Laszlo Kiraly^1-3, Jin Ye Yeo⁴

¹Department of Cardiac, Thoracic and Vascular Surgery, National University Hospital Singapore, Singapore; ²Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; ³Department of Public Health, Professor in Medicine (Hon), Semmelweis University, Budapest, Hungary; ⁴PM Editorial Office, AME Publishing Company

Correspondence to: Jin Ye Yeo. PM Editorial Office, AME Publishing Company. Email: pm@amegroups.com

Expert introduction

Prof. Laszlo Kiraly (Figure 1) graduated from Semmelweis Medical University in Budapest, Hungary. Having accomplished the curriculum of General Surgery in Hungary, he received full training in Cardiothoracic Surgery in France (Centre Chirurgical Marie Lannelongue [CCML], Paris), in the UK (Great Ormond Street Hospital [GOS] in London, Birmingham Children’s Hospital and Wessex Cardiothoracic Centre, Southampton) and in the US, concluding in National and European Cardiothoracic Board certification (FETCS). He was Pediatric Cardiac Surgeon-in-Chief and Chair of Congenital and Pediatric Cardiac Surgery/Intensive Care Unit at the National Pediatric Centre in Budapest between 2000 and 2006. During this period, that Centre became the leading pediatric cardiac unit in Central Europe. Prof. Kiraly established and lead the national center for congenital cardiac surgery at Sheikh Khalifa Medical City, Abu Dhabi for fifteen years. In 2021, he joined National University Hospital in Singapore.

Prof. Kiraly has developed special expertise in 3D printing and modelling for healthcare and a strong interest in surgical visualization and minimally invasive pediatric cardiac surgery. Prof. Kiraly joined National University Hospital Singapore and National University of Singapore to develop a centre-of-excellence in pediatric cardiothoracic surgery in 2021.

Prof. Kiraly received many awards, most recently the “Markusovszky Award “presented by the Editorial Board of Hungarian Medical Journal (Orvosi Hetilap) for authoring of the most substantial clinical paper in 2019 (2020), Hungary, EU. He also has Professional Memberships of Singapore Medical Council (SMC), European Association for Cardiothoracic Surgery (EACTS), Emirates Cardiac Society (ECS), Pan-Arab Congenital Heart Disease Association (PACHDA), Extracorporeal Life Support Organization (ELSO), center membership, International Society for Minimally Invasive Cardiac Surgery (ISMICS), Asian Society for Cardiovascular and Thoracic Surgery (ASCVTS), Hungarian Society for Cardiology (MKT) and the World Society for Pediatric and Congenital Heart Surgery (WSPCHS).

Figure 1 Prof. Laszlo Kiraly

Interview

PM: What drove you into the field of pediatric cardiothoracic surgery?

Prof. Kiraly: I had a very colorful childhood and was very playful. When I was nine years old, I was run over by a car and fractured my skull. In those days, a skull fracture would have kept you in bed for several weeks. My mum used that time to teach me French by reading me magazine articles in French. One of the magazines was Paris Match, and on one of the magazine covers, there was a photograph of a surgeon in a surgical gown and cap holding a scalpel (Figure 2). I liked the photograph very much because his headdress looked like my bandage. I then told my mum to pin up that photograph on the wall because I would aspire to be like him one day. That surgeon was Christiaan Barnard, the surgeon to perform the first human heart transplantation in 1967. Ever since then, I knew I wanted to be a cardiac surgeon. But I was not interested in adults and more interested in babies, which made it obvious for me to pursue the congenital pediatric domain. I do not feel sorry for my decision as this profession gives me a huge source of happiness and satisfaction to be able to provide a source of hope for my patients and their family.

Figure 2 Prof. Kiraly with Paris Match cover of Christiaan Barnard

PM: In pediatric cardiac surgery, information on sternal wound management remains limited. Could you share what are some existing challenges in this area of pediatric cardiac surgery?

Prof. Kiraly: This is an interesting question as babies are known to have fantastic vitality and regeneration abilities. During this part of growth in somatic development, we do not see many wound problems in pediatric cardiac surgery. Of course, there have been cases with wound healing problems, especially in cyanotic babies where the blood oxygen content is reduced by the anomaly, and we may observe delayed wound healing and even infections in these patients.

