- American Association for Thoracic Surgery

Transcription

8:25 PM
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Tuesday Issue
TUESDAY
7:00 A.M. Cardiac Surgery Forum
General Thoracic Surgery Forum
8:45 A.M. Plenary Scientific Session
11:40 A.M. Honored Speaker Lecture
The Honorable Richard B. Cheney
Former Vice President of the United States
of America
2:00 P.M. Simultaneous Scientific Sessions
Adult Cardiac Surgery
Congenital Heart Disease
General Thoracic Surgery
New this year: AORTIC/ENDOVASCULAR
SURGERY
5:15 P.M. – 5:45 P.M. Executive Session
(AATS Members Only)
WEDNESDAY
7:00 A.M. Emerging Technologies and
Techniques Forum
9:00 A.M. Controversies in Cardiothoracic
Surgery
10:00 A.M. Adult Cardiac Controversies
Congenital Controversies
General Thoracic Controversies
11:00 A.M. Transcatheter Therapy and
Collaboration: Defining Our Future
2:30 P.M. 93rd Annual Meeting Adjourns
MINNEAPOLIS CONVENTION CENTER •
F
Visit AATS Daily News and
THORACIC SURGERY NEWS online:
www.thoracicsurgerynews.com
MAY 4 – 8, 2013
Presidential Address – Unintended
Consequences, Unexpected Opportunity
n his presidential address, on
Monday, Hartzell V. Schaff, MD,
addressed two key issues – leadership and scholarship. “To me,
these two values, leadership and
scholarship, define the American
Association for Thoracic Surgery
and its members,” he explained.
“On one level, thoracic surgeons, indeed all surgeons must be
leaders, leaders of your team in
the operating room and in the
hospital at large,” he said.
But the emphasis on leadership
has evolved over the last two
decades because of the financial
pressures in medicine and the complexity of the academic medical environment that requires interaction
with many others and prioritizes
I
the team approach, integrated practices, and multidisciplinary committees, according to Dr. Schaff. And
this has often led to a view that
does not adequately distinguish
leadership from management.
“I hope no one leaves this hall
thinking that I don’t understand or
appreciate the value of good management as a characteristic of
leadership,” said Dr. Schaff. “But
in overemphasizing management,
we risk overlooking other critically
important characteristics of leadership.”
To describe leadership, Dr.
Schaff recalled examples from author John Maxwell, who has a
long list of pithy quotes including
Presidential Address page 18
Hartzell V. Schaff, MD, spoke of the
key values that define the AATS.
Plenary’s Focus is Improving Outcomes
Honored Guest Lecturer: Former
Vice President Richard B. Cheney
ormer Vice President
Cheney may be almost as well known for
his long history of cardiovascular disease and
multiple procedures as
he is for his political career. He has had
quadruple bypass
RICHARD B. CHENEY
surgery, coronary artery
stenting, balloon angioplasty, was fitted with an LVAD, then finally
received a heart transplant in 2012. He will
bring his insights as a patient to our annual
meeting on Tuesday morning at 11:40 a.m.
MINNEAPOLIS, MN •
M ARTIN A LLRED
5/6/2013
he Plenary Sessions at the
AATS Annual Meeting feature some of the most significant research being performed in
cardiothoracic surgery today.
Moderated by Hartzell V. Schaff,
MD, of Mayo Clinic, and Thoralf
M. Sundt, III, MD, of Massachusetts General Hospital, the Mon-
T
day morning Plenary Session included talks ranging from the use
of anticoagulant therapy after
aortic valve replacement to human recombinant erythropoietin
therapy to help lower blood transfusions.
Using less aggressive
anticoagulant
therapy after AVR
Anticoagulant therapy after aortic valve
replacement with a
mechanical prosthesis can lead to increased risk of
major and minor
bleeding. John D.
Puskas, MD, of
Emory University,
initiated The
Prospective Randomized On-X Anticoagulation Clinical
Trial (PROACT) to
John D. Puskas, MD, presented the results of the
determine whether
PROACT trial.
it is safe and effecM ARTIN A LLRED
01_5_18aats13_Tues.qxp
tive to manage aortic valve replacement patients with a less aggressive
anticoagulant therapy, targeting a
lower International Normalized
Ratio (INR) than recommend by
ACC/AHA guidelines.
“Our study showed that using
such a less aggressive therapy led to
improved results with regard to
bleeding, without increased risk of
major events,” Dr. Puskas said during his presentation.
He and his colleagues randomized
patients with elevated preoperative
risk factors for thromboembolism
requiring aortic valve replacement
(AVR) to receive either lower dose
warfarin (treatment International
Normalized Ratio [INR] 1.5-2.0) or
to continue standard dose warfarin
(control INR 2.0-3.0), 3 months after
mechanical AVR. INR was adjusted
by home monitoring, and aspirin 81
mg daily was given to all patients.
The study was conducted under a
Food and Drug Administration
(FDA) investigational device exempPlenary Session page 3
5/4/2013
3:39 PM
Page 2
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5/6/2013
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AATS 93 RD ANNUAL MEETING
MINNEAPOLIS CONVENTION CENTER • MINNEAPOLIS, MN • MAY 4 – 8, 2013
M ARTIN A LLRED
Technical Performance Score is associated
with outcomes in cardiac surgery
Meena Nathan, MD, discussed predicting early
outcomes in cardiothoracic surgery patients.
Meena Nathan, MD, presented the results of a
prospective study of more than 800 consecutive
cardiothoracic surgery patients discharged at the
Boston Children’s Hospital, between Jan. 1, 2011 to
Dec. 31, 2011.
“Previous work at our institution validated the
efficacy of using a Technical Performance Score to
predict early outcomes in a select subset of procedures and age groups. We hypothesized that this
score can effectively predict early outcomes in
wider range of diagnosis and age groups,” said Dr.
Nathan
Technical Performance Scores (TPS) were assigned based on discharge echocardiograms and
the need for reinterventions in anatomic area of
interest. Case complexity was determined by
RACHS-1 scoring system and mortality and postoperative adverse events (excluding reinterventions
as they are components of the TPS) were also
monitored.
The median age of the patients was around 1.8
years. Over 90% of the procedures were performed
on pump. Around 17% of the patients were
neonates, around 73% were infants and children,
and almost 10% were adults, according to Dr.
Nathan.
the first operation. The rest received palliative
treatment and had a median survival of 25
months, which was a significant difference compared to curative treatment.
“We found that MnDCT was significantly better than chest x-ray for the detection of new or
recurrent lung cancer after curative resection.
The majority of new or recurrent cancer was detected by MnDCT at a subclinical stage within 2
years of surgery. This allowed for the delivery of
curative treatment in the majority of patients
with asymptomatic cancer and was associated
with long survival,” Dr. Hanna concluded.
Low-dose CT predicts new, recurrent lung
cancer
A minimal dose computed tomography chest scan
(MnDCT) delivers a radiation dose comparable to
a chest x-ray, and much lower than a diagnostic
CT scan, which could allow for more frequent
imaging with less concern about radiation exposure.
