Washington University Cardiothoracic Surgery Annual Report

Shaping the Future of Cardiothoracic Surgery 2021 ANNUAL REPORT Division of Cardiothoracic Surgery

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 Faculty .......................................................................... 34 Washington University Medical Campus.................................. 35 Cardiothoracic Surgery Clinical Locations ................................ 36 CT on Social .................................................................... 39 Cover: Washington University cardiothoracic surgeon Shuddhadeb Ray, MD, MPHS, performs surgery at Christian Hospital in north St. Louis County. Read more about his practice on page 15. *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 Over the last decade, we have seen continued growth in both adult cardiovascular and general Ralph J. Damiano, Jr., MD thoracic surgical volumes, and have expanded both Division Chief of Cardiothoracic Surgery our inpatient and outpatient facilities. We also Evarts A. Graham Professor of Surgery have experienced considerable expansion of our The Division of Cardiothoracic Surgery at Washington basic and clinical research programs. Our faculty of cardiothoracic surgeons, critical care anesthesiology University School of Medicine, Barnes-Jewish Hospital, has intensivists, laboratory-based investigators and active had a long tradition of excellence in patient care, research emeritus professors is leading the specialty through and education. The chest service was initially established excellent patient care and innovative research. by Evarts Graham, MD, in 1920. Since then, our division Our clinical research and data management unit has grown tremendously to include 19 faculty and over comprises 18 clinical research coordinators and data 70 support staff. We now incorporate not just thoracic managers who support the research efforts of the surgery, but also sections of adult cardiac surgery, pediatric faculty and fellows. Our basic science laboratory is cardiothoracic surgery, and heart and lung transplantation. supported by numerous peer-reviewed extramural Over this time, we have had a strong commitment to our grants. During a time in which many academic residency program, which is the second-oldest in the programs have shrunk, our growth has been made country, established in 1929. Our goal is to train the future possible by both the development of exciting new leaders of our specialty. Our faculty is dedicated to providing programs and the generous support we have received a nurturing and stimulating educational experience for our from Washington University School of Medicine, the fellows. We are very fortunate to practice in an incredibly Department of Surgery, Barnes-Jewish Hospital, St. supportive hospital and university environment that has Louis Children’s Hospital, and from our patients, facilitated our mission. their families and friends. Our outstanding clinical Our division encompasses the entire breadth and depth of facilities have enabled the introduction of state-of- clinical programs in our specialty, while at the same time the-art techniques in adult cardiac, general thoracic providing multiple opportunities for basic and clinical and pediatric cardiothoracic surgery. We have been a research. We have an integrated team, consisting of five pioneering center in lung transplantation and recently subspecialty units: adult cardiac surgery, adult general performed our 10,000th transplant. In addition thoracic surgery, pediatric cardiothoracic surgery, heart to this expertise, our faculty have also developed and lung transplantation, and cardiothoracic critical care. active and renowned programs in minimally invasive In adult cardiac and general thoracic surgery, we have both cardiac procedures, advanced arrhythmia surgery, university and community-based surgeons to enhance the endovascular techniques, heart transplantation, training program. Moreover, we have opened a program at ventricular assist devices, video-assisted thoracic our VA hospital, which will add another dimension to our surgery, and robotic and endoscopic procedures. residency training. While we have superb clinical facilities and a supportive environment for academic surgery, our greatest asset has always been and continues to be our faculty. We have a truly exceptional group of committed and talented individuals who work together closely as a team. We support one another and take pride in each other’s accomplishments. Together, we are united in our dedication to providing the highest quality and most innovative 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 to give the prestigious Glenn Lecture at the American Heart Association. It is my privilege to serve as division chief and work for this outstanding group of individuals. Division of Cardiothoracic Surgery | 2021 Annual Report 3

History of Cardiothoracic Surgery at Washington University in St. Louis The Division of Cardiothoracic Surgery at Washington University evolved a century ago to address what many considered to be the last surgical frontier: diseases of the chest. In addition, 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. Beginning with Evarts A. Graham and continuing through to Ralph J. Damiano Jr., the leaders of the division have had a profound impact on the field of cardiothoracic surgery. -Marc Moon, MD, on the History of Cardiothoracic Surgery at Washington University in St. Louis Read Moon’s full article on PubMed: https://pubmed.ncbi.nlm.nih.gov/28285680/ Evarts A. Graham Thoracic Surgical Seminal Article Fellowship on Lung Cancer 1920’s 1933 1951 Thomas H. Burford 1919 1929 1950 Division Established Pneumonectomy 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

Washington University in St. Louis, a view from above. Clarence S. Weldon Pediatric CT Thoracic Surgery Heart Transplant 1983 1987 1995 James L. Cox 1968 1985 1988 Cox-Maze Procedure Barnes-Jewish Hospital Joel D. Cooper G. Alexander Patterson TAVR 2002 2009 2014 Cox-Maze IV Lung Transplant 1997 2005 2010 Ralph J. Damiano, Jr. Division of Cardiothoracic Surgery | 2021 Annual Report 5

DIVISION OF CARDIOTHORACIC SURGERY Section of Cardiac Surgery 2,895 Operating room cases 5,996 Visits $2,350,974 Research funding 82 Clinical research studies 10 Faculty Muhammad Faraz Masood, MD, center, and his surgical team during a procedure. Our cardiac surgeons have a long history of performing cardiac surgical procedures and are widely recognized as surgical leaders. Our group performs the entire spectrum of adult cardiac surgery, and we have the largest program in our region. Working with cardiologists, vascular surgeons, anesthesiologists, intensivists, and a highly qualified, experienced nursing staff, cardiac surgeons offer the latest advances in technology and innovative therapies. They also employ practices supported by scientific evidence as they strive to achieve the best possible outcomes in their patients. 6 Washington University School of Medicine in St. Louis | Department of Surgery

Ma Shaping the Future of Cardiac Research The mission of the Cardiac Surgical Research Laboratory is to solve the clinical problems that face cardiac surgeons. Among the many accomplishments of the continuously NIH-funded laboratory is the development of the Cox-Maze IV procedure—the first cure for atrial fibrillation. The laboratory also trains future scientists from around the world who will lead the field of cardiac surgery for generations to come. Zemlin will continue this tradition of academic excellence by offering a formal training program for biomedical engineering students from the McKelvey School of Engineering. “I am excited to continue the lab’s groundbreaking work on the surgical treatment of arrhythmias and to build new collaborations with WashU’s outstanding groups in biomedical engineering and cardiovascular research,” says Zemlin. Christian Zemlin, PhD, MSc. Zemlin earned a master’s degree in physics from the Technical University Berlin in 1998 and a doctorate in Christian Zemlin, PhD, MSc, has been named director theoretical physics from Humboldt University in Berlin of the Cardiac Surgical Research Laboratory in the in 2002. He completed his postdoctoral research in Division of Cardiothoracic Surgery at Washington cardiac electrophysiology at SUNY Upstate Medical University School of Medicine in St. Louis. Zemlin, University in Syracuse. His research uses voltage- whose work focuses on the mechanisms and sensitive fluorescent probes to experimentally treatment of arrhythmias, was recruited from Old study cardiac activity, and computer modeling Dominion University in Norfolk, Virginia, where he to understand how arrhythmias are initiated and served as graduate program director of the Biomedical maintained. Zemlin developed a new ablation Engineering Program. modality for cardiac tissue based on ultrashort “Christian will not only continue the exceptional work electric pulses that cause irreversible electroporation. historically produced by our laboratory, but he will His research has been funded by the American Heart also put his own unique stamp on future productivity Association, the NIH, intramural funding and industry. with his expertise in cardiac electrophysiology and biomedical engineering,” says Chief of Cardiothoracic “I am excited to continue the lab’s Surgery Ralph Damiano Jr., MD, the Evarts Graham groundbreaking work on the surgical Professor of Surgery. treatment of arrhythmias and to build new In 2020, Richard Schuessler, PhD, retired after leading collaborations with WashU’s outstanding the research program for 20 years. A world-renowned groups in biomedical engineering and scientist, Schuessler collaborated with a team of cardiovascular research.” Washington University investigators and cardiac surgeons to rigorously evaluate ablation devices. Christian Zemlin, PhD, MSc Together, Schuessler and Damiano developed clinical innovations in the treatment of atrial fibrillation. Division of Cardiothoracic Surgery | 2021 Annual Report 7

