Two Trailblazing Black Women Surgeons at Stanford Break Barriers and Save Lives
by Lynn Nichols
October 13, 2023
In the world of cardiothoracic surgery where precision, expertise, and dedication are paramount, two extraordinary women of the Stanford Medicine Department of Cardiothoracic (CT) Surgery are making their mark and shattering glass ceilings. Leah Backhus, MD, MPH, FACS, and Elan Burton, MD, MHA, have been building innovative programs and recently, in an event that might be the first of its kind, they joined forces to successfully complete a highly complex combined heart-lung tumor resection on a Stanford Healthcare patient.
Dr. Backhus: Decorated surgeon, educator, and researcher
It can be very challenging for surgeons to successfully achieve all three missions of academic medicine, clinical care, research, and education but that is exactly what Dr. Backhus is doing at Stanford where she serves as Chief of Thoracic Surgery at the Palo Alto VA Health Care System. After completing her undergraduate degree at Stanford University in 1995, she obtained her MD and trained in general surgery at the University of Southern California and then conducted her cardiothoracic surgery training at the University of California Los Angeles. In 2015, she returned to Stanford, joining the Department of Cardiothoracic Surgery, and in 2023 she was promoted to the rank of Professor.
Here at Stanford, Dr. Backhus is improving patient surgical outcomes while advancing medical knowledge. She especially enjoys training, leading, and inspiring future generations of women and minorities. To this end, she was the first woman, Black woman, and Stanford faculty member to ever receive the Dr. Dwight C. McGoon Award, a prestigious award given annually by the Thoracic Surgery Residents Association (TSRA) to honor outstanding resident education and mentorship. She has received numerous other awards and is actively involved in shaping the training and education for organized thoracic surgery groups nationally and internationally.
Dr. Backhus is an active researcher who contributes much to the field of cardiothoracic surgery. Her work has recently been featured in the Journal of American Medical Association, The American Association for Thoracic Surgery, JTCVS Open, Journal of Surgical Research, and additional peer-reviewed journals.
"Since joining our department in 2015, Dr. Backhus has consistently
distinguished herself as a highly regarded and expert surgeon,
novel researcher, and skilled teacher." - Dr. Joseph Woo
For her excellence in thoracic surgery, Dr. Backhus was named the 2023 recipient of the Extraordinary Women in Cardiothoracic Surgery Award by the Society of Thoracic Surgeons. She maintains an active clinical practice and frequently operates on patients with lung cancer, esophageal cancer, and chest wall conditions. In addition, she has published impactful research on thoracic surgery, lung cancer, and patient outcomes.
Dr. Leah Backhus
Dr. Burton: A heart surgeon with expertise and vision
Dr. Élan Burton is an outstanding cardiothoracic surgeon who practices at Stanford Health Care, the Palo Alto VA Health Care System, and Santa Clara Valley Health System. She has been recognized for her exceptional surgical skills and research advancements. Dr. Burton attended Duke University for her undergraduate degree and completed her general surgery residency at the University of Pittsburgh-Mercy in Pennsylvania. She completed two fellowships, one in cardiothoracic surgery from the University of Minnesota, and another in structural heart and endovascular surgery at the University of Maryland - Baltimore.
Dr. Burton performs all cardiac surgeries, specializing in coronary bypass grafting, valve surgery, aortic surgery, and complex reconstructions. To better serve her patients, she completed specialized training in robotic technique for minimally invasive direct coronary artery bypass (MIDCAB). This procedure enables surgical access to the heart with a smaller incision versus traditional sternotomy. For her surgical acumen during training, Dr. Burton earned honors including the Coleman Connolly Award in Thoracic Surgery, which recognizes the exemplary efforts of thoracic surgery residents.
