Cardiothoracic Anesthesiology Division

Cardiothoracic Division

Left to Right (back): Drs. Eleanor Vega, Mandisa Jones, Madhav Swaminathan, Yasmin Maisonave, Rebecca Klinger, Kamrouz Ghadimi, Ian Welsby, Michael Manning, Anne Cherry, Mark Newman (Alumni), Mihai Podgoreanu (Chief), Joseph Mathew, Quintin Quinones, F. Willem Lombard (Alumni).
Left to Right (front): Claire Dakik, J. Mauricio Del Rio, Mark Stafford Smith, Solomon Aronson, Annemarie Thompson, Alina Nicoara.
Not Pictured: Drs. Brandi Bottiger, Jorn Karhausen, Miklos Kertai, Jerrold Levy

As it turns out, members of the Division of Cardiothoracic Anesthesiology at Duke are skilled not only in the areas of clinical care, research, and education—they’re pretty good at marketing, too. The division’s tagline, “What we do changes our world,” epitomizes the team’s mission. As implied by their succinct tagline, these physicians are making breakthroughs to improve care for patients with cardiac and vascular disease at Duke and around the world.

The Cardiac Division (later renamed the Cardiothoracic Division) at Duke was formed in 1984. Joseph “Jerry” Reves, MD, served as the first division chief. A keen proponent of investing in others, Dr. Reves quickly developed a series of faculty training days that he referred to as “career development days.” Dr. Reves’ philosophy continues to be cherished by the division today. “You can invest in the infrastructure all you want, but if you do not invest in the people, you will end up with nothing,” emphasizes Chairman, Joseph Mathew, MD, MHSc, Jerry Reves, MD, Professor of Anesthesiology. “People make the difference. Develop their careers and help them grow, then step back, and let them tell you what they think needs to be done,” he says.

This philosophy has produced a spectacular lineage of leadership. In addition to creating the cardiac division and serving as the division’s first chief, Dr. Reves was the founding leader of the Duke Heart Center. Among many other accomplishments, he is credited with fostering the unique environment that still exists in the division today where talented faculty can establish and grow their academic careers. He went on to become department chair. After leaving Duke , he was appointed vice president for medical affairs and dean of the College of Medicine for the Medical University of South Carolina.

Fiona Clements, MD, who became chief in 1991, is widely recognized as a pioneer of transesophageal echocardiography (TEE) during cardiac surgery. Dr. Clements and her husband (and fellow division member) Norbert de Bruijn, MD, authored the first Society of Cardiovascular Anesthesiologists monograph for intraoperative TEE in the ’80s and established the division as a leader in the perioperative application of TEE.

Mark Newman, MD, the Merel H. Harmel Professor of Anesthesiology and professor of medicine, who followed Dr. Clements as chief, had an early passion for neurological outcomes research that developed into a lifelong mission to improve perioperative patient outcomes. He is now considered a pioneer in the field of perioperative neurologic research, having largely defined the now widely accepted demographic, procedural, and genetic risk factors for cognitive dysfunction after surgery. Most importantly, he has been the prime force behind several (including the first) interventional trials attempting to reduce the incidence of this devastating outcome. Dr. Newman, along with Dr. Reves, was instrumental in defining the detrimental effect of rapid rewarming and high temperatures during surgery upon cognitive outcomes. These findings have fundamentally altered how patients undergoing cardiopulmonary bypass are managed throughout the world. Like Dr. Reves, Dr. Newman was later appointed department chair.

Following in the tradition of Drs. Reves and Newman, Dr. Mathew served as division chief until 2013, and is a recognized leader in the field of Postoperative Cognitive Decline (POCD) and in TEE. He is the co-editor of a leading TEE textbook and is engaged in genetic, metabolomic, and advanced neuroimaging studies designed to further elucidate mechanisms of POCD. During his service as a division chief, Dr. Mathew acquired a passion to develop leaders around him, recognizing that “it is not the position that makes the leader but the leader who makes the position.”

Today, Dr. Mihai Podgoreanu is leading the charge as division chief. A native of Romania, Dr. Podgoreanu came to Duke in 2000 to pursue a three-year fellowship continuum in Cardiothoracic Anesthesia, Critical Care Medicine, and molecular genetics. After joining the faculty in 2003, he raised through the ranks to an Associate Professor with Tenure in the Division of Cardiothoracic Anesthesia and Critical Care, leader of the Duke Perioperative Genomics and Safety Outcome Study (PEGASUS) investigative team, and principal investigator of the Systems Modeling of Perioperative Cardiovascular Injury and Adaptation Laboratory.

