STS News, Winter 2021 — Who invented the modified Bentall procedure?
“I asked my fellows that question the other day and no one knew the answer,” said TSF President Joseph E. Bavaria, MD, from Penn Medicine in Philadelphia. “They do now.”
STS Past President and former Historian Nicholas T. Kouchoukos, MD, has had a long, remarkable career in cardiothoracic surgery, and among his greatest achievements was the development of the modified Bentall procedure.
“Everyone who performs aortic root surgery uses a modified Bentall. It has become a gold standard,” said Dr. Bavaria. “This operation has saved a lot of lives and continues to—I’ve done three in the last 48 hours. Dr. Kouchoukos’s contributions are mammoth and have changed the entire landscape of aortic surgery.”
The modified Bentall procedure uses a composite aortic graft to replace the ascending aorta and aortic valve. Coronary artery circulation is maintained by removing full-thickness “buttons,” making it easier to implant the coronary arteries into openings made in the graft. The buttons are then attached to the graft.
According to Dr. Bavaria, the “button” idea came from a different operation—the arterial switch, which also uses coronary artery buttons. “Dr. Kouchoukos was so innovative. He took part of one operation and applied it to a totally different procedure. Everything changed after that.”
Nicholas Kouchoukos, MD, now retired, had a long, remarkable career that included the performance of more than 13,000 heart procedures.
‘See One, Do One, Teach One’ Era
As a medical student, Dr. Kouchoukos worked in the laboratory at Washington University in St. Louis, where renowned surgeons Thomas B. Ferguson, MD, and Charles L. Roper, MD, encouraged him to pursue a career in cardiothoracic surgery.
In the late 1960s, after completing a general surgery residency in St. Louis, Dr. Kouchoukos went on to the University of Alabama in Birmingham, where he completed his training in cardiothoracic surgery under the direction of the legendary John W. Kirklin, MD, a pioneer in the development the heart-lung machine and open heart surgery.
Despite increased risks associated with certain procedures, there were multiple opportunities to develop new techniques and protocols to treat patients with congenital and acquired heart problems and improve outcomes. The groundbreaking surgeons of what proved to be the “golden age” of cardiac surgery—Dr. Kouchoukos included—made revolutionary decisions and important contributions that dramatically advanced the specialty.
“It was the ‘see one, do one, teach one era,ʼ” said TSF Vice President Keith S. Naunheim, MD, from Saint Louis University in Missouri. “Surgeons like Dr. Kouchoukos would have these ideas, these epiphanies, and back then, they immediately could act on those inspirations and forge a new procedure. They were both innovative and fearless. That's how surgery evolved in the earlier era.”
“Dr. Kouchoukos’s contributions are mammoth and have changed the entire landscape of aortic surgery.
A Distinguished Career Recognized
During his career, Dr. Kouchoukos performed more than 13,000 cardiac and major vascular procedures and strongly advocated for training the next generation of cardiothoracic surgeons. He is a co-author of the most recent editions of Cardiac Surgery, a textbook on adult and pediatric cardiothoracic surgery that is widely used in cardiovascular surgical centers around the world.
In recognition of his dedication to the specialty and its future, Dr. Kouchoukos recently was honored with a fellowship award in his name—The Kouchoukos Award.
This fellowship highlights Dr. Kouchoukos’s commitment to refining the practice of cardiothoracic surgery, teaching innovative surgical skills, and advancing the careers of bright and motivated young surgeons, which is essential for the specialty to advance and thrive in the future.
“I am honored and humbled to have this fellowship established in my name, and I am indebted to the Foundation and to Drs. Bavaria and Naunheim who spearheaded this effort,” said Dr. Kouchoukos. “The award will provide surgeons who have an interest in aortic surgery an extraordinary opportunity to visit and learn from recognized experts in the field.”
The Kouchoukos Award will provide cardiothoracic surgeons or residents who are committed to the treatment of thoracic aortic disease with up to $10,000 for travel to another institution with the purpose of observing experienced aortic surgeons and learning new techniques in order to enhance patient care.
Surgeons who want to be “great vessel specialists” should take a close look at this award, advises Dr. Naunheim: “Aortic surgery is changing but not disappearing, and it will require surgical expertise and advanced technical ability to devise safer operations. Through this fellowship, young surgeons can stand on the shoulders of these giants who are nationally and internationally recognized and learn techniques that are essentially refinements of practices that Dr. Kouchoukos started more than 30 years ago.”
Applications for The Kouchoukos Award are expected to open in July 2021. In the meantime, fundraising to build the fellowship fund is under way. For more information on donating to this award, visit thoracicsurgeryfoundation.org.
TSF Hosts First Virtual Run to Coincide with STS 2021
Working out at the gym may not be an option these days, but don’t sweat it!
The Thoracic Surgery Foundation—the Society’s charitable arm—is offering a way to get energized about STS 2021 while also raising money for cardiothoracic surgery research and education.
In this time of social distancing, the TSF Virtual 5K Fun Run & Walk provides an opportunity to stay active, engage with the cardiothoracic surgery community, and take part in some healthy competition.
This virtual race gives runners and walkers the flexibility to participate:
- Any day and time from January 22 to January 31
- At any pace
- In any location—in the house on a treadmill or outside in the neighborhood
The challenge can be completed solo or as part of a team, which can include a group of friends, family members, hospital employees, STS exhibitors, corporate staff, patients, or even STS staff.
Times will be based on the honor system and will be uploaded and compared with those of other participants. Race results will be shared on a leaderboard during STS 2021 and on social media, with special recognition given to high achievers. Don’t forget to post photos on social media using the following hashtags: #STS2021 and #TSF5K.
The cost is $50 (a portion is tax deductible), and each participant will receive a special TSF Fun Run & Walk t-shirt, which will be shipped to those who live in the United States or Canada. All proceeds will support the Foundation’s cardiothoracic surgery research and education programs. Sign up at runsignup.com/TSF5K.
If you are unable to participate in the 5K, but would still like to support TSF, visit thoracicsurgeryfoundation.org/donate.