"Dr. Burton is a remarkable surgeon who combines dedication, determination,
and skill with a passionate commitment to her patients. Her attention to detail,
innovative spirit, and drive have greatly enhanced our department, bringing
new surgical techniques to Stanford." - Dr. Joseph Woo
While improving the lives of her patients is her first priority, Dr. Burton is also devoted to improving the overall way we provide cardiothoracic surgical care, including increasing access and equity. For the last several years, Dr. Burton has focused her research interests on efficiency in healthcare, health disparities in cardiovascular disease, health equity, and social determinants of health, along with advanced surgical techniques. Her work has appeared in the Journal of Cardiac Surgery, JTCVS Techniques, JAMA Network Open, and additional peer-reviewed journals.
To this end, Dr. Burton served on the Stanford School of Medicine taskforce for the Mitigation of the Impact of COVID-19 on Women in Medicine and served as co-chair, representing the School of Medicine, for the Black Employee Advancement Mentoring Through Empowerment committee. She currently serves on the Women Faculty Network steering committee and the Stanford Health Care Health Equity Alignment steering committee.
To further integrate her two passions of providing exceptional surgical care and improving the way we provide cardiovascular surgical care, Dr. Burton earned her Master’s in Healthcare Administration at the University of Minnesota as an attending surgeon. She was driven by her desire to enhance healthcare delivery systems and operational management within medical institutions. Most recently, Dr. Burton was promoted to Clinical Associate Professor in November 2022 and Section Chief for Stanford Medicine Affiliates in September 2023.
Backhus and Burton: Partnering with a purpose at the VA
Over the past few years, cardiothoracic surgery has made remarkable progress in pioneering achievements, new technologies, and techniques. This was especially evident for our CT Surgeons at the VA - and for our two superstar Black women surgeons, Backhus and Burton.
In March 2018, Dr. Backhus performed the first robotic thoracic surgery at the Palo Alto VA. Her groundbreaking procedure opened new avenues for treating patients with lung tumors, marking a significant milestone for the VA in offering state-of-the-art minimally invasive surgical care. In June 2018, Dr. Backhus performed another historic procedure with the first anatomic lung resection performed on a veteran with early-stage lung cancer involving a right lower lobectomy.
The success of Dr. Backhus’s surgeries ushered in a new era; today, more than 80% of lobectomies at the Palo Alto VA are carried out using robotic technology, offering patients the benefits of minimally invasive procedures.
In 2022, Dr. Backhus continued to bring new techniques into the VA, including robotic minimally invasive esophagectomies. Another female Stanford faculty member, Irmina Elliott, MD, has lent her surgical skills in helping deliver the highest level of care using state-of-the-art surgical technology to veterans.
Building on their shared momentum, Dr. Burton added another milestone achievement to their collective work in August 2023 when she successfully performed the first robotic assisted minimally invasive direct coronary artery bypass grafting surgery (MIDCAB) at the Palo Alto VA. Her pioneering achievement signifies a new era in the treatment of heart disease through surgery, promising improved outcomes and enhanced care for veterans. The two surgeons and their colleagues not only move forward cardiac and thoracic surgery at the VA, they demonstrate the VA's unwavering commitment to delivering cutting-edge care to those who have served our nation.
Bringing their collaborative innovation full circle in a highly complex heart-lung surgery
On Aug. 3, 2023, Drs. Backhus and Burton came together on a highly complex case, a combined lung and superior vena cava (SVC)/innominate vein tumor resection. It was an intricate and challenging surgery that requires tremendous planning, forethought, and collaboration.
"Superior vena cava (SVC) reconstruction was performed in the setting of a complex resection of a tumor invading the right upper lobe and SVC, including the confluence of the innominate veins," explained Dr. Burton. "Tumors in this area can cause significant blockages and disrupt cardiovascular blood flow, leading to serious health issues."
