DAILY NEWS DOMAINS
ANNUAL MEETING HIGHLIGHTS
The official newspaper of the 35th EACTS Annual Meeting 2021
Issue 1 Thursday 14 October
LOOKING TO THE FUTURE with Techno College Page 3
WELCOME TH TO THE 35 EACTS ANNUAL MEETING.
Domain and Taskforce Chairs outline some of the key sessions at this year’s Annual Meeting. Pages 6-9 The EACTS Annual Meeting, now in its 35th year, is one of the most important dates for the cardiothoracic surgical community. The meeting provides an unparalleled opportunity to learn from experts in their field about the latest innovations and techniques as well as the current research and trial results. This year is no exception. The Annual Meeting always offers much more than high quality education. What makes this meeting so special is the opportunity to reunite with friends and acquaintances and forge new relationships that will last a lifetime. Mark Hazekamp EACTS President
SKILLS CORNER Expand your specialist knowledge through in-person tutorials, demonstrations and masterclasses. Page 13
THE EACTS ANNUAL MEETING, NOW IN ITS 35TH YEAR, IS ONE OF THE MOST IMPORTANT DATES FOR THE CARDIOTHORACIC SURGICAL COMMUNITY.
Reconnecting It is with good reason that the theme of this year’s Annual Meeting is ‘reconnecting’. After a challenging 18 months we have all sorely missed the opportunity to meet face to face and share experiences and learning with members of our community. We are delighted that so many of you have been able make the journey to the vibrant city of Barcelona to attend in-person. This includes EBCP members who are joining this year’s meeting. Throughout the months of planning for the 35th EACTS Annual Meeting your
health and safety have always been our priority. My thanks to the EACTS team who have worked so hard to ensure comprehensive safety measures are in place while still delivering an exciting programme of world class science, hands-on training and discussion. We recognise that not everyone is able to make the in-person meeting, which is why for the first time the event will run in a hybrid format. Our new virtual platform means more people than ever can explore new scientific insights, learn about the latest innovations in cardiothoracic surgery and take part in stimulating debates alongside global experts. I am confident this innovative new platform will deliver a great experience wherever you are. The latest innovations We have already enjoyed a fantastic start to the Annual Meeting programme with a full day of Techno College sessions yesterday. These sessions provided a welcome opportunity to explore the latest innovations in treatments and techniques in the field of cardiovascular surgery as well as the chance to view live surgery and interventions.
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EACTS DAILY NEWS
WELCOME
EACTS
IN TODAY’S ISSUE 3. Techno College
EACTS
6. DOMAIN AND TASKFORCE HIGHLIGHTS
The EACTS Domain and Task Force chairs outline their programme highlights for this year’s Annual Meeting.
10. Annual Meeting in numbers 11. Abstract presentations 13. Skills Corner 15. Satellite Symposia 16. Programme Agenda
CONTINUED FROM PAGE 1 The next three days offer further opportunities to learn more about new technology and innovations. This includes focus sessions on ‘New technologies and strategies in CHD’ and ‘Current and future perspectives in VAD therapy’ as well as an abstract session on ‘The science behind the future of valve surgery’. This year we are also introducing a new addition to the Annual Meeting – the EACTS Skills Corner. The Skills Corner, located in the Exhibition area onsite in Barcelona for in-person attendees and online via the EACTS platform, offers in-depth live training and step-by-step demonstrations of key procedures carried out by experienced surgeons and key opinion leaders.
To help get the most out of our packed programme of education and discussion I encourage you to download the EACTS App so you can create your own personalised schedule for the next three days. Finally I would like to say thank you to all our Industry partners for their invaluable and continued support of the Annual Meeting. The trade exhibition opens this afternoon and I encourage everyone to take some time to look around. It’s another good way to keep up to date with newto-market technology, state-of-the-art products, innovations and developments in the cardiothoracic market. I wish you all an enjoyable and informative three days.
TODAY’S PROGRAMME HIGHLIGHTS
EACTS
18. EXHIBITION FLOOR PLAN
Keep up to date with new to market technology, state of the art products, innovations and developments in the cardiothoracic market.r?
20. Abstract presentations 31. Visiting Barcelona 32. The 36th EACTS Annual Meeting
ANDROID
DOWNLOAD THE EACTS APP
APPLE
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09:00 - 10:30 FOCUS SESSION
11:00 - 12:30 FOCUS SESSION
Minimally invasive mitral repair masterclass
Questioning the treatment of acute Type A aortic dissection
09:00 - 10:30
11:00 - 12:30
ABSTRACT SESSION
FOCUS SESSION
Extensive aortic arch repair: To freeze does not mean to heal
Timing for Aortic valve repair in aortic regurgitation
09:00 - 10:30
14:15 - 15:45
FOCUS SESSION
FOCUS SESSION
Minimally Invasive CABG: a missed opportunity?
CABG and PCI (not CABG vs PCI)
09:00 - 10:30
16:00 - 17:30
FOCUS SESSION
ABSTRACT SESSION
TMVI for beginners
Management of neonates and lowweight infants with CHD
11:00 - 12:30
16:00 - 17:30
FOCUS SESSION
Heart Team – does it still exist?
FOCUS SESSION
Are Men from Mars and Women from Venus even for CABG?
TECHNO COLLEGE
Issue 1 Thursday 14th October
LOOKING TO THE FUTURE WITH TECHNO COLLEGE Our exploration of the latest world-class innovation and advances in the field of cardiovascular and thoracic surgery – as well as interventional cardiology – began yesterday with a full day dedicated to showcasing new technology and techniques. While sessions throughout the Annual Meeting focus on the recent developments and the latest research, the Techno College offers an opportunity for a more in-depth look at the science. Those who attended yesterday’s session were able to pick up ideas, advice, tips and insights that they can take back to their own practice to improve patient outcomes. This year’s topics included Valve and Minimally Invasive Surgery, Transcatheter and Robotic Surgery and Sublodar Resections. There was also an opportunity to hear about latest technologies and techniques in the field of thoracic surgery. Younger surgeons have the chance to learn from experienced surgeons about performing particular techniques, and experienced surgeons are able to learn more about the latest developments. Techno College offers something for everyone, whatever their level of experience. The Techno College has a unique format that includes live surgery and interventions, live-in-box cases and state-of-the-art lectures – demonstrating to surgeons and cardiologists the appropriate use of the newest cardiovascular techniques. Since its foundation, the Techno College has emerged as one of the leading worldwide meetings in cardiac surgery. The topics for this year’s programme were selected by the New Technology Taskforce, chaired by Professor Volkmar Falk, based on their relevance and potential impact to change practice. They include innovations in the form of patents, inventions, techniques and new products. “These sessions give surgeons the opportunity to explore the latest and greatest innovations in treatments and techniques required in their daily practice. Innovations and advances in the field are now emerging at incredible speed, so keeping abreast of developments in the market is key.” says Professor Falk.
“These sessions give surgeons the opportunity to explore the latest and greatest innovations in treatments and techniques required in their daily practice.”
The Techno College has a unique format that includes live surgery and interventions, live-in-box cases and state-of-the-art lectures
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Issue 1 Thursday 14th October
Celebrating the best in innovation One of the highlights of the Techno College is the Lion’s Den where cardiothoracic surgeons get just two minutes to present their innovative ideas, techniques and developments in all areas related to thoracic and cardiovascular research to the audience and expert panel. The best presentation is awarded the Techno College Innovation Award.
THE SUPPORT OF OUR INDUSTRY PARTNERS IS IMPORTANT. WE WOULD LIKE TO THANK OUR We are also grateful for the support of Abbott Medical GmbH for their TECHNO COLLEGE SPONSORS. support of this year’s Techno College
Former recipients of the award include Max Emmert, from Wyss Zurich at the University of Zurich and the Department of Cardiothoracic Surgery at the German Heart Center Berlin, for the LifeMatrix bioengineering platform. This year’s finalists for the Techno College Innovation Award are: PulmoVR: A hybrid virtual reality and artificial intelligence tool for complex lung surgery planning A. H. Sadeghi, Rotterdam, The Netherlands PerDeCT Device (Pericardial Device to monitor Cardiac output and diagnose Tamponade) for cardiac surgery H. Fallouh, Wales, UK Haermonics’ Laebroides - to improve patient outcome D. Koolbergen, Amsterdam, The Netherlands Conceptualization of an Innovative Surgical Device in Delayed Sternal Closure Utilizing Nano-Silver Technology M. A. Amir, Shah Alam, Malaysia
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EACTS DAILY NEWS
DOMAIN AND TASKFORCE HIGHLIGHTS
The Annual Meeting scientific programme is put together by experts on the Domain and Taskforce Committees. Here, the EACTS Domain and Task Force chairs outline their programme highlights for this year.
THORACIC DISEASE DOMAIN
Professor Eric Roessner Chair, Thoracic Disease Domain We have prepared an exciting thoracic programme for you this year. We are proud to host the first ever joint meeting with the International Association for the Study of Lung Cancer (IASLC). The focus of this session ‘Insights beyond TNM’ is on the interaction between medical and surgical oncology.
We have a great session on the challenges that Covid has presented for thoracic surgeons. This is an opportunity to hear the inside view not only from surgeons but also from nurses who have worked at the forefront of this pandemic.
Thoracic Disease Domain Sessions to look out for
The Saturday focus session on trials and landmark papers is very important, featuring the primary investigators of major trials including PulMiCC VIOLET, ADAURA and PACIFIC who will be presenting and reporting on their data. The key objective of this session is to understand how these studies will impact on a thoracic surgeon’s practice.
14:30 - 16:00 – Covid 19 topics in thoracic surgery
The Annual Meeting is a great opportunity to get the latest news in the great field of thoracic surgery.
10:30 - 12:00 Major trials and landmark papers – what the thoracic surgeon needs to know
Friday 15 October
16:15 - 17:45 – Insights beyond TNM - Joint session with IASLC
Saturday 16 October
“We have a great session on the challenges that Covid has presented for thoracic surgeons. This is an opportunity to hear the inside view not only from surgeons but also from nurses who have worked at the forefront of this pandemic.”
CONGENITAL DISEASE DOMAIN
Dr Lorenzo Galletti Chair, Congenital Disease Domain The 35th EACTS Annual Meeting marks the first opportunity to participate in an in-person meeting after a very difficult time. The Annual Meeting is important for our community. It enables us to update our knowledge and take part in discussions around specific issues that we encounter in our everyday practice. This year the Congenital Domain has prepared a programme that spans congenital surgery for newborns through to adult congenital. This includes sessions on the ‘Management of neonates
and low-weight infants with CHD’ and ‘An update on Mitral Valve Surgery in Paediatrics’ which will consider the principles of mitral valve surgery in infants and children affected by congenital and acquired valve disease.
Congenital Disease Domain Sessions to look out for
The programme also includes a session on heart transportation and mechanical devices, an increasing problem in our practice.
16:00 - 17:30 Management of neonates and low-weight infants with CHD
Interesting sessions on adult congenital include ‘The Aortic Valve and Aortic Root in Adolescent and Adult with CHD’ which will explore the “Ideal” Ross Operation in adolescent and young adults. In addition to this session, the domain will also be running a wetlab dedicated to the Ross procedure. For this year’s Annual Meeting we have organised three special sessions, including two sessions with the Association for European Paediatric and Congenital Cardiology (AEPC). The first of these sessions takes place on Saturday morning and will provide an update on medical and surgical strategies for patients with Failing Fontan. The second session is dedicated to the intervention of surgical management of congenital heart disease. Finally, this year we will be dedicating a session to two giants of our profession – Aldo Castaneda and Bill Norwood, who sadly passed away last year. The format of this session will be a little different, which I hope is enough information to pique your curiosity.
Thursday 14 October
Friday 15 October 10:00 - 11:30 HTX /mechanical support 16:15 - 17:45 A Tribute to Giants: Aldo Castaneda and Bill Norwood
Saturday 16 October 08:30 - 10:00 Failing Fontan: any news? Joint session EACTS/AEPC
Issue 1 Thursday 14th October
VASCULAR DISEASE DOMAIN Other sessions taking place on Thursday will explore various perspectives to approach the acute Type A aortic dissection and the treatment options of aortic repair in acute Type A aortic dissection. This year we are excited to host two joint Professional Challenge sessions with the STS on Friday afternoon. We will discuss the recent evidence and techniques regarding the endovascular treatment of the aortic arch.
Dr Konstantinos Tsagakis Chair, Vascular Disease Domain The Vascular disease domain has worked hard to put together an interesting programme for this year’s Annual Meeting. There are a number of stimulating sessions on acute type A aortic dissections and on the management of the aortic arch, where we are seeing more new developments. Our first session on aortic arch repair takes place on Thursday morning and offers delegates an opportunity to learn about the risks and benefits of extended thoracic aortic surgery.
On Saturday we will take delegates on an exciting journey around the aortic world in 90 minutes, in a focus session that explores the various surgical strategies for aortic arch repair around the globe. I hope you will join us. New for this year’s Annual Meeting is the TEVAR simulation session in the Training Village. This is a great opportunity to practice your skills with our hands-on training on endovascular stentgraft thoracic aortic treatment.
“This year we are excited to host two joint Professional Challenge sessions with the STS.”
Vascular Disease Domain Sessions to look out for
Thursday 14 October 09:00 - 10:30 - Extensive aortic arch repair: To freeze does not mean to heal 11:00 - 12:30 - Questioning the treatment of acute Type A aortic dissection
Friday 15th October 14:30 - 16:00 - EACTS/STS Joint Meeting - EndoArch is here to stay (1)
Saturday 16 October 14:15 - 15:45 - An exciting journey around the aortic world in 90 minutes
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EACTS DAILY NEWS
ACQUIRED CARDIAC DISEASE DOMAIN The trial update plenary session provides a critical appraisal of key subjects and new data. This will bring surgeons and cardiologists together. We’ll also be covering alternative definitions of MI, the UK Academy trial, and the Gary registry data. A late breaking RCT promises to give us new tools to prevent peri operative atrial fibrillation, and another session not to miss is on the upcoming EACTS CSE 2021 Valvular Heart Disease Guidelines, providing insights into their application in clinical practice.
Dr Patrick Myers Chair, Acquired Cardiac Disease Domain What can attendees expect from the Acquired Cardiac Disease Domain at the Annual Meeting? The taskforces have organised a fantastic programme spanning the breadth of adult cardiac surgery, reviewing the latest evidence in CABG, new techniques and minimally invasive approaches in complex valve repairs, as well as mastering transcatheter techniques in theory through focus sessions and in practise in the Skills Corner. We’ve also integrated basic science into each session to look at the science behind the future of these key fields.
Over the next few days I look forward to reconnecting with friends and colleagues from around the world. The pandemic has taken a huge toll on scientific meetings, and this is the first opportunity for us to meet in person, to share and discuss science and enjoy coming together again.
Acquired Cardiac Disease Domain Sessions to look out for
Thursday 14 October 09:00 - 10:30 Minimally Invasive CABG: a missed opportunity?
Saturday 16 October 10:15 - 12:15 Clinical Trial Updates 12:30 - 14:00 2021 EACTS/ESC Guidelines for the management of valvular heart disease: Meet the task force members
“The trial update plenary session provides a critical appraisal of key subjects and new data. This will bring surgeons and cardiologists together.”
EACTS AORTIC VALVE AND ROOT TASKFORCE We have two 90-minute focus sessions each day looking at the most common clinical situations. Some look at the state of the art in a particular area, and others deal with controversial subjects that are likely to spark fierce debates. Thursday’s first focus session looks at the correct timing for aortic valve repair (AVR) in aortic regurgitation and then discusses the conflicting opinions. The second session deals with current controversies in AVR, which is rapidly evolving from an experimental setting to a standard of care.
Filip Casselman and Ruggero de Paulis, co-chairs, EACTS Aortic Valve and Root Task Force The EACTS Aortic Valve and Root Task Force has been working hard in recent months to design a series of practical and stimulating scientific sessions for the Annual Meeting. First, we have several sessions featuring the best abstracts selected from a range of submitted work. At these sessions you will find the latest advances in the field and the results of the most recent clinical research. You can also take part in the discussions on the work.
On Friday, we cover the current status on minimally invasive aortic valve and root surgery. Now that minimally invasive aortic replacement has become standard, this approach is being applied to more complex operations. Early adopters and antagonists will debate the pros and cons of reducing the surgical access. Friday’s second focus session is ‘Matching the best substitute for aortic valve replacement to the patient’. This discussion covers all the available options in the light of patient characteristics and increasing requests for a tailored choice for each patient. The first focus session on Saturday examines newer opportunities in AVR, such as new tissue treatments, tissue engineered valves, wrapping an autograft and others. The last session is devoted to bicuspid aortic valve repair, which has had a lot of attention recently. Attendees will have gained a clear overview of this topic by the end of the session.
Finally, we have a 180-minute professional challenge session on the Ross procedure. Experts in the field cover the entire spectrum of the procedure – good long-term results have ignited new enthusiasm for this old technique, with more and more surgeons considering it when valve replacement needs to be avoided. All sessions are moderated by expert physicians and panellists to ensure the best scientific content and a high-quality learning environment. Aortic Valve and Root Task Force Sessions to look out for
Thursday 14 October 11:00 - 12:30 Timing for Aortic valve repair in aortic regurgitation
Friday 15 October 10:00 - 11:30 Matching the best substitute for aortic valve replacement to the patient
Saturday 16 October 16:00 - 17:30 Bicuspid AV repair
Issue 1 Thursday 14th October
CORONARY ARTERY SURGERY TASKFORCE with low EF’ will provide guidance on how to treat this very complex patient.
