Chamberlain Papers Will Be Presented at Sunday Plenary

Transcatheter aortic valve replacement (TAVR) outcomes, the influence of regionalization on outcomes after pulmonary resection, and long-term survival differences between arterial and atrial switch procedures are the focuses of this year’s prestigious J. Maxwell Chamberlain Memorial Papers. These papers will be presented during the new Sunday opening plenary session. 

J. Maxwell Chamberlain Memorial Papers

Sunday

2:30 p.m. – 3:30 p.m.

Ballroom 20

SAVR Volume May Predict TAVR Outcomes
Hospital surgical aortic valve replacement (SAVR) volume alone appears to be an independent predictor of mid-term TAVR outcomes—specifically, the lower a hospital’s SAVR volume, the higher the mortality after TAVR.

Sameer A. Hirji, MD

Sameer A. Hirji, MD

“We found that unadjusted and adjusted mortality at 30 days and 90 days after TAVR were much higher in low-volume SAVR centers versus high-volume SAVR centers,” said Sameer A. Hirji, MD, of Brigham and Women’s Hospital in Boston. Dr. Hirji will present the Chamberlain Paper for Adult Cardiac Surgery. Low-volume was defined as centers performing 10-99 SAVR cases a year; high-volume was defined as centers performing at least 200 SAVR cases a year.

There has been a significant paradigm shift in the management of patients with symptomatic aortic stenosis and, correspondingly, a remarkable growth in the utilization of TAVR technologies. This is in part due to accumulating operator experience, innovations in valve design and technology, and improvements in patient selection, Dr. Hirji said. 

As a result, the Centers for Medicare & Medicaid Services (CMS) is re-examining its national coverage determination (NCD) for TAVR, which was released in 2012. This past July, STS was among the four medical specialty societies that provided information on minimum procedure volume requirements during a Medicare Evidence Development and Coverage Advisory Committee meeting. CMS is expected to unveil its updated TAVR NCD later this year.  

“Our study provides useful data that will help inform physicians, patients, and CMS policymakers as we all seek to further improve patient mortality and morbidity following TAVR,” added Tsuyoshi Kaneko, MD, also of Brigham and Women’s Hospital, who was senior principal investigator of the study.

Thoracic Surgery Regionalization Improves Outcomes
Not only is it possible to boost regionalization in US health care systems, but doing so can make a measurable, positive difference in patient outcomes following major pulmonary resection, according to the Chamberlain Paper for General Thoracic Surgery. 

Sora Ely, MD

Sora Ely, MD

The current literature on the volume-outcome relationship in major pulmonary resection for lung cancer is mixed and inconclusive. Additionally, many of the existing studies are based on data following centralization within national, single-payer systems, according to lead author Sora Ely, MD, of the University of California San Francisco East Bay Surgery Program in Oakland.

“We needed to examine whether similar changes to increase regionalization were possible in US systems and whether the improvement in results could be reproduced,” Dr. Ely said. 

The researchers found that regionalization:

  • More than tripled annual site volume and nearly doubled surgeon volume
  • Dramatically increased video-assisted thoracoscopic surgery (VATS) utilization and decreased intensive care unit utilization
  • Improved outcomes, with significant reductions in length of stay and complication rates

While the average VATS lobectomy operative time significantly decreased, average open lobectomy operative time significantly increased. 

“Although this finding initially surprised us, we believe that these changes together represent a maximization of safe VATS utilization, such that only the most difficult cases were performed using the open approach,” said Dr. Ely. “Our study’s regionalization process may be used as a model for implementation in other health care networks.”

Arterial Switch Trumps Atrial Switch for Long-Term Survival
Patients with transposition of the great arteries (TGA) who underwent either Mustard or Senning atrial switch repairs have a higher risk of premature death after 30 years than TGA patients treated with the Jatene arterial switch procedure.

Paul J. Devlin, MD

Paul J. Devlin, MD

The Chamberlain Paper for Congenital Heart Surgery presents findings from the Congenital Heart Surgeon’s Society (CHSS) TGA patient cohort, which was assembled during a unique period (1985-1989) when there was equipoise between the traditional Mustard and Senning atrial switch procedures and the newer Jatene arterial switch procedure. 

Today, the Jatene arterial switch procedure is the preferred surgery for TGA, but many adults who were treated with one of the atrial switch procedures are still alive.

“In addition to analyzing the long-term survival of these patients, we assessed patients’ perceptions of their own functional health status—which was similar across all domains,” said lead author Paul J. Devlin, MD, of The Hospital for Sick Children in Toronto, Canada.

To support important longitudinal studies such as this one, Dr. Devlin encouraged surgeons and cardiologists to follow-up with TGA-repaired patients and ensure that they are periodically meeting with an adult congenital heart disease specialist.

“It is important to closely monitor patients who have undergone one of the atrial switch procedures and reassess them for any changes in health status,” said Dr. Devlin. “Increasing surveillance of adults who have undergone TGA repair, especially the atrial switch patients, will ensure that they receive the care necessary to help alleviate their risk for premature death long after their initial repair.”

The Chamberlain Papers are considered by the Workforce on Annual Meeting Program Task Force to be among the best scientific abstracts submitted for the meeting. They honor the scientific contributions of Dr. Chamberlain, a renowned cardiothoracic surgeon who chaired the steering committee tasked with creating The Society of Thoracic Surgeons. 

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