The 71-year-old male patient had been diagnosed with a locally aggressive lung cancer affecting the right upper lobe of his lung, with tumor invasion into the mediastinum. Dr. Backhus was particularly concerned about the involvement of the innominate veins and superior vena cava. Prior to the surgery, the patient had undergone induction chemotherapy combined with immunotherapy. "The response to the systemic therapy was excellent, allowing us to move forward with surgical resection, but given the prior superior vena cava involvement this meant it was going to be an exceptionally complex procedure," Dr. Backhus said.
The surgery demanded a different strategy than usual. To remove the tumor, major veins needed to be transected first, which was challenging, and required veno-venous bypass. The duo had to maintain adequate venous drainage from the upper body and head during the resection.
Drs. Burton and Backhus during surgery
(left to right) Drs. Elan Burton, Matthew Vanneman, Leah Backhus, Albert (AJ) Pedroza, and Leon Narr
Drs. Burton and Backhus determined this approach would best help them achieve clear margins. Dr. Burton considered how to maintain adequate drainage for the head and upper extremities while keeping cannulas out of areas slated for resection. Due to the involvement of the confluence of the innominate veins, Dr. Burton elected to cannulate the right axillary vein and left innominate vein for drainage with return flow through a cannula in the right atrial appendage. Dr. Burton used an aortic homograft to reconstruct the patient’s superior vena cava and bilateral innominate veins to minimize the risk of thrombosis.
The surgery was a success. The patient had an uneventful, smooth recovery and was discharged after a week. His follow-up testing revealed an exceptional pathological response with a positive prognosis. The entire surgical team was inspired by the collaboration and careful planning of the surgery. "This case was tremendous because it highlighted the importance of rigorous pre-operative planning and collaboration," commented Dr. Albert (AJ) Pedroza, an integrated cardiothoracic resident who was a part of the surgical team.
Drs. Ioana Baiu and Leah Backhus operating
A trend of successful women in cardiothoracic surgery
This historic case exemplifies the dedication Stanford Medicine has to promoting women and minorities in cardiothoracic surgery. According to the American Board of Thoracic Surgery (ABTS), just 4.3% of cardiothoracic surgeons in the United States are women. At Stanford, 27% of our faculty surgeons are women - six times the national average.
"Stanford Medicine is so fortunate to have several extraordinary women dedicated to excellence on our cardiothoracic surgical team, and we are privileged to learn from their experiences and wisdom," said Dr. Woo.
For Dr. Ioana Baiu, a thoracic surgery fellow in her final year of training and the third female surgeon to participate in the surgery, the case represented the best of Stanford Medicine’s care for its patients and the opportunities it gives all of its physicians to learn and grow.
"As a woman in surgery, it is incredibly powerful to have
exceptional role models [like Drs. Backhus and Burton]
to work with and be inspired by." - Dr. Ioana Baiu.
Dr. Backhus wholeheartedly believes that empowered women empower women. She is proud of her role as a mentor for female CT surgeons.
"To the future generation, remember: your success is not only a reflection of your own dreams but also the dreams you help ignite in others. Together, we rise, break barriers, and redefine what's possible," she said.
Stanford CT Surgery Female Faculty and Trainees with Chairman Dr. Joseph Woo
Photo credit AGS/AmandaRose Photo Art
Dr. Elan Burton
Selected Contributions by Black Surgeons to Cardiothoracic Surgery
Black surgeons and researchers have long been integral to the development of both cardiac and thoracic surgery.
● Dr. Daniel Hale Williams, a general surgeon, founded the U.S.'s first interracial medical facility, Provident Hospital and Training School for Nurses in Chicago, Ill. In 1893, he performed the first successful open heart surgery, repairing a pericardial wound at that very hospital, which is today called Provident Hospital of Cook County.
● Dr. Myra Adele Logan was the first African-American woman to perform open-heart surgery. In 1943, she became the first woman in the world to perform the procedure. She was also the first African-American woman to be elected a fellow of the American College of Surgeons.
● Dr. Rosalyn P. Scott became the first Black woman to train in thoracic surgery, beginning her residency at Boston University Medical Center in 1977.