LEAVING A LEGACY
Eminent surgeon who built cardiac tumor program is passing the torch
The sound of Dr. Michael Reardon’s cellphone filled his 14th-floor corner office at Houston Methodist Hospital, interrupting his small talk with Jesse Shinault, a 71-year-old Louisiana man anxiously awaiting the doctor’s assessment of the tumor inside his heart.
Reardon, already late to see other patients, took the call from behind his Lshaped desk. A doctor on the other end needed help with a man in the operating room.
“It would be best if it’s not me,” Reardon said. “... But if he’s in a hole, call me and I’ll come dig him out.”
The 69-year-old Reardon hung up and apologized to Shinault. “That’s the problem with being the oldest guy here,” he said. “(People say) ‘Hey this guy is having trouble. Can you help him?’ Well, yeah, I can.”
Trained by legendary Drs. Denton Cooley and Michael DeBakey, Reardon has come to be relied upon as one of the most experienced heart surgeons in the Texas Medical Center, and one of the pioneering doctors who helped put the city on the map during an era of cardiac surgery innovations.
In 1998, he performed the first successful cardiac autotransplant for a cancerous heart tumor, in which he removed a patient’s heart, cut out the malignant tumor and reimplanted the repaired organ in the patient’s body. He remains one of the few doctors in the world who can perform this difficult and rarely needed operation.
Gray-haired and energetic, Reardon’s work consumes him. He can be seen walking through the hospital as early as 5 a.m. The Houston native long has planned to begin stepping away from treating patients when he turns 70, and he does not want to see the cardiac tumor program he built over 30 years disappear. Those patients have few options for what often is a death sentence.
So now, he is taking on the daunting task of finding and training a successor to handle the complex cases for which he has become known.
“I’m pretty sure when I die nobody is going to care how many papers I wrote or how many trials I did,”
Reardon said. “But all the people I’ve helped in my career, the residents, the patients … they’re going to remember me. Those are the things that are going to really count. So, my goal right now is to build a succession plan and leave behind a legacy. I don’t want to operate until I fall over dead.”
Experience needed
Shinault had driven from the Shreveport area for his appointment with Reardon on Aug. 18, 2022, hoping for some relief after what had been a difficult year. He was diagnosed with prostate cancer. Doctors removed it, but scans revealed a benign tumor, unrelated to the cancer, growing inside his heart.
Louisiana surgeons took out pieces of the tumor to prevent Shinault from suffering a massive heart attack, but they could not remove the entire mass. Reardon was his last hope.
Tumors that originate in the heart, known as primary cardiac tumors, affect up to one quarter of 1 percent of the population, according to the National Cancer Institute. Surgeons need considerable experience to remove them. The tumors often are located in the left atrium, positioned in the back of the heart, and require doctors to cut away the organ, either partly or completely, to see it. Depending on the aggressiveness of the tumor, the surgeons may have to rebuild large sections of the organ with the outer sac of a cow heart.
If heart valve replacement can be compared to replacing the door of a home, cardiac tumor surgery is like rebuilding the foundation. The mortality rate during surgery can be up to 50 percent, if doctors have to remove the lung and heart to access the tumor. For malignant cardiac tumors, post-operative survival is measured in months, not years.
Other experienced heart surgeons are not always willing to accept that risk, said Dr. Shanda Blackmon, a thoracic surgeon at the Mayo Clinic who trained under Reardon in the early 2000s.
“Mike was always willing to take on those cases where, perhaps, someone had a 100 percent chance of dying if they didn’t have the surgery,” she said. “But, yeah, he knew the surgery was very high-risk.”
Reardon estimates he has operated on more than 400 primary cardiac tumors in his career. He is known for his experience with the malignant kind, but even the more common benign tumors can cause heart failure and require a seasoned physician.
The doctor explained the surgical challenges to Shinault on Aug. 18 in his office, decorated with news clippings of the 1998 autotransplant with Cooley, a “Come and Take It” flag and a replica of one of the original tri-color flags of Texas.
“That (tumor) is sometimes hard to see unless you use some special tricks,” Reardon said, pointing at a small black dot wobbling in Shinault’s chest on a CT scan.
“You got the tricks?” Shinault asked, leaning over Reardon’s desk.
“We got the tricks,” Reardon said.
Shinault sat back and started to cry.
“You don’t know how much better you made me feel right there.”
A snag in the plan
Reardon is respected not just for his technical skill, but for his relationships with patients and younger doctors, and his eagerness to work across different disciplines. He created the heart tumor program in partnership with MD Anderson Cancer Center, where physicians and cancer scientists meet monthly to brainstorm advances and treatments. He was willing to explore minimally invasive heart surgery techniques involving catheters — a field for which he is now an international leader — and work with Methodist’s cardiology department at a time when many surgeons would not, Blackmon said.
“He was able to build bridges like nobody else could,” Blackmon said.
It would be difficult enough to find a surgeon who could fill his role, but the departure of Dr. Tom MacGillivray last year further complicated Reardon’s succession plan.
MacGillivray had been the ideal candidate. A national leader in adult congenital heart disease, he was recruited from Boston to Houston Methodist to become chief of cardiac surgery and thoracic transplant in 2017.
He partnered with Reardon on roughly 30 cardiac tumor surgeries. Then MacGillivray announced he would be taking a job at MedStar Heart & Vascular Institute in Washington, D.C., which would put him closer to his family in Boston. MacGillivray was sad to leave Reardon, whom he said was the among the best surgeons he has worked with.
