The 37th EACTS Annual Meeting | Daily News 06.10.23

PRESIDENTIAL ADDRESS

HIGHLIGHTS FROM THURSDAY

EMBRACING INNOVATION

Bringing forward the very best technologies and techniques in cardiothoracic surgery

Page 18

RESIDENTS AT THE ANNUAL MEETING

Support the teams competing in the CT Surgery Resident Showdown.

YOUR CHANCE TO HEAR FROM THE GIANTS OF CARDIAC SURGERY

Be inspired by a special session taking place today that recognises the careers and legacy of four giants of cardiothoracic surgery.

‘The Life and Advice from Giants in Cardiac Surgery’ is an unmissable opportunity to hear directly from Bruce Keogh, Ernst Wolner, Carlos Mestres and David Adams about the experiences that have shaped their distinguished careers over the years.

Billed as a conversation about their life in cardiac surgery, in this fascinating session they will reflect on their decision to become a cardiac surgeon and share the most memorable moments of their careers. In a wide-ranging discussion these giants of cardiac surgery will also consider the significant developments in the field during their careers and give their views on the number one factor

that will define cardiac surgery over the next 10 years.

Rafa Sádaba, Chair of the EACTS Education Committee, said, “The Annual Meeting has a strong scientific programme and often our focus is, quite rightly, on science and the data but it is also important that we consider the philosophical side of cardiac surgery. This session explores the life experiences of four highly influential figures from whom we can learn so much. They are truly ‘giants’ of our specialty and this recognition is well deserved. It will be a fascinating and inspirational session.”

This is an interactive session and audience participation is strongly encouraged so don’t miss the opportunity to ask questions and get advice from four giants of cardiac surgery.

Meet the giants of cardiothoracic surgery

Bruce Keogh has had a distinguished international career as a cardiac surgeon, with a special interest in reconstructive mitral valve surgery. He served as EACTS Secretary General from 2003-2008 and was appointed Medical Director of the England’s National Health Service (NHS) in 2007. As the most senior doctor in the NHS, he was responsible for clinical policy and strategy, clinical leadership and innovation across the health service. In 2018 he became Chair of the Birmingham Women’s and Children’s NHS Foundation Trust.

David Adams is Chair of the Department of Cardiothoracic Surgery at Mount Sinai Hospital in New York City and is a recognised leader in the field of heart valve surgery and continued page 2

Chairs : Jose Luis Pomar Jörg Kempfert

EACTS IN TODAY’S ISSUE

CONTINUED FROM PAGE 1

mitral valve reconstruction. In 2009, he founded the Mitral Foundation, a nonprofit organisation which educates patients and cardiologists about the importance of mitral valve repair vs. replacement, provides training for surgeons and performs medical missions in developing countries. He is also a Past President of AATS.

Ernst Wolner trained in the Department of Surgery at the University Hospital of Vienna and became Professor of Surgery at the hospital in 1981. In addition to his distinguished career as a cardiac surgeon, he has been extensively involved in experimental activity, which includes the development of cardiac assist devices. He is a ‘Founding Father’ of EACTS and served as President of the Association from 1996-97. He is also a former deputy chairman of the Vienna State Medical Council. He currently serves as a consultant and supervisory board member on various healthcare committees.

Carlos Mestres has worked in renowned institutions around the world. A clinical surgeon, he has experience and expertise in cardiovascular and thoracic surgery and has been a global leader in endocarditis

and aortic surgery. He participated in the development of the Endocarditis Board at the University Hospital Zürich in Switzerland as well as the development of Cardiovascular Tissue banking in Spain, the first of its kind in the country. Currently he serves as Extraordinary Professor at the Department of Cardiothoracic Surgery and the Robert W.M. Frater Cardiovascular Research Centre at the University of the Free State in South Africa.

“This is an interactive session and audience participation is strongly encouraged so don’t miss the opportunity to ask questions and get advice from four giants of cardiac surgery.” LIFE

10:00 - 11:00

Hall E2 (Interactive)

TODAY’S PROGRAMME HIGHLIGHTS

13:45 - 14:45

ABSTRACT SESSION

16:15 - 17:15

FOCUS SESSION

Science worth spreading

HIGHLIGHTS FROM THURSDAY

With a packed programme full of world-class scientific insight, innovation and discussion, the 37th EACTS Annual Meeting is living up to its reputation as one of the leading events for the cardiothoracic community.

Thursday kicked off with the new President's Choice session which showcased the leading abstract presentations across all four domains. Unique sessions designed by our Residents' Committee and Women in Cardiothoracic Surgery Committee also took place, focused on fostering professional development.

LATE BREAKING SCIENCE

The very best in late breaking science was preseented during two dedicated sessions featuring the latest results and data from high impact studies. This includes insights from the CAST-HF trial and the TITAN SvS trial.

Don't miss the final Late Breaking Science session today at 13:45.

Residents' Committee - Escape the Coffin interactive session

HIGHLIGHTS FROM THURSDAY

The EACTS Learning Lab opened yesterday with a full programme of dry and wet lab training.

Under guidance from some of the world's most experienced and expert surgeons, those taking part had an opportunity to practice and learn the basic techniques in endoscopic surgery for mitral valve repair on high-fidelity simulators as well as training with the latest transcatheter devices for aortic and mitral valve procedures.

Today's EACTS Learning Lab programme can be found on page 19.

of belonging in high performance

the

IMPORTANT NEWS FROM BERLIN...

We are very pleased to inform you that the patients who took part in Wednesday's Techno-College are all doing well. The operations were filmed live from Berlin to the audience at Techno-College. We are very grateful to everyone who agreed to take part.

Executive Coach Sharon Ehrlich discussed the impact

during

Women in Cardiothoracic Surgery Committee focus session

Honoured Guest speaker, Professor Hounkpatin, the Beninese Minister for Health, gave insights into the health challenges of Benin

BREAK FREE FROM DOGMAS

This year's Presidential Address aims to challenge your thinking.

One of the highlights of the Annual Meeting is the Presidential Address which takes place this morning. José Luis Pomar will introduce his close friend and colleague, Patrick Perier, EACTS President for 2022/23. In his Address today, one of his final acts as President of EACTS, Patrick will be nudging us beyond our comfort zones. He will use highly engaging examples from science and hospital life to challenge our thinking.

Patrick says, "I want to shed light on our mindset, demonstrate the danger of a closed mind, and the vital importance of breaking free from dogmas. To embark on this endeavour, I will explore our collective thinking, studying how it shapes our “scientific” approach to cardiovascular and thoracic surgery."

Will you break free from dogmas? Join Patrick this morning on a journey of discovery.

PRESIDENTIAL ADDRESS

The Presidential Address, the death of dogma is the birth of reality, starts at 11.15 in Hall D.

“I want to shed light on our mindset, demonstrate the danger of a closed mind, and the vital importance of breaking free from dogmas.”

RESIDENTS’ COMMITTEE

The EACTS Residents’ Committee has planned an exciting and inspiring programme at this year’s Annual Meeting Don’t miss these sessions taking place today. Science worth spreading

16:15 - 17:15 | Room 0.31/0.32

Focusing on the surgeon-scientist, this session explores how to start-up and complete high level scientific research, whilst working as a clinician. Invited speakers with a wealth of research background will share their experiences of performing good scientific research, the highs and the lows and give an insight into developing a clinical trial from an idea.

The winner of the new annual Residents’ Corner award will be announced during the Science worth spreading session session. The Residents’ Corner award was established by EACTS and the Residents’ Committee to recognise the important academic work of EACTS residents. This year’s finalists include Michael Graber, Medical University Innsbruck

Austria Toll-like receptor 3 mediates

ischaemia/ reperfusion injury after cardiac transplantation (published in EJCTS)

Guido Ascione, I.R.C.C.S. San Raffaele Hospital, Milan

The impact of mitral valve surgery on ventricular arrhythmias in patients with Barlow’s disease: preliminary results of a prospective study (published in ICVTS)

Bardia Arabkhani, LUMC, Leiden, the Netherlands

A multicentre, propensity score matched analysis comparing a valve-sparing approach to valve replacement in aortic root aneurysm: Insight from the AVIATOR database (Published in EJCTS)

Breaking the taboo – Every surgeon has a graveyard

13:45 - 14:45 | Hall E2

In this popular session residents will present the key events of a nightmare cardiothoracic surgery case - two cardiac cases and a single thoracic case - and an expert operating surgeon will highlight

areas where things went wrong and discuss how these could be mitigated in the future. The floor will be open to the audience to discuss the case in detail in a friendly, supportive environment.

