Frank Smart, MD: Bringing engineering know-how to HF care

Issue: November 2013

Frank Smart, MD, always had a fascination with technology, so cardiology — and mechanical circulatory support systems for HF patients, in particular — was a natural focus when he decided to switch his course of study from engineering to medicine. A prominent transplant cardiologist, he has been a lead researcher on studies of immunosuppression in transplantation and in transplant CAD. He has advised many medical device companies on how to support device design. His passion for engineering and building systems extends to his free time as well, in the form of refurbishing cars and welding.

Smart received his undergraduate degree from Southeastern Louisiana University and his medical degree from Louisiana State University School of Medicine in New Orleans. He completed his internship and residency at Ochsner Foundation Hospital in New Orleans and his fellowship at Baylor College of Medicine.

Today, Smart is professor and chief of the section of cardiology in the department of medicine at Louisiana State University Health Science Center. He previously held positions at Atlantic Health in New Jersey, Mount Sinai School of Medicine, St. Luke’s Episcopal Hospital, the Texas Heart Institute and Tulane University, among other institutions.

Frank Smart, MD
Professor and Chief Section of Cardiology,
Department of Medicine, Louisiana State
University Health Science Center
Member, HF and Transplantation section of
Cardiology Today’s Editorial Board

What do you enjoy doing when you’re not practicing medicine?

I like to refurbish old cars. I also weld pieces of furniture, art and other things.

If you hadn’t gone into cardiology, what would you have done?

I would have been an engineer. I actually studied engineering prior to medical school, and the third semester of calculus was brutal. That prompted my consideration of other options. But, I really like engineering. I’ve always loved design and devices. One of the reasons I’m a cardiologist is because of the engineering component of hemodynamics and flow dynamics. I like the study and care of HF and mechanical circulatory support because of the engineering aspect of the discipline.

What would you consider one of your biggest successes in your specialty?

From a contribution to medicine, what I think that I helped with is modulating immunosuppression, and doing so in the recognition of transplant CAD. During the earlier years of heart transplantation, we established CAD in the transplanted heart as chronic rejection and set the guidelines for monitoring and subsequent treatment. I was able to be a part of immunosuppression modulation trials. The other thing in HF that I really liked has been developing HF systems. To go back to engineering, I am good at systems development and have enjoyed creating systems of patient-directed self-management. This approach was similar to what had occurred in diabetes, but was just evolving when we made patient-directed goals.

What is the last book you read? Why, and what did you think of it?

The last book I read was Following the Equator by Mark Twain. It’s a book that I had always wanted to read because I like Twain; I enjoy his wit and the fact that he was a person who was socially way ahead of his time. So I was not disappointed. It was witty and it was very enlightened when you consider the time that he wrote it and the social atmosphere of that era.

Whom do you most admire, and what would you ask that person if you had 5 minutes with him/her?

I most admire Abraham Lincoln. The reasons I admire him are many, but one that has always captured me is when he was elected, it was a very hotly contested race, the country was amazingly divided, and yet Lincoln took all of his opponents and put them into the cabinet. Therefore, he was able to somehow pull some of these varying factions together in a really tough time. Clearly the divisions of the country persisted into and through the Civil War, but his skill at working with his opponents has timeless value. I’d ask him how he thought enough to do that, and how he was able to keep everybody and their really large egos directed at moving the country forward. That was amazing leadership. I don’t know if I’ve seen that skill before or since.

When not practicing medicine, Smart tries his hand at welding.

Photo courtesy of: Frank Smart, MD

What is the best advice you’ve ever received?

Don’t write an email that you don’t expect to be read by 50 people.

Whom do you consider a mentor?

James B. Young, MD, the Cardiology Today HF and Transplantation Senior Editor, is my mentor. Jim trained me when I was a fellow. He’s more than a guy who trained me; he is a friend and a true mentor. He has helped me a million times along the way. If I called him up tomorrow and said, ‘Jim, I need you to help me,’ he would be right there. He really is the definition of a mentor. There also have been others, like John B. “Jack” O’Connell, MD, and Denton A. Cooley, MD.

What kind of diet and exercise regimen do you follow?

I am terrible about diet and exercise, I really am. Right now, I am trying to follow a low-carbohydrate diet to lose weight. But, it has been a challenge because I could live off of bread and sweets. However, at the same time, I’m doing better and have lost about 30 lb so far. I don’t exercise routinely to any great degree, although I know I should.

What do you think will have the biggest influence on cardiology in the next 10 years?

The development of structural heart disease percutaneous valve work will have a big influence on cardiology, broad spectrum, among clinical cardiologists everywhere. I think pharmacogenetics and genomics will have the biggest impact on scientific discovery and that aspect of cardiology, but the clinical utility is likely beyond the 10-year mark.

What is your favorite travel destination?

San Francisco and the Pacific Northwest.

What is your favorite restaurant?

Clancy’s restaurant in New Orleans is my absolute favorite. They have fried oysters with brie, which goes along with my lack of diet. It’s absolutely phenomenal.