The official newspaper of the 38th EACTS Annual Meeting 2024
Highlights from Friday at the 38th EACTS Annual Meeting.
We welcome Volkmar Falk as the new EACTS President. Find out more about the Officers and Councillors elected during yesterday evening's EACTS General Assembly.
ALLIED HEALTH PROFESSIONALS COMMITTEE
The importance of the patient's voice in delivering high quality care is just one of the topics discussed in today's allied health professionals committee sessions.
Senator Guisy Versace shared her story with delegates to highlight the importance of positivity, one of Franca Melfi's three principles in her Presidential Address.
DIVING INTO THE DATA
Bart Scheenstra presents the paper 'Personalised multimodal teleprehabilitation in elective cardiac surgery’
Today’s ‘Trial Update Session’ will be a valuable opportunity to learn more about some important current trials that could impact clinical practice and guidelines in the future. A highlight of this year’s scientific programme, this focus session will cover three main areas: surgical mitral valve repair versus transcatheter edge-to-edge repair (TEER), treatments for aortic stenosis and myocardial revascularisation.
Presenters will delve deep into the data, discussing the details behind the trials and what the results could mean for patient care.
Patrick Myers, Secretary General, said, “This session is invaluable for EACTS members. This is our opportunity to learn about the latest trials and familiarise ourselves with aspects of trial design. The way in which trials are established is critical and I am keen that as surgeons we contribute our skills and experience to improve trial design in the future. This session is a forum to discuss the results of trials and will give us key insights so that we can have informed discussions within our heart teams.’
Keynote Lecture
Roberto Canessa will share his story of survival and how it has inspired his remarkable life.
12:35 - 13:20
Auditorium 1
Joanna Chikwe, the primary investigator of one of two major mitral valve repairs trials, will present on the ‘Current trends and future perspectives of Surgical Repair and TEER for the treatment of primary mitral regurgitation’.
Current data shows the main benefits of TEER are in patients with secondary mitral regurgitation. Patients in Europe with primary regurgitation are currently treated surgically, with excellent results. In the US, TEER is used more widely to treat both primary and secondary regurgitation. This current trial may change things. If the data shows that TEER can be used effectively for patients with primary regurgitation, European guidance may change. Joanna Chikwe will present an overview of what the trials are investigating, how they have been designed and the expected outcomes.
Current trials focused on aortic stenosis and the benefits of transcatheter aortic valve implantation (TAVI) versus surgical aortic valve replacement (SAVR) in treating aortic valves will also be discussed. Torsten Doenst, Chairman of the Department of Cardiothoracic Surgery at the University of Jena, Germany, will explore the long-term outcomes in TAVI and SAVR. While TAVI achieves very positive short-term results in selected patients, Torsten Doenst will give an overview of current trial data looking at the longer-term outcomes of TAVI.
Continued on page 2
Awards Ceremony
Celebrate training and research excellence at this year's Annual Meeting.
12:35 - 13:20
Auditorium 1
IN THIS ISSUE
EACTS is a growing community of nearly 4,000 people connected to the cardiothoracic community from around the world. Learn more about the expanding range of benefits for EACTS members.
DIVING INTO THE DATA
CONTINUED FROM PAGE 1
Find out more about the collaborative work of EACTS, AATS, ESTS and STS to develop a comprehensive methodology for creating clinical practice guidelines and other essential clinical documents.
Read summary articles of some of the focus sessions taking place today, including key messages from current myocardial revascularisation guidelines.
Don't miss the opportunity to meet with industry and learn about new-to-market technologies.
CT SURGERY
Congratulations to the winning European team of this year's CT Surgery Resident Showdown - the ultimate test
NOTION-2 and DEDICATE trials, both published recently, have shown surprisingly poor early surgical outcomes when compared to results from TAVI. In the presentation ‘TAVI and SAVR in younger patient population: Short-Term Data from the NOTION-2 Trial’, Hanna Dagnegård will examine the impact of including bicuspid valves in TAVI trials and ask if the data we currently have is powerful enough to guide our decisions. Sabine Bleiziffer will then examine the DEDICATE trial, which compared TAVI and SAVR outcomes in low-risk patients. After one year, patients in this trial who were treated with TAVI saw much better results than those who received surgery. We need to understand why. Both in-depth presentations will look at the trial design, the selection of patients and provide some answers to explain the outcome of the trial.
Two dedicated randomised controlled trials on bicuspid valves are set to move forward. These trials will be critical to generating good evidence around biscuspid aortic valves.
Following the publication of the latest guidelines for the Management of Chronic Coronary Syndrome in August, Milan Milojevic will give the final presentation. In Guidelines on Myocardial Revascularisation, he will explain how the new guidelines form a comprehensive, patient-centred framework, focusing on all aspects of diagnosis, treatment, secondary prevention and follow-up for patients with progressive CCS.
Awake, no neurological deficits, stable hemodynamics under milrinone and low dose catecholamines, weaned off from NO insufflation, planned extubation for Thursday afternoon, expected transfer to the ward on Friday morning. 18 11 6 21
The EACTS Annual Meeting continues to attract high quality submissions and trials. Yesterday, for the first time, a late breaking clinical trial was presented at a cardiothoracic surgical meeting and simultaneously published in a major cardiology journal. The paper
‘Personalised multimodal teleprehabilitation in elective cardiac surgery’ was published simultaneously in JACC and presented during our Late Breaking Science focus session. Proof, if we need it, that the Annual Meeting is home for the very latest science.
11:05 - 12:35
Trial Update session Auditorium 1
WE ARE PLEASED TO SHARE THAT ALL THE PATIENTS WHO FEATURED IN LIVE SURGERY AT TECHNO-COLLEGE ARE DOING WELL.
STATUS ON POST-OPERATIVE DAY #1
Marco Di Eusanio et al.: Frozen Elephant Trunk and CABG
Extubated at midnight, no neurological deficits, stable hemodynamics without catecholamines, transferred to the ward (midday Thursday).
Philipp Kiefer et al.: Transaxillary SAVR
Extubated shortly after the procedure, stable hemodynamics without catecholamines, minor drainage blood loss, TTE: good LV function and aortic valve performance, expected transfer to the ward on Friday morning.
Axel Unbehaun et al.: Transfemoral TAVI
Direct transfer to IMC, stable hemodynamics, initially minor signs of delirium, TTE: trace paravalvular leakage, no pericardial effusion, expected discharge home on Saturday.
Farhad Bakhtiary et al.: Mini mitral valve replacement
Uncomplicated postoperative course, extubated timely, stable hemodynamics without catecholamines. Transferred to IMC-light on Thursday afternoon.
Tomas Holubec et al.: Endoscopic beatingheart tricuspid repair redo surgery
08:30 - 09:30
From incision to emission – a sustainable future - Auditorium 3+4 (Interactive)
08:30 - 09:30
Pre-Trainee session - Room 5A, Pav 5
10:00 - 11:00
Francis Fontan Fellowship - Auditorium 3+4 (Interactive)
11:05 - 12:35
Trial Update session - Auditorium 1
FRIDAY'S HIGHLIGHTS
FOCUS SESSION
Martin Czerny discussed how the 2023 EACTS/STS Aortic Guidelines have changed daily practice in a joint EACTS/STS session.
PRESIDENTIAL ADDRESS
A full auditorium enjoyed the Presidential Address in which Franca Melfi explored the three key principles that sum up her 'never give up' philosophy.
RESIDENTS' COMMITTEE
Ryanair pilots, Martin
and Anna Modos, explored the intriguing parallels between aviation and cardiothoracic surgery.
Masat
SURVIVING IMPOSSIBLE ODDS
Auditorium 1 / 12:35 - 13:20
On Friday 13th October 1972, 19-year-old medical student Roberto Canessa boarded Uruguayan Air Force Flight 571 bound for Santiago, Chile. Canessa played for the Old Christians Rugby Union team, and their captain had chartered the plane to take the team to a match. On board were 45 people, including the team's friends and family and the crew. What should have been a 90-minute flight turned into a 72day ordeal that would leave only 16 of the remaining passengers alive and become known worldwide as the Miracle of The Andes.
“When I looked out of the window, I was surprised to see the peaks of the Andes so close to the wings” remembers Roberto Canessa in his memoir. The inexperienced co-pilot had misjudged their position, taking them too deep into the mountains. Thick fog obscured the view as they started what they believed to be their descent into
Santiago. As the pilots realised their mistake, they tried to lift the plane over an oncoming peak. The belly smashed into the ridge in a crash that would kill 12 passengers immediately and leave the surviving 33 at the mercy of the elements. Roberto Canessa remembers: “There were mountains all around us, where the rest of the plane should have been, and a blizzard was whipping aside everything in its path, lashing us with the cold.”
During the 72 days that followed, Roberto Canessa and the other survivors experienced unimaginable hardships. Along with the brutal cold, thirst and hunger, an avalanche crashed into the wreckage of the plane, killing 13 more. As time wore on and their hopes of rescue faded, the survivors realised their only hope was to eat the flesh of their dead fellow passengers. “Taking this leap was a final break, and the consequences were irreversible: we were never the same.”
Two months after the crash, Roberto Canessa and his friend Nando Parrado set out across the mountains in a last-ditch attempt to find help. Using only materials from the aircraft wreck, they hiked over 73 miles in 10 days, eventually finding three men who could raise the alarm. Two and a half months after the crash, the remaining 14 survivors were rescued from the site, thanks to Canessa and Parrado’s heroism.
Now a paediatric cardiologist, Roberto Canessa has spent his life since the crash helping others at their most vulnerable. We are honoured to welcome this real-life hero to deliver this year’s keynote who will share with us his story of survival and how it has inspired his remarkable
Auditorium 3+4 / 08:30 - 09:30
Providing Part of the Solution: EACTS Sustainability Committee
Climate change is undoubtedly a consequence of anthropogenic activities, resulting in unprecedented socio-economic consequences. The global healthcare sector is a major contributor to climate change by emitting two metric gigatons of CO2 equivalent (roughly the same as all of India) annually. The paradox that healthcare systems are a major contributor to the climate crisis, which has devastating consequences for human health worldwide, must be reversed.
EACTS recognises the need to address this issue head-on. The newly proposed EACTS Environmental Sustainability Committee is set to lead the way in promoting ecological sustainability within cardiothoracic surgery.
The committee’s primary goal is to advocate for sustainability in both the EACTS’ internal operations and in clinical practice across the field. This includes reducing the carbon footprint of EACTS’ key activities such as the Annual Meeting, Journals, and the Quality Improvement Programme, while also developing ‘EACTS Practice Guidelines on Ecological Sustainability in Cardiothoracic Surgery’.
To achieve these objectives, the committee will gather and analyse data to identify opportunities for reducing environmental impact. The insights gained will inform the creation of the EACTS Strategic Roadmap, which
life: “Getting out of the Andes meant kind of an extra responsibility...thanks to those 29 friends that died and that enabled us to stay alive. So, I am not only myself but also myself on behalf of others. My life can’t be led in an ordinary way. If I did so, they would question me: "Roberto: what have you done with the life we contributed to keep?"
Don’t miss Roberto Canessa's keynote session, ‘How I survived impossible odds’ today at 12.35 in Auditorium 1.
There were mountains all around us, where the rest of the plane should have been, and a blizzard was whipping aside everything in its path, lashing us with the cold.
will outline specific steps to become the first net-zero medical society. Additionally, the committee will publish clinical guidelines to help cardiothoracic surgeons adopt sustainable practices in their day-to-day operations.
By leading these efforts, EACTS aims to become a role model for sustainability in healthcare.
The newly proposed EACTS Environmental Sustainability Committee is set to lead the way in promoting ecological sustainability within cardiothoracic surgery.
Felix Nägele Medical University of Innsbruck, Austria
Roberto Canessa FOCUS
EACTS GENERAL ASSEMBLY
WELCOMING NEW OFFICERS AND COUNCILLORS
We are delighted to welcome Volkmar Falk as the new EACTS President. Volkmar Falk has held a number of different positions in the Association including, most recently, as Chair of the New Technology Task Force.
The Presidential Chain was passed on to Volkmar Falk by Franca Melfi during the Presidential Dinner on Friday evening. He will serve a one-year term.
Volkmar Falk said, “I am grateful for the support from EACTS over the years. I have served the Association in various roles and it has been a great journey. I am humbled by how EACTS has built my career, and I hope I can give back to the Association.
EACTS is a vital organisation that continues to attract new talent and people. Their participation guarantees the future of cardiothoracic surgery.
"Next year will be interesting with lots of challenges facing our specialty. We have to regain interest in the field of cardiac surgery and promote our profession. There is an increasing need to collaborate with cardiology and a main focus will be to work more intensively with cardiologists and ESC in particular. I would like to improve our representation in the guidelines developed by ESC.”
The election of new Officers and Councillors also took place yesterday at the EACTS General Assembly, with the following positions announced:
As the decision-making body of EACTS, the Council is responsible for ensuring EACTS complies with its governing document, relevant legislation and best practice guidelines. Members of the EACTS Council have an active role in providing strategic direction to EACTS and setting overall policy and targets.
Rafael Sádaba Vice President
Vladimiro Vida Congenital Domain Chair
Korkut Bostanci Thoracic Domain Chair
Gloria Färber Acquired Domain Chair-elect
(to take Chair role in 2025) (to be voted in by General Assembly as Acquired Cardiac Domain Chair in 2025)
APPLY TO JOIN EACTS TODAY
Last night, 500 new members were welcomed into the Association. It's an exciting time to be an EACTS member. EACTS is a growing community of nearly 4,000 people connected to the cardiothoracic community from around the world – with an expanding range of benefits for its members. As an EACTS member, you will be able to access best-in-class resources, including free access to the European Journal of Cardio-Thoracic Surgery and the newly launched EACTS Adult Cardiac Database, member-exclusive rates for networking and education opportunities that will help you improve patient outcomes and much more.
If you’re not already an EACTS member and are looking to join us again for the 39th EACTS Annual Meeting in Copenhagen next year, why not become a member today and save a significant amount on your ticket? Standard membership rates are just €250.
Learn with EACTS
You’ll also benefit from member-exclusive rates for 50+ EACTS Academy courses and conferences – including EACTS’ Mechanical Circulatory Support Summit – helping you to develop your skills and learn from experts, including courses designed specifically for your skill level. You will also be able to access EACTS Academy webinars free of charge and apply for EACTS’ unique Francis Fontan Fellowships to learn new techniques at some of the most prestigious institutions around the world.
New member benefits
As well as being able to join influential EACTS guideline task forces, domains and committees, we are introducing two new membership benefits that will support EACTS members shape the future of cardiothoracic surgery.
1. Members, whose hospitals sign up, will be able to access the new EACTS Adult Cardiac Database and use advanced data tools to improve clinical practice for patients
2. The new EACTS Innovation Hub will give members the opportunity to access research advice and apply for research and innovation grants.
VIEW MEMBERSHIP VIDEO
We’ve also introduced some new lower rates and additional benefits to further diversify membership and appeal to an even wider section of the cardiothoracic community.
• A broader offer for allied health professionals, including a new fellowship and a lower membership rate
• More education opportunities in thoracic surgery - and across our other domains
• The opportunity for pre-trainees to apply for bursaries to the Annual Meeting and join EACTS at a reduced rate
• Medical students and those working in some of the most economically challenged countries in the world can also join at a reduced rate. For more information on special rates, please go to eacts.org.
Join the EACTS community and start saving today.
Visit the EACTS stand in the exhibition or join online at eacts.org/our-community/become-a-member/
SUPPORTING THE NEXT GENERATION
The Pre-Trainee session will introduce the Pre-Trainee Committee and outline the opportunities available to pre-trainees and pre-training doctors. The Committee, chaired by Samuel Burton, has been established to attract and engage the next generation of cardiothoracic surgeons, bringing them into the specialty and introducing EACTS early in their careers.
New educational grants have also been made available to EACTS pre-trainee members to attend the 38th EACTS Annual Meeting and gain insights from cutting-edge research and forge global connections for career development. The response was fantastic. Following a high number of applications, we increased the number of grants available from five to eight.
“The pre-trainee session is designed for all delegates, including mentors and mentees. During the session, we will explore essential topics on how to develop both professionally and technically, aimed at medical students and surgeons in the early stages of their careers. This is a fantastic opportunity to meet the new Pre-Trainee Committee and learn about the exciting initiatives planned for junior colleagues in the upcoming year. The session provides valuable insights into career growth, mentorship, and skill-building that can benefit all attendees.”
Samuel Burton, Chair of the Pre-Trainee Committee
Pre-Trainee session 08:30 - 09:30 Room 5A, Pav 5
THE POST LAAOS III ERA
Andy Dong & Derrick Tam Cedars-Sinai Medical Center
1: Freedom from stroke in patients who received concomitant prophylactic left atrial appendage closure (LAAC) versus those that did not (no LAAC).
Patient Level Meta-Analysis of Prophylactic Left Atrial Appendage Closure during Cardiac Surgery
The recent clinical trial, LAAOS III, found that left atrial appendage closure (LAAC) during cardiac surgery reduced the risk of stroke in patients with preoperative atrial fibrillation (AF).1 However, most cardiac surgery patients do not have preoperative AF, but are at risk for postoperative AF. Our patient level meta-analysis sought to determine whether prophylactic LAAC during cardiac surgery reduces the risk of late stroke.
We included six studies, one of which was a randomised control trial and five were observational that compared LAAC (n=2,629) to no LAAC (n=2,369) in patients without preoperative AF history. The primary outcome was freedom from stroke at 5-years with a median followup time of 3.6 years.
There were no differences in baseline characteristics. The study-level meta-analysis showed no difference in 30-day mortality (LAAC 1.0% vs no LAAC 1.1%, p=0.8).
The rate of post-operative AF was numerically higher in the LAAC group (29.5% vs 22.2%), but this was not significant (p=0.07).
We reconstructed individual patient level data from digitised Kaplan Meier curves. The risk of stroke at 5-years was reduced in the LAAC group (Figure 1: freedom from stroke 96.4% vs 94.1% no LAAC, pooled HR: 0.58, 95%CI: 0.41-0.82, p=0.002).
In summary, concomitant prophylactic LAAC was associated with less late strokes with a modest protective benefit (number needed to treat to prevent one stroke=43). Until the completion of the LeAAPS trial (NCT05478304) in 2032 which will provide definitive randomized data to address this knowledge gap, this meta-analysis subsumes all the available evidence on prophylactic LAAC.
Our patient level meta-analysis sought to determine whether prophylactic LAAC during cardiac surgery reduces the risk of late stroke.
Figure
EACTS AWARDS
MARKO TURINA AWARD FOR BEST MMCTS RESIDENT'S TUTORIAL
The Marko Turina Award is presented in recognition of the best core skills video tutorial. This follows a competition, launched earlier this year by EACTS and TSRA (Thoracic Surgery Residents Association) to recognise the best core skills video tutorial with a specific focus on technical quality, surgical skills and educational clarity.
Manuel Egle, Sarah Longnus, Murat Yildiz, Matthias Siepe & David Reineke
The winning video is an audio-visual step-by-step tutorial on the surgical procedure of heart procurement, preparation and perfusion using the Organ Care System (OCS)™. Using the OCS, cardiac grafts are returned to a beating state during transport using warm, oxygenated perfusion. When applied either in certain organ donor populations, or to overcome geographical barriers, it can enable the utilisation of grafts that would otherwise not have been used, ultimately increasing the number of hearts available for transplantation.
WINNER
Surgical techniques for cardiac procurement, preparation and perfusion using the Organ Care System
I am very happy that my team and I won this year's MMCTS Residents' Tutorial. I am especially excited about the award because I am very passionate about the topic and I put a lot of effort into the project. Furthermore, I am delighted that our video has been published on the MMCTS platform, which is one of the most important and valuable platforms providing surgeons of all experience levels, but especially residents, with valuable audio-visual tutorials and exciting case reports on various topics in the field of cardiothoracic surgery.
ROBOTICS WORKSHOPS
2024
WINNER: Karol Chorazy, Austria
RESIDENTS
WINNER: Marco Gemelli, Italy
ASSOCIATE EDITOR AWARDS
2023 ASSOCIATE EDITOR AWARD
WINNER: Luca Bertolaccini
REVIEWER OF THE YEAR
2023 REVIEWER OF THE YEAR
WINNER: Haruhisa Matsuguma
2023 ASSOCIATE EDITOR AWARD
WINNER: Cecilia Pompili
2023 REVIEWER OF THE YEAR
WINNER: Mohamed Rahouma
Advancing With You
By Surrounding You With Aortic-Centric Solutions
Our Focused Commitment to Partner with Cardiovascular Surgeons
Since we were founded in 1984, Artivion has collaborated with cardiovascular surgeons to bring innovative technologies to market to treat patients with aortic
Today, as a global company of over 1300 employees, our focused commitment to partner with and support cardiovascular surgeons remains at the core of our mission.
NURSING & ALLIED HEALTH PROFESSIONALS
The Allied Health Professionals Committee is hosting two inspiring sessions today, offering the opportunity to hear some different perspectives and experiences.
The role of patients and the value of understanding lived experiences will feature in this morning’s session ‘Multidisciplinary teams working to keep patients at the centre of care’. We welcome Catherine Fowler from The Aortic Dissection Charitable Trust in the UK to discuss the charity’s work in shaping a safer future for aortic dissection.
Catherine was instrumental in setting up the charity, which began as a family petition following the death of her father, Tim. He died of an aortic dissection in 2015 after being sent home from the emergency department with an incorrect diagnosis of indigestion. The petition gathered the support of thousands of bereaved families impacted by misdiagnosis, along with many patients who had poor outcomes because of a delayed diagnosis of aortic dissection.
FOCUS SESSION
Richard Van Valen
and Cristina Ruizsegria Allied Health Professionals Committee
Having conversations with patients and listening to their needs is essential to ensure a positive impact on patient care and outcomes, including reducing the risk of complications, the optimum use of medication and effective rehabilitation.
A whole-team approach
The involvement of nurses in the early treatment of cardiac arrest and cardiac surgery is becoming more commonplace with more centres recognising the vital role that nurses can take in acute situations. A heart team from Hospital Santa Cruz in Lisbon will share details of their new programme designed to train ICU nurses on how to attend a cardiac arrest after surgery.
This presentation will reinforce the importance of adopting a whole-team approach. Literature shows that training the whole team leads to better results and outcomes for patients.
This presentation will reinforce the importance of adopting a whole-team approach. Literature shows that training the whole team leads to better results and outcomes for patients.
Multidisciplinary teams working to keep patients at the centre of care
10:00 - 11:00
Room 5B, Pav 5
Nursing & Allied Health Professionals: Abstracts
11:05 - 12:35
Room 5B, Pav 5
Finally, later this morning we look forward to a very busy abstract session. Our call for abstracts attracted a strong response. There is a wide and impressive variety of topics, from paediatric cardiac surgery nursing to prehabilitation of cardiac surgery patients and older patients. This abstract session is a great opportunity to showcase the projects and research undertaken by nurses and allied health professionals to a larger audience. Room 5B / 10:00 - 11:00 MULTIDISCIPLINARY TEAMS
WORKING TO KEEP PATIENTS AT THE CENTRE OF CARE
Uniting the medical community and those with lived experience to shape a safer future for Aortic Dissection
The Aortic Dissection Charitable Trust is the UK and Ireland's charity dedicated to improving the diagnosis, treatment, and long-term outcomes for those affected by aortic dissection. We unite patients, families, clinicians, and researchers to enhance survival rates and reduce the disability associated with this life-threatening condition. Our work covers the entire care pathway - diagnosis, treatment, and aftercare. We advocate for faster diagnosis through education for emergency responders, ensuring they recognise symptoms quickly. Our efforts have led to the NHS introducing the Acute Aortic Dissection Toolkit to expedite treatment, and we are expanding this to include aftercare, focusing on risk management, mental health, lifestyle guidance, and family screening.
Research and education are at our core. Partnering with the National Institute for Health and Care Research, we fund studies to improve outcomes and offer educational programmes for healthcare professionals across NHS trusts. Despite progress, our audit showed fewer than half of NHS trusts have guidelines for aortic dissection in emergency departments. We are committed to addressing this through advocacy and training.
Empowering patients is also vital. We provide online videos and patient-led support materials, approved by medical experts, to offer essential guidance. We also fund Aortic Dissection Advanced Practitioners who ensure patients receive regular monitoring, lifestyle advice, and emotional support, bridging the gap in follow-up care. Together, we aim to create a future where aortic dissection is swiftly diagnosed, effectively treated, and managed comprehensively.
Empowering patients is also vital. We provide online videos and patient-led support materials, approved by medical experts, to offer essential guidance.
John A. Elefteriades, Maryann Babcock, Catherine Fowler & Graham Cooper Aortic Dissection Charitable Trust
SCIENTIFIC PROGRAMME
THURSDAY 10 OCTOBER
FRIDAY 11 OCTOBER
Aortic
surgery in Marfans
FRIDAY 11 OCTOBER
and VSD surgery
Late breaking science: coronary artery bypass grafting and perioperative
SATURDAY 12 OCTOBER
ADVANCING CLINICAL PRACTICE GUIDELINES: A NEW COLLABORATIVE METHODOLOGY
In response to growing concerns regarding the credibility and transparency of clinical practice guidelines (CPGs), four leading cardiothoracic organisations—EACTS, AATS, ESTS, and STS—have taken decisive action. Recognising the critical need for clear, reliable, and unbiased medical guidance, these organisations have collaborated to develop a comprehensive methodology for creating CPGs and other essential clinical documents.
Historically, the development of CPGs has faced challenges, such as inconsistent methodologies, lack of transparency, and potential conflicts of interest. These concerns have resulted in diminishing trust among healthcare professionals and patients. To address these issues, the newly introduced joint methodology prioritises transparency, multidisciplinary input, and rigorous evidence evaluation. The goal is to ensure that future guidelines are not only evidence-based but also reliable and universally accepted.
This collaborative effort incorporates key processes such as systematic literature reviews, comprehensive evidence synthesis, dealing with COIs, reaching consensus processes and strict adherence to grading standards, further enhancing the integrity of the process. Importantly, the document focusing on establishing best practices to guide optimal patient care not taking into account cost-benefit analyses.
This new methodology, developed with contributions from experts in clinical document creation, has already received unanimous approval from the participating organisations' governing bodies. Now when its published, it will serve as a foundational framework for producing trustworthy guidelines, setting a new standard in the field of cardiothoracic surgery.
By reinforcing collaboration and standardisation, this initiative aims to rebuild confidence in CPGs, ensuring they are a valuable resource for clinicians, patients, and healthcare stakeholders alike.
Thomas Schwann
Cardiothoracic
Surgeon, Corewell
Health East William Beaumont University Hospital
Auditorium 1 / 08:30 - 09:30
HOW TO GET THE BEST RESULTS IN COMPLEX CABG POPULATIONS
CABG strategies in the morbidly obese
Obesity has become a worldwide epidemic. According to the World Health Organisation, 70% and 59% of the US and European populations are overweight or obese, respectively. 43% of CABG patients in the STS database are obese. The CDC estimates that the total annual cost of obesity in the US is $173 billion with an additional $300 billion spent on weight loss programs annually. The health care risk of obesity has been known since ancient times. Hippocrates observed “Sudden death is more common in those who are naturally fat than in the lean”.
Obesity is most commonly determined by body mass index (BMI – kg/m2). Other less commonly used parameters of obesity are waist circumference or body fat percentage. Obesity is frequently associated with the metabolic syndrome and is a significant risk for coronary artery disease. Even patients who are metabolically healthy but obese have a 49% and 96% increased risk of coronary artery disease and heart failure, respectively. Obese patients present challenges for surgeons due to their bulk which results in appropriate visualisation and access to organs, predisposes to retraction injury with increased wound tension and wound healing complications. Furthermore, morbidly obese patients pose difficulties in personal hygiene as well as mobilisation for nursing staff. In addition to challenges of managing sheer bulk in the obese, adipose tissue has been recognised as
metabolically active resulting in chronic low grade inflammatory state that may have implications for durability of coronary grafts.
Despite these challenges, CABG can be performed with acceptable results. Importantly, both short and long operative mortality shows a U-shaped relationship with BMI whereby the mortality risk rises with large deviations in either direction from normal weight (Figure 1a, 1b). As in other cardiovascular conditions, there exists an “obesity paradox” such that mild obesity (BMI of 29kg/m2) is associated with best long term survival among CABG patients with a steep rise in mortality above a BMI of 37kg/ m2 (Figure 1b).
The available data indicates that multi arterial bypass grafting (MABG) is also associated with a long term survival benefit in obese patients, although in a recent study based on the STS database of over one million patients, MABG was associated with decreased survival among patients with BMI over 40kg/m2 . This MABG long survival benefit is more firmly documented for the radial artery versus the right internal thoracic artery when used as a second arterial conduit in conjunction with the left internal thoracic artery. Moreover, in another STS databased study, bilateral internal thoracic artery grafting was associated with an increased risk of peri-operative mortality compared to traditional single arterial CABG. Given these observations, and the increased risk of deep sternal wound infection across the entire BMI spectrum due to the extensive devascularisation of the anterior chest wall in bilateral internal thoracic artery bypass grafting superimposed on the already poor vascularity of adipose tissue, the value of bilateral internal thoracic artery grafting in obese patients is not yet defined. Hence radial artery based MABG, rather than bilateral internal thoracic artery based MABG or the traditional single arterial CABG, may be the optimal grafting strategy in the obese.
Even patients who are metabolically healthy but obese have a 49% and 96% increased risk of coronary artery disease and heart failure, respectively.
2024 ESC Guidelines for the Management of Chronic Coronary Syndrome, endorsed by EACTS: A Long-Awaited Unified Recommendations for CABG and PCI
Room 3C, Pav 3 / 10:00 - 11:00
In August 2024, the European Society of Cardiology (ESC) published its latest Guidelines for the Management of Chronic Coronary Syndrome (CCS), endorsed by EACTS. This document integrates two previously separate guidelines, those on the diagnosis and medical therapies of chronic coronary syndromes and myocardial revascularisation, into one comprehensive, patient-centered framework. It focuses on all aspects of diagnosis, treatment, secondary prevention, and followup for patients with progressive CCS.
The core recommendations for decision-making between CABG and PCI in treating CCS are summarised in two key recommendation tables. The 2024 guidelines shift away from purely procedure-based approaches to a more holistic, patient-centered strategy. Importantly, they emphasise shared decision-making, reinforcing the central role of the Heart Team in guiding treatment decisions, particularly for patients in whom both PCI and CABG are viable treatment options. In cases where
cardiac surgery is not available onsite, interventional units partnered with cardiac surgery institutions should establish institutional protocols to ensure the appropriate revascularisation strategy is implemented in accordance with European guidelines.
CABG remains the preferred approach for patients with more complex coronary artery disease, including those with left main coronary artery disease, diabetes mellitus, or heart failure. PCI, on the other hand, is recommended for patients with lower anatomical complexity or when surgery is not feasible. Due to space constraints imposed by strict word limits, the procedural aspects of interventions like CABG and PCI are less detailed than in previous versions. As a result, the responsibility for the technical execution of these procedures falls on the individual expertise of surgeons and interventional cardiologists once the Heart Team has made the decision for intervention.
This collaborative effort by the ESC and EACTS highlights Europe’s commitment to developing transparent, evidencebased, and patient-centered guidelines. By continuing to refine the decision-making process for treating cardiovascular diseases, these guidelines are advancing patient safety, promoting long-term outcomes, and upholding the highest standards of care in cardiovascular medicine.
These guidelines will also be discussed during the ‘Trial Update Session’ at 11:05 in Auditorium 1.
Milan Milojevic & Torsten Doenst
FOCUS SESSION
Figure 1a
Figure 1b
Sara Ricciardi Consultant Thoracic Surgeon, San Camillo Forlanini Hospital, Rome, Italy
Auditorium 2 / 11:05 - 12:35
SCREENING OF LUNG CANCER IN THE TWENTIES
Incidental findings on a screening programme (inc false +ve & false -ve)
During lung cancer screening, notewort hy anomaliesdistinct from lung cancer - known as incidental findings (IFs), are often detected. Those abnormalities can be intra and extra-thoracic, and are reported in nearly 70% of screened individuals. The most common IFs are coronary artery calcification, emphysema, and interstitial lung diseases.
Detecting IFs as well as “indeterminate” category nodules, often leads to additional diagnostic interventions, increasing screening costs and risks. One of the more expected uncertainties during a screening program is the overdiagnosis, over management, and overtreatment. For this reason, a proper balance
between the benefits of early resection of a possible lung cancer, and the conceivable harm inherent to false positive and negative lesions is required.
Interestingly, both the MILD and NELSON trials reported a significant rate of ground glass opacities (GGO) and also demonstrated the distinguishing slow growth and indolent behaviour of those lesions, confirming that careful surveillance of GGOs should be performed at first, to recognise biologically relevant nodules (particularly part solid nodules with a solid component ≥5 mm; a new solid component and a short mass doubling time).
Several guidelines and artificial intelligence (AI) models have been also developed in order to properly manage solid nodules, GGOs and IFs in lung cancer screening program, however many controversies remain open in this area.
Excessive bleeding is a complication that is associated with serious postoperative adverse events, including sepsis, ARDS, renal failure, and death.1
How does this affect your clinical practice?
Meet us at booth no. 201 & 202 in hall 2
1 Christensen MC et al. J Thorac Cardiovasc Surg 2009; 138:687-93.
EXHIBITION FLOOR PLAN
Your guide to what's on
TUNE IN
Watch live and recorded content from this year's Annual Meeting on EACTS TV. Educational and entertaining, EACTS TV features compelling panel debates, Annual Meeting highlights and interviews with the world’s leading cardiothoracic surgeons.
SATURDAY 12 OCTOBER
09:15 - 09:30 On the Pulse: Exploring the Exhibition
09:30-09:50 The Daily Preview – Today at the Annual Meeting
10:00-10:15 Innovation in CT Surgery
10:20-10:30 Previewing the 2025 Annual Meeting
10:35-10:55 EACTS Award Winners 2023 - One year on
11:00-12:30 Live broadcast: Trial Update Session
Roy Sheppard (Host)
Jeroen Bax Richard Milton
Can Gollmann-Tepeköylü Joe Bavaria
Volkmar Falk
Volkmar Falk Patrick Myers
Debora Brascia Giuseppe Comentale Justin Ren
12:30-13:20 Live broadcast: Keynote Lecture & Awards Ceremony R. J. Canessa
LEARNING LABS
Hands-on guidance from the experts
Saturday 12 October
09:00 – 11:00 Transcatheter
09:00 – 11:00 Endoscopic Dry Lab Training
THIS YEAR'S WINNERS
CONGRATULATIONS TO THE EUROPEAN CHAMPIONS OF THE CT SURGERY RESIDENT SHOWDOWN
Marco Gemelli and Francesco Bertelli, University of Padova
Taking place in Buenos Aires, Argentina from 5-7 December, the 2024 EACTS/STS/LACES Latin America Cardiovascular Surgery Conference will showcase the latest surgical innovations and research.
The programme features a world-class, international faculty with experts from Europe, Latin America and North America.
Designed for surgeons at all stages in their careers, Rafael Sádaba, Programme Chair, explains, “We have sessions dedicated to residents and other sessions focused on more complex procedures. Various topics across adult cardiac and congenital cardiac surgery will be discussed, including mitral valve, aortic valve, aortic dissections, coronary surgery and more.”
The line-up includes original scientific abstracts, interactive panel discussions and technical videos – described by Programme Director, Joseph Bavaria, as “an excellent portion of the conference that’s really important for surgeons as they need to know how to do these operations.”
Speaking about this year’s event, Patrick Myers, EACTS Secretary General, remarks, “We’re really focusing on what is most important and relevant for surgeons in Latin America. I’m particularly looking forward to the session on the Ross procedure, an operation that’s been around for a long time but has had a resurgence over the past few years.”
E-POSTERS
DESIGNING THE FUTURE INNOVATE, DISCOVER, EDUCATE
THE 39TH EACTS ANNUAL MEETING 8 - 11 October 2025 • Copenhagen, Denmark
Join us next year in Copenhagen for the 39th EACTS Annual Meeting. For 2025 you can expect robust debate and discussion led by global experts, the latest technological advances on display and an opportunity to share knowledge and socialise with your peers from around the world.