THIS YEAR’S TEAMS INCLUDE:

Allianz Herzchirurgie Zürich

Laura Rings

Mathias van Hemelrijck

Allianz Herzchirurgie Zürich

Vasileios Ntinopoulos

Lilly Ilcheva

University of Pavia

Alessia Ruffini

Ivan Casale

University of Padova

Marco Gemelli

Francesco Bertelli

Castle Hill Hospital

Nabil Hussein

Brianda Ripoll

Ege University

Sedat Karaca

Dilek Erdinli

COME AND SUPPORT THE TWO-PERSON TEAMS OF RESIDENTS COMPETING TO BE CROWNED THE EUROPEAN CHAMPION OF THE CT SURGERY RESIDENT SHOWDOWN.

This exciting Jeopardy-style competition of cognitive skills tests residents’ knowledge in five cardiothoracic surgery categories – cardiac, congenital, thoracic, history of the specialty and decision making.

The popular Residents' lunch took place yesterday

ABSTRACT SESSION

Long-term outcomes in CABG

Hall E2

08:30 - 09:30

Maximilian Y. Emmert / Deutsches Herzzentrum der Charite (DHZC), Berlin, Germany

Q. Where did you carry out your training? University Hospital Zurich, Switzerland

Q. What are your main areas of interest within cardiothoracic surgery?

Coronary artery bypass graft (CABG), valves, LAA management, and the development of new implants for cardiovascular surgery.

Q. What are you most looking forward to at this year’s Annual Meeting? Techno-College sessions, new data and innovations, and meeting colleagues and friends.

Q. What are your interests outside of your work? Soccer and travelling.

Transatlantic comparison of patient profiles and one-year overall survival after isolated coronary artery bypass grafting

European and US cardiovascular surgery societies continuously exchange knowledge and best practice to optimise the standard of care for patients in coronary artery bypass grafting (CABG), which is also reflected in the similarity of current guidelines1-7 and their overall coherence8

However, there is limited evidence whether this results in similar patient outcomes after CABG. Therefore, we compared patient profiles and one-year overall survival in large European and US cohorts undergoing isolated CABG. Patients from the European DuraGraft Registry (n=2,522) who underwent isolated CABG at 45 sites in eight European countries between 2016 and 2019 were compared to randomly-selected patients from the STS database operated on during the same period (n=294,725). Free conduits from patients in the DuraGraft registry were intra-operatively stored in DuraGraft, an endothelial damage inhibitor, before anastomosis. Propensity score models (PSM) were used to account for differences in patient baseline and surgical characteristics, using a primary PSM with 35 variables (2,400 patients matched) and a secondary PSM with 25 variables (2,522 patients matched, sensitivity analysis), as shown in table 1. Overall survival was used as ‘hard’ primary endpoint.

The analysis showed that the US and European cohorts show significant differences in demographics, pre- and intraoperative variables, as shown in table 2. After PS matching, these differences were well balanced for survival analysis. For both PSM models there was no difference in survival between the European and the US cohort over one-year post CABG, as shown in figure 1.

anastomoses with more saphenous vein grafts (SVGs) that were primarily harvested endoscopically, EU patients presented with more left main disease, underwent more off-pump CABG and received more arterial grafts together with more all arterial grafting procedures. However, after PS matching, there was no difference in overall survival between US and EU patients over oneyear after isolated CABG.

This mortality equivalence was evident irrespective of the inclusion of surgical variables in the propensity score models, demonstrating the robustness of the findings. While these results cannot be solely attributed to the coherence in EU and US guidelines, they underscore the importance of consensus on best practices in CABG.

This large-scale transatlantic comparative analysis shows that there are significant differences in demographics, pre- and intraoperative variables between US and EU patients. While US patients received more distal

Footnote:

Variables included in both models: Age; Male sex; Black race; BMI <20 kg/m2; Previous or Current Smoker; Diabetes on Insulin; Diabetes Not on Insulin; CRF (Cr > 2.0 mg/dl); Renal Dialysis; Peripheral Vascular Disease; Pulmonary Hypertension; History of Pulmonary Disease; History of CVA; MI ≤24h; MI >24h; Unstable Angina; Congestive Heart Failure; Cardiogenic Shock; Pre-operative Afib; Re-operation; LVEF<30%; Status Urgent; Status Emergent; Left Main Disease (≥50%); 3-vessel disease *Variables only included in the primary model: Previous CABG; Previous PCI; No of distal anastomoses; On Pump; Use of LIMA graft; No of arterial grafts; No of venous grafts; All arterial grafting; All venous grafting; Endoscopic Harvesting

References:

1. Windecker et al. Eur Heart J. 2014;35:2541619

2. Hillis et al. Circulation. 2011;124:e652-735

3. Fihn et al. Circulation. 2012;126:e354-471

4. Fihn et al. Circulation. 2014;130:1749-67

5. Aldea et al. Ann Thorac Surg. 2016;101:801-9

6. Neumann et al. Eur Heart J. 2018;40:87-165

7. Lawton et al., JACC 2021;79:e21-e129

8. Kohl et al. Eur J Cardiothorac Surg. 2016;49:1307-17

Disclosure: Maximilian Y. Emmert is the principal investigator of the DuraGraft registry, the chair of the Registry Advisory Committee, and a consultant for Marizyme.

Figure 1: Kaplan Meir estimates of the overall survival over 1-year post CABG

Table 1: Variables included in the PSM models

Table 2: Selection of patient demographics and surgical characteristics for primary PS model

“European and US cardiovascular surgery societies continuously exchange knowledge and best practice to optimise the standard of care for patients in coronary artery bypass grafting (CABG), which is also reflected in the similarity of current guidelines1-7 and their overall coherence8.”

ABSTRACT SESSION

Long-term outcomes in CABG

Hall E2

08:30 - 09:30

Association between lipoprotein(a) and five-year clinical outcomes in patients underwent coronary artery bypass grafting

Qixiang Yu 1†, Qing Xue2†, Hao Liu3†, Junlong Hu4, Rui Wang5, Yuanyuan Song6, Yanzai Zhou 1, Wei Zhang 7, Yunpeng Zhu 1*, Qiang Zhao1

1. Department of Cardiovascular Surgery, Ruijin Hospital Shanghai Jiao Tong University School of Medicine, Shanghai, China 2. Department of Cardiovascular Surgery, Changhai Hospital of Shanghai, Shanghai, China 3. Department of Cardiothoracic Surgery, Xinhua Hospital Shanghai Jiao Tong University School of Medicine, Shanghai, China

4. Department of Cardiac Surgery, Heart Center of Henan Provincial People’s Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, China 5. Department of Cardiovascular Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China. 6. Department of Cardiovascular Surgery, Jiangsu Province Hospital, Nanjing, China. 7. Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China †. These authors contributed equally to this work

In a post-hoc analysis of a five-year follow-up of the DACAB trial (NCT02201771), we found that exposure to increased baseline Lp(a) level was associated with worse five-year clinical outcomes in coronary artery bypass graft (CABG) patients.

In the DACAB trial, 500 patients who underwent primary isolated CABG were randomised to three different antiplatelet therapies for one year after surgery. Of them, 459 patients with prospectively collected baseline Lp(a) levels were recruited in the current analysis.

The mean age of the study population was 63.2 years and 81.5% were male. A total of 356 (77.6%) patients received off-pump CABG. These patients were stratified into Lp(a) <30 mg/dL and≥30 mg/dL subgroups. The primary outcome was four-point major adverse cardiovascular events (MACE-4), (all-cause death, myocardial infarction, stroke, and repeated revascularisation. The secondary outcomes included MACE-3 (cardiovascular death, myocardial infarction, and stroke), MACE5 (all-cause death, myocardial infarction, stroke, repeated revascularisation and rehospitalisation for unstable angina) and individual components.

Lp(a) ≥30 mg/dL was identified in 131 (28.5%) patients. During a median of 5.2 years of followup, compared with the Lp(a) <30 mg/dL group, patients with Lp(a) ≥30 mg/dL had a higher

Yunpeng Zhu / Ruijin Hospital Shanghai

Jiao Tong University School of Medicine, Shanghai, China

Q. Where did you carry out your training?

Ruijin Hospital Shanghai Jiao Tong University School of Medicine, Shanghai, China.

incidence of MACE-4 (35.9% vs. 26.2%, HR = 1.50, 95% CI, 1.05–2.14; P = 0.025), and this was mainly due to the increased risk of myocardial infarction (22.1% vs. 13.4%, HR = 1.73, 95% CI, 1.09–2.77; P = 0.021).

Similarly, Lp(a) ≥30 mg/dL was associated with increased risk of MACE-3 (29.0% vs. 19.5%, HR = 1.60, 95% CI, 1.07–2.39; P = 0.022) and MACE-5 (35.9% vs. 26.8%, HR = 1.49, 95% CI, 1.03–2.09; P = 0.034).