Wael C. Hanna, MD, and his colleagues at the
University of Toronto, hypothesized that in patients with completely resected lung cancer, surveillance with MnDCT, when compared to a
chest x-ray, would lead to earlier detection and a
higher rate of treatment of new or recurrent
lung cancer.
Between 2007 and 2012, over 300 patients
were prospectively enrolled in the study after
curative resection of lung cancer. Each patient
underwent surveillance MnDCT and CXR at 3,
6, 12, 18, 24, 36, 48 and 60 months after
surgery
The images were interpreted by different radiologists who were blinded to the other modality.
MnDCT was significantly more sensitive by
more than fourfold and had a significantly higher negative predictive value than chest x-ray for
the diagnosis of new or recurrent lung cancer.
Two-thirds of the asymptomatic patients were
diagnosed with MnDCT within the first year, with
around 26% within the second year. No asymptomatic patients were diagnosed with MnDCT in the
fourth and fifth year.
The majority of asymptomatic patients were
treated with curative intent surgery or radiation
and had a median survival of 69 months from
Blood-sparing cardiac surgery improved
using erythropoietin
In previous studies, Luca Weltert, MD, and his
colleagues at the European Hospital, Rome,
M ARTIN A LLRED
tion using a bileaflet mechanical valve prosthesis,
and adverse events were independently adjudicated
according to the AATS/STS guidelines for valve
studies, according to Dr. Puskas.
A total of 385 AVR patients were randomized
into roughly equal control and treatment
groups. The treatment group experienced significantly lower major and minor bleeding event
rates in terms of percentage of patients per year.
In addition, there was no significant difference in
the incidence of stroke, transient ischemic attack
(TIA), or total neurological events in the treatment group and compared with the controls,
said Dr. Puskas. “Maintaining INR between 1.5
and -2.0 appears to be safe in AVR patients after
implantation of this approved prosthesis,” concluded Dr. Puskas.
RACHS-1 categories and TPS were all significantly associated with mortality and occurrence of
adverse events in univariate analysis. After adjusting for complexity and age, multivariable modeling
showed that inadequate TPS was strongly associated with mortality, adverse events, and length of
stay.
“We found that the Technical Performance
Score is strongly associated with early outcomes
across a wide range of age and disease complexity, showing that it can serve as an important tool
for self-assessment and quality improvement,”
Dr. Nathan concluded.
Human recombinant erythropoietin can be used to
lower blood transfusions, said Luca Weltert,MD.
M ARTIN A LLRED
Plenary Session from page 1
3
Low-dose CT was superior to x-ray for detection of
new lung cancer, said Wael C. Hanna, MD,
showed that using human recombinant erythropoietin (HRE) helped lower blood transfusions
even when used at very short term before cardiac surgery.
“However, our original protocol, consisting of
five different doses in 5 days, proved to be complicated for everyday use and was too often discontinued. We therefore did a randomized prospective
study to find out if a receptor-saturating dose of
80,000 IU given as a bolus just 2 days before operation could match the efficacy of the previous protocol,” Dr. Weltert said.
He and his colleagues enrolled 600 consecutive
patients who were randomized to either an HRE
or a no-HRE control group. The primary end
point was the need for blood transfusion. The secondary end point was the incidence of adverse
events.
The HRE Group required nearly one-third fewer
blood units per patient, compared with the control
group (0.39 units vs. 1.12 units, respectively). The
mean hemoglobin level on postoperative day 4 in
the HRE group was slightly over 10 g/dL, compared with 9 g/dL in the control group, also a significant difference, said Dr. Weltert.
“Our new, simplified protocol maintains the
efficacy of the original, while avoiding a complicated dose regimen and refracted administration. Thus the use of HRE is confirmed as an
important step in a blood-sparing strategy,” Dr.
Weltert concluded.
4
5/6/2013
8:30 PM
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Science Lecture Illustrates Heart Valve Pathology
he basic science lecture,
“Update on SurgicalPathologic Correlates of
Valvular Heart Disease,”
proved anything but basic in
the hands of William D. Edwards, MD, who provided a
comprehensive look at aortic
and mitral valves with regard
to stenosis, regurgitation and
pathogenesis. He offered the
audience a wealth of surgical
and autopsy specimen slides
to illustrate each condition,
with more than a few
iPhones and iPads popping
up in the crowd to capture
the images.
Dr. Edwards, a member of
both the anatomic pathology department and the laboratory of medicine and
pathology at the Mayo Clinic, paid particular attention
M ARTIN A LLRED
T
William D. Edwards, MD, illustrated his talk with an abundance
of specimen slides showing features of valvular disease.
to the pathogenesis of degenerative and bicuspid
states of aortic stenosis, the
two states that lead to most
of the valve surgery performed today.
“With the aging of the
North American population,
you’re going to be seeing,
both in the relative sense and
the bacteremic sense, more
and more and more patients
with the degenerative form
of calcific aortic stenosis,” he
observed. “What you’d like
to be able to come up with is
some way to slow down or
prevent the development of
calcification.”
Dr. Edwards also turned
his attention to mitral regurgitation because it “far outstrips aortic regurgitation in
terms of surgical interventions.” Barlow’s disease and
fibroelastic deficiency are
the two main culprits associated with the degenerative
form of mitral regurgitation, which accounts for
about 80% of cases. The
two diseases can be easily
differentiated, but there is
also a mixed type that falls
somewhere between the
two, he said. It has been reported that patients with
mitral regurgitation have
commissures and Dr. Edwards took care to differentiate these from clefts.
The lecture was peppered
with pearls and good humor,
including Dr. Edwards’ attempts to secure a catfish after hearing of an elliptical,
fish-mouth deformity present
in the mitral valves of patients with the rheumatic
type of mitral stenosis. After
some quick maneuvering and
dissection in the laboratory,
he confirmed, “Rheumatic
mitral stenosis does indeed
have a fish-like mouth deformity to the orifice.”
AATS Graham Reception
AATS Awards Presentations
The AATS Scientific Achievement Award was presented to Dr. Eugene
Blackstone (left). The AATS Lifetime Achievement Award was presented
to Dr. Eugene Braunwald (second left). The winners are standing with Dr.
David J. Sugarbaker (second right) and Dr. Bruce W. Lytle (right)
The winner of the 16th
Annual C. Walter Lillehei
Resident Forum was
announced on Monday.
Jeevan Nagendran, University
of Alberta, Canada, received
the award for his research,
“Functional Recovery
Following a Brief Period of
Ischemia is Enhanced in
Hearts from Inducible
Cardiomyocyte-Specific CD36
Deficient Mice.” Eight
outstanding papers, focused
on hypothesis-driven studies
and basic science, were
presented on Sunday. The
Forum is named for C. Walton
Lillehei, a pioneer in open
heart surgery, inventor, and
educator.
M ARTIN A LLRED
AATS
The AATS Graham Reception, held on Sunday evening, honored
this year's Graham Foundation Award recipients and the TSFRE
Award Recipients.
