Uncover Tips for Adult Cardiac, General Thoracic Surgery

“HOW TO” VIDEO SESSIONS

Sunday

TECHNICAL TRICKS AND PITFALLS TO SIMPLIFY CARDIAC SURGERY PROCEDURES

10:00 a.m. – 4:30 p.m.

Room 320ABC

TIPS AND TRICKS IN GENERAL THORACIC SURGERY

1:00 p.m. – 4:30 p.m.

Room 351DEF

Two exciting how-to video sessions on Sunday will provide attendees with specific strategies for success and pitfalls to avoid related to adult cardiac and general thoracic surgical procedures.

Adult Cardiac Surgery

In this session, 30 presentations will focus on six adult cardiac surgery areas—coronary artery bypass grafting (CABG) surgery, mitral valve surgery, atrial fibrillation, aortic valve surgery, thoracic aortic surgery, and heart failure. The presentations cover routine to more complex procedures that appeal to both private practice and academic surgeons.

One section of the program was developed in response to recent investigations showing surgical ablation of atrial fibrillation during mitral valve surgery is effective. The atrial fibrillation section also will cover how to perform a Maze procedure, along with how to employ newer techniques in a minimally invasive fashion.

By adding a section on heart failure and weaning catastrophes, co-moderator Gorav Ailawadi, MD sought to give surgeons approaches for dealing with challenging high-risk patients.

“We want to help the audience get the patient out of the operating room and provide other options,” said Dr. Ailawadi, of the University of Virginia Health System in Charlottesville.

The how-to video sessions will help STS Annual Meeting attendees hone their techniques in several procedures.

The how-to video sessions will help STS Annual Meeting attendees hone their techniques in several procedures.

In particular, presenters will offer guidance on how to perform techniques that should be part of any busy surgeon’s armamentarium: weaning from a subclavian intra-aortic balloon pump, the Impella 5.0, a temporary left ventricular assist device (LVAD), and a right VAD. This section also will cover elective LVAD insertion, the minimally invasive HeartWare VAD, and pulmonary thromboendarterectomy for treatment of acute pulmonary embolism.

Presenters in the CABG section will demonstrate no-touch aorta CABG, among other procedures.

“We’ll focus on how to handle some of the more challenging situations, such as when you have a completely occluded artery and you have to remove the plaque in order to do the bypass,” Dr. Ailawadi said.

With widespread adoption of mitral surgery by cardiothoracic surgeons, the mitral valve section will offer several talks, including transseptal exposure of the mitral valve during surgery and transcatheter puncture for the MitraClip procedure.

Transcatheter aortic valve replacement is becoming more common, and the aortic valve surgery section will delve into how to handle some of the complications seen with the procedure, such as paravalvular leak with valve malposition and annular rupture. Another talk will highlight running sutures during aortic valve replacement.

Planners also sought to touch on aortic surgery with four presentations, including one on homograft insertion for root abscess.

“On an increasing basis, we are seeing more patients with aortic endocarditis, mitral valve endocarditis, and aortic root abscesses,” said Workforce on Annual Meeting Chair and co-moderator of the session Wilson Y. Szeto, MD, of the University of Pennsylvania in Philadelphia.

Dr. Szeto will describe the valve-sparing David procedure, which he said is being performed more commonly. Two other presenters will offer advice on endografting for chronic dissections with aneurysm and endografting in the setting of the hybrid procedure, which Dr. Szeto said has continued to improve due to innovation and creativity.

General Thoracic Surgery

The technical tips and tricks session incorporated into the General Thoracic Surgical Symposium is tailored to help participants conduct more difficult operations and the challenging portions of operations in a safe and effective manner.

“We selected areas that we think are challenging for surgeons, especially those who may not work every day in a subspecialty of our field. They also may be called on to do any of these procedures in a minimally invasive fashion, which is often more difficult, because patients have come to expect that,” said Joseph B. Shrager, MD, Co-Chair of the Surgical Symposia Task Force.

Divided into four sections, the first will cover esophageal techniques. The anastomosis seems to be the Achilles heel of minimally invasive esophagectomy. Dr. Shrager pointed to two predominant minimally invasive techniques for esophagogastric anastomosis. One expert surgeon will therefore discuss the stapled, functional end-to-end, minimally invasive anastomosis, and another will describe his use of the OrVil EEA end-to-end anastomoser. Then the focus will move to the emerging use of ischemic preconditioning and SPY technology to create better blood flow in the gastric conduit.

“Leaking from an esophageal anastomosis is a big problem that everyone is interested in trying to reduce,” said Dr. Shrager, from Stanford University School of Medicine in California.

Three talks in the second section cover difficult pulmonary cases, with how-to advice on post-induction dissections via thoracotomy or minimally invasive surgery.

“This is useful for cases where there’s been preoperative treatment and a lot of scarring due to preoperative chemotherapy or radiation,” said Dr. Shrager.

Speakers in the third section will share their expertise on intraoperative decision making for difficult germ cell tumors and tricks for minimally invasively removing large thymomas.

“Decision making for mediastinal germ cell tumors is very complex,” Dr. Shrager said. “It’s always hard to know how aggressive we need to be to get out every little bit of these tumors, which often prove to have only benign elements after chemotherapy, but may involve major structures. Taking out every last fragment can substantially increase the scope of the surgery—but when is that okay?

“We’ll also have probably the world’s highest-volume robotic thymoma surgeon talking about how to remove larger thymomas safely without the risk of intraoperative spilling, which would be a disaster.”

Dr. Shrager will then describe his technique and results using a simplified method he has adopted to allow easy performance of diaphragm plication via video-assisted thoracic surgery.

The fourth and final section will offer help on transitioning to minimally invasive approaches and understanding the learning curve.

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