Washington University Division of Cardiothoracic Surgery - Annual Report 2022

Division of Cardiothoracic Surgery 2022 Annual Report Living Our Legacy

TABLE OF CONTENTS Letter from the Chief 3 History 4 Cardiac Surgery 6 Thoracic Surgery 12 Pediatric Cardiothoracic Surgery 18 Research 24 Publications 25 Residency Training 26 Former Trainees 30 Washington University Medical Campus 34 Faculty 35 Cardiothoracic Surgery Clinical Locations 36 500th Robotic Surgery at Christian Hospital 38 CT on Social 39 Cover: CAPTION *For the safety of our faculty and campus community, all photos included were taken either pre-COVID or following social distancing guidelines. **Clinical Services in Illinois provided by Washington University Physicians in Illinois Inc. 2 Washington University School of Medicine in St. Louis | Department of Surgery

LETTER FROM THE CHIEF programs. Our faculty of cardiothoracic surgeons, critical care anesthesiology intensivists, laboratory- Ralph J. Damiano Jr., MD based investigators and active emeritus professors Division Chief of Cardiothoracic Surgery are leaders in our specialty both in the clinical and Evarts A. Graham Professor of Surgery research arenas. Our clinical research and data management team of 20 personnel comprised of The Division of Cardiothoracic Surgery at Washington clinical research coordinators, statistical analysts, and data managers who support the research University School of Medicine, Barnes-Jewish Hospital, efforts of the faculty and fellows. Last year, we has had a long tradition of excellence in patient care, participated in 52 clinical trials, more than 80 active research and education. The chest service was initially clinical research projects, and collect data for 12 established by Evarts Graham, MD, in 1920. Since then, registries. Our basic science laboratory is supported our Division has grown tremendously to include 26 by numerous peer-reviewed extramural grants. faculty and 62 support staff. We now incorporate not just During a time in which many academic programs thoracic surgery, but also have sections of adult cardiac have shrunk, our growth has been made possible surgery, pediatric cardiothoracic surgery, and heart and by both the development of exciting new programs lung transplantation. From the beginning, we have had and the generous support we have received from a strong commitment to our residency program, which Washington University School of Medicine, the is the second-oldest in the country, established in 1929. Department of Surgery, Barnes-Jewish Hospital, St. Our goal is to train the future leaders of our specialty. Louis Children’s Hospital, and from our patients, Our faculty is dedicated to providing a nurturing and their families and friends. Our outstanding clinical stimulating educational experience for our fellows. We facilities have enabled the introduction of state-of- are very fortunate to practice in an incredibly supportive the-art techniques in adult cardiac, general thoracic hospital and university environment that has facilitated and pediatric cardiothoracic surgery. We have our mission. been a pioneering center in lung transplantation Our Division encompasses the entire breadth and depth and recently performed our 10,000th transplant. of clinical programs in our specialty, while at the same In addition to this expertise, our faculty have time providing multiple opportunities for basic and also developed active and renowned programs in clinical research. We have an integrated team, consisting minimally invasive cardiac procedures, advanced of four subspecialty units: adult cardiac surgery, adult arrhythmia surgery, transcatheter valve therapeutics, general thoracic surgery, pediatric cardiothoracic surgery, heart transplantation, ventricular assist devices, and heart and lung transplantation. In adult cardiac video-assisted thoracic surgery, and robotic and and general thoracic surgery, we have both university endoscopic procedures. and community-based surgeons to enhance the training While we have superb clinical facilities and a program. Moreover, we have established a cardiothoracic supportive environment for academic surgery, our surgery program at the Cochran VA Hospital, which greatest asset has always been and continues to has allowed us to broaden our outreach to the veteran be our faculty. We have a truly exceptional group population. of committed and talented individuals who work Over the last decade, we have seen continued growth together to improve the lives of our patients and in both adult cardiovascular and general thoracic advance the field through innovative research. We surgical volumes, and have expanded both our inpatient support one another and take pride in each other’s and outpatient facilities. We also have experienced accomplishments. Together, we are united in our considerable expansion of our basic and clinical research dedication to providing the highest quality care for our patients, as well as the most stimulating educational opportunities for our fellows. Our distinguished faculty are widely recognized for their important contributions, both in the operating room and the research laboratory. They occupy important positions of leadership in our societies and journals. Recently, members of our group have been chosen President of the American Association for Thoracic Surgery (AATS), Editor of the Journal of Thoracic and Cardiovascular Surgery, Vice Chair of the Department of Surgery, and have given the prestigious Glenn Lecture at the American Heart Association. They also hold other important leadership positions in the American Board of Thoracic Surgery (ABTS) and AATS. It is my privilege to serve as Division Chief and work for this outstanding group of individuals. Division of Cardiothoracic Surgery | 2022 Annual Report 3

HISTORY OF CARDIOTHORACIC SURGERY at Washington University in St. Louis The Washington University Division of Cardiothoracic Surgery evolved a century ago to address what was then considered the last surgical frontier: diseases of the chest. As one of the first training programs in thoracic surgery, Washington University has been responsible for educating more thoracic surgeons than nearly any other program in the world. Leaders of the division, from Evarts Graham to Ralph Damiano Jr., have had a profound impact on cardiothoracic surgery. Evarts Graham Thoracic Surgical Seminal Article Fellowship on Lung Cancer 1920’s 1933 1951 Pneumonectomy Thomas Burford 1919 1929 1950 Division Established Dr. Evarts Graham, cardiothoracic surgeon and founding chairman of the department of surgery at Washington University School of Medicine. 4 Washington University School of Medicine in St. Louis | Department of Surgery





















THORACIC SURGERY Bryan Meyers, MD, MPH. Shuddhadeb Ray, MD, MPHS. Varun Puri, MD, MSCI. Benjamin Kozower, MD, MPH. ROBOT READY DaVinci surgical robot. On Dec. 1, 2021, thoracic surgeons Varun Puri, MD, MSCI, Minimally invasive robotic surgery has potential to become the gold standard of care when it comes to Nabil Munfakh, MD, and their operative staff carried out many thoracic procedures. In offering future surgeons the 500th robotic thoracic surgery at Christian Hospital opportunities to train alongside experts in this in north St. Louis. This marked a major milestone for the practice, the program has major influence on the next Washington University thoracic robotic surgery program, generation of leaders in thoracic surgery. “This area which has continued to grow significantly in both clinical of our practice has reached a critical mass, so that we volume and training practices since its establishment. see our trainees leave with a very firm grounding in From the program’s early success at Christian Hospital, robotoc skills,” says Meyers. “They are ready to hit the Benjamin Kozower, MD, MPH, professor of surgery, ground running with robotic pulmonary resections has helped to establish a successful robotic practice at and robotic benign esophageal surgery.” Barnes-Jewish Hospital. The number of robotic cases at Christian Hospital and “What we’ve seen is a significant growth in our robotic Barnes-Jewish Hospital has only been growing over practice in recent years,” says Bryan Meyers, MD, MPH, the past several years, and that trend is projected to Patrick and Joy Williamson Professor of Surgery. “Dr. Puri continue its growth in coming years. and Dr. Kozower lead the way in building this practice. In “Our recent trainees have all completed the program more recent years, Dr. Ray and I have also become active ‘robot-ready,’” says Meyers. The trainees undergoing in robotic surgery.” this invaluable experience with minimally invasive Shuddhadeb Ray, MD, MPHS, a former trainee of the robotic technology and techniques early on in their robotic surgery program, is now a key member of the careers have the opportunity to change the very face team at Christian Hospital. His expertise in minimally of thoracic surgery. invasive procedures has contributed greatly to the growth of the program and the quality of training offered. Division of Cardiothoracic Surgery | 2022 Annual Report 15

THORACIC SURGERY “WITH THIS UNDERSTANDING OF THE FORM OF CELL DEATH AFFECTING LUNGS DURING ISCHEMIA, WE CAN TARGET NECROPTOSIS WITH FUTURE THERAPEUTICS.” -DANIEL KREISEL, MD, PHD Daniel Kreisel, MD, PhD, left, and Yuriko Terada, MD. Identifying Causes of Vascular Damage in Lung Transplantation A new study led by investigators inflammation. The neutrophils in transplanted organs, meaning destroy the vessel wall and lead to a reduced risk of ischemia- in the Thoracic Immunology lung graft dysfunction,” says study reperfusion injury and primary graft Laboratory at Washington senior author Daniel Kreisel, MD, dysfunction,” says Kreisel. University School of Medicine has PhD, the inaugural G. Alexander “One take-home message of this identified triggers that cause tissue Patterson, MD/Mid-America study is that each organ has its damage in donor lungs during Transplant Endowed Distinguished own intricacies in terms of immune reperfusion. Chair in Lung Transplantation. response and cell death pathways,” “We found that there is substantially Kreisel, a professor of surgery, Kreisel says. “Therapies need to more infiltration of neutrophils in pathology and immunology, and Li, be tailored so that we treat lung the lungs when lungs are subjected an associate professor of surgery, transplantation with different drugs to a period of warm ischemia. These used intravital imaging to observe than other organs.” neutrophils are attracted to certain how the immune system responds vessels, which they destroy on their to lung transplantation in real time. Recipient neutrophils (green) infiltrating lung grafts way into the air spaces. This process This technique makes it possible that have been subjected to warm ischemic storage, is associated with substantial to see how living cells behave in where they form large clusters and damage small damage to the donor lungs. We their natural environment. Such vessels (red). were able to describe the individual contributions have advanced the steps that guide the neutrophils scientific understanding of immune into the lungs during this process,” responses to transplantation for says first author Wenjun Li, MD. researchers around the globe. The investigators described that One key finding from this study necroptosis triggered recruitment is that the lungs are damaged of neutrophils. “The damage caused through a different process than by necroptosis releases damage- other organs. In 2019, Li published associated molecular patterns, a study describing ferroptosis, the which engage receptors on the cells inflammatory cell death pathway in the lungs, including nonclassical affecting donor hearts. This type monocytes and vascular endothelial of cell death differs from the cells. These nonclassical monocytes necroptosis in transplanted lungs secrete chemokines, which bring described in the PNAS study. neutrophils into the vessels. Think “Tailoring future pharmacological of chemokines as the immune therapies for each organ could system’s breadcrumbs. Neutrophils prevent inflammatory responses follow these breadcrumbs to the vessels, where they cause sterile 16 Washington University School of Medicine in St. Louis | Department of Surgery