Left to Right: John Ikonomidis, Medical University of South
Carolina, Chair TSFRE Research Committee; Alec Patterson,
Washington University, TSFRE President; Brody Wehman,
University of Maryland, TSFRE Research Fellow; Bryan Burt,
Stanford University, TSFRE Research Award; Meena Nathan,
Boston Children's Hospital, TSFRE Braunwald Research Grant;
Amy Fiedler, Brigham and Women's Hospital, TSFRE Braunwald
Fellow; Kal Parekh, University of Iowa, TSFRE NHLBI KO8
Awardee; Min Kim, Methodist Hospital, AATS Second John Kirklin
Research Scholar; David Sugarbaker, Brigham and Women's
Hospital, AATS Graham Research Foundation President. Not
pictured: Haifeng Wang, 2013 Graham Traveling Fellow
5/4/2013
3:39 PM
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Cardiac Session Got to the (Aortic) Root of the Problem
N ICK P IEGARI /IMNG M EDICAL M EDIA
D
Elizabeth H. Stephens, MD, looked at aortic regurgitation
after valve-sparing aortic root replacement.
Tirone E. David, MD, reviewed the success of the
Ross procedure over 20 years.
tic annulus greater than 27 mm were both significantly associated with an increased risk of reoperation on the pulmonary autograft.
Thus, the Ross procedure showed that it had
excellent 20-year survival outcomes. However,
the presence of preoperative aortic insufficiency
or mixed lesions and an aortic annulus greater
than 27 mm were associated with the increased
risk of failure of the pulmonary autograft, Dr.
David concluded.
Elizabeth H. Stephens, MD, presented a study she
and her colleagues from Stanford University performed examining the incidence and progression of
mild aortic regurgitation (AR) after valve-sparing
aortic root replacement. Although mild AR is
known to be a complication after such surgery, its incidence and level of progression have not been completely assessed, Dr. Stephens said.
To examine this problem, they assessed patients
who underwent Tirone David valve-sparing aortic
root replacement. The majority of the patients were
men.
Patients had a 1-year follow-up transthoracic
echocardiography (TTE) and a late TTE, which
were analyzed. AR was evaluated by a single experienced echocardiographer and multi-linear
regression was used to identify factors predictive
of AR and its progression.
At the 1-year echo, 43% of patients had mild
AR. By the late TTE, over 80% showed stable
mild AR at a median of 55 months. By a median
of 33 months, 13% of patients progressed to
moderate AR and remained stable thereafter,
with one patient progressing to severe AR requiring re-operation.
At total of 43% of patients had mild AR at the 1year ECHO. Mild AR remained stable in 85%,
which progressed to moderate AR in 12% and progressed to severe AR in one patient.
Significant independent predictors of mild AR
were AV repair and preopertive AR grade.
“Connective tissue disease, bicuspid aortic valve,
preop and postop annular dimension, and mild AR
on pre-discharge Echo were not significant predictors of mild AR,” Dr. Stephens added.
Mild AR occurs frequently after 1-year valvesparing root surgery, which is not surprising, said
Dr. Stephens.
“Fortunately, based on this analysis, the mild AR
at 1-year does not jeopardize the success of the operation over the midterm,” she concluded.
Rakesh M. Suri, MD, of the Mayo Clinic, examined the question of whether earlier repair
for aortic valve regurgitation was indicated in
modern practice, given the improved outcomes
seen vs. the use of biologic aortic valve replacement.
“We assessed over 300 patients who underwent
elective aortic valve repair for aortic insufficiency
from 1986 to 2011. The mean patient age was 53
years old and just over three-fourths were men. Our
results in these patients indicate that early aortic
valve repair prior to symptom onset seems justified,” he stated.
The patients were categorized according to the
type of valve disease: including annular dilation leading to central leakage, bicuspid valve, and tricuspid
valve prolapse.
Freedom from aortic valve reoperation was 90%
at 5 years, 79% at 10 years, and 70% at 15 years.
Aortic reoperation percent by pathologic group
uring Monday’s Adult Cardiac Surgery Simultaneous Scientific Session, Tirone E. David,
MD, and colleagues presented their study of
the Ross procedure which looked at the associations between preoperative variables and longterm outcomes.
Despite the Ross procedure being in use since the
1960s, when it was developed by Dr. Donald Ross,
indications for the procedure remain controversial,
according to Dr. David and his colleagues at the
University of Toronto. “Our data show that patients
who had the Ross procedure had excellent 20-year
survival,” he said.
Because the Ross procedure relies on replacing the diseased aortic valve with a pulmonary
autograft and requires replacing the patient’s
pulmonary valve with an allograft, outcomes included the subsequent behavior of both valves.
The researchers followed all-cause mortality, reoperation on the aortic valve, aortic insufficiency, and evidence of pulmonary dysfunction.
Their study assessed the Ross procedure as
performed in over 200 consecutive patients in
the period from 1990 through 2004. Patient age
averaged approximately 35 years, with the majority being men, and more than 80% having
congenital aortic valve disease.
Around half the patients had aortic stenosis
(AS) as their lesion, with the other half of patients presenting with aortic insufficiency (AI) or
mixed lesion. The sub-coronary or inclusion
technique was performed in roughly equal number of patients. Dr. David described how patients were prospectively followed with clinical
and echocardiographic assessment.
Freedom from all-cause mortality was nearly
98% at 10 years, dropping to around 94% at 20
years. Freedom from reoperation on the aortic
valves similarly ranged from around 97% at 10
years to around 92% at 20 years. Aortic insufficiency was a more common problem, with a lower
90% freedom at 10 years, down to around 63% at
20 years.
Analysis showed that preoperative AI and an aor-
Rakesh M. Suri, MD discussed the issue of
reoperation after elective aortic valve repair.
was found to be 13% for annular dilation, 9% for bicuspid, 18% for tricuspid prolapse, and 4% for perforation.
“Aortic valve repair is safe, with an early mortality of 0.6%. The freedom from aortic reoperation
and valve-related events is comparable to bioprosthetic devices,” he said.
The predictors for improved survival are preserved ejection fraction, smaller LVESD, and
younger age.
“However, mortality increases threefold with an
ejection fraction less than or equal to 50% and 2fold with an LVESD greater than 50 mm,” Dr. Suri
concluded.”
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Perioperative Care Session Launched on Monday
M ARTIN
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M
Nicholas Bonaros, MD, discussed
periprosthetic regurgitation and TAVI.
the relative amplitude index (RAI)
and correlated this index to observed outcomes. RAI was calculated as [(Post TAVI blood pressure
amplitude)/(Post TAVI systolic
blood pressure) - (Pre TAVI blood
pressure amplitude)/(Pre TAVI systolic blood pressure)] x 100%.
They evaluated paravalvular leakage by echocardiography during
TAVI and prior to discharge in 110
patients and calculated an RAI for
each. They also performed univariate
and multivariate analysis looking for
risk factors for perioperative mortality, and a receiver operating curve
(ROC) analysis to calculate relevant
RAI cut-off values.
They found that there was significantly increased perioperative mor-
tality for those patients with an RAI
greater than 13%, with a signficant
relative risk value greater than 3. A
higher RAI was also significantly predictive of greater cardiac, renal, and
lung complications at 1 year.
