Adult, Pediatric Surgeons Can Collaborate for Improved Outcomes



8:00 a.m. – 12:00 p.m.

Room 350DEF

Advances in surgical options for aortic valve disease and failing Fontans are helping to change long-term treatment strategies for patients with congenital heart disease. Surgeons have the potential to improve outcomes for adult and pediatric heart patients by sharing lessons learned in their respective areas of expertise.

Management strategies and tips will be provided in a 4-hour symposium on Sunday. The first part of the session will focus on managing aortic valve and aortic root disease, while the second part will look at issues related to transplantation and artificial hearts.

Jennifer S. Nelson, MD

Jennifer S. Nelson, MD

“The spirit of this session is to share ideas, collaborate, and focus on areas in cardiac surgery where pediatric cardiac surgeons and adult cardiac surgeons overlap,” said Jennifer S. Nelson, MD, symposium co-moderator and a congenital heart surgeon from Norfolk, Va. “We think that collaboration and sharing of ideas make us all better. This session asks you to step outside your comfort zone to see how it is done on the other side.”

Two presentations in the first part of the symposium will try to put in perspective two options for replacing aortic valves—transcatheter aortic valve replacement (TAVR) and a Ross procedure.

Vinod H. Thourani, MD, of Emory University in Atlanta, will discuss staging for TAVR. As aortic valve replacement has become more common in older patients, surgeons have begun to think about how that affects the treatment of young adults.

“The younger aortic valve population may require TAVR in the future, so this talk is designed to shed some light on staging, which is setting up that valve for the next valve procedure if it is going to be percutaneous,” Dr. Nelson said.

Another option is a Ross procedure. Richard G. Ohye, MD, of the University of Michigan C.S. Mott Children’s Hospital in Ann Arbor, will present data from his institution and discuss his indications for performing the procedure.

“When do the benefits of a Ross procedure in an older child become outweighed by the risks?” Dr. Nelson asked. “At what age is a mechanical valve or other prosthetic valve a better choice? We now have more long-term outcomes data on the durability of the Ross procedure.”

The session also will address when to determine if a valve-sparing procedure is not an option and long-term outcomes for repair of bicuspid aortic valves.

During the second half of the session, two presentations will focus on the long-term impact of living with single-ventricle physiology.

Steven J. Kindel, MD, from Children’s Hospital of Wisconsin in Milwaukee, will examine the timing of transplantation for a patient with a failing Fontan, as well as the role of temporary mechanical support as a bridge to transplantation. Kristine J. Guleserian, MD, of Miami Children’s Hospital, will discuss the challenges of transplantation in adult congenital patients who have been operated on several times.

“In the multiple redo situation, these can be very difficult cases. There often is a lot of reconstruction to be done,” Dr. Nelson said. “Dr. Guleserian will present video and photos to describe techniques and strategies not only for how you implant and reconstruct during the transplant, but also how you should harvest organs to make these reconstructions successful.”

Two personal case studies dealing with failing Fontans will be covered in another presentation by Carl L. Backer, MD, of Northwestern University School of Medicine in Chicago.

Two other surgeons will present tips for success on the cutting edge of mechanical support. Francisco A. Arabia, MD, MBA, of Cedars-Sinai Medical Center in Los Angeles, and J. William Gaynor, MD, of Children’s Hospital of Philadelphia, will discuss total artificial heart implantation and the use of artificial heart devices in patients with small body surface areas.

Dr. Nelson’s co-moderators are Joshua L. Hermsen, MD, of the University of Washington in Seattle, Robert B. Jaquiss, MD, of Duke University Medical Center in Durham, N.C., and Frank G. Scholl, MD, of Joe DiMaggio Children’s Hospital in Hollywood, Fla.

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