Session Preps Surgeons on Advanced Therapies for End-Stage Heart Disease

The field of treating advanced-stage heart failure is rapidly evolving, and several expert speakers will introduce the latest recommendations in mechanical circulatory support, heart transplantation, and alternative treatment strategies during a half-day of education Tuesday.

Francis D. Pagani, MD, co-moderator of the 1:00 p.m. to 5:30 p.m. session in Room 128AB, said with the advent of ENDURANCE, ROADMAP, and other left ventricular assist device (LVAD) clinical trial results, along with newer devices planned for clinical evaluation, it is important to update surgeons about the implications for patient outcomes.

Michael A. Acker, MD, Philadelphia, will discuss whether ENDURANCE and ROADMAP have changed the practice of LVAD therapy in the United States. In ROADMAP, trial investigators evaluated the effects of treatment with the HeartMate II LVAD to standard medical therapy. ENDURANCE, for which Dr. Pagani is a co-principal investigator, compared the HeartWare HVAD against the HeartMate II LVAD.

“Although both the HeartMate II and HeartWare HVAD are efficacious in terms of keeping patients alive without a heart failure, they have different adverse event profiles. It’s important for surgeons to understand those differences,” said Dr. Pagani, the Otto Gago, MD Professor of Cardiac Surgery, Surgical Director of Adult Heart Transplantation, and Director of the Center for Circulatory Support at the University of Michigan in Ann Arbor.

Daniel J. Goldstein, MD, Bronx, N.Y., will discuss new LVAD trials and technology, including whether these new LVADs have been associated with better patient outcomes. In particular, he will discuss the recently completed HeartMate 3 trial in Europe.

Three speakers will help surgeons understand where the field is at in terms of new devices. Carmelo A. Milano, MD, Durham, N.C., will present on developing a rational approach to treatment of shock with extracorporeal mechanical circulatory support and extracorporeal membrane oxygenation. Nicholas G. Smedira, MD, Cleveland, will describe high-risk alternative strategies in the era of STS National Database reporting. Jay D. Pal, MD, Seattle, will talk about non-sternotomy approaches to VAD implantation.

After a panel discussion and two abstract presentations, four speakers will tackle important topics. Gonzalo V. Gonzalez-Stawinski, MD, Dallas, will discuss solutions for the unique challenges of LVAD therapy or transplant for adult congenital heart disease. Eric J. Velazquez, MD, Durham, N.C., will update attendees on the STICH trial, including whether the approach to ischemic heart disease should be altered because of trial results. Stephanie L. Mick, MD, Cleveland, will look at percutaneous options for structural heart disease in the setting of severe left ventricle dysfunction, as these patients are not optimal surgical candidates. The last speaker, Donald D. Glower, MD, Durham, N.C., will give a talk on the evolution of surgical management of functional mitral insufficiency, including recent trial results.