JOURNEY TO THE TOP:
THE INCREDIBLE EVOLUTION OF THE HEART AND VASCULAR CENTER
One family’s visionary generosity nearly 40 years ago has led to the evolution of one of the top-rated heart programs in the country: the Washington University and Barnes-Jewish Heart and Vascular Center.
Today, the program is positioned to spearhead even more innovations under the leadership of Tsuyoshi Kaneko, MD, the John M. Shoenberg Chair in Cardiovascular Disease and the chief of cardiac surgery at Washington University and Barnes-Jewish Hospital. Dr. Kaneko is a world-renowned leader in the field and has been instrumental in pioneering novel minimally invasive therapies.
The John M. Shoenberg Chair in Cardiovascular Disease at The Foundation for Barnes-Jewish Hospital stems from a long tradition of community leadership and philanthropy by the Shoenberg family and the Shoenberg Foundation.
The Shoenbergs were instrumental in the success of the former Jewish Hospital and continue their generous support of health care in the community through The Foundation for Barnes-Jewish Hospital.
John M. Shoenberg was president of the Jewish Hospital of St. Louis from 1958 to 1963 and was a longtime board member. He was only 59 when he died of a heart attack, which motivated his family to establish this endowed chair focused on heart care. This philanthropy over many generations has rippled worldwide and fueled multiple discoveries and innovations led by the Shoenberg chairholders.
Since 1984, the Shoenberg chair has been held by expert physicians who, together, have created a leading cardiothoracic program that continues to innovate with new lifesaving techniques, procedures, and research to better care for patients.
THESE CHAIRHOLDERS INCLUDE:
• Nicholas Kouchoukos, MD
• William Gay, MD
• Ralph Damiano Jr., MD
• Marc Moon, MD
• Tsuyoshi Kaneko, MD
THE FIRST CHAIRHOLDER:
NICHOLAS KOUCHOUKOS, MD
A Legend in Aortic Surgery
The first Shoenberg chairholder was Nicholas Kouchoukos, MD, a cardiac surgeon who was recruited to the former Jewish Hospital in 1985.
The newly established Shoenberg chair was a significant draw for him, Dr. Kouchoukos says. “It was a real honor to come back to St. Louis and assume the first Shoenberg chair that allowed me flexibility to do things I wouldn’t have had the opportunity to do otherwise.”
Dr. Kouchoukos had completed his general surgery residency at Washington University School of Medicine in St. Louis in 1967. After his cardiothoracic surgery residency at the University of Alabama–Birmingham, Dr. Kouchoukos built a successful aortic surgery program there over the next 17 years.
As his career developed, he worked alongside some of the pioneers of the “golden age” of open heart surgery. When he returned to St. Louis and to the former Jewish Hospital, he brought this knowledge and expertise to develop a leading aortic surgery program.
Dr. Kouchoukos held the Shoenberg chair position from 1985-1996. Throughout his career, he created new surgical techniques to improve aortic and valve surgeries.
“We rise on the shoulders of others,” he humbly explains. “I devised several procedures using modifications of other surgical procedures. It was a great source of satisfaction to see these new procedures adopted by other surgeons and institutions.”
Dr. Kouchoukos has had a worldwide impact on the surgical management of cardiovascular disease, has held distinctive leadership roles, and has earned honors from national professional organizations. He also has co-authored a leading textbook called “Cardiac Surgery” that continues to be used in medical schools around the world. It’s currently in its fourth edition.
“Dr. Kouchoukos is a legend in the field,” Dr. Damiano says. “He established a world-class aortic program at Jewish Hospital and brought people from all over the world to study here.”
EDUCATING THE NEXT GENERATION
Dr. Kouchoukos remains a strong advocate for training the next generation of cardiothoracic surgeons and still stays in touch with many physicians he has trained over his career.
When Barnes Hospital and Jewish Hospital merged in 1996, Dr. Kouchoukos left to join a new heart program at Missouri Baptist Medical Center, which is part of BJC HealthCare. Yet his legacy continued at Barnes-Jewish, and respect and admiration for his achievements only grew.
To fittingly cap off his career, he was installed as the first-ever Emeritus John M. Shoenberg Chair in Cardiothoracic Surgery at The Foundation for Barnes-Jewish Hospital in 2018.
Since his retirement in 2020, he hasn’t slowed down. As emeritus chair, he works closely with Dr. Kaneko and contributes to the clinical research activities in the department.
“Through the kindness of Dr. Damiano, Dr. Kaneko and others, I have been given the opportunity to stay involved,” he says. “I still try to stay up to date on what is happening in the cardiovascular surgery field and contribute to the division in any way I can. It has been a wonderful opportunity for me.”
That commitment is motivating for his colleagues. “Since Dr. Kouchoukos became the emeritus chair, he has been a fantastic supporter for us,” Dr. Damiano says. “He still comes to conferences and meetings and helps with residents and fellows. He has been an amazing resource.”
Dr. Kouchoukos is excited about the possibilities with Dr. Kaneko as chief and the new Shoenberg chair. “Dr. Damiano set a high standard, and I’m pleased that Dr. Kaneko will continue that high standard to keep the division at the forefront of cardiothoracic surgery with an active research program and resident training.”