Our study shows that the relative
amplitude index is a useful, non-invasive and easy-to-use means of predicting the effect of paravalvular
regurgitation on perioperative and 1year outcomes in patients after TAVI,
concluded Dr. Bonaros.
Profound thrombocytopenia, defined as a platelet count of less than
60,000, is a potentially devastating
complication after cardiac surgery.
But its etiology is unclear, according
to J. Scott Rankin, MD, of Vanderbilt
University.
People have postulated causes ranging from inappropriate PF4 heparin
auto-antibodies, postoperative TTPlike antibodies, and super-antigens
generated by pulmonary infections.
Knowledge of such causality is important, because it can determine treatment potentials. For example,
modulation of immune-mediated profound thrombocytopenia with intravenous immunoglobulin (IVIG) is an
on-label indication and could be efficacious for any of the above conditions.
Dr. Rankin presented his research
on 20 consecutive patients who,
from 2002 to 2010, developed profound thrombocytopenia within 1-8
days after cardiac surgery. The average age was 68 years and half the
patients were men.
5” modified chest spreader retractor
for either a proximal or distal
mini-sternotomy procedure
The universal lift is attached to the
sternal retractor arm and is used to
lift the patient’s left chest one to
two inches
All but one of the patients had
complex valve and/or aortic surgery,
the last having a coronary bypass. He
found that the condition is likely related to the triggering of inappropriate autoimmune moieties, which
caused peripheral platelet aggregation and multiorgan failure.
M ARTIN A LLRED
onday afternoon saw the
launch of a new Simultaneous
Scientific Session. The goal of
the Monday’s Perioperative Care Simultaneous Scientific Session was to
provide cardiothoracic surgeons with
valuable information on perioperative factors, including clinical, drugs,
and procedural, that ultimately impact surgical outcomes. The afternoon’s presentations ranged from a
study that sought to predict the impact of paravalvular leaks on transcatheter aortic valve implantation
(TAVI) to a late-breaking trial on the
role of analgesia in thoracotomy.
Nicholas Bonaros, MD, of the Innsbruck Medical University, presented a
study on a new relative amplitude index that he and his colleagues developed in order to predict the impact of
periprosthetic regurgitation on outcomes after TAVI. Such paravalvular
leakage (PL) is not uncommon, but its
effect on hemodynamic performance
remains disputed, Dr. Bonaros said.
It is important therefore to be
able to predict PL, but previous efforts using common hemodynamic
parameters such as diastolic blood
pressure or the blood pressure amplitude after the procedure have not
provided reproducible results, according to Dr. Bonaros and his colleagues.
In an effort to provide a more reliable predictive tool, they performed a prospective study to
systematically evaluate changes in
hemodynamic parameters by using
J. Scott Rankin, MD addressed the
problem of profound thromboycytopenia.
Preoperative risk profiles for these
were high: they had a mean age of 68
years and all had comorbidities. Nearly
one- third non-elective presentation, a
quarter had previous cardiac operations, and nearly one-third had moderate/severe left ventricular dysfunction.
When platelet counts approached
60K, IVIG was started at 1.5 gm/kg
IV over 5 days. No anticoagulant was
used, and platelet transfusions were
avoided. In one patient, IVIG failed
to reverse pT promptly, and daily
plasmapheresis was introduced until
platelet counts rose. Using retrospective chart review, platelet counts before and after interventions were
assessed with linear regression analyses over time. Associated morbidity
and other clinical responses were
documented.
In all but one of the patients, pT
stabilized and rebounded within 2-4
days after initiating IVIG. The remaining slow responder had a rapid
recovery with the addition of
plasmapheresis. In every patient,
coincident multiorgan failure reversed. All but one of the patients
recovered uneventfully, survived
hospitalization, and had no limb ischemia or tissue loss. In this series,
no complications were seen as a result of IVIG therapy or plasmapheresis.
Despite a lack of confirmed etiology,
the use of immunomodulation with
IVIG supplemented by plasmapheresis
appeared safe and efficacious in the
Perioperative Care following page
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Page 8
Emerging Technologies
Forum Highlights Innovation
Perioperative Care previous page
ednesday morning’s Emerging Technologies forum will
feature 10 papers that highlight intriguing new developments
in cardiothoracic surgery.
Some of the papers address preclinical devices, others describe early data in humans; all have the
potential to impact clinical practice,
according to Vivek Rao, MD, of
Toronto General Hospital, who will
moderate the forum along with
Matthew R. Williams, MD, of Columbia University.
The 2-hour forum will begin with
two reports on technologies for the
treatment of mitral regurgitation.
The first is a presentation of early
findings regarding the use of a novel
leaflet plication clip (LCP) for the repair of mitral valve prolapse, which
will be presented by Eric N. Feins,
MD, of Boston Children’s Hospital
and Harvard Medical School.
The LCP, which was designed to
treat a prolapsed leaflet segment –
mimicking a segmental leaflet resection – was successful for treating mitral regurgitation secondary to mitral
valve prolapse in an animal model.
In previous ex-vivo studies, the device was shown to successfully eliminate P2 segment prolapse and
mitral regurgitation in fresh swine
hearts.
Dr. Feins will present data that suggest the device has the potential to
improve the effectiveness of beatingheart valve surgery, and may enhance
the ease and reproducibility of leaflet
plication in patients undergoing
open-heart minimally invasive valve
surgery.
The second paper is a report of
early results from the Transapical
Placement of Artificial Chordae
Tendinae (TACT) Trial – an industry-sponsored, multicenter, prospective, non-randomized study to
evaluate a new technology for offpump, beating-heart correction of
mitral regurgitation.
The technology involves placement of an artificial chorda tendina
(ACT) using the Neochord chordal
delivery system (Neochord Inc.
Minneapolis).
Giovanni Speziali, MD, of the University of Pittsburgh Medical Center,
will present findings in the first 30
patients, 26 of whom were treated
successfully. Although the overall
durability of mitral regurgitation repair was only 65% at 30 days among
those who experienced acute proce-
W
M ARTIN A LLRED
treatment of profound thrombocytopenia. This approach is also probably cost effective,” said Dr. Rankin.
Routine immunologic interventions
for pT have the potential of reducing
cardiac surgical mortality and morbidity significantly,” he concluded.
Infants having cardiopulmonary bypass are often given perioperative corticosteroids, but there is a question as to
what the effect of corticosteroid drug
levels has on the innate hypothalamic
pituitary response in these children.
Sheri S. Crow, MD, and her colleagues at the Mayo Clinic, found
that corticosteroid induced adrenal
suppression persists even after
blood levels of these drugs have declined, suggesting that continued
therapeutic intervention may be
benefical.
They looked at the relationship
between dexamethasone, methylprednisolone, cortisol, and adrenocorticotropic hormone (ACTH)
plasma levels following perioperative corticosteroid administration in
infants undergoing CPB surgery for
congenital heart disease. Dr. Crow
and her colleagues measured plasma levels of the steroids, cortisol,
and ACTH in 32 infants ranging
from 3 days old to around 11
Sheri S. Crow, MD, examined corticosteroids in congenital heart surgery.
months at the following perioperative times: anesthesia induction,
post-bypass/pre-modified ultrafiltration (MUF), and at 0, 4, 8, 12,
and 24 hrs after ICU arrival.
