A dedicated modular system for open-chest stabilization in thoracic transplantation

Luiz Maracaja; Jacob Niall Schoroder; Jeffrey Keenan; Jacob A Klapper; Ian James Welsby; Matthew Hartwig; Mihai V Podgoreanu; Hiroshi Date; Gabriel Esmailian; Betty C Tong; Kunal Patel; Brittany Zwischenberger; P Lynn McGugan; Jamel Ortoleva; Jason Stokes; Akshay Kumar; Sachin Mehta; Navin Vigneshwar; Andrew M Vekstein; Carmelo Alessio Milano

doi:10.1016/j.healun.2026.04.032

A dedicated modular system for open-chest stabilization in thoracic transplantation

J Heart Lung Transplant. 2026 May 25:S1053-2498(26)01909-1. doi: 10.1016/j.healun.2026.04.032. Online ahead of print.

Authors

Luiz Maracaja¹, Jacob Niall Schoroder², Jeffrey Keenan³, Jacob A Klapper³, Ian James Welsby⁴, Matthew Hartwig⁵, Mihai V Podgoreanu⁶, Hiroshi Date⁷, Gabriel Esmailian⁸, Betty C Tong³, Kunal Patel², Brittany Zwischenberger³, P Lynn McGugan⁹, Jamel Ortoleva¹⁰, Jason Stokes⁹, Akshay Kumar¹¹, Sachin Mehta¹², Navin Vigneshwar¹³, Andrew M Vekstein², Carmelo Alessio Milano⁷

Affiliations

¹ Associate Professor Department of Anesthesiology, Duke University, Durham, North Carolina. Electronic address: luiz.maracaja@duke.edu.
² Assistant Professor of Surgery, Duke University, Durham, North Carolina.
³ Associate Professor of Surgery, Duke University, Durham, North Carolina.
⁴ Professor of Anesthesiology, Professor of Medicine, Duke University, Durham, North Carolina.
⁵ Professor of Surgery - Professor of Biomedical Engineering, Duke University, Durham, North Carolina.
⁶ Associate Professor Department of Anesthesiology, Duke University, Durham, North Carolina.
⁷ Professor of Surgery, Duke University, Durham, North Carolina.
⁸ Surgical Resident, Duke University, Durham, North Carolina.
⁹ Duke University, Durham, North Carolina.
¹⁰ Associate Professor of Anesthesiology, Boston Medical Center, Boston, Massachusetts.
¹¹ Assistant Professor of Surgery, NYU Langone Health, New York, New York.
¹² Assistant Professor of Anesthesiology, Duke University, Durham, North Carolina.
¹³ Fellow Cardiothoracic Surgery, Duke University, Durham, North Carolina.

PMID: 42114695
DOI: 10.1016/j.healun.2026.04.032

Abstract

Delayed chest closure is frequently required following heart and lung transplantation due to graft edema, bleeding, size mismatch, or hemodynamic instability, yet current open-chest management strategies rely largely on improvised spacers with recognized mechanical and physiologic limitations. We describe the design and initial clinical application of a modular open-chest management system intended to provide controlled sternal separation while minimizing mediastinal compression and direct cardiac interaction. The device incorporates interchangeable plates and crossbars constructed from a biocompatible-fiberglass-reinforced polymer selected for mechanical strength, low profile, partial radiopacity, and MRI compatibility. Observational clinical use in thoracic transplant recipients demonstrated reproducible deployment, stable chest wall mechanics, preserved ventricular filling, and compatibility with postoperative imaging without device-related complications. This approach may provide a more standardized and physiologically consistent alternative to improvised open-chest techniques in selected transplant patients requiring delayed closure.

Keywords: Open chest management.