Because Dr. Kouchoukos feels so passionately about research and training the next generation, he established The Nicholas T. Kouchoukos, MD, Endowed Fellowship in Cardiothoracic Surgery at The Foundation for Barnes-Jewish Hospital in 2018.
“We need to train cardiothoracic surgeons who are both good surgeons and good clinical investigators,” Dr. Kouchoukos says. “It’s critical to have people in the field who are innovative, continue to push the limits, and make advances that enhance patient care.”
With this mission in mind, Dr. Kouchoukos established the fellowship to provide funds for cardiothoracic surgery residents to spend time doing research, independent of their clinical activity.
“Dr. Damiano has structured the program so that trainees can take one or two years away from their clinical training to do research,” he says. “This is essential for the future of the specialty, and at the same time it is essential that financial support for this activity continue through additional donations.”
To honor Dr. Kouchoukos’s impactful career as a surgeon, scientist and mentor, The Foundation for Barnes-Jewish Hospital initiated an annual Nicholas T. Kouchoukos Research Day in 2021. Each year, this event allows the cardiothoracic surgical trainees engaged in research to present the results of their studies to the entire department of surgery and to compete for a monetary prize.
THE LONGEST CHAIRHOLDER:
RALPH DAMIANO JR., MD
A Heart Arrhythmia Expert
Ralph Damiano Jr., MD, has the distinction of holding the Shoenberg chair the longest at 14 years. He arrived at Barnes-Jewish Hospital in 2000 and became the chair.
A visionary leader and innovator, Dr. Damiano has built on the legacy of Dr. Kouchoukos as chief of cardiac surgery and now as the division chief of cardiothoracic surgery and co-leader of the Heart and Vascular Center. His predecessor inspires him.
“Dr. Kouchoukos established a tradition of excellence that we continue to build on,” Dr. Damiano says. “He had the foresight to use the funds from his chair to create an endowment with the Foundation that has played a critical role in us developing an excellent academic program that supports both research and development on the cardiac surgical side. Without that funding, we could not have achieved so many innovations. He continued that by also establishing a research fellowship. These endowments have been invaluable to help us grow.”
Innovations fueled by donor support have been a consistent theme in the Heart and Vascular Center over decades. Since Dr. Damiano’s arrival 23 years ago, the volume of patients at the Heart and Vascular Center has nearly quadrupled, and the faculty has doubled in size. The spectrum of procedures also has vastly expanded.
However, his major contributions to the field have been in arrhythmia surgery. Dr. Damiano has been a leader in developing minimally invasive cardiac surgery. He performed the first robotically assisted surgery in North America in 1998 and published the first series of minimally invasive robotic cardiac surgeries in the world several years later. His pioneering work in this area was recognized by a Smithsonian Innovation Award in 1997, and he was elected president of the International Society for Minimally Invasive Cardiothoracic Surgery in 2011.
In 1987, Washington University cardiothoracic surgeons James Cox, MD, and Michael E. Cain, MD, perfected electrical mapping of the heart and developed the Cox-Maze procedure, which became the gold standard to treat heart arrhythmias.
As a world-renowned expert in atrial fibrillation treatment, Dr. Damiano further modified the procedure to perform it minimally invasively and more quickly in 2002. This was termed the Cox-Maze IV procedure. He also developed a procedure and devices to simplify the operation and surgical techniques.
“Today, Maze IV is the only procedure ever approved by the FDA to treat atrial fibrillation,” Dr. Damiano explains. “And it can be done by all surgeons, so now more than 60,000 procedures are done a year. That has been a great accomplishment for the field.”
In addition, Dr. Damiano was at the forefront of a revolutionary minimally invasive transcatheter aortic valve replacement (TAVR) surgery, which is ideal for patients who may not be candidates for more invasive surgery.
In 2008, Dr. Damiano and his colleagues were the first in the St. Louis area to perform TAVR and trained other surgeons around the country. Today, the Barnes-Jewish Hospital team performs more TAVR procedures than any other center in the region.
With the arrival of Dr. Kaneko as the new Shoenberg chair and chief, Dr. Damiano is happy to see the minimally invasive focus expand at Barnes-Jewish.
“I was part of the team that started the TAVR program, but Dr. Kaneko is taking it to a different level,” Dr. Damiano says. “He is a national thought leader in this area. In less than a year since he has arrived, Dr. Kaneko has already brought the TAVR program into national prominence. He’s also a world-renowned leader in minimally invasive surgery, and that’s where the field is going.”
RECRUITING A DREAM TEAM
Like Dr. Kouchoukos, Dr. Damiano is proud of the faculty and residents he has trained who have gone on to leadership positions. “At least two dozen are now chiefs of their sections, divisions, or departments all over the country,” he says. “We have a fantastic training program for both physician-scientists and clinical cardiac surgeons. The research fellowship from Dr. Kouchoukos allows this to continue since NIH (National Institutes of Health) funding is difficult to get.”
Recruiting the right team to grow the cardiothoracic team has been a vital part of Dr. Damiano’s role. The combined strength and expertise of these leaders has led to exponential growth of the program’s capabilities.
“Over the last 20 years, I’ve led cardiothoracic surgery through a huge transition,” he says. “When I first came here, bypass surgery was the most common operation. Today, less than 20% of our patients have bypass surgery. For the past 10 years, the program has been one of the busiest programs in the country for surgical treatment of heart failure. And we’re a leader in transcatheter therapeutics and maintain leadership in minimally invasive valve surgery.”
He praises the thoracic team for their innovations, as well. “They may be the most preeminent program in the world. They are doing groundbreaking research and have a premier lung transplant program. Thanks to our endowment with the Foundation, we’ve been able to support the growth of both the cardiac and the thoracic side.”
Dr. Damiano says the program’s success has been a team effort. “Lots of people have worked hard to build the division to what it is today. The chiefs in the last 20 years have been impressive and I stand on the shoulders of people who have done a great job.”
Although Dr. Damiano is proud of the advances he and his team have made, his patients give him the greatest sense of accomplishment.
“My proudest achievement is all the patients I’ve been able to take care of. They still motivate me every day to come in and do my best.”
THE NEWEST CHAIRHOLDER:
TSUYOSHI KANEKO, MD
A Pioneer in Minimally Invasive Surgery
Tsuyoshi Kaneko, MD, is maximizing the contributions of his predecessors as the new Shoenberg chair and chief of cardiac surgery.
When he came to Barnes-Jewish Hospital in February, he brought his clinical skill in complex valvular heart disease, a commitment to patient outcomes, and dedication to training future cardiothoracic surgeons.
A highly regarded pioneer, Dr. Kaneko has developed important advances in cardiac surgery techniques and is driving the field toward more minimally invasive procedures.
Even with his own accomplishments, Dr. Kaneko is in awe of his predecessors. “If you look at past Shoenberg chairs, it’s an incredible list,” he says. “Starting with Dr. Kouchoukos, who is a legend in aortic surgery. Then Dr. Damiano, who is the most renowned surgical arrythmia expert in the world. And Dr. Marc Moon, who is also very well respected in cardiac surgery. They all put this place on the map. To carry on that legacy is a huge honor and is one of the most important aspects of what drove me here.”
Dr. Kaneko was recruited from Brigham and Women’s Hospital and Harvard Medical School. As the leader of the largest structural heart program in New England, he advanced patient care nationally by developing innovative approaches to endovascular treatment for aortic and valvular heart disease, among his other achievements.
Dr. Kaneko has made such a difference in patient lives that a former patient from his previous position in Boston made a gift at The Foundation for Barnes-Jewish Hospital in his honor—after he came to Barnes-Jewish. “That was priceless,” Dr. Kaneko says. “It tells me I’ve impacted someone’s life and they appreciated the care provided, no matter where it is.”
Since he came to Barnes-Jewish Hospital, he has already expanded treatment options for patients.
Dr. Kaneko brought a new Ross procedure to the hospital to treat damaged aortic valves minimally invasively. He also is developing a robotic valve surgery program at Barnes-Jewish. This procedure uses a surgical robot to create precise movements so surgeons can treat valves through tiny incisions. A
MINDSET FOR INNOVATION
Dr. Kaneko feels fortunate to work alongside heart experts such as Dr. Kouchoukos and Dr. Damiano. “They are both ‘extreme experts’ in the field. And they still want to learn and still have curiosity and motivation. It’s that mindset that paves the way for innovation. And my role is to make sure we continue to be the site of innovations.”
One way he plans to do that is through research.
“Although TAVR has become standard therapy for aortic stenosis in 2023, we still have some unanswered questions about it that need additional research,” he says.
And he’s right in the middle of it as he continues to grow research in cardiothoracic surgery to advance treatments. It aligns with his vision for the future.
“My vision for the Heart and Vascular Center includes two purposes: First, we treat the sickest and highest risk patients because we have the expertise and tools to treat them,” he says.
“Secondly, Barnes-Jewish Hospital will be a center for innovation in cardiac surgery. The Ross procedure and robotic surgery are just some of our innovations. We will be in the center of breakthroughs and hopefully produce some of the newest innovations in the field right here.”
Dr. Kaneko says philanthropy plays a critical role in these innovations.
“We need good training so we can safely launch the robotic valve surgery program and other innovative procedures,” he says. “We also want to do more clinical outcomes research to help us identify which treatments are the safest and most effective. And we need to find gaps where we need to innovate. All of this can only be done with philanthropic help.”
In 2026, heart care at Barnes-Jewish Hospital will get a new home with the construction of a new patient bed tower.
“The new building will be a catalyst for all our innovations,” Dr. Kaneko says. “Beyond the structure, we’re building more of a team and concept. I believe the new facility will bring new motivation for the staff to pursue excellence and serve patients better. It also will give us an opportunity to better collaborate with cardiology and vascular surgery partners for research.”
He continues: “With every step, my goal is to bring more innovation and move the field forward with Barnes-Jewish at the center of it. That’s what I hope to accomplish.”
Written by Joyce Romine
Photography by Tim Parker and Peter Newcomb