Highlights from Cardiac Surgery CLINICAL Kunal Kotkar, MD. Hypertrophic obstructive cardiomyopathy (HOCM) is a genetic disorder that causes thickening of the heart muscles and obstructs blood flow from the heart. Septal myectomy surgery, the treatment of choice for HOCM, provides long-term symptom relief and survival. Cardiothoracic Surgery Division Chief Ralph DamianoJr., MD, has performed minimally invasive HOCM procedures for nearly two decades. The minimally invasive procedure has resulted in less blood loss, shorter ICU length of stay and better postoperative pulmonary function for patients. Cardiac surgeon Kunal Kotkar, MD, joins Damiano in performing septal myectomies at the Washington University Hypertrophic Cardiomyopathy Center, the only National Hypertrophic Cardiomyopathy Association Center of Excellence in the region. RESEARCH Muhammad Faraz Masood, MD. The 2021 St. Louis Shock Symposium, led by Director of the Extracorporeal Life Support (ECLS) Program at Barnes-Jewish Hospital Muhammad Faraz Masood, MD, focused on critical conditions such as cardiogenic shock, COVID-19 related acute respiratory distress syndrome and pulmonary embolism. Washington University cardiothoracic surgeons, including Masood, Kunal Kotkar, MD, and Varun Puri, MD, presented research and clinical experience with these conditions. During the COVID-19 pandemic, Washington University cardiac surgeons have played a vital part in the treatment of the most critically ill patients. Health care professionals from across the region attended the conference to learn from leading experts and understand the optimal treatments for patients with cardiogenic shock and severe respiratory distress. EDUCATION While cardiac surgeons nationwide are trending towards private practice following their training, the Washington University cardiothoracic training programs continue to produce cardiac surgeons with an interest in academic surgery. Cardiothoracic Surgery Residency Program Director Varun Puri, MD, MSCI, provides advanced training while also maintaining an emphasis on wellness in the training program. “Because of the environment they have been part of at Washington University, our cardiothoracic trainees do not consider their training to be an end point, but rather the beginning to their academic career educating future generations of surgeons,” says Cardiac Surgery Section Chief Marc Moon, MD. Varun Puri, MD, MSCI. 8 Washington University School of Medicine in St. Louis | Department of Surgery

Leading the Charge in Transcatheter Therapies Shuddhadeb Ray, MD, MPHS, operates at Christian Hospital in North St. Louis. Washington University cardiac surgeons continue to Anterior (front) view of advance the most innovative techniques in transcatheter an adult heart with ECG therapies for valvular diseases. Transcatheter therapies rhythm. are minimally invasive procedures with shorter recovery times than open surgery and rewarding patient outcomes. Over the last decade, industry developers have put forward numerous devices for clinical study. “One of the unique things about Washington University is treatment option for patients with aortic stenosis, one that our high clinical volume and surgical expertise allow of the most common, insidious valve diseases in the us to participate in almost all studies of new devices,” says United States. Many patients with aortic stenosis are Cardiac Surgery Section Chief Marc Moon, MD, the John M. considered too high-risk for invasive surgery because Shoenberg Professor of Surgery. “Some of these devices of their age, heart function or other comorbidities. will prove to be excellent replacements for more invasive TAVR provides a minimally invasive option for valve techniques. Some may create opportunities for patients replacement. Led by Spencer Melby, MD, Washington who presently have few therapeutic options.” University cardiac surgeons were among the first in Leading the charge in these investigations of transcatheter the country to participate in TAVR clinical trials, and therapies is cardiac surgeon Puja Kachroo, MD. This year, continue to innovate with the procedure today. Kachroo and the team at the Washington University and Christian Hospital in North St. Louis provides leading- Barnes-Jewish Heart & Vascular Center performed one edge heart procedures in a hybrid room equipped of the first transcatheter interventions for tricuspid valve with advanced imaging technology and surgical disease. cRaapya, bMilDit,iMesP. HCaSr,dreioctehnotrlyacpiecrsfuorrgmeeodnoSnheuodfdthhaedfeirbst “Our goal is to evaluate and treat patients with valvular planned TAVR in TAVR procedures in the St. Louis area. heart disease expeditiously, in a multidisciplinary fashion, For a TAVR patient whose original replacement valve offering state of the art diagnostic and novel therapeutic has deteriorated over time, TAVR in TAVR is an option surgical or catheter-based interventions, in order to that utilizes additional prostheses for a second valve provide exceptional care,” says Kachroo. replacement. This procedure, for a patient with renal Transcatheter valve therapies originated with TAVR failure, was the first at Christian Hospital to use the (transcatheter aortic valve replacement). TAVR is a carotid artery as an alternative access site for TAVR. As the section continues to innovate in transcatheter “One of the unique things about Washington therapies, patient care is at the forefront for University is that our high clinical volume and Washington University cardiac surgeons. Through surgical expertise allow us to participate in advanced multidisciplinary care, the Cardiac Surgery almost all studies of new devices.” Section expands therapeutic options for patients with even the most challenging valvular diseases. Marc Moon, MD Division of Cardiothoracic Surgery | 2021 Annual Report 9

Surgeons with Heart Washington University cardiothoracic surgeons have played a critical role in treating patients with COVID-19. Cardiothoracic surgeons typically treat conditions of the heart and lungs, but the pandemic presented a unique problem: a deadly virus that could affect both organs and required extreme caution to protect health care workers from infection. Cardiac surgeons Akinobu Itoh, MD, PhD, Kunal Kotkar, MD, and Muhammad Faraz Masood, MD, met this problem head-on, with a commitment to do whatever it takes for their patients. “The differences between COVID and flu or From left: Muhammad Faraz Masood, MD, Kunal Kotkar, MD, and Akinobu Itoh, MD, PhD . pneumonia patients start with the preparation,” Masood says. The necessary personal protective School of Medicine in St. Louis over the past three equipment and limitations on personnel in a COVID years. In 2020, over 200 people, including COVID intensive care unit (ICU) changed how this type of and non-COVID patients, were placed on ECMO at care looked from the very beginning. Normally, a the School of Medicine. team including surgeons, intensivists, infectious “Unlike flu or pneumonia, COVID affects the entire disease doctors and nursing staff would all be in body,” Masood says. “It can have its own effects on the room with an ECMO patient. The interactions the lungs, heart and immune system.” with COVID patients on ECMO, Masood says, are COVID affects different patients in different ways. more critical and intense. This team still provides In every case, the emotional toll is significant. A the same critical care, but surgeons shoulder a typical flu patient might need ECMO for about two significant burden to limit the rest of the team’s weeks. ECMO times for COVID patients can be much exposure. longer. During that time, the team is there for them Extracorporeal membrane oxygenation (ECMO) through the long hours, sometimes late into the provides COVID patients the chance to rest their night. When the surgeons finally leave the hospital, heart and lungs when the organs are failing. ECMO they have to isolate from their families, living in acts as a heart and lung for the patient, taking basements or RVs to protect their loved ones. The blood from the body, oxygenating it and pumping willingness of Itoh, Kotkar and Masood to show up it back into the body at about six to eight liters every day, despite the uncertainties and challenges, per minute. ECMO was originally invented to care has been vital to delivering the highest quality care for pediatric patients with lung failure, but was to the sickest of COVID patients. rapidly adopted for both congenital and adult “The ability of our clinical faculty to pull together, patients whose organ failure did not improve with problem-solve and rise to the occasion has resulted traditional methods. in superb patient care,” says Timothy Eberlein, ECMO is an intensive form of therapy that requires a MD, the William K. Bixby Professor & Chair of the multidisciplinary team and high-level nursing care. Department of Surgery. “We have been ahead of the Few institutions nationwide have the resources and curve in caring for the sickest COVID patients in our ability to provide this care. ECMO is considered an ICU thanks to the innovation and commitment of evolving field in cardiothoracic surgery, and has our faculty.” seen significant growth at Washington University “Unlike flu or pneumonia, COVID affects the entire body. It can have its own effects on the lungs, heart and immune system.” Muhammad Faraz Masood, MD 10 Washington University School of Medicine in St. Louis | Department of Surgery

Numbers at a Glance Adult Cardiac Surgery Volumes General Cardiac Cardiac TX Minor/other 1923 2033 2034 1952 1962 1775 1002 1175 1273 1172 1091 1205 33 25 37 35 31 42 740 723 723 827 830 715 2015 2016 2017 2018 2019 2020 Highlights from the Data: Largest transcatheter World leaders in Largest surgical heart program in the region arrhythmia surgery failure program in the - Invented the Cox- region Maze procedure Division of Cardiothoracic Surgery | 2021 Annual Report 11

DIVISION OF CARDIOTHORACIC SURGERY Section of Thoracic Surgery 1,677 Operating room cases 110 Office procedures 8,542 Visits $4,022,430 Research funding 50 Clinical research studies 9 Faculty Daniel Kreisel, MD, PhD, left, and Andrew Gelman, PhD, pursue methods to advance lung transplantation. Board-certified, internationally recognized thoracic surgeons provide leading-edge respiratory medical and critical care, research and training. Treatments offered by Washington University general thoracic surgeons include airway surgery, procedures for benign esophageal disease, esophageal and lung cancer, and lung transplantation. The lung transplant program at Barnes-Jewish Hospital is among the most active transplant centers in the world. These surgeons also train the next generation of thoracic surgeons through multiple fellowships. 12 Washington University School of Medicine in St. Louis | Department of Surgery

Editors with Expertise The Thoracic Surgery Section at Washington University The Thoracic Surgery Section, (starting top left row) G. Alexander Patterson, MD, School of Medicine in St. Louis has an established Varun Puri, MD, MSCI, Benjamin Kozower, MD, MPH, Ruben Nava, MD, Daniel tradition of leading the major publications in Kreisel, MD, PhD, and Kathryn Engelhardt, MD. cardiothoracic surgery. This year, G. Alexander Patterson, MD, the Joseph “One of the things that makes Alec such C. Bancroft Professor of Surgery, was appointed the a good role model to us all is his ability new Editor-in-Chief of the Journal of Thoracic and to draw us in and motivate us to become Cardiovascular Surgery (JTCVS). Patterson, a surgical involved.” innovator with a prolific career in cardiothoracic surgery, has served as Editor-in-Chief of the Annals of Bryan Meyers, MD, MPH Thoracic Surgery since 2015. He was part of the team cardiothoracic surgery, served as editor of the Annals that performed the first successful long-term single- of Thoracic Surgery for 17 years, and other past and lung transplant in 1983, as well as the first successful present cardiothoracic faculty have held numerous long-term double-lung transplant for cystic fibrosis in editorial positions over the years. 1988. A former associate editor of JTCVS, the American This tradition of excellence extends to cardiothoracic Journal of Lung Transplantation, and the Journal of trainees. Thoracic Surgery Fellow Kathryn Engelhardt, Heart and Lung Transplantation, Patterson joined the MD, was named a 2020 Reviewer of the Year by the School of Medicine in 1991. Annals of Thoracic Surgery. This award recognizes peer “One of the things that makes Alec such a good role reviewers who consistently provide a combination of model to us all is his ability to draw us in and motivate high-quality, thorough and professional reviews in a us to become involved,” says Thoracic Surgery timely manner. Chief Bryan Meyers, MD, MPH, the Patrick and Joy “We are contributing to the selection of current and Williamson Professor of Surgery. future literature in thoracic surgery,” says Meyers. “Our Multiple faculty hold leadership positions at the editorial presence shows that there is a high density of JTCVS. Meyers is a member of the Editorial Board. expertise in thoracic surgery at Washington University. Cardiothoracic Surgery Residency Program Director It is also a sign of our willingness to give back to the Varun Puri, MD, MSCI, is Associate Statistical Editor, field as a whole by contributing time and expertise.” and Professor of Surgery Benjamin Kozower, MD, MPH, is Deputy Statistical Editor. Thoracic surgeon 13 Ruben Nava, MD, is the recipient of a 2021 Surgical Investigator award from the American Association for Thoracic Surgery, which publishes JTCVS. Surgical Director of the Lung Transplant Program Daniel Kreisel, MD, PhD, is a member of the Editorial Board of Transplantation Proceedings. He is also Deputy Editor of the American Journal of Transplantation. Meyers notes that the division has a rich history of leadership in editing cardiothoracic surgical journals. The late Thomas Ferguson, MD, professor emeritus of Division of Cardiothoracic Surgery | 2021 Annual Report

Highlights from Thoracic Surgery CLINICAL Bryan Meyers, MD. Brendan Heiden, MD. Washington University cardiothoracic surgeons have expanded their services to a new lung and esophageal cancer clinic in Illinois. The clinic is located at the Siteman Cancer Center facility at Memorial Hospital Shiloh. The facility marks the sixth and newest Siteman location overall. Cardiothoracic surgeons Varun Puri, MD, MSCI, and Ruben Nava, MD, have begun surgical consultations at the lung and esophageal cancer clinic, led by Section Chief Bryan Meyers, MD, the Patrick and Joy Williamson Endowed Chair in Cardiothoracic Surgery. The clinic provides the latest advances in cancer care in a convenient location for patients in southern Illinois. RESEARCH Research programs in the Division of Cardiothoracic Surgery provide excellent opportunities for trainees interested in pursuing a career in academic medicine to establish a robust curriculum vitae during residency training. General surgery resident Brendan Heiden, MD, MPHS, has had an exemplary experience as a research resident in the division. This year Heiden published research in collaboration with Professor of Surgery Varun Puri, MD, MSCI, on the risks of delaying lung cancer surgery. He has also studied cost-effectiveness of robotic lung cancer surgery, lung cancer screening guidelines and readmissions following pulmonary lobectomy, leading to numerous publications and presentations. EDUCATION Hailey Shepherd, MD. Training programs in the Division of Cardiothoracic Surgery offer complex cardiothoracic surgical experience and opportunities in established basic science and clinical research programs. General surgery resident Hailey Shepherd, MD, recently joined the laboratory of Daniel Kreisel, MD, PhD, the G. Alexander Patterson, MD/Mid-America Transplant Endowed Distinguished Chair in Lung Transplantation. Shepherd is collaborating with Cardiothoracic Surgery Residency Program Director Varun Puri, MD, MSCI, and thoracic surgeon Ruben Nava, MD, on lung transplant outcomes research. Her collaborative research, including a study of donor selection published this year in the Journal of Thoracic Disease, aims to expand the lung donor pool and improve lung transplant survival. 14 Washington University School of Medicine in St. Louis | Department of Surgery

Advancing Cardiothoracic Care Nabil Munfakh, MD, left, and Shuddhadeb Ray, MD, MPHS. Since completing his thoracic surgery fellowship at as well as mechanical circulatory support systems, such as Washington University School of Medicine in St. Louis, the Impella heart pump, for advanced heart failure cases.” Shuddhadeb Ray, MD, MPHS, has joined the Washington Ray specializes in minimally invasive techniques, including University Cardiothoracic Surgery Faculty at Christian laparoscopic and robotic surgery. These surgeries use Hospital, where he delivers expert care for patients with smaller incisions than traditional open surgery. Patients heart, lung and esophageal conditions in North St. Louis. who are treated with these techniques usually have a Ray earned his medical degree at University of Kansas shorter hospital stay and a much faster recovery than with School of Medicine in 2011, then completed general traditional open surgery. Using a laparoscopic approach surgery residency training and a Master of Population has helped him expand surgical offerings at Christian Health Sciences degree at Washington University School Hospital to treat more benign esophageal conditions, of Medicine. For Ray, surgical training at Washington including hiatal hernia, achalasia, esophageal diverticular University was a homecoming—before medical school, disease and other benign esophageal conditions. he had earned a degree in biomedical engineering from After years of training in St. Louis, it was obvious to Ray Washington University. He completed the Thoracic Surgery that this was where he wanted to start his career as a Fellowship program in 2020. surgeon. Now Ray joins his mentor, Washington University “Over almost a decade in St. Louis, a lot happened cardiothoracic surgeon Nabil Munfakh, MD, at Christian professionally and personally to closely link my life to Hospital. this city,” he says. “I married my college sweetheart, had Ray and Munfakh offer some of the most advanced heart two amazing children, moved into our first house, and care procedures available in the region. Some of the heart progressively made it through general surgery residency procedures provided include heart valve surgery, coronary and cardiothoracic fellowship. I knew it would be the artery bypass grafting (CABG), transcatheter aortic valve perfect place to start my career. I can’t imagine a better replacements (TAVR), and mechanical circulatory support. place to care for patients, advance my research interests, They offer the latest surgical treatments for diseases and help train residents and fellows, all with excellent of the chest, including lung cancer, esophageal cancer, mentors for guidance.” gastroesophageal reflux disease (GERD), mesothelioma and pleural disease. Surgical techniques include open “I want my patients to know that we have surgery and minimally invasive options, many of which use the most state-of-the-art technologies robot-assisted surgery. Furthermore, Ray and Munfakh are available at Christian Hospital.” a critical part of the cardiothoracic training program, with the fellows rotating at Christian Hospital. Shuddhadeb Ray, MD, MPHS “I want my patients to know that we have the most state- of-the-art technologies available at Christian Hospital,” Ray says. “These include the surgical robot for thoracic cases, Division of Cardiothoracic Surgery | 2021 Annual Report 15

Collaborative Care in Lung Transplantation The Lung Transplant Program at Washington University School of Medicine in St. Louis excels due to its emphasis on multidisciplinary collaboration, clinical expertise and innovative research. As part of the Lung Center at Barnes-Jewish Hospital, the program is ranked among the best in the country by U.S. News & World Report. The program has reached new milestones under the leadership of Surgical Program Director Daniel Kreisel, MD, PhD, and Medical Program Director Ramsey Hachem, MD. In 2021, the Lung Transplant Program performed its 1,900th lung transplant. “Our team is highly collaborative,” says Kreisel, Healthy adult lungs enclosed inside ribcage. Chief of Cardiothoracic Transplantation. “Our thoracic surgeons and colleagues in pulmonary to discover new clues as to why lung transplants medicine work closely together to achieve the best are vulnerable to antibody-mediated rejection, a outcomes for our patients.” condition that leads to death for many transplant The team, which includes transplant coordinators, recipients. In an upcoming multicenter clinical transplant pharmacists, respiratory therapists, study partnering with researchers from Harvard dieticians, social workers and financial Medical School, Kreisel and Hachem will investigate coordinators, partners to deliver world-class care a promising therapy for prevention of antibody- for lung transplant recipients. mediated rejection: a cytokine inhibitor targeting “The internal partnerships established within interleukin-6. Washington University School of Medicine “The Lung Transplant Program has also made consistently allow patients to receive genuine significant strides in optimizing the evaluation tailored care,” says Hachem, the Tracey C. Marshall and management of lung donors, a critical – Dr. Elbert P. Trulock Distinguished Professor of step in ensuring good clinical outcomes,” says Medicine in the Division of Pulmonary and Critical Associate Surgical Director Varun Puri, MD, MSCI. Care Medicine. Puri is currently supported by an NIH grant to Faculty advance the field of transplantation design optimal donor care pathways and leads through collaborative basic science, translational a collaborative effort involving multiple organ research and clinical studies. As Scientific Director procurement organizations nationwide. Puri and of the Transplant Center, Kreisel led researchers Professor of Surgery Benjamin Kozower, MD, MPH, are initiating additional collaborative research on “What differentiates the Lung the management of lung cancer patients. Transplant Program at Washington “What differentiates the Lung Transplant Program University and Barnes-Jewish Hospital at Washington University and Barnes-Jewish is that we combine excellence in Hospital is that we combine excellence in clinical clinical care, high clinical volume, and care, high clinical volume, and innovation in basic innovation in basic and translational and translational research,” says Kreisel, the research.” inaugural G. Alexander Patterson, MD/Mid-America Transplant Endowed Distinguished Chair in Lung Daniel Kreisel, MD, PhD Transplantation. “My vision is that within the next five years we will have personalized medicine for each lung transplant recipient that accounts for their unique characteristics.” 16 Washington University School of Medicine in St. Louis | Department of Surgery

Numbers at a Glance Adult Thoracic Surgery Volumes General Thoracic Lung Tx Minor/other 1718 1640 1596 1605 1543 1450 971 918 810 849 879 747 64 78 84 89 87 80 683 600 649 667 674 623 2015 2016 2017 2018 2019 2020 Highlights from the Data: Robotic surgical Advanced, complex High-volume applications resection for lung transplant lung cancer program Division of Cardiothoracic Surgery | 2021 Annual Report 17

DIVISION OF CARDIOTHORACIC SURGERY Section of Pediatric Cardiothoracic Surgery 1,345 Operating room cases 1,511 Visits $1,474,538 Research funding 48 Clinical research studies 3 Faculty Pirooz Eghtesady, MD, PhD, left, talks with Jacob Miller, MD. Pediatric cardiothoracic surgeons treat children with congenital cardiac disorders. These surgeons treat a 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 the most active of its kind in the world, attracting patients with cystic fibrosis and other lethal lung diseases. The pediatric heart transplant program is considered one of the leaders in the United States. 18 Washington University School of Medicine in St. Louis | Department of Surgery

We’ve Got Heart Three-dimensional heart model. People born with congenital heart defects often “We have one of the leading pediatric require multiple interventions and lifelong heart transplant programs in the management to ensure their hearts are pumping country. Our patients can see our track blood through the body properly. Heart defects can record of outstanding outcomes and lead to chronic congestion, which can cause problems know that they are in good hands.” with both the heart and liver. When these problems progress to liver dysfunction and liver failure, Dilip Nath, MD transplant may be the best treatment option. Our patients can see our track record of outstanding Congenital cardiac surgeons Jacob Miller, MD, outcomes and know that they are in good hands.” and Dilip Nath, MD, combine clinical expertise and The Heart Center is led by Section Chief of Pediatric multidisciplinary care to achieve the best outcomes Cardiothoracic Surgery Pirooz Eghtesady, MD, for heart-liver transplant patients at the Washington PhD, the Cardiothoracic Surgeon-in-Chief at St. University and St. Louis Children’s Hospital Heart Louis Children’s Hospital, who has performed heart Center. transplants in children, teens and adults at the School “These are patients who may have had several of Medicine. previous surgeries to treat their heart defects,” says “I consider myself one of the most fortunate people Miller, who completed cardiothoracic and congenital alive to be working with such wonderful, talented cardiac fellowship training at the School of Medicine. individuals,” says Eghtesady, who is the Emerson “When their condition has worsened to the extent that Chair in Pediatric Cardiothoracic Surgery at St. Louis they require heart-liver transplant, they need to see Children’s Hospital. “Our team continues to grow and a team with the coordination and capability to make improve the health of our patients. We’ve got heart.” them better.” The Heart Center, the first pediatric center in the From left: Jacob Miller, MD, and Dilip Nath, MD. Midwest to perform over 500 heart transplants, is 19 nationally recognized as a top heart program by U.S. News & World Report. Miller and Nath partner with the Pediatric Liver and Transplant Center team at St. Louis Children’s Hospital, led by Director of Liver Transplant and Mid-America Transplant/Department of Surgery Distinguished Endowed Chair in Abdominal Transplantation Maria B. Majella Doyle, MD, MBA, to coordinate care for heart-liver transplant procedures, which can take 12 or more hours to complete and require a large operating room staff. “We have seen excellent results in these challenging cases,” says Nath. “We have one of the leading pediatric heart transplant programs in the country. Division of Cardiothoracic Surgery | 2021 Annual Report

Highlights from Pediatric Cardiothoracic Surgery CLINICAL St. Louis Children’s Hospital. Washington University pediatric cardiothoracic surgeons are international leaders in Potts shunt procedures for children with severe pulmonary hypertension. The procedure connects the left pulmonary artery to the descending aorta as a palliative treatment for children who may otherwise need lung transplantation. The Section of Pediatric Cardiothoracic Surgery is among the most clinically active in North America, receiving national and international referrals for this procedure. Midterm outcomes are comparable to lung transplant, according to a recent School of Medicine study published in the Journal of Thoracic and Cardiovascular Surgery. As data becomes available, the section will study long-term outcomes and refine the patient selection process. RESEARCH Pregnant women with type 1 diabetes are at increased risk of having children with congenital heart defects. Researchers in the Section of Pediatric Cardiothoracic Surgery are investigating the role of certain pathogenic viruses in altering the maternal microbiome, which may play a role in causing congenital heart defects. In a recent study published in the Journal of the American Heart Association, the research team found an association between a virus and congenital heart defects in an animal model. An upcoming multidisciplinary clinical study will examine the gut virome of women to understand the link between viruses and congenital heart defects. Pirooz Eghtesady, MD, PhD. EDUCATION Vinod Sebastian, MD. In 2020, the Section of Pediatric Cardiothoracic Surgery at Washington University School of Medicine introduced an ACGME-accredited Congenital Cardiac Surgery Fellowship. The program became one of only 11 congenital cardiac fellowships in the United States. Accredited fellowship training in congenital cardiac surgery provides opportunities for cardiothoracic surgeons to develop the expertise necessary for subspecialization in these complex procedures. Jacob Miller, MD, the inaugural fellow, joins the section as Instructor of Cardiothoracic Surgery. Current fellow Vinod Sebastian, MD, completed cardiothoracic fellowship training at UT Southwestern Medical Center and has over a decade of experience as a practicing cardiothoracic surgeon. 20 Washington University School of Medicine in St. Louis | Department of Surgery

Growth Potential “Is there something else a surgeon could use that has growth potential?” Pirooz Eghtesady, MD, PhD Pirooz Eghtesady, MD, PhD, Chief of Pediatric Cardiothoracic Surgery. in Pediatric Cardiothoracic Surgery. “Specifically, the pericardium has good tensile strength. The Tetralogy of Fallot is a congenital heart defect that problem is that the pericardium degenerates and affects normal blood flow through the heart. It does not have growth potential. I asked myself, ‘Is consists of pulmonary stenosis, ventricular septal there something else a surgeon could use that has defect, overriding aorta and right ventricular growth potential?’” hypertrophy. Together, these defects can reduce A replacement valve with the potential to grow with the amount of oxygen in the blood that flows to the a patient, like a functional valve in a heart without rest of the body. Congenital cardiac surgeons at congenital defect, might reduce the number of Washington University School of Medicine combine issues common to patients with tetralogy of Fallot clinical expertise with innovative research to solve and other congenital heart defects. From this the problems facing patients with congenital heart initial idea, Eghtesady began collaborating with disease. Washington University biomedical engineers to Treating tetralogy of Fallot requires surgery to widen test atrial appendage tissue. He has now used the or replace the pulmonary valve. Patients treated for approach in select cases with positive results. the condition require lifelong monitoring. Blood flow Eghtesady, who leads a research laboratory at the may still be restricted after surgery. Deterioration of School of Medicine, is developing plans to further childhood heart repairs can lead to pulmonary valve study the use of this tissue in valve repair. If proven regurgitation. Cardiac arrhythmias are common effective, the technique could revolutionize the in patients after tetralogy of Fallot surgery. These treatment of congenital heart disease, including problems lead many patients to require repeat common problems with few current treatment interventions throughout their lifetime. options, such as bicuspid aortic valve. Chief of Pediatric Cardiothoracic Surgery Pirooz Eghtesady, MD, PhD, is developing a novel Pediatric pleural cavity containing surgical technique using heart tissue to replace the cross-sectioned ribs, lungs and heart. pulmonary valve. Eghtesady, who is Cardiothoracic Surgeon-in-Chief at St. Louis Children’s Hospital, 21 takes tissue from the right atrial appendage and creates a replacement valve. “Surgeons have done valve repairs for decades using other materials,” says Eghtesady, the Emerson Chair Division of Cardiothoracic Surgery | 2021 Annual Report

Helping Families, One Innovation at a Time process, connecting arteries and vessels, rebuilding valves. 3D models have also played a role in surgical training. In addition to allowing practice on highly accurate simulators, the 3D models expose trainees to pathological features they may rarely encounter. Future Congenital Cardiac Surgery fellows will have the opportunity to practice an index of rare, complex operations on 3D-printed hearts, preparing them to help a wider spectrum of cardiac patients after training. Three-dimensional heart model. “The cornerstone of our section has been innovation. My mission statement is to Patients with congenital heart disease often have make it a better world of families that rare, complex heart defects. These conditions need our help, one innovation at a time.” present challenges for preoperative planning, trainee education and patient counseling. It can Pirooz Eghtesady, MD, PhD be difficult to describe a heart defect to a patient or their family. Cases of rare congenital cardiac “This technology also allows us to think differently problems may not arise during a fellow’s training. and develop new operations for some of the Developing innovative methods of treating these most complex congenital problems,” Eghtesady conditions requires a simulated environment for says. “The cornerstone of our section has been surgeons to practice new techniques outside of the innovation. My mission statement is to make it a operating room. better world of families that need our help, one Surgeons in the Section of Pediatric Cardiothoracic innovation at a time.” Surgery have found 3D printing to be a transformative technology for preoperative planning and surgical simulation in congenital heart disease. Printing models of the heart allows the surgeon to plan for a procedure, teach trainees in a safe simulated environment and, importantly, educate patients and families. “It’s quite helpful,” says Section Chief and Cardiothoracic Surgeon-in-Chief at St. Louis Children’s Hospital Pirooz Eghtesady, MD, PhD. “Some of the hearts we’re working with are the size of a strawberry. When you talk to the family and you can show them why this is a complex operation, I think it helps them have a better understanding of what we are doing.” Eghtesady describes congenital heart surgery as Pirooz Eghtesady, MD, PhD, right, talks with Jacob Miller, MD. being like rebuilding a house. With 3D-printed hearts, surgeons can move pieces to practice this 22 Washington University School of Medicine in St. Louis | Department of Surgery

Numbers at a Glance Pediatric Surgery Volumes Cardiothoracic Transplant Adult Congenital 447 9 421 13 375 9 392 6 378 6 375 10 28 24 27 33 26 26 410 384 339 353 346 339 2015 2016 2017 2018 2019 2020 Highlights from the Data: Leading infant lung Busiest pediatric Leading Potts shunt transplant program heart transplant/VAD surgery center in the program in the region in the world world Division of Cardiothoracic Surgery | 2021 Annual Report 23

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

Research Selected 2021 Publications • Scozzi D, Cano M, Ma L, Zhou D, Zhu JH, O’Halloran JA, Goss C, Rauseo AM, Liu Z, Peritore V, Rocco M, Ricci A, Amodeo R, Aimati L, Ibrahim M, Hchem R, Kreisel D, Mudd PA, Kulkarni HS, Gelman AE. Circulating mitrochondrial DNA is an early indicator of severe illness and mortality from COVID-19. JCI Insight. 2021 Feb 22;6(4):e143299. PMID: 33444289. • Finnan MJ, Bakir NH, Itoh A, Kotkar KD, Pasque MK, Damiano RJ Jr, Moon MR, Ewald GA, Schilling JD, Masood MF. 30 years of heart transplant: Outcomes after mechanical circulatory support from a single center. Ann Thorac Surg. 2021 Mar 3;S0003- 4975(21)00353-2. Online ahead of print. PMID: 33675715. • Moon MR. Equal means equal: Cardiothoracic surgery in its second century. J Thorac Cardiovasc Surg. 2021 Apr;161(4):1381- 1389. PMIC: 33487415. • Carvajal HG, Merritt TC, Canter MW, Abarbanell AM, Nath DS, Eghtesady P. Improved outcomes of infant lung transplantation over three decades. Ann Thorac Surg. 2021 Apr 27;S0003-4975(21)00735-9. doi: 10.1016/j.athoracsur.2021.04.032. Online ahead of print. PMID: 33930357. • Heiden BT, Eaton DB Jr, Englehardt KE, Chang SH, Yan Y, Patel MR, Kreisel D, Nava RG, Meyers BF, Kozower BD, Puri V. Analysis of delayed surgical treatment and oncologic outcomes in clinical Stage I non-small cell lung cancer. JAMA Netw Open. 2021 May 3;4(3):e2111613. PMID: 34042991. • 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. 2021 Apr 17:S0022-5223(21)00668-1. doi: 10.1016/j.jtcvs.2021.03.109. Online ahead of print. PMID: 34045056. • McGilvray MMO, Bakir NH, Kelly MO, Perez SC, Sinn LA, Schuessler RB, Zemlin CW, Maniar HS, Melby SJ, Damiano RJ Jr. Efficacy of the stand-alone Cox-Maze IV procedure in patients with longstanding persistent atrial fibrillation. J Cardiovasc Electrophysiol. 2021 2021 Oct;32(10):2884-2894. PMID: 34041815. • Shepherd HM, Gauthier JM, Li W, Krupnick AS, Gelman AE, Kreisel D. Innate immunity in lung transplantation. J Heart Lung Transplant. 2021 Jul;40(7):562-578. PMID: 34020867. • Tague LK, Bedair B, Witt C, Byers DE, Vazques-Guillamet R, Kulkarni H, Alexander-Brett J, Nava R, Puri V, Kreisel D, Trulock EP Gelman A, Hachem RR. Lung protective ventilation based on donor size is associated with a lower risk of severe primary graft dysfunction after lung transplantation. J Heart Lung Transplant. 2021 Oct;40(10):1212-1222. PMID: 34353713. • Heiden BT, Eaton Jr DB, Chang S-H, Yan Y, Schoen MW, Patel MR, Kreisel D, Nava RG, Meyers BF, Kozower BD, Puri V. Comparison between veteran and non-veteran populations with clinical Stage I non-small cell lung cancer undergoing surgery. Ann Surg. 2021 May 11. doi:01.1097/SLA.0000000000004928. Online ahead of print. PMID: 35440662. Highlights of Publications: Average over 100 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 | 2021 Annual Report 25

Residency Training The Next Generation of Cardiothoracic Surgeons Matthew Henn, MD, MS, Jacob Miller, MD, and From left: Shuddhadeb Ray, MD, MPH, Matthew Henn, MS, MD, and Shuddhadeb Ray, MD, MPH, all graduated from the Jacob Miller, MD. Thoracic Surgery Fellowship at Washington University School of Medicine in St. Louis in 2020. The Thoracic “I have had the pleasure of working with all three Surgery Program cultivates future generations of gentlemen and they really are exceptional,” says surgical leaders through its commitment to excellent Pirooz Eghtesady, MD, PhD, Section Chief of patient care, innovative research and education in Pediatric Cardiothoracic Surgery. “Indeed, I think surgery. at one time or another, we tried to convince all of Henn, Miller and Ray started their general surgery them to pursue pediatric cardiac surgery. Not only residencies together at the School of Medicine nearly a do all three have outstanding technical abilities, decade ago. Over the years, these three fellows learned they are incredibly hard working and they are valuable lessons in and out of the operating room, wonderful human beings. It is a blessing to have formed lifelong friendships and acquired the skills they worked with such exceptional young individuals will need for their future careers in surgery. who are truly the future of cardiothoracic surgery; “I’ve known Matt and Shuddie and Jacob for several we are in good hands with them leading the charge. years, from their time in the laboratory during I am delighted that we succeeded to at least their general surgery years, and through all their ensnare Jacob, who will be our first congenital cardiothoracic surgery training,” says Spencer Melby, fellow. Our program was officially approved as MD, Thoracic Surgery Fellowship Program Director. an ACGME-accredited congenital program this “These surgeons are remarkable. The advanced training year, one of 11 in the United States, and a first they have completed is the most arduous that any for the Division of Cardiothoracic Surgery. It is medical specialty offers. Besides the many long hours quite exciting and we—the entire team at St. of complex and demanding surgery, which requires Louis Children’s Hospital—are very much looking the highest level of technical ability, these surgeons forward to Jacob’s start in July. He certainly has have been trained in critical care of patients who are already made a name for himself in the pediatric the sickest in the hospital. It is typical that these young community; most folks don’t know that he was surgeons would arrive several hours before daylight named as the co-Chair of the Communications and and return home long after the sun had set, operating Publications Committee of the American Academy sometimes for 12 or more hours in a row, while rounding of Pediatrics Section of Cardiology and Cardiac on their patients and making sure they receive the care Surgery last year, a first for an individual during they need. These surgeons have risen to the top, and are their training.” now ready to move on to the next phase of independent The Department of Surgery congratulates these operating and care of cardiac surgery patients. Each of three fellows on their accomplishments, and looks them have been primary authors on papers that change forward to their future successes in the field of the way surgeons care for patients. Each of them cardiothoracic surgery. has potential to be a leader in our field. I am excited to see their careers develop, and the mark they each will make—not just on patient care, but in our field of cardiac surgery.” All three fellows have continued to advance their careers in cardiothoracic surgery after graduating. Henn returned to his home state of Ohio to practice at The Ohio State University; Miller completed the ACGME- accredited Congenital Cardiac Surgery Fellowship at the School of Medicine in 2021, then joined the faculty in the Section of Pediatric Cardiothoracic Surgery; Ray joined the faculty in 2020 and operates at Christian Hospital. 26 Washington University School of Medicine in St. Louis | Department of Surgery

Residency Training Residency ProgramAn aerial view of Washington University Medical Campus. Our Division views the training of thoracic surgery The residents achieve their educational goals through residents as central to our mission. The entire faculty the assumption of graded levels of clinical responsibility is deeply committed to the clinical, academic, and under the close supervision of the faculty. This includes personal development of our trainees. preoperative evaluation and preparation, intraoperative The primary goals of the cardiothoracic residency participation, up to and including assuming the role of program are: primary surgeon, and postoperative care. There is close • To ensure that graduating residents will have the and frequent contact between the faculty and residents to assure that patient care follows appropriate pathways clinical educational experience needed for successful and that the educational experience is maximized. completion of the American Board of Thoracic A comprehensive educational program includes lectures, Surgery certification process, and case discussions, multidisciplinary conferences, mentored board preparation, and a focused simulation • To build a strong foundation for a lifetime of self- program. While some of these activities are linked to education, improvement, and academic contribution individual rotations, others involve the participation in their chosen field. of all residents in the program. The curriculum ensures Residents join the program in two pathways: detailed exposure to the core knowledge in the field Conventional (5+2) – five years of general surgery while also introducing the trainees to emerging science. training followed by two years of thoracic surgery All residents are strongly encouraged to identify a training, or Early Specialization (4+3) – graduated research project(s) in collaboration with a faculty entry into the program after four years of training mentor. The division includes a clinical research unit in general surgery. The program fosters a cohesive comprising of over 25 personnel who provide active and collaborative environment for residents entering support in completing these projects. Virtually all the program via either pathway. There are four thoracic surgery residents publish and present at least basic rotations for residents in the program: adult one (and usually multiple) studies during their training. cardiac surgery, general thoracic surgery, pediatric cardiothoracic surgery, and Christian Hospital Conventional (5+2) – five years of general (cardiothoracic surgery in a community setting). Away surgery training followed by two years of rotations at other U.S. or international sites are arranged thoracic surgery training on a case-by-case basis. Although there are two Early Specialization (4+3) – graduated entry identifiable tracks in the program, general thoracic and into the program after four years of training in cardiac, all residents rotate through all subspecialties. general surgery Division of Cardiothoracic Surgery | 2021 Annual Report 27

Residency Training Operative Case Log Requirement Summary Cardiac 2 YEAR 4 + 3 2 YEAR 4+3 Minimum CARDIAC CARDIAC Thoracic THOR THOR TOTAL TOTAL OPERATIVE EXPERIENCE TOTAL TOTAL Minimum 143 61 Adult General Thoracic 65 50 50 56 14 Lung Major Anatomic Resections 30 10 10 25 63 32 25 27 30 262 107 Lung Major VATS/Robotic Anatomic 100 87 105 11 12 Resections 675 15 8 5 4 5 15 5 14 Lung Biopsy/Wedge Resection 25 005 31 34 10 12 25 21 26 Total Lung 60 8 21 10 17 18 10 6 10 10 9 Pleura Major 0 505 106 38 Total Major TOTAL 35 6 20 46 41 Pleura Minor 0 19 34 10 Operative Experience OPERATIVE EXPERIENCE 49 32 Interventional: In Dwelling Cuffed Pleural 0 2 24 5 249 164 Catheter Insertion 79 91 60 542 305 189 190 190 Total Pleura 10 Chest Wall and Diaphragm 5 Mediastinum 5 Cardiac Minimum Tracheobronchial Airway Surgery 0 405 460 Esophagus Esophagectomy 5 Esophagus Benign Major 5 Laparoscopic Hiatal Hernia or Paraesophageal 0 Repair Total Esophagus 20 Adult General Thoracic Total 90 2 YEAR 4 + 3 2 YEAR 4+3 2 YEAR 1012 1102 THOR THOR CARDIAC TOTAL TOTAL TOTAL 44 44 m ipsumMinor Procedures Cardiac CARDIAC CARDIAC Thoracic 35 35 Minimum TOTAL TOTAL Minimum 79 79 77 77 Bronchoscopy Simple 0 34 28 30 24 28 101 105 Bronchoscopy Complex 0 4 6 10 0 0 14 14 Total Bronchoscopy 30 38 34 40 21 21 UGI Endoscopy Simple 0 8 37 20 38 38 4 + 3 YEAR 17 17 CARDIAC UGI Endoscopy Complex 0 2 12 10 35 35 1413 1538 125 125 TOTAL Total UGI Endoscopy 10 10 49 30 305 309 Mediastinal Assessment 0030 Mediastinal Assessment Mediastinoscopy 0 4 3 0 Mediastinal Assessment EBUS/FNA 0 0 0 10 Mediastinal Assessment Chamberlain or Mediastinal Node Dissection 0 17 15 0 Mediastinoscopy Chamberlain 5 5 11 15 Mediastinal Assessment Node Dissection 10 16 10 30 Total Mediastinal Assessment 15 42 42 55 Minor Procedures Total 55 90 125 125 Thoracic 330 455 Minimum 1262 Cardiac 2 YEAR 4+3 Thoracic 2 YEAR 4 + 3 THOR Minimum CARDIAC CARDIAC Minimum THOR TOTAL TOTAL TOTAL TOTAL OPERATIVE EXPERIENCE 2 YEAR Congenital Heart THOR TOTAL Congenital Heart Disease (as Primary Surgeon) 5 12 27 0 6 31 Congenital Heart Disease (as Assistant) 15 14 66 20 16 86 10 20 97 957 Total Congenital Heart Disease Adult Cardiac Experience 60 28 113 10 56 301 25 17 92 Acquired Valvular Heart Disease 15 181 268 30 26 81 4 + 3 YEAR 1515 1824 AVR, AV Repair 5 61 83 15 10 20 THOR MVR, MV Repair 5 65 71 5 7 15 TOTAL TVR, TV Repair, Annuloplasty 10 21 21 5 18 TAVR (as Primary Surgeon) 80 16 10 0 53 131 TAVR (as Assistant) 15 15 11 5 10 100 Myocardial Revascularization 15 132 125 35 127 121 Re Do Sternotomy 5 51 93 5 49 Interventional Skills or Procedures 10 50 117 5 9 28 Left Heart Cath, PCI, TEVAR, Mitral Clip 5 55 0 66 Intra aortic Balloon Pump 10 15 12 5 6 84 Conduit Dissection and Preparation 10 75 5 11 50 Aortic Procedures 39 82 5 Arrhythmia Surgery 5 21 52 0 5 39 5 6 17 Left Atrial or Biatrial Maze, Pulmonary Vein Isolation, 5 13 37 0 76 Right Side Maze 10 34 5 Pacemaker Insertion or Removal 295 16 15 0 395 1113 Cardiopulmonary Bypass set up and pump run Circulatory Assist/Cardiac Transplant 555 Adult Cardiac Experience Total 82 98 5 795 1110 130 28 Washington University School of Medicine in St. Louis | Department of Surgery

Residency Training Case Count PROGRAM EXPERIENCE, TWO-YEAR AVERAGE (07/2019 - 06/2021) MAJOR GENERAL THORACIC PROCEDURES Barnes- Childrens Christian NE Total Chest Wall Jewish Lung and Pleura 85 170 Tracheobronchial 157 2 106 492 Mediastinum 384 32 23 Diaphragm 18 2 13 52 Esophagus 37 01 19 Video-assisted Thoracoscopic Procedures 18 0 15 238 223 0 12 68 Total Major General Thoracic Procedures 56 15 154 1062 893 MAJOR CARDIAC PROCEDURES Childrens Christian NE Total Closed Operations for Congenital Heart Disease Barnes- Open Operations for Congenital Heart Disease Jewish 26 0 26 Valvular Heart Disease 161 0 170 Resection of Cardiac Tumor 0 696 Operations for Coronary Atherosclerosis 9 0 107 28 Pericardium 589 64 398 Other Cardiac 18 0 115 52 Thoracic Vascular 283 26 613 Transplantation 44 46 29 126 Major Peripheral Vascular Surgery 538 14 136 121 24 0 12 Total Major Cardiac Procedures 112 08 2257 4 266 273 1718 3319 Total Major Cases 2611 281 427 1965 Total Minor Cases (Thoracic & Cardiac) 1867 35 63 Division of Cardiothoracic Surgery | 2021 Annual Report 29

Former Trainees DIVISION OF CARDIOTHORACIC SURGERY 2019-2021 Academic Practice University of Michigan Medicine Timothy Lancaster, MD Military, Navy Walter Reed National Military Medical Center Conor Hynes, MD Academic Practice University of Colorado Simran Randhawa, MD 2018-2020 Academic Practice Ohio State University Wexner Medical Center Matthew Henn, MD Academic Practice Washington University School of Medicine Jacob Miller, MD Academic Practice Washington University School of Medicine Shuddhadeb Ray, MD 2017-2019 Academic Practice New York University Langone Health Stephanie Chang, MD Academic Practice Southern Illinois University School of Medicine Christopher Lawrance, MD Private Practice Orlando, Florida Karen (Kalei) Walker, MD 2016-2018 Academic Practice Southern Illinois University School of Medicine Lindsey Saint, MD Academic Practice Washington University School of Medicine Ruben Bahena-Nava, MD Academic Practice SUNY Upstate Medical University Stephen Waterford, MD 2015-2017 Academic Practice University of Colorado Anschutz Jessica Rove, MD Academic Practice Cleveland Clinic 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 2013-2015 Academic Practice Memorial Sloan Kettering Cancer Center Matthew Bott, MD Academic Practice Stanford University Anson Lee, MD Academic Practice University of Chicago Seth Krantz, MD Academic Practice University of Texas MD Anderson Academic Practice University of California, Davis 2012-2014 Academic Practice Harvard, Boston Children’s Hospital Mara Antonoff, MD Private Practice St. Louis, Missouri Lisa Brown, MD David Hoganson, MD Jeremy Leidenfrost, MD 2011-2013 Academic Practice Northwestern University Ankit Bharat, MD Private Practice Plano, Texas Kelley Hutcheson, MD Academic Practice University of Iowa John Keech, MD 30 Washington University School of Medicine in St. Louis | Department of Surgery

Former Trainees DIVISION OF CARDIOTHORACIC SURGERY 2010-2012 Academic Practice Johns Hopkins University Stephen Broderick, MD Private Practice Cincinnati, Ohio Mario Castillo-Sang, MD Academic Practice University of Minnesota Rochus Voeller, MD 2009-2011 Private Practice Wichita, Kansas Brett Grizzell, MD Academic Practice Washington University School of Medicine Spencer Melby, MD Private Practice Los Angeles, California Wael Yacoub, MD 2008-2010 Private Practice St. Louis, Missouri Laura Adam, MD Private Practice Phoenix, Arizona Elbert Kuo, MD Academic Practice University of Louisville Victor van Berkel, MD 2007-2009 Academic Practice Indiana University School of Medicine Chad Denlinger, MD Academic Practice Emory University Felix Fernandez, MD Academic Practice Washington University School of Medicine Varun Puri, MD, MSCI 2006-2008 Academic Practice Virginia Mason Medical Center Robert Moraca, MD Academic Practice Johns Hopkins University Stefano Schena, MD, PhD Academic Practice University of Kansas Nirmal Veeramachaneni, MD 2005-2007 Private Practice Springfield, Missouri Hersh Maniar, MD Academic Practice University of Virginia Alexander Krupnick, MD Academic Practice University of Rochester Sunil Prasad, MD 2004-2006 Private Practice San Jose, California Omid Javadi, MD Academic Practice Benjamin Kozower, MD, MPH Private Practice Washington University School of Medicine Parvez Sultan, MD Birmingham, Alabama 2003-2005 Academic Practice Washington University School of Medicine Daniel Kreisel, MD, PhD Private Practice Austin, Texas Eric Hoenicke, MD Academic Practice University of Maryland Christine Lau, MD 2002-2004 Academic Practice Southern Illinois University Traves Crabtree, MD Private Practice Salt Lake City, Utah David Affleck, MD Academic Practice Creighton University Phoenix Michael Smith, MD Division of Cardiothoracic Surgery | 2021 Annual Report 31

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

Former Trainees 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 1991-1993 Academic Practice Harvard, Massachusetts General Hospital Thoralf Sundt III, MD Academic Practice University of Cincinnati James Tweddell, MD Private Practice New Albany, Indiana Michael Bousamra II, MD Division of Cardiothoracic Surgery | 2021 Annual Report 33

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 Marc R. Moon, MD Chief, Section of Cardiac Surgery John M. Shoenberg Chair in Cardiovascular Disease Endowed Professors Associate Professors Assistant Professors Ralph J. Damiano, Jr., MD Spencer J. Melby, MD Puja Kachroo, MD Harold G. Roberts, Jr., MD Kunal D. Kotkar, MD Professors Christian W. Zemlin, PhD, MSc Muhammad Faraz Masood, MD Nabil A. Munfakh, MD Michael K. Pasque, MD Section of Thoracic Surgery Bryan F. Meyers, MD, MPH Chief, Section of Thoracic Surgery Patrick and Joy Williamson Chair in Cardiothoracic Surgery Endowed Professors Assistant Professors Instructor Andrew E. Gelman, PhD Ruben G. Nava Bahena, MD Tsuyoshi Takahashi, MD Daniel Kreisel, MD, PhD Shuddhadeb Ray, MD, MPHS G. Alexander Patterson, 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 Assistant Professor Instructor Dilip Nath, MD Jacob Miller, MD 34 Washington University School of Medicine in St. Louis | Department of Surgery

Washington University Medical Campus Washington University Medical Campus includes Barnes-Jewish Hospital, St. Louis Children’s Hospital, and the Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine. Covering 178 acres over 18 city blocks, the Medical Campus is located at the intersection of St. Louis’ Central West End and Forest Park Southeast neighborhoods. The School of Medicine’s clinical practice group St. Louis Children’s Hospital is the largest children’s hospital in the region, with nearly of more than 1,500 full-time clinical physicians 400 licensed beds and an American College of and surgeons, called Washington University Surgeons-verified Level I pediatric trauma center. Physicians, is one of the largest academic clinical It offers comprehensive services in every pediatric practices in the nation. In addition to providing medical and surgical specialty and is recognized care on the Medical Campus, these physicians as one of America’s top children’s hospitals by U.S. extend patient care to community practice News & World Report, which in 2020 ranked the across the St. Louis region at locations including hospital in all 10 specialties surveyed. Christian Hospital and Alton Memorial Hospital. Siteman Cancer Center is the only National Surgeons are among the almost 1,700 attending Cancer Institute-designated Comprehensive physicians at Barnes-Jewish Hospital, the largest Cancer Center in Missouri and is ranked as one hospital in Missouri. Barnes-Jewish is consistently of the nation’s top cancer facilities by U.S. News ranked among the nation’s best hospitals by & World Report. In 2020, Siteman earned the U.S. News & World Report. The hospital holds highest possible rating—exceptional—by the advanced certification from the Joint Commission National Cancer Institute, as part of a rigorous, for lung volume reduction surgery and is an peer-reviewed five-year evaluation of Siteman’s American College of Surgeons-verified Level research programs. I trauma center. The hospital has over 1,300 licensed beds. Division of Cardiothoracic Surgery | 2021 Annual Report 35

CT Surgery Clinical Locations Barnes-Jewish Hospital Website: barnesjewish.org Main phone number: (314) 747-3000 Barnes-Jewish Hospital, the primary adult teaching hospital for Washington University School of Medicine, has 1,259 licensed beds and a medical staff of more than 1,800. Since its inception, BJH has been a prominent center of medical and surgical innovation. The hospital has been at the forefront with advances such as the first pneumonectomy for lung cancer (Evarts Graham, MD, 1933). It is a leading lung and heart transplantation center as well as a leader in cardiac mapping and dysrhythmia surgery. The daily census of patients on the cardiothoracic service is between 45 and 50. BJH is consistently ranked among the top pulmonology and heart programs by U.S. News & World Report in its best hospital editions. The hospital has a 21-bed cardiothoracic intensive care unit, a thoracic surgery nursing division and a cardiac surgery nursing division. St. Louis Children’s Hospital Website: cardiothoracicsurgery.wustl.edu/patient-care/pediatric/location Main phone number: (314) 454-6000 St. Louis Children’s Hospital, the primary pediatric teaching hospital for Washington University School of Medicine, has 250 licensed beds and approximately 3,000 employees. The facility – founded in 1879 – is the oldest children’s hospital west of the Mississippi River. It 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. The daily census for children on the cardiothoracic surgery service averages approximately 20. There is one room in the operating suite assigned solely to the cardiothoracic surgery service and one additional room assigned for cardiothoracic procedures every Tuesday and Friday. Patients requiring intensive care following cardiac surgery are taken to a specifically designated region of the Pediatric Intensive Care Unit. This consists of 11 beds out of a 22- bed unit. The division has an active extracorporeal membrane oxygenation (ECMO) program for neonates and children with cardiac and cardiopulmonary diseases, which cares for 35 patients a year, along with its active lung and heart transplant program. 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. Christian Hospital Northeast is a 493-bed general acute care hospital with more than 2,100 employees. In addition to general acute medical care, Christian Hospital Northeast offers a cardiothoracic surgery program, facilities for inpatient rehabilitation and “extended care” skilled nursing. The operating suite includes a total of 14 operating rooms, two of which are devoted to cardiothoracic surgery. The 26-bed ICU is divided into a six-bed cardiovascular unit (CVU), an eight-bed coronary care unit, a six-bed medical intensive care unit and a six-bed surgical intensive care unit (SICU). Postoperative cardiac surgical patients receive their initial care in the CVU and general thoracic surgical patients are admitted to the SICU. 36 Washington University School of Medicine in St. Louis | Department of Surgery

CT Surgery Clinical Locations Center for Advanced Medicine Website: cardiothoracicsurgery.wustl.edu/places/center-for-advanced-medicine Washington University cardiothoracic surgeons provide world-class care at the Heart & Vascular Center and Jacqueline Maritz Lung Center, located in the Center for Advanced Medicine. 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. 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. 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. 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. 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. 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. John Cochran Veterans Hospital Website: va.gov/directory/guide/facility.asp?id=128 Washington University cardiothoracic surgeons provide surgical services at the John Cochran Division of the Veterans Affairs St. Louis Health Care System. *Clinical services in Illinois provided by Washington University Physicians in Illinois, Inc. 37 Division of Cardiothoracic Surgery | 2021 Annual Report

CT Surgery Clinical Locations Combating Misconceptions of Cancer Surgery at VA Hospitals As the nation’s largest integrated healthcare system, the Veterans Health Administration (VHA) provides care to nearly 10 million Veterans in over 1,000 facilities across the United States. The VHA has faced scrutiny over the quality of its care in the past. However, several recent studies have shown that contrary to public sentiment the VA outperforms non-VA hospitals in several metrics of care for common clinical conditions. A recent study by Washington University researchers, John Cochran Division of the Veterans Affairs St. Louis Health Care System (VA). published in Annals of Surgery, compared outcomes between patients receiving care for lung cancer at VA “The Department of Surgery has a long-standing versus non-VA hospitals. tradition of promoting high-powered academic “In our study, we sought to examine patients with research to advance our understanding of several early-stage lung cancer, comparing the quality of diseases and cancers,” says Heiden. “Projects like surgical care received through VA versus civilian this are only possible due to the generous support of hospitals,” says principal author Brendan Heiden, MD, the Department and its faculty. It is also important to MPHS, research fellow in the Division of Cardiothoracic recognize our large team of researchers from the VA Surgery at Washington University School of Medicine who work tirelessly to better the care of Veterans in our in St. Louis. country.” For this retrospective cohort study, researchers The study revealed that Veterans who receive care for from the Divisions of Cardiothoracic Surgery and their early-stage lung cancer through the VA receive Public Health Sciences, the Institute for Clinical and exceptional care with favorable outcomes, including Translational Sciences, and physicians from the VA significantly longer overall survival, compared to the St. Louis Health Care System compared operative general population. characteristics and outcomes between patients “The primary means of combating the misconceptions receiving treatment at VHA facilities and non-VHA about surgical care in the VA is through the direct facilities. The team hypothesized that Veterans patient care that we deliver with a compassionate receiving surgery through VA hospitals receive high- presence and the resultant outcomes that our patients quality care and have similar outcomes compared to share with their friends and family,” says Mayank the general population. Patel, MD, thoracic surgeon and Chief of Surgery at VA The researchers analyzed 10 years of patient data St. Louis Health Care System. collected from the VA Health Care System and The researchers explained that facilities like the VA St. compared this to the National Cancer Database, Louis Healthcare System are often staffed by surgeons which represents civilian hospitals. The team’s from nearby academic medical centers – in this primary interest was comparing long-term survival instance, Washington University School of Medicine – between these care settings. However, they also which may help to explain the superior outcomes that compared secondary outcomes including surgical they observed in their study. quality measures (like the rate of minimally invasive “Our partnerships with our academic affiliates have surgeries), hospital length of stay and readmission helped us develop a comprehensive surgical service rates. with superior clinical outcomes and academic opportunities to advance surgical care,” says Patel. “The primary means of combating the “This combined with the unique resources available to misconceptions about surgical care in the Veterans through VHA allows us to fulfill our mission VA is through the direct patient care that we to provide our nation’s heroes with the best care deliver with a compassionate presence and available right here in St. Louis.” the resultant outcomes that our patients share with their friends and family.” Mayank Patel, MD 38 Washington University School of Medicine in St. Louis | Department of Surgery

Cardiothoracic Surgery on Social As Seen on Social Washington University Cardiothoracic Surgery: Twitter - WashU CT Twitter: https://cardiothoracicsurgery.wustl.edu https://twitter.com/WashU_CT Facebook - WashU Surgery Facebook: Instagram - WashU Surgery Instagram: https://www.facebook.com/WashUSurgery https://www.instagram.com/washusurgres Resident and research fellow Brendan Heiden, MD, Cardiac surgeon Kunal Kotkar, MD, expressed gratitude Director of the 2021 St. Louis Shock Symposium MPHS, presented his research at the 101st American with anesthesiologist Michael Avidan, MBBCh. Muhammad Faraz Masood, MD, shared photos of the Association for Thoracic Surgery Annual Meeting. event’s setup. Division of Cardiothoracic Surgery | 2021 Annual Report 39

Division of Partner Institutions Cardiothoracic Surgery OFFICE OF THE CHAIR Ralph Damiano, Jr., MD Division Chief of Cardiothoracic Surgery Evarts A. Graham Professor of Surgery Washington University School of Medicine Campus Box 8234 660 S. Euclid Ave. St. Louis, MO 63110 Section of Cardiac Surgery (314) 362-7260 Section of General Thoracic Surgery (314) 362-7260 Section of Pediatric Cardiothoracic Surgery (314) 454-6165