All 32 patients received dexamethasone at anesthetic induction,
with infants less than 30 days old
(around 19%) also receiving methylprednisolone at midnight prior to
surgery.
This session was moderated by
Lyle D. Joyce, MD, and Harold M.
Burkhart, MD, both of the Mayo
Clinic.
dure success, refinements of surgical
technique throughout the study dramatically improved the results at 30
days in the latter half of the study
population, according to Dr. Speziali.
Among the other emerging technologies and techniques that will be
discussed are:
씰 A novel surgical technique for performing sympathectomy by embryonic natural orifice transumbilical
endoscopic surgery using a nasal gastroscope for the treatment of patients with hyperhidrosis. Weisheng
Chen, MD, of Fuzhou General Hospital, will present 1-year results in 35
patients showing that 97% and 72%
of those with palmar and axillary hyperhidrosis, respectively, were treated
successfully.
씰 The use of thoracic aortic endografts to facilitate the resection of
tumors infiltrating the aorta.
Stephane Collaud, MD, of Toronto
General Hospital will present data
from five patients suggesting that
this innovative approach is safe and
effective. After a median of 30
months, all five patients – who had
either non–small cell lung carcinomas or sarcomas infiltrating the aorta – were alive and disease-free, and
none suffered complications from
the endograft.
씰 A laser-assisted zero ischemia coronary anastomotic connector, which
serves as a simplified alternative for
hand-sutured anastomosis to facilitate
minimal access and closed chest coronary artery bypass grafting (CABG).
David Stecher, MD, of University
Medical Center, Utrecht, will present
findings from a porcine model showing that the connector enabled fast,
simple and reliable anastomosis construction, and that it has potential for
minimally invasive or endoscopic
CABG.
“The technological field is changing rapidly,” Dr. Rao said, noting
that the forum will provide attendees with an improved awareness of
these and other emerging technologies that they may be inclined to
employ in their own practice, and
will provide a glimpse of the future
landscape in cardiothoracic technology.
Dr. Rao disclosed that he has received compensation for serving as
an advisory board member or consultant for Medtronic, CorMatrix
Cardiovascular, Terumo Inc., and
HeartWare Inc. He owns CorMatrix
Cardiovascular stock options.
06_9aats13_Tues.qxp
5/4/2013
3:42 PM
Page 9
This moment
your team meets our hands-on training
is everything.
This is the moment your team embraces innovation
with customized training. It’s the moment you our
clinical experts support you with current advances.
This is the moment your team achieves its
aspirations with Edwards.
Progress Confidently
Learn more about the history, products,
and educational opportunities in this moment.
www.edwards.com/ThisMoment
Edwards, Edwards Lifesciences, and the stylized E logo are trademarks of Edwards Lifesciences Corporation.
© 2012 Edwards Lifesciences Corporation. All rights reserved. AR08712
Edwards Lifesciences
Irvine, USA I Nyon, Switzerland I Tokyo, Japan I Singapore, Singapore I São Paulo, Brazil
edwards.com
10_15aats13_Tues.qxp
5/6/2013
6:08 PM
Page 10
10 AATS 93 RD ANNUAL MEETING
2013 AATS Annual Meeting Exhibitors
AATS Exhibit Hall Hours
Tuesday, May 7, 2013
9:00 am – 4:00 pm
A & E Medical Corporation
1631
2310 South Miami Blvd., Suite 240
Durham, NC 27703-5796
Acute Innovations
526
21421 NW Jacobson Road, Suite 700
Hillsboro, OR 97124
www.acuteinnovations.com
Furthering their reputation as a leader in the
thoracic industry, ACUTE Innovations® continues to make advancements in chestwall stabilization technology. Stop by booth 526 to learn
about ACUTE’s cutting-edge products: the RibLoc® Rib Fracture Plating system, Biobridge®
Resorbable Chest Wall Stabilization Plate, and
the AcuTie® Sternal Closure System.
AME Publishing Company
539
3/F, Building 1#, Lesu Science Park, 1526
Chunbo Road, Binjiang district
Hangzhou, China
www.amepc.org
The Annals of Cardiothoracic Surgery is a bimonthly peer-reviewed publication, dedicated
to the field of cardiothoracic surgery. Each issue is overseen by a special Guest Editor and
features operative videos provided by
renowned surgeons. The Journal of Thoracic
Disease is a bi-monthly, international,
Pubmed-indexed journal with a primary focus
on thoracic disease.
ATMOS, Inc.
745
3717 Huckleberry Road
Allentown, PA 18104
www.atmosmed.com
Atmos offers the S201 Thorax Drainage Monitoring System. Our advanced digital chest
drainage system allows for patient mobility while
maintaining suction, quantifies drainage flow in
L/min, requires less intervention and ultimately
a reduction in length of stay for the patient.
AtriCure, Inc.
1419
6217 Central Park Drive
West Chester, OH 45069
www.atricure.com
AtriCure, Your Partner in Afib Solutions, featuring the only FDA approved surgical AF device,
Synergy RF, and Cryothermic Ablation energy
devices. Providing the only Maze IV AF certification course. AtriCure’s portfolio includes the
AtriClip®, which is the ONLY Complete LA Appendage management solution that permanently isolates both mechanically and electrically.
Atrium Medical Corporation - a MAQUET
Getinge Group company
929
5 Wentworth Drive
Hudson, NH 3051
www.atriummed.com
Atrium is now part of MAQUET Getinge Group.
Express Mini 500TM and PneumostatTM Mobile Chest Drains, OceanTM Water Seal, OasisTM Dry Suction & ExpressTM Dry Seal Chest
Drains. Coated & uncoated PVC & Silicone Thoracic Catheters, PleuraGuideTM Disposable
Chest Tube Kit, Cardiac Surgery Devices &
complete line of Aortic Vascular Grafts.
Baxter Healthcare
627
One Baxter Parkway
Deerfield, IL 60015
www.baxter.com
Baxter is a global, diversified healthcare company with expertise in medical devices, pharmaceuticals, and biotechnology. The company
continues its quest for advancing BioSurgery by
offering a comprehensive line of products for
hemostasis and sealing, adhesion reduction solution, and preparation/delivery devices based
on the latest scientific advances in the field.
Berlin Heart
520
200 Valleywood Rd., Ste. A500
The Woodlands, TX 77380
www.berlinheart.com
Berlin Heart, the only company worldwide, that
develops, manufactures and distributes VADs
for patients of every age and body size. EXCOR® Pediatric provides medium to long-term
circulatory support specifically for infants and
children awaiting heart transplants. EXCOR Pe-
diatric is approved for use in the USA under
HDE regulations by the FDA.
BFW, Inc.
1029
2307 River Road, #103
Louisville, KY 40206
www.bfwinc.com
Recognized worldwide for unmatched design
and engineering in surgical illumination, from
its Thru-the-Lens Headlight Video System to
the groundbreaking 10,000-hour ChromaLUME™ Plasmas Headlight System, or the incredibly bright and portable VistaView II LED,
BWF™ is the technological leader offering the
most dependable headlight illumination system
in the medical field today.