EACCME ACCREDITATION

The 37th EACTS Annual Meeting, Vienna, Austria, 04/10/2023-07/10/2023 has been accredited by the European Accreditation Council for Continuing Medical Education (EACCME®) with 24 European CME credits (ECMEC®s). Each medical specialist should claim only those hours of credit that he/she actually spent in the educational activity. Through an agreement between the Union Européenne des Médecins Spécialistes and the American Medical Association, physicians may convert EACCME® credits to an equivalent number of AMA PRA Category 1 CreditsTM .

Q. What are your main areas of interest within cardiothoracic surgery?

Coronary surgery, especially multi-arterial grafts, FFR-Guided CABG, and secondary medication prevention after CABG.

Q. What are you most looking forward to at this year’s Annual Meeting?

LBCT clinical trials and EACTS readings of new ESC/EACTS guidelines.

Q. What are your interests outside of your work?

History, philosophy and science fiction.

Therefore, we consider that exposure to increased baseline Lp(a) level was associated with worse fiveyear clinical outcomes in Chinese CABG patients. Adding Lp(a)-targeted lowering therapy might be beneficial in further improving the prognosis of the CABG population.

FOCUS SESSION

The science behind aortic valve repair

Hall G2

08:30 - 09:30

New preoperative index to predict long term results of AV repair

Aortic valve repair is a niche operation that, when performed successfully, grants an unmatched long-lasting quality of life to our patients. However, mastering of the technique has proved so challenging that the difficulties have prevented it from becoming mainstream.

A key problem is the lack of standardisation, leaving a lot to ‘eyeballing’, which relies on experience.

A great step toward standardisation was introduced with the use of the caliper from Professor Schafers, which led the idea, provocative at first, that mathematical estimation could guide a more reliable repair technique.

Trying to follow in his footsteps, we first used human specimens to determine a range of acceptable ratios between the key elements of the aortic root which are involved in the repair: the annulus, the sinotubular junction and the aortic leaflet.

We used a simplified version of the anatomical counterpart to generate a series of models which were tested in a digital environment to evaluate the combinations still generating a properly coapting valve configuration. A mathematical index summarises the optimal and rejectable combinations; we called it the RAI (repair aortic index)

The results of the combination were used to build a guidance chart in which the surgeon can input the numbers of their patient to check what aortic annulus and sinotubular junction sizes are acceptable for each given geometric height. The ideal combinations are colour-coded in green, thus simplifying the frame of measures to adopt to maximise the probability of a correctly repaired aortic valve and possibly lead to the wider adoption of this promising technique.

Luca Weltert / Divisione di Cardiochirurgia, Saint Camillus International University of Health and Medical Sciences

Figure 1: Systematic adjustment of root dimensions to cusp size in aortic valve repair - a computer simulation study

ABSTRACT SESSION

Controversies in sublobar resection

Hall K1

10:00 - 11:00

Complete numeric revascularisation

Segmentectomy for tumours larger than 2cm

Historically, the standard treatment of early-stage non-small cell lung cancer (NSCLC) has been lobectomy with lymph node dissection. Sublobar anatomical resections such as segmentectomy or wedge resection were exclusively proposed to patients with several comorbidities or decreased pulmonary function unable to undergo lobectomy. These sublobar resections come with the advantage of preserving pulmonary function, thus expanding the possibilities of resection of future pulmonary tumours. Recently, two randomised controlled trials (JCOG 0802 and CALGB 140503) compared lobar to sublobar resection in NSCLCs of 2cm and less with no lymph node involvement. The survival and recurrence results were comparable between groups and are suggesting that segmentectomy will become the standard approach for tumours of less than 2cm.

However, tumour size is an important prognostic factor of survival for NSCLC and controversy still surrounds the optimal extent of lung resection for clinical/pathological T1cN0M0 lung cancer.

Several series have shown that overall survival was better after lobectomy in these subgroups of patients, but these studies included open procedures (thoracotomy) and heterogeneous populations. With the development of minimally invasive surgical approaches and thin-slice CT scans or 3D reconstruction allowing a precise

Michel Gonzalez / University Hospital of Lausanne, Switzerland

Q. Where did you carry out your training?

I completed medical studies at the University of Geneva in 2002 and initially obtained the General Surgery Board in 2008. In 2009, I joined the service of Thoracic Surgery in Lausanne and obtained successively the Swiss Thoracic Surgery Board and the European Board of Thoracic Surgery in 2013. Since 2014, I am staff surgeon in the service of Thoracic Surgery of the University Hospital of Lausanne.

Q. What are your main areas of interest within cardiothoracic surgery?

I am interested in all procedures by minimal invasive surgery since 2010, when I introduced

description of bronchovascular segmental and tumoral anatomy, segmentectomy is becoming technically easier to perform and allows optimal resection with sufficient surgical margin even for a larger tumour. Recent studies have shown comparable results between VATS lobectomies and segmentectomies for clinical or pathological T1c tumours. Recently, neo-adjuvant immunotherapy has increased the rate of complete pathological response and sublobar resection could potentially be an alternative to lobectomy, particularly in compromised patients.

the technique. I am also involved in the lung transplantation programme. My research interests include lung and mediastinal surgery, minimal invasive thoracic surgery, enhanced recovery pathways and pulmonary metastasectomy.

Q. What are you most looking forward to at this year’s Annual Meeting?

In addition to the thoracic surgery programme, which looks promising this year with interesting sessions on a variety of subjects, it's above all an opportunity to meet, discuss and exchange ideas with friends and colleagues whom we unfortunately don't get to meet very often because of our activities.

Q. What are your interests outside of your work?

As the father of four young children, my days are full. I try to spend as much time as possible with them and do family activities such as mountain walks, tennis or swimming.

“Several series have shown that overall survival was better after lobectomy in these subgroups of patients, but these studies included open procedures (thoracotomy) and heterogeneous populations.”

ABSTRACT SESSION

Congenital - Miscellaneous

Room 0.14

12:15 - 13:15

Samir Sarikouch MD, PhD/ Hannover Medical School, Department of Cardiothoracic Surgery, Germany

Q. Where did you carry out your training?

I trained at the Heart centre in Duisburg, Germany and the Heart and Diabetes Centre Bad Oeynhausen, Germany. Since 2008, I have been the clinical research director within our department for cardiothoracic surgery at Hannover Medical School.

Q. What are your main areas of interest within cardiothoracic surgery?

Being a paediatric surgeon and paediatric cardiologist by training my focus lies on congenital heart defects.

Q. What are you most looking forward to at this year’s Annual Meeting?

I unfortunately missed the meeting last year, and so it will be my first meeting after the pandemic and I am really looking forward to meet the colleagues from our joint studies.

Q. What are your interests outside of your work?

I am an outdoor fan and will do anything from small farming to fishing.

Paediatric aortic valve replacement using decellularized allografts: A multi-centre update following 143 implantations and 5-year mean follow-up

Options for paediatric aortic valve replacement (AVR) are sparse once aortic valve repair is not feasible. Decellularized aortic homografts (DAH) may be an additional AVR option in children as they hold the potential to overcome

the high early failure rate of conventional allogenic and xenogeneic aortic valve prostheses, while avoiding the inherent risks of mechanical prostheses associated with anticoagulation.

143 decellularized aortic homografts (DAH) were implanted between February 2008 and February 2023 in 137 children (106 male, 74%) with a median age of 10.8 years (IQR 6.6-14.6, mean 10.4 ± 4.8 years). Follow-up was complete: 84 (59%) had undergone previous cardiac operations (47 with 1, 24 with 2, 13 with ≥ 3 previous operations). 24 (17%) had undergone previous AVR (19 with 1, 4 with 2, and 1 with 3 previous operations). The median implanted DAH diameter was 21 mm (IQR 19-23). The median operation duration was 348 min (IQR 227-439) with a median CPB time of 212 min (IQR 171-257) and a median cross-clamp time of 135 min (IQR 113-164).

After a median follow-up of 5.3 yrs. (IQR 3.3-7.2, max. 15.2 yrs.), the primary efficacy endpoints peak gradient of median 14 mmHg (IQR 9-28) and regurgitation of median 0.5 (IQR 0-1, Grade 0-3) showed good results but an increased progression over time.

Freedom from death was 97.8% and 96.3% at five and 10 years, an outstanding result, which underlines the expertise of the participating centres.

Adverse events such as re-operation, valve degeneration, endocarditis or thromboembolism after a median follow-up of 5.3 years were comparable to the results from current paediatric Ross cohorts, despite patients undergoing twice as many previous cardiac operations (59% vs. 32.3%) and significantly more previous AVR (17% vs. 2.3%).

