Q&A with Vincent Gaudiani, MD, Cardiac Surgeon at PCCSV

With more than 10,000 heart operations under his belt, Dr. Vincent Gaudiani is one of the most prolific practitioners in cardiovascular surgery. His early career followed a similar path as Dr. Fogarty’s, and the two later met at Stanford and have been colleagues and steadfast friends ever since.

Dr. Gaudiani received his bachelor’s degree in English from Harvard University, Doctor of Medicine from Case Western Reserve University and is certified by the American Board of Thoracic Surgery in thoracic and cardiac surgery. Throughout his 30-plus years in practice, he has received numerous awards and recognitions and has been published in scores of publications.

Today, in addition to still practicing on some of the most complicated cases referred to him by cardiologists across the nation, much like Dr. Fogarty he devotes his time to mentoring future generations and is already responsible for helping develop more than a dozen surgeons in the Bay Area. Also, similarly to Dr. Fogarty, he is incredibly patient-centric, insisting on meeting not only his patient prior to the surgery, but also the patient’s family members.

We had the privilege of chatting with Dr. Gaudiani about his career, philosophy and trends in the field.

Q. How did you first become interested in healthcare and decide to become a cardiac surgeon?

A. After graduating from Harvard, I began working in a cardiac surgery lab, following in the footsteps of my grandfathers who were both physicians. At the time, we were doing shock experiments for the U.S. Army, and I really enjoyed learning how to better care for people who had combat wounds. As part of the process, we were operating on the chest of dogs. I got “a nose for it” and decided to enter medical school; by the time I arrived, I knew I wanted to be a heart surgeon and made that my area of focus.

When I finished medical school, I began my general surgery residency and did a two-year fellowship in cardiac surgery at the National Institutes of Health (NIH), the same place and same exact job that Tom Fogarty had a decade before me. After my general surgery residency, I went to Stanford for my final residency, and upon completion, Tom hired me immediately. That was 35 years ago, and he has been a great mentor and friend ever since.

Q. Having spent so much time with Dr. Fogarty, what is the one key lesson you learned from him?

A. The road of academia and training can be long – in my tenure I had been at Harvard, Case Western Reserve University, NIH and Stanford — and then, all of a sudden, you are out there all by yourself. And if you don’t work for a big hospital, you are literally just yourself, without anything after your name. Learning how to deal with creating your own little “brand” was one of the most important things I learned from Tom.

I remember exactly where I was when we had this discussion around 1982: Tom already had his own “label,” due to the Fogarty embolectomy catheter. He understood the importance of that and got me thinking about how to package my own capabilities and vision – who I am, what I stand for, the way I want to practice. We had a wonderfully symbiotic relationship; he wanted to innovate, and I wanted to perform surgeries, because that’s what I liked. And I still do at the age of 73. You find something that you love to do, and you stick with it – that’s the good fortune I have had.

Q. On that note, what has kept you in cardiac surgery all these years?

A. For me it is the rewarding nature of meeting and interacting with patients, which I particularly like to do, and then figuring out the technical aspects of how to fix their condition quickly and effectively.

It’s just a joyful thing to do, and people are so kind and they remember what you do for them. It’s little things, like getting a letter from a former patient’s family member. One I received said something like, “You probably don’t remember, but you operated on my uncle 20 years ago and he just died last month; but thanks to your surgery, he lived to see six more grandchildren being born and two more graduate from college. We just wanted to let you know that he lived a full life and we wanted to thank you.” It’s these types of human interactions that make my job very fulfilling, and the reward is very immediate.

I also feel that I have been very fortunate to have been given a special gift – operating makes profound sense to me, and that means that I am able to perform very difficult surgeries that often others aren’t able to do. I have been given the gifts of being fast, accurate and unafraid, and I feel I have to use this gift passionately as long as I can. Much like Tom who has the gift of innovation that he is still exercising at age 85, I feel very fortunate that I have had this unusual pleasure to keep working and helping patients.

Q. What are some of the trends you are seeing and what role has medical technology played in advancing your field?

A. “Big case surgeries”– as in those cases that are technologically and technically challenging – are always dangerous because a person’s life is at stake with one mistake. But over the period of our careers, medical technology has evolved and made it simpler to solve some of these problems so that fewer patients have to face big case surgery.

But at the same time, that has created its own slight difficulty in the sense that there isn’t as much “ordinary” surgery around for beginning surgeons to learn on and acquire skills before they have to face these more advanced cases. Increasingly, it’s only those challenging cases that are going to be left in heart surgery as all the more moderate cases will be treated through technology that requires less surgical intervention.

However, since any surgical procedure always contains danger, technology is great in the sense that it’s reduced the number of patients who have to undergo big dangerous operations because for many, there are equally effective but less invasive protocols available. Yet there will always remain a residual of very challenging cases, and that motivates me to hang around, work on these cases and pass along my knowledge because patients are still going to need this in the future.

In short, I believe that cardiac surgery is going to get smaller as many technological advances take the place of technique, but we will always need skilled surgeons.

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