Dr Mario Gaudino Chair, Coronary Artery Surgery Task Force The Coronary Artery Surgery Task Force has provided a programme covering every aspect of coronary artery bypass graft surgery (CABG), catering to the interests of both the generalist cardiac surgeon, who does CABG as part of his or her practice, and the specialist coronary surgeon, who wants to dig really deep into the technical complexity of the operation. The treatment of CABG patients with low ejection fraction (EF) promises to be an exciting session. These are very challenging patients who require a multidisciplinary approach and specific treatment pre-operatively, inter-operatively and post-operatively. The session ‘CABG, in patients
A session on ‘Coronary Surgery in 2021’ will touch on the key controversial topics from quality control to new perspectives. The session will open with a lecture from the “father” of modern coronary artery surgery, Dr Bruce Lytle. Dr Lytle is the mentor of all of us who have spent most of our time doing coronary surgery. This interesting lecture is about where we come from and where we’re going, highlighting our roots, but also the future perspective. For the first time the Annual Meeting will include a session fully dedicated to women in coronary bypass surgery. Women have been traditionally underrepresented in cardiac surgery studies and trials. This is potentially a very important problem. There are surgical and biological reasons to believe the outcomes we see in studies are based on a prevalently male patient population and do not apply to women. EACTS has spent a lot of effort in trying to improve the outcome of women through a generation of new evidence. The session ‘Are Men from Mars and Women from Venus even for CABG?’ will explore not only what is available in terms of current evidence, but also what the challenges are for generating evidence that applies to women – potentially to the level of designing randomised trials for women only.
Not to be missed will be the CABG versus PCI debate. We will have a number of controversial topics, which will be debated by both interventional cardiologists and surgeons in a friendly and collaborative atmosphere. Coronary Artery Surgery Task Force Sessions to look out for
Thursday 14 October 14:15 - 15:45 CABG and PCI (not CABG vs PCI) 16:00 - 17:30 Are Men from Mars and Women from Venus even for CABG?
Saturday 16 October 08:30 - 10:00 CABG, in patients with low EF 14:15 - 15:45 Coronary Surgery in 2021
“For the first time the Annual Meeting will include a session fully dedicated to women in coronary bypass surgery.”
TRANSCATHETER TECHNIQUES TASKFORCE Once again, the Annual Meeting will hold its popular ‘TMVI for beginners’ session, which includes presentations on echo evaluation, indications, and procedural planning/CT reconstruction. There will be a dedicated session, run by both senior and junior clinicians, to recognise the importance of the heart team. This will include its importance for education and discussions about its future, as well as definitions and histories of different heart teams.
Dr Gry Dahle Chair, Transcatheter Techniques Task Force At this year’s Annual Meeting delegates can expect a programme full of interesting abstracts, hot topics, and controversies in transcatheter treatment. The Transcatheter Techniques Task Force has organised hands-on simulator sessions, for both TAVI and transcatheter mitral valve interventions, which are being held in the EACTS Training Village. These sessions offer a fantastic hands-on experience, with teaching from specialists and supervision from experienced physicians. They will be very useful for both senior and junior clinicians, so I recommend delegates sign up early to ensure a place.
A session on the hazards of radiation in transcatheter procedures is another highlight of the meeting. It will cover what kind of instruments are available for imaging, and how we can protect both patients and physicians. The session will feature a presentation on new CT tools for transcatheter procedure planning. An important discussion at the Annual Meeting will be on whether to repair or replace in transcatheter mitral therapy. The session will include evidence, guidelines, and ask whether repair or replace has the same indications as for open surgery. As part of a session on TAVI in younger patients I will be presenting on the difference between younger and low risk patients. The session will also look at the evidence in guidance and trials, and threats in younger patients.
I’m very much looking forward to the Annual Meeting. It is a welcome opportunity to catch up and share experiences face-to-face with many colleagues who I haven’t seen for two years. Transcatheter Techniques Task Force Sessions to look out for
Thursday 14 October 11:00 - 12:30 Heart Team – does it still exist?
Friday 15 October 16:15 - 17:45 Are we ready for TAVI in younger patients 14:30 - 16:00 Can we overcome the hazard of radiation in transcatheter procedures?
Saturday 16 October 08:30 - 10:00 Are we ready to discuss whether to repair or replace in transcatheter mitral therapy?
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EACTS DAILY NEWS
OUR WORLD CLASS SCIENCE OVER THE NEXT THREE DAYS INCLUDES
37 57 ABSTRACT SESSIONS
187
FOCUS SESSIONS
Abstract sessions are a fantastic opportunity to learn more about the latest emerging evidence and research in cardiothoracic surgery. Find out more about some of the abstracts being presented during today’s sessions.
ABSTRACT PRESENTATIONS
NINE
HANDS-ON TRAINING SESSIONS
ABSTRACT SESSION
09:00 - 10:30 Cardiac Transplantation Ex-vivo organ preservation and Heart Transplantation: unmasking unsuitable grafts
However, the detected graft deterioration was not considered related to the ex-vivo perfusion.
S. Sponga, Udine, V. Ferrara, Udine, A. P. Beltrami, Udine, N. Finato, Udine, A. Lechiancole, Udine, N. Chiara, Udine, I. Vendramin, Udine, U. Livi, Udine
In conclusion, ex-vivo perfusion, through its continuous evaluation of marginal donor hearts, could represent a useful tool to safely expand the donor pool, permitting to exclude possible unsuitable grafts, and consequently reducing the risk of early graft failure in transplanted patients.
In the last decade, donor shortage has become a serious limit in heart transplantation, due to a transplant waitlist steadily increasing year by year. To face this issue, one option is expanding the donor pool by accepting extended criteria donors, with an increasing risk of primary graft failure or other life-threatening complications. Ex-vivo normothermic perfusion is a procedure of donor beating heart preservation, which limits ischemic-reperfusion injuries and allows potential resuscitation of suboptimal organs. Thanks to the possibility of real-time monitoring of hemodynamic parameters and the evaluation of lactate trend, as marker of organ preservation, the system permits a timely identification of potentially unsuitable hearts. The aim of our study was, in fact, to analyse the grafts discarded after ex-vivo perfusion in our centre. Since 2007, 339 heart transplantations were performed at our centre, 214 of which with “not-standard donors”. The criteria we adopted to define a donor as “not-standard” were: age ≥55 years, expected ischemic time of >4 hours, left ventricular ejection fraction of ≤50%, interventricular septum thickness of ≥14 mm, drug abuse history, episodes of cardiac arrest and the presence of mild coronary artery disease. Among these marginal grafts, 35 were transported with ex-vivo perfusion, with eight organs discarded. An unfavourable lactate trend, venous lactate > arterial lactate or unstable hemodynamic condition during transportation were considered sufficient indicators to reject the organ. We collected myocardial biopsies at graft procurement and after ex-vivo preservation. Besides, in the discarded organs, a pathological evaluation was made and clinical and histopathological characteristics were investigated. All discarded grafts revealed the presence of several pathological alterations, such as a post-traumatic dissection or severe stenosis of coronary arteries, biventricular wide haemorrhagic and oedema suffusion, fibrosis, necrosis and adipose tissue infiltration. All these alterations may potentially have led to a primary graft failure.
“Ex-vivo normothermic perfusion is a procedure of donor beating heart preservation, which limits ischemic-reperfusion injuries and allows potential resuscitation of suboptimal organs.”
Issue 1 Thursday 14th October
ABSTRACT SESSION
09:00 - 10:30 Different outcomes for various biological materials in AVR Peri-operative Platelet Reduction after Aortic Bioprosthesis Implantation: Results from the PORTRAIT Study Federica Jiritano MD1,2; Giuseppe Filiberto Serraino MD, PhD1; Mariusz Kowalewski MD2,3; Leonardo Patanè MD4: Giangiuseppe Cappabianca MD5; Elena Caporali MD6; Roberto Scrofani MD4; Roberto Lorusso MD, PhD2. 1. Cardiac Surgery Unit, Dept. Experimental and Clinical Medicine, University “Magna Graecia” of Catanzaro, Catanzaro, Italy. 2. Cardio-Thoracic Surgery Dept., Heart & Vascular Centre, Maastricht University Medical Centre (MUMC), Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands. 3. Clinical Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior and Administration, Centre of Postgraduate Medical Education, Warsaw, Poland. 4. Cardiology Cardiac Surgery Department (Centro Cuore), Centro Clinico Diagnostico G.B. Morgagni, Pedara (Catania), Italy. 5. Department of Surgical and Morphological Sciences, Circolo Hospital, University of Insubria, Varese, Italy 6. Cardiac Surgery, Cardiocentro Ticino, Lugano, Switzerland 7. Cardiac Surgery Unit, Luigi Sacco Hospital, Milan, Italy In recent years, peri-operative platelet count reduction (PR) after aortic bioprosthesis implantation has aroused growing interest and intense discussion [1]. The present PORTRAIT (PostOperative Thrombocytopenia After Bio-prosthesis Implantation) sub-study aims to investigate the platelet count variation and the clinical impact of PR in three different surgical bioprostheses.
09:00 - 10:30 Different outcomes for various biological materials in AVR
From February 2001 to December 2019, 1.233 patients that had undergone surgical aortic bioprosthesis implantation were enrolled in 10 different centres: 945 patients received a stented bioprosthesis (Stented Group), 218 patients received a rapid deployment valve (RDV Group), and 72 patients had a Stentless bioprosthesis (Stentless Group). The platelet count at discharge was lower than the baseline values (p <0.001) in all groups, but mostly in the RDV patients (Figure 1). The minimum platelet value occurred on the POD 3 for all prostheses, but the higher PR to the minimum platelet count happened in the RDV and Stentless groups, both showing a similar PR and the highest number of patients with a platelet count <100.000 u/L on POD 2 and 3. We found also a greater platelet count drop occurring as the size of the bioprosthesis increased in RDV (p = 0.01) and decreased in Stented bioprostheses (p<0.001). Conversely, CPB time (p= 0.635) and cross-clamp time (p= 0.051) did not affect PR in all groups. Among the groups, RDV subjects had a greater drainage blood loss (p<0.001), received more blood products (p<0.001), experienced more re-thoracotomy (p=0.006), and had a higher inhospital mortality (p=0.007). In a multivariate analysis, platelet count variation was found associated to (1)ischemic strokes in the overall population, (2)bleeding events and in-hospital mortality in the stented patients, and (3)drainage blood loss in the RDV patients. These findings are inline with a recent meta-analysis and systematic review[1]. Aortic bioprosthesis implantation is associated with significant but transient PR. At first, the phenomenon was accounted to the effect of the CPB[2], but our results proved otherwise. We sought the root of PR in the prosthesis itself: its design and size could elicit blood turbulence resulting in platelet activation or destruction[1,3]. Although PR was often thought as a drawback with no effect on patients’ clinical outcomes[4,5], we found that it is related to clinical adverse events. Platelet count variation is associated
Figure 1: Cumulative incidence function (with 95% Confidence Intervals) of the Trifecta and Intuity group for structural valve deterioration (SVD) considering death and re-interventions due to other reasons than SVD as competing events
Structural Valve Deterioration after Surgical Aortic Valve Replacement with the Trifecta and the Intuity Valve - Long Term Results
Figure 1: predicted platelet variation over time in the three groups.
Federica Jiritano MD
Roberto Lorusso MD
References 1. Jiritano F, Santarpino G, Serraino GF, Ten Cate H, Matteucci M, Fina D, et al. Peri-procedural thrombocytopenia after aortic bioprosthesis implant: A systematic review and meta-analysis comparison among conventional, stentless, rapid-deployment, and transcatheter valves. Int J Cardiol. 2019;296:43-50. doi:10.1016/j.ijcard.2019.07.056 2. Vogt F, Moscarelli M, Pollari F, Kalisnik JM, Pfeiffer S, Fittkau M, et al. Two approaches-one phenomenon-thrombocytopenia after surgical and transcatheter aortic valve replacement. J Card Surg. 2020;35(6):11861194. doi:10.1111/jocs.14547 3. Hilker L, Wodny M, Ginesta M, Wollert HG, Eckel L. Differences in the recovery of platelet counts after biological aortic valve replacement. Interact Cardiovasc Thorac Surg. 2009 Jan;8(1):70-3. doi: 10.1510/ icvts.2008.188524. Epub 2008 Oct 8. 4. Stegmeier P, Schlömicher M, Stiegler H, Strauch JT, Bechtel JFM. Thrombocytopenia after implantation of the Perceval S aortic bioprosthesis. J Thorac Cardiovasc Surg. 2020;160(1):61-68.e8. doi:10.1016/j.jtcvs.2019.07.046 5. Lorusso R, Jiritano F, Roselli E, Shrestha M, Folliguet T, Meuris B, Pollari F, Fischlein T. Perioperative platelet reduction after sutureless or stented valve implantation: results from the PERSIST-AVR controlled randomised trial. Eur J Cardiothorac Surg. 2021 Jun 12:ezab175. doi: 10.1093/ejcts/ezab175. Epub ahead of print. PMID: 34118150.
for implantation of the Intuity valve). Retro- and prospective echocardiographic and clinical followup was performed. With 27 cases (Trifecta n=23, Intuity n=4) of SVD observed, cumulative incidence of SVD was significantly higher in the Trifecta cohort (p<0.001). Implantation of a Trifecta valve (HR 11.20; 95% CI 3.79-33.09), log-transformed preoperative creatinine (HR 2.47; 1.37-4.44) and sex (male HR 0.42; 0.19-0.92) emerged as prognostic factors of SVD. A significantly higher cumulative incidence of re-interventions was observed in the Trifecta cohort (p=0.004) and valve type was an independent timevarying risk factor (HR at 12 months 2.78; 95 % CI 1.42-5.45). Overall, no significant differences in allcause mortality were observed between the groups (log-rank test: p=0.052).
Paul WERNER,1 Iuliana COTI1, Alexandra KAIDER2, Jasmin GRITSCH1, Markus MACH1, Alfred KOCHER1; Guenther LAUFER1; Martin ANDREAS1 1 Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria2 Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria Within the last decades, a trend towards the increased use of bioprosthetic valves in patients undergoing surgical aortic valve replacement (SAVR) has been observed. Continuous efforts to improve bioprosthetic Paul Werner valve design and to optimise their hemodynamic performance were made. Longterm durability of surgical bio-prostheses, however, remains a key factor, especially in the era of transcatheter aortic valve replacement (TAVR). We compared the incidence of structural
to ischemic strokes, regardless of the bioprosthesis type. Moreover, mostly RDV patients experienced the worst postoperative clinical scenario. Further prospective studies could try to explain the mechanism underlying the platelet reduction in relation to the prosthesis valve type and size.
valve deterioration (SVD) between patients undergoing SAVR with two modern bioprostheses, the Trifecta (Abbott Laboratories, Abbott Park, IL, USA) and the Intuity valve (Edwards Lifesciences, Irvine, CA, USA). Both bioprostheses, one a rapid deployment and one a sutured valve, are currently in wide use and provide an excellent hemodynamic profile at short- to intermediate follow-up. Between April 2010 and May 2020, 1118 patients underwent SAVR with the Trifecta (n=346) and the Intuity (n=772) valve at a single center. 1070 patients (Trifecta n=298, Intuity n=772) were analysed after the exclusion of patients with pure regurgitation and endocarditis (contraindications
Within the studied collective, SVD was significantly more present in patients receiving a Trifecta valve and its implantation was an independent risk factor for the occurrence of SVD and aortic valve reinterventions. A rapid increase of observed SVDs in the Trifecta group starting at 6 years after surgery was observed while the Intuity valve showed exceptionally low rates of SVD throughout the study period. These results put the long-term durability of the Trifecta valve in question and need to be taken into consideration when performing bioprosthetic aortic valve replacement.
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ABSTRACT SESSION
09:00 - 10:30 Oncology I LIONS PREY: A new logistic scoring system for the prediction of malignant pulmonary nodules Fabian Doerr, Annika Giese, Hruy Menghesha, Georg Schlachtenberger, Matthias Heldwein, Thorsten Wahlers, Khosro Hekmat Department for Cardiothoracic Surgery, University Hospital of Cologne, Cologne, Germany The classification of pulmonary lesions in terms of malignancy is at times controversial and MDT-meetings tend to delay because of long debates. To remedy this, score systems have been developed predicting the likelihood Dr. Fabian Doerr of malignancy. Due to unfavorable variables, existing systems such as the ‘Brock model’ lack precision. We developed the ‘LIONS PREY’ (Lung lesION Score PREdicts malignancY), a new logistic scoring system, which precisely predicts malignancy of pulmonary nodules in percent. We prospectively evaluated all patients that were presented to the MDT of our university hospital between January 2013 and December 2020.
Patients that presented with a pulmonary mass (> 40 mm) were excluded. After resection or CT-/ EBUS- guided sampling, tissue was histologically analysed. The availability of pathological result was mandatory upon study inclusion. Patients were grouped according to the dignity of their pulmonary nodule. Two groups were formed: Group A: Malignant pulmonary nodule (N=238). Group B: Benign pulmonary nodule (N=148). Initially 21 potential score parameters were derived from the patients’ medical history. In case of missing data, patients or relatives were contacted.
The eight LIONS PREY variables are simple, routinely and reproducibly measurable and readily available. All MDT members could use the new score to reinforce and facilitate decision making. Especially inexperienced physicians have a tool that helps them focus on essential parameters. Patients may find it easier to consent to surgery knowing the likelihood of pulmonary malignancy. The LIONS PREY App is available for free for iOS and Android devices
After uni- and multivariate analysis we identified eight relevant score parameters. Age (years): Group A: 64.5±10.2 versus Group B: 61.6±13.8; (multivariate) p-value: 0.024. Nodule size (mm): 21.8±7.5 vs. 18.3±7.9; 0.003. Nodule spiculation (%): 73.1 vs. 41.9; <0.0001. Nodule solidity (%): 84.9 vs. 62.8; <0.0001. Size dynamics (mm/3 months): 6.4±7.7 vs. 0.2±0.9; <0.0001. Positive history of smoking (%): 92.0 vs. 43.9; <0.0001. Pack years: 35.1±19.1 vs. 21.3±18.8; 0.041. Positive history of cancer (%): 34.9 vs. 24.3; 0.023. Beta-coefficients were calculated for each of the eight parameters. Considering the parameters’ constants and the associated beta coefficients, we calculated the LIONS PREY. The new system achieved excellent precision in predicting the malignancy of pulmonary nodules (Figure 1). Overall correct classification: 96.0%; Calibration (observed/expected-ratio): 1.1. Discrimination (ROC-analysis): AUC (95%-CI) 0.943 (0.922-0.965).
Figure 1: ROC-curve of LIONS PREY Figure 2: Screenshot of LIONS PREY App
Issue 1 Thursday 14th October
SKILLS CORNER The new EACTS Skills Corner is waiting for you
As part of our work to continue raising standards across the cardiothoracic community through education and training, we are delighted to introduce the brand new EACTS Skills Corner at this year’s Annual Meeting. The Skills Corner offers a fantastic opportunity to expand your own specialist knowledge by drawing on the help and guidance of some of the world’s most experienced and expert surgeons. Visit the Skills Corner and benefit from in-depth training focusing on specific products via live demonstrations, tailored approaches, step-by-step masterclasses, and educational tutorials. The Skills Corner includes: • Live training workshops from the EACTS Training Village, on-site in Barcelona. • Training workshops brought to you by our industry partners • How-I-Do-It video training sessions with stepby-step demonstrations of key procedures • Video presentations highlighting new procedures and techniques Rafael Sádaba, EACTS Secretary General, says, “The Skills Corner is an exciting innovation that offers an invaluable opportunity to see and explore new devices and techniques via in-person tutorials, demonstrations and masterclasses. I’m really excited to spend some time in our new Skills Corner over the next few days. I hope to see you there.”
TRAINING VILLAGE Our broad and immersive training programme also includes wetlab, drylab and simulator sessions taking place in the Training Village. These handson sessions are an opportunity to experience new and more traditional techniques with experts in those procedures. These sessions can be accessed both in-person at the CCIB, and via the virtual platform. The EACTS Training Village sessions have limited places and will be allocated on a first-come, firstserved basis. Training Village sessions require an additional €50 fee.
“The Skills Corner is an exciting innovation that offers an invaluable opportunity to see and explore new devices and techniques via in-person tutorials, demonstrations and masterclasses. I’m really excited to spend some time in our new Skills Corner over the next few days. I hope to see you there.”
Thursday 14 October 08:30 to 10:30; 15:00 to 17:00 Endoscopic Mitral Valve Repair Drylab training sessions with high-fidelity mitral valve simulators. Novice surgeons and those with some experience will get hands-on training on simulators under the guidance of experienced endoscopic surgeons. Each session is strictly limited to a maximum of 15 registered delegates. 12:00 to 14:00 Coronary Surgery Learn how to perform coronary anastomoses. The techniques for proximal and distal anastomoses, sequential and composite grafts will be demonstrated along with techniques and devices for conduit harvesting and methods for intraoperative graft assessment. 15:00 to 17:00 Aortic Valve Repair Learn about the two main techniques for valve sparing aortic root surgery: choose either reimplantation or remodelling – the two sessions will run side by side.
Friday 15 October 09:00 to 11:30 Mitral and Tricuspid Valve Repair Basic training on mitral and tricuspid valve access, repair and replacement. 14:00 to 16:00 Endoscopic Mitral Valve Repair See Thursday 14 October for details of this session.
Friday 15 October (cont) 14:00 to 17:00 TAVI/TMVI Simulator Session During this session delegates can enjoy hands-on experience with guidewires, valves, delivery systems and simulators. You can also embark on a fascinating journey through the latest transcatheter valve devices and technologies.
Saturday 16 October 09:00 to 11:00 Congenital Surgery Learn about the Ross and Ross-Konno procedure in this hands-on wetlab. 09:00 to 11:00; 14:00 to 16:00 Endoscopic Mitral Valve Repair See Thursday 14 October. 12:00 to 14:00 TEVAR Simulator Session New for this year’s event, come and practice your skills with our hands-on training on endovascular stentgraft thoracic aortic treatment. 15:00 to 17:00 Thoracic Surgery Practice your skills across three practical simulation stations: robot-assisted surgery (RATS), video-assisted thoracoscopic surgery (VATS) and chest wall surgery.
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14
EACTS DAILY NEWS
FOCUS SESSION
09:00 - 10:30 Minimally Invasive CABG: a missed opportunity?
incidence of return to the OR, and lower mortality (O/E: 0.0 vs 0.42, p=0.014). Readmission rate for the early discharge group was 4.2%, similar to the standard discharge protocol group’s readmission rate of 6.6% (p=0.542). Time to return to work was shorter in the early discharge group, although it did not reach statistical significance (11 vs 18 days, p=0.057).
Post-operative Day 1 Discharge after Robotic Totally Endoscopic Coronary Bypass: The Ultimate in Early Recovery after Surgery (ERAS)
S. Nisivaco; B. Patel; C. Coleman; G. Torregrossa; H. Balkhy, Cardiac Surgery, University of Chicago Medicine, Chicago, United States of America This study found no statistical difference in readmission rates in patients discharged on the first postoperative day after robotic TECAB when compared to patients discharged per standard protocol. The benefits of Early Recovery after Surgery (ERAS) protocols are being recognised in multiple surgical specialties. Protocols have been initiated to decrease length of stay following CABG to improve quality of care and decrease costs. Current studies show that over 50% of coronary artery bypass (CABG) patients are discharged within five days of surgery. We developed an ultrafast-track protocol for patients undergoing robotic totally-endoscopic coronary bypass surgery (TECAB) to be discharged on post-operative (POD) 1. The aim of our study is to present the characteristics and outcomes of POD1 discharge after robotic TECAB in comparison to patients discharged after POD1.
In a retrospective study of 620 patients undergoing single and multivessel robotic beating-heart TECAB over a seven year period at our institution, the fast-track protocol identified 72 patients who could be discharged on POD1. We compared the perioperative characteristics and outcomes of this group to the remaining 548 patients who were discharged per standard protocol (non-POD1 discharge). The early discharge group was significantly younger and had a lower STS risk of mortality. Additionally, this group had a lower incidence of obesity, diabetes, and chronic kidney disease. Patients discharged on POD1 were more often extubated in the OR (64% vs 36%, p=0.001). This group also had a lower blood transfusion requirement, lower
Patients better suited for this ‘ultra-fast-track’ approach were more likely to be younger, have a lower STS risk and fewer comorbidities, and more likely to be extubated in the OR. We believe early discharge after robotic TECAB is safe and effective in appropriately selected patients with close home follow-up. It offers the benefits of potentially lowering hospital costs, and affords patients the ability to recover at home.
Sarah Nisivaco
Dr. Balkhy
ABSTRACT SESSION
11:00 - 12:30 Shock, ECLS and temporary right heart support Post-infarction ventricular septal defect: a nationwide registry P. Magro, Lisbon, P. Antunes, Coimbra, N. Carvalho Guerra, Lisboa, A. Nobre, Lisboa, M. Antunes, Coimbra, J. Neves, Lisboa, M. Sousa Uva, Lisboa Ventricular septal defect (VSD) is a rare complication of myocardial infarction associated with a high mortality risk. Our objective is to use the collective analysis of a post-myocardial infarction VSD dedicated Pedro Magro national registry to further elucidate controverse areas of this clinical entity’s surgical treatment: (1) timing of the surgery, (2) surgical technique, (3) ECMO as bridge to closure, (4) concomitant procedures, (5) the role of percutaneous closure. Descriptive statistics; cumulative survival using the Kaplan-Meier method, multivariate logistic regression of risk factors for 30-days mortality and a Cox’s proportional hazard late survival model for patients alive at 30-days are presented. Median survival of the cohort (n=76) was 72 months (six years, 95% CI 4-144 months). Survival at
discharge was 61.8%. Patients who underwent VSD closure in the first 10 days after onset of symptoms rather than later seem to have performed worse (log-rank p=0.023). Concomitant CABG (logrank p=0.4); different closure techniques (logrank p=0.5); location of the VSD (log-rank p=0.9); ECMO as bridge to closure (log-rank p=0.9) or IABP as bridge to closure did not show a statistically significant difference at Kaplan-Meier analysis. When evaluating 30-days mortality, only concomitant mitral surgery (OR 36.64; 95% CI 1.20-1116; p=0.039) and cardiogenic shock (OR 12.17; 95% CI 1.28-115.6; p=0.03) had a statistically significant association at multivariate analysis. Multivariate cox regression survival analysis of patients alive at 30 days postoperatively (n=51) revealed that post-operative stroke (HR 6.69; 95% 1.55-28-85; p=0.01); bleeding requiring reoperation (HR 4.56; 95% CI 1.12-18.52.40; p=0.03); and tracheostomy (HR 11.06; 95% CI 1.91-64.08; p=0.01 were associated with worse long-term survival. Our results are comparable with previous reports, regarding early mortality, the role of concomitant CABG and surgical technique. Also, we present a small number of patients with ECMO as bridge to closure and post-operative percutaneous closure of residual VSD, which suggest a potential role of these techniques in selected patients. Timing of surgery remains a controverse issue. Latter closure seems to be advantageous, although, an important observational bias exists.
Figure 1: Kaplan-Meier curve of the early (first 10 days) vs delayed intervention groups (log-rank p=0.0023). Also shown, detail of first 1 year of follow-up.
“Our objective is to use the collective analysis of a postmyocardial infarction VSD dedicated national registry to further elucidate controverse areas of this clinical entity’s surgical treatment.”
Issue 1 Thursday 14th October
SATELLITE SYMPOSIA 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. THURSDAY 14TH OCTOBER Room: 112
Combining Technology and Experience to excel with LVAD Therapy
Room: 114
MCS 2021 – New Perspectives in Cardiac Surgery on Generation of Evidence
Room: 111
AF Management in the Operating Room: building a Standard of Care
Room: 113
Hemoadsorption with CytoSorb in various cardiac surgery indications
Room: 211
Optimising outcomes for AF patients in standalone and concomitant procedures
Room: 116/117
The future of SAVR: the big debate
Room: 212
TAVI innovation and the new VHD guidelines – the evolving role of Cardiac Surgeon
Room: 115
ERACS – Managing Postoperative Risks
Room: 111
Benchmark results with pulsatile VADs
Room: 112
100’000 implants with INSPIRIS RESILIA aortic valve: why Real-World Evidence is crucial?
Room: 211
Mitral Valve replacement in the current era: new guidelines and practical considerations to tailor the treatment to every patient
Room: 114
What can pMCS offer in CS – extending options for bridge to & innovative concepts
Room: 113
Role of CytoSorb hemoadsorption therapy in endocarditis patients
Room: 111
Treatment options for Arch Pathologies: from the Acute to the Chronic
Room: 112
Mitral innovation landscape: Embrace the change!
Room: 116/117
Physiological Mitral repair: Latest innovations and Technical Showcase
12:45-14:00
18:00-19:15
FRIDAY 15TH OCTOBER
12:45-14:00
RESIDENTS’ COMMITTEE AT THE ANNUAL MEETING
The official EACTS Residents’ Zone, located at the EACTS’ booth, at the Annual Meeting is a great opportunity to come and meet the residents in person and learn about the latest activities, and find out how you can take part in shaping the future of CTS surgery in Europe.
DON’T MISS THE RESIDENTS’ LUNCHEON SATURDAY 16 OCTOBER, 12:15 - 14:45 Seize the opportunity to discuss issues with senior surgeons at lunch. Pre-registration is required.
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EACTS DAILY NEWS
SESSION KEY
EACTS 2021 AGENDA
ABSTRACT FOCUS SESSION PROFESSIONAL CHALLENGE HANDS-ON TRAINING PLENARY
THURSDAY 14TH OCTOBER 08:30 - 10:30
Endoscopic Mitral Valve Repair Drylab Training
EACTS Training Village 2
Adult Cardiac
09:00 - 10:30
Different outcomes for various biological materials in AVR
Room 116-117
Adult Cardiac
09:00 - 10:30
TMVI for beginners
Room 113
Adult Cardiac
09:00 - 10:30
Minimally Invasive CABG: a missed opportunity?
Room 114
Adult Cardiac
14:15 - 15:45
The conundrum of non degenerative mitral regurgitation: looking for a solution!
Room 113
Adult Cardiac
14:15 - 15:45
Cardiac surgery in times of COVID
Room 114
Adult Cardiac
14:15 - 15:45
EUROMACS
Room 115
Adult Cardiac
14:15 - 15:45
Problems and concerns related to the choice of an optimal aortic valve substitute
Room 111
Adult Cardiac
09:00 - 10:30
Cardiac Transplantation
Room 115
Adult Cardiac
09:00 - 10:30
Minimally invasive mitral repair masterclass.
Room 111
Adult Cardiac
14:15 - 15:45
Type B aortic dissection - Light at the end of the tunnel?
Room 112
Vascular Disease
09:00 - 10:30
Extensive aortic arch repair: To freeze does not mean to heal
Room 112
Vascular Disease
14:15 - 15:45
The Aortic Valve and Aortic Root in Adolescent and Adult with CHD
Room 211
Congenital Heart Disease
09:00 - 10:30
Miscellaneous - aortic arch and left heart obstructions
Room 211
Congenital Heart Disease
14:15 - 15:45
Chest Wall – Tumors, Deformities and Trauma
Room 212
Thoracic Disease
09:00 - 10:30
Oncology I
Room 212
Thoracic Disease
15:00 - 17:00
Training Village – AV Repair
EACTS Training Village
Adult Cardiac
11:00 - 12:30
Timing for Aortic valve repair in aortic regurgitation.
Room 116-117
Adult Cardiac
15:00 - 17:00
Endoscopic Mitral Valve Repair Drylab Training
EACTS Training Village 2
Adult Cardiac
11:00 - 12:30
Successful ablation of atrial fibrillation: approaching the target!
Room 113
Adult Cardiac
16:00 - 17:30
Are Men from Mars and Women from Venus even for CABG?
Room 116-117
Adult Cardiac
11:00 - 12:30
Sternum, chest wall and beyond
Room 114
Adult Cardiac
16:00 - 17:30
Room 113
Adult Cardiac
11:00 - 12:30
Shock, ECLS and temporary right heart support
The latest on degenerative mitral regurgitation
Room 115
Adult Cardiac
16:00 - 17:30
Room 114
Adult Cardiac
11:00 - 12:30
Heart Team – does it still exist?
Room 111
Adult Cardiac
Hot topics in transcatheter valve treatment
11:00 - 12:30
Questioning the treatment of acute Type A aortic dissection
Room 112
Vascular Disease
16:00 - 17:30
Challenges of the small LV – Room for improvement
Room 115
Adult Cardiac
11:00 - 12:30
Update in Single ventricle management
Room 211
Congenital Heart Disease
16:00 - 17:30
Controversies in Aortic Valve Repair
Room 111
Adult Cardiac
11:00 - 12:30
Mediastinum and Esophagus
Room 212
Thoracic Disease
16:00 - 17:30
Various perspectives to approach the acute Type A aortic dissection
Room 112
Vascular Disease
12:00 - 14:00
Training Village - Coronary
EACTS Training Village
Adult Cardiac
16:00 - 17:30
Management of neonates and low-weight infants with CHD
Room 211
Congenital Heart Disease
14:15 - 15:45
CABG and PCI (not CABG vs PCI)
Room 116 - 117
Adult Cardiac
16:00 - 17:30
Treatment options for end-stage emphysema
Room 212
Thoracic Disease
FRIDAY 15TH OCTOBER 08:15 - 09:45
Minimally invasive aortic valve and root surgery: status quo?
Room 116-117
Adult Cardiac
08:15 - 09:45
Cardiac rehabilitation and perioperative medicine
Room 113
Adult Cardiac
08:15 - 09:45
The science behind the future of valve surgery
Room 114
Adult Cardiac
08:15 - 09:45
Left ventricular assist devices – From implant to long-term care
Room 115
Adult Cardiac
08:15 - 09:45
Arrhythmia surgery: between confirmations and surprises
Room 111
Adult Cardiac
Searching for options to improve the aortic treatment
Room 112
Update on treatment of complex disease
Room 211
Oncology II
Room 212
08:15 - 09:45 08:15 - 09:45
08:15 - 09:45
Vascular Disease Congenital Heart Disease Thoracic Disease
10:00 - 11:30
Infective Endocarditis
Room 114
Adult Cardiac
10:00 - 11:30
Controversies in transcatheter valve treatments
Room 115
Adult Cardiac
10:00 - 11:30
CABG video technical masterclass
Room 111
Adult Cardiac
10:00 - 11:30
Insights into proximal aortic disease: Treatment and long term results
Room 112
Vascular Disease
10:00 - 11:30
HTX /mechanical support
Room 211
Congenital Heart Disease
10:00 - 11:30
Oncology III
Room 212
Thoracic Disease
11:45 - 12:30
Presidential Address and Awards
Room 116-117
35th EACTS Annual Meeting
12:45 - 14:15
The challenge of atrioventricular valve regurgitation in single ventricle
Room 115
Congenital Heart Disease
12:45 - 14:15
Thoracic Miscellaneous
Room 212
Thoracic Disease
09:00 - 11:30
Training Village – Mitral
EACTS Training Village
Adult Cardiac
10:00 - 11:30
Matching the best substitute for aortic valve replacement to the patient
Room 116-117
Adult Cardiac
14:00 - 17:00
Training Village – TAVI/TMVI Simulators
EACTS Training Village
Adult Cardiac
10:00 - 11:30
Current and future perspectives in VAD therapy
Room 113
Adult Cardiac
14:00 - 16:00
Endoscopic Mitral Valve Repair Drylab Training
EACTS Training Village 2
Adult Cardiac
Issue 1 Thursday 14th October
SESSION KEY
VIEW THE FULL ONLINE EVENT CALENDAR
ABSTRACT FOCUS SESSION PROFESSIONAL CHALLENGE HANDS-ON TRAINING PLENARY
FRIDAY 15TH OCTOBER (cont) 16:15 - 17:45
Are we ready for TAVI in younger patients
Room 116-117
Adult Cardiac
16:15 - 17:45
Managing post-infarction complications
Room 113
Adult Cardiac
16:15 - 17:45
Game of Thrones: The Heart Team Live on Stage
Room 114
EACTS Annual Meeting
16:15 - 17:45
Challenging decisions and longterm outcomes in tricuspid and mitral disease
Room 115
Adult Cardiac
16:15 - 17:45
Room 111
Adult Cardiac
Room 112
Vascular Disease
CPB and patient blood management
16:15 - 17:45
Room 112
An update on Mitral Valve Surgery in Paediatrics
Vascular Disease
Room 211
Congenital Heart Disease
EACTS/STS Joint Meeting Endo-Arch is here to stay (2)
16:15 - 17:45
Room 211
Congenital Heart Disease
Covid 19 topics in thoracic surgery
Room 212
Thoracic Disease
A Tribute to Giants: Aldo Castañeda and Bill Norwood
16:15 - 17:45
Insights beyond TNM - Joint session with IASLC
Room 212
Thoracic Disease
14:30 - 16:00
Can we overcome the hazard of radiation in transcatheter procedures?
Room 116-117
Adult Cardiac
14:30 - 16:00
Mechanical circulatory support in COVID patients
Room 113
Adult Cardiac
14:30 - 16:00
Controversies in CABG
Room 114
Adult Cardiac
14:30 - 16:00
The science behind the future of coronary and vascular conduits
Room 115
Adult Cardiac
14:30 - 16:00
Sparing and repairing. An effort to avoid valve replacement
Room 111
Adult Cardiac
14:30 - 16:00
EACTS/STS Joint Meeting – EndoArch is here to stay (1)
14:30 - 16:00 14:30 - 16:00
SATURDAY 16TH OCTOBER 08:30 - 10:00
Recent opportunities in AVR
Room 116-117
Adult Cardiac
08:30 - 10:00
Video session in arrhythmia surgery: technical details for success in ablation and LAA closure
Room 113
Adult Cardiac
08:30 - 10:00
Nightmares in Cardiothoracic Surgery
Room 114
35th EACTS Annual Meeting
14:00 - 16:00
Endoscopic Mitral Valve Repair Drylab Training
EACTS Training Village 2
Adult Cardiac
14:15 - 15:45
Coronary Surgery in 2021
Room 113
Adult Cardiac
14:15 - 15:45
Non degenerative mitral regurgitation: the hard bit!
Room 114
Adult Cardiac
14:15 - 15:45
Global Cardiac Surgery: Changing the Narrative
Room 115
35th EACTS Annual Meeting
14:15 - 15:45
Current trends and Future Directions in Development of Joint Trustworthy Clinical Practice Guidelines
Room 111
Adult Cardiac
08:30 - 10:00
Are we ready to discuss whether to repair or replace in transcatheter mitral therapy
Room 115
Adult Cardiac
08:30 - 10:00
CABG in patients with low EF
Room 111
Adult Cardiac
08:30 - 10:00
Dissecting the thoracoabdominal aortic dissection
Room 112
Vascular Disease
14:15 - 15:45
Room 112
Room 211
Congenital Heart Disease
Vascular Disease
08:30 - 10:00
Failing Fontan: any news? Joint session EACTS/AEPC
An exciting journey around the aortic world in 90 minutes
14:15 - 15:45
Thoracic MDT
Room 212
08:30 - 10:00
Advanced thoracic surgery for thoracic infections
Room 212
Thoracic Disease
Thoracic Disease
15:00 - 17:00
Training Village – Thoracic
EACTS Training Village
Thoracic Disease
16:00 - 17:30
Reducing long term risk after CABG
Room 116-117
Adult Cardiac
16:00 - 17:30
HOCM and constrictive pericarditis
Room 113
Adult Cardiac
16:00 - 17:30
Bicuspid AV repair
Room 114
Adult Cardiac
16:00 - 17:30
Surgery for tricuspid disease: hot topics
Room 115
Adult Cardiac
09:00 - 11:00
Training Village – Congenital
EACTS Training Village
Congenital Heart Disease
09:00 - 11:00
Endoscopic Mitral Valve Repair Drylab Training
EACTS Training Village 2
Adult Cardiac
10:15 - 12:15
Evidence and Trials Update
Room 116-117
Adult Cardiac
10:30 - 12:00
New technologies and strategies in CHD
Room 211
Congenital Heart Disease
10:30 - 12:00
Major trials and landmark papers – what the thoracic surgeon needs to know
Room 212
Thoracic Disease
16:00 - 17:30
Late breaking clinical trials
Room 111
12:00 - 14:00
Training Village – TEVAR Simulation
EACTS Training Village
35th EACTS Annual Meeting
Vascular Disease
16:00 - 17:30
Thoracic aortic surgery – precaution is better than aftercare
Room 112
Vascular Disease
12:30 - 15:45
The Ross Operation and its Failures – State of the art.
Room 116-117
Adult Cardiac 16:00 - 17:30
Better Percutaneous or surgical treatment in CHD? - Joint session EACTS/AEPC
Room 211
Congenital Heart Disease
16:00 - 17:30
Rare Thoracic Surgery (ped tumors, cardiac denervation, Hyperhydrosis, TOS)
Room 212
Thoracic Disease
35th EACTS Annual Meeting
12:30 - 14:00
Women in Cardiothoracic Surgery
12:30 - 14:00
Technical pearls in mitral valve repair: surgical video tour in neochordae adjustment for anterior leaflet prolapse
Room 114
Adult Cardiac
12:30 - 14:00
Nurses and Allied Health Professionals
Room 115
35th EACTS Annual Meeting
12:30 - 14:00
2021 EACTS/ESC Guidelines for the management of valvular heart disease: Meet the task force members
Room 111
35th EACTS Annual Meeting
12:30 - 14:00
Chronic aortic disease – Make the right decision
Room 112
Vascular Disease
12:30 - 15:45
Anomalous Aortic Origin of Coronary Arteries: Are we doing well?
Room 211
Congenital Heart Disease
12:30 - 14:00
Advances in ERAS – how far can we go?
Room 212
Thoracic Disease
Room 113
SKILLS CORNER THURSDAY 14TH OCTOBER: 12:00-17:00 FRIDAY 15TH OCTOBER: 09:00-17:00 SATURDAY 16TH OCTOBER: 09:00-17:00
17
18
EACTS DAILY NEWS
THE 35TH EACTS ANNUAL MEETING
EXHIBITION FLOOR PLAN CATERING
CATERING
CATERING
ER
N OR SC ILL SK
9
10
22
23
32
33
42
43
52
53
62
63
11
12
24
25
34
35
44
45
54
55
64
65
13
14
18
19
66
67
38
39
15
16
20
21
68
69
40
41
17A
17B
17C
17D
71
48
49
72
73
50
51
28
29
30
31
70 27
37
ENTRANCE
56
46
36
57
TRAINING VILLAGE ABBOTT
ENTRANCE
Abbott
57
GEISTER Medizintechnik GmbH
17A & 17B
ABIOMED
56
Global Heart Hub (Heart Valve Voice UK)
18
Advancis Surgical
40
HAART- Aortic Valve Repair Technologies by BioStable Science & Engineering
70
AMT Medical B.V.
51
Andocor NV
54
ISMICS/HVS (International Society for Minimally Invasive Cardiothoracic Surgery & Heart Valve Society)
32 & 33
AngioDynamics
62
KLS Martin Group
42 & 43
AtriCure Europe B.V.
36
LeMaitre Vascular GmbH
10
BFW, Inc.
63
LifeTec Group
19
BioCer Entwicklungs-GmbH
55
LSI Solutions
24 & 25
Cardia Innovation AB
52
Medela AG
15 & 16
CardiaMed B.V.
48 & 49
Medistim ASA
17C & 17D
CARMAT
20
Metrum Cryoflex
12
Chalice Medical Ltd
14
NEOS SURGERY
41
Cryolife Inc./JOTEC GmbH
46
Osypka AG
53
CytoSorbents Europe GmbH
66 & 68 & 69
R&D Surgical Ltd
28 & 29
Delacroix-Chevalier
34 & 35
REDAX Spa
38 & 39
Dr. Franz Koehler Chemie GmbH
11
Scanlan International, Inc
44 & 45
EACTS -European Association for Cardio-Thoracic Surgery
27
Terumo Aortic
71
Edwards Lifesciences
37
Terumo Europe N.V.
30 & 31
em-tec GmbH
67
tisgenX
21
EpiHeart Oy
50
Transonic Systems, Inc.
64 & 65
Fehling Instruments GmbH & Co KG
72 & 73
Wexler Surgical & TeDan Surgical Innovations
22 & 23
EXHIBITION OPENING TIMES: Thursday 14 October 14:00-18:30, Welcome Reception 17:00-18:30 / Friday 15 October 09:00-17:00 / Saturday 16 October 09:00-14:00
Issue 1 Thursday 14th October
ABSTRACT SESSION
11:00 - 12:30 Successful ablation of atrial fibrillation approaching the target!
than in G1-4 group, while among patients with LAA amputation, AF incidence was not different between two groups. Concomitant LAA amputation during CABG might prevent the incidence of AF after CABG in G5 group.
The preventive effect of left atrial appendage amputation on atrial fibrillation in patients with end-stage renal disease
Further research is needed on the role of the left atrial appendage in patients with end-stage renal disease.
Daisuke Endo1, Taira Yamamoto2, Satoshi Matsushita1, Tohru Asai1, Atsushi Amano1 1. Department of Cardiovascular Surgery, Juntendo University Hospital, Tokyo, Japan 2. Department of Cardiovascular Surgery, Juntendo University Nerima Hospital, Nerima, Japan The number of patients with end-stage renal failure undergoing coronary artery bypass grafting (CABG) has been increasing. It is well known that the prevalence of atrial fibrillation (AF) increases in chronic renal failure patients undergoing hemodialysis (HD). The impact of surgical left atrial appendage (LAA) closure on stroke prevention has been proved. However, the effect of LAA closure on AF remains controversial. The aims of this study are to investigate: i) the prevalence of AF after CABG Daisuke Endo according to the renal function, ii) the effect of LAA closure on late-onset AF after CABG. A single-center retrospective study analysed a total of 2691 consecutive patients undergoing CABG between 2002 and 2020. Patients with only preoperative sinus rhythm undergoing initial CABG were included. Concomitant LAA amputation with CABG has been routinely performed mainly since March 2013. Mean follow-up was 7.3 years. Prevalence of late-onset AF according to CKD Stages was investigated. The effect of LAA amputation on AF incidence was compared between G5 group (HD) and G1-4 group (non-HD).
Figure 1: According to CKD Stages, among patients undergoing CABG, AF free rate at 15-year was lowest in G5 group than other groups.
Figure 2: In patients without LAA amputation, AF free rate was lower in G5 group than in G1-4 group. However, in patients with LAA amputation, there was no significant difference in AF incidence between G1-4 group and G5 group.
According to CKD Stages, there were 353 (13.1%) in G1 group, 1247 (46.3%) in G2 group, 732 (27.2%) in G3 group, 98 (3.6%) in G4 group, and 261 (9.7%) in G5 group. The AF free rate at 15-year was 86.9%, 86.9%, 82.6%, 86.8%, and 68.5% respectively (Log-rank test; p=0.005). Among the CKD Stages, the incidence of AF in G5 group was as high as 31.5% at 15-year after CABG. Among patients without LAA amputation, AF incidence was significantly higher in G5 group
11:00 - 12:30 Successful ablation of atrial fibrillation approaching the target! Heart failure status after twelve months sinus rhythm restoration in patients with non-paroxysmal atrial fibrillation A. zotov, Moscow, S. Vachev, Moscow, E. Sakharov, Moskva, A. Troitskiy, Moscow, R. Khabazov, Moscow, S. Korolev, Moscow Atrial fibrillation (AF) is rising in prevalence in the general population, and this condition is associated with reduced long-term survival and impaired quality of life. Moreover, persistent and longstanding persistent AF can lead to occurrence and subsequent decompensation of congestive heart failure. The main aim of the study was to assess the state of chronic heart failure after twelve months sinus rhythm restoration in patients who were characterised by the presence of a non-paroxysmal Alex Zotov form of atrial fibrillation and heart failure developing after the onset symptoms of atrial fibrillation. In our Clinical center from April 2017 to March 2020, 146 patients underwent thoracoscopic «GALAXY» procedure. Among them, there were 25 patients with heart failure status. This group is of particular interest as it shows the importance of sinus rhythm restoring in stopping the progression of chronic heart failure in the patients presented in this study. There were 9 (36%) patients with persistent and 16 (64%) with long-standing persistent AF. Preoperative characteristics are presented in Table 1. Left atrial appendage resection was performed in all cases. There were no complications such as bleeding, stroke, myocardial infarction and diaphragm paresis. One patient (4%) had pneumothorax in the postoperative period, two patients (8%) had pneumonia and one patient (4%) had recurrent atrial fibrillation; therefore, follow-up results were evaluated in 24 patients. Total follow-up was twelve months long. In the follow-up we observed improving 6-minute walking distance test, decreasing in pro-BNP level, and positive results of ECHO characteristics. These dates indicate decreasing symptoms of severe heart failure (Table 2). From the research I can tell that
thoracoscopic ablation is a reliable treatment to restore sinus rhythm for patients with arrhythmogenic heart failure. I believe that the sinus rhythm restoration had a key role in stopping the progression of chronic heart failure in the patients presented in this study. Table 1: Baseline characteristic of patients Age, years, median (min; max)
64 (46; 78)
Male, number of patients (N [%])
16 (64%)
Persistent atrial fibrillation, number of patients (N [%])
9 (36%)
Long-standing persistent atrial fibrillation, number of patients (N [%])
16 (64%)
Catheter ablation, number of patients (N [%])
6 (24%)
Arterial hypertension, number of patients (N [%])
11 (44%)
Diabetes mellitus, number of patients (N [%])
6 (24%)
NYHA II, number of patients (N [%])
16 (64%)
NYHA III, number of patients (N [%])
9 (36%)
Duration of atrial fibrillation, years, median (min; max)
4.9 (0.9; 6.8)
EHRA II, number of patients (N [%])
17 (68%)
EHRA III, number of patients (N [%])
8 (32%)
CHA2DS2-VASc, median (min; max)
4 (2; 5)
HAS-BLED, median (min; max)
3 (2; 4)
Table 2: 12 months follow-up of patients with heart failure
Ejection fraction of LV, %, median (min; max) NT-proBNP, pg/ml, median (min; max)
Pre-operative
Follow-up 12 months
46.8 (40; 50)
54 (46; 57)
1186 (580; 1450)
308 (150; 460)
52.1 (41; 59)
46.9 (39; 51)
20.2 (13.6; 26.1)
18 (14-21,6)
Indexed volume of LA, ml/m², median (min; max) TAPSE, mm, median (min; max) Septal e/, cm/s, median (min; max)
7.8 (7.0; 9.1)
7.2 (6.4; 8.7)
Lateral e/, cm/s, median (min; max)
11 (8.1; 14.2)
10.1 (8.0; 12.2)
FAC, %, median (min; max)
35.6 (32.5; 39)
34.8 (32; 39)
6-minute walk distance test, meters, median (min; max)
350 (180; 440)
520 (480; 590)
19
20
EACTS DAILY NEWS
ABSTRACT SESSION
11:00 - 12:30 Update in Single ventricle management Extracardiac anomalies as a risk for mortality and morbidities in staged single ventricle palliation Janez Vodiskar 1, Takashi Kido 1, Jannik Mertin 1, Martina Strbad 1, Julie Cleuziou 1, Alfred Hager 2, Peter Ewert 2, Jürgen Hörer 1, Masamichi Ono 1. 1. Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technical University of Munich, Munich, Germany. Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, LudwigMaximilians-Universität, Munich, Germany 2. Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich, Technical University of Munich, Munich, Germany Overall prevalence of extracardiac (EC) anomalies in patients with congenital heart disease is estimated to be between 15 and 30 %. Previous studies demonstrated that association of EC anomalies in patients with functional single ventricle is a risk for mortality during staged palliation. However, it has not been fully studied in which phase EC anomalies affects the mortality, or what types of EC anomalies are risk for mortality. This study was intended to determinate the impact of EC anomalies on outcome of patients with functional single ventricle who underwent staged palliation.
We reviewed the medical records of patients who underwent staged I palliation at our center between 2001 and 2020. Outcomes of patients with EC anomalies during staged palliation were compared with those without EC anomalies. Analysis was performed to determine what types of extracardiac anomalies are risks using Cox regression model. Among 602 patients who underwent staged I palliation, 81 patients (13.5%) had EC anomalies. Patients with EC anomalies were younger, more often born prematurely, and smaller, compared to patient without EC anomalies. Mortality before stage II in patients with EC anomalies was similar to those without EC anomalies (24.7 vs. 17.1 %, p=0.10). However, mortality between stage II and stage III in patients with EC anomalies was higher compared to those without EC anomalies (22.2 vs. 12.5%, p=0.02). Morality after stage III in patients with EC anomalies was also higher compared to those without EC anomalies (4.9 vs. 1.5 %, p=0.04). Transplant-free survival in patients with EC anomalies after stage I procedure was lower than those without EC anomalies (p=0.003, Figure 1). In subgroup analysis of 81 patients with EC anomalies, renal anomalies was identified as a risk factor for mortality (p=0.02, Figure 2). In conclusion, the incidence of EC anomalies was 14 % in this study, and was associated with other additional risks such as prematurity and low birth weight. Association of EC anomalies did not affect the mortality before stage II palliation, but was associated with higher mortality between stage II and stage III, and after stage III phase. In subgroup analysis in patients with EC anomalies, renal anomalies was identified as a risk factor for mortality.
11:00 - 12:30 Update in Single ventricle management Abstract session Surgical intervention for systemic ventricular outflow tract after Norwood operation
Figure 1: Transplant-free survival of patients with and without extracardiac anomalies
Figure 2: Subgroup analysis of patients with extracardiac anomalies. Transplant-free survival of patients with and without renal anomalies.
ane Janez Vodiskar
odiskar
ane
odiskar Masa i hi no Masa Masamichi Onoi hi no
Figure 1: Serial change in pressure gradient within a subgroup of patients who underwent both BCPS and surgical reintervention for SVOT obstruction (n=19). The data were shown according to the timing of surgical SVOT reintervention. In Group 2, one patient died after BCPS and 2 are waiting for next cardiac catheterization. In Group 3, one patient died after BCPS. BCPS, bidirectional cavopulmonary shunt; TCPC, total cavopulmonary connection; SVOT, systemic ventricular outflow tract
Takashi Kido1, Maria-Thresa Steringer1, Paul Philipp Heinisch1, Melchior Burri2, Janez Vodiskar1, Martina Strbad1, Julie Cleuziou1, Peter Ewert3, Alfred Hager3, Jürgen Hörer1, Masamichi Ono1* 1. Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technical University of Munich, Munich, Germany, Division of congenital and pediatric heart surgery, University Hospital of Munich, Ludwig-Maximilians-Universität, Munich, Germany 2. Department of cardiovascular surgery, German Heart Center Munich, Technical University of Munich, Munich, Germany 3. Department of pediatric cardiology and congenital heart disease, German Heart Center Munich, Technical University of Munich, Munich, Germany The present study was aiming to identify the prevalence of surgical reinterventions for systemic ventricular outflow tract (SVOT) after Norwood procedure and their impacts on long-term outcomes. We retrospectively reviewed the medical records of all patients who underwent Norwood procedure between 2001 to 2020. The impacts of surgical reintervention for SVOT were analyzed in each stage of palliation. A total of 335 patients were included in this study. Thirty patients (9 %) underwent surgical reintervention for SVOT after Norwood procedure. The timing of reintervention were before stage II in 13 patients (45%), at stage II in 7 (25%), between stage II and stage III in 5 (13%), at stage III in 3 (10%), and after stage III in 2 (7%). Before stage II, a history of the reintervention was significantly associated with mortality (p<0.001). In patients who underwent bidirectional cavopulmonary shunt (n= 251), the reintervention had no significant impact on increased mortality. In patients who underwent total cavopulmonary connection (n= 188), a history of the reintervention was significantly associated with higher mean pulmonary pressure (p=0.05) and higher rate of reduced ventricular function (p=0.002) before total cavopulmonary connection. Greater than mild atrioventricular valve (AVV) regurgitation was significantly associated with development of a significant SVOT stenosis after stage II (p= 0.03). In conclusion, A history of surgical SVOT reintervention after Norwood procedure were not related to increased mortality after stage II, but significantly associated with higher rate of reduced ventricular function and elevated mean pulmonary artery pressure. Mild SVOT is likely to progress after stage II in association with AVV regurgitation.
Figure 2: Representative aortography 1 month before BCPS (A) and 2 month after BCPS (B) of a patient in Group 3. This patient developed a significant SVOT obstruction with a pressure gradient from 12 mmHg before BCPS to 44 mmHg after BCPS. SVOT, systemic ventricular outflow tract obstruction; BCPS, bidirectional cavopulmonary shunt
Maria-Thresa Steringer
Maria-Theresa Steringer
Takashi Kido
Maria-Theresa Steringer
Takashi Kido
Takashi Kido
Issue 1 Thursday 14th October
ABSTRACT SESSION
11:00 - 12:30 Sternum, chest wall and beyond Late mediastinitis post Aortic dissection repair: dismantling an atomic bomb. Alessandro Affronti1, Marta Hernández-Meneses2, Elena Sandoval1, Eduard Quintana1 1. Cardiovascular Surgery Department and 2. Infectious Disease Department, Hospital Clínic de Barcelona. University of Barcelona Mediastinitis after type A aortic dissection repair is a rare but potentially catastrophic complication. It may occur immediately after surgery or have a delayed presentation. In our case, the patient underwent ascending aorta-hemiarch replacement and coronary bypass surgery elsewhere. After an initial favourable postoperative course he was admitted to our hospital 1 year later with fever, malaise, weight loss and a nonpulsatile and inflammatory presternal mass (image 1). He underwent comprehensive urgent evaluation, including PET/CT scan (image 2) and was diagnosed with Staphylococcus aureus mediastinitis. Infection of a prosthetic Dacron graft is difficult to eradicate with conservative medical management. Suture line dehiscence is usually the ultimate result of incomplete treatment or the natural course of untreated disease, leading to cataclysmic bleeding. To avoid vascular disconnection, surgery has been used to obtain macroscopic debridement and replace the infected vascular graft. Operative management is usually extremely challenging and its association with prolonged antibiotic therapy seems the treatment of choice for the majority of patients that are deemed fit. The addition of a living tissue (omentum) plasty, delayed chest closure, continuous mediastinal irrigation and the appropriate duration of antibiotics remain under investigation. The management of such patients should be reserved for multidisciplinary Endocarditis Teams to maximize the chances of survival.
There is no consensus on the duration of associated antibiotic therapy with literature ranging from a minimum of 6 weeks to lifelong regimens. Whether antibiotics can be discontinued after surgery is an unsolved clinical question. In our patient, PETCT was used not only obtain to serve as a baseline inflammatory reference point but also for evaluating postoperative mediastinal inflammation and guide antibiotic de-escalation. Our patient completed 6 weeks of iv antibiotic followed by 9 months of oral antibiotic. At the present time he has been completely off any antibiotic treatment for 24 months and has returned to a normal lifestyle. The follow up PET/ CT shows no signs of abnormal uptake suggesting a relapse of intrathoracic infection (image 4). A “never give-up” strategy through aggressive and tailored rescue operations may be the last option for patients that would otherwise face dismal prognosis. As mentioned before, this is a highly demanding and not standardized surgery where frequently it is necessary to switch plan on the fly and apply bailout strategies.
Figure 3: A: VAC-assisted secondary intention wound closure. B: sternal wound completely healed
Figure 4: post-op PET-CT showing the disappearance of the intense preoperative mediastinal uptake
Figure 1: the huge purulent sternal swelling
Figure 2: pre-op PET-CT showing the intense uptake around the vascular graft extended to the subcutaneous presternal tissue
There is general agreement on the necessity of a complete removal of all foreign material followed by extensive tissue debridement. Surgical reconstruction with human allografts may be helpful in avoiding recurrences and may facilitate anastomosis in irregular structures. Open chest management with daily washouts, delayed sternal closure when infection appears macroscopically controlled followed by wound VAC therapy (no sutures above sternal wires) to facilitate secondary intention healing are part of our operative management (image 3).
EACTS GENERAL ASSEMBLY Friday 15TH October 2021 18:00 - 18:30 Room 113 (P1 Floor)
Photo of the authors (from left): Alessandro Affronti, Elena Sandoval, Marta Hernández-Meneses, Eduard Quintana
1. LeMaire SA, Coselli JS. Options for managing infected ascending aortic grafts. J Thorac Cardiovasc Surg 2007;134: 839-43 2. Coselli JS, Köksoy C, LeMaire SA. Management of thoracic aortic graft infections. Ann Thorac Surg. 1999; 67:1990-3. 3. Umminger J, Krueger H, Beckmann E et al. Management of early graft infections in the ascending aorta and aortic arch: a comparison between graft replacement and graft preservation techniques. Euro J Cardiothorac Surg 2016. 50 (4); 660–667. 4. Vogt PR, Turina MI. Management of infected aortic grafts: development of less invasive surgery using cryopreserved homografts. Ann Thorac Surg 1999; 67:1986–9; discussion 1997–8.
21
22
EACTS DAILY NEWS
ABSTRACT SESSION
14:15 - 15:45 Cardiac surgery in times of COVID Validation of STS COVID-19 Resource Prediction Instrument for Cardiac Surgery in the Spanish population M. Piñón, Vigo, F. Estevez, A Coruña, E. Quintana, Barcelona, M. Carnero Alcázar, Madrid, J. M. Martinez Cereijo, Santiago de Compostela, J. LopezMenendez, Madrid, G. Cuerpo, Madrid, J. Gualis Cardona, León COVID-19, in addition to SARS and MERS, is the third coronavirus infection in recent years, but it is the one that with the greatest social and economic impact. It represented the most significant public health challenge to date, globally. SARS-CoV-2 is a highly infectious virus (basic reproductive number (R0) of 3-7 and doubling times between 2,4-3,7 days, in early phases). COVID-19 was declared a pandemic on March 11, 2020,(1). During its first wave, the hospitalisation rate was high: by mid-July 2020, 125,797 patients required hospitalization and 11,721 were admitted to the ICU. COVID-19 was responsible for 40% of ICU occupation and Madrid or Catalonia triplicated their number of ICU beds (2). Although from June 2020 need for hospitalisation lowered (7%, of which 10% needed ICU) (3, 4), first effect was overreacting to give response, and elective surgical programmes were disrupted worldwide. Cardiac surgery was mainly affected because of critical care needs for the postoperative period. This strategy has penalised patients with chronic conditions and cardiovascular diseases, whose interventions have been delayed, affecting their survival. Up to a 40% of PCI or 81% in structural procedures were reduced in Spanish centers (5). So, recognition of patients at risk of prolonged LOS by using prediction models could improve the clinical and operational performance. Validation of management tools would help to safely restart elective cardiac surgery programmes while maintaining the response capacity of health systems. We sought the predictive capacity of the STS COVID-19 resource prediction instrument for ventilation and ICU times after cardiac surgery, by analysing discrimination and calibration of this tool (6). For this purpose, we designed a prospective multicenter observational registry, which included consecutive patients submitted to cardiac surgery. 1748 patients were prospectively registered from March 16, 2020 to February 27,2021. It included the whole second period of COVID-19 in Spain. Median ventilation time was 6,0±53,5 hours and median ICU stay1,0±8,0days (74%of the patients stayed in ICU less than three days). For ventilation time, scores showed poor discrimination (-AUC- ROC values 0,46; 95%CI: 0,36-0,55) and calibration (Hosmer-Lemershow;p=ns). For ICU
14:15 - 15:45 Cardiac surgery in times of COVID Type A aortic dissections as an indicator for the state of the healthcare system during the COVID-19 pandemic Asen Petrov1, Adrian Mahlmann2, Juan Pablo De Glee Romera1, Tamer Ghazy3, Klaus Matschke1, Norbert Weiss2, Utz Kappert1 The coronavirus disease 2019 (COVID-19) has dominated the landscape of healthcare through its remarkable worldwide proliferation. Countries have implemented measures to mitigate its consequences, while maintaining adequate patient care. A reduction in hospital admissions has been well documented across multiple locations and medical specialties. The aim of this study is to demonstrate changes in emergent surgical treatment as an indicator of the adequacy of measures during Asen Petrov the COVID-19 pandemic in Germany. We use type A aortic dissections - a life-threatening condition with no viable alternative treatments besides surgery, to evaluate the social and organisational aspects of the response to the pandemic in Germany. We performed a retrospective analysis of the number of surgically treated aortic dissections at our facility from January 2010 to February 2021 (n = 437). Nationwide COVID-19 data was obtained from the German government’s national institute for the surveillance and prevention of diseases and intensive care unit capacity was provided by the German Intensive Care Availability Register. We found no change in the monthly and yearly operations after the beginning of the pandemic (3.5 ± 1.69 vs 3.0 ± 1.76, p=0.36 and 40.1 ± 5.22 vs 36, p = 0.52 respectively). COVID-19 cases or the capacity of beds in intensive care units did not correlate with the number of operations for aortic dissections (r2<0.01, p=0.98 and r2=0.01, p=0.74 respectively). Furthermore, patient demographics during this period remained unchanged.
length of stay, discrimination was also weak (-AUC- ROC 0,57; 95%CI: 0,53-0,60), however calibration seems to be slightly better OR=1,79; p=0,053. Ventilation time and length of stay in ICU seem to be less predictable outcomes, since a series of heterogeneous individual or institutional parameters not considered in this tool can affect these times (i.e professional judgement, expertise, local outcomes or institutional policies among them) (7). Figure 1
Ventilation time
ICU-LOS
References 1. World Health Organization. WHO Timeline - COVID-19 2020 [Available from: https://www.who.int/newsroom/detail/27-04-2020-who-timeline---covid-19?gclid=Cj0KCQjw6ar4BRDnARIsAITGzlCP3ooLkq0332yYaqBPjSMfK-6YRlfL71J6i8s__ZdH8zFahKkNCcaAjsNEALw_wcB. Last accessed 2021, Aug 30. 2. Pérez de la Sota E, Piñón M, Quintana E, Mestres CA. COVID 19—A Spanish perspective. Journal of Cardiac Surgery. 2021;36(5):1624-31. 3. Instituto de Salud Carlos III. Centro Nacional de Epidemiología. RENAVE. Report 90. COVID-19 situation. Spain.2021, August 04. Available from: https://www.isciii.es/QueHacemos/Servicios/ VigilanciaSaludPublicaRENAVE/EnfermedadesTransmisibles/Documents/INFORMES/Informes%20 COVID-19/INFORMES%20COVID-19%202021/Informe%20nº%2090%20Situación%20de%20COVID-19%20 en%20España%20a%2004%20de%20agosto%20de%202021.pdf. Last accessed 2021, Aug 30. 4. European Centre for Disease Prevention and Control (ECDC). (ECDC). ECfDPaC. Data on hospital and ICU admission rates and current occupancy for COVID-19. https://www.ecdc.europa.eu/en/publications-data/ download-data-hospital-and-icu-admission-rates-and-current-occupancy-covid-19. Last accessed 2021, Aug 30. 5. Rodríguez-Leor O, Cid-Álvarez B, Ojeda S, Martín-Moreiras J, Rumoroso JR, López-Palop R, et al. Impacto de la pandemia de COVID-19 sobre la actividad asistencial en cardiología intervencionista en España. REC Interv Cardiol. 2020;2:82-9. 6. The Society of Thoracic Surgeons. STS COVID-19 Resource Prediction Instrument for Cardiac Surgery. 2020. https://heartcenter.shinyapps.io/sts_covid/. Last accessed 2021, Aug 30. 7. Widyastuti Y, Stenseth R, Wahba A, Pleym H, Videm V. Length of intensive care unit stay following cardiac surgery: is it impossible to find a universal prediction model? Interact Cardiovasc Thorac Surg. 2012;15(5):825-32.
The current situation has undisputedly influenced the healthcare systems globally and a rapid decline in the operations for acute type A aortic dissections has been observed by other working groups. We consider the lack of change in aortic dissection demographics amongst our patients as indicative of an adequate capacity to treat patients in need of emergent surgical therapy and the readiness of patients to seek medical attention. Figure 1: Number of monthly operations since January 2010 prior to (blue) and after (red) the COVID-19 pandemic (3.5 ± 1.69, n=417 vs 3.0 ± 1.76, n=36, p=0.36).
Figure 2: Number of aortic dissection operations per year in the period before (blue) and during (red) COVID-19.
References 1. Department of Cardiac Surgery; University Heart Center Dresden, Dresden, Germany. 2. University Centre for Vascular Medicine and Division of Angiology, Department of Internal Medicine III, University Hospital Carl Gustav Carus, Dresden University of Technology, Germany 3. Department of Cardiac and Vascular Thoracic Surgery, Philipps-University Hospital Marburg, Marburg, Germany
Issue 1 Thursday 14th October
ABSTRACT SESSION
14:15 - 15:45 Problems and concerns related to the choice of an optimal aortic valve substitute Hancock II vs. St Jude Trifecta vs. Carpentier-Edwards Perimount Magna vs. Magna Ease: what do we know after 10 years? (COMPARE SAVR Study) Radosław Litwinowicz 1,2 Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Krakow, Poland 2 Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
1
Survival analysis presented no significant differences for in-hospital mortality period: 3.93% in Hancock II, 3.09 % in Perimount, 3.28 % in Magna and 2.14% in Trifecta group. 5-year mortality was significantly higher in Hancock II group (25.64%) compared to others bioprostheses:12.08% in Perimount, 9.13% in Magna and 10.70% in Trifecta group respectively. Comparison of the four most commonly used bioprostheses showed that Trifecta, Perimount Magna, and Magna Ease had similar 5-year mortality rates, whereas the Hancock II valve was associated with a significantly higher mortality rate and was actually observed to be an independent risk factor for fatal events. There are no evident data to favour or discourage the use of any of the other three valves. Figure 1
Surgical aortic valve replacement is one of the most common cardiac surgery procedures worldwide. With ever-changing medical knowledge and thus guidelines, more and more patients are becoming candidates for a bioprosthesis instead of a mechanical valve. This is accompanied by the invention of new types and generations of biological valves with the aim of improving durability and reducing the risk of structural valve disease. We present a real-life analysis of 10-year surgical aortic valve replacement (sAVR) outcomes for the four most commonly used aortic bioprostheses: the Hancock II, the Carpentier-Edwards Perimount Magna, the Carpentier - Edwards Perimount Magna Ease, and the Trifecta valve. We believe that this analysis of 10 – yearlong sAVR experience using bioprostheses will provide important results that can be translated into the daily practice of valve selection in sAVR. Radosław Litwinowicz
The study population comprised of 1 589 consecutive patients, who underwent isolated sAVR: using aortic bioprostheses between 2009 and 2019. The main outcome measures were changes in the number of procedures, characteristics, operative details, in-hospital and long term mortality. Patients in Hancock II group were older, had higher NYHA and CCS classes, had lower prevalence of hypertension, hyperlipidemia but higher prevalence of diabetes. The lowest mean valve size was observed in Trifecta group, the highest in Magna group (p<0.001).
14:15 - 15:45 Problems and concerns related to the choice of an optimal aortic valve substitute Mechanical vs. bioprosthetic aortic valve replacement in patients younger than 70 years of age – a hazard ratio meta-analysis D. Leviner, haifa, G. Witberg, Petah Tikva, A. Levi, Petah Tikva, U. Landes, Petah Tikva, A. Shiran, Haifa, R. Kornowski, Petah Tikva, E. Sharoni, Haifa The choice between mechanical valves and bioprosthetic valves in patients undergoing aortic valve replacement is complex, requiring a balance between inferior durability of bioprosthetic valves and the indicated long-term anticoagulation therapy with mechanichal valves, and taking into consideration the patients’ beliefs and wishes. This is especially challenging in middle-aged patients (50 to 70 years), in which the use of bioprosthetic valves has increased over recent years. This trend Dror Leviner coincides with the advent of transcatheter aortic valve replacement, fuelled, in part, by the notion that the decreased durability of bioprosthetic valves can be mitigated by a valve in valve transcatheter aortic valve replacement once structural valve deterioration has occurred. Randomised data in this area is limited, with most of the data derived from observational trials using either propensity score matching or inverseprobability-weighing to try and overcome the inherent limitations of these studies. In an attempt to improve the knowledge base for clinical decision making we conducted a meta-analysis of randomised controlled trials (RCT’s), and observational studies using propensity score matching (PSM) and inverseprobability-weighing (IPW) to examine the clinical outcomes of patients <70 years of age undergoing aortic valve replacement. The primary outcome was overall long-term mortality. Secondary outcomes included bleeding events, re-operation, systemic thromboembolism, and cerebrovascular accident. The initial literature search yielded 656 citations, 108 of which were deemed
potentially eligible and underwent full text review which ultimately led to the inclusion of fifteen studies (1 RCT, 13 PSM, and 2 IPW studies, with an aggregated sample size 16,876 patients). The median follow-up of the included trials was 7.8 years. Mortality was higher with biological valves compared with mechanical valves (hazard ratio (HR) 1.22 [1.00-1.49]), as was re-operation (HR 3.05 [2.22-4.19]). Bleeding risk was lower with BV (HR 0.62 [0.56-0.69]), and the risk of stroke was similar in both valve types (HR 0.96 [0.83-1.11]). To conclude, in this comprehensive meta-analysis comparing biological and mechanical aortic valves, the results suggest a survival benefit for mechanical valves in patients under 70 years of age. This finding should lead to a reassessment of current patterns of valve choice in the aortic position for patients <70 among the cardiothoracic surgery community. Figure 1:
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EACTS DAILY NEWS
ABSTRACT SESSION
09:30 - 10:30 Miscellaneous - aortic arch and left heart obstructions
Figure 1
Long-term outcomes after surgical repair of subvalvular aortic stenosis in pediatric patients Johanna Schlein1, Dominik Wiedemann1, Claudia Herbst1, Gregor Wollenek1, Paul Simon1, Ina Michel-Behnke2, Günther Laufer1, Daniel Zimpfer1 1 University Clinic of Surgery, Department of Cardiac Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria 2 University Clinic of Children and Adolescent Medicine, Department of Pediatric Cardiology, Medical University of Vienna, Waehringer Guertel 1820, 1090 Vienna, Austria
Johanna Schlein
We reviewed our 30-year single-centre experience with the repair of subaortic stenosis in pediatric patients. Although surgical repair of subaortic stenosis in pediatric patients has excellent shortterm outcomes, recurrence rate of subaortic stenosis is not to be neglected and the progression of aortic regurgitation might require aortic valve surgery. The modified Konno procedure is the treatment of choice in patients with tunnel-like left ventricular outflow tract stenosis.
Subvalvular aortic stenosis (SAS) is a rare, but progressive disease. The disease spectrum spans from a minor fibrous ridge on the subvalvular ventricular septum (discrete SAS) to a narrow fibromuscular tunnel-like obstruction of the left ventricular outflow tract (LVOT) (1, 2). Aortic regurgitation is common, due to the turbulent blood flow causing damage, scarring and prolapse of the aortic valve, or alternatively, due to the direct extension of the subaortic tissue onto the aortic valve leaflets (3). Long term outcomes in children concerning late reoperation and valve insufficiency requiring valve repair or replacement remain incompletely defined (1). Therefore, we reviewed our long-term single-center experience with repair of SAS in pediatric patients.
Figure 2
Figure 3
From May 1985 until April 2020, 112 patients (53.6% male, 17.9% hypertrophic obstructive cardiomyopathy (HOCM), 22.3% bicuspid aortic valve) underwent 133 SAS repairs. SAS repair was performed as following: Myectomy: 30 (22.6%); membrane resection: 50 (37.6%); membrane resection and myectomy: 42 (31.6%); modified Konno procedure: 11 (8.3%). Median age at time of surgery was 6.2 years (IQR 2.3-10.7). Concomitant aortic valve repair was performed in 19 (14.3%) cases and concomitant aortic valve replacement in 9 (6.8%) cases. In 9 (6.8%) cases concomitant right ventricular outflow tract myectomy was necessary. There were 7 early deaths and 3 late deaths. All early deaths occurred in patients with complex congenital heart disease or HOCM. Kaplan-Meier estimated survival was 91.3% ± 2.8% at 10 years and 89.2 % ± 3.4% at 20 and 30 years (Figure 1). Two patients with HOCM underwent cardiac transplantation 0.9 years and 12.4 years after initial SAS repair respectively. Freedom from re-operation for subvalvular aortic stenosis was at 75.8 % ± 4.5% at 10 years and 66.3% ± 6.1% at 20 and 30 years (Figure 2). Freedom from any aortic valve re-operation (repair and replacement) was 87% ± 3.6% at 10 years and 81.5% ± 5.3% at 20 and 30 years (Figure 3). Recurrence and re-operation rates remain a concern in pediatric patients with SAS. Close long-term follow up is warranted in these patients, though overall survival is good. The modified Konno procedure is an excellent treatment option in patients with tunnel-like SAS. Re-operation for SAS was associated with younger age at time of surgery (HR 0.9 for each increase in year; p = 0.021).
References 1. Pickard SS, Geva A, Gauvreau K, del Nido PJ, Geva T. Long-term outcomes and risk factors for aortic regurgitation after discrete subvalvular aortic stenosis resection in children. Heart (British Cardiac Society). 2015;101(19):1547-53. 2. Takahashi Y, Hanzawa Y. Modified Konno procedure: surgical management of tunnel-like left ventricular outflow tract stenosis. General thoracic and cardiovascular surgery. 2014;62(1):3-8. 3. Donald JS, Naimo PS, d’Udekem Y, Richardson M, Bullock A, Weintraub RG, et al. Outcomes of Subaortic Obstruction Resection in Children. Heart, lung & circulation. 2017;26(2):179-86.
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Issue 1 Thursday 14th October
ABSTRACT SESSION
14:15 - 15:45 The conundrum of non degenerative mitral regurgitation: looking for a solution! Secondary mitral regurgitation due to isolated annular dilatation: the role and impact of atrial fibrillation Gonçalo F Coutinho, MD, PhD, University Hospital and Centre of Coimbra; Faculty of Medicine of the University of Coimbra Severe mitral regurgitation (MR) due to isolated annular dilatation (iAD), in the absence of organic or secondary mitral valve disease, such as ischaemic heart disease or cardiomyopathy (CDM), is often found Gonçalo F Coutinho during mitral valve (MV) surgery. Secondary MR has been found in up to 6.4% of patients at first presentation of atrial fibrillation (AF). However, controversy surrounds the role of AF on the genesis of MR, particularly when there is iAD. In this study, we aimed at: 1- comparing the perioperative and long-term results between patients with degenerative MR (flail leaflet) and those with secondary MR (non-ischaemic and nonassociated with CDM), submitted to MV surgery; 2-determining the association between AF and secondary MR; 3- evaluating the impact of MV
surgery in patients with isolated annular dilatation. Figure 1 exhibits the flowchart of the study. Patients with iAD were significantly older (63.2±12.8 vs 59.9±13.7years), more symptomatic (63.4% vs 47.2%), with higher prevalence of tricuspid regurgitation (62.5% vs 16.7%), LV dysfunction (20.8% vs 4.5%), hypertension (50.9% vs 20.9%) and AF (47.2% vs 27.8%). Mitral valve repair rate was slightly higher in the degenerative group (97.2% vs 95.4%, p=0.160). All patients with secondary aetiology had an annuloplasty procedure (vs 96.1%, p=0.605). The mean mitral ring size was smaller in the latter (31.8±1.9mm vs 32.7±1.6mm, p<0.001). Thirty-day mortality was low for both groups (Secondary-0.9% vs 0.8%, p=0.692). Patients from the secondary group had longer hospital stays (10.0±10.3 vs 8.3±6.0 days, p=0.020). Unadjusted and adjusted survival was significantly better in the degenerative group. Patients in the latter group had similar survival of the general population (age- and sex-adjusted). On the contrary, patients with secondary MR had worse survival (p<0.001). The presence of AF was strongly associated with patients with isolated MR due to annular dilatation. Patients with AF had a dismal prognosis in comparison with those without AF (figure 2). In conclusion: 1-Patients with MR due to iAD can have their valves repaired in the majority of cases, with low operative mortality. Nonetheless, they have worse long-term survival than those with degenerative MR and of the general population (age and gender matched); 2- patients with secondary MR due to iAD (non-ischaemic or non-
CDM) have higher incidence of atrial fibrillation than those with degenerative MR. Nearly two thirds of patients with isolated MR and iAD were in permanent/persistent AF at the time of surgery, reinforcing the strong association between AF and Text this entity; 3- patients with iAD and preoperative AF at increased risk late in Severe are mitral regurgitation (MR) due to isolated annularof dilatation (iAD), mortality in the absence comparison those without Strategies of organic or secondarywith mitral valve disease, such as ischaemic AF. heart disease or cardiomyopathy (CDM), isAF often found during mitral (M ) surgery. Secondary MR to eliminate should bevalvepursued in order to has been found in this up to 6. deleterious % of patients at first presentation minimise effect. of atrial fibrillation (AF). owever, controversy surrounds the role of AF on the genesis of MR, particularly when there is iAD.1: Study flowchart Figure Figure . Study flowchart
4032 Patients
96.1%, p=0.605). The mean mitral ring size was smaller in the latter (31.8±1.9mm vs Rheumatic, infectious and 32.7±1.6mm, p<0.001). Thirty-day mortality was low for both groups (Secondary-0.9% ischemic MR and DCM
excluded vs 0.8%, p=0.692). Patients from the secondary group had longer hospital stays 1351 Patients
(10.0±10.3 vs 8.3±6.0 days, p=0.020). Unadjusted and adjusted survival was significantly better in the degenerative group. Patients in the latter group had similar survival of the Primary analysis 1135 Degenerative MR
216 Secondary MR
general population (age- and sex-adjusted). On the contrary, patients with secondary MR had worse survival (p<0.001). 84 Without aortic surgery
132 With aortic surgery
Secondary analysis
The presence of AF was strongly associated with patients with isolated MR due to annular dilatation. Patients with AF had a dismal prognosis in comparison with those In this study, we aimed at: 1- comparing the perioperative and long-term results without AF (figure 2). Figure 2: Study flowchartMR (flail leaflet) and those with secondary MR between patients with degenerative Figure 2. Study flowchart (non-ischaemic and non-associated with CDM), submitted to M surgery; 2-determining the association between AF and secondary MR; 3- evaluating the impact of M surgery in patients with isolated annular dilatation. Figure 1 exhibits the flowchart of the study. Patients with iAD were significantly older (63.2±12.8 vs 59.9±13.7years), more symptomatic (63. % vs 7.2%), with higher prevalence of tricuspid regurgitation (62.5% vs 16.7%),
dysfunction (20.8% vs .5%), hypertension (50.9% vs 20.9%) and AF ( 7.2%
vs 27.8%). Mitral valve repair rate was slightly higher in the degenerative group (97.2% vs 95. %, p=0.160). All patients with secondary aetiology had an annuloplasty procedure (vs
In conclusion: 1-Patients with MR due to iAD can have their valves repaired in the majority of cases, with low operative mortality. Nonetheless, they have worse longterm survival than those with degenerative MR and of the general population (age and gender matched); 2- patients with secondary MR due to iAD (non-ischaemic or non-CDM) have higher incidence of atrial fibrillation than those with degenerative MR. Nearly two thirds of patients with isolated MR and iAD were in permanent/persistent AF at the time of surgery, reinforcing the strong association
16:00 - 17:30 Challenges of the small LV Room for improvement Subvalvular Mitral Apparatus Remodeling during Hypertrophic Obstructive Cardiomyopathy Surgery: a 15-years of experience Giuseppe M Raffa and Michele Pilato Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation. IRCCS – ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy The transaortic surgical septal myectomy is the most commonly used technique to treat hypertrophic obstructive cardiomyopathy (HOCM), and is associated with low operative morbidity and mortality and reduction of the outflow gradients. The involvement of the mitral valve in the pathophysiology of HOCM has been addressed as systolic anterior motion (SAM) –related left ventricle out flow tract (LVOT) obstruction. Hypertrophic cardiomyopathy mitral malformations include leaflets elongation and a wide array of malformations of the papillary muscles (PM) and chordae that can be detected by transthoracic and transesophageal echocardiography and by cardiac magnetic resonance. Because they participate fundamentally in the predisposition to SAM, they have increasingly been repaired surgically. Sixty seven consecutive patients who underwent HOCM surgery at IRCCS-ISMETT from 2007 to 2021 were retrospectively reviewed in order to assess the role of the mitral valve (leaflet, chordae and PM) in the LVOT obstruction and the
results of the surgical treatment. Indications for operation included patients with severe symptoms unresponsive to or intolerant of optimal medical therapy with LVOT pressure gradients greater than or equal to 50 mm Hg (measured with Doppler echocardiography either under resting conditions and/or with provocation, preferably utilizing physiologic exercise). Secondary chordae tendineae tractioning the anterior mitral leaflet to the interventricular septum, and systolic anterior motion were detected in the majority of the patients. Anomalous, hypertrophied, and fused PM with muscularis trabeculae hypertrophy were also commonly observed. Four patients had posterior leaflet redundancy. Subvalvular mitral apparatus remodeling (secondary chordae, PM, and muscularis trabeculae resection, and PM splitting and elongation) were added variably to septal myectomy. Nine procedures on mitral valve leaflets were performed. Long-term follow up was 4.6±3.7 years. There was no hospital mortality, and NYHA classification, LVOT gradient, mitral valve regurgitation and septum thickness were significantly reduced after surgery. The mitral valve substantially contributes to LVOT obstruction in patients with HOCM. Thus, surgical correction (subvalvular mitral apparatus remodeling) in addition to extended myectomy is recommended during surgery. Surgeons with expertise in mitral valve anatomy and extensive repair techniques, guided by a dedicated team for planning the proper operative strategy, can help guarantee the best operative results.
between AF and this entity; 3- patients with iADbulging and preoperative AF are at increased Figure 1: Interventricular septum before resection. risk of late mortality in comparison with those without AF. Strategies to eliminate AF should be pursued in order to minimise this deleterious effect.
