Adelino Leite Moreira, Cardiac Surgeon at CUF Porto and CUF Coimbra Hospitals - “[…] in this speciality, the line between life and death is a fine one, there is no margin for error.”

Somewhere between the precision of science and the urgencies of life, AdelinoLeite Moreira, cardiac surgeon at CUF Porto and CUF Coimbra Hospitals, Director of the Cardiothoracic Surgery Department at the São João University Hospital and Full Professor at the Faculty of Medicine of the University of Porto, has carved out a career in whichacademic rigour crosses paths with clinical excellence. Speaking with Villas&Golfe, he discussed knowledge, innovation and a human perspective on medicine, particularly in a speciality where the heart and lungs are of vital importance.

Your career in medicine has taken you to a particularly demanding and life-saving field. What drove you to choose cardiothoracic surgery? 
I’ve always been somebody who was much more interested in the sciences than the humanities. I’ve always really enjoyed figuring out how things work. When I was deciding what to study, I was torn between engineering and medicine, but family expectations led me towards medicine. When I started studying medicine, I became aware of its extraordinary dimension, in human terms, but also in terms of the possibility of dealing with mechanisms. […] And I wanted to be able to make a contribution towards discovering new ones. The way I see medicine is that we understand the basic principles, the mechanisms, and build on that. Cardiology fits this model remarkably well, because the heart is like an engine. Indeed, it even has an electrical component and a mechanical one. At a certain point over the course of my academic career, I was also invited to take part in academic work related to Physiology and Cardiovascular Surgery, which I continue to this day. […] I believe that clinical and academic work complement each other, and I have mentored more than 60 PhD students. Throughout my career, I have published more than 500 scientific articles, some of which are widely cited and highly relevant, and many of which develop concepts with practical applications that objectively help patients. 

“The way I see medicine is that we understand the basic principles, the mechanisms, and build on that.”

From your experience, what are the most significant modern factors that compromise cardiovascular health? 
There is a part we are unable to control, which is ageing and genetics. But the way we live in today’s world contributes to an increased risk and incidence of cardiovascular disease. Lack of physical exercise, a sedentary lifestyle, stress, smoking, obesity and high blood pressure are the main factors, some of which are linked to a metabolic disorder involving diabetes. These are the culprits that are responsible for cardiovascular disease remaining the leading cause of death and disability in developed countries, despite countless technological advances and a decline in the number of people dying from it. The outlook for the future is troubling because, given the rising number of metabolic disorders such as obesity, diabetes and a sedentary lifestyle, there is a risk that, for the first time in human history, the next generation will live shorter lives than the one before it.

What are the most promising areas of research currently being explored in the field of cardiovascular medicine, and what technological and scientific advances have there been over the last decade? 
There are now methods that help us treat diseases earlier and more effectively, new drugs, specifically for diabetes and obesity, which help treat cardiovascular health, and a whole raft of technological innovations that make it possible for us to treat more complex, older and frailer patients by means of progressively less invasive approaches, particularly in heart surgery. I believe that Artificial Intelligence will also play an important role in the future, particularly in the early diagnosis of conditions and in guiding medical practice, but I believe that cardiac surgery, due to its complexity, will be one of the areas where it takes longer to arrive.

What daily practices do you consider to be essential for protecting the heart and lungs in the long term? 
Engaging in healthy physical activity, which doesn’t mean doing strenuous exercise, but keeping active. Eating a healthy diet, reducing intake of salt, simple sugars and animal fats, cutting down on red meat and choosing complex carbohydrates. 

“I believe that clinical and academic work complement each other[…]”

What does a good quality of life mean to you? 
For me, first and foremost, it means having time to reflect, doing what you enjoy and taking care of yourself. Quality of life and health go hand in hand. The social aspect is also very important. Spending time with others, time for your loved ones. Financial security, because extreme poverty brings neither health nor happiness.

What personal habits would you never give up? 
I try to watch what I eat. I don’t do as much physical activity as I’d like, but my work as a heart surgeon and academic is something I really enjoy and find motivating. I try to throw myself into what I love with passion every day. And when I don’t have time to exercise, I try to incorporate small habits, such as taking the stairs instead of the lift.

Throughout your career, has daily contact with human frailty changed the way you think about time and priorities in life?
Without a doubt. As a professional, I, too, have experienced increasing levels of stress over time, but these days I no longer let everyday problems and challenges have the same impact on my life. There’s a saying I use and share with my patients: a problem is only a problem until a bigger one comes along. When a patient comes to see me, I make sure to tell them exactly that. They can have a serious illness, but what’s worse is having an illness with no treatment. Surgery isn’t a death sentence, nor is it a way of dying. It’s a way of life, performed with ever-increasing safety. Of course, there are still diseases with no cure. Dealing with complex situations every day undoubtedly adds to my stress levels. But time helps us learn to manage it, to put things into perspective. Planning is also very important. Hoping for the best but preparing for the worst. As I tell my patients, I have a plan B, a plan C… Often, I lie in bed thinking about my strategy. But in this speciality, the line between life and death is a fine one, there is no margin for error.

Has there been any clinical case that has made a particular impression on you?
Several. In this field, we see the outcome of what we do very quickly, whether it is success or failure. We can all experience unsuccessful outcomes, but I can say that here at CUF, 30% of the patients I have operated on have been turned away by other institutions, both public and private, due to the complexity of their cases. Let me give you the example of a daughter who came to me in despair to present her father’s case, because he had already been turned down for surgery by other institutions and was receiving palliative care in an almost terminal condition. I assessed the situation, the patient was admitted here and, fortunately, he survived. It was a situation that was a bit delicate, even from a social point of view. They had no health insurance. They had a limited budget, and he was discharged shortly before the budget ran out. As doctors, we have to carry all of this with us. Another case involved a lady who had spent years ‘running away’ from doctors. Then the doctors were ‘running away’ from her. Eventually, she found a colleague who referred her to me. She collapsed in my consulting room with acute pulmonary oedema. She had been deemed inoperable. She went from my consulting room at CUF to the intensive care unit, where she remained until the operation. I couldn’t even extubate her. She underwent surgery, made a recovery, was referred to the consultant cardiologist, and is currently travelling the world and enjoying life. To be honest with you, I have never had a patient in this hospital who died on the operating table.

“Surgery isn’t a death sentence, nor is it a way of dying. It’s a way of life, performed with ever-increasing safety.”

These days, there is an undeniable desire to achieve longevity. If you could offer just one piece of advice to anyone hoping to live a long and fulfilling life, what would it be? 
Active and healthy ageing may be a challenge for Western Europe, which has a rapidly ageing population. I’m not talking in terms of retirement age, because that’s a matter of politics, but what I mean is that retirement shouldn’t mean inactivity. And the great challenge for society will be to make the most of these people, who are often in great shape and possess a wealth of knowledge that can be useful both to society and to themselves. They should do something they enjoy, cultivate interests that keep them active, and not succumb to social isolation. 

Text: Carla Martins
Photos: Ana Nogueira