The medium to long-term results, however, also demonstrate rising gradients and regurgitation in DAH over time, leading to surgical re-intervention. Despite thorough decellularization and detailed quality assurance through individual DAH testing before release, DAH appear to elicit a low-grade immune response, which, in contrast to classic T-cell mediated immune reactions, is thought to be more antibody-mediated.

Figure 1 exhibits the patient with the longest follow-up after re-do DAH implantation.

Following two balloon dilatations, the patient underwent AVR with a 10mm DAH at the age of two months in 2010 and a subsequent re-do AVR in 2015 with a 17mm DAH due to subvalvular stenosis leading to aortic regurgitation by Jet-lesion destruction of one cusp. The patient had normal left ventricular and homograft function eight years after the re-do procedure.

Figure 1: 0.2-year old boy, S/P 2 x aortic valve balloon valvuloplasty, AVR with DAH 10 mm in 2010 and re-do AVR in 2015 with 17 mm DAH. Recent echocardiography 8 years after re-do DAH implantation shows normal ventricular dimensions and function. Competent and pliable DAH cusps and a normal, untouched pulmonary valve. DAH- decellularized aortic homograft, AVR –aortic valve replacement

“Freedom from death was 97.8% and 96.3% at five and 10 years, an outstanding result, which underlines the expertise of the participating centres.”

The past, present and future of HOCM surgery

Hall G2

13:45 - 14:45

Juan Esteban de Villarreal Soto / Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain

Q. Where did you carry out your training? In Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain.

Q. What are your main areas of interest within cardiothoracic surgery?

Aortic valve repair, surgery for hypertrophic cardiomyopathy minimal invasive surgery, and transcatheter valve implantation.

Q. What are you most looking forward to at this year’s Annual Meeting?

Attending interesting meetings and discussions on novel aspects in our field, also participating in controversies in cardiac surgery.

Q. What are your interests outside of your work?

Cooking, travelling, reading, swimming, gym and last but not least, the formation of future cardiovascular surgeons alongside EACTS and LACES.

Extended septal myectomy versus alcohol septal ablation, an inverse-probability weighted regression adjustment.

When medical therapies fail, extended septal myectomy and alcohol septal ablation are two invasive treatments for hypertrophic obstructive cardiomyopathy. The main prognostic factor of hypertrophic obstructive cardiomyopathy is left ventricle outflow tract obstruction. We aim to compare which of these techniques achieves a higher reduction in gradients, improvement in the New York Heart Association (NYHA) class, and reduction in medical treatment.

Our study is a single-center retrospective study using a prospective database. An inverseprobability weighted regression-adjustment based on Euroscore II was used. A multivariate-logistic regression for the probability of developing anterior systolic movement of the mitral valve was evaluated according to the group, adjusting for baseline anterior systolic movement of the mitral valve and Euroscore II. Ordered-logistic regression for the probability of patients receiving ablation/ myectomy of being in each of the NYHA classes post-procedure.

The main results of our study are that average treatment effects for basal and Valsalva gradients after myectomy are reduced in a higher degree in comparison to ablation, 20.99 mmHg (p=0.001, -33.34; -8.65), and 33.70mmHg (p<0.001, -50.767; -16.647) respectively. Moreover, average treatment effect for mitral regurgitation after myectomy was diminished by 15.3% (p = 0.1). The ablation group presented a 20% risk of moderate mitral regurgitation vs 4.7% for myectomy (p = 0.1). (OR 0.51 0.18; 1.47). NYHA class post procedure improved for myectomy: NYHA I 83,1%; NYHA II 15,4% and NYHA III 1.5%; vs ablation NYHA I 9.7%; NYHA II 46,16% and NYHA III 44,08%. Both groups continued with betablocker therapy,

meanwhile patients after myectomy could discontinue most of the calcium channel blockers (pre- 48% vs.15.4%; post- 16% vs. 3.8%; p=0.054) and disopyramide (pre- 20% vs. 59%; post- 36% vs. 1.3%; p<0.001).

In summary, after an inverse-probability weighted regression-adjustment based on Euroscore II, myectomy reduces basal and Valsalva gradients to a greater extent in comparison to ablation. Myectomy also achieves a better NYHA class and reduces the need for medical treatment.

“Our study is a single-center retrospective study using a prospective database.”

Figure 1: Predicted probability by the corresponding model in each NYHA group.

ABSTRACT SESSION

The past, present and future of HOCM surgery

Hall G2

13:45 - 14:45

Q. Where did you carry out your training?

Belarusian State Medical University (Minsk), Belarusian Scientific and Practical Center “Cardiology” (Minsk), Lung Clinic Heckeshorn (Berlin), Departments of Cardiac and Thoracic Surgery AKH Vienna General Hospital, Salzburg-Cleveland Medical Seminars, Cardiac Surgery

Department of Medical University Hannover, Centre for Hypertrophic Cardiomyopathy and Valvular Heart Disease (Monza).

Q. What are your main areas of interest within cardiothoracic surgery?

Hypertrophic cardiomyopathy, and valvular disease.

Q. What are you most looking forward to at this year’s Annual Meeting?

The application of modern technologies of 3D visualisation, 3D printing, virtual reality, and artificial intelligence in cardiac surgery.

Q. What are your interests outside of your work? Travelling, music (the Blues), and cycling.

3D-visualisation and 3D-printing as a personalised method for septal myectomy planning and surgical intervention.

U. Andrushchuk, Białystok, A. Niavyhlas, Minsk, V. Adzintsou, Leipzig, D. Tretsiakou, Minsk, H. Zakharava, Minsk, T. Seuruk, Minsk, V. Alejnikava, Minsk, M. Shchatsinka, Southampton. Septal myectomy represents the main invasive treatment method for hypertrophic obstructive cardiomyopathy (HOCM). The results of surgical interventions vary considerably depending on the experience of the centre and the surgeon.

Radical septal myectomy eliminates systolic anterior motion (SAM), normalises mitral valve function, results in low residual gradients at the level of obstruction and is associated with left ventricular remodeling. Despite recent progress in technology, available methods of intraoperative control of interventricular septum thickness are far from being perfect and are often subjective.

The use of 3D-visualisation and 3D-printing in septal myectomy planning and surgical intervention allows us to personalise HOCM treatment according to the variable phenotype of this disease. In our practice, during six consecutive years we used virtual and 3D-printed interventricular septum models and virtual septal myectomy in the treatment of more than 200 patients. The geography of utilising this technology is expanding; we took part in the first interventions at the MHH Hospital Hannover and University Hospital Bialystok. We performed the first comparative analysis of septal myectomy results in two groups of patients with and without 3D-technology using the propensity score matching.

With 3D-technology we were able to avoid mitral valve replacement, iatrogenic ventricular septal defects to reduce cardiac complications (by

10%), the overall incidence of complications (by 14.3%), the residual systolic gradient (by 4 mmHg). In the long-term we were able to reduce prosthesisrelated complications (by 18.7%), mortality due to cardiac causes (by 12%), total mortality (by 13.5%). We left behind sub-optimal postoperative gradients at the level of obstruction, mitral valve replacement with no structural valve changes, and iatrogenic interventricular septum defects.

Arrhythmias and cardioembolic complications now play a key role in the changed pattern of perioperative complications. Recent major long-term complications include the progression of mitral and aortic regurgitation, the progression of heart failure and of arrhythmias. These are new challenges for cardiac surgeons.

“Radical septal myectomy eliminates systolic anterior motion (SAM), normalises mitral valve function, results in low residual gradients at the level of obstruction and is associated with left ventricular remodeling.”

Uladzimir Andrushchuk / Cardiac Surgery Department, University Clinical Hospital, Bialystok, Poland

Figure 1: 3D team

Figure 2: Inteventricular septum 3D model for myectomy planning

Unsolved issues in transcatheter valve procedures

Hall E1

16:15 - 17:15

Q. Where did you carry out your training?

I carried out my training at AOU Città della Salute e della Scienza of Turin (Professor Mauro Rinaldi) and then at Mauriziano Hospital (Dott. Paolo Centofanti).

Q. What are your main areas of interest within cardiothoracic surgery?

My main areas of interest are transcatheter procedures and mechanical circulatory supports.

Q. What are you most looking forward to at this year’s Annual Meeting?

I am looking forward to discovering the latest innovations in cardiac surgery, joining the presentations of famous global experts and getting inspiration for my future work.

Q. What are your interests outside of your work?

In my free time I like travelling around the world discovering new cultures.

Five-year outcomes after transcatheter versus surgical aortic valve replacement in low-risk patients.

