Most Searched
Originally published October 28, 2025
Last updated October 28, 2025
Reading Time: 9 minutes
Search more articles
News & Magazine
Topics
Cardiac surgery capabilities are advancing alongside new technology, medical research and — at specialized cardiovascular institutes like the USC Cardiac and Vascular Institute, part of Keck Medicine of USC — multidisciplinary collaboration between cardiac surgeons, vascular surgeons and cardiologists.
USC Cardiac and Vascular Institute cardiac surgeon Craig J. Baker, MD, the Alfred E. Mann Chair in Cardiac Surgery and division chief of cardiac surgery for the Department of Surgery at the Keck School of Medicine of USC, explains five of the biggest developments he sees happening in his field.
Baker: One of the biggest advancements I’ve seen has to do with hybrid and cross-specialty approaches to endovascular treatment of aortic disease.
Traditionally, major thoracic aortic cases, like aortic arch disease or descending thoracic aortic disease, were major, complex operations that were lengthy and carried significant risk. But now, new technologies like endovascular grafts can be placed percutaneously to take care of large degenerative aneurysms. In addition, there are newer devices that can be placed intraoperatively and make it much safer for us to do open cardiac procedures — for example, of the aortic arch. I’ve been practicing cardiac surgery for a little over 20 years, and the devices I’m able to use now during an operation have simplified these operations and made them so much safer. They’ve really streamlined and improved the outcomes of some of these big operations — and that is a real benefit to patients.
Part of what has made this possible at the USC Cardiac and Vascular Institute is extensive collaboration between cardiac surgeons and vascular surgeons. For example, at the Institute’s USC George and Meryl Young Aortic Center, a cardiac surgeon and a vascular surgeon act as co-directors. This collaboration offers life-saving solutions for many patients. Our teams work together a lot, and what we’re seeing is that operations that used to carry significant risk can now be done much more safely, with better results. It’s fantastic to work within this institute model where I have partners in not just cardiac surgery but also vascular surgery and cardiology because it creates a very patient-centric approach. We’re not competing with each other. We really want to offer the patient the best therapy that suits their individual needs.
Baker: One of the biggest changes that will continue to evolve are catheter-based therapies for structural valve disease. Most people have heard of TAVR, or transcatheter aortic valve replacement. TAVR didn’t exist when I was in training, but now in conjunction with our heart valve team and the cardiologists at the USC Cardiac and Vascular Institute, we have the ability to replace certain patients’ aortic valves with transcatheter therapies that don’t require opening the patient’s chest and don’t require a heart-lung machine.
TAVR was initially reserved for patients considered extreme-risk or for patients believed not to be surgical candidates, but that envelope has moved down to where now it’s really considered standard therapy for at least elderly patients that need new aortic valves.
I think what we’re going to see happen in the next 5-10 years is an evolution of transcatheter therapies. While surgery will often remain the best therapy for valvular heart disease, there will be more options available for other areas of the heart, such as mitral valve disease and right-sided valve disease like tricuspid valve disease, and I think this is really good for patients.
Baker: We’re finding much better treatments for people with end-stage heart disease. Twenty years ago, the devices we had to support a failing heart were very cumbersome, very burdensome and caused a lot of complications such as strokes. Some patients used to be bedridden when they had a failing heart because they had to have some of these big, bulky devices put in. These devices now, for lack of a better word, have been somewhat miniaturized and feature better technology, so there are fewer risks of complications. Now, we have patients whose hearts are just as sick but who can have much smaller devices, and they’re able to walk around the ICUs and rehabilitate.
Examples of some of these devices are miniaturized ventricular assist devices (VAD) that get inserted percutaneously through small incisions. These devices can support both the left and right ventricles in someone in decompensated heart failure. They’ve also helped us operate on sicker people who in the past may have been turned down for heart surgery. Now, we can offer patients these devices as a backup if their hearts aren’t ready to support their full function after the operation. It enables us to operate on sicker patients and perform more challenging operations.
The collaboration between surgeons and heart failure cardiologists at the USC Cardiac and Vascular Institute has led to significant advances in the area of heart failure. This includes patients that are candidates for advanced therapies, including heart transplant and ventricular assist devices. Given the shortage of available donors, very important research related to xenotransplantation, using animal organs to temporarily replace human hearts, is being performed. Surgeons at the USC Cardiac and Vascular Institute have been at the forefront of these advances.
Baker: Patients and doctors should be aware that there have been a number of studies, especially in the last decade, showing there is a benefit to using more arterial grafts when you’re performing bypass surgery, especially in younger patients. CABG, or coronary artery bypass grafting, is an excellent option that we know prolongs life and saves people from having heart attacks. For years, CABG was typically done using one artery and then using veins from people’s legs. But more and more data suggests that the more arteries you can use, the bigger the benefit and the better the improved survival of the operation. We’re starting to see more attention placed on this nationally.
