Early-Career Cardiac Surgeon Finds a Place to Pair Patient Experience With Research Innovation

A year before cardiothoracic surgeon Aaron Weiss, MD, completed his training at the Icahn School of Medicine at Mount Sinai in New York, he was among a handful of trainees asked to present their research to a senior surgeon who was visiting for grand rounds.

Much to his surprise, Dr. Weiss was contacted the next day by the office of that senior surgeon — Cleveland Clinic Heart, Vascular & Thoracic Institute Chair Lars Svensson, MD, PhD, — and invited to visit Cleveland Clinic. He didn’t know the reason for the invitation, but he came and met with several Cleveland Clinic staff surgeons. At the end of the visit, Dr. Svensson said he was impressed by the young surgeon’s research interests in combining big data from the electronic medical record [EMR] and innovative machine learning approaches to develop improved risk prediction models for cardiac surgery patients. He explained that the combination of these interests with Dr. Weiss’ clear passion to give patients the best possible preoperative counseling was the essence of Cleveland Clinic’s ethic of pairing innovation with patient experience. He concluded the visit by inviting Dr. Weiss to return for a formal interview the following year for a position in Cleveland Clinic’s Department of Thoracic and Cardiovascular Surgery.

Dr. Weiss did indeed return for that interview, which resulted in him joining the Cleveland Clinic staff in September 2019. He has since put his diverse surgical training to use on cases ranging from coronary artery bypass grafting to valve surgery to adult congenital repairs, but his passion and niche is in the surgical treatment of failing hearts through heart transplantation and mechanical circulatory support devices. He recently spoke with Consult QD about his clinical and research interests.

Q: What drew you to cardiac surgery?

Dr. Weiss: I first said I wanted to be a heart surgeon when I was six, but it was in the seventh grade that I became serious about that goal. That’s when I got the chance to shadow a University of Pittsburgh heart surgeon for a day. I was able to observe clinical rounds and even put on scrubs and watch a ventricular septal defect repair in a 17-month-old child. I also got to visit the research lab where the surgeon was working on the Jarvik artificial heart.

When my mother picked me up at the end of the day, she told me to write everything down because I might never get an opportunity like this again and I would want to remember it. I turned to her and said that I was going to be a heart surgeon. Although I explored other specialties during medical school and residency, the thrill and challenges of cardiac surgery kept pulling me back. It’s an amazing field full of intricate complexities and the potential for real patient impact that’s both immediate and long-lasting. I consider myself incredibly fortunate to be a cardiac surgeon, especially at the best hospital in the country to have open heart surgery.

Q: Why have you chosen to focus on heart failure?

Dr. Weiss: Although I enjoy all the different areas of heart surgery, heart failure is the surgical subspecialty that I’m especially passionate about. Patients who require advanced surgical therapies for their heart failure have maximized the benefits and longevity that can be obtained from medical therapy. Without surgical intervention, they will continue to have worsening quality of life and are unlikely to survive the next 12 months. Being able to take patients from the brink of death and not only bring them back to life but give them many more years is incredibly rewarding.

The complexity of these patients requires a heart team approach to optimize outcomes and offer hope in cases previously considered hopeless. That team-based approach is exemplified here at Cleveland Clinic. I am incredibly fortunate to be working with some of the nation’s best cardiologists, intensivists, perfusionists, nurses and other caregivers. Our team approach allows patients to experience outcomes far superior to what could be achieved by individual providers working less collaboratively.

Q: Your surgical training is completed, but your formal education isn’t. Tell us about that.

Dr. Weiss: When I was in medical school, I met an endocrinologist conducting systems biology research in the cardiothoracic surgery ICU. The work involved a “top-down” approach that would broadly integrate the overall effects in a given biological system in the context of health or disease. This was in contrast to the more “bottom-up” approach to research that I was mostly familiar with in the laboratory or clinical research setting.

This more holistic approach to research fascinated me and eventually led to me pursuing more formalized research training for a PhD in clinical research. So during my cardiothoracic surgery residency, I was simultaneously enrolled in my PhD classes and took a dedicated two-year block of time for my thesis, which is focused on using machine learning techniques and routinely collected EMR data to develop improved risk prediction models for cardiac surgery patients. I am currently in the final stages of completing the PhD and should be defending in the fall of 2020. I hope to further my work in this area here at Cleveland Clinic and use the vast network of resources here to do even more.

Q: Tell us more about your research and its goals.

Dr. Weiss: The discipline of cardiothoracic surgery is great at getting patients through surgery, but we’re not as great at giving them an accurate, evidence-based estimate of their risk. Patients want to know their chances of having a complication-free operation with a beneficial outcome when it’s performed by a specific surgeon at a specific institution, but we’re not really able to tell them.

That’s because most routinely used cardiac surgery risk-stratification models are based on regression techniques, which incorrectly assume interactions occur in a linear fashion. The models I’m developing use nonlinear methods based on machine learning, with the aim of enabling risk to be predicted with greater accuracy. My hope is that these will be “living models” that continue to improve their risk prediction accuracy through continuous data feeds available in real time. Furthermore, the models will be able to capture all the various unique and complex surgical procedures that are being performed instead of just index cases, thereby allowing for broader applicability.

Q: Will this largely supplant a surgeon’s clinical acumen?

Dr. Weiss: Not at all. Artificial intelligence and machine learning will supplement surgeons and empower them to make better decisions. These methods will help guide a surgeon on whether surgery is the right decision for a particular patient and, if so, how it should be modified to lower the patient’s risk. They may also help inform individual surgeons about their own outcomes in real time and allow for more readily available feedback to promote best practices. But the bottom line is that the effects of machine learning are intended to be supplemental and very much integrated into the personal care provided by clinicians at the bedside.