The rapid development and wider indication for TAVI in younger and lowerrisk patients have led to increased attention to long-term follow up.

Nevertheless, current randomised control trials based on low-risk patients provide only short- and mid-term follow up and do not reflect the real-world population. Our study aimed to retrospectively compare post-procedural outcomes and five-year survival of low-risk patients who underwent SAVR versus trans-femoral TAVI at our department.

Inclusion criteria were patients aged between 75 and 85 years with low surgical risk (Euroscore II < 4%) and isolated severe aortic stenosis.

A total of 351 patients (SAVR=108, TAVI=243) were enrolled between September 2017 to December 2021.

TAVI patients were older (81.28 � 2.6 vs 78.45 � 2.5, p<0,001), with higher incidence of advanced CKD (33.3% vs 15.7%, p<0,001) and poor mobility (15,6% vs 5,6%, p=0,008) and a higher Euroscore II (2.40 � 0.80 vs 2,11 � 0.82, p=0,002) compared to SAVR patients.

The incidence of post-procedural AKI was significantly higher in the SAVR group (29.6% vs 4.5%, p<0.001), whereas post LBBB occurred in 23.9% of TAVI patients and in 1.8% of surgical patients (p<0.001).

The incidence of PVL was significantly higher in the TAVI group (4.5% vs 0%, p=0.021).

A propensity score matching resulted in a good match of 78 patients in each group.

SAVR patients still had a higher incidence of post procedural AKI (33.3% vs 5.1%, p<0.001), while TAVI patients had a higher incidence of postprocedural LBBB (11.5% vs 1.3%, p=0,018) (see Figure 1). Five-years survival was significantly higher in SAVR patients, confirmed even in the matched cohort (see Figure 2).

As reported in literature, TAVI is associated with a higher incidence of conduction abnormalities and PVL, which can overall impact on the longterm survival.

Routine TAVI indication in younger and lower-risk patients should only be considered when the longer-term outcomes of these patients are available.

Vittoria Lodo / AO Ordine Mauriziano, Turin, Italy

Figure 1: Post procedural outcomes matched cohort

Figure 2: Kaplan-Meier survival curves for TAVI vs SAVR patients, matched cohort

“Our study aimed to retrospectively compare post-procedural outcomes and five-year survival of low-risk patients who underwent SAVR versus trans-femoral TAVI at our department.”

ABSTRACT SESSION

Young Investigator Award –Adult Cardiac

Hall F1

10:00 - 11:00

Given the low socioeconomic status of the RHD, patients present late, and the thromboembolic complications of mechanical valves are common. Most patients find that the tissue valves, Ross procedure and TAVI are difficult to afford.

AVNeo is considered a promising alternative in light of limited resources, yet no evidence in rheumatic pathology has been published. Patients and methods: This prospective multicentre trial (with four regional tertiary referral centers) started from June 2019 to the present date.

Mid-term results of Ozaki aortic valve neocuspidisation for rheumatic aortic valve disease: a prospective multicentre trial.

Mohammed Sanad 1, Mohammed Gabr1, Hatem Beshir1, Mohammed Hegazy 2 , Ahmed Amin 2 , Mohammed Abdallah3

1. Department of cardiothoracic surgery, Faculty of Medicine, Mansoura University, Egypt. 2. Department of anesthesia and surgical intensive care, Faculty of Medicine, Mansoura University, Egypt.

3. Department of cardiovascular medicine, Faculty of Medicine, Mansoura University, Egypt.

Introduction: Ozaki aortic valve neocuspidisation via autologous pericardium (AVNeo) can be applied to a wide spectrum of aortic valve diseases. The foremost pathological cause of aortic valve disease in Egypt (110 million plus) and the region is rheumatic heart disease (RHD).

A total of 33 patients with isolated rheumatic aortic valve disease (bicuspid and tricuspid) underwent Ozaki aortic valve neocuspidisation by standard AVNeo equipment and technique. All cases were followed up. Echo and examination were performed intraoperatively by TEE, predischarge, and then at one month, three months, six months, one year and then yearly via trans-thoracic echo.

Results:

Demographics: Out of 67 Ozaki cases that were operated on to date, 33 isolated rheumatic aortic valve cases were included. Females 11, mean age 39.36±10.81 (21-60) years, BSA 1.84±0.14 m2.

Preparative echocardiographic data: Bicuspid 11, tricuspid 12, stenosis 14, regurge 11, mixed 8. Peak Gr. 63.24±38.49mmHg, mean Gr. 38.27±25.48 mmHg, AVA 1.55±1.05 cm2, Indexed AVA 0.87±0.06 cm2/m2, annular diameter 23.03±2.87mm, EF 63.12±0.71%.

Operative: RCC size 26.21±3.38 mm, LCC 25.67±3.14 mm, NCC 26.67±3.14mm. Cross-clamp time 127.4±21.05 minutes, Bypass time 151±24.26 minutes.

Postoperative echocardiographic data: Peak Gr. 10.48±3.64, mean Gr. 4.52±2.22, mean AVA 2.58±0.34 cm2, indexed AVA 1.48±0.35 cm2/m2. No regurge 30, trivial regurge 2, Mild regurge 1. Duration of follow up: mean 24.53±13.37 months (one to 45 months) to date.

Complications: no intraoperative mortality, no conversions, one reoperation after one week (acute suture break RCC and severe AR), two mortalities (three years infective endocarditis and aortic root abscess, and one case with pneumonia and multiorgan failure 1 month after discharge).

Freedom from AR: one case progressed from mild to moderate AR after three years under close follow up.

Conclusion: The five-year results of AVNeo for rheumatic aortic valve disease provided a promising alternative for these patients. To our knowledge, the results of this study is one of very few that explored the mid-term outcomes of Ozaki procedure in the rheumatic valve population.

Reshaping Mitral Repair

Mohammed Sanad / Department of cardiothoracic surgery, Faculty of Medicine, Mansoura University, Egypt.

EMBRACING INNOVATION

EACTS is proud to be at the heart of the global debate about the future of cardio thoracic surgery, with our renewed focus on innovation.

The inaugural EACTS Innovation Summit, which took place in Paris in April 2023, reaffirmed our commitment to fostering a culture of discovery and development to bring forward the very best technologies and techniques for the benefit of patients.

An invited audience of more than 60 surgeons, engineers, scientists, cardiologists and industry leaders attended the two-day summit and responded positively to a call to embrace innovation in surgery and the development of new ideas and concepts.

The inaugural Innovation Summit was led by two Past Presidents of EACTS, Friedhelm Beyersdorf and Mark Hazekamp. Prof Hazekamp said, “We must incorporate innovation thinking into our blood and bring innovations to the clinic. It is really important; there is no future if we do not do that.”

The summit is expected to become an annual event, with the next one scheduled to take place in Paris in April 2024, as well as contributing to the EACTS Annual Meeting every year. You can read all about the 2023 Paris summit in our new Innovation Report.

The spirit of innovation from Paris will live on in Vienna. Innovation is one of the themes of this year’s Annual Meeting and members will have an

INNOVATION TIMELINE:

1896

First successful suture of a heart wound by Ludwig Rehn, Frankfurt

1952

ASD closure using deep hypothermic arrest by Lewis and Taufic

1953

First successful heart operation using a heart lung machine (ASD closure) by John Gibbon, Philadelphia

opportunity to further discuss and develop proposals put forward in Paris earlier in the year. In particular, there will be an opportunity to build on the proposed creation of a new Innovation Domain.

In addition, four presentations from Paris have been selected to feature in this afternoon’s session ‘Highlights of EACTS Innovation Summit 2023’. The aim is to disseminate new ideas to the wider cardiothoracic surgery community. Topics include shockwaves for myocardial regeneration; opto-electronic implants; mitochondrial transplantation, which sees healthy autologous mitochondria transferred into damaged cardiac cells; and controlled automated reperfusion of the whole body (CARL). These sessions will be moderated by Prof Beyersdorf and Prof Hazekamp, and the panellists are Prof Sir Bruce Keogh and Prof Franca Melfi.

Innovation and the latest technology are also on display throughout the exhibition. The event showcases state-of-the-art products and developments in the cardiothoracic market and gives an opportunity to strengthen relationships with the innovative companies who will help cardiothoracic surgery move forward in the coming years.