NUMBERS AT A GLANCE ADULT THORACIC SURGERY VOLUMES AT BARNES-JEWISH HOSPITAL General Thoracic Lung Transplant Minor/Other 1,605 1,640 1,674 1,543 1,584 1,450 810 849 879 747 896 613 59 84 89 87 80 77 649 667 674 623 701 912 2017 2018 2019 2020 2021 2022 Total thoracic cases by type, 2017-2022. Robotic surgical HIGHLIGHTS FROM THE DATA: High-volume lung applications Advanced, complex transplant program resection for lung cancer Division of Cardiothoracic Surgery | 2022 Annual Report 17

DIVISION OF CARDIOTHORACIC SURGERY Section of Pediatric Cardiothoracic Surgery Illustrated three-dimensional Pirooz Eghtesady, MD, PhD, center, and his heart model illustration. surgical team during a procedure. Pirooz Eghtesady, MD, PhD. Jacob Miller, MD, left, and Dilip Nath, MD, outside St. Louis Children’s Hospital. Washington University pediatric cardiothoracic surgeons treat children with congenital cardiac disorders. Washington University specialists treat a wide range of conditions, from atrial septal defects to complex single ventricle anomalies, neonatal surgery, surgery for congenital heart disease and tracheal reconstruction. The lung transplant program at St. Louis Children’s Hospital is among the most active of its kind in the world, attracting patients with cystic fibrosis and other lethal lung diseases from around the globe. The pediatric heart transplant program is considered a national leader in the specialty. The section also offers advanced training through an ACGME-accredited congenital cardiothoracic surgery fellowship. 1,027 $215,473 Operating room cases $$$ Grant Research Funding 1,420 30 Visits Clinical research studies 4 Faculty 18 Washington University School of Medicine in St. Louis | Department of Surgery

PEDIATRIC CARDIOTHORACIC SURGERY Audrey holding hands with her mother and father on her first birthday. A Beautiful New Heart: Audrey’s Story This March, Audrey celebrated her first birthday at home “Dr. Eghtesady has such a calm confidence,” Wallach says. “I remember him coming up to me on the night with her family. Audrey’s mother, Molly Wallach, as an of Audrey’s first surgery, putting his hand on my assistant nurse manager at the St. Louis Children’s and shoulder and saying, ‘I’m going to take care of your Washington University Heart Center, knew there was a daughter.’ I was so scared, but then I felt this rush of chance Audrey would spend her first birthday in a hospital relief. I knew that Dr. Eghtesady would go to the ends room. of the earth for Audrey.” Audrey was diagnosed with a congenital left ventricular At three months old, Audrey underwent VAD aneurysm before she was born and dilated placement. She spent just over three months awaiting cardiomyopathy at three weeks old. This combination a transplant in the hospital, supported by her VAD, her of rare heart conditions required multiple operations, care team and the love of her family. including a heart transplant at only six months old. The Heart Center is a nationally recognized Thanks to an organ donor and the team of specialists at Mechanical Assist Device program. Placing a VAD in the Heart Center, Audrey is now a happy, healthy one- a left ventricular aneurysm is an exceptionally rare year-old girl. procedure, but Wallach knew her child was in good Audrey’s Heart Center team included Pirooz Eghtesady, hands with Eghtesady, who is also chief of pediatric MD, PhD, Cardiothoracic Surgeon-in-Chief at St. Louis cardiothoracic surgery at Washington University. Children’s Hospital, as well as Washington University “As a practitioner, it was anxiety provoking that I congenital cardiac surgeons Jacob Miller, MD, and was caring for one of our own,” says Eghtesady. “At Dilip Nath, MD. the same time, the trust and privilege the Wallach’s provided us by trusting Audrey’s care in our hands was a testament to the relationship as well as a precious vote of confidence in our team. I am grateful they would trust Audrey’s surgery to us and that we were able to provide her with a great outcome.” Audrey’s room at the Sam and Molly Wallach with After an unusual first year, Audrey is now back home St. Louis Children’s Hospital. daughters Audrey and Caroline. with her family, vibrant and healthy. “We want Audrey to experience life,” Wallach says. “Drs. Eghtesady, Miller and Nath always remind me that, at the Heart Center, we choose transplant because we want kids to live. Now that Audrey has a beautiful new heart beating in her chest, we’re going to let her live a normal life.” Division of Cardiothoracic Surgery | 2022 Annual Report 19

Highlights from Pediatric Cardiothoracic Surgery CLINICAL St. Louis Children’s Hospital. Pirooz Eghtesady, MD, PhD. Washington University pediatric cardiothoracic surgeons provide the highest quality care to patients with congenital heart defects. To ensure the program’s continued excellence, the team engages in several rigorous practices to regularly review performance and outcomes. During monthly performance improvement rounds, the team reviews each patient’s hospital course from admission to discharge, comparing their findings to a national database and determining what lessons can be learned to continuously improve. This practice seeks to enhance dialogue across disciplines by recognizing both areas for improvement and the team’s successes. Surgeons from the section also follow up with patients and caregivers to examine long-term outcomes and evaluate the durability and effectiveness of treatments. RESEARCH Tetralogy of Fallot is a congenital heart defect that affects normal blood flow through the heart. Pirooz Eghtesady, MD, PhD, and his research team is developing a novel surgical technique using heart tissue to treat Tetralogy of Fallot. In 2022, the team presented a 14- year evolution of management of the pulmonary valve using living right atrial appendage tissue, concluding that this method of repair is a safe operation with excellent outcomes. A second study describes a technique for complete repair of Tetralogy of Fallot with other defects using right atrial appendage tissue. This technique provides advantages of right heart protection and the use of living tissue capable of growth with the patient. EDUCATION Vinod Sebastian, MD. In 2020, the Section of Pediatric Cardiothoracic Surgery introduced an ACGME-accredited congenital cardiac surgery fellowship, one of only 11 congenital cardiac fellowships in the country. This program now accepts one distinguished fellow every other year. Training through this program provides opportunities for cardiothoracic surgeons to develop the expertise necessary for subspecialization in congenital cardiac surgery. Inaugural fellow Jacob Miller, MD, joined the Section of Pediatric Cardiothoracic Surgery at Washington University School of Medicine in St. Louis in 2021 as an instructor of surgery. The most recent fellow, Vinod Sebastian, MD, finished his pediatric cardiothoracic fellowship and now works as a pediatric cardiac surgeon with University of California, San Francisco. 20 Washington University School of Medicine in St. Louis | Department of Surgery

PEDIATRIC CARDIOTHORACIC SURGERY A HANDS-ON APPROACH TO TRAINING 3D-printed silicone simulation model utilized by the HOST program. After gaining valuable experience utilizes 3D models in preoperative Jacob Miller, MD, practicing surgery on a planning, trainee education and realistic model during the HOST training during an in-depth, hands-on patient education at St. Louis training experience, Washington Children’s Hospital, the HOST session. University pediatric cardiothoracic program gives the surgeons a new surgeons and fellows can utilize perspective in treating congenital “Since the session was conducted new tools to diagnose and plan heart conditions. in a virtual environment with a treatment strategies for patients “We were astounded by the level webcam spotlighting the surgical with rare and complex heart defects. of detail shown in the specially area and model, surgeons received This year, pediatric cardiothoracic prepared silicone models used real-time feedback from the course surgeons joined a specialized in this program,” says Pediatric proctors during their procedures training program tailored around Cardiothoracic Surgery Section and received a final review of their treating congenital heart defects. Chief Pirooz Eghtesady, MD, approaches and anatomic results,” The HOST (Hands-On Surgical PhD. “The models, designed in says Eghtesady, cardiothoracic Training) program, led by accordance with real defects surgeon-in-chief at St. Louis cardiovascular surgeons from the captured by CT or MRI imaging, Children’s Hospital. “We are happy Hospital for Sick Children in Toronto, were 3D-printed, assembled and to report the patients did well Canada, guides surgeons from shipped to our team.” under the hands of our surgeons.” around the world through the repair Following an introductory Following the success of the initial of complex heart defects utilizing preparatory course, trainees training program, the division realistic simulation models. The and faculty members practiced conducts ongoing simulation team from Washington University simulated procedures, such as training monthly as part of its were the only surgeons from the U.S. extended end-to-end coarctation comprehensive surgical that participated in the session. aorta repairs and Norwood training curriculum. Though the Section of Pediatric procedures, on the complex Cardiothoracic Surgery currently models with guided instructions. 21 Dilip Nath, MD. “In patients with complex disease, these models provide a great resource and allow for one to really visualize pathology. The models are the closest thing to mimic actual surgery that I’ve ever seen,” says Jacob Miller, MD, an instructor of pediatric cardiothoracic surgery. “They also act as a great reference to facilitate discussion with the faculty and discuss tips and tricks used to optimize the repair.” Division of Cardiothoracic Surgery | 2022 Annual Report

