Cardiothoracic Advanced Surgical Materials Laboratory

JW MacArthur Lab

The Cardiothoracic Advanced Surgical Materials Laboratory is interested in investigating and developing strategies to treat pressing issues in cardiovascular and respiratory health. We use the interaction of materials science, bioengineering, and cardiothoracic surgery to innovate novel treatment approaches to coronary ischemia, end-stage heart and lung failure, and valvular heart disease. Our mission is focused singularly on improving the health and longevity of our patients.

Members

John W. MacArthur, MD

Assistant Professor of Cardiothoracic Surgery (Adult Cardiac Surgery)


Elbert Heng, MD

Postdoctoral Research Fellow

Lab member since 2021

Daniel Alnasir

Life Science Research Professional

Aravind Krishnan, MD

Postdoctoral Research Fellow

Lab member since 2021

Alyssa Garrison, MS

Life Science Research Professional

Lab member since 2022

Alumni

Ashley Mathews

Life Science Research Professional

Lab member since 2021

Skylar Hyat, BS

Life Science Research Professional

Lab member since 2023

Publications

Publications

  • Beating Heart Transplantation: How to Do It. Innovations (Philadelphia, Pa.) Krishnan, A., Guenthart, B. A., Ruengesri, C., Elde, S., Zhu, Y., MacArthur, J. W., Woo, Y. J. 2024: 15569845231220678

    Abstract

    Heart transplantation utilizing deceased after circulatory death (DCD) donors has expanded the donor pool through the use of ex vivo normothermic perfusion. Compared with brain death donation, the conventional method of performing DCD heart transplantation includes an additional period of warm and cold ischemia. We have developed a beating heart implantation technique that obliviates the need for a second cardioplegic arrest and the associated reperfusion injury. We hypothesize this reproducible method may improve short-term and long-term outcomes to mirror results seen in brain death donors and provide details on how to perform beating heart transplantation.

    View details for DOI 10.1177/15569845231220678

    View details for PubMedID 38258625

  • Reconstruction of the aorta and pulmonary artery during heart-liver transplantation in an adult congenital patient. JTCVS techniques Mullis, D. M., Limbu, L., Bonham, C. A., MacArthur, J. W. 2023; 21: 129-131

    View details for DOI 10.1016/j.xjtc.2023.06.011

    View details for PubMedID 37854833

    View details for PubMedCentralID PMC10580035

  • Blood transfusion in cardiac surgeries - Toward a personalized protocol. American journal of surgery Min, Y., Dalal, A. R., Pedroza, A. J., Pham, T. D., Panigrahi, A. K., Goldstone, A. B., MacArthur, J. W., Woo, Y. J., Baiocchi, M., Fischbein, M. P. 2023

    View details for DOI 10.1016/j.amjsurg.2023.07.035

    View details for PubMedID 37558518

  • Successful Heart Transplants from Over 2,000 Miles Away. The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation Weininger, G., Choi, A. Y., Joseph Woo, Y., MacArthur, J. W. 2023

    View details for DOI 10.1016/j.healun.2023.07.005

    View details for PubMedID 37479048

  • Percutaneous Bailout Technique for Trapping an Embolized Valve During Valve-in-Valve TAVR. The Journal of invasive cardiology Stathogiannis, K. E., MacArthur, J. W., Lee, J. T., Sharma, R. P. 2023; 35 (3): E160

    Abstract

    A complex 15-year treatment history of a 75-year-old man with New York Heart Association class III symptoms is presented via images and video. His treatment history was noteworthy of bicuspid aortic valve (AV) and a ventricular septal defect (VSD), for which he had an AV replacement and VSD closure in 2005. In 2015, he underwent redo AV replacement and root reconstruction. Echocardiography demonstrated severe bioprosthetic AV stenosis and moderate AV regurgitation. Valve-in-valve transcatheter aortic valve replacement with a Sentinel cerebral protection device was recommended. Pre-operative computed tomography scan showed dilated aortic root and descending aorta with evidence of pseudocoarcta- tion. This case highlights the need for multidisciplinary team approach and the in-depth knowledge of various devices and techniques available.

