Dr. Marc Ruel reflects on 11 years as chief of cardiac surgery

Dr. Marc Ruel led as head of cardiac surgery at the University of Ottawa Heart Institute (UOHI) for 11 years. On September 15, 2023, his second mandate at the helm of heart surgery ended, and his successor, Dr. Pierre Voisine, assumed his role as the UOHI’s new visionary for cardiac surgery.

Dr. Ruel has largely shaped the division’s approach to nearly all aspects of patient care while driving translational and clinical research outputs, advanced surgical education, and new forays in surgical innovation.

In a recent interview with The Beat, we asked the cardiac surgeon and former president of the Canadian Cardiovascular Society to reflect on more than a decade as the leader of cardiac surgery at the country’s most esteemed cardiac care facility.

The Beat: What motivated you to pursue a career in cardiac surgery?
Dr. Marc Ruel: I have always thought to lead in this field is like being the captain of a ship. You face waters that can be treacherous at times. You have to keep your team together. You must navigate through hardship and challenges and, at other times, enjoy beautiful sailings. This is one aspect of cardiac surgery I love. As a trainee doctor, every opportunity I had to operate on or near the heart was like magic. Even now, every time I step into the operating room, a magic emanates. But what truly drives me forward to this day is being able to fix a very serious health problem and improve both the quantity and quality of life for a patient. As a cardiac surgeon, this is one of the most beautiful things.

How do you feel now that your mandate as head of the Division of Cardiac Surgery has come to an end?
We have built a strong division of which I am extremely proud. Our colleagues and staff continue to support our mission. We provide timely access to surgery resulting in great outcomes, and innovative procedures supported by a strong research and education structure. I think this is the beauty of the Heart Institute. It’s something I wouldn’t trade for anything else. It has been a wonderful privilege for me to lead this outstanding division of talented surgeons and world-class team members.

Can you share some major accomplishments and milestones that you achieved during your tenure as the head of cardiac surgery?
Over the last decade, our Division of Cardiac Surgery has authored or co-authored close to 800 papers. We’ve secured large grants to support groundbreaking research. We led Canada in establishing the Society of Thoracic Surgeons National Database, which is by far the most comprehensive medical database in the world. We’ve grown in terms of access and outreach, too. We now receive referrals from coast to coast to coast because of the innovative platform we’ve built, which is unique to all centres in the country. We’re the only institution routinely performing minimally invasive valve and complex coronary surgery; the first institution with a dedicated robotic program for cardiac surgery; the only ones who routinely repair both mitral and aortic valves. Over the last 11 years, we’ve experienced remarkable growth in structural heart interventions and open-heart procedures. We have also expanded our footprint and ability to provide top care for patients with a brand-new surgical infrastructure — an ultramodern critical care tower for all life-saving services. Our facilities are among the most modern and innovative infrastructures for cardiac surgery in the world. It’s been a great ride. I am so happy with everything we have accomplished together.   

Can you discuss significant advancements or innovations in cardiac surgical techniques that you have introduced during your time as the head of cardiac surgery?
I’ve always found that while cardiac surgery is effective, robust, and safe, it can be very invasive. That struck me even as a resident. Frankly, I couldn’t wait to do things differently. I am elated to tell you that several of our division members today are minimally invasive cardiac surgeons. We perform hundreds of less invasive cardiac surgeries yearly. Our program is world-leading, especially on the coronary side. We developed an innovative procedure that enables us to perform multiple coronary bypasses without splitting the breast bone. Other surgeons are now emulating this less invasive, non-sternotomy approach to coronary and valve procedures. A shift is happening in cardiac surgery to less invasive approaches, and we are one of the key innovators on the world scene.

How did you foster collaboration and interdisciplinary teamwork within the Division of Cardiac Surgery to enhance patient care and outcomes?
The Heart Institute has been an innovator in terms of its heart teams concept, which is essentially bringing together divisions and specialties for patient-centred care. Working in silos is a flawed concept in medicine and especially in cardiovascular care. We established the Dr. T.G. Mesana Endowed Team Chair in Heart Valve Disease, which is co-held by Dr. David Messika-Zeitoun, a cardiologist, and Dr. Vincent Chan, a cardiac surgeon. If you centre everything around a specialty, your perspective is limited. However, when your thinking revolves around disease processes, and when you unite specialists with varying viewpoints and skill sets, the result is more informed patient-centred discussions about the best approach to treating each patient. This interdisciplinary teamwork is essential for improved patient care and outcomes.