PEDIATRIC CARDIOTHORACIC SURGERY The Evolution of Tetralogy of Fallot Repair A new study led by Washington University pediatric cardiothoracic “TETRALOGY OF FALLOT IS A VERY RARE CONDITION, BUT surgeons has presented a safe and effective repair strategy for tetralogy of WE HAVE THE OPPORTUNITY Fallot (TOF). The study, published in The Annals of Thoracic Surgery, was TO CARE FOR A LARGE conducted over a period of 14 years, during which investigators tracked POPULATION OF THESE the evolution of pulmonary valve management following a valve-sparing PATIENTS AT WASHINGTON repair operation. UNIVERSITY.” Between January 2007 and June 2021, 172 consecutive patients underwent complete repair of TOF. The repair process involved pulmonary -JACOB MILLER, MD valve management utilizing a transannular patch to valve-sparing repair to neopulmonary valve (NPV) creation using living right atrial appendage tissue. Overall follow-up occurred after 44 months, and at the final follow-up, only 10 percent of patients who underwent this type of repair experienced NPV failure described as repeat intervention for recurrent right ventricular outflow tract obstruction (RVOTO). Even in cases of failed valve-sparing repair and RVOTO, researchers observed significantly lower pulmonary valve z-scores. Over the entire course of the 14-year study, the research team experienced no hospital mortalities. The team of researchers included Pirooz Eghtesady, MD, PhD, Dilip Nath, MD, Jacob Miller, MD, cardiothoracic surgery fellow Linda Schulte, MD, and general surgery resident Horacio Carvajal-Dominguez, MD. Eghtesady serves both as Chief of Pediatric Cardiothoracic Surgery in the Department of Surgery and Cardiac Surgeon-in- Chief at St. Louis Children’s Hospital. Nath is an associate professor of surgery in the Division of Cardiac Surgery and Miller serves as an assistant professor of surgery in the Section of Pediatric Surgery. With extensive collective experience in pediatric cardiothoracic surgery, repair techniques of congenital heart conditions including TOF and treatment for a myriad of other cardiothoracic conditions, this team of specialists was uniquely equipped to support their team in tackling the challenges associated with effectively treating TOF. “This research shows our evolution of pulmonary valve management in tetralogy of Fallot, under Dr. Eghtesady’s leadership,” says Schulte, who is first author on the study. “Our high clinical volume and the expertise of our faculty make it possible for us to innovate and look closely at how those advances benefit outcomes in the long run.” Jacob Miller, MD, left, and Pirooz Eghtesady, MD, PhD. There is much debate surrounding the optimal repair strategy for TOF, but the data collected from this study found NPV creation, which avoids right ventricular dilation, to be an option even in patients with a small pulmonary valve. These findings define this operation as a safe procedure with promising long-term outcomes. 22 Washington University School of Medicine in St. Louis | Department of Surgery

NUMBERS AT A GLANCE PEDIATRIC SURGERY VOLUMES AT ST. LOUIS CHILDREN'S HOSPITAL Cardiothoracic Transplant Adult Congenital 431 423 14 392 19 25 375 6 378 375 20 9 33 6 10 27 26 26 339 353 346 339 398 378 2017 2018 2019 2020 2021 2022 Total pediatric cardiothoracic cases by type, 2017-2022. Leading infant lung HIGHLIGHTS FROM THE DATA: Leading Potts shunt transplant program Busiest pediatric surgery center in heart transplant/ the world in the world VAD program in the region 23 Division of Cardiothoracic Surgery | 2022 Annual Report

DIVISION OF CARDIOTHORACIC RESEARCH PROGRAM The history of the Division of Cardiothoracic Surgery Christian Zemlin, PhD, MSc. includes a robust research pedigree. Significant work CLINICAL RESEARCH AND DATA MANAGEMENT GROUP is done both in the basic science research laboratory Clinical research has always been considered a core and in collaboration with the clinical research and data value to the practice and is emphasized throughout management team. the residency training program. The Division of The basic science research laboratory is a joint Cardiothoracic Surgery created the Clinical Research laboratory of all the general thoracic, cardiac and and Data Management Group (CRDM) in 1996 to support pediatric cardiothoracic surgeons. Research interests the growing demand for ongoing clinical investigation. of the faculty include transplant immunology, lung The CRDM works alongside the faculty to design transplantation, lung cancer, arrhythmia surgery, studies and to develop strategies for data gathering cardiac electrophysiology, myocardial preservation and analysis. Led by Bryan Meyers, MD, MPH and and cardiac mechanics. Collaborations extend across Marci Damiano, RN, BSN, the CRDM provides critical specialties within surgery, the School of Medicine and assistance to the division in developing, implementing among institutions nationally and internationally. and performing clinical studies, ensuring regulatory, Cardiothoracic research facilities—occupying more review board and HIPAA compliance. The CRDM than 7,500 square feet of space—are located in the coordinates and standardizes data collection, and Clinical Sciences Research Building and the BJC provides valuable expertise in data analysis. Institute of Health at Washington University in the hospital/medical school campus. AREAS OF EXCELLENCE The facilities include animal surgical suites equipped with state-of-the-art respirators and Transplant Immunology Cardiac Mechanics anesthesia machines, ECG machines, high-fidelity pressure monitors, flow meters, defibrillators and Lung Transplantation Myocardial Preservation cardiopulmonary bypass machines. A joint optical mapping facility shared by pathology, cell and Lung Cancer Cardiac Electrophysiology molecular biology, medicine and neurology is located in the cardiothoracic surgery laboratory. The sharing Arrhythmia Surgery Defibrillators of equipment and expertise not only facilitates research, but also provides a broader research training State-of-the-art Respirators and Anesthesia Machines experience for the research fellows. The laboratory is well equipped for performing a wide Flow Meters High-fidelity Pressure Monitors range of investigations—from cellular and molecular biology to large animal system physiology—with full- Cardiopulmonary Bypass Machines time staff providing complete support for all ongoing research. ECG Machines Cellular and Molecular Biology LABORATORY WEBSITES Clinical Studies ECMO To learn more, visit our laboratory websites: » Cardiothoracicsurgery.wustl.edu/research/ » Eghtesadylab.wustl.edu/ » Lungimmunolab.wustl.edu/ 24 Washington University School of Medicine in St. Louis | Department of Surgery