    View details for PubMedID 36884365

  • Strategies for Transcatheter Aortic Valve Replacement in Patients With a Right Aortic Arch. Structural heart : the journal of the Heart Team Wang, H., Akanbi, O., MacArthur, J. W., Sharma, R. P. 2023; 7 (2): 100099

    View details for DOI 10.1016/j.shj.2022.100099

    View details for PubMedID 37275589

    View details for PubMedCentralID PMC10236863

  • Blood transfusion in aortic root surgery impairs midterm survival. JTCVS open Dalal, A. R., Pedroza, A. J., Krishnan, A., Min, Y., Tognozzi, E., Yokoyama, N., Nakamura, K., Mitchel, O. R., Baiocchi, M., Woo, Y. J., MacArthur, J. W., Fischbein, M. P. 2023; 13: 9-19

    Abstract

    To evaluate the effect of perioperative allogeneic packed red blood cell (RBC) transfusion during aortic root replacement.We reviewed patients undergoing aortic root replacement at our institution between March 2014 and April 2020. In total, 760 patients underwent aortic root replacement, of whom 442 (58%) received a perioperative RBC transfusion. Propensity score matching was used to account for baseline and operative differences resulting in 159 matched pairs. All-cause mortality was assessed with Kaplan-Meier curves. Data were obtained from our institutional Society of Thoracic Surgeons database and chart review.After propensity score matching, the RBC-transfused and -nontransfused groups were similar for all preoperative characteristics. Cardiopulmonary bypass time, crossclamp time, and lowest operative temperature were similar between the transfused and nontransfused groups (standardized mean difference <0.05). RBC transfusion was associated with more frequent postoperative ventilation greater than 24 hours (36/159 [23%] vs 19/159 [12%]; P = .01), postoperative hemodialysis (9/159 [5.7%] vs 0/159 [0%]; P = .003), reoperation for mediastinal hemorrhage (9/159 [5.7%] vs 0/159 [0%]; P = .003), and longer intensive care unit and hospital length of stay (3 vs 2 days and 8 vs 6 days respectively; P < .001). Thirty-day operative mortality after propensity score matching was similar between the cohorts (1.9%; 3/159 vs 0%; P = .2), and 5-year survival was reduced in the RBC transfusion cohort (90.2% [95% confidence interval, 84.1%-96.7%] vs 97.1% [95% confidence interval, 92.3%-100%] P = .035).Aortic root replacement frequently requires RBC transfusion during and after the operation, but even after matching for observed preoperative and operative characteristics, RBC transfusion is associated with more frequent postoperative complications and reduced midterm survival.

    View details for DOI 10.1016/j.xjon.2023.01.006

    View details for PubMedID 37063152

    View details for PubMedCentralID PMC10091283

  • Outcomes after concomitant arch replacement at the time of aortic root surgery. JTCVS open Krishnan, A., Dalal, A. R., Pedroza, A. J., Nakamura, K., Yokoyama, N., Tognozzi, E., Woo, Y. J., Fischbein, M., MacArthur, J. W. 2023; 13: 1-8

    Abstract

    Contemporary series of aortic arch replacement at the time of aortic root surgery are limited in number of patients and mostly address hemiarch replacement. We describe outcomes after aortic root and concomitant arch replacement, including total arch replacement.This single-institution retrospective review studied 1196 consecutive patients from May 2004 to September 2020 who underwent first-time aortic root replacement. Patients undergoing surgery for endocarditis were excluded (n = 68, 5.7%). Patients undergoing concomitant root and arch replacement were propensity matched with patients undergoing isolated root surgery based on indication, clinical and operative characteristics, demographics, medical history including connective tissue disorders, and urgency. Multivariable Cox proportional hazards and logistic regression modeling were used to assess the primary outcome of all-cause mortality and the secondary outcomes of prolonged ventilator use, postoperative blood transfusion, and debilitating stroke, adjusted for patient and operative characteristics.Among the 1128 patients who underwent aortic root intervention during the study period, 471 (41.8%) underwent concomitant aortic arch replacement. Most underwent hemiarch replacement (n = 411, 87.4%); 59 patients (12.6%) underwent total arch replacement (with elephant trunk: n = 23, 4.9%; without elephant trunk: n = 36, 7.7%). The mean follow-up time was 4.6 years postprocedure. Operative mortality was 2.2%, and total mortality over the entire study period was 9.2%. Propensity matching generated 348 matches (295 concomitant hemiarch, 53 concomitant total arch). Concomitant hemiarch (hazard ratio, 1.00; 95% confidence interval, 0.54-1.86, P = .99) and total arch replacement (hazard ratio, 1.60, 95% confidence interval, 0.72-3.57, P = .24) were not significantly associated with increased mortality. Rates of stroke were not significantly different among each group: isolated root (n = 11/348, 3.7%), root + hemiarch (n = 17/295, 5.8%), and root + total arch (n = 3/53, 5.7%) replacement (P = .50), nor was the adjusted risk of stroke. Both concomitant arch interventions were associated with prolonged ventilator use and use of postoperative blood transfusions.Hemiarch and total arch replacement are safe to perform at the time of aortic root intervention, with no significant differences in survival or stroke rates, but increased ventilator and blood product use.

