Plenary Session Unveils New Approaches to Familiar Problems

Expanding the pool of donors for neonatal heart transplantation and using adjuvant therapy for node-positive esophageal cancer have the potential to improve patient outcomes, according to two studies that will be presented at today’s plenary session.

Plenary Session

Monday

9:30 a.m. – 12:15 p.m.

Ballroom 20

In addition to these abstracts, a late-breaking study on platelet transfusion during the rewarming phase of cardiopulmonary bypass in neonates also will be presented. The three papers will be followed by the highly anticipated Presidential Address from Keith S. Naunheim, MD.

Research Confirms Promising Results for Adjuvant Therapy
A retrospective cohort study across nine institutions and more than 1,000 patients has found that adjuvant treatment following surgery for esophageal cancer is associated with a 24% reduction in mortality. 

Tara Semenkovich, MD

Tara Semenkovich, MD

Median survival for patients who received adjuvant therapy following resection was 2.6 years, compared to 2.3 years for patients who did not receive adjuvant therapy.

“We know the optimal treatment is neoadjuvant chemotherapy or chemoradiation therapy followed by surgical resection if you have locally or regionally advanced cancer and you are a good operative candidate,” said Tara Semenkovich, MD, MPHS, of the Washington University School of Medicine in St. Louis. “It is well established that patients who have residual positive lymph nodes following resection have a worse prognosis, but there was controversy regarding what to do about it.”

An earlier study at Washington University showed promising results for adjuvant therapy, but the cohort was only about 100 patients. A similarly small study from another institution found no benefit from adjuvant therapy. Population studies using the National Cancer Database suggested potential benefit, but the conclusion was clouded by possible selection bias. 

“Clinical guidelines right now are ambiguous, as you might expect from the lack of good data,” Dr. Semenkovich said. “This is the largest and most detailed cohort of esophageal cancer patients receiving adjuvant treatment that has ever been assembled to look specifically at this question. Our study makes a much stronger argument for providing adjuvant chemotherapy to patients who can tolerate it and can help guide clinical decision-making.”

Researchers Look to Expand Donor Pool for Neonatal Heart Transplantation
In what may be the largest consecutive case series of newborn heart transplant patients ever presented, nearly all of the neonates who received transplants to treat congenital heart defects at one institution are still alive with the same hearts that were transplanted as long as 34 years ago. 

“We wanted to show that babies who receive heart transplants do very well in the long run,” said John Mohan, MD, of Loma Linda University School of Medicine in California. “If we can find ways to enlarge the organ pool, we could increase the applicability of transplantation and make a dramatic improvement in these babies’ lives.”

The dilemma of how to treat newborns with congenital heart defects has more to do with logistics than clinical issues. Heart transplantation has long been recognized as preferable to palliative reconstructive surgery, with a 5-year survival of 80%-85% following heart transplantation compared to 58%-76% for staged palliation. But the organ pool of neonatal hearts is so small that most potential candidates are never placed on the transplantation list.

The advent of infant car seats dramatically reduced the number of newborns suffering fatal head trauma, and the decline of sudden infant death syndrome resulting from putting infants to sleep on their backs virtually eliminated the other major pool of newborn hearts that was available in the 1980s and 1990s.

But there are at least two other pools of potential donors, Dr. Mohan said. One is the 600 to 700 babies born annually in the United States with anencephaly, who inevitably die. Policies regarding the determination of brain death in these infants are not uniform, and the issue is fraught with ethical questions.

A second potential pool is donation after circulatory determination of death (DCD). Transplants using DCD organs are currently less successful than transplantation of organs retrieved following brain death.

“If we can find a way to make donation after cardiac death more usable, that would increase the pool of organ donors,” Dr. Mohan said. “We should seriously consider both these options if we want to increase the number of donor organs available for newborn heart transplantation.” 

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