RESEARCH CARDIOTHORACIC SURGERY SELECTED PUBLICATIONS 2022 1. Bery AI, Shepherd HM, Li W, Krupnick AS, Gelman AE, Kreisel D. Role of tertiary lymphoid organs in the regulation of immune responses in the periphery. Cell Mol Life Sci. 2022 Jun 11;79(7):359. PMID: 35689679. 2. Carvajal HG, Gooch C, Merritt TC, Fox JC, Pourney AN, Kumaresan HD, Canter MW, Eghtesady E. Mid-term outcomes of heart transplantation in children with genetic disorders. Ann Thorac Surg. 2022 Aug;114(2):519-525. PMID: 35007503. 3. Guo A, Kotkar K, Schilling J, Jocher B, Fischer I, Masood MF, Itoh A. Improvements in extra corporeal membrane oxygenation for primary graft failure after heart transplant. Ann Thorac Surg. 2022 Apr 14;S0003-4975(22)00516-1. PMID: 35430222. Online ahead of print. 4. Habertheuer A, Chatterjee S, Japp AS, Ram C, Kortula L, Ochiya T, Li W, Terada Y, Takahashi T, Nava RG, Puri V, Kreisel D, Vallabhajosuyla P. Donor extracellular vesicle trafficking via the pleural space represents a novel pathway for allorecognition after lung transplantation. Am J Transplant. 2022 Jul;22(7):1909-1918. PMID: 35285127. 5. Heiden BT, Eaton DB, Chang S-H, Yan Y, Schoen MW, Thomas TS, Patel MR, Kreisel D, Nava RG, Meyers BF, Kozower BD, Puri V. Association between imaging surveillance frequency and outcomes following surgical treatment of early-stage lung cancer. J Natl Cancer Inst. 2022 Nov 29;208. PMID: 36442509. Online ahead of print. 6. Heiden BT, Eaton DB Jr, Brant WS, Chang S-H, Yan y, Schoen MW, Patel MR, Kreisel D, Nava RG, Meyers BF, Kozower BD, Puri V. Development and validation of the VA Lung Cancer Mortality (VALCAN-m) Score for 90- day mortality following surgical treatment of clinical Stage I lung cancer. Ann Surg. 2022 Oct 17. doi: 10.1097/ SLA.0000000000005725. PMID: 36250678. Online ahead of print. 7. Huang HJ, Schechtman K, Askar M, Bernadt C, Mittler B, Dore P, Witt C, Byers D, Vazquez-Guillamet R, Halverson L, Nava R, Puri V, Gelman A, Kreisel D, Hachem RR. A pilot randomized controlled trial of de novo belatacept-based immunosuppression following anti-thymocyte globulin induction in lung transplantation. Am J Transplant. 2022 Jul;22(7):1884-1892. PMID: 35286760. 8. Kachroo P, Kelly MO, Bakir NH, Cooper C, Braverman AC, Kouchoukos NT, Moon MR. Impact of aortic valve effective height following valve-sparing root replacement on postoperative insufficiency and reoperation. J Thorac Cardiovasc Surg. 2022 Dec;164(6):1672-1680.e3. PMIC: 35659124. 9. Khiabani AJ, MacGregor RM, Bakir NH, Manghelli JL, Sinn LA, Maniar HS, Moon MR, Schuessler RB, Melby SJ, Damiano RJ Jr. The long-term outcomes and durability of the Cox-Maze IV procedure for atrial fibrillation. J Thorac Cardiovasc Surg. 2022 Feb;163(2):629-641. PMID: 32563577. 10. Li W, Terada Y, Tyurina YY, Tyurin VA, Bery AI, Gauthier JM, Higashikubo R, Tong AY, Zhou D, Nunez-Santana F, Lecuona E, Hassan A, Hashimoto K, Scozzi D, Puri V, Nava RG, Krupnick AS, Lavine KJ, Gelman AE, Miller MJ, Kagan VE, Bharat A, Kreisel D. Necroptosis triggers spatially restricted neutrophil-mediate vascular damage during lung ischemia reperfusion injury. Proc Natl Acad Sci U S A. 2022 Mar 8;119(10):e2111537119. PMID: 35238643. 11. MacGregor RM, Bakir NH, Pedamallu H, Sinn LA Maniar HS, Melby SJ, Damiano RJ Jr. Late results after stand-alone surgical ablation for atrial fibrillation. J Thorac Cardiovasc Surg. 2022 Nov;164(5):1515-1528. PID: 34045056. 12. Subramanian MP, Yang Z, Chang S-H, Willis D, Zhang J, Semenkovich TR, Heiden BT, Kozower BD, Kreisel D, Meyers BF, Patterson GA, Nava RG, Puri V. Minimum volume standards for surgical care of early-stage lung cancer: A cost- effectiveness analysis. Ann Thorac Surg. 2022 Dec;114(6):2001-2007. PMID: 35780816. Highlights of Publications: Average over 130 23% of publications Scholarly 47% of publications publications per year in collaboration collaborations with in the top 25% Harvard University, with international University of Virginia, citation percentile investigators Cleveland Clinic Foundation, Johns Hopkins University, Duke University Division of Cardiothoracic Surgery | 2022 Annual Report 25

RESIDENCY TRAINING Resident Books Flight for Donor Lungs On January 28, 2022, general surgery resident Cooler containing donor lungs is strapped in for emergency transport on a commercial flight. Katharine Caldwell, MD, was at the wheel of a nearly impossible situation. It began with the lifesaving gift of They arrived at the new flight as the doors were donated lungs. closing. Despite delays and a torturous wait, the Caldwell was part of a three-member transplant team plane took to the sky. Caldwell had already sent that left St. Louis just after midnight. Racing against a message to the surgical team. Miles away, they a snowstorm, they hoped to get the donated lungs started prepping the patient for transplant. from a hospital in Chicago and return to Washington Caldwell and Benton arrived at Barnes-Jewish University for transplant surgery. Everything had gone Hospital around 9 a.m. After receiving the donated to plan until the team returned to their small Mid- lungs, Washington University surgeons began the America Transplant plane. The storm had arrived, procedure. bringing heavy snow and a threatening, freezing fog. The surgery was a success. The 67-year-old The charter plane could not take off. recipient had been suffering from idiopathic Caldwell, in her sixth year of clinical and research pulmonary fibrosis, a condition in which the lungs residency at Barnes-Jewish Hospital, assessed the progressively thicken and become stiff, and he had situation. She looked at the larger commercial planes been struggling for weeks to breathe. If the team at Midway International Airport. had been even half an hour later, the patient may “I am by nature a problem-solver,” says Caldwell. not have received this life-saving gift. “Someone tells me something can’t be done, I’m like: Caldwell sees their efforts as part of a chain in the OK, what is the workaround? Are the big planes flying?” network of donation and care. “A single individual The only option that would get them back in time was and their family had chosen to do the most a direct Southwest flight leaving at 6:20 a.m. In their incredible, heroic thing in choosing to donate life, scrubs and pulling a wheeled cooler marked “Human and my job was making sure we did honor to that.” organ for transplant,” Caldwell and her team members raced to the commercial airport, got their tickets and rushed through security. “We got lots of stares,” Caldwell remembers. Katharine Caldwell, MD, MSCI. Washington University School of Medicine in St. Louis | Department of Surgery 26

RESIDENCY TRAINING Residency Program Residents Whitney Brandt, MD, left, and Horacio Carvajal Dominguez, MD, right, pictured with Pirooz Eghtesady, MD, PhD, center. Our division views the training of thoracic surgery under the close supervision of the faculty. This includes preoperative evaluation and preparation, residents as central to our mission. The entire faculty is intraoperative participation, up to and including deeply committed to the clinical, academic and personal assuming the role of primary surgeon, and development of our trainees. postoperative care. There is close and frequent contact between the faculty and residents to The primary goals of the cardiothoracic assure that patient care follows appropriate residency program are: pathways and that the educational experience is 1. Dedicated to providing excellence and commitment maximized. in patient care, cultivating future generations of A comprehensive educational program includes surgical leaders, and promoting diversity and inclusion lectures, case discussions, multidisciplinary while simultaneously providing innovative research conferences, mentored board preparation and and education within our immediate and national a focused simulation program. While some of community. these activities are linked to individual rotations, others involve the participation of all residents 2. Provide excellence in patient care and lay the in the program. The curriculum ensures detailed foundation for safe and compassionate patient care exposure to the core knowledge in the field while simultaneously cultivating a lifetime of self-education also introducing the trainees to emerging science. and improvement in the field. All residents are strongly encouraged to identify a Residents join the program in two pathways: Conventional research project(s) in collaboration with a faculty (5+2) – five years of general surgery training followed mentor. The division includes a clinical research by two years of thoracic surgery training, or Early unit comprising of over 25 personnel who provide Specialization (4+3) – graduated entry into the active support in completing these projects. program after four years of training in general surgery. Virtually all thoracic surgery residents publish and The program fosters a cohesive and collaborative present at least one (and usually multiple) studies environment for residents entering the program via either during their training. pathway. There are four basic rotations for residents in the program: adult cardiac surgery, general thoracic Conventional (5+2) – five years of surgery, pediatric cardiothoracic surgery and Christian general surgery training followed by two Hospital (cardiothoracic surgery in a community setting). years of thoracic surgery training Away rotations at other U.S. or international sites are Early Specialization (4+3) – graduated arranged on a case-by-case basis. Although there are two entry into the program after four years of identifiable tracks in the program, general thoracic and training in general surgery cardiac, all residents rotate through all subspecialties. The residents achieve their educational goals through 27 the assumption of graded levels of clinical responsibility Division of Cardiothoracic Surgery | 2022 Annual Report