Can you tell us about an initiative you implemented recently of which you are proud?
Pre-COVID, we were regularly operating on high-risk patients from Newfoundland at the Heart Institute. When COVID hit, these referrals suddenly became impossible, and patients suffered. Hospitals in Ontario, including our institution, were limited to performing only emergency surgeries. In Newfoundland, this meant many patients were not receiving the urgent care they needed. Our solution was to send our senior surgeons to Newfoundland to perform these surgeries. We established a program that has been an overwhelming success. We have been sending a senior surgeon from Ottawa to Newfoundland to perform surgeries monthly since. We’ve operated on hundreds of patients in Newfoundland and in Ottawa. Our teams are now collaborating to perform complex or less invasive surgeries, help with their recruitment, conduct joint research, and train the next generation of surgeons.  

Can you discuss any research projects or clinical trials that you were involved in during your time as the head of cardiac surgery, and their potential impact on the field?
I am very proud to have founded the BEaTS (BioEngineering and Therapeutic Solutions) Research Program, which is now expertly led by Dr. Erik Suuronen and Dr. Emilio Alarcon. This is a fantastic example of translational research. On the clinical side, my aspiration has always been to make bypass surgery safer, more effective and less invasive. We’ve published several landmark papers on this subject, regarding the first development of multi-vessel minimally invasive bypass surgery, and exploring ways to optimize the patency of bypass grafts. Recently, we received a $3M grant from the Canadian Institutes of Health Research to continue this important work. We want to build the best minimally invasive coronary surgery program in the world. I know the Heart Institute is the right place to do this.    

How have you engaged with the local community and raised awareness about cardiovascular health during your tenure?
Fundraising and telling the Heart Institute’s story is something I greatly enjoy. One great example of an initiative we’ve developed with the support from our community is our cardiac surgical robotic program, which came about entirely from philanthropic funds. Our community is an essential partner; our success is their success and, frankly, we couldn’t do what we do without them. We hope what we do at the Heart Institute is good for our community, and we respect and make the best use of every amount that is given. We are thankful and grateful to have their ongoing support.

As the outgoing head, what advice would you give to your successor in terms of managing the Division of Cardiac Surgery and ensuring continued excellence in patient care and research?
Always do what is best for patients, and never let anything get in the way of that. The leadership and the infrastructure we have at the Heart Institute is strongly geared toward excellence. I know Pierre very well and I am certain that he will never lose sight of this. If you ask me about what our culture is, in a nutshell, I will tell you, “The patient always comes first. Second, it is essential to treat our team like a family, and to remember we are all in this together. Third, it is important to consider the Heart Institute as our family home. This is where our ability to provide excellence in patient care originates.”

Can you share any future directions or aspirations that you envision for the University of Ottawa Heart Institute’s Division of Cardiac Surgery, and how you believe they will contribute to advancing patient care and outcomes?
Dr. Voisine will approach the role with his strengths and his own style, and that is a beautiful thing. Our goal is for the Division of Cardiac Surgery at the Heart Institute to continue to provide the best patient care and to have one of the very top cardiac surgery divisions in the world. I know that Pierre will pursue this mission.

As for me, I believe the work we’ve accomplished in these last 11 years has made a positive and lasting impact—the Heart Institute is the most recognized it has been, and this is voiced externally on many platforms. I am delighted to pass on the leadership to Dr. Pierre Voisine. I know that he will take cardiac surgery to new heights.

Dr. Marc Ruel remains at the University of Ottawa Heart Institute as a cardiac surgeon, professor, and as the endowed chair of minimally invasive cardiac research in the Division of Cardiac Surgery. He is dedicated to building the best minimally invasive cardiac surgery program in the world.