“There were times when I would look at a tumor and say, ‘I don’t think we’re gonna be able to do this,’ ” he said. “Mike would always have a technique or an experience or a trick to make it happen.”
Reardon and MacGillivray likely would have performed Shinault’s surgery together. Instead, Reardon was joined by a young fellow for the September 2022 operation. Both physicians cut away many of the vessels and arteries around Shinault’s heart and rolled the organ onto its side within Shinault’s chest cavity. They removed what was left of the tumor and only needed to rebuild a small patch of extracted tissue.
The operation proved to be routine for the elder surgeon. Shinault left the hospital eight days later, feeling as if a weight had been lifted.
By then, another possible successor landed on Reardon’s radar.
Dr. Marvin Atkins, a youthful 49-year-old with a calm demeanor, was hired at Methodist’s Sugar Land campus in 2018 and recently became director of its aortic surgery division. He had experience with both cardiac and vascular surgery, two distinct specialties that Reardon felt made him well-suited to take the reins.
Atkins, who had trained at Texas A&M, Harvard Medical School and the University of Pennsylvania, relished the challenge. He enjoyed the creativity involved in the procedure. He had operated on a few benign heart tumors before, but lacked exposure to the wide range of patients who traveled to see Reardon.
Months later, a woman with a malignant cardiac tumor would test his ability.
Taking over
Suzette Stover, 65, did not fear death. A former in-home caregiver for seniors, she watched two of her patients die. Cancer had taken her father, 10 of his 12 siblings and her cousin. She had wrestled with her own uterine cancer diagnosis for two years.
By early February, her cancer had spread. Doctors discovered a malignant tumor filling her heart’s left atrium, blocking a valve. Nodules also appeared on her lung. Surgery with Reardon would help her stave off heart failure and give her a chance to undergo chemotherapy on the remaining cancer.
“I figure I’d try to do everything I can to stay alive,” Stover said, sitting in her Methodist hospital room with her husband of nearly 30 years a few days before her Feb. 21 operation.
Atkins would lead the surgery, with a fellow assisting and Reardon guiding from the other side of the table. At that point, Atkins had performed about 10 operations on cardiac tumors with Reardon. He expected a challenge with Stover.
Her tumor was roughly the size of a large avocado. Atkins would have to prevent pieces from flaking off into the bloodstream, which could trigger a stroke. He also had to work efficiently, to ensure Stover did not have to rely on the heartlung machine for too long.
There were questions about how deep the tumor might be protruding into a vein, and how much reconstruction could be necessary. The surgeons would have to see for themselves.
At 8:30 a.m. in a bustling Operating Room 10, Atkins began cutting down the middle of the anesthetized woman’s chest. Within 45 minutes, he had separated her breastbone with a metal clamp, exposed the beating heart, and, with Reardon’s help, diverted all of her blood away from the heart with a series of tubes that spilled out of her chest.
For a moment, Atkins bobbed his head to Miley Cyrus’ “Flowers,” playing quietly on speakers. He injected a solution to temporarily stop the heart, then methodically cut away enough arteries and veins to roll the organ over and get his first look inside the left atrium.
“There’s the main tumor,” Reardon said.
The smooth, bright-pink ball spilled out of the pulmonary vein, which sends blood from the lungs to the heart, and floated freely inside the chamber. Atkins began to sever the part of the tumor connected to the vein. “Take your time,” Reardon said quietly. Atkins was done in seconds. Reardon fished out the mass with his hand and plopped it into a clear bowl. Without breaking focus, Atkins continued to probe into the vein, attempting to free the remnants stuck inside.
“I think you’ve got about all you’re really going to get out of that, Marvin,” Reardon said.
Atkins had been working quietly for about an hour and a half — “lightning” fast for a surgery so complex, Reardon said — before he began sewing the heart back together. Reconstruction was not necessary. The surgical team had accomplished its goal of buying Stover time, but she would need additional treatment in the coming months to address the cancer lingering in the rest of her body.
Reardon is gaining confidence in his apprentice. When he turns 70 this summer, he plans to take his name off the on-call schedule and spend more time with his wife of nearly 50 years and four grandkids. He will continue to operate with Atkins and travel the world to talk about his research and experience with minimally invasive heart valve replacement surgery.
“I think he could take over the program right now,” Reardon said of Atkins, weeks after Stover’s surgery. “But I’d like to see him do 50 or 60 cases before I’m gone and really be kind of the world expert on this.”
Atkins said he feels he will be comfortable performing the surgeries on his own within the next year.
“Mike is a great surgeon, a great mentor and a great teacher,” Atkins said. “To have the opportunity to carry on the program he’s built is very humbling. I’ve got a big task ahead of me.”
After the surgeries …
Jesse Shinault said a heart test in mid-March showed he remains cancer free, with no sign of tumor regrowth. He is not fully recovered from his surgery yet. Sneezing and coughing still causes pain in his chest, and his heart rate is slower than normal. He is getting back to light activity, however, tending to the cows on his and his wife’s 40-acre plot in Frierson, La., about 30 minutes southeast of Shreveport.
Suzette Stover returned to her Houston apartment near the Medical Center after four days. She recently saw an oncologist, who wants her to start chemotherapy next month to address the nodules in her right and left lungs. She is regaining strength every day. She can now walk her dog, a cocker spaniel named Caesar, half a block down the street.