Biomet Microfixation
737
1520 Tradeport Drive
Jacksonville, FL 32218
www.biometmicrofixation.com
Biomet Microfixation is a leading global healthcare provider of orthopedic products. Our thoracic portfolio includes the Pectus Bar for
repair of Pectus Excavatum and the SternaLock
Blu Primary Closure System for sternal closure.
The Blu System aligns and stabilizes the sternum after sternotomy and enables easier closure after minimally invasive access.
Bolton Medical Inc.
621
799 International Pkwy
Sunrise, FL 33325
www.boltonmedical.com
Bolton Medical is a subsidiary of the Werfen
Life Group. Werfen Life Group is an international company that manufactures and distributes
medical diagnostic solutions and medical devices worldwide. Bolton Medical sells endovascular therapies for thoracic repair, such as
Relay Thoracic Stent-Graft in both U.S. and international markets and Relay NBS (non-bare
stent) in international markets.
Cardiovascular Research Foundation
428
111 E. 59th Street
New York, NY 10022
www.crf.com
The Cardiovascular Research Foundation (CRF)
is an independent, academically focused nonprofit organization dedicated to improving the
survival and quality of life for people with cardiovascular disease through research and education.
Since its inception in 1991, CRF has played a
major role in realizing dramatic improvements in
treating heart disease by establishing the safe
use of new technologies, drugs, and therapies in
interventional cardiovascular medicine.
Cardivon
427
602, Block A, Jinzun International Suite
Huaian, Jiangsu Province, 223002 China
Chase Medical
444
885 E. Collins Suite #110
Richardson, TX 75081
www.chasemedical.com
Chase Medical: Dedicated to providing cardiac
surgeons innovative devices for sugery. The SVR
System creates an elliptical ventricle every
time. The Triumph System is a soft aortic balloon occlusion cannula used for minimally invasive valve procedures. Our beating heart
products include heart stabilizers, shunts, blower misters and apical lift devices.
Cook Medical
1310
750 Daniels Way, P.O. Box 489
Bloomington, IN 47402-0489
Cormatrix Cardiovascular, Inc.
CORONEO
1628
9250 Park Avenue, #514
Montreal, QC H2N 1Z2 Canada
Covidien
805
555 Long Wharf Drive
New Haven, CT 6511
www.covidien.com
Covidien is a leading global healthcare products
Continued on page 11
Sanofi
Biosurgery
837
S2
Edwards
Lifesciences
1334
Kapp Surgical
Instrument Inc
1328
Surgitel/General
Scientific Corp
1730
Olympus Medical
Systems Group
Thompson Surgical
Instruments, Inc
Terumo
Cardiovascular
Systems
423
419
919
I-Flow Corporation
Sorin Group
Internet
Cafe
1019
Edwards
Lifesciences
Medtronic Inc.
1607
605
905
1613
286 South Main Street Suite 200
Alpharetta, GA 30009
www.cormatrix.com
CorMatrix® Cardiovascular markets its ECM®
Technology biomaterial devices for pericardial
closure, cardiac tissue repair, and carotid repair and is currently conducting preclinical
studies to evaluate future applications in
heart failure as well as other cardiovascular
applications.
MAQUET Medical
Systems, USA
AATS Daily News Advertisers
5/6/2013
6:08 PM
Page 11
Continued from page 10
company that creates innovative medical solutions for better patient outcomes and delivers
value through clinical leadership and excellence.
Please visit www.covidien.com to learn more.
CRC Press - Taylor
& Francis Group LLC
939
6000 Broken Sound Parkway NW,
Suite 300
Boca Raton, FL 33487
www.crcpress.com
CRC Press – Taylor & Francis Group is a global
publisher of world-class references, handbooks,
journals, and textbooks for the medical, scientific and technical communities including academics, professionals, and students. Our
award-winning CRCnetBASE has our eBook collections. Visit www.crcpress.com or contact us at
1-800-634-7064, or +44 (0) 1235 400 524.
CryoLife, Inc.
729
1655 Roberts Blvd.
Kennesaw, GA 30144
www.cryolife.com
CryoLife® is a leader in the development and
implementation of advanced technologies associated with allograft processing and cryopreservation. CryoLife also offers solutions for
patients with Refractory Angina utilizing Transmyocardial Revascularization or TMR with the
Cardiogenesis Holmium:YAG system.
CTSNet
410
www.ctsnet.org
CTSNet (www.ctsnet.org), headquartered in
Chicago, Illinois, USA, is the leading international source of online resources related to
cardiothoracic surgery, as well as the major
hub of the international online community of
cardiothoracic surgeons and allied health care
professionals.
Dallen Medical
522
1046 Calle Recodo, Suite G
San Clemente, CA 92673
www.dallenmedical.com
Dallen Medical, Inc. is an early stage orthopedic company whose patented technology provides superior fixation and compression. Dallen
has FDA 510(K) clearances for its Compressyn™ band for sternal closure & the Compressyn for small bone fixation and expects to
file additional 510(K)’s around its banding
technology.
Davol Inc., a BARD Company
1407
60 Technology Drive
Irvine, CA 92618
Delacroix - Chevalier
1429
3825 Commerce Dr.
St. Charles, IL 60174
www.delacroix-chevalier.com
Famous French instrument manufacturer since
1920, DELACROIX-CHEVALIER is proud to offer indisputable best-seller instruments and innovative devices dedicated to MIS and video
cardio-thoracic surgery developed in cooperation with key opinion leaders. Specialized R&D,
cutting edge manufacturing capabilities, and
dynamic market strategies help DelacroixChevalier rank among world market leaders in
the field.
DePuy Synthes CMF
1210
1301 Goshen Parkway
West Chester, PA 19380
www.synthes.com
Synthes CMF develops, produces and markets
instruments and implants for the surgical reconstruction of the human skeleton and soft
tissues. Our product offering includes systems
for internal fixation of the sternum following a
sternotomy/ osteotomy or fracture of the sternum and rib, with options to stabilize and promote fusion.
Designs For Vision, Inc.
1606
760 Koehler Avenue
Ronkonkoma, NY 11779
www.designsforvision.com
Just See It™ with Designs for Vision's lightweight custom-made Surgical Telescopes- now
available with Nike® frames. See It Event Better™ with the L.E.D. Daylite®, the new UltraMini L.E.D. Daylite® or trin Beam®, L.E.D.
Daylite® providing the brightest and safest untethered illumination.
Dynasil Products
1542
44 Hunt Street
Watertown, MA 2472
EACTS
412
Maderia Walk
Windsor, SL4 1LU UK
www.eacts.org
The EACTS is the largest European Association
devoted to the practice of Cardio-thoracic
surgery. The main objects of the Association are
to advance education in the field of cardio-thoracic surgery and to promote, for the public
benefit, research into cardiovascular and thoracic physiology and therapy and to correlate
and disseminate the useful results thereof. Visit
the booth for information on membership, future meetings, EACTS Academy and all other
activities of EACTS.