Figure 2: Secondary chordae thickened and retracted anchoring the anterior leaflet of the mitral valve to the septum were identified and resected.
Figure 3: Michele Pilato (left), MD, Giuseppe Raffa, MD, PhD, Eluisa La Franca, MD
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EACTS DAILY NEWS
ABSTRACT SESSION
16:00 - 17:30 Challenges of the small LV - Room for improvement
Table 2: Transthoracic echocardiography data
Surgical treatment of hypertrophic obstructive cardiomyopathy in patients after alcohol septal ablation K. Rudenko1, M. Tregubova2, L. Nevmerzhytska1, P. Danchenko3 1. Department of mini-invasive and reconstructive surgery, Amosov National Institute of Cardiovascular Surgery, Kyiv, Ukraine 2. Department of radiology, Amosov National Institute of Cardiovascular Surgery, Kyiv, Ukraine 3. Department of surgery with course of emergency and vascular surgery, Bogomolets National medical university, Kyiv, Ukraine
K Rudenko
The current strategies in hypertrophic obstructive cardiomyopathy (HOCM) treatment remain uncertain despite the recommendations provided in European and American clinical guidelines [1, 2]. The tendency of choosing the mini-invasive approach (e.g., alcohol septal ablation – ASA) has partially eclipsed surgical approach, however it may not always allow to perform adequate correction of all the anomalies of the mitral valve (MV) and the left ventricle (LV) that are seen in these patients.
Before correction
At discharge (10-14 day after procedure)
2 years after procedure
p-value
63.5±38.4
18.9±8.6
14.7±8.9
<0.001
0
0 (0)
0 (0)
1 (6.3)
<0.02
1
3 (18.8)
15 (93.7)
15 (93.7)
<0.05
2
11 (68.8)
1 (6.3)
0 (0)
<0.02
3
2 (12.5)
0 (0)
0 (0)
<0.02
4
0 (0)
0 (0)
0 (0)
<0.05
Basal septum thickness, cm; mean (range)
2.4 (2.0-3.6)
1.5 (1.0-2.1)
1.4 (1.0-2.1)
<0.001
EDV, ml; (mean±SD)
92.8 ± 22.4
97.5 ± 16.9
101.9±14.2
<0.001
AML, mm; (mean±SD)
38.2±1.7
31.6±1.9
31.4±1.6
<0.002
EF, %; (mean±SD)
63.6 ± 5.6
61.3±3.7
62.5±4.3
<0.05
SPG on LVOT at rest or on exertion, mmHg; (mean±SD) Mitral regurgitation degree, n (%):
Figure 1: CT of the heart (long axis view) showing the zone of calcified IVS (green arrow) in patient with HOCM who previously underwent ASA
We studied 16 patients after failed ASA who underwent extended septal myectomy to analyse the immediate and long-term results of surgical correction and identify technical pitfalls which every surgeon should expect. Methods. 16 patients (mean age 50.5±14.6, median – 54; males – 5 (31.3%)) presented at our center with symptoms of progressive heart failure. Routine pre-operative CT or cardiac magnetic resonance (CMR) planning (Fig. 1) and intraoperative transesophageal echocardiography (TTE) were performed in each of the studied patients. All 16 individuals underwent surgical correction that included 4 mandatory steps: extended septal myectomy, resection of anomalous chordal attachments, papillary muscles mobilisation (in 10 patients (62,5%)) and plication of the anterior mitral leaflet (AML) (Fig. 2). A sudden cardiac death (SCD) risk score [3] was calculated for each of the studied individuals dividing them into three risk-groups. Results. The immediate and 2-year follow-up results of the procedure are presented in Tables 1, 2. 8 (50%) patients were in III/IV HYHA functional class, 1 (6.3%) had persistent atrial fibrillation, and 1 (6.3%) presented with infective endocarditis. 1 (6.3%) patient underwent ASA, DDD pacemaker and ICD implantation. 3 (18.8%) patients previously underwent more than 1 ASA. Calcified basal interventricular septum was identified in 2 (%) patients.
Figure 2: Septal myectomy performed in patient who underwent ASA. Fragments of the calcified IVS.
In-hospital mortality after septal myectomy accounted 0%. No lifethreatening cardiovascular events (0%) (sudden cardiac death, ventricular fibrillation or cardiac arrest) were registered during 2-year follow up. Conclusion. Surgical treatment of HOCM in patients who previously underwent ASA requires a complex approach that will provide correction of all pathological manifestations of the disease. Routine pre-operative CT or CMR provides detailed anatomy of the anomalous LV and MV structures as well as allows to measure the extension of myectomy preserving from iatrogenic VSD. When performing septal myectomy of calcified IVS, it is recommended to avoid applying one-piece technique since fragmental myectomy allows visual control of the adequacy of LVOT release. Table 1: Clinical and post-operative outcomes of the extended myectomy in 16 patients who previously underwent ASA Characteristic features
Before correction
At discharge (10-14 day after procedure)
2 years after procedure
p-value
NYHA functional class:
References:
I
1 (6.3)
2 (12.5)
12 (25)
<0.05
II
7 (43.8)
14 (87.5)
4 (25)
<0.05
III
8 (50)
0 (0)
0 (0)
<0.02
IV
0 (0)
0 (0)
0 (0)
<0.002
Mild, n (%)
6 (40)
14 (93.3%)
15 (100)
<0.002
Moderate, n (%)
7 (46.7)
1 (6.7)
0 (0)
<0.05
High, n (%)
2 (13.3)
0 (0)
0 (0)
<0.004
ICD implantation
1 (6.3)
0 (0)
0 (0)
SCD risk (15 patients):
1. Elliott PM, Anastasakis A, Borger MA, Borggrefe M, Cecchi F, Charron P, Hagege AA, Lafont A, Limongelli G, Mahrholdt H, McKenna WJ, Mogensen J, Nihoyannopoulos P, Nistri S, Pieper PG, Pieske B, Rapezzi C, Rutten FH, Tillmanns C, Watkins H. 2014 ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy: the Task Force for the Diagnosis and Management of Hypertrophic Cardiomyopathy of the European Society of Cardiology (ESC). Eur Heart J. 2014 Oct 14;35(39):2733-79. 2. Ommen SR, Mital S, Burke MA, Day SM, Deswal A, Elliott P, Evanovich LL, Hung J, Joglar JA, Kantor P, Kimmelstiel C, Kittleson M, Link MS, Maron MS, Martinez MW, Miyake CY, Schaff HV, Semsarian C, Sorajja P. 2020 AHA/ACC Guideline for the Diagnosis and Treatment of Patients With Hypertrophic Cardiomyopathy: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2020 Dec 22;142(25):e533-e557. 3. O’Mahony C, Jichi F, Pavlou M, Monserrat L, Anastasakis A, Rapezzi C, Biagini E, Gimeno JR, Limongelli G, McKenna WJ, Omar RZ, Elliott PM; Hypertrophic Cardiomyopathy Outcomes Investigators. A novel clinical risk prediction model for sudden cardiac death in hypertrophic cardiomyopathy (HCM risk-SCD). Eur Heart J. 2014 Aug 7;35(30):2010-20.
Issue 1 Thursday 14th October
ABSTRACT SESSION
16:00 - 17:30 Challenges of the small LV Room for improvement Transapical approach to myectomy in hypertrophic cardiomyopathy: an option in midventricular obstruction and apical growth E. C. Ríos Rosado, Majadahonda, C. Martín, Majadahonda, J. E. De Villarreal Soto, Majadahonda, D. Martínez López, Majadahonda, B. Vera, Majadahonda, S. Villar, Majadahonda, S. Serrano-Fiz, Majadahonda, A. Forteza, Majadahonda Hypertrophic cardiomyopathy (HCM) is a heart disease characterized by left ventricular hypertrophy, in the absence of another etiology. At least 20% of patients with HCM present mid-ventricular and apical hypertrophy, with secondary diastolic dysfunction leading to an advanced functional class. In these stages, until recently, the only treatment that could be offered to patients was a heart transplant, alongside with the difficulties that this implies. In 2010 Schaff et al. described the transapical myectomy as a therapeutic option in patients with apical or mid-ventricular hypertrophy,
1600 - 1730 Management of neonates and low-weight infants with CHD Ultrafiltration Extracts Several Inflammatory Cytokines during Pediatric Cardiac Surgery and Cardiopulmonary Bypass
increasing the left ventricular cavity and relieving diastolic dysfunction. In 2016, our centre started the management program for patients with HCM, with 7 patients undergoing apical myectomy in the last 5 years. The aim of this study is to present the functional outcomes of ventricular cavity augmentation trough the transapical myectomy procedure in these patients. We collected data from the electronic health record and the cardiovascular surgical database from November 2016 to April 2021. A group of 7 patients underwent transapical myectomy associated or not with transaortic myectomy. The data were grouped and compared with SPSS 2.7 (IBM Corp. Released 2020. IBM SPSS Statistics for Windows, Version 27.0. Armonk, NY: IBM Corp).
We conclude that transapical myectomy, associated or not with other cardiac surgeries, is a safe and effective approach for symptomatic relief in HCM patients with apical and mid-ventricular hypertrophy. Myectomy is the only current surgical option in patients with HCM before requiring a heart transplant. Figure 1
We found all patients were in New York Heart Association (NYHA) class III or IV, 42,8% had angina and 28,6% had syncope. 71,4% of patients underwent transapical myectomy associated with transaortic myectomy. In the analysis of data, we evidenced a decrease in maximum wall thickness from 23,9 to 12,41 mm (p=0,003) and a reduction in the maximum gradient from 32,43 to 0 mmHg (p=0,051). The left ventricular enddiastolic volume increased from 59,06 to 91,26 (p=0,06). The hospital mortality was 14.2% due to the death of a patient because of SARS-CoV 2
and IL-8 have been observed to be produced during the CPB time.[3] This innate immune reaction can cause vasoplegia and significant post-operative multi-organ dysfunction in some patients. [1,4] Therefore, systemic inflammation can be a source of morbidity and prolonged recovery for infants and children with congenital heart disease undergoing operative repair.
J. Bierer and D. Horne Cardiac surgery with cardiopulmonary bypass (CPB) elicits a systemic inflammatory response in pediatric patients. [1] Other factors such as tissue ischemiareperfusion, contact system activation, coagulation cascade Joel Bierer dysregulation, nonpulsatile blood flow, hypothermia, deep hypothermic circulatory arrest and blood product administration amplify inflammation during the surgery.[2] Circulating levels of activated complement, C3a and C5a, as well as pro-inflammatory cytokines TNF-α, IL-6
infection during admission. Survival at 1 and 3 years was similar, 85.71%. 71,4% of patients were in NYHA I after surgery and all the patients showed a decrease in the cardiological medication during the postoperative period.
Ultrafiltration has been used for decades to remove excess volume and hemoconcentrate both blood cells and coagulation factors.[5] Furthermore, this technique extracts small molecules through the membrane’s pores which are selective by molecular weight (<65kDa).[5] Cytokines are small, usually less than 40 kDa, and should be extracted as well. However, only a limited number of these inflammatory mediators have been directly identified in the ultrafiltration effluent. To better understand the impact of ultrafiltration on the innate immune response during CPB, our research group measured the concentrations of 38 inflammatory factors (complement, cytokine, chemokine, and leukocyte adhesion pathway) in the blood and ultrafiltrate effluent of 20 pediatric patients at the end of CPB. Our center utilizes a continuous form of ultrafiltration called subzero-
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balance ultrafiltration (SBUF).[6] Twenty-one entities were directly measured in the effluent, including C5a, TNF-α, IL-1β, IL-6, IL-8 and several chemokines. Therefore, SBUF functions as an immunomodulatory therapy throughout the entire CPB time. Ongoing translational work will identify which pro-inflammatory mediators are best correlated with adverse post-operative outcomes and, furthermore, how ultrafiltration can be optimised to dampen the systemic inflammatory response and enhance recovery for infants and children undergoing cardiac surgery with CPB. References 1 Bronicki RA, Hall M. Cardiopulmonary bypass-induced inflammatory response: Pathophysiology and treatment. Pediatr Crit Care Med 2016;17:S272–8. 2 Kozik DJ, Tweddell JS. Characterizing the Inflammatory Response to Cardiopulmonary Bypass in Children. Ann Thorac Surg 2006;81. 3 Paparella D, Yau TM, Young E. Cardiopulmonary bypass induced inflammation: pathophysiology and treatment. An update. Eur J Cardiothorac Surg 2002;21:232–44. 4 Omar S, Zedan A, Nugent K. Cardiac Vasoplegia Syndrome : Pathophysiology, Risk Factors and Treatment. Am J Med Sci 2015;349:80–8. 5 Bierer J, Stanzel R, Henderson M, Sett S, Horne D. Ultrafiltration in Pediatric Cardiac Surgery Review. World J Pediatr Congenit Hear Surg 2019;10:778–88. 6 Bierer J, Henderson M, Stanzel R, Sett S, Horne D. Subzero balance simple modified ultrafiltration (SBUF-SMUF) technique for pediatric cardiopulmonary bypass. Perfusion 2021:1–4.
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EACTS DAILY NEWS
ABSTRACT SESSION
16:00 - 17:30 The latest on degenerative mitral regurgitation Three technical additions improve outcome and operative times in minimally invasive mitral surgery N. Bonaros, Innsbruck, D. Höfer, Innsbruck, C. ÖZpeker, Innsbruck, C. Gollmann-Tepeköylü, Innsbruck, L. Stastny, Innsbruck, H. Hangler, Innsbruck, M. Grimm, Innsbruck, L. Müller, Innsbruck In this study, we aimed to identify the impact of era and technical improvements on perioperative outcome after minimally invasive mitral valve surgery (MIMVS). We retrospectively investigated 1000 patients (mean age: 60.8±12.7y, 60.3% male) who underwent MIMVS between 2001-2020 in our institution. The patients were allocated to 4 groups according to the case number quartiles. Periprocedural success, safety and operative times were identified as outcome parameters. Operative success was defined as: Successful primary mitral repair without conversion to replacement, or larger thoracic incisions, no residual MR>mild at intraoperative TEE, and no need for reoperation within 30d. Nikolas Bonaros
16:00 - 17:30 The latest on degenerative mitral regurgitation Significance of mitral annular disjunction to avoid coronary artery injury during mitral valve surgery Kuroda Y, Marui A, Arai Y, Nagasawa A, Ono N Department of cardiovascular surgery, Kokura Memorial Hospital, Fukuoka, Japan The left circumflex coronary artery (LCX) is susceptible to injury during mitral valve surgery. Mitral annular disjunction (MAD) is defined as a separation between the atrial wall-mitral valve junction and the left ventricular attachment. It is associated with mitral valve prolapse. The relationship between mitral annulus and LCX in patients with MAD is poorly documented. The aim of this study is to investigate the distance between mitral annulus and LCX and to clarify whether LCX is close to mitral annulus in patients with MAD compared with patients without MAD. Of the 52 patients who underwent mitral valve repair for mitral valve prolapse (patients with infective endocarditis were excluded.) in our hospital in 2020, measurement of the distance between mitral annulus and LCX with TEE was performed in 40 patients. We measured distance between mitral
The definition of safety included: freedom from perioperative (30d) death, myocardial infarction, stroke, use of ECMO or reoperation for bleeding. Three technical interventions were introduced during the observed period of 19 years: (1) the introduction of a fully endoscopic technique through 3D visualisation, (2) the adoption of pre-measured loops of neochordae for prolapse correction and (3) the implementation of a preoperative CT scan to exclude unsuitable candidates for MIMVS. Comparisons were made between the 4 quartiles and before and after the introduction of technical improvements by chisquare test and one-way ANOVA.
Take home message Increased surgical experience improves safety in MIMVS. Technical improvements -such as 3D visualisation, standardised use of loops and preoperative CT scan- are related to increased operative success and decreased operative times in patients undergoing mitral repair.
