiac Surgeon University of Maryland umd.edu Dr. Erre?’s nonlinear medical journey, shaped by unpredictable events, reflects a commitment to surgical excellence, global healthcare reform, and sustainable training programs for underserved regions. St. Michael’s Hospital, University of Toronto h?ps://unityhealth.to/loca?ons /st-michaels-hospital/ Dr. Lee Erre? Chief of Cardiac Surgery Omar Specializes in advanced cardiac procedures, focusing on pa?ent-centered care and cu?ng-edge surgical techniques to improve outcomes in complex heart condi?ons. Omar Jarral Lenox Hill Hospital lenoxhill.northwell.edu A?ending Cardiac Surgeon Professor Ali Dodge-Khatami Professor & Director of Minimal Invasive Pediatric & Congenital Heart Surgery A leading surgeon in pediatric and congenital heart surgery, Ali excels in minimally invasive techniques, trains young surgeons, and performs life-saving surgeries globally with over 25 years of experience. Uniklinikum Aachen ukaachen.de

10. Dr. Lee Errett Chief of Cardiac Surgery St. Michael’s Hospital, University of Toronto

11. Lee Errett Pioneering a Future Where Quality Healthcare Knows No Borders It wasn’t just about helping with the cataract surgery. I was thrown into a position I hadn’t anticipated—becoming a nurse, helping prepare patients, and making sure everything went smoothly post-surgery.

12. Top Surgeons Making a Global Impact in Surgery I journey as Chief of Cardiac Surgery at St. Michael’s Hospital, University of Toronto is anything but linear. His dedication to treating patients and healthcare reform activities came after multiple unpredictable life events that shaped his professional path. t’s easy to view a career in medicine as a straight path, one defined by years of schooling, training, and refining technical skills. But for Dr. Lee Errett, his experience for him, one that would forever change his outlook on healthcare disparities. “It wasn’t just about helping with the cataract surgery,” he explains. “I was thrown into a position I hadn’t anticipated—becoming a nurse, helping prepare patients, and making sure everything went smoothly post-surgery. And then, there was this elderly man, in his late 70s, coming in to get his cataract fixed. He was holding the hand of a young boy, who, it turned out, was his seeing-eye dog.” The man had lived in a world of near blindness due to the severity of his cataracts. For years, his vision had been impaired, limiting his ability to see the people and the world around him. Dr. Errett’s journey into global healthcare did not begin at St. Michael’s alone. His foundation in surgery was built at McGill University, refined during his fellowship at Oxford, and further honed in Yale’s prestigious teaching hospitals before he spent two decades at St. Michael’s in Toronto. As a distinguished faculty member of the University of Toronto’s Department of Surgery, his work has consistently pushed the boundaries of surgical excellence and healthcare accessibility worldwide. Beyond his work in Canada, Dr. Errett is also the founder of the Bethune Medical Development Association (BMDAC), an organization with close to 600 members across six countries. This network of healthcare professionals has been instrumental in establishing training centers, providing surgical expertise, and developing sustainable healthcare infrastructure in underserved regions. After the procedure, Dr. Errett assisted the elderly man in removing his eye patch. “When he saw his grandson for the first time after the cataract surgery, he broke down in tears,” he recounts. “He wasn’t crying out of pain or anxiety—he was crying because he could finally see his grandson clearly. A simple surgery, one that would take only 45 minutes in North America, had restored his life, his family’s life, and their future.” This brief yet powerful encounter left a lasting impact on Dr. Errett, shaping his perspective on global healthcare disparities. He understood that cataract treatments, which are normal in developed nations, hold essential value for people who reside in underserved areas. The fact that such a life-changing surgery could take up to eight years to access in Jamaica, versus two weeks in Canada, highlighted just how crucial his global health work was. From his time as the Chief of Cardiac Surgery at St. Michael’s Hospital in Toronto to his work on international surgical missions, Dr. Errett consistently extended his willingness to go beyond professional boundaries. He has spent most of his career establishing training programs that prepare future health leaders to serve diverse populations effectively—thus providing medical staff with specialized tools for long-term success. Through his leadership practices, he developed a philosophy that extends beyond treating individual patients to establishing lasting healthcare infrastructure. When he saw his grandson for the first time after the cataract surgery, he broke down in tears. He wasn’t crying out of pain or anxiety—he was crying because he could finally see his grandson clearly. Let’s read on to explore how Dr. Errett’s leadership and humanitarian spirit are changing lives across borders! The Beginning of a Global Health Mission Dr. Errett discovered his purpose to advocate for global healthcare when he spent time working in areas without adequate medical assistance. During his mission to Jamaica, his skills were tested in unexpected ways. Working as part of a team of cardiologists and surgeons, he was called to help with a cataract surgery mission at an eye clinic that had been experiencing staffing shortages. What was intended to be a simple assist turned into an emotional and eye-opening

