Continuing a Tradition of Leadership Innovation

From the 2014 Department of Surgery Annual Report

Pirooz EghtesadyThe Section of Pediatric Cardiothoracic Surgery performs roughly 550 surgical procedures each year.THE FIRST open-heart surgeries were performed in children with congenital heart defects after John Gibbon Jr., MD, introduced the use of the heart-lung pump in Philadelphia in 1953. In 1958, Washington University surgeon Thomas Ferguson, MD, and colleagues performed St. Louis Children’s Hospital’s first openheart procedure in an 18-month-old girl. The operation was made possible by afundraising effort to bring the GibbonMayo heart-lung pump to St. Louis.

The pediatric cardiothoracic surgery service began under Charles Weldon, MD, who served as chief from 1968-1983. Weldon and his successors have gone on to establish leading programs in the treatment of congenital conditions, including heart and lung transplant centers that are among the most active in the country.

“There is a long tradition of distinguished surgeons who trained or practiced here,” says Pirooz Eghtesady, MD, PhD, Emerson Chair and chief of the Section of Pediatric Cardiothoracic Surgery. “In recent years, we have had a number of firsts at St. Louis Children’s Hospital that have enabled us to build on our successful track record.”

One of the section’s other surgeons, Peter Manning, MD, is an internationally recognized expert in tracheal reconstruction who recently established a program at St. Louis Children’s Hospital to treat patients with this condition. His other interests include cardiac surgery in infants and methods to minimize the need for blood-product transfusion during open-heart surgery in children. Other section accomplishments include:

The first three Potts Shunt palliations performed in pediatric patients in North America for pulmonary hypertension (PH) and associated severe right heart failure.

New technique for mechanical circulatory support of newborns with single ventricle physiology

Selected as Vanguard Center for the Pumps for Kids, Infants, and Neonates (PumpKIN) NIH Clinical Trial to explore the potential benefit of therapy offered by a novel pediatric circulatory support device for infants

Future improvements also may come from a concerted effort to identify factors that lead to the best outcomes. With the Washington University Department of Computer Science and Engineering, within the School of Engineering and Applied
Science, a new funded research program explores applications of machine learning algorithms to large data sets from children who have undergone heart surgery.

“Already we have found that among millions of different care decisions made following performance of a rather common neonatal procedure — the systemic to pulmonary artery shunting procedure — early initiation of aspirin is most critical,” says Eghtesday. “Also, early initiation of diuretics, previously not appreciated in any study, is vital in ensuring the best outcomes.