Operative Case Log Requirement Summary (July 2018 - June 2022) Operative Case Log Requirement Summary July 2018 - June 2022 2 YEAR 4+ 3 2 YEAR THOR Cardiac CARDIAC CARDIAC Th oracic TOTAL 4 + 3 THOR Minimum Minimum TOTAL TOTAL TOTAL OPERATIVE EXPERIENCE Congenital Heart Congenital Heart Disease (as Primary SurOgeopn) erative Case Log5 Requi1r1ement29 0 5 28 Congenital Heart Disease (as Assistant) Summar1y5 16 87 10 13 54 Total Congenital HeJaurtlyDis2e0as1e8 - Ju2n0e 2022 27 116 10 18 82 Operative Case Log Re2qYuEAiRreme4n+ 3t 2 YEAR Adult Cardiac Experience Acquired Valvular Heart Disease 2S0u1mM8Cmin-airJam62d50uriuaynmc e CAR1D48IAC CAR3D10IAC Th o3ra0cic TH5O0R 4 + 33T0H1OR AVR, AV Repair TOT80AL Minim15um TOT19AL TOT74AL OPMEVRRA, MTIVVREepEaXirPERIENCE July 20T2O2T49AL CoTnVgRe, nTiVtaRl eHpaeiar,rAtnnuloplasty 15 25Y1EAR 704 + 3 5 20YEAR 68 C5ardiac 8THOR 4 2+03 THOR CA16RDIAC CA23RDIAC T5horacic CToAnVgRen(itaasl HPreiamrtaDryisSeuarsgeeo(ans) Primary Surgeon) Mi5n5imum 1T17OTAL 2T191OTAL M00inimum 5T4OTAL 218T5OTAL OCTPoAnEVgRRenA(itaTaslIVHAsEesairEsttXDaniPst)eEaRseIE(aNsCAEssistant) 1150 1162 8172 105 138 548 CMonyogceanrdiitaal lRHeveaasrctularization 2800 21706 111268 1305 1586 81231 Total Congenital Heart Disease AdRCueolntDgCoenaSirtteadrlinHaoectoamrEtyxDpiseeraiseen(caes Primary Surgeon) 155 2711 9329 50 85 76 28 AICnctoqenurgivreeenndtiitVoaanl laHvlueSlaakrritlHlDseiosarertPaDsroeisc(eeaadssuAeresssistant) 610515 1458016 31110587 305 10 5807 13 310014 54 ALVeRft ,HAeVarRt Cepaathir, PCI, TEVAR, Mitral Clip 121555020 451194227 7810052116 150 193 744 ATTTMICAAAAMdnVAAVrocVotuVVVRrrrqRnRahltRRRu,idty,c,aTiut,Mr((ohACPiVeMaatrmVVrdassDtRioVcirVRRAPicaesdRBeasreepsSiidlsaeppamevauuilpaiacuslrcrraoaiitglt,erriaaroioeAsrEyrnnnrntySHx)PnaupunuerldmaeogrrpePptilorDaenesin)pstyaceraeastieon Total Congenital Heart Disease 11723267081454198 211583125013871000 55 10 207 18 6186 82 Total Major TOTAL 15201107663176 1192131358651231 Operative Experience OPERATIVE EXPERIENCE 12 12 155110500126055 46106 55128 55 30 86 50 206 301 162027 192893 05 15 47 19 1753 74 63704250 18,51041195 50 5 89 20 850 68 2481142 5512152 RMInPLTTeteyaAVefocDrtRVvceARoea,mtnrrTSdia(taVtiaikeoalsernRlonraPRreolIrBnpteSiosmavimkaeiaritarlsr,yltrisciAayoulonnlSMranouruParirlzrzgoRoaeepcte,oliaeomPnsdn)uotuylvrmeasol nary Vein Isolation, Right Side Maze 80 5 35 5 56 8 131 20 Cardiac 405 460 155 5 50 0 84 4 7266 15 Minimum 155 50 875 1074 TAVR (as Assistant) 10 5 8 8 LCMefaytroHdcieoaaprrudtliCmalaoRtnhea,vrPyaCsBIc,yuTplaEsrViszAasRteio,t nMupitaranldCpluipmp run 5580 05 35 37 56 46 131 InCRtrieracDauoloartStoictreyBrnAaolsltosooimsnty/PCuamrdpiac Transplant 110015 55 5 725 8 165 76 AACALIILdnnrooueruttrnnfrehttlaidgryctHvutahPiGeetMomnraDreotatriiiicantojcsoenCesSrBdaerauuAlacatrrlShntgleli,oakoesoPtTinrolnylChmasPonIio,dcrurTamPRPEcrperVeioscApceaRecrdt,aiuoMtirnoesintsrAadl CullitpCardiac Experience Total 21590515 1530 3673387 976390104 5 5 2 YEAR CARDIAC 1300150 050 0 961 3 5601 4 833 933 5 7 16 TOTAL Operative Case Log RequirementPLLACeauofoctnrneAgtidmtcruiaMiPatklraDeoojrocirsIreBnsdVseiuaeAcrtrtrTeitioisaSonln/RMaoonarbdzRoePte,ircmPeApuoalnvmraaatolotnimoanricy 111632370 311652850 6 3028 2751 73 LAurnrhgytBhmiopiasyS/uWrgeedrgye Resection RVeeisneIcstoiolantsion, Right SideJMulayze2S0u1m8m- Jaur552y5n5115e00 025 5 414 6 2164 0 5 5 7 7 30 0 34 9 32 50 Total Lung 2022 1607 560 2 YE68A3 R 4 +5913 1505 2 YE17A09R Cardiopulmonary Bypass set up and pump run Ca1rd00ia5c CAR6D04I1A3C CAR9D87IA36C Th or5a5cic0 CPLielrefctuuArlaatrtoiMarlyaojAorsrBsiiasttr/iCaal rMdiaazceT, Praunlmspolannatry Vein Isolation, Right Side Maze TH2O156R 4 4 + 3 T51H2O2R6 PPlaecuerma aMkienroIrnsertion or RemovalAdult Cardiac Experience Total Min2i9m05u5m TO6T47A21L6 T1O1T46A91L5 Min1im3105um0 TO3T39A3L5 TO9T9A80L 7 4 + 3 YEAR CARDIAC 1,466 1,591 AOdInuPtelEtrvRGeAnetTinoIenVarEla: lEInTXDhPowEreaRllicInEigcNCCufEfed Pleural Catheter Insertion 0 2 0 5 14 14 CLCuonangrgdieMonpauijtloamrloAHnnaeartayormBtiycpRasessescettiounpsand pump run 31005 4113 6 5123 5 5205 5 6319 7 6314 6 TOTAL Total Pleura Circulatory Assist/Cardiac Transplant 10 60 98 5 25 5 AALLCMTELduuCCdusrnnhueaoounoggedlcnngplstihggthatBMeeesaGWCMonnigtaoibiiaenuattajpraaousrnljsollormdeynaHHrVi/EcrnWaAeeAhadsaacniTolearrDapttdSlEtTihDDog/axRahemApiigsspoohiRreieeebrcrwcaaeoartRsssgatoicieeemyecmeic((nsScAtyaaeicunosscreantPAgitooesrimnrsmysisiacAtraRdynuteS)sluTterocgCtteiaaoolnnrCs)doinagceEnixtapleHreTiaeornttacDleiLseuTanosgteal 26215550505523905 12183112167302386564412 182129127971260916415249 111023000211505500015300 1115133801123449714636313 8521138240321429768896910 PPELAllueescnuuoqgrrpuaahiarMMMegduaainsVjjooarrlBvVeuAnlaTigrSnH/MReaoarbjtooDrtiicseAansaetomic Resections 6050 147418012 316730212 30510 510461 3014121 0 5 154112178269612356684837430 71281221902903021340761296717 15 25 9 14 8 14 Thoracic 330 455 ICMnLPLPAMTTThtauelleAVVAeeepndVruusaVRVRgviRarrtreRR,,soaaW,nTAtsBMit((incMMVVaiaaoouoVlssnlRRiapmpnaaAPRjsieeoolcny:srepprrid/sHpamaWIinaiiDsirraait,eDriartaAdaynwpglntSh)eHenrululaeRrilngrogengmpesiloaCaenscou)ttrfyifoePndarPaleesuoArapdlhuCaglatethaGel tReenrepeInarsiarelrtTiToohntoarTl aEocstTaoioclptPhaTlleaoLugturuaansl g 121195502550050500260005 115550121556950050013105055 2138481213190396746021911390649 126783312110548348466024511380227 Minimum 913 81033632 114208660 TIMnrateycrohvceeaonrbtdriioanlacRlh:eiavITnlasoDActwuiralweallraliizyMnagStaiCuorjnugofeferrydOPlPeuEraRl CAaTthIeVteEr InEseXrtPionERIENCE 406050 3355305 651661014 1133917714 2 YEAR THOR ERsoepDhaogSusternEostoomphyagectomy Total Pleura 15510 2176 13 963 13 520 25 834 39 7368 34 TOTAL MECiIsnnhotoeeprshrvatePgWnurtsiaoolcnl BaaelnedSdnukiDgrilnelisaMspoharrjPoarrgomcedures 155 5 5100 25 13125 24 510 10 8471 26 10441 26 660 LMTaLInrpeetaarfdtcariHoha©aseseocotarAiobtrnipctrcuoicCmcBnraecaHtdhlhliiio,ataaoPtlatniCloPHnAI,uieCTrmrwoEnupVaianyAcoRSilru,fPorMgraiGretarrraaeyldsCuoaplithpeaMgeeadlicRaelpEadirucation 5 48 59 0 10 3 17 4/81/42360220198 5 162 3 1226 0 55 5 732 11 1664 38 1100 0 1661 34 73305 41 3709 41 50 ECsoonpdhuaigt DusissEescotiopnhaagnedcPtormepyaration Total Esophagus 250 5 678 16 957 6 560 20 9 9100 5 1360410 2800132 1590 10 EAsoorptihcaPgruoscedBuerneisgn Major Adult General Thoracic Total 10 28 51 0 Arrhythmia Surgery Laparoscopic HTiaotatlaHleMrniaajoor PraOraPesEopRhaAOgeTapIl VReEepraaEirXtiPvEeRICENaCseE Lo4g050Requ8i3r3e6men1t46626 Left Atrial or Biatrial Maze, Pulmonary Vein Isolation, RighTtoStiadleEMsaozpehSaugmusma ur55yn92e00 13 36 330 5 66032 137732 4 + 3 YEAR MiPnaocremPraokecreIndsuerretiosn or Removal Adult General ThorJaucliyc 2T0o1ta8l - J 2022 16 68 15 97 THOR 1,377 1,694 0 4 26 TOTAL 164 201 0 60 5 161 7 164 309 305 2 YEAR 4+ 3 190 2 YEAR CCiarrcd©uiolapAtuoclrcmyreAodnsiastariTystitoo/BCnytaCparaodlsuisanMccsieTlatfrojuaorpnGsarprnalOdadnuptaPutmeEMpRerudAnicTalIEVdEucaEtioXnPERIENCE MC1inair1m5d40iu0amc5 CATOR6T6D08AIA3LC3 CTAOR9T5D18AI4AL6C6 MTihnoim55ra3ucmi3c0 TTOH2T7O5AR6L604 4+T/83O/2TT650HA210LO3R77 OPERATIVE EXPERIENCE Adult Cardiac Experience Total 221 642 1149 130 333 990 MCAidonunolgrteGPniertonacel erHadeluaTrrehtsoracic BLrouncghoMscaojopryAnSaitmompliec Resections 300 4215 5228 5300 6410 6416 BCroonncgh©eonsiActaoclpcHyreedaCirttaoDtmioispneleCaxoseun(caisl fPorrimGrardyuaStuergMeeodni)cal Education 151 269 010 525 2448/08/2020 CLuonnggeMnitaajloHr VeaArTt DS/iRseoabsoetic(aAsnAastosmisitcanRt)esections Total Bronchoscopy 105 13260 183274 214050 16345 51846 Total Congenital Heart Disease 321701 1231776 31200 315481 83821 ULGuIngEnBdioospcsoy/pWy edSgime Rpleesection 31505 AUdGuI ltECndaorsdcioapcy ECxopmeprlieexnce 2050 Total Lung 600 863 9112 10150 10197 10276 16000 PAclequuriaredMVaajolvr ular Heart Disease Total UGI Endoscopy 2005 11478 347190 35300 156608 31102017 110050550 MPAelVdeRiuar,saAtinVMaRlinAeopsrasierssment 4719 8630 150 1990 7840 MMTIMneeVtddVeRiirRaav,ss,eTttMiinnnVtaaiVoRllnRAAeaepssl:passiaeeIrniss,rssDAmmnwneeeunnlllttoinpgMElaBCseUtduyifSafe/sdFtiNPnolAesucroaplyCatheter Insertion 511111055605555505550 5112743316 12710303301 255501500 123841149063 12631128054423 TAVR (as Primary Surgeon) Total Pleura 100 MMMMTEITELMCRneeeesAsrthedddyeeafooeVtiiiodrDcaaappsHviRchssshhatoeaeetttaasWiiin(rSoannnggtadtibraaouiutnaisoetrasllssulnroCllAAAcmnanaRosaossEBlcnstptessShhseodiyveeis,nokma,DasstPpiialCglsssyhliCnncsammhaAtupI)agMo,eelihmerarTnnrawcraPEttbjitoazgorVeCrmoyaNmrActlhiSoaRyeoadiudnmn,eruMgrbDeeietrsirrysalsaleiCncltoiipor nTMoeMtdaiilanMsotierndaPilaNrsotoicdneealdDAuissrsseeescstsiTomonetanlt 4921650000 11211251511183400560072375360 11121931411109562222340251855 1121135555015325000005055 22548113138833117664172566903 1121437310948341388166214116247 LInatpraaraoosrctiocpBicaHlloiaotnalPHumerpnia or Paraesophageal Repair 162 1262 55 372 3126 Conduit Dissection anTdOPrTepAarLatioOn PERATIVE EXToPtEalREsIoEpNhaCguEs 10 91633768043 125985007911 1469555005 39167601193 1317666034594 Aortic Procedures Adult General Thoracic Total 28Arrhythmia Surgery W28ashing5t1on Un0iversity9 Schoo50l of Medicine in St. Louis | Department of Surgery C2A8YR13ED3A3IARC C1A44R3+66D6I3AC 26TYH64EO0ARR Left Atrial or BiaTtrioaltMaalzMe, aPujolmronOarPy EVeRinAIsTolaIVtioEn, REiXghPt SEidRe IMEaNzeCE C3ar35d1iac TO1T6AL TO1T5AL Th3o30r0acic 4 1+33276T7HOR TO5TAL Pacemaker Insertion or Removal Minim5 um Min0imum TO7TAL Minor Procedures Cardiopulmonary BypTasostsaetluMp aandjopurmOp pruen rative Experience 4055 836 3 14566 3530 6760 136 77

