Inspired by a legendary surgeon, Cleveland Clinic heart chief advances 'maturing' technologies

Lars Svensson, MD, PhD, was on vacation in 1967 when he and his father heard about the first person-to-person heart transplant, performed by South African surgeon Christiaan Barnard. 

"I was intrigued and always kept that in the back of my mind," he told Becker's. He went to college for engineering but switched to medical school in his senior year. For his surgical training, Dr. Svensson applied to train with Dr. Barnard but when Dr. Barnard stopped operating he decided to get further training in the USA.

Now, Dr. Svensson is chief of the Heart, Vascular & Thoracic Institute at Cleveland Clinic. Here, he notes some of his proudest achievements, what he has his eye on and his best leadership advice:

The procedure he is most excited about: "We've had a very exciting time in cardiac surgery and cardiology with percutaneous catheter-based treatments for valve surgery. We were very involved in TAVR and were one of the three first sites in the United States involved in the first FDA trial. I was involved in animal research in the early phases. The technology has really taken off and is maturing. I think what we are seeing now is more innovation and procedure tweaks, and that's part of our strategy, to continue to innovate for less invasive procedures."

Up-and-coming treatment he has his eye on: "One of the things I think will influence cardiovascular medicine is the new CRISPR changes to DNA, or insertion of cassettes into the DNA. These correct a mutation that patients have. One that's gotten a lot of coverage is spherocytosis of red blood cells. We've just started a project where patients who have inherited cardiomyopathy get an injection of a gene to correct a mutation. We're also now seeing potential CRISPR gene editing gene corrections, for example, for people who have inherited hypercholesterolemia. That to me is very exciting."

His greatest concern: "Increasingly, various government types of payers are paying for healthcare in the United States, and the money from these insurance entities are not rising at the same rate as inflation. At the Cleveland Clinic, we're getting more and more patients with complex disease not only for cardiac surgery, but for vascular surgery and cardiology interventions, like structural heart and invasive procedures. It's incumbent [on] hospitals [to] become more efficient in managing these patients who often have quite advanced comorbid disease."

Some of Cleveland Clinic's achievements: "Despite the increasing complexity of disease, we continue to improve the quality of health treatment outcomes. For example, over the last 10 years, overall risk of death for heart surgery has gone down from about 5% to about 1.4% risk of death for all types of surgery — and that includes all emergencies, patients with endocarditis, patients with ruptured or dissected aortas, lung transplants, heart transplants, routine operations, like aortic valve replacements and mitral valve repairs. We've done over 4,600 mitral valve repairs since 2014 without a death; it's much safer to have a heart operation often than having a gallbladder. And this last year for coronary artery bypass surgery at Main Campus, the results were also excellent with a 0.2% mortality rate; in other words, 99.8% survived."

Best leadership advice: "Engage everybody in decision-making, build relationships and address the culture of a team. I think the team is so much more powerful than one individual person who dominates the conversation."

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