The reason for the benefit is that vein grafts have an attrition rate. If you do a coronary bypass operation on somebody who is 50-60 years old, we know that somewhere 10-15 years down the road, some of those vein grafts will become blocked or what we call stenosed — or sometimes completely occluded. Arteries, on the other hand, tend to last a long time, even for the remainder of the patient’s life. It makes sense that the more arteries a patient has, the less likely they are to have complications and need subsequent procedures.
At the USC Cardiac and Vascular Institute, we have a number of options for using more arterial grafts. Traditionally, in a bypass operation, we use the left internal mammary artery, which is an artery on the left side of your chest wall. We are also using the right internal mammary as well as radial arteries from people’s arms. It’s our belief — and I think the data bears this out — that patients who have more arterial grafts will have better long-term outcomes.
Baker: We’re seeing renewed interest in the Ross procedure based on recent data suggesting that there’s a survival advantage for young patients. Some background on the Ross procedure: Traditionally, younger patients with aortic valve disease who need a valve replacement have considered two options: tissue valves and mechanical valves. Tissue valves, typically porcine or bovine, are great because they don’t require the patient to undergo lifelong anticoagulation. The downside of these valves is that they can ultimately fail secondary to structural valve deterioration over the years. Mechanical valves, commonly referred to as a metal valve, structurally can last for someone’s entire life. The downside, however, is that a patient has to commit to taking blood thinners every day. Traditionally, younger patients who had 40-50 years to live would often receive mechanical valves and then have to commit to taking blood thinners for the rest of their life. And, as we know, there are complications and risks to being on blood thinners for your whole life — bleeding being the main one and that can be severe.
With the Ross procedure, we take out a patient’s right-sided heart valve, the pulmonary valve, and move it over to the left side and replace the patient’s left-sided aortic valve with an autogenous valve that is the patient’s own tissue. Then we use a human preserved pulmonary valve to replace the valve we took out from the right side of the heart. Essentially, you’re giving a patient a valve substitute that’s their own tissue and that doesn’t require anticoagulation. Physiologically, it seems to behave very similarly to a patient’s normal valve.
At the USC Cardiac and Vascular Institute, we’re fortunate to have Dr. Vaughn Starnes, a world leader in the Ross procedure and chair of surgery at the Keck School of Medicine of USC, as head of the institute. He has been a leader in performing the Ross procedure in infants, which is critical because there really is no good valve substitute for infants. With an infant — even a neonate or a newborn or someone in their first year of life — when you use their own valve, the valve actually grows with them. It’s somatic growth, and the valve can actually grow as the child grows. We’ve seen people out 30, 40, 50 years where the valve is functioning fine after being put in when they were neonates or one month old.
Dr. Starnes has trained the next generation of surgeons, including myself, to safely do this procedure and has adopted the Ross operation for younger adult patients. And studies in the last decade have suggested when you perform the Ross procedure in young patients, there may be a long-term survival advantage compared with using biologic or mechanical valves.
It’s a very technically demanding operation, but because of this data, more surgeons around the United States and the world are interested in adopting this technique to offer their younger patients. We are proud to serve as a training site for surgeons who want to learn this operation.
Baker: We always want to remain on the forefront of new devices and technology and ensure our patients have access to the most current and state-of-the-art therapies. As new devices come on the market, however, it’s important that we as surgeons ensure they can really benefit patients in the long run. As an academic center, it’s our job to investigate, interrogate and participate in these trials.
Finally, it’s also exciting to see how we are training the next generation of cardiac surgeons. Cardiac surgery is becoming a very sought-after specialty, and what’s really exciting to me is that now there is a pathway to becoming a cardiac surgeon directly from medical school that didn’t exist when I was in medical school. When I trained, and how most surgeons in this country trained, is that after you finished medical school for four years, then you did a 5-7 year general surgery training program after which you could enter thoracic surgery training. People spent anywhere from 10-12 years in training.
Now, some institutions like the Keck School of Medicine offer what’s called an integrated pathway. Medical students interested in thoracic surgery can match directly after medical school into a six-year clinical pathway. I’m very proud of to be the director of this program. And while the overall time of training is shortened, what we’ve found here at the Keck School is that being exposed to the specialty that you’re going to pursue for the rest of your life really prepares you for the field. Only about 36 programs in the country offer the integrated pathway, the Keck School being one of them, and it’s incredibly competitive. For the last few years, the integrated training pathway in thoracic surgery has been the most competitive surgical specialty in the United States.
Share