RESIDENCY TRAINING Case Count PROGRAM EXPERIENCE, TWO-YEAR AVERAGE (07/2020 - 06/2022) MAJOR GENERAL THORACIC PROCEDURES Barnes-Jewish St. Louis Christian Total Hospital Children's Hospital Hospital Chest Wall 218 258 Lung and Pleura 716 16 24 908 Tracheobronchial 27 8 184 28 Mediastinum 86 1 0 102 Diaphragm 33 2 14 49 Esophagus 421 10 6 433 Video-assisted Thoracoscopic Procedures 98 0 12 129 Total Major General Thoracic Procedures 1,599 2 29 1,907 39 269 Total MAJOR CARDIAC PROCEDURES Barnes-Jewish St. Louis Christian Hospital Children's Hospital Hospital 52 Closed Operations for Congenital Heart Disease 1 363 Open Operations for Congenital Heart Disease 3 51 0 1,515 Valvular Heart Disease 1,145 360 0 39 Resection of Cardiac Tumor 33 2 368 697 Operations for Coronary Atherosclerosis 391 0 6 74 Pericardium 57 0 306 1,356 Other Cardiac 1,193 0 17 285 Thoracic Vascular 274 116 47 261 Transplantation 222 0 11 32 Major Peripheral Vascular Surgery 20 39 0 2 10 Barnes-Jewish Total Major Total Minor Cases Total Major Cardiac Hospital Cases (Thoracic & Cardiac) Procedures 4,938 3,339 3,561 St. Louis 609 109 570 Children's Hospital Christian 1,034 102 765 Hospital TOTAL 6,581 3,772 4,674 Division of Cardiothoracic Surgery | 2022 Annual Report 29

FORMER TRAINEES DIVISION OF CARDIOTHORACIC SURGERY 2020-2022 Academic Practice Baylor College of Medicine Lauren Barron, MD Academic Practice Medical Universities of South Carolina Kate Engelhardt, MD, MS Academic Practice Washington University School of Medicine Matthew Schill, MD Academic Practice University of Michigan/CS Mott Children’s Hospital 2019-2021 Military, Navy Walter Reed National Military Medical Center Timothy Lancaster, MD Academic Practice University of Colorado Anschutz Conor Hynes, MD Academic Practice Ohio State University Wexner Medical Center Simran Randhawa, MD Academic Practice Washington University School of Medicine 2018-2020 Academic Practice Washington University School of Medicine Matthew Henn, MD Academic Practice New York University Langone Health Jacob Miller, MD Academic Practice Southern Illinois University School of Medicine Shuddhadeb Ray, MD, MPH Private Practice Orlando, Florida 2017-2019 Academic Practice Southern Illinois University School of Medicine Stephanie Chang, MD Academic Practice Washington University School of Medicine Christopher Lawrance, MD Academic Practice SUNY Upstate Medical University Karen (Kalei) Walker, MD Academic Practice University of Colorado Anschutz 2016-2018 Academic Practice Cleveland Clinic Lindsey Saint, MD Ruben Bahena-Nava, MD Stephen Waterford, MD 2015-2017 Jessica Rove, MD Alex Bribriesco, MD 2014-2016 Academic Practice Washington University School of Medicine Puja Kachroo, MD Private Practice Phoenix, Arizona Chirag Patel, MD Private Practice San Antonio, Texas Thomas Percival, MD Academic Practice Memorial Sloan Kettering Cancer Center 2013-2015 Academic Practice Stanford University Matthew Bott, MD Academic Practice University of Chicago Anson Lee, MD Academic Practice University of Texas MD Anderson Seth Krantz, MD Academic Practice University of California, Davis Academic Practice Harvard, Boston Children’s Hospital 2012-2014 Private Practice St. Louis, Missouri Mara Antonoff, MD Lisa Brown, MD David Hoganson, MD Jeremy Leidenfrost, MD 30 Washington University School of Medicine in St. Louis | Department of Surgery

FORMER TRAINEES DIVISION OF CARDIOTHORACIC SURGERY 2011-2013 Academic Practice Northwestern University Ankit Bharat, MD Private Practice Plano, Texas Kelly Hutcheson, MD Academic Practice University of Iowa John Keech, MD Academic Practice Johns Hopkins University 2010-2012 Private Practice Cincinnati, Ohio Stephen Broderick, MD Academic Practice University of Minnesota Mario Castillo-Sang, MD Private Practice Wichita, Kansas Rochus Voeller, MD Academic Practice Washington University School of Medicine 2009-2011 Private Practice Los Angeles, California Brett Grizzell, MD Private Practice St. Louis, Missouri Spencer Melby, MD Private Practice Phoenix, Arizona Wael Yacoub, MD Academic Practice University of Louisville 2008-2010 Academic Practice Indiana University School of Medicine Laura Adam, MD Academic Practice Emory University Elbert Kuo, MD Academic Practice Washington University School of Medicine Victor Van Berkel, MD Academic Practice Virginia Mason Medical Center 2007-2009 Academic Practice Johns Hopkins University Chad Denlinger, MD Academic Practice University of Kansas Felix Fernandez, MD Private Practice Springfield, Missouri Varun Puri, MD, MSCI Academic Practice University of Virginia 2006-2008 Academic Practice University of Rochester Robert Moraca, MD Private Practice San Jose, California Stefano Schena, MD, PhD Academic Practice Washington University School of Medicine Nirmal Veeramachaneni, MD Private Practice Birmingham, Alabama Academic Practice Washington University School of Medicine 2005-2007 Private Practice Austin, Texas Hersh Maniar, MD Academic Practice University of Maryland Alexander Krupnick, MD Sunil Prasad, MD 2004-2006 Omid Javadi, MD Benjamin Kozower, MD, MPH Parvez Sultan, MD 2003-2005 Daniel Kreisel, MD, PhD Eric Hoenicke, MD Christine Lau, MD Division of Cardiothoracic Surgery | 2022 Annual Report 31

