Innovating heart health by connecting research and clinical care


by Michael Mack, MD and William Gray, DO

Apr 9, 2021

Meet Drs. Gray and Mack — two physicians who have dedicated their lives to taking care of people’s hearts. They’re part of a cardiovascular research team that’s woven across Baylor Scott & White and has for years spearheaded changes and improvements in how heart and lung conditions are treated. We sat down with this duo to talk about how their work together has forever changed the landscape of open heart surgery.

William Gray, DO, is a physician on the medical staff at Baylor Scott and White Medical Center – College Station. Dr. Gray first joined the Baylor Scott & White family years ago in Plano where he met and studied under heart surgeon Michael Mack, MD.

Michael Mack, MD, is a pioneer in the field of cardiothoracic surgery and a world-renowned physician. He is the medical director of Cardiothoracic Surgery for Baylor Scott & White Health and the chairman of Baylor Scott & White The Heart Hospital – Plano Research Center. Throughout his medical career, Dr. Mack has performed more than 7,000 cardiac surgeries, with more than 3,000 involving heart valve procedures. 

Why is the connection between research and clinical care so important?

Dr. Mack: For one, we have a responsibility to our patients to give them access to options. It’s that simple. The bond between clinical practice and research helps create that access in a safe and regulated environment. Another one of the overarching components here is the level of education and understanding in a procedure, in a medication, in a therapeutic approach that research provides. It helps us understand all the nuances, the data, the variables that go into that option, so we can ask the right questions and provide the most informed recommendations to patients for those options that receive FDA approval.

That is exactly what we experienced with TAVR. It received FDA approval for certain patients, but we had the advantage of having been involved in the research and knew so much more about the procedure down to these granular details right out of the gate.

What was the TAVR trial about?

Dr. Gray: Aortic stenosis — where arteries sending blood through the heart narrow — is a prime example of structural heart disease. For quite some time, the brand standard for treating aortic stenosis has been open heart surgery.

Baylor Scott & White got involved in research around a procedure called TAVR (Transcatheter Aortic Valve Replacement) very early in its inception. The procedure essentially was studied as an alternative to open heart surgery. TAVR threads a device through an artery in the leg and replaces the damaged valve. That approach offered a big contrast to open heart surgery which, while effective, was incredibly taxing on the body.

Dr. Mack: TAVR was developed because open heart surgery takes a toll on patients. In many cases, the recovery needed just to get back to a normal baseline of activity can take weeks. It’s important to stress that there’s no flaw with open heart surgery in terms of results. This has been the brand standard for 60 years. But if we can find an option that allows us to complete the same task with less cutting, less recovery time and the same outcomes, why not explore that potential?

How are you working to expand access to TAVR in Texas?

Dr. Mack: This really goes back to the point about why blending clinical care with research is something we feel so strongly about. We are able to deliver our patients access to the most cutting edge, advanced technology possible. Because of all our experience in research and because of the ability to access this care, we now have six programs, including in College Station, that are able to provide TAVR. We are the largest provider of this therapy in Texas and the fourth largest in the country.

Being involved in these research trials certainly allows us to bring new therapy to patients and to have a front row seat in learning about the therapy, so we can make the most informed decision about what therapy is best for our patients.

Dr. Gray: I had to take many patients from the Brazos Valley out of Bryan/College Station and over to Austin to get TAVR’s done before, or they had to drive all the way to Houston. They were happy that they got that they got access to the treatment and got their valve replaced, but it was still very inconvenient in terms of the travel time. When you don’t feel well, you barely want to get in the car and drive to your doctor, much less drive a few hours away. With the support and help of Dr. Mack and the Central Texas crew, we were able to establish the program here in College Station and basically cut that travel problem out.

Is TAVR the final answer?

Dr. Mack: TAVR will continue to evolve and get better. Probably the most common question that we ask is, “Well, if TAVR is so good, why isn’t it for everybody?” The reason is that it has only been studied in elderly patients. We don’t know how long the TAVR valves last and we don’t know if they last as long as the surgical valves do. They’re basically made of the same material but are of a different design. When you’re in your 50s and 60s, you need a valve to last hopefully 25 or 30 years. So, the main question we have right now for a 60-year-old patient coming in is, is this the best valve for them? Right now, we still recommend surgery in those patients.

So, there’s still a lot of study that can and should be done. It’s a great valve, but is it a perfect valve? I think there’s always a way to make something better.

Dr. Gray: This is what research is about — continuing to improve upon what exists, to increase the options, enhance the choices and most importantly, get people more access to the care they need. We take what we see day in and day out clinically and treat as best as we can based on what’s available, then we turn to research and see what we can do to help make more available.

What motivates you to keep pushing your research forward amid challenges?

Dr. Mack: Research is all about operating around challenges — fixing problems and finding solutions to questions that exist related to a patient or a condition. I’ve been doing this for 45 years now and focusing on the science continues to be a comfort. You also have to remind yourself of the wins, frankly. Not every study creates an FDA-approved drug or clears the way for the next TAVR. But you find answers even at more grassroots levels. You help people by giving them more time, giving them hope. You’ve got to embrace those wins.

Dr. Gray: I had the distinct honor and privilege of caring for a patient who was a World War II hero. He recently died and his family wrote me a letter thanking me for giving him six more years of life to meet his grandchildren and finish writing a book. We can talk about research and we can talk about all these new technologies and what have you, but it really comes down to the patients that we’re treating. It all comes down to giving these patients that kind of life and helping them with another year, or another six, like we were able to do with this gentleman.  

Learn more about ongoing heart and vascular research through the Baylor Scott & White Research Institute.

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