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

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.