FORMER TRAINEES (Cont’d.) DIVISION OF CARDIOTHORACIC SURGERY 2002-2004 Academic Practice Southern Illinois University School of Medicine Traves Crabtree, MD Private Practice Salt Lake City, Utah David Affleck, MD Academic Practice Creighton University Phoenix Michael Smith, MD Academic Practice Emory University 2001-2003 Academic Practice Medical City Children’s Hospital Seth Force, MD Academic Practice Oregon Health and Science University Kristine Guleserian, MD Academic Practice Mayo Clinic, Rochester Paul Schipper, MD Academic Practice Medical College of Georgia at Augusta 2000-2002 Private Practice Tallahassee, Florida Stephen Cassivi, MD Academic Practice University of Pennsylvania Richard Lee, MD Academic Practice University of Iowa Jerome McDonald, MD Academic Practice University of Wisconsin 1999-2001 Academic Practice University of Illinois at Peoria Taine Pechet, MD Academic Practice University of Maryland Arun Singhal, MD, PhD Academic Practice Indiana University Nilto Carias DeOliveira, MD Academic Practice University of Nebraska 1998-2000 Private Practice St. Louis, Missouri Richard Anderson, MD Academic Practice Washington University School of Medicine Whitney Burrows, MD Academic Practice Louisiana State University Medical Center 1997-1999 Private Practice St. Louis, Missouri Mark Rodefeld, MD Private Practice Hollywood, Florida Michael Moulton, MD Academic Practice University of Mississippi Hon Chi Suen, MD Private Practice Olympia, Washington 1996-1998 Private Practice Portland, Oregon Bryan Meyers, MD, MPH Private Practice Buffalo, New York Timothy Pettitt, MD Private Practice Lima, Ohio Seiichi Noda, MD Private Practice Nashville, Tennessee 1995-1997 Academic Practice Massachusetts General Hospital Mark Block, MD Larry Creswell, MD Dwight Hand, MD 1994-1996 Steven DeMeester, MD Stephen Downing, MD Gary Parenteau, MD 1993-1995 John Pirolo, MD Henning Gaissert, MD 32 Washington University School of Medicine in St. Louis | Department of Surgery

FORMER TRAINEES (Cont’d.) DIVISION OF CARDIOTHORACIC SURGERY 1992-1994 Academic Practice UT Southwestern Robert D.B. Jaquiss, MD Private Practice Dallas, Texas Eric Mendeloff, MD Academic Practice Carolinas Medical Center Jeffrey Hagen, MD Academic Practice Harvard, Massachusetts General Hospital 1991-1993 Academic Practice University of Cincinnati Thoralf Sundt III, MD Private Practice New Albany, Indiana James Tweddell, MD Michael Bousamra II, MD Faculty collaborate to develop patient education materials. Division of Cardiothoracic Surgery | 2022 Annual Report 33

WASHINGTON UNIVERSITY MEDICAL CAMPUS Barnes-Jewish Hospital in the spring. The School of Medicine’s clinical practice group of more than 1,500 full-time clinical physicians and surgeons, called Washington University Physicians, is one of the largest academic clinical practices in the nation. In addition to providing care on the Medical Campus, these physicians extend patient care to community practice across the St. Louis region at locations including Christian Hospital and Alton Memorial Hospital. Surgeons are among the almost 1,700 attending physicians at Barnes-Jewish Hospital, the largest hospital in Missouri. Barnes-Jewish is consistently ranked among the nation’s best hospitals by U.S. News & World Report. The hospital holds advanced certification from the Joint Commission for lung volume reduction surgery and is an American College of Surgeons- verified Level I trauma center. The hospital has over 1,300 licensed beds. St. Louis Children’s Hospital is the St. Louis Children’s Hospital. largest children’s hospital in the region, with nearly 400 licensed beds and an American College of Surgeons-verified Level I pediatric trauma center. It offers comprehensive services in every pediatric medical and surgical specialty and is recognized as one of America’s top children’s hospitals by U.S. News & World Report, which in 2020 ranked the hospital in all 10 specialties surveyed. Siteman Cancer Center is the only Alvin J. Siteman Cancer Center. National Cancer Institute-designated Comprehensive Cancer Center in Washington University Medical Campus includes Barnes-Jewish Missouri and is ranked as one of Hospital, St. Louis Children’s Hospital, and the Alvin J. Siteman the nation’s top cancer facilities by Cancer Center at Barnes-Jewish Hospital and Washington University U.S. News & World Report. In 2020, School of Medicine. Covering 178 acres over 18 city blocks, the Siteman earned the highest possible Medical Campus is located at the intersection of St. Louis’ Central rating—exceptional—by the National West End and Forest Park Southeast neighborhoods. Cancer Institute, as part of a rigorous, peer-reviewed five-year evaluation of Siteman’s research programs. 34 Washington University School of Medicine in St. Louis | Department of Surgery

FACULTY DIVISION OF CARDIOTHORACIC SURGERY Ralph J. Damiano, Jr., MD Chief, Division of Cardiothoracic Surgery Evarts A. Graham Professor of Surgery SECTION OF CARDIAC SURGERY Tsuyoshi Kaneko, MD Chief, Section of Cardiac Surgery John M. Shoenberg Chair in Cardiovascular Disease Endowed Professor Associate Professors Assistant Professors Ralph J. Damiano, Jr., MD Puja Kachroo, MD Kunal D. Kotkar, MD Muhammad Faraz Masood, MD Shuddhadeb Ray, MD, MPHS Professors Spencer J. Melby, MD Instructor Nabil A. Munfakh, MD Amit A. Pawale, MBBS Matthew R. Schill, MD Michael K. Pasque, MD Harold G. Roberts, Jr., MD Christian W. Zemlin, PhD, MSc Instructors Tsuyoshi Takahashi, MD SECTION OF THORACIC SURGERY 35 Bryan F. Meyers, MD, MPH Chief, Section of Thoracic Surgery Patrick and Joy Williamson Chair in Cardiothoracic Surgery Endowed Professors Associate Professor Andrew E. Gelman, PhD WenJun Li, MD Daniel Kreisel, MD, PhD Assistant Professor G. Alexander Patterson, MD Ruben G. Nava Bahena, MD Professors Benjamin D. Kozower, MD, MPH Varun Puri, MD, MSCI SECTION OF PEDIATRIC CARDIOTHORACIC SURGERY Pirooz Eghtesady, MD, PhD Chief, Section of Pediatric Cardiothoracic Surgery Emerson Chair in Pediatric Cardiothoracic Surgery Associate Professor Assistant Professor Dilip S. Nath, MD Jacob R. Miller, MD Division of Cardiothoracic Surgery | 2022 Annual Report

CT SURGERY CLINICAL LOCATIONS 1) Barnes-Jewish Hospital Website: barnesjewish.org Main phone number: (314) 747-3000 Barnes-Jewish Hospital is consistently ranked among the top pulmonology and heart programs by U.S. News & World Report. The hospital has a 21-bed cardiothoracic ICU, a thoracic surgery nursing division and a cardiac surgery nursing division. 2) St. Louis Children’s Hospital Website: cardiothoracicsurgery.wustl.edu/patient-care/pediatric/location Main phone number: (314) 454-6000 St. Louis C6h7ildren’s Hospital provides a full range of health services within a 200-mile radius service area, and patients from around the world have received care from the hospital in various specialty areas. Patients requiring 79 intensive care following cardiac surgery are taken to a specifically designated region of the Pediatric ICU. 3) Center for Advanced Medicine 67 3 Website: cardiothoracic6s7urgery.wustl.edu/places/center-for-advanced-medicine Main phone number: (3617 4) 742557-3000 55 OLD Washington Universi3ty cardiothoracic surgeons provide world-class care at the Heart & Vascular MONROE Center a94nd Jacqueline MaALTrOiNtz Lu1n40g CeBEnTHAtLeTOr, located i1n40 the Center for Advanced Medicine. 140 94 67 79 370 7 4 70 IVER 367 111 EDWARDSVILLE 40 ST. CHARLES Graham67 8 3 ST. PETERS 55 61 MISSOURI 70 14 364 270 40 PEORIA 94 364 MISSOURI R ILLINOIS 255 270 70 64 40 61 GLEN 40 O’FALLON 270 8 CARBON 364 67 170 GRANITE 56 3 CITY 40 340 Woods Mill Mason 213 4 55 COLLINSVILLE 111 157 Ballas Rd Forest Park Hanley 157 Skinker 15 340 141 64 40 ST. LOUIS 50 12 50 ST. LOUIS 100 100 67 EAST 64 61 50 270 44 55 ST. LOUIS FAIRVIEW 13 50 3 CAHOKIA 161 HEIGHTS SHILOH SALEM CAHOKIA 364 163 11 64 15 255 13 MidAmerica/ Scott Air CAPE GIRARDEAU Force Base 141 MISSISSIPPI RIVER 50 BELLEVILLE 44 10 9 255 PACIFIC 30 163 55 3 MILLSTADT BYRNES 21 St. LMIoLL uis Metropolita61n Area Regional HOUSE Hospita6l7 1) 13) Sa15lem Memorial - Salem, MO BaSrPRnINGeS s-Jewish 23)0 St. Louis Children’s Hospital 3) CJoehnnteCro2f1ochr rAadnvVaBAenRNtcHeAeRrTdanMseHdoicsipnieta–lBarnes-JewishWAHTERoLOsOpital 4) Affiliates 5) Heart & VascularFESCTUSenter – Barnes West County 6) Siteman Cancer CCee5nn5tteerr – Barnes West County 14) Unity Point Health - Peoria, IL 7) Siteman Cancer – Barnes-Jewish St. Peters 3 15) Southeast Health - Cape Girardeau, MO 8) Christian Hospital 9) Center for Advanced Medicine – South County 10) Siteman Cancer Center – South County 11) Memorial Hospital – Belleville • Shiloh* 12) Siteman Cancer Center – Shiloh* *Clinical services in Illinois provided by Washington University Physicians in Illinois, Inc. 36 Washington University School of Medicine in St. Louis | Department of Surgery

CT SURGERY CLINICAL LOCATIONS 4) John Cochran Veterans Hospital Website: va.gov/st-louis-health-care/locations/john-j-cochran-veterans-hospital/ Washington University cardiothoracic surgeons provide surgical services at the John Cochran Division of the Veterans Affairs St. Louis Health Care System. 5) Heart & Vascular Center – Barnes West County Website: barnesjewishwestcounty.org/Medical-Services/Heart-Vascular The Heart & Vascular Center at Barnes-Jewish West County Hospital provides a comprehensive approach to heart care, including full-service cardiac diagnostic testing, a cardiac catheterization lab and a non-invasive vascular lab. 6) Siteman Cancer Center – Barnes West County Website: cardiothoracicsurgery.wustl.edu/places/siteman-cancer-center-west-county-hospital The Siteman Cancer Center facility on the campus of Barnes-Jewish West County Hospital offers a convenient location for patients to receive treatment, see their physicians and undergo necessary testing. 7) Siteman Cancer Center – Barnes-Jewish St. Peters Website: cardiothoracicsurgery.wustl.edu/places/siteman-cancer-center-barnes-jewish-st-peters-hospital The Siteman Cancer Center facility on the campus of Barnes-Jewish St. Peters Hospital brings comprehensive cancer care closer to home for patients in St. Charles County and beyond. 8) Christian Hospital Website: cardiothoracicsurgery.wustl.edu/places/christian-hospital Main phone number: (314) 653-5000 Christian Hospital is located in north St. Louis County, approximately 10 miles from Washington University Medical Center. The hospital offers a cardiothoracic surgery program, facilities for inpatient rehabilitation and “extended care” skilled nursing. 9) Center for Advanced Medicine – South County Website: barnesjewish.org/Patients-Visitors/Locations-Directions/Center-for-Advanced-Medicine-South-County This outpatient facility provides a wide range of medical services, including cardiology, radiology and outpatient surgery at a convenient clinical location for patients in the greater St. Louis area, southern Missouri and Illinois. 10) Siteman Cancer Center – South County Website: cardiothoracicsurgery.wustl.edu/places/1051 The 37,000-square-foot Siteman Cancer Center facility in south St. Louis County brings world-class medical, radiation and surgical oncology to patients in the greater St. Louis area, southern Missouri and Illinois. 11) Memorial Hospital – Belleville • Shiloh* Website: memhosp.org/our-locations/ Washington University cardiac surgeons at Memorial Hospital Belleville and thoracic surgeons at Memorial Hospital Shiloh offer the most advanced, innovative treatments for heart and lung conditions. 12) Siteman Cancer Center – Shiloh* Website: siteman.wustl.edu/visiting/illinois The new Siteman Cancer Center facility at the Memorial Hospital Shiloh campus offers convenient access to nationally recognized cancer care for residents of southern and central Illinois and beyond. Division of Cardiothoracic Surgery | 2022 Annual Report *Clinical services in Illinois provided by Washington University Physicians in Illinois, Inc. 37

A MILESTONE TO REMEMBER: Christian Hospital in St. Louis. 500th Robotic Thoracic Surgery Occurs at Christian Hospital Washington University thoracic In 2020, Thoracic Surgery Chief Bryan Meyers, MD, MPH, surgeons at Christian Hospital “I AM ALSO PROUD THAT recognized that thoracic surgery recently accomplished a major CHRISTIAN WAS THE FIRST had reached its tipping point milestone in its pursuit of offering HOSPITAL IN THE ST. LOUIS and was thrilled to offer these precise, leading-edge medical AREA TO USE THIS INNOVATIVE procedures and advancements to care. On Dec. 1, 2021, thoracic MINIMALLY INVASIVE TECHNOLOGY the growing number of patients surgeons Varun Puri, MD, MSCI, TO RESECT TUMORS OF THE CHEST throughout the region. Nabil Munfakh, MD, and their AND ALLOW PATIENTS TO RECOVER operative staff carried out Christian FASTER FROM SURGERY.” Hospital’s 500th robotic thoracic “This milestone is just the surgery. -NABIL MUNFAKH, MD beginning of the thoracic “I am proud that our team of surgery team’s legacy of surgical surgeons and OR staff has built the excellence at Christian Hospital,” biggest experience in performing says Meyers. “The future of these complex cases in the St. Christian Hospital through his robotic thoracic surgery is bright Louis metro area,” says Munfakh, expertise in the minimally invasive and our team looks forward to professor of surgery and medical procedures. utilizing these techniques in the director of cardiothoracic surgery years to come.” at Christian Hospital. Robotic thoracic surgery is In 2011, the team at Christian frequently utilized in pulmonary Hospital performed the St. Louis resections, esophageal surgery, region’s first robotic full-lung hiatal hernia repair and surgery lobectomy to successfully treat for mediastinal tumors in the lung cancer. Since then, use of chest and lungs. robotic technology at Christian Robotic techniques give Hospital and Barnes-Jewish thoracic surgeons the Hospital has expanded and opportunity to perform continues to thrive, providing a variety of complex advanced options for simple and procedures with more complex cases across specialties. precision, flexibility and After completing a thoracic surgery control than is possible fellowship at Washington with open techniques. University in 2020, Shuddhadeb Other advantages to this Ray, MD, MPHS, joined the thoracic type of surgery include surgery team at Christian Hospital. smaller incisions and Ray has greatly contributed to often results in quicker the growth in robotic surgery at healing and less pain than open surgery for Varun Puri, MD, MSCI (front center), Nabil Munfakh, MD (front right), and their operative staff celebrate the milestone. most patients. 38 Washington University School of Medicine in St. Louis | Department of Surgery

CARDIOTHORACIC SURGERY ON SOCIAL Division of Cardiothoracic Surgery Twitter home page Washington University Cardiothoracic Surgery: WashU CT Twitter: cardiothoracicsurgery.wustl.edu twitter.com/WashU_CT WashU Surgery Facebook: WashU Surgery Instagram: facebook.com/WashUSurgery instagram.com/washusurg Fellow Ali Khiabani, MD, MHA, shares a photo of Medical student Nadia Bakir, MD, and M. Faraz Fellow Linda Schulte performs a mini thoractomy with Matthew Schill, MD, during his first case as a new Masood, MD, present their research at Ralph Damiano Jr., MD. the AATS annual meeting. faculty member. Division of Cardiothoracic Surgery | 2022 Annual Report 39

DIVISION OF CARDIOTHORACIC SURGERY OFFICE OF THE CHIEF Ralph J. Damiano Jr., MD Division Chief of Cardiothoracic Surgery Evarts A. Graham Professor of Surgery WASHINGTON UNIVERSITY SCHOOL OF MEDICINE MSC 8234-05-02 660 S. Euclid Ave. St. Louis, MO 63110 Section of Section of Section of Cardiac Surgery General Thoracic Surgery Pediatric Cardiothoracic Surgery (314) 362-7260 (314) 362-7260 (314) 454-6165 cardiothoracicsurgery.wustl.edu PARTNER INSTITUTIONS The 1,500 specialty and primary care clinicians who make up Washington University Physicians comprise the medical staffs at Barnes-Jewish Hospital and St. Louis Children’s Hospital. SCAN ME SHARE ON TWITTER For more, please scan the QR code above or visit @WashU_CT cardiothoracicsurgery.wustl.edu CONTACT: [email protected]