What Drew One Young Cardiothoracic Surgeon to Cleveland Clinic

Dr. Daniel Burns on mentorship, robotic valve surgery, statistics and more

When Daniel Burns, MD, MPhil, decided on a career in minimally invasive and robotically assisted heart surgery, there was one place he particularly wanted to practice: Cleveland Clinic. After one year as associate staff, he was invited to join Cleveland Clinic’s Miller Family Heart, Vascular & Thoracic Institute as full staff and made a seamless transition.

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As he completes his first year with over 100 cases under his belt, Dr. Burns is confident he made the right choice. He is increasingly applying his graduate training in epidemiology and biostatistics to examine patient outcomes in minimally invasive and robotic surgery, and he frequently works alongside two of the world’s most experienced surgeons in robotic mitral valve operations, A. Marc Gillinov, MD, and Per Wierup, MD, PhD. He recently spoke with Consult Q&D for this Q&A.

Q: Why did you choose to start your career at Cleveland Clinic?

Dr. Burns: Cleveland Clinic has a long and storied history in cardiac surgery, so the opportunity to join this team of experienced, talented surgeons was one I couldn’t pass up.

What has impressed me more is the degree of high-level mentorship offered here. My senior colleagues are always willing to help and ensure I have the resources to make advanced procedures possible. When faced with challenging, complex cases, there is ample expertise here to support me if needed. It’s hard to imagine a more supportive environment.

Another draw for me was Cleveland Clinic’s highly developed minimally invasive program with an unmatched volume of robotically assisted mitral valve cases. Every day we do at least one robotically assisted mitral valve repair. We aim to operate as a team, with a robotics fellow assisting and often with a second attending surgeon in the room as well. This collaborative approach is one reason I’ve developed the skills I have, and it produces great outcomes.

Q: What drew you to your personal surgical interests?

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Dr. Burns: Cardiac surgery grabbed me very early on for many reasons. I liked seeing an immediate difference in patients. You can replace or repair a valve, and very often the patient feels better even before leaving the hospital.

I was drawn to the mitral valve because of its complexity, but also its amenability to repair. There is a misconception that mitral valve repair is a hyperspecialized art that’s inaccessible to the average surgeon. In reality, although clear understanding of the mechanism of dysfunction is necessary, the repair techniques required are straightforward and reproducible. For minimally invasive surgery, if you can achieve the same result in terms of quality and durability with a less invasive approach, then, by definition, the less invasive approach is better. That’s something I wanted to be part of.

Q: What do you hope to accomplish in your specialty areas?

Dr. Burns: I think you will continue to see younger generations of cardiac surgeons take what our mentors have achieved and run with it, and it will be interesting to watch where we take the field. I think it’s moving toward smaller incisions and faster operations. We keep pushing to create smaller access or use partial incisions. For example, when we can’t do a mitral valve case robotically, we often will only partially divide the sternum. I’m doing what I can to champion and grow this approach.

Q: Tell us about your training in biostatistics and how you’re using it today.

Dr. Burns: I was fortunate to be able to take academic leave from my residency training to get a master’s degree in epidemiology from the University of Cambridge. I now do statistical review for several major medical journals, and was recently promoted to an Associate Statistical Editor position for the Journal of Thoracic and Cardiovascular Surgery. We examine a study’s methodology and analysis techniques to ensure it is sound and of publishable quality. It keeps me sharp. Here at Cleveland Clinic, I have the opportunity to collaborate with Eugene Blackstone, MD, Head of Clinical Investigations in our Heart, Vascular & Thoracic Institute, on both peer-review work and clinical research for publication.

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Q: What’s something about minimally invasive surgery that isn’t properly appreciated?

Dr. Burns: There are still many patients for whom it’s not the best approach. We do an amazing number of advanced mitral repairs every year with excellent results and minimal pain and downtime. Thanks to this experience, we know exactly what type of patient should or should not undergo this approach. It’s not for everybody. Our goal is not only to perform the best operation, but also the safest. We will do a minimally invasive procedure if we can, but not if it means compromising safety or quality. When considering a patient for a minimally invasive approach, we always articulate this and give the patient a straight answer.

This also applies to aortic valve replacement patients. I see patients all the time who have been referred for transcatheter aortic valve replacement (TAVR) but are not always good candidates. This can be due to anatomic constraints or perceived patient risk. For example, at this point we only have short-term clinical data on TAVR in low-risk patients, so we have to be careful. We don’t yet know how these patients will fare at 10 years. This is something else that drew me to Cleveland Clinic — our broad experience with all approaches makes it easy to be very objective with patients about their options.

A colleague’s perspective

“We are thrilled that Dr. Burns has joined our team,” says Dr. Marc Gillinov, Chair of Thoracic and Cardiovascular Surgery at Cleveland Clinic. “He possesses the special combination of outstanding surgical skill and a focus on innovation and research. These are the qualities that ensure that Cleveland Clinic will lead in heart care both today and in the future.”