1954

First successful cross-circulation (Perfusion by one parent, “living heart lung machine”) by Walt Lillehei, Minnesota

1960

First successful aortic valve replacement by Dwight Harken, Boston

1967

Coronary bypass surgery by René Favaloro, Cleveland Clinic

1967

First heart transplantation by Christiaan Barnard, Cape Town

1969

Mechanical circulatory support (“artificial heart”) by Denton Cooley, Houston

ABSTRACT SUBMISSION FOR EACTS INNOVATION SUMMIT, APRIL 18-20, 2024

The EACTS Innovation Summit 2024 invites surgeons, engineers, innovators, researchers, and scientists active in or even outside the field of Thoracic and Cardiovascular Surgery to submit abstracts to the upcoming Innovation Summit 2024. We are looking for disruptive ideas and breakthroughs in all areas related to thoracic and cardiovascular research in the following five topics:

• The Future of Robotic Surgery

• Heart Valve of the Future

• Extracorporeal Circulation (CPB, ECMO, ECLS, hibernation and hypothermia)

• Artificial Intelligence for CT Surgery – IT

• Lymphatic/glymphatic system (heart and brain)

1983

Isolated lung transplantation by Joel Cooper and Alec Patterson, Toronto

Since we are looking for disruptive ideas, abstracts can also be submitted, if they do not fit in these main topics:

“Wild Card” Submission

The submitted material should be new and should have the potential to change our daily practice and can and should be at an early stage. We are not looking for small improvements in current techniques.

After review by a dedicated Innovation Summit Reviewer Team, the presenters will be invited to the Innovation Summit 2024 near Paris to participate in the entire programme from 18-20 April. Please note, however, that presenters will be responsible for their own travel expenses to and from the venue. The best presentations will be selected for presentation thereafter at the 38th EACTS Annual Meeting in Lisbon, Portugal.

The Call for Abstracts will open on Tuesday 10 October and close on 25 November 2023. For further information please contact programme@eacts.co.uk

EACTS LEARNING LAB

Don’t miss the great opportunity to learn specialist techniques from the world’s most experienced and expert surgeons and gain ‘hands-on’ experience using the latest devices. EACTS Learning Lab, including both wet and dry labs, are available to book now.

FRIDAY 6 OCTOBER

Coronary Masterclass

Learn how to perform coronary anastomoses and manage different types of graft configurations and find out more about techniques for proximal and distal anastomosis, sequentials, elongation and composite grafts. Join discussions about the use of devices for conduits harvesting and graft assessment.

HAART

tips.

Simplified sizing that ensures good leaflet coaptation and restoration of annular size.

INTERNAL ANNULOPLASTY

Internal device placement can simplify repair and enable surgeons to only replace what is necessary.

STANDARD APPROACH

One repair approach for the many forms of Aortic Insufficiency, for both Bicuspid and Tricuspid valves.

EXHIBITION FLOOR PLAN

EXHIBITION OPENING TIMES:

Thursday 5 October 09:00 - 18:30, Welcome Reception 17:00 - 18:30

Friday 6 October 09:00 - 17:00

Saturday 7 October 09:00 - 12:00

EACTS TV GUIDE

Our premium TV channel features live broadcasts, one-to-one interviews and punditry from our expert panellists and key opinion leaders. Join us at the EACTS TV studio located in the Exhibition Hall and take part in live discussions on some of the day’s key topics.

VIEW THE TV SCHEDULE BELOW. IF YOU'RE NOT ABLE TO VIEW THESE IN-PERSON, YOU CAN WATCH THEM VIA THE EACTS APP.

FRIDAY

6 OCTOBER

HIGHLIGHTS FROM THURSDAY'S TV STUDIO

Innovation, mitral valve interventions and the role of nurses in cardiac surgery were just some of the topics discussed by expert panellists on EACTS TV.

- Aortic Valve Repair techniques

16:00 - 16:30 Science Friction - The Daily Review A. Zientara, Freiburg, J. Kempfert, Berlin, M. Milojevic, Beograd

16:30 - 16:45 On The Pulse: Exploring the Exhibition

SATURDAY 7 OCTOBER

TIME PROGRAMME PANELLISTS

09:45 - 10:15 The Daily Preview: Today at the Annual Meeting J. Bax, Leiden University Medical Center, R. Sádaba, Pamplona S. Sandner, Wien

10:15 - 10:20

Women in Cardio-Thoracic Surgery

10:20 - 10:30 Yesterday at the Annual Meeting

10:30 - 12:00 Live Broadcast: Trials Update

12:30 - 12:45

Live Broadcast: the 2023

EACTS Awards

DEVELOPING A SUSTAINABLE CARDIAC SURGERY PROGRAMME IN AFRICA

He noted that capacity building and advanced training for cardiac programmes as well as the role of skill training on simulators and clinical research are now recognised as essential tools to build this clinical structure. Developing a heart surgery programme demands the highest level of governmental support, philanthropy, profound know-how, leadership and international collaboration.

Around 250,000 children with congenital heart diseases require urgent surgery in sub-Saharan Africa (SSA), but many don’t reach their first birthday due to a lack of medical professionals to deliver cardiological services. If they do survive into adulthood, an estimated 76 per cent of them will develop heart failure and die.

Also, about five million people world-wide develop rheumatic heart disease (RHD), and it is estimated that 817,000 children in SSA with RHD will be denied the opportunity to get surgical palliation or cure.

To date, the high-tech complex cardiac surgery programmes have not gained the expected stability and sustainability in sub-Saharan regions except in South Africa. Constraints in the healthcare delivery systems in these regions include inadequate human resource capacity, limited public financing to the health sector as a whole, poor administrative management and ineffective strategic planning of integrated health systems.

programmes (webinars) and delivering inperson educational programmes, which includes a joint EACTS/PASCaTS session at this year’s Annual Meeting. During this session the results of a multi-centre nonrandomised studies on ‘Concomitant Tricuspid Annuloplasty during Rheumatic Mitral Valve Surgery’ were presented.

Since 2019, PASCaTS has also provided simulation courses to young and senior surgeons in Africa to develop new surgical skills and has established three regional simulation centres in Africa.

A need for new concepts and strategic plans for sustainability and resilience

PASCaTs has called upon stakeholders, foundations of global cardiovascular healthcare, professional organisations, industries and policy makers to focus on the needs of LMICs. This includes is a call to action among experienced surgeons to take the initiative to lead these efforts on a full-time pro bono basis to complement the contributions from government subsidies. It is vital to establish regional centres of excellence to improve capacity building programmes and surgical performance to provide adequate service to increasing number of patients among a growing population of 1.14 bn, which is projected to double by 2050.

Professor Charles Yankah, President of PASCaTS, featured on EACTS TV yesterday to discuss the need to develop a sustainable clinical infrastructure in order to reduce disparities in cardiac surgery services in low- and middleincome countries (LMICs) as cardiovascular surgery remains challenging to many national healthcare providers.

Joint Efforts to Develop Sustainable and Resilient Programmes

PASCaTS, the leading organisation for cardiothoracic surgery practice in Africa, has developed vital partnerships with international institutions and EACTS to support the transfer of know-how. This includes working in collaboration with German Heart Center Charité Berlin to produce digital educational

SATELLITE SYMPOSIA

Read more about the Joint Efforts to Develop Sustainable and Resilient Programmes

Satellite symposia, organised by some of our industry partners, are an opportunity to learn more about new-to-market technology, state-of-the-art products, innovations and developments in the cardiothoracic market. These sponsored programmes do not form part of the official scientific programme of EACTS.

Hall K1 More than a buzzword: Patient lifetime management

Hall G1 New product innovations in pMCS and first experiences with new therapy solutions

Hall K2 Hemoadsorption with CytoSorb after 10 years – Where do we stand?

12:15-13:30

Hall E1 Mitral valve replacement: current perspective

Hall F1 Discovery fire session: New frontiers for Mitral valve treatment

Hall G2 Segmentectomy with 3D Reconstruction

Room 0.31-0.32 Empowering limitless Hybrid Solutions

FRIDAY 6TH OCTOBER

ABSTRACT SESSION

E-POSTERS

ABSTRACT SESSION

A record number of high-quality abstract presentations were submitted for consideration at this year’s Annual Meeting. The standard of submissions was very high so, in addition to those abstracts included in the scientific programme, we are delighted to present a selection of abstracts in poster format, giving you access to even more scientific insights and research.

All e-posters will be available to view during the Annual Meeting at the different e-poster terminals in Exhibition Hall X1.

The following e-posters will be presented during moderated sessions today between 09:30-10:00 with the e-poster authors for presentation and discussion.