Edwards Lifesciences
905
One Edwards Way
Irvine, CA 92614
www.edwards.com
Edwards Lifesciences is the global leader in the
science of heart valves and hemodynamic monitoring. Driven by a passion to help patients,
the company partners with clinicians to develop
innovative technologies in the areas of structural heart disease and critical care monitoring
that enable them to save and enhance lives.
Additional company information can be found
at www.edwards.com.
Elmed Incorporated
1325
60 West Fay Ave.
Addison, IL 60101
www.elmed.com
ELMED INCORPORATED has been serving the
Medical Profession since 1955. We will be introducing the “Jacubian” Cardio-Vascular Occluder Clamp – Maximum occlusion at
minimum trauma. Featuring Endoscopic Cardiothoracic Instruments and the all new
ELMED “Strong-Arm Retractor System for the
MICS CABG procedure along with the traditional Retract-Robot, the most versatile retractor
system.
Elsevier Inc.
1304
1600 JFK Blvd. , Ste 1800
Philadelphia, PA 19103
www.us.elsevierhealth.com
ELSEVIER is a leading publisher of health science publications, advancing medicine by delivering superior reference information and
decision support tools to doctors, nurses, health
practitioners and students. With an extensive
media spectrum — print, online and handheld,
we are able to supply the information you need
in the most convenient format.
Enova Illumination
1036
1839 Buerkle Rd
St Paul, MN 55110
ESTS
426
1 The Quadrant, Wonford Road
Exeter, EX2 4LE UK
www.ests.org
ESTS is the largest international general thoracic surgery organization with over 1300 members from all Continents. Our mission is to
improve quality in our specialty: from clinical
and surgical management of patients to education, training and credentialing of thoracic surgeons worldwide.
Ethicon Endo-Surgery
1204
4545 Creek Road
Cincinnati, OH 45242
www.ethicon.com
The ETHICON brand is used for the products of
Ethicon, Inc. and Ethicon Endo-Surgery, Inc.,
two companies with long histories of medical
innovation, which provide globally a broad
range of surgical technologies and products
used to treat colorectal and thoracic conditions,
women’s health conditions, hernias, cancer and
AATS 93 RD ANNUAL MEETING 11
obesity.
Experimental Surgical Services
621
420 Delaware St. SE MMC 220
Minneapolis, MN 55455
www.ess.umn.edu
Experimental Surgical Services as the University of Minnesota is more then just a contract research organization. From discovery to
regulatory strategy to submission we are the industry leader in research and testing rep-clinical medical devices and surgical techniques.
Fehling Surgical Instruments, Inc.
718
509 Broadstone Lane
Acworth, GA 30101
www.fehlingsurgical.com
FEHLING SURGICAL features the “CERAMO®
Instrument Line”, “SUPERPLAST Probes” and
new innovative Retractor Systems for Minimally
Invasive Cardiac Surgery. CERAMO® surface
means high efficiency through enhanced performance, increased endurance and minimal
maintenance.
G & N Medical
518
Maydwell Ave, Off Stane St.
Horsham, 91902 UK
www.gandn.com
G & N Medical is a British medical device manufacturer and distributor. Having gained its regulatory approvals, the new patented sternal
closure device ThorAcc® was launched in Europe in September 2012. Following successful
evaluation in Boston, MA and elsewhere, the
device is being introduced to US surgeons at
this year's Meeting.
Genesee BioMedical, Inc.
1624
1308 South Jason Street
Denver, CO 80223-3408
www.geneseebiomedical.com
Design Beyond Standard. Genesee BioMedical, Inc. provides unique devices for cardiothoracic surgery including sternal/thoracic
valve retractors, instruments for MICS, coronary graft markers, suture guards, retraction
clips and myocardial needles. All products
are CE approved.
Gore & Associates, Inc.
535
960 W. Elliot Rd
Tempe, AZ 85284
www.goremedical.com
The Gore Medical Products Division has provided creative solutions to medical problems for
three decades. Over 35 million Gore Medical
Devices have been implanted worldwide. Products include vascular grafts, endovascular and
interventional devices, surgical materials, and
sutures for use in vascular, cardiac and general
surgery. For more information, visit
http://www.goremedical.com.
Haemonetics Corp.
430
400 Wood Road
Braintree, MA 2184
www.haemonetics.com
Haemonetics is a global healthcare company
dedicated to providing innovative blood management solutions for our customers. Our devices, consumables, IT products, and
consulting services deliver a suite of business
solutions to help our customers improve clinical
outcomes and reduce the cost of healthcare for
blood collectors, hospitals, and patients around
the world.
Heart Hugger/
Gen'l Cardiac Technology
644
15814 Winchester Blvd., #105
Los Gatos, CA 95030
www.hearthugger.com
Heart Hugger-Sternum Support Harness is a
patient operated support harness applied postop to splint surgical wounds. Benefits include
improved patient compliance, faster return to
premorbid respiratory levels, fewer wound complications and better post-op mobility. It is useful for post open-heart, thoracotomy, fractured
rib and other chest trauma patients.
HeartWare, Inc
205 Newbury St.
Framingham, MA 1701
434
www.heartware.com
HeartWare is dedicated to delivering safe, highperforming and transformative therapies that
enable patients with heart failure to get back to
life. The company’s breakthrough innovations
begin with the HVAD® Pump, designed to be
implanted in the pericardial space avoiding the
more invasive surgical procedures required with
older LVAD technologies. The HVAD Pump is
commercially available around the world.
I-Flow, LLC, a Kimberly-Clark
Health Care Company
419
20202 Windrow Dr.
Lake Forest, CA 92630
www.iflo.com
I-Flow, LLC, a Kimberly-Clark Health Care Company, is the manufacturer of the non-narcotic,
ON-Q* Pain Relief System, and is a global market leader in acute pain and ambulatory medication delivery, driving innovative clinical
applications for surgical procedures and regional anesthesia for better outcomes and satisfied
patients. For more information, visit
www.iflo.com.
Integra Lifesciences
1234
311 Enterprise Drive
Plainsboro, NJ 8536
www.integralife.com
Integra is a leader in Acute Care Surgical Products. The company’s portfolio includes quality
instrumentation solutions for your sterile processing and OR needs in laparoscopic, general,
cardiovascular, neuro, plastic and reconstructive surgery. Products include Luxtec® illumination systems and cables, instruments from
Jarit®, Redmond™, Padgett ®, Omni-Tract®
table-mounted retractors and CIMS® Consulting Services.
International Society of Minimally Invasive
Cardiothoracic Surgery
935
500 Cummings Center, Suite 4550
Beverly, MA 1915
www.ismics.org
ISMICS is the leader in Innovation, Technologies, and Techniques in Cardiothoracic and Cardiovascular/Vascular Surgery. 2013 ISMICS
Annual Scientific Meeting, 12-15 June 2013,
Hilton Prague, Prague, Czech Republic, www.ismics.org.
Intuitive Surgical, Inc.