    View details for DOI 10.1016/j.xjon.2022.12.014

    View details for PubMedID 37063158

    View details for PubMedCentralID PMC10091289

  • Outcomes of Reoperative Aortic Root Replacement After Previous Acute Type A Dissection Repair. Seminars in thoracic and cardiovascular surgery Pedroza, A. J., Dalal, A. R., Krishnan, A., Yokoyama, N., Nakamura, K., Tognozzi, E., Woo, Y. J., Macarthur, J. W., Fischbein, M. P. 2023

    Abstract

    Limited aortic root repair for acute type A dissection is associated with greater risk of proximal reoperations compared to full aortic root replacement. Surgical outcomes for patients undergoing reoperative root replacement after previous dissection repair are unknown. This study seeks to determine outcomes for these patients to further inform the debate surrounding optimal upfront management of the aortic root in acute dissection. Retrospective record review of all patients who underwent full aortic root replacement after a previous type A dissection repair operation at a tertiary academic referral center from 2004-2020 was performed. Among 57 cases of reoperative root replacement after type A repair, 35 cases included concomitant aortic arch replacements, and 21 cases involved coronary reconstruction (unilateral or bilateral modified Cabrol grafts). There were 3 acute post-operative strokes and 4 operative mortalities (composite 30-day and in-hospital deaths, 7.0%) . Mid-term outcomes were equivalent for patients who required arch replacement compared to isolated proximal repairs (81.8% vs. 80.6% estimated 5-year survival, median follow-up 5.53 years. Reoperative root replacement after index type A dissection repairs, including those with concomitant aortic arch replacement and/or coronary reconstruction is achievable with acceptable outcomes at an experienced aortic center.

    View details for DOI 10.1053/j.semtcvs.2023.02.001

    View details for PubMedID 36758660

  • Surgical management of severe mitral annular calcification. Asian cardiovascular & thoracic annals Elde, S., Zhu, Y., MacArthur, J. W., Woo, Y. J. 2022: 2184923221136935

    Abstract

    BACKGROUND: Surgical management of severe mitral annular calcification (MAC) presents a challenging problem for even the most experienced surgeons. Preoperative planning is the most effective strategy to mitigate risk in these scenarios. MAC alone should not disqualify a patient from consideration for mitral valve repair, although the presence of concurrent greater than moderate stenosis warrants consideration of mitral valve replacement.METHODS: While repair and replacement techniques for mitral regurgitation in the setting of MAC overlap with those used to repair a non-calcified mitral apparatus, there are unique considerations to the surgical conduct of these procedures. Specifically, this article describes techniques that may be employed when the severity of MAC precludes typical repair or replacement strategies.RESULTS: Between 2014 and 2021, 77 patients were operated on by a single surgeon for mitral valve disease complicated by severe MAC. Using the systematic approach described herein, 1-year mortality was 7.8% and overall mortality over a follow-up period extending 1 to 8 years was 9.1%.CONCLUSIONS: Despite the inherent challenges of mitral valve repair or replacement in the setting of severe MAC, a systematic approach beginning with preoperative planning, modification of annular suture placement, and techniques to mitigate severe complications have, in our experience, resulting in a reliable methodology for managing severe MAC with excellent outcomes.

    View details for DOI 10.1177/02184923221136935

    View details for PubMedID 36537728