ADULT CARDIAC POSTER STATION

09:30

Vasoplegic syndrome in cardiovascular surgery; evaluating effects of sevoflurane and glibenclamide in a porcine model

A. Winter, Frankfurt am Main, N. Pascal, Frankfurt, M. Hermann, Mönchengladbach, S. Rieß, Frankfurt, A. Steinbicker, Frankfurt, T. Holubec, Frankfurt am Main, T. Walther, Frankfurt, F. Emrich, Frankfurt am Main

09:36

Morphological and dynamic analysis of the normal aortic valve with 4D Computed tomography

A. Fikani, Limoges, C. Boulogne, Limoges, G. Soulat, Paris, D. Craiem, Buenos Aires, A. Rouchaud, Limoges, J. Jouan, Limoges

09:42

CardioFollow.AI – randomised prospective study for home telemonitoring program – preliminary results

J. Pinheiro Santos, Lisboa, P. Dias, Lisbon, R. Santos, Lisboa, H. Semedo, Lisboa, C. Vital, Lisboa, A. R. Londral, Lisbon, P. Coelho, Lisboa, J. Fragata, Lisbon

09:48

Hydrogen supply in “Organ Care System” promotes heart recovery after cadaveric donation in a mice model

N. Madrahimov, Würzburg, V. Mutsenko, Würzburg, E. Zaiatc, Würzburg, Z. Omerbasic, Würzburg, D. Keller, Würzburg, D. Radakovic, Würzburg, R. Leyh, Würzburg, C. Bening, Würzburg

09:54

Training in advanced coronary surgery in the United Kingdom

J. Chan, Bristol, D. P. Fudulu, Bristol, S. Sinha, Bristol, A. Dimagli, Bristol, P. Narayan, Kolkata, T. Dong, Bristol, G. D. Angelini, Bristol

CONGENITAL POSTER STATION

09:30

Indications and Timing of Pulmonary Valve Replacement in Repaired Tetralogy of Fallot: 2023 Multi-Society Clinical Practice Guidelines

J. Nelson, Orlando, J. St.louis, Augusta, A. Ashfaq, Cincinnati, G. Sarris, Athens, E. Stephens, Rochester, Y. Orr, Westmead, C. Lee, Seoul, J. Jacobs, Gainesville

09:36

Leveraging Metadata Reveals Differential Expression of Genes FBXO32 and PTGES in Tetralogy of Fallot versus Controls

S. Voskamp, Orlando, T. Knapp, Orlando, M. Hammonds, Orlando, D. Hadley, Orlando, J. Nelson, Orlando

09:42

Reversibly limiting Sano blood flow with partial clips in low weight infants during Stage I operation improves operative survival

D. Hoganson, Boston, B. Piekarski, Boston, K. Rich, Boston, C. Baird, Boston, L. Quinonez, Boston, E. Feins, Boston, A. Kaza, Boston, S. Emani, Boston

09:48

Valveless DEA-based Impedance Pump as a Cardiac Assist Device: Introduction and preliminary study

A. Benouhiba, Neuchâtel, A. Walter, Neuchâtel, S. E. Jahren, Bern, T. Martinez, Neuchâtel, F. Clavica, Bern, D. Obrist, Bern, Y. Civet, Neuchâtel, Y. Perriard, Neuchâtel

09:54

Use Of The Right Atrial Appendage Valve(The RAA Valve ) For The Right Ventricular Outflow Tract, Mid-Term Results In 142 Patients

A. A. Amirghofran, Shiraz, M. Rafati Navaei, Shiraz, M. R. Edraki, Shiraz, H. Amoozgar, Shiraz

THORACIC POSTER STATION

09:30

Incidence of chronic post-thoracotomy pain after thoracotomy versus video-assisted thoracoscopy: a new IT-supported patient pathway

S. Kampe, Essen, C. Aigner, Vienna, H. Winter, Heidelberg, S. Welter, Hemer, T. Krbek, Moers, G. Weinreich, Essen

09:36

Feasibility and safety of uniportal thoracoscopic segmentectomy using unidirectional dissection approach without dissection of a fissure

H. Igai, Maebashi, K. Numajiri, Maebashi, F. Ohsawa, Maebashi, M. Kamiyoshihara, Maebashi-shi

09:42

Tracheobronchoplasty for Severe Tracheobronchomalacia: A Caseseries of Patients with Acute and Chronic Critical Comorbidities

R. Herron, Morgantown, A. Dhamija,, Stony Brook, J. Shumar,, Morgantown, J. Kakuturu,, Morgantown, J. Hayanga, Morgantown, J. Lamb,, Morgantown, A. Toker, Morgantown

09:48

A novel minimally invasive dual cavity double crown technique for large diaphragmatic hernias delivered in a multidisciplinary approach

H. M. Hemead, Birmingham, M. Shatila, Birmingham, L. Maltby, Birmingham, A. Menon, Birmingham, V. Rogers, Birmingham, B. Naidu, Birmingham, R. Singhal, Birmingham, H. Fallouh, Birmingham

09:54

Novel challenges in Thoracic surgery training. What has the pandemic taught us?

D. Jones, Leeds, M. Sherif, Leeds, M. Buller, Leeds, R. Milton, Leeds, N. Chaudhuri, Leeds, J. Lodhia, Leeds, A. Brunelli,, Leeds, P. Tcherveniakov, Leeds

VASCULAR POSTER STATION

09:30

Utility of Thoracic Endovascular Aortic Repair for Acute Aortic Dissection Complicated by Mesenteric Malperfusion: An Evaluation by Computational Fluid Dynamics

N. Kimura, Saitama, S. Imada, Nagoya, D. Hori, Saitama, T. Yamamoto, Saitama, K. Komiya, Nagoya, A. Yamaguchi, Saitama, M. Nakamura, Nagoya

09:36

Covering of the intercostal artery branching the Adamkiewicz artery during thoracic endovascular aortic repair for degenerative descending thoracic aortic aneurysm increases risk of spinal cord ischemia

Y. Seike, Suita, K. Shinzato, Suita, K. Yoshida, Suita, Y. Koki, Suita, M. Kenta, Suita, I. Yosuke, Suita, T. Fukuda, Suita, H. Matsuda, Suita

09:42

Clinical outcomes of thoracic endovascular aortic repair with entire proximal landing zone placed in dissected aortic arch

K. Masada, Suita, K. Shinzato, Suita, K. Yoshida, Suita, K. Yokawa, Suita, Y. Inoue, Suita, Y. Seike, Suita, H. Matsuda, Suita

09:48

Severity of Aortic Arch Atherosclerosis and Stroke after Open Repair of Descending or Thoracoabdominal Aortic Aneurysm

J.-H. Kim, Seoul, L. Seung-Hyun, Seoul, L. Sak, Seoul, Y. Young-Nam, Seoul, Y. Kyung-Jong, Seoul, J. Hyun-Chel, Seoul, South Korea

09:54

Mid- to long-term result of branched xenopericardial roll graft replacement to treat aortic arch /arch graft infection

H. Kubota, Tokyo, H. Endo, Tokyo, S. Minegishi, Tokyo, Y. Inaba, Tokyo, Y. Takahashi, Tokyo

WELCOME BACK TO VIENNA

Nearly 40 years ago in September 1987, cardiothoracic surgeons from across Europe gathered right here in Vienna for the first ever EACTS Annual Meeting. The meeting was a success, with 500 delegates from 20 countries across Europe taking part.

This success was not a forgone conclusion. The decision to hold the meeting was taken just a year and a half before, leaving very little time to deliver such an ambitious event. In March 1986 Francis Fontan had presented his idea to the 12 Founding Fathers – a group of distinguished surgeons – for an association of European cardiothoracic surgeons. His vision was an orderly, scientific association with a constitution built on selected individuals of high professional standing. It would have a journal and an annual meeting. His fellow Founding Fathers agreed with his vision, and the European Association for Cardio-Thoracic Surgery (EACTS) was born.

The decision to hold the first Annual Meeting only 18 months after founding EACTS meant that the new Association focused its energies on making this meeting a success. Ernst Wolner, a leading cardiac surgeon in Austria and EACTS Founding Father, volunteered to take on the local arrangements and became Chairman of the Local Organising Committee.

Professor Wolner remembers this challenge, “We worked solidly that year preparing for the first Annual Meeting. We called for abstracts, selected a programme, invited new members, found a venue and much more. We wanted to deliver a very high-quality programme, with the presentation of original papers, poster sessions and scientific discussions. It was essential that members played an active part in the programme, so we planned sessions that covered a wide range of topics, from sessions focusing on surgical techniques to a President's Reception. There was a common spirit between the Founding Fathers of making EACTS a success, but in a tight financial situation.”

VISITING VIENNA

Opulent and atmospheric, Vienna has captured visitors’ hearts for hundreds of years. The city boasts a rich historical and cultural heritage, as well as eclectic restaurants, galleries and shops, making it the perfect place to unwind.

For a taste of history, visit the Innere Stadt (1st District) and wander the streets, palaces and parks that make up this unique neighbourhood. Climb the 343 steps of St Stephens’s Cathedral for unrivalled views of Vienna and the beautiful countryside beyond. Don’t miss the Hofburg, the former imperial palace of the Habsburg dynasty, who ruled the region for over 600 years. Here you’ll find state apartments and crown jewels, and just next door is the world-famous Spanish Riding School. Visit on a Sunday morning to hear the Vienna Boys’ Choir sing mass at the Burgkapelle.

CLASSICAL MUSIC LOVERS ARE SPOILT FOR CHOICE IN VIENNA

Composers from Haydn to Schubert were attracted to the city, and their legacy lives on in a vibrant live music scene. Visit the Palais Schönborn to hear the Vienna Baroque Orchestra, the Sala Terrena for the Mozart Ensemble string quartet or the Imperial Hall for the Vienna Royal Orchestra.

Registration fees for the first Annual Meeting were paid in Austrian Schillings. EACTS members paid ATS 2.400 (around 150 GBP or 174 Euros in today’s money), non-members 3.000, trainees 1.800 and students and nurses attended for free. The fee covered entry into the scientific programme, a welcome cocktail, the President’s Reception and all congress documents including the abstract book.

A highlight of the first meeting was the presidential address, delivered by Francis Fontan and titled ‘Faith in the Future’. Since then, presidential addresses have covered a vast range of topics, from the relationship between surgery and music, art and literature, to the future of cardio-thoracic surgery and how to adapt to technological change.

Since the first meeting in Vienna, the EACTS Annual Meeting has taken place in cities across Europe, from Glasgow to Milan.

More than half of Vienna is parkland, making it one of the world’s greenest cities. Run, swim or cycle on Danube Island, a 21 kilometer long ‘recreational paradise’ in the heart of the city, or visit the stunning Schönbrunn Gardens, a UNESCO world heritage site. Round off you stay with coffee and cake at a traditional Viennese Kaffeehaus. Coffee houses played a vital role in the city’s cultural and intellectual history, with Gustav Klimt, Sigmund Freud and Alfred Adler all regular visitors. There are still over 1,000 Kaffehäuser to choose from, and many have changed very little over the years, so grab a table and soak up that old world charm.

"In September 1987, cardiothoracic surgeons from across Europe gathered right here in Vienna for the first ever EACTS Annual Meeting."

imaging a three- dimensional structure using a two-dimensional lumenogram”, Alexander Truesdell (Virginia Heart/Inova Heart and Vascular Institute, Falls Church, USA) and colleagues write in their JACC paper, in which they analyse all currently available intravascular imaging techniques, and review the data supporting the use of adjunctive imaging for PCI optimisation. Based upon their review, Truesdell and colleagues recommend the routine use of intravascular imaging as an essential adjunct to conventional angiography during PCI. While observing that current evidence supports intravascular imaging of specific lesion subsets including left main and proximal left anterior descending (LAD) lesions, complex lesions, or any scenario where angiography may not be sufficient to fully elucidate anatomy, they further note that there is increasing evidence of benefit for intravascular imaging for all-comer lesions. Offering his view as to why the uptake of intracoronary

Statins save lives after aortic repair regardless of dose

imaging has, so far, been slow, Truesdell told Cardiovascular News that there are a variety of reasons driving this reluctance from operators. “Some of it is likely to be habit,” he said. “In an extremely rapidly evolving field like interventional cardiology

I think it is difficult for many to repeatedly and continuously evolve over the course of a multi-decade career. I think this may be even harder for lower volume operators in the USA who may not get enough annual experience to ensure proficiency.” According to Truesdell, these points may be addressed by focused online and in-person training, spearheaded by national and international societies, as well as side-by-side training amongst colleagues. Whilst latest data confirm that the pace of change is slow, there is a suggestion that adoption is growing—similar to the recent experience with other contemporary PCI tools and techniques such as transradial access. At the ACC meeting, Reza Fazel (Beth Israel Deaconess Medical Center, Boston, USA) presented data on temporal trends and clinical outcomes of PCI procedures performed using intravascular imaging guidance, measuring the uptake of the technology in the USA between 2013 to 2019. The research, conducted alongside Eric Secemsky (Beth Israel Deaconess Medical Center, Boston, USA), found that overall usage of the technology had risen from 9.5% in 2013 to 15.4% in 2019.

We all need to overcome our own barriers to use— whether it is perceived added procedural time or discomfort with imaging interpretation— to provide the best care for our patients.”

Continued on page 7

Statin treatment after aortic repair is associated with improved long-term survival, while dose does not matter. This was the key message from a first-to-podiumpresentation delivered by Kevin Mani (Uppsala University, Uppsala, Sweden) at the 2023 Charing Cross (CX) International Symposium (25–27 April, London, UK). The CX audience showed their support for this conclusion, with 89% agreeing with the statement ‘Statins save lives’ during discussion time.

MANI BEGAN BY UNDERLINING the fact that abdominal aortic aneurysm (AAA) is a cardiovascular disease that shares risk factors with atherosclerotic cardiovascular disease (ASCVD). According to the American Heart Association (AHA), the presenter detailed, AAA is in fact classified as one of the ASCVDs. “AAA patients have a higher mortality than the general population due to cardiovascular disease,” Mani noted, adding that statin treatment is associated with improved survival in patients with ASCVD.

The presenter detailed that current European Society for Vascular Surgery (ESVS) guidelines on the management of abdominal aortoiliac artery aneurysms, published in 2019, suggest that patients with AAA should have blood pressure control, statins and antiplatelet therapy. “This is a class IIa recommendation with level b evidence,” the presenter specified, which he said indicates that “probably all patients” with AAA should have statin treatment. The AHA guidelines, Mani highlighted, split statin treatment into high dose and moderate to low dose. “The suggestion is that patients with ASCVD including those with AAA should have high-dose statin treatment,” the presenter shared with the CX 2023 audience. “However,”

BOOK YOUR PLACE ON EACTS ACADEMY 2024 PROGRAMME

Booking is now open for 2024 training opportunities with the EACTS Academy.

The programme offers surgical communities around the world unrivalled opportunities to develop their skills and knowledge. Surgeons gain handson experience and expert tuition from our world-renowned faculty. Whether working with trainees or established surgeons, we offer the right courses at the right time to support career development. By mixing online and in-person training opportunities, we are able to reach surgeons in over 75 countries.

Rafa Sádaba, Chair of the EACTS Education Committee, said, “For over 10 years EACTS Academy has been at the forefront of surgical education. We are proud of our global approach which brings surgeons from across the world together to develop their skills. This is an exciting time for surgery as we look towards new technologies and advances in medicine, and the EACTS Academy will continue to keep in step and offer innovative and critical training.”

A record number of courses

A record number of training opportunities will be available next year in response to the growing demand for education. Alongside well-established courses such as Case Corner, there are several new courses, including

Upcoming courses

a webinar series on the Fundamentals of Congenital Heart Disease, open to residents in training. ‘The Surgical Aspects of Cardiopulmonary Transplantation’ course is also back on the Academy calendar next year; this course sold out very quickly this year, so early booking for 2024 is highly recommended.

Other courses to look out for in 2024 include the 8th Mechanical Circulatory Summit in Prague, which is taking place in November.

The 2024 programme will also see the launch of a new webinar series for medical students and pre-trainee doctors. Our ‘Next Generation’ series will cover topics such as the future and innovations in thoracic surgery, the life of a cardiothoracic resident and aortic valve surgery.

To join the thousands of surgeons and other members of the medical community who have benefitted from EACTS Academy training in their careers, book your place now at www.eacts.org

“For over 10 years EACTS Academy has been at the forefront of surgical education. We are proud of our global approach which brings surgeons from across the world together to develop their skills”

INSPIRIS RESILIA aortic valve

*No clinical data are available that evaluate the long-term impact of RESILIA tissue in patients. Additional clinical data for up to 10 years of follow-up are being collected to monitor the long-term safety and performance of RESILIA tissue.

Medical device for professional use. For a listing of indications, contraindications, precautions, warnings, and potential adverse events, please refer to the Instructions for Use (consult eifu.edwards.com where applicable).

Edwards, Edwards Lifesciences, the stylized E logo, INSPIRIS, INSPIRIS RESILIA, and RESILIA are trademarks of Edwards Lifesciences Corporation or its a liates. All other trademarks are the property of their respective owners.

© 2023 Edwards Lifesciences Corporation. All rights reserved. PP--EU-6981v1.0

Edwards Lifesciences

• Route de l’Etraz 70, 1260 Nyon, Switzerland • edwards.com

Built with lifetime management in mind through enhanced tissue* and expansion zone for potential future procedures