Figure 1
Perioperative survival, periprocedural success and safety were 99.1%, 93.5% and 96.3% respectively. There was a significant improvement in the combined periprocedural safety endpoint within the different eras mainly attributed to the lower need for ECMO support (p=0.036) and less reoperations for bleeding (p=0.007). On the other hand, the influence of era according to the different quartiles on periprocedural success was not statistically significant (p=0.590). The impact of technical improvements was thoroughly investigated in 897/1000 patients who underwent mitral valve repair on an intent to treat basis. The implementation of endoscopic techniques through 3D visualisation had a significant impact on periprocedural success but not on safety. All three improvements led to decreased cardiopulmonary bypass and cross-clamp times in this patients’ cohort (s. Table 1).
annulus and LCX by multiplanar reconstruction (MPR) of three-dimensional (3D) TEE. Patients with MAD (group M) were compared to patients without MAD (group N). The minimum distance between mitral annulus and LCX was less than 3mm in 33% of the patients. The area of the closest distance from mitral annulus to LCX was 70-90 degree counterclockwise (near anterolateral commissure) regardless of the presence of MAD. In patients with MAD, the minimum distance between the mitral annulus and LCX was about 50% as compared to those without MAD. In conclusion, more careful stitching near anterolateral commissure is required during mitral valve surgery in patients with MAD than in patients without MAD. Figure 1
MAD Carmo, P. et al. Cardiovasc Ultrasound 8, 53 (2010) (modified)
Figure 2
Proximity area 70-90°
70° P1A1A2 P2
A3 P3
Issue 1 Thursday 14th October
ABSTRACT SESSION
16:00 - 17:30 Various perspectives to approach the acute Type A aortic dissection Effects of a frozen elephant trunk on postoperative renal dysfunction in acute type A aortic dissection extending into the renal artery Homare Okamura, Nerima Hikarigaoka Hospital, Tokyo, Japan Preoperative renal malperfusion is reportedly an independent predictor of postoperative acute kidney injury (AKI) and operative mortality in patients who undergo surgical treatment for acute type A aortic dissection (ATAAD). The frozen elephant trunk (FET) technique promotes blood flow into the true lumen (TL), induce false lumen (FL) thrombosis, and minimise late reoperation rates in patients with ATAAD. However, it is unclear whether the FET technique followed by restoration of blood flow into the TL is beneficial or harmful for renal perfusion and postoperative renal function in patients with renal malperfusion, particularly in those in whom the renal artery (RA) originates from the FL. In this study, we
investigated the effects of FET on early outcomes, including renal dysfunction, in patients with ATAAD extending into the RA. This study included 53 patients with preoperative CT-documented ATAAD extension into the RA. Clinical outcomes and computed tomography (CT) findings of the RA were compared between 29 patients with and 24 patients without the FET prosthesis. RA abnormalities secondary to the ATAAD were categorised into the following types: occlusion, dissection, RA originating from the FL, and narrowed TL (<50% of the RA). Figure 1 shows the numbers of patients with each aforementioned RA abnormality and the representative CT images. Origin of the RA from the FL was the predominant morphological abnormality in this study. The left RA was more frequently affected by the ATAAD, except in patients with RA occlusion.
The radiographic morphology of the RAs was compared pre- and postoperatively between 21 patients in the non-FET and 28 patients in the FET group. Overall, most RAs that originated from the FL preoperatively did not show postoperative changes. One occluded RA was changed to the dissected RA postoperatively. Three of the 7 RAs with narrow TL preoperatively changed to normal RA postoperatively. In this study, the FET technique effectively prevented postoperative AKI in patients with ATAAD extension into the RA. Large-scale studies are warranted to conclusively establish this result. Figure 1: The numbers of patients with each renal artery abnormality and the representative computed tomography images
Although the cardiopulmonary bypass and lower body hypothermic circulatory arrest times were longer in the FET group, the postoperative AKI rates were lower in the FET group than in the nonFET group (34.5% vs. 66.7%, P=0.028). However, no intergroup difference was observed in the rates of hemodialysis necessitated by postoperative renal dysfunction.
16:00 - 17:30 Various perspectives to approach the acute Type A aortic dissection Quantification of visceral perfusion and impact of femoral cannulation in vitro model of aortic dissection. W. Heo, Busan, S.-W. Song, Seoul, T.-H. Kim, Seoul, H. Ha, Chuncheon-si, G.H. Lee, Chuncheon-si, K. J. Yoo, Seoul, B.-K. Cho, Seoul In this study, we aimed to simulate visceral perfusion and the impact of additional femoral cannulation in an in-vitro model of aortic dissection. This is important, as it is difficult to study hemodynamics of such cases in vivo, and we hypothesised that femoral-artery cannulation in the initial phase of cardiopulmonary bypass would improve visceral perfusion via restored blood flow in the true lumen in patients with visceral malperfusion due to acute aortic dissection. Via in-vitro experiments and 4D Flow MRI flow analysis, we confirmed that intimal-flap motion can partially block blood flow to the celiac axis (CA) and superior mesenteric artery (SMA). As the total flow increased with AC, the intimal flap moved closer to the CA and SMA, which indicates that AC-derived flow may induce visceral malperfusion. In our in-vitro experiment, we also confirmed that additional femoral cannulation can increase visceral perfusion. Thus, Axillary and femoral cannuulation (AFC) may increase visceral perfusion during the initial phase of CPB. We believe that our study makes a significant contribution to the literature because our model can be used to perform computational fluid-dynamic analysis by taking into account the fluid–structure interaction, which is useful in predicting the hemodynamic changes caused by aortic dissection.
“In our in-vitro experiment, we also confirmed that additional femoral cannulation can increase visceral perfusion.”
Figure 1: The flap deformation of the celiac and superior mesenteric artery in the AC (A), in the AFC (B)
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EACTS DAILY NEWS
ABSTRACT SESSION
16:00 - 17:30 Treatment options for end-stage emphysema Prolonged cold ischemia and indirect allorecognition are fundamental for the development of chronic lung allograft dysfunction Hengshuo Liu12, Christine Hollauer2, Christian Hagl1, Sebastian Michel1, Ali Oender Yildirim2, Alexey Dashkevich1 1. Department of Cardiac Surgery, Ludwig Maximilian University of Munich, Germany 2. Comprehensive Pneumology Center (CPC), Institute of Lung Biology and Disease, Helmholtz Zentrum Munich, Member of the German Center for Lung Research (DZL), Nueherberg, Germany. Lung transplantation (LTx) is a life-saving treatment for patients with terminal lung diseases. During 2020, some patients with COVID-19-associated acute respiratory distress syndrome received LTx bridged by extracorporeal membrane oxygenation. The biggest challenge of this surgical treatment is the poor long-term survival (6.2 years in adult, 5.7 years in paediatric, from ISHLT registry 2019) due to the onset and progression of chronic lung allograft dysfunction (CLAD), which comprises histologically Hengshuo Liu and clinically heterogeneous phenotypes including bronchiolitis obliterans syndrome (BOS) and restrictive allograft syndrome (RAS). Due to the lack of animal model, the mechanisms of the onset and development of CLAD are largely
16:00 - 17:30 Controversies in Aortic Valve Repair
unknown. Studies have shown that lymphatic vessels play fundamental roles in protecting damage from acute lung rejection and influenza, as well as maintaining lung homeostasis, suggesting that lymphatic vessels and lymphatic endothelial cells might be a novel therapeutic target for improving the long-term survival of LTx patients. To evaluate this hypothesis, I established a mouse model of orthotopic LTx with a single mismatch between donor lungs from HLA-A2-knockin mice on a C57BL/6J and their C57BL/7J recipients. Donor lung was induced 6-hour cold ischemia. Two months after the LTx, the allogeneic LTx mouse lung developed late stage CLAD with features of both BOS and RAS, whereas the syngeneic LTx mouse lung didn’t show signs of pathological condition. In our recent publication, when 1-hour cold ischemia is induced on this model, the allogeneic LTx mouse lung develops lymphocytic bronchiolitis, an early stage of BOS. Taken together, these data suggest that deteriorated ischemia reperfusion injury and alloimmune response are fundamental for the development of late-stage CLAD in our experimental LTx model. Furthermore, the prolonged cold ischemia in allogeneic LTx led to a lymphatic phenotype similar to human RAS. Since lymphangiognesis is mediated by vascular endothelial growth factor receptor 3 signalling, the elevated lymphatic density in LTx was likely driven by the increased vascular endothelial growth factor C (VEGFC) expression in pro-inflammatory macrophages and antiinflammatory macrophage that infiltrated to the lung graft.
“these data suggest that deteriorated ischemia reperfusion injury and alloimmune response are fundamental for the development of late-stage CLAD in our experimental LTx model.”
Figure 1: A. Intra-operative image of Aortic Reimplantation of a bicuspid aortic valve with borderline root ectasia. B. Intraoperative image of External Ring annuloplasty of a bicuspid aortic valve with borderline root ectasia.
Reimplantation versus Aortic Ring annuloplasty in bicuspid valve with borderline aortic root ectasia Francesco Giosuè Irace1,2,3, Ilaria Chirichilli1,2, Giulio Folino1,4, Andrea Salicaa, Lorenzo Guerrieri Wolfa, Raffaele Scaffaa, Salvatore D’Aleoa, Luca Paolo Weltert1,5, Ruggero De Paulisa,6 1. Department of Cardiac Surgery, European Hospital, Rome, Italy 2. Department of Cardiac Surgery and Heart Transplantation, San Camillo Forlanini Hospital, Rome, Italy 3. Department of General and Specialized Surgery “Paride Stefanini”, Sapienza University, Rome, Italy 4. Department of Cardio-Thoracic and Vascular Sciences, University of Padua, Italy 5. Department of Statistics, UniCamillus International University of Health Sciences, Rome, Italy 6. Chair of Cardiac Surgery, UniCamillus, International University of Health Sciences, Rome, Italy
Figure 2: Schematic representation of fate of non-replaced aortic root in External Ring patients: after the immediate pot-operative reduction, aortic root dimensions did not vary significantly over time.
We selected patients with BAV and borderline ectasia of the aortic root (40-48 mm) who underwent Reimplantation or ER repair. We compared the two techniques, analysing immediate post-operative and follow-up echocardiography. Only patients with at least 1 year follow-up were included. Mean follow-up time was 47.7 ± 27.6 months. There were no deaths during follow-up periods in both groups. Three patients required reoperation in ER group because of recurrent aortic regurgitation, with a freedom from reoperation of 77.8 ± 12 % at 7 years (no reoperations were required in Reimplantation group). In ER group we observed an immediate post-operative root diameter reduction (mean reduction -3.2 ± 2.9 mm, P<0.01) and no significative expansion during follow-up + 0.4 mm/y (P = 0.184) (Figure 2). In conclusion, excellent results of reimplantation technique are confirmed and are stable over time. Root diameter in borderline BAV patients seems to remain stable over time when treated with External Ring technique. The higher incidence of reoperation after External Ring appears to be due to the progressive learning curve (246 pts vs. 52). Longer follow–up studies are needed. References:
Over the past 20 years, bicuspid aortic valve (BAV) repair has become a valid alternative to conventional aortic valve replacement (AVR) with excellent hemodynamic and survival results1. In our recent anatomical study, we compared Ilaria Chirichilli, MD aortic reimplantation and Francesco Giosuè with Valsalva graft Irace, MD. with aortic External Ring (ER) annuloplasty in BAVs, analysing their morphological features with CT scan2. We found that, both reimplantation with Valsalva graft and external ring annuloplasty, achieve an efficient aortic annuloplasty with similar anatomical and functional results on BAVs, in terms of effective
Height (eH) and coaptation Length (cL). In general, the BAV repair comprises the plication of the free margins of the prolapsing cusps to correct the prolapse plus an annuloplasty suture or ring to correct annular dilatation and stabilize the repair3. Hence, BAV repair can be achieved, among a variety of surgical technique depending on the type of BAV pathology, through aortic reimplantation procedure (David) or External Ring annuloplasty (Figure 1). The first approach could be an “overtreatment” in case of nonaneurysmatic aortic root. The second approach, on the contrary, could be an “undertreatment” in case of dilated root. The aim of the study is to retrospectively compare the two techniques in patients with borderline aortic root dimensions (between 40 and 48 mm), analysing early results, aortic regurgitation recurrence and the fate of non-replaced root over time.
1. Ehrlich T, de Kerchove L, Vojacek J, Boodhwani M, El-Hamamsy I, De Paulis R, Lansac E , Bavaria JE, El Khoury G, Schäfers HJ. State-of-the art bicuspid aortic valve repair in 2020. Prog Cardiovasc Dis. Jul-Aug 2020;63(4):457-464. 2. Chirichilli I, Irace FG, Salica A, D’Aleo S, Guerrieri Wolf L, Garufi L. and De Paulis R. Root reimplantation and aortic annuloplasty with external ring in bicuspid aortic valve: an anatomical comparison. Semin Thoracic Surg. 2021 Jul 1:S1043-0679(21)00307-5. 3. Michelena HI, Della Corte A, Evangelista A, Maleszewski JJ, Edwards WD, Roman MJ, Devereux RB, Fernandez B, Asch FM, Barker AJ, SierraGalan LM, De Kerchove L, Fernandes SM, Fedak PWM, Girdauskas E, Delgado V, Abbara S, Lansac E, Prakash SK, Bissell MM, Popescu BA, Hope MD, Sitges M, Thourani VH, Pibarot P, Chandrasekaran K, Lancellotti P, Borger MA, Forrest JK, Webb J, Milewicz DM, Makkar R, Leon MB, Sanders SP, MD, Markl M, Ferrari A, Roberts WC, Song JK, Blanke P, White CS, Siu S, Svensson LG, Braverman AC, Bavaria J, Sundt TM, El Khoury G, De Paulis R, Enriquez-Sarano M, Bax JJ, Otto C, Schafers HJ. International Consensus Statement on Nomenclature and Classification of the Congenital Bicuspid Aortic Valve and its Aortopathy, for clinical, surgical, interventional and research purposes. Eur J Cardiothorac Surg. 2021 July 22;ezab038. Online ahead of print.
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VISITING BARCELONA BARCELONA HAS SOME OF THE MOST UNIQUE AND INSPIRING ARCHITECTURE IN THE WORLD. A VISIT TO THIS WONDERFUL CITY IS NOT COMPLETE WITHOUT A TOUR OF SOME OF ITS MOST FAMOUS AND AWE-INSPIRING BUILDINGS AND MUSEUMS. The most notable architecture in Barcelona is undoubtedly the masterpieces of Catalan architect, Antoni Gaudí. This includes the magnificent Basílica de la Sagrada Familia, which has become a symbol of the city. Other examples of Gaudi’s work include Casa Batlló, once home to the Batlló family. Known for its vibrant colors, intricate tile work and skeletal- looking terraces, the façade of this UNESCO World Heritage site is inspired by the legend of St. George, the famous dragon slayer.
CELEBRATE SPORTING EXCELLENCE
And if you’re a football fan, you can’t leave Barcelona without a visit to FC Barcelona’s headquarters, Camp Nou Stadium. With a seating capacity of 99,354, it is the largest stadium in Europe. Take a tour around the stadium and celebrate the club’s history in the FC Barcelona Museum.
Located down the street from Casa Batlló is La Pedrera (Casa Milà), the last private residence designed by Gaudí. The Catalan-style art nouveau building gets its name, which means ‘the stone quarry’, from its rough-looking facade. A climb to the rooftop of this building is rewarded with excellent views of the city, especially at night. The Barri Gòtic, or Gothic Quarter, is the medieval centre of the city. The labyrinth of narrow roads lead to picturesque plazas that are home to Roman and Medieval-era architecture. Stop in Plaça Reial and the smaller, much quainter Plaça Sant Felip Neri, which was bombed by Spanish dictator Francisco Franco during the Spanish Civil War (you can see scars from the attack on the church in the square). The Gothic Quarter is free to explore all hours of the day and night. The Barcelona Tourism Board also offers walking tours.
FOR ART LOVERS Barcelona is an appealing city for art lovers, with a large number of museums celebrating the work of the city’s most influential artists. The Museu Nacional d’Art de Catalunya is located in the stunning Palau Nacional of Montjuïc. The museum houses the best collection of Romanesque mural paintings in the world as well as the works of many Catalan artists, including Salvador Dalí. Current exhibitions include ‘Museum in Danger! Safeguarding and organisation of Catalan art during the Civil War’. When travelling to Barcelona, you will inevitably come across art works by Joan Miró, one of the city’s most famous artists and a pioneer of Surrealism. A huge mosaic of Miró greets visitors at the airport and a tile mosaic designed by the artist can be found on La Rambla, the tree lined pedestrian street which runs through the heart of the city. One of the most comprehensive selections of Miró’s work, offering a thorough overview of all the stages of his life and career, can be found at the Fundació Joan Miró. Lastly, the Picasso Museum is a must see for any fans of Picasso. This museum is dedicated to his formative years, focusing on art he made whilst living in the city and is home to the largest collection of Picasso’s art in the world.
“Barcelona is an appealing city for art lovers, with a large number of museums celebrating the work of the city’s most influential artists.”
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