1033
1266 Kifer Rd, Bldg 101
Sunnyvale, CA 94086
www.intuitivesurgical.com
Intuituve Surgical is the global leader in minimally invasive, robotic-assisted surgery. The
Company's da Vinci® System- with 3D-HD vision and EndoWrist® instrumentation-enables
surgeons to offer a minimally invasive approach
for complex conditions. With da Vinci heart and
lung surgery patients typically avoid the large
incision and rub-spreading of open surgery
IsoRay Medical
743
350 Hills St, Suite 106
Richland, WA 99354
www.isoray.com
IsoRay Medical offers radiation therapy
(brachytherapy) products for the treatment of
prostate, brain and lung cancers, among others.
IsoRay’s FDA-cleared cesium-131 mesh implant is applied to the staple line following resection of Stage I NSCLC. The 9.7 day half-life
of cesium-131 guarantees dose delivery six
times faster than iodine-125 implants.
Kapp Surgical Instrument Inc.
1334
4919 Warrensville Center Rd.
Cleveland, OH 44128
www.kappsurgical.com
Kapp Surgical is a custom design shop which
designs surgical instruments and implants,
manufactures them, and sells as well as distributes domestically and internationally. Kapp’s
exclusive products are: The Cosgrove Heart Retractor, Bariatric Ring, Strip T’s surgical organizer, and countless surgical devices all FDA
approved with several pending approvals.(Kapp
5/6/2013
6:09 PM
Page 12
owns 39 patents)
Karl Storz Endoscopy-America, Inc.
1525
2151 E. Grand Ave
El Segundo, CA 90245
www.karlstorz.com
KARL STORZ, a leader in endoscopic equipment and instruments, offers solutions for
video-assisted thoracic surgery (VATS). Our EndoCAMeleon® Laparoscope enables surgeons
to adjust the viewing direction from 0° to 120°
throughout procedures without changing laparoscopes. And our Video Mediastinoscopes with
DCI®-D1® Camera allow video recording while
working under direct vision.
KLS Martin, LP
742
PO Box 16369
Jacksonville, FL 32245
www.klsmartinnorthamerica.com
KLS-Martin, a responsive company, is focused
on the development of innovative products for
oral, plastic and craniomaxillofacial surgery.
New product developments in our titanium osteosynthesis plating systems allow these products to be used for rapid sternal fixation and
reconstruction.
Lexion Medical
843
109 Preston Court
Macon, GA 31210
www.lexionmedical.com
LEXION Medical, a leader of innovative medical technologies improving patient safety, offers humidified warm gas via the Insuflow®
Gas Conditioning System for all thoracic and
abdominal laparoscopic procedures, VesselGuardian® for desiccation free saphenous
vein harvesting and PneuVIEW®XE Smoke
Elimination System.
LifeNet Health
1335
1864 Concert Dr
Virginia Beach, VA 23453
Lippincott Williams & Wilkins
508
2 Commerce Sq, 2001 Market Street
Philadelphia, PA 19103
www.lww.com
Lippincott Williams & Wilkins, a Wolters Kluwer
Health company, is a leading international publisher of medical books, journals, and electronic
media. We proudly offer specialized publications and software for physicians, nurses, students and clinicians. Please visit our booth to
browse our comprehensive product line.
LoupeCam
1034
23623 N. Scottsdale Road D 3256
Scottsdale, AZ 85255
www.loupeCam.com
HD Video Recording Camera Solutions for Surgical Loupes & Headlights. Finally, Surgical HD
Video Recording has never been easier and accessible for under 5K. USB Footpedals offer a
complete control over the camera and MegaPixel Lenses guarantee the needed Magnification.
USB Plug and Play for Hands-On Surgeons.
LSI Solutions
842
7796 Victor-Mendon Road
Victor, NY 14564
www.lsisolutions.com
COR-KNOT® delivers instant security with automated knotting and integrated suture trimming in one easy step. COR-KNOT® may
reduce cardiopulmonary bypass and crossclamp time in your OR. Visit LSI SOLUTIONS®
at booth 842 and see the newest edition to the
COR-KNOT® family, the CK® Standard.
MAQUET Medical Systems, USA
1607
45 Barbour Pond Road
Wayne, NJ 7470
www.maquet.com
MAQUET Medical Systems, USA is a global
market leader offering a comprehensive portfolio
of products designed for use in the Hybrid OR,
ICU, Cath Lab and Cardiovascular Therapies.
Market Access Partners
3236 S. Meadow View Road
Evergreen, CO 80439
1435
www.marketaccesspartners.com
Market Access Partners provides market research consulting to the medical device and
pharmaceutical industries. We use innovative
qualitative and quantitative methodologies to
research opinions of physicians, nurses and patients. We offer a management orientated approach to product development and marketing.
development and design expertise, comprehensive global regulatory support, and broad manufacturing, assembly and packaging capabilities.
For over 25 years, Micromedics has developed
and manufactured quality, single-use devices for
optimal delivery of single- and multi-component
liquid biomaterials. Visit us in booth 1229.
Mayo Clinic and
University of Minnesota
3500 Corporate Parkway, POB 610
Center Valley, PA 18034-0610
www.olympusamerica.com
Olympus offers the newest, most versatile video
system, EVIS EXERA III. Compatible with any
Olympus scope, rigid of flexible, this universal
platform can be used with the EndoBronchial
UltraSound(EBUS) bronchoscope and ViziShot,
EBUS-TBNA, aspiration needle system. Integrate further with ENDOALPHA ™, and control
your OR equipment from a single touch screen.
507
200 1st Street SW
Rochester, MN 55905
www.mayoclinic.org
Mayo Clinic and University of Minnesota present Healing the Heart, a heritage of innovation
exhibit. This display brings together, for the
first time, two of the original heart-lung bypass
circuits that helped set the world standard for
open heart surgery. These institutions serve patients and advance science throughout the
United States and around the world.
Medafor Inc.
513
2700 Freeway Blvd. Suite 800
www.medafor.com
Medafor’s patented technology, Microporous
Polysaccharide Hemospheres (MPH®) provides
a unique solution for adjunctive hemostasis in
surgical applications. Arista® with MPH is a
surgically-indicated, plant-based hemostat, providing an all-natural way to accelerate the
body’s intrinsic clotting cascade with no inherent risk of adverse events.
Medical Concepts Europe
545
1083 Delaware Ave
Buffalo, NY 14209
www.medicalconcepts.eu
MCE provides complete solutions for temporary
pacing. Advanced design of temporary pacing
leads and FastLockSingle Ude Interconnect Cables increase reliability and efficacy of pacing
while reducing potential bleeding. Bipolar and
Pediatric leads are available.
Medistim
1519
14000 25th Ave. N. Ste. 108
Plymouth, MN 55447
Medpace Medical Device
1038
5375 Medpace Way
Cincinnati, OH 45227
www.medpace.com/devices
Medpace Medical Device, MMD, is a division of
Medpace exclusively dedicated to the design
and conduct of medical device trials and offers
global support for in over 40 countries. The division is led by device experts highly knowledgeable about international regulatory
requirements, i.e. FDA and EMA regulations.
Medtronic Inc.
605
710 Medtronic Parkway
www.medtronic.com
Find Opportunity in Change and consider
Medtronic’s intuitive solutions in structural
heart and aortic diseases including: tissue, mechