Redmond P. Burke (born 4 November 1958) is an American congenital heart surgeon,[1] innovator, software developer, author, inventor, and founder of The Congenital Heart Institute at Miami Children's Hospital in Miami, Florida. He starred in the ABC pilot television show The Miracle Workers.[2][3] Burke has been recognized as one of the world's most innovative surgeons,[4] and for his use of information technology to improve surgical outcomes.[5]
Redmond Burke was born in Honolulu, Hawaii, to a US Navy flight navigator, Redmond Joseph Burke, and his wife Claire Lorraine Burke, both from San Francisco, California. In 1995, he married Kim Horstman, a registered nurse from Strongsville, Ohio, and they have three daughters - Olivia, Noelle, and Grace. Olivia is an undergraduate at The University of Miami. Noelle a senior at Ransom Everglades High School, and Grace is attending the middle school.
Burke with his sister at Stanford Stadium in 1977
Burke and his three younger sisters, Alannah Radke, Claire Chinn, and Christine Jaeger, grew up in Cupertino, California. He was educated in public schools - Portal Elementary School, John F. Kennedy Junior High School, and Monta Vista High School, where he co-captained the varsity wrestling and Championship football teams, and won the Outstanding Wrestler award at the Central Coast Section Championships in 1976. Burke placed fifth at 165 pounds, in the California State Wrestling Championships that year.[6] Burke's influential coaches included Patrick Lovell, Ron Edwards, Dave Vierra, Rudy Lapera, and Duane "Buck" Shore.
Burke attended medical school at Harvard University from 1980 to 1984.[7] Influential instructors included Hardy Hendren, Paul Buttenweiser, Judah Folkman, and Nobel Prize winner Baruj Benacerraf. Nicholas Tilney taught a course in aseptic surgical technique to Harvard Medical students, and was a mentor. Burke was a student observer for the first heart transplants in New England, performed by Professor John J. Collins, at the Brigham and Women's Hospital.
Burke was selected for General Surgical Residency Training at the Brigham and Women's Hospital, under then Surgeon in Chief John A. Mannick MD, Mosely Professor of Surgery at Harvard Medical School. The Brigham surgical training philosophy was "see one, do one, teach one." The intense five-year program was notable for a rigorous call schedule - every other night in the hospital - with routine 120-hour work weeks. Notable instructors included Nobel Prize Winner Joseph Murray, who performed the world's first kidney transplant, and David J. Sugarbaker, who performed the first lung transplants at the Brigham and Women's Hospital.
In 1989, after completing general surgery training at the Brigham, and in preparation for cardiac surgery training, Burke spent a year as a research fellow at the Massachusetts Institute of Technology, in the Spectroscopy Laboratory, under Michael Stephen Feld, PhD. Burke developed the idea that Laser-induced fluorescence spectroscopy could be used to diagnose rejection in transplanted cardiac tissue, thereby avoiding the need for traumatic biopsies.
Burke was selected for cardiac surgery training at the Brigham and Women's Hospital, under program director Lawrence H. Cohn. He spent six months as the Chief Resident in Pediatric Cardiac Surgery under Professor Aldo Castaneda, and attending surgeons, Richard Jonas MD, John Mayer MD, and Frank Hanley MD. When Hanley accepted the position of Chief of Pediatric Cardiac Surgery at the University of California, San Francisco, Burke was offered his position, and he joined the Children's Hospital Boston attending staff in 1992, becoming an Instructor in Surgery at the Harvard Medical School.
Boston
Castaneda encouraged Burke to develop a research interest. He explored the possibility of using endoscopic surgical techniques for congenital heart surgery, designing instruments and techniques in the laboratory. He began clinical applications in 1993, subsequently performing a series of surgical firsts, including the world's first endoscopic vascular ring division, diaphragm plication, and thoracic duct ligation.[8][9][10] Burke became a recognized expert in the field of minimally invasive pediatric cardiac surgery.[11] He developed thoracoscopic surgical instruments with engineers from Pilling Weck, Inc.[12] Burke and Craig Lillehei, an attending pediatric surgeon, also performed the first three pediatric Heart-Lung Transplantations in New England,[13] with the help of colleagues from the Brigham and Women's Hospital including Malcolm Decamp, and Sari Aranki. In early 1995, Castaneda retired, and Burke was invited to interview for a position as Chief of Pediatric Cardiac Surgery at Miami Children's Hospital in Miami, Florida.
PEDIATRIC CARDIAC SURGERY
PIONEERED BY/ INSTITUTION
REFERENCE SOURCE
First Minimally Invasive Repair of Patent Ductus Arteriosus in the United States
At age 36, Burke became the Chief of Pediatric Cardiovascular Surgery at Miami Children's Hospital.[17] Miami Children's Hospital is now The Nicklaus Children's Hospital, named after world-renowned golfer and philanthropist Jack Nicklaus. Building on lessons learned in Boston and Silicon Valley, Burke's program was designed around two key principles:
Reduce the trauma of care for each patient over their lifetime.
Leverage the power of information technology to improve medical outcomes.
Reducing surgical trauma
In an effort to reduce cumulative therapeutic trauma, the Miami team unified the efforts of cardiac surgeons and interventional cardiologists, attempting to develop less invasive treatments for a broad range of congenital heart defects. Beginning in 1996, Burke and the interventional cardiology team at Miami Children's Hospital published a series of hybrid approaches, where the surgeons operated in the catheterization laboratory, and the cardiologists performed interventions in the operating room.[18] Many of these procedures used the video assisted thoracoscopic techniques Burke developed in Boston.
Burke and associate surgeon Robert Hannan worked with their Director of Perfusion, Jorge W. Ojito, to develop a less traumatic cardiopulmonary bypass technique.[19] They also designed a miniaturized Cardiopulmonary Support circuit, allowing critically ill patients to be transported by plane, helicopter or ambulance over great distances on full heart lung bypass. In 2007, Burke and Zahn, at Miami Children's partnered with cardiac teams in Boston and New York in the first US trial of the Medtronic Melody Transcatheter Pulmonary Valve, which allowed patients with pulmonary valve disease to have their valves replaced without surgery.[20] Burke performed the first open tricuspid valve replacement on a patient with a transcatheter valve after the patient developed severe early onset endocarditis in his Melody Transcatheter Pulmonary Valve in the Tricuspid position. The patient subsequently did well after surgical tricuspid valve replacement.
PEDIATRIC CARDIAC SURGERY
PIONEERED BY/ INSTITUTION
REFERENCE SOURCE
Extracardiac Fontan Operation Without Cardiopulmonary Bypass
When Burke arrived in Miami in 1995, he hired Jeffrey A. White to act as a technology advisor, working with the heart team to find and develop applications of information technology to improve medical outcomes.[37] This collaboration resulted in a relational database for congenital heart surgery, a web-based information system for a medical team, and web based reporting of medical outcomes in real time. The web-based information system enabled a unique form of rounds, which they called "internet rounds," enabling information exchange and clinical decision making over the Internet.[38] Beginning in 2002, Burke's surgical team started continuously measuring and reporting their surgical outcomes on the web. In 2006, Burke and White collaborated with IBM to create a voice activated medical information system for use in hands free hospital environments, like the operating room, allowing the surgeons to access critical information from their electronic medical records with voice activated commands.[39] In 2007, Burke and his team enabled patients and families to access their electronic medical record, also known as a personal health record, any time, anywhere, with any web enabled device.[40] In 2013, Burke's team was selected for the Google Glass Explorer program after presenting a YouTube video [41] demonstrating how they intended to "heal with Glass". Their proposal was recognized in several IT publications including PC Magazine.[42] In 2015, the heart team used a 3D printed model of a child's heart and lungs to design a novel repair for complex total anomalous pulmonary venous connection. The operation was successful, and generated worldwide media coverage.[43] In 2016, an "inoperable" patient with a single lung and hypoplastic left heart syndrome was referred to Nicklaus Children's Hospital. Using Google Cardboard as a Virtual Reality Viewer, a novel operation was planned and performed successfully. This unique synthesis of technology and surgery was recognized worldwide.[44][45]
In 2002, the Arnold Palmer Hospital for Children in Orlando, Florida lost their congenital heart program. Burke initiated meetings with hospital administrator Janet Livingstone, CEO John Hillenmeyer, and Medical Director Mark Swanson MD, proposing that the Miami Children's Cardiac Team help rebuild the Arnold Palmer Heart Program.[57]Arnold Palmer, the hospital's founder, approved of the plan, and used his considerable influence to finance the effort. The Congenital Heart Institute at Miami Children's Hospital and Arnold Palmer Hospital was created, with Redmond Burke and Evan Zahn acting as Co-Directors. The synthesis of Burke's work was to achieve resonance within a congenital heart team, a condition where every member of the team was driven by a common desire to reduce therapeutic trauma.[58] To attain this resonance, the team continues to develop techniques in intensive care, information management, interventional catheterization, and minimally invasive surgery. The human side of Burke's congenital heart team at Nicklaus Children's Hospital has been described in parent's websites,[59] and in the media.[60] Immediately after Hurricane Maria in 2017, Burke and colleagues Kristine Guleserian MD, Anthony Rossi MD, and Darline Santana-Acosta, MD worked with physicians in Puerto Rico to transport newborn babies with critical heart defects to Miami for urgent surgical care.[61]
Television
Burke was cast as the host of the ABC network television reality program Miracle Workers, which first aired March 6, 2006.[62] The program followed patients through complex medical treatments, showing the technical and emotional aspects of modern medical care.[63] The program was controversial, as it potentially induced patients to give up their privacy in return for excellent medical care. Reviews were mixed, some finding the program "inspirational and informative" [64] and others finding the emotional content to be inappropriate. Burke wrestled with the ethical conflicts of a medical reality TV show. Burke has appeared on CNN (1996),[65]Good Morning America (1997, 2006),[66]The Today Show (1997), CNN Showbiz Tonight (March 8, 2006),[67]Extra (2006) and Entertainment Tonight (1996) to describe novel medical achievements. Citrix, an international computer networking company, used Redmond Burke's experience with information technology to highlight their concept of on demand information - "for your life's work".[68] Creative media teams have developed compelling connections between the Miami Children's Hospital Congenital Heart Surgery Team, and innovations in Information Technology. [69]
Print and press
Boston Herald - Boston, Ma. Merry Christmas, New England Family love is best gift of all.[70]
Boston Herald - Boston, Ma. One tough kid tugs at grandfather's tender heart.[71]
Sun Sentinel - Fort Lauderdale: Glad to be back: Last year, Kevin Stenmark had heart surgery. This year he pitched a no-hitter.[72]
Associated Press: Doctors Risk Storm to Retrieve Heart For Miami Girl, 14, October 9, 1996 [75]
Sun Sentinel, Broward Metro Edition, Heart Surgery is Big Step for Infant.[76]
Computerworld: Now we're talking: speech technologies are moving far beyond call centers and into critical corporate applications such as search and security, by Drew Robb, October 2, 2006 [77]
Cardiothoracic surgery is the field of medicine involved in surgical treatment of organs inside the thoracic cavity — generally treatment of conditions of the heart, lungs, and other pleural or mediastinal structures.
Pectus excavatum is a structural deformity of the anterior thoracic wall in which the sternum and rib cage are shaped abnormally. This produces a caved-in or sunken appearance of the chest. It can either be present at birth or develop after puberty.
Cardiac surgery, or cardiovascular surgery, is surgery on the heart or great vessels performed by cardiac surgeons. It is often used to treat complications of ischemic heart disease ; to correct congenital heart disease; or to treat valvular heart disease from various causes, including endocarditis, rheumatic heart disease, and atherosclerosis. It also includes heart transplantation.
