58 Years with a Scalpel in Hand: Professor Romans Lācis on His Journey in Medicine and Teaching Students

At Latvia’s most prestigious healthcare event, the Annual Medical Awards 2024, cardiac surgeon and Head of the RSU Cardiac Surgery Residency Programme, Emeritus Professor Romans Lācis, was honoured with the Lifetime Achievement Award. At 79, he still works and operates.

In the article, Professor Lācis speaks about his personal journey in medicine, the evolution of surgery, and the next generation of talented colleagues. Just a day before the interview, he had performed surgery – marking 58 years "at the scalpel" and 55 years at the Latvian Cardiac Surgery Centre.

A fragment of the conversation

Dr Pēteris Apinis asks: "How does the surgeon Romans Lācis of the 1970s differ from the surgeon Romans Lācis of the 2020s?" Professor Lācis replies: “In 1969, when the Cardiac Surgery Centre began its work, surgery was a harsh and unforgiving reality – dramatic medicine that people truly needed. Patients no longer die after complex operations – well, hardly ever.

We could not predict surgical outcomes at the time. Today, we can predict them with confidence.

Patients no longer die after complex operations – well, hardly ever.

There were things we simply didn’t know back then. For example, during open-heart surgery, air can enter the heart chambers – and that air must be meticulously removed. Today, we have entire protocols for that. But in the 1970s, no one – not in Rīga, not in Moscow, not even in leading global centres – knew about this. We saw serious cerebral complications from air embolisms.

Our experience grew slowly – it was a collective human experience. At that time, we didn’t even have disposable syringes or gloves. We shortened needles with scissors. The atraumatic needles available for valve replacement were too long – I would cut them in half and sharpen the ends myself.”

A Milestone: The First Heart Transplant in Latvia

Professor Lācis recalls his proudest career moment – the first heart transplant in Latvia: “Christian Neethling Barnard performed the world’s first heart transplant in Cape Town in 1967. I performed Latvia’s first in 2002 – on a patient named Tatjana Ostelis.

We had long prepared for this milestone. Together with Professor Jānis Volkolākovs, we travelled the world to observe heart transplants in other countries. We even simulated a transplant between two deceased individuals to understand the exact technical process. Today, that wouldn’t be legally possible – the regulations have become more complex.

Our first patient Tatjana was fully conscious and feeling well the very next day – almost unthinkable, considering we had no prior experience.

She lived for another nine years. Ironically, she passed away from the flu.”

Cardiac Surgery as a Symphony

Professor Lācis compares cardiac surgery to a great orchestra: “Everyone knows their part – the surgeon, the anaesthesiologist, the organiser, the financial expert. The surgeon is not a soloist. One surgeon alone can’t accomplish anything.”

Of the many students who have trained under him and now “operate like gods”, he highlights Uldis Strazdiņš: “He’s been by my side since becoming a doctor. Pēteris Stradiņš, Mārtiņš Kalējs, Ints Putniņš, and Artūrs Koris are also excellent surgeons. The younger generation – Kristiāns Meidrops, Ivars Brečs – show great promise.

What brings me the most joy is that cardiac surgery remains a team effort. During surgery, it’s often hard to tell who is the most important person in the room.”

On Life Lessons

Professor Lācis reflects: “I tell my children and my students that they must always strive to be the best – but not by elbowing their way to the top. I’ve seen such behaviour. Even if no one sees you push a competitor off a cliff, you simply must not do it.

The only way to reach your goal is to truly be the best. One way to do that is by analysing your own mistakes. You don’t always need to announce them, but you must be aware of them.”