Consistent with his background as a physician-scientist, Dr. Podgoreanu’s vision for the future promotes a constant interplay between scholarly educational activities, research, and clinical practice, with the specific goals of identifying clinically relevant questions that can be addressed through a programmatic approach to perioperative biology or explored by scholarly work to ultimately benefit patient care and enrich the educational experience of the next generations of cardiothoracic anesthesiologists and intensivists.

Over the years, the cardiothoracic faculty members have been innovators of clinical care, education, and research. Although every divisional faculty member has made important contributions, only a few can be listed here:

  • Joannes H. Karis, MD, served as the director of one of the world’s first surgical intensive care units, and was recruited to Duke in 1975. At Duke, he was involved in basic science research to understand the physiologic
    mechanisms of neuromuscular blockade agents and in the development of the Duke Automated Monitoring Equipment (DAME).
  • Dr. Norbert de Bruijn excelled not only in perioperative TEE, but also in operating room management.
  • Debra A. Schwinn, MD, James B. Duke Professor of Anesthesiology, now chair at the University of Washington in Seattle, spearheaded the study
    of mechanisms underlying regulation of adrenergic receptors in health and disease.
  • Hilary Grocott, MD, FRCPC, who completed a fellowship at Duke and is currently at the University of Manitoba, developed the first rat model of cardiopulmonary bypass (CPB) and made significant contributions to temperature management during CPB.
  • After refining Dr. Grocott’s original rodent model, G. Burkhard Mackensen, MD, PhD, extensively evaluated cerebral, hematologic, renal, and pulmonary responses to perioperative ischemia-reperfusion injury and inflammatory stress. He is now the Cardiothoracic Anesthesiology division chief at the University of Washington.
  • Current division chief Mihai Podgoreanu, MD, is an internationally recognized expert in perioperative genomics and led the discovery of several genetic variants associated with perioperative adverse events using a systems biology paradigm. He is now directing the multidisciplinary Duke Perioperative Genomics Program.
  • Current faculty member Ian J. Welsby, BSc, MBBS, FRCA, is widely considered an expert in perioperative coagulation disorders.
  • Mark Stafford Smith, MD, CM, FRCPC, is not only the world’s foremost expert in perioperative renal injury, but has also excelled in leading the Duke Cardiothoracic Anesthesiology Fellowship. Under his guidance, the fellowship program has garnered universal acclaim and is widely regarded as the best in the world. Since the first Duke cardiac anesthesia fellow graduated in 1985, more than 150 fellows have trained here.
  • Current faculty member Madhav Swaminathan, MBBS, is also an expert in perioperative renal injury, and is known worldwide for his expertise in TEE education and identifying echocardiographic predictors of adverse outcome. Under his directorship, Duke Anesthesiology was one of the first to use a TEE simulator to enhance the fellowship training experience, expanding TEE training to non-cardiac anesthesiologists.
  • Katherine “Kathy” Grichnik , MD, MS, is the associate dean for continuing medical education (CME) for the Duke Health System. She supervises a staff and faculty of 22 and is supported by more than $11 million in educational grants to certify more than 600 local, regional, and national educational programs. She is also the director of the Center for Educational Excellence at the Duke Clinical Research Institute, which manages educational programs outside of the CME realm, including clinical trials education, regional systems of care efforts, and patient safety education.
  • Solomon “Sol” Aronson, MD, MBA, is an expert in perioperative hypertension and TEE. He is currently the president of the Society of Cardiovascular Anesthesiologists and also serves as department executive vice-chair.
  • Steven “Steve” Hill, MD, is an authority on blood conservation strategies. He is chair of the Transfusion Committee and has served as co-director of the Duke Center for Blood Conservation.

Although the Cardiothoracic Division is made up of a number of nationally and internationally recognized leaders in the field, faculty members are humble, rarely taking individual credit for accomplishments and continuously emphasizing the importance of junior faculty. Teamwork is at the heart of this division’s philosophy, and teamwork is what will ensure its future success. Together, these faculty members are defining the future of clinical care. Together, they are changing our world.

Chris KeithCardiothoracic Anesthesiology Division