A child shouldn't need another open operation because the graft inside them can't grow. On Life of Flow, I sat down with Dr. Arush Kalra, a physician, biomedical engineer, and co-founder and chief scientific officer of PECA Labs. He left surgical training to build the things surgeons use. His question now reaches adult vascular surgery: can a graft we already know resist clot and infection and still feel intuitive?
Leaving Surgery & Reimagining Grafts
Dr. Arush Kalra of PECA Labs on leaving surgical training, a graft built to grow with a child, and redesigning ePTFE to resist clot and hold antibiotics.
Watch The Episode
Leaving Surgery & Reimagining Grafts, LOF #133 of Life of Flow, hosted by Dr. Lucas Ferrer and Dr. Miguel Montero-Baker.
Make The Game
Arush grew up above a neonatal hospital in north India that his father built.
He was in pediatric urology training when an attending told him, "Don't play the game; make the game." At first he thought the man was just being rude. Then it clicked. He shouldn't be doing surgery. He should be making things for surgery.
The reason was personal. His mother has Marfan syndrome and a bicuspid aortic valve, and her progressive aortic disease pushed him toward cardiovascular materials. That road led to Carnegie Mellon and biomedical engineering.
Keep The Surgeon's Hands The Same
His design rule is strict. Better technology shouldn't force a surgeon to relearn the craft.
So PECA started with ePTFE, a material every surgeon already knows, and changed what's underneath. Their first conduit was expandable, built to grow with a child, with radiopaque markers. The markers copy a bedside clock his cousin gave him in fourth grade. He figured no surgeon would miss them.
The name came from a FedEx truck. PECA stands for pediatric cardiac.
Arush says that graft is now in 5,000 patients globally.
The Sandwich
Arush describes the new graft as a sandwich. The surfaces govern how the body responds. The center supplies strength, flexibility and compliance.
His team bought a scanning electron microscope, and every graft they make goes under it.
In a nine-month large-animal study against a Gore graft, he says theirs came out looking the way it did on implant day, while the comparison graft showed large thrombus. He says it can hold antibiotic for more than three months. By his account, a graft dipped in antibiotic loses it within the first day.
For dialysis access, he says it's designed for repeated 13-gauge needle puncture testing.
All of this is preclinical and investigational. None of it is a clinical promise yet.
Start Where Failure Hurts Least
Most companies chase the biggest market first. Arush wants to start in peripheral vascular disease.
His reasoning is about safety. Don't plan around the most likely outcome. Picture the worst one, and start where it would hurt a patient least.
"Commercial focus will find you," he said. "Be honest and sincere to your craft."
He also said something we rarely hear on this show: the FDA has been a pleasure to work with.
The Takeaway
Arush says an inventor has to think like an artist, a scientist and a surgeon at the same time.
Keep the feel. Change the material. Then let the data decide.
Disclosure: one of the hosts mentioned on the episode that he is an investor in PECA Labs.