15. The Power of Leadership in Healthcare “It’s a reminder of how a relatively simple intervention can have such a profound impact on a person’s life. It stayed with me long after the mission was over,” he says. Dr. Errett’s work extends beyond teaching and surgical interventions; his leadership philosophy is centered on sustainability. A major realization from his international work is that it’s not enough to simply perform surgeries and leave. “We need to build systems that will continue long after we’re gone,” he stresses. His aim is to create self- sustaining healthcare systems that will eventually not require the expertise of foreign doctors, but that will function autonomously to address the needs of their populations. Building a Global Healthcare Network Although Dr. Errett spent 17 years at St. Michael’s Hospital, his global perspective was shaped by experiences that extended far beyond Canada. One of his most significant contributions has been his work in China, where he has traveled 27 times with BMDAC, expanding surgical training programs and healthcare accessibility. Each year, he leads a team of 60 surgeons and physicians, impacting over 150 medical centers annually. His approach has transformed global surgery from short-term interventions to long-term regional commitments, ensuring sustainable healthcare improvements. Beyond China, his work has spanned 34 countries over 30 years, addressing systemic challenges in surgical care while training the next generation of healthcare leaders. His leadership philosophy is centered on ensuring that medical initiatives foster long- term impact rather than temporary relief. Dr. Errett believes that successful global health initiatives require three key elements: securing government approval, fostering collaboration with local medical teams, and earning the trust of patients. Without these, even the most well-intended efforts struggle to create lasting change. His work through BMDAC and the University of Toronto ensures that beyond providing medical care, his teams also train local surgeons, equip hospitals, and develop long-term healthcare infrastructure to enable self-sufficient medical systems. “I want to provide the tools—education, training, infrastructure—so that local doctors can continue this work,” he says. “It’s about creating lasting change.” “We had trainees from 21 different countries, from regions where the healthcare system faced significant challenges,” he says. “These specialists came to learn, but we also learned from them. They returned to their countries with advanced skills and knowledge, helping to elevate the standards of care and create sustainable changes.” A key part of this is the practice of mentorship. Dr. Errett has always believed in cultivating growth not just in individuals but in entire teams. “I’m a firm believer that leadership should not be about individual recognition. It should be about enabling others to succeed,” he says, highlighting the importance of mentorship in building future healthcare leaders. “I don’t want to just be a good surgeon. I want to be someone who creates an environment where others can thrive.” His leadership style emphasizes collaboration and shared responsibility. “When you're working as a team, especially in healthcare, every patient is the responsibility of every member of the team. Knowing that support exists amongst your co-workers makes a huge difference,” he explains. The same approach applied in his global healthcare missions, where he worked closely with colleagues from other countries, always fostering a partnership-based, rather than hierarchical, approach. In many parts of the world, the medical culture is very hierarchical—one boss calls the shots. But in my view, it’s important to approach healthcare as a partnership. “In many parts of the world, the medical culture is very hierarchical—one boss calls the shots,” Dr. Errett explains. “But in my view, it’s important to approach healthcare as a partnership. When we go to other countries, we are not just the ‘experts.’ We are colleagues. There’s so much to learn from one another.” This attitude of humility and respect has been fundamental in his approach to international missions in places like China, Africa, and the Caribbean. It has earned him not just trust, but the continued invitation to return and collaborate on ongoing projects.

16. We can’t just sit on the sidelines and pretend this isn’t happening. Every day, people are dying because they cannot access the care they need. That has to change. of accessibility in developing countries. His passion for addressing this issue is not only evident in his speeches but in his daily commitment to global healthcare reform. “We can’t just sit on the sidelines and pretend this isn’t happening. Every day, people are dying because they cannot access the care they need. That has to change.” His ability to cultivate new leaders is evident in the network of surgeons, healthcare professionals, and academics who have been inspired by his work. Several of his former fellows and colleagues now lead their own international healthcare projects, perpetuating the culture of education and sustainable healthcare practices he helped establish. “When you mentor someone, you don’t just teach them how to perform a surgery. You teach them how to think about medicine, to approach it with empathy and respect, and to pass that knowledge down,” he reflects. His legacy will be measured not just by the number of surgeries he performed, but by the ripple effect he’s created within the medical community. A Vision for Healthcare’s Future Looking forward, Dr. Errett continues to be driven by a singular mission: to ensure that everyone, no matter where they live, has access to high-quality healthcare. His leadership, both in his work at St. Michael’s Hospital and on international missions, is grounded in the belief that healthcare should be a universal right, not a privilege. His work is far from finished, but the legacy he is building—through mentorship, education, and sustainable healthcare models—is one that will inspire future generations of healthcare leaders. The Global Healthcare Crisis The 2015 Lancet Commission on Global Surgery highlighted that 5 billion people lack access to safe, affordable surgical care—a crisis that contributes to more deaths than TB, malaria, HIV, and Ebola combined. Dr. Errett has seen firsthand how these gaps in healthcare access affect millions. “Despite having the resources to treat everyone, we fail to do so,” he explains, emphasizing the urgent need for global healthcare reform that prioritizes surgical access and long-term solutions. All of Dr. Errett’s work is on behalf of the University of Toronto, reinforcing its commitment to advancing global healthcare solutions. “The future of healthcare lies in collaboration and access,” he asserts. “We must look beyond immediate challenges and focus on building a healthcare system that serves everyone, everywhere.” His lifelong mission remains clear: to ensure that high-quality healthcare is accessible to all, regardless of geography or economic status.” His advocacy goes beyond awareness—it is rooted in tangible action. He has been working tirelessly to raise awareness about the importance of surgical care and its lack

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18. How AI Robotics Are Shaping the future of Heart Surgery and I nsights are C March 2025 16

19. C ardiovascular disease is still among the leading causes of death globally and thus among the reasons for medical technology to keep being more efficient in its healing. The latest advances in the heart's treatment are robotics and artificial intelligence (AI). They are transforming heart surgery with greater accuracy, less risk, and quicker recovery. With more advanced AI-based analytics and robot-assisted procedures, the science of cardiovascular medicine is advancing toward a less expensive, more efficient, and safer era for heart surgery. AI in Heart Surgery: Precision and Decision-Making Improvement More and more, artificial intelligence is being used in heart surgery to help the surgeon diagnose disease, plan the procedure, and predict preoperative complications. It can do this with machine learning software by sorting through mountains of information on patients and creating patterns that human experts cannot understand. It is diagnosing heart diseases at an early stage, customizing treatment, and improving surgical methods. One of the most uncomplicated applications of AI in cardiac surgery is imaging. Computers that are programmed with AI can read echocardiograms, CT scans, and MRIs almost as well as a human can, and with high-definition real-time imaging, surgeons can literally see what they're getting themselves into. AI-enhanced equipment helps preoperative planning by allowing surgeons to better visualize the heart anatomy so that there is less chance that they will get into trouble once they are inside. Apart from that, AI can also forecast the result of patients based on the evaluation of different risk factors such as the age of the patient, patient history, and patient genes. Predictive analytics allow doctors to identify the best method of conducting surgery on some patients that optimizes survival and minimizes post-surgery complications. Robotic-Assisted Heart Surgery: Precision Beyond Human Capability Robotically assisted cardiac surgery has been an age of precision, flexibility, and delicacy that is unmatched. Robotic systems like the Da Vinci Surgical System are becoming more common in minimal access cardiac surgery, and the more accurately and delicately the surgeon is able to operate. InsightsCare March 2025 17

20. Challenges and Ethical Considerations Robotic surgery compared to the old method of large incisions open-heart surgery with huge risk of complications is all about tiny incisions with zero blood loss and quick recovery. Robotic technology provides super-magnified, high-definition 3D vision of the area, which enables the surgeons to perform the very delicate maneuvers more accurately. Despite the broad breakthroughs in robotics and artificial intelligence, there are some challenges and ethical issues. Robot-assisted surgical systems are very expensive, and this makes them impossible to implement in the majority of the hospitals, particularly in the developing nations. In addition, AI-based diagnosis and treatment protocols must be thoroughly tested for accuracy and safety. One of the major advantages of robotic surgery is that it has the potential to end surgeon fatigue. With artificial intelligence-driven robotic machines performing intricate movements, surgeons have time freed from decision- making and are less burdened with eye-hand coordination. This upgrade increases overall efficiency and reduces the possibility of human error in high-risk surgeries. There also are certain ethical concerns in relying on AI in taking decisions. Despite the possibility to utilize AI to aid surgeons, ultimate decision-making in patient treatment always has to be left to human doctors. Human wisdom and AI technology have to be balanced so that one is able to rely on such technologies. Remote Surgery: Improving Cardiac Care Accessibility The Future of AI and Robotics in Heart Surgery Artificial intelligence and robotics technology even enable cardiac surgery to be performed remotely, and bring the advantage of quality healthcare to patients miles away in remote and underserved locations. Robotic technology and real-time analysis of data by artificial intelligence enable telesurgery over several thousand miles. The application of robot and AI in cardiac surgery is at the door, but the potential is huge. As robot hardware and AI algorithms become better, more and more developments in cardiology are lined up in the pipeline. The future can be from fully automatic robotic interventions to customized therapy protocols with AI and even more remote control of surgery. For instance, robotic surgery that is 5G-enabled has already made remote heart surgery possible. In 2019, a Chinese surgeon named Chen Gang carried out the world's first remote heart surgery on a patient through robotic technology via a 5G network. This is one of the means through which AI and robotics are bridging healthcare gaps such that even rural regions can have access to quality surgical services. Moreover, ongoing investment and research into these technologies will see them become cheaper, and robotic heart surgery will be available to more of the globe. With ongoing advancements in AI and robotics, not only will they improve precision in surgery but also, they can revolutionize the treatment of cardiovascular disease and, as an aftermath, save thousands of lives. AI and Robotics in Post-Surgical Care and Rehabilitation Lastly, robotics and artificial intelligence are revolutionizing heart surgery with accuracy, reducing risk, and bringing medicine closer to the people. True, there are issues still, but the future of cardiac surgery is certainly being penned employing these cutting-edge technologies. With fresh innovations rolling out step by step, we are stepping into a period where heart surgery is safer, faster, and more effective than ever. Outside the operating theatre, robotics and AI are changing postoperative recovery and care too. Wearable sensors use AI to track the heart of a patient around the clock, note any anomalies, and alert medical professionals in real time. Smart devices prevent complications by acting before time. Another possible application of robotic-assisted rehabilitation is in open-heart patients. Robotic exoskeletons and artificial intelligence physiotherapy software enable patients to regain strength and mobility more rapidly and effectively than traditional rehabilitation. The machines enhance long-term health results and recovery rates. - Natalie May I nsights are C March 2025 18

22. In surgery, the smallest detail can mean the difference between SUCCESS AND FAILURE.

24. Professor Ali Dodge-Khatami A Global Leader in Minimally Invasive Congenital Heart Surgery P 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. rofessor Ali Dodge-Khatami is a leading surgeon in pediatric and congenital heart surgery, known for his work in minimally invasive techniques. As the 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. 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. 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. 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 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. InsightsCare March 2025 22

25. Ali Dodge-Khatami Professor, Director of Minimal Invasive Pediatric & Congenital Heart Surgery Uniklinikum Aachen InsightsCare March 2025 23

26. 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. network, through multi-institutional gathering of data and publication of results, online communication of precise and didactic 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. 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 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. InsightsCare March 2025 24

27. 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. 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. 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: 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 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. InsightsCare March 2025 25

28. 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. 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? 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!” 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. 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? 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 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. 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. InsightsCare March 2025 26

30. Next-Gen Surgery Advancements InsightsCare March 2025 28

31. Precision, Innovation, and Care C ardiac surgery has changed completely over the past few decades with precision medicine, technology, and patient-centered care. Robotics combined with artificial intelligence (AI) and minimally invasive surgical techniques have revolutionized the practices of heart surgeries. The most significant leading causes of death in the world arise from cardiovascular diseases (CVDs) which future technology plays crucial roles through better outcomes along with shorter recovery durations for safer treatment of patients. Minimally Invasive and Robot-Assisted Cardiac Surgery The greatest innovation in modern cardiac surgery consists of robot-assisted procedures and minimally invasive surgery approaches. Modern heart surgery brings faster recuperation through small incisions instead of using open- heart surgical methods that require dangerous large cuts and lengthy hospital periods. The da Vinci Surgical System serves as an example of robotically assisted cardiac surgery devices which enhance complex operations with improved precision and handling capabilities for surgeons. The surgeon uses robotic arms through a console which provides 3D high-definition imaging of the surgical site. The technique finds its ideal use in treating damaged mitral valves, performing coronary artery bypass grafting, and cutting out problem areas of atrial fibrillation. Patients receive three advantages from these interventions which include decreased infection risk and pain, shorter hospital stays, and a faster return to regular activities. Artificial Intelligence and Machine Learning in Cardiac Surgery The field of cardiac surgery makes considerable gains from artificial intelligence and machine learning because these technologies enable surgeons to plan before operations, use real-time data during operations, and manage patients post- surgery. Computer programs use analyzed patient background and test outcomes to create surgical risk models along with specific treatment recommendations. Modern machine learning software analyzes precise echocardiogram and CT scan and MRI scan results to diagnose cardiac conditions before they advance. Subsequent stages of robotic surgery system development utilize artificial intelligence to execute stitching operations while reducing operator mistakes and delivering higher InsightsCare March 2025 29

32. procedural precision. Hospital resource planning receives benefits alongside procedural accuracy improvements from these technologies. Miniaturized biocompatible circuits of CPB are being engineered to reduce blood trauma and preserve organ function. Normothermic perfusion technologies enable physiological conditions, i.e., enhanced post-operative recovery and decreased complications. Such technologies lie at the center of the provision of enhanced patient outcomes in intricate cardiac surgery. 3D Printing and Customized Cardiac Implants 3D printing enables detailed patient-specific planning for cardiac procedures because of its implementation in medicine. Surgeons use imaging data to print heart models of individual patients then utilize these models for practicing complicated surgical procedures before hospital treatments. Through the procedure, surgical teams achieve higher precision while lowering intraoperative complications to a substantial extent. Gene and Stem Cell Therapy in Cardiac Regeneration Regenerative medicine, including gene and stem cell therapy, is of outstanding promise in the cure of once- permanent cardiac disorders. Bone marrow, umbilical cord, or stem cells derived from iPSC are employed to restore damaged heart tissues, improve the function of the heart, and prevent heart failure. The technology enables doctors to create patient-tailored designs for heart valves and stents as well as implants by using individual anatomical data. Customized design enhances device compatibility, which leads to fewer immune reactions and better surgical performance. Through its relatively new and emerging status, authorities within this field now investigate ways to develop human heart tissue and potentially print full individual heart organs which could revolutionize cardiac transplant operations. Gene therapy is also being tested in clinical trials to restore unhealthy heart muscle by inducing new blood vessel formation. The treatments can reduce surgery and confer long-term benefit to patients with advanced cardiovascular disease. Remote Monitoring and Wearable Technologies Transcatheter Heart Procedures and Valve Replacement Utilization of wearable and remote monitoring devices in postcardiac surgery care and early detection of complications has been a game-changer. Smartwatches, implantable sensors, and biosensors can track real-time vital signs like heart rate, oxygen saturation, and ECG trends and warn the patients and physicians in case of any deviation. Doctors prefer transcatheter procedures as minimally invasive medical procedures above open-heart surgery treatment. TAVR, together with TMVR, has revolutionized the treatment of valvular heart disease specifically for patients who cannot undergo standard surgical procedures because of high-risk profiles. Remote monitoring decreases hospital readmission, enables early intervention, and involves patients' individualized cardiac care plans. Telemedicine is also very crucial in post- surgery follow-ups since it enables the patient to sit down with their doctor without necessarily having to visit hospitals occasionally. The implantation of catheter-based prosthetic valves through the femoral artery occurs without performing sternotomy surgery (opening of the chest). TAVR provides patients shorter scarring, reduced hospitalization time, and faster recovery speeds. Medical teams now employ identical innovative methods when treating patients for mitral and tricuspid valve surgery to generate better safety results. - Natalie May Advances in Cardiopulmonary Bypass and Perfusion Technology Traditional heart surgery commonly employs CPB pumps, which are used to temporarily take over the role of the heart and lungs. Advances in perfusion technology are optimizing CPB safety and efficacy and minimizing complications such as inflammation, clotting, and organ failure. I nsights are C March 2025 30

34. opportunity.“ Healing is a matter of time, but it is sometimes also a matter of