Endoscopic thoracic sympathectomy (ETS) is a surgical procedure in which a portion of the sympathetic nerve trunk in the thoracic region is destroyed. ETS is used to treat excessive sweating in certain parts of the body, facial blushing, Raynaud's disease and reflex sympathetic dystrophy. By far the most common complaint treated with ETS is sweaty palms. The intervention is controversial and illegal in some jurisdictions. Like any surgical procedure, it has risks; the endoscopic sympathetic block (ESB) procedure and those procedures that affect fewer nerves have lower risks.
Hypoplastic left heart syndrome (HLHS) is a rare congenital heart defect in which the left side of the heart is severely underdeveloped and incapable of supporting the systemic circulation. It is estimated to account for 2-3% of all congenital heart disease. Early signs and symptoms include poor feeding, cyanosis, and diminished pulse in the extremities. The etiology is believed to be multifactorial resulting from a combination of genetic mutations and defects resulting in altered blood flow in the heart. Several structures can be affected including the left ventricle, aorta, aortic valve, or mitral valve all resulting in decreased systemic blood flow.
Atrioventricular septal defect (AVSD) or atrioventricular canal defect (AVCD), also known as "common atrioventricular canal" or "endocardial cushion defect" (ECD), is characterized by a deficiency of the atrioventricular septum of the heart that creates connections between all four of its chambers. It is a very specific combination of 3 defects:
Median sternotomy is a type of surgical procedure in which a vertical inline incision is made along the sternum, after which the sternum itself is divided using a sternal saw. This procedure provides access to the heart and lungs for surgical procedures such as heart transplant, lung transplant, corrective surgery for congenital heart defects, or coronary artery bypass surgery.
Edward Bove is an American pediatric cardiac surgeon who has worked in the University of Michigan Health System most of his career.
Cardiothoracic anesthesiology is a subspeciality of the medical practice of anesthesiology, devoted to the preoperative, intraoperative, and postoperative care of adult and pediatric patients undergoing cardiothoracic surgery and related invasive procedures.
Anomalous left coronary artery from the pulmonary artery is a rare congenital anomaly occurring in approximately 1 in 300,000 liveborn children. The diagnosis comprises between 0.24 and 0.46% of all cases of congenital heart disease. The anomalous left coronary artery (LCA) usually arises from the pulmonary artery instead of the aortic sinus. In fetal life, the high pressure in the pulmonic artery and the fetal shunts enable oxygen-rich blood to flow in the LCA. By the time of birth, the pressure will decrease in the pulmonic artery and the child will have a postnatal circulation. The myocardium which is supplied by the LCA, will therefore be dependent on collateral blood flow from the other coronary arteries, mainly the RCA. Because the pressure in RCA exceeds the pressure in LCA a collateral circulation will increase. This situation ultimately can lead to blood flowing from the RCA into the LCA retrograde and into the pulmonary artery, thus forming a left-to-right shunt.
Cardiac fibroma, also known as cardiac fibromatosis, cardiac fibrous hamartoma, fibroelastic hamartoma of heart and fibroma of heart is the second highest type of primary cardiac tumor seen in infants and children. This benign tumor made by connective tissue and fibroblast is largely observed in the ventricles of the heart. The left ventricle is the most common location of cardiac fibroma and accounts for approximately 57% of cardiac fibroma cases followed by the right ventricle with 27.5% of cases. Symptoms of the disease depend on the size of the tumor, its location relative to the conduction system, and whether it obstructs blood flow. Two-thirds of children with this tumor are asymptomatic, showing no signs and symptoms. Therefore the cause of cardiac fibroma is unexplained but has been associated with Gorlin Syndrome. Echocardiography is the primarily diagnostic method used to detect if an individual has cardiac fibroma. Resection of the tumor is recommended however heart transplantation is done if surgery is not possible. Overall prognosis of resection is favorable and the chance of recurrence is scarcely reported.
The Blalock–Hanlon procedure was created by Alfred Blalock and C. Rollins Hanlon. It was described in 1950. Alfred Blalock was an American surgeon most known for his work on the Blue Baby syndrome. C. Rollins Hanlon was also an American surgeon but was best known for his work in cardiology. The procedure that these two men created, known as the Blalock–Hanlon procedure, was a new concept termed atrial septectomy. This procedure had been experimented on the right atrium of dogs before Dr. Blalock and Dr. Hanlon had performed it on humans.