On this Earth, we are actually surrounded by bacteria and viruses, and our bodies are in constant balance with them. This can potentially lead to wound healing problems. Hence, preventing the entry of bacteria is important and remains a constant challenge in pediatric cardiac surgery.

PM: Your recent research works focus on sternal wound management (1). What are some lessons you have learned or insights gained from the process of expediting and streamlining wound care in children?

Prof. Kiraly: From studying the approximately 5000 surgical patients, we attempted to find the root cause of episodes of wound healing clusters. This includes not only the patient-specific factors, but also environmental factors where breaches in asepsis could be identified. We reached the best outcomes when we actively treated patients by assisting with drainage, which is one of the recent developments in wound care. From studies, we learned to be proactive while adhering to aseptic techniques, and that early application of wound care is extremely useful.

PM: Could you share some of the projects that you are working on, and what research gaps you hope to tackle with these projects?

Prof. Kiraly: One of the problems we face in pediatric congenital cardiac surgery is the lack of prosthesis that is viable in growing. Whenever we implant a patch to close a defect inside the heart, the patch stays in place and the body will grow over it and covers it with its own lining. This process proceeds smoothly when we use a two-dimensional or even spherical patch as the body can grow around it. Problems arise when we have to implant something cylindrical and not viable for growing, as the body will outgrow the tube and we would have to replace it someday down the road. The problem is more complex if the cylinder also contains a valve, as valves are indispensable parts of the heart.

Another problem we face is the lack of biologically-friendly prosthetic materials. We have artificial materials such as Teflon and Dacron, which are very resilient materials, but they are synthetic and not natural tissues. When we introduce these materials into the body, they will not be rejected by the body, but the body will still work against them and they eventually become rigid or even calcify.

Our project aims to find a suitable prosthesis material that is structurally resilient to sustain the high pressures yet compatible with the patient’s own cells. The idea, though not new, is to develop a scaffold and seed it with the patient’s own cells. The impact of this discovery will be huge as we can potentially reduce reoperations and subsequently reduce suffering in the patients and their families. On a societal level, we may save a lot of energy, money, and investments in this area if we are able to find the ideal prosthesis material.

PM: You have also developed special expertise in 3D printing and modeling for healthcare. In which aspects of healthcare and/or cardiothoracic surgery do you hope to see more of such application?

Prof. Kiraly: Currently, 3D printing (Figure 3) is used to create prototypes from imaging data, which can help surgeons obtain haptic information, even before going to the operating room. We can also emulate different operation scenarios by operating on the prototype (2). However, 3D printing can bring us to another level. Beyond using plastic materials such as resin to print out the models, if we can use 3D printing to develop a bioscaffold for patients’ cells to grow into, also called bioprinting, there is a lot of promise that it can bring (3).

Figure 3 Prof. Kiraly holding a 3D-printed heart model

PM: How have your collaborations with PM been?

Prof. Kiraly: My experience collaborating with PM has been excellent. The editorial office is extremely professional and particular to looking at the details. Their aim to keep the highest possible standard is also admirable, which is a great prospect.

PM: As the Editorial Board Member, what are your expectations for PM?

Prof. Kiraly: One of the biggest expectations I have for the journal is the content to be readable for the wider audience. What I really like and hope the journal can maintain its open access status. Subscription fees, access-only-by-payment to professional papers restricts free communication, limits freedom for scientific information and access to resources. Not everyone has the financial means to access papers, and it is important to maintain the open access status.

Reference

1. Jha NK, Shafique M, Thomas R, et al. Sternal Wound Management in Pediatric Cardiac Surgical Patients: A Novel Strategic Interprofessional Approach. Adv Skin Wound Care. 2023 May 1;36(5):259-266. doi: 10.1097/01.ASW.0000924128.52669.ea. Erratum in: Adv Skin Wound Care. 2023 Sep 1;36(9):1. doi: 10.1097/ASW.0000000000000031.
2. Kiraly L, Shah NC, Abdullah O, et al. Three-dimensional virtual and printed prototypes in complex congenital and pediatric cardiac surgery-a multidisciplinary team-learning experience. Biomolecules. 2021;11(11):1703. doi:10.3390/biom11111703 (Editor’s Choice article)
3. Kiraly L, Vijayavenkataraman S. Biofabrication in congenital cardiac surgery: a plea from the operating theatre, promise from science. Micromachines (Basel). 2021;12(3):332. doi:10.3390/mi12030332