Richard Lee is a cardiac surgeon in St. Louis, Missouri, who helped pioneer a staged Hybrid Maze, a procedure for atrial fibrillation or AFIB. combining surgery and catheter based approaches.
Nina Starr Braunwald (1928–1992) was an American thoracic surgeon and medical researcher who was among the first women to perform open-heart surgery. She was also the first woman to be certified by the American Board of Thoracic Surgery, and the first to be elected to the American Association for Thoracic Surgery. In 1960, at the age of 32, she led the operative team at the U.S. National Institutes of Health (NIH) that implanted the first successful artificial mitral human heart valve replacement, which she had designed and fabricated. She died in August 1992 in Weston, Massachusetts, after a career that included prominent appointments at the NIH, University of California, San Diego, Harvard Medical School, and Brigham and Women's Hospital.
Philip Caves (1940–1978) was an Irish cardiothoracic surgeon. In 1972, while at Stanford University, he pioneered the use of the bioptome and transvenous endomyocardial biopsy in the early diagnosis of heart transplant rejection. It was considered the most significant advance in antirejection therapy of the time. Awarded the British American Research Fellowship in 1971, Caves worked with pioneering cardiothoracic surgeon Norman Shumway at Stanford and became staff surgeon leading the transplant programme by 1973. A year later he went to Edinburgh as a senior lecturer in cardiac surgery, where he became particularly interested in pediatric cardiac surgery.
Willis John Potts was an American pediatric surgeon and one of the earliest physicians to focus on the surgical treatment of heart problems in children. Potts set up one of the country's first pediatric surgery programs at Children's Memorial Hospital in Chicago.
Bullectomy is a surgical procedure in which dilated air-spaces or bullae in lung parenchyma are removed. Common causes of dilated air-spaces include chronic obstructive pulmonary disease and emphysema. Patients with giant bullae filling half the thoracic volume and compressing relatively normal adjacent parenchyma are recommended for bullectomy. It is also indicated in severe dyspnea, repeated respiratory infections and spontaneous pneumothorax. The size of dilated air-spaces or bullae volume is the most important factor in relation to ventilator capacity post-bullectomy. In cases where the size of bullae are enlarged, bullectomy is indicated if the percentage of forced expiratory volume in one second(FEV1%) is greater than 40% and the regional ventilation over volume dynamic(V/V Dynamic) is greater than 0.5.
Absent pulmonary valve syndrome(APVS) is a congenital heart defect that occurs when the flaps of the pulmonary valve do not develop or are severely underdeveloped (hypoplasia) resulting in aneurysms (dilation) of the pulmonary arteries and softening of the trachea and bronchi (tracheobronchomalacia). Usually, APVS occurs together with other congenital heart defects, most commonly ventricular septal defect and right ventricular outflow tract obstruction. It is sometimes considered a variant of Tetralogy of Fallot. The first case of absent pulmonary valve syndrome was reported Crampton in 1830.
The Yasui procedure is a pediatric heart operation used to bypass the left ventricular outflow tract (LVOT) that combines the aortic repair of the Norwood procedure and a shunt similar to that used in the Rastelli procedure in a single operation. It is used to repair defects that result in the physiology of hypoplastic left heart syndrome even though both ventricles are functioning normally. These defects are common in DiGeorge syndrome and include interrupted aortic arch and LVOT obstruction (IAA/LVOTO); aortic atresia-severe stenosis with ventricular septal defect (AA/VSD); and aortic atresia with interrupted aortic arch and aortopulmonary window. This procedure allows the surgeon to keep the left ventricle connected to the systemic circulation while using the pulmonary valve as its outflow valve, by connecting them through the ventricular septal defect. The Yasui procedure includes a modified Damus–Kaye–Stansel procedure to connect the aortic and pulmonary roots, allowing the coronary arteries to remain perfused. It was first described in 1987.
Dr. Anil Bhan is the Chairman of Cardiac Surgery Heart Institute, Medanta Hospital, Gurugram, India. He graduated from Medical College Srinagar. He has the largest experience in aortic surgery in India since he has designed and developed more than 50 surgical instruments in the field of cardiac surgery. He was one of the team members to perform the first successful heart transplant in India in1994. He served as a co-founder of Max Heart and Vascular Institute, Saket, New Delhi, Director and Chief Co-Ordinator, Cardio thoracic and Vascular Surgery, MHVI, Saket.Additional Professor, Cardiothoracic Surgery and Vascular Surgery, AIIMS, New Delhi.
↑ Mazza IL, Jacobs JP, Aldousany A, Chang AC, Burke RP (July 1998). "Video-assisted cardioscopy for left ventricular thrombectomy in a child". The Annals of Thoracic Surgery. 66 (1): 248–50. doi:10.1016/S0003-4975(98)00366-X. PMID9692476.
↑ Jacobs JP, Quintessenza JA, Andrews T, etal. (September 1999). "Tracheal allograft reconstruction: the total North American and worldwide pediatric experiences". The Annals of Thoracic Surgery. 68 (3): 1043–51, discussion 1052. doi:10.1016/S0003-4975(99)00878-4. PMID10510005.
↑ Van Smith C, Jacobs JP, Burke RP (March 1998). "Minimally invasive diaphragm plication in an infant". The Annals of Thoracic Surgery. 65 (3): 842–4. doi:10.1016/S0003-4975(98)00008-3. PMID9527232.
↑ Miyaji K, Hannan RL, Ojito JW, White JA, Burke RP (March 2000). "The Ross operation in a Jehovah's Witness: a paradigm for heart surgery in children without transfusion". The Annals of Thoracic Surgery. 69 (3): 935–7. doi:10.1016/S0003-4975(99)01405-8. PMID10750791.
↑ Ojito JW, McConaghey T, Jacobs JP, Burke RP (June 1997). "Rapid pediatric cardiopulmonary support system". The Journal of Extra-corporeal Technology. 29 (2): 96–9. PMID10168538.
↑ Lopez L, Mercer-Rosa L, Zahn EM, Altman NR, Dubois R, Burke RP (August 2006). "The "hinge-twist" technique for anomalous origin of the left coronary artery". The Annals of Thoracic Surgery. 82 (2): e19–21. doi:10.1016/j.athoracsur.2006.05.018. PMID16863730.
↑ Fishberger, Steve; Anthony Rossi; Juan Bolivar; Leo Lopez; Robert Hannan; Redmond Burke (31 Oct 2007). "Congenital cardiac surgery without routine placement of wires for temporary pacing". Cardiology in the Young. 18 (1): 96–9. doi:10.1017/S1047951107001424. PMID17977466. S2CID6939177.
↑ Burke, Redmond; Robert Hannan; Jennifer Zabinsky; Christopher Tirotta; Evan Zahn (2009). "Hybrid Ventricular Decompression in Pulmonary Atresia with Intact Septum". The Annals of Thoracic Surgery. 88 (2): 688–689. doi:10.1016/j.athoracsur.2008.11.063. PMID19632452.
↑ Burke RP, White JA (2004). "Internet rounds: a congenital heart surgeon's Web log". Seminars in Thoracic and Cardiovascular Surgery. 16 (3): 283–92. doi:10.1053/j.semtcvs.2004.08.012. PMID15619198.
↑ Burke, Redmond P.; Rossi, Anthony F.; Wilner, Bryan R.; Hannan, Robert L.; Zabinsky, Jennifer A.; White, Jeffrey A. (11 May 2010). "Transforming patient and family access to medical information: utilisation patterns of a patient-accessible electronic health record". Cardiology in the Young. 20 (5): 477–484. doi:10.1017/S1047951110000363. PMID20456816. S2CID10153966.
↑ Burke, Redmond (2001). "Reducing the Trauma of Congenital Heart Surgery". Seminars in Thoracic and Cardiovascular Surgery. Pediatric Cardiac Surgery Annual. 4: 216–228. doi:10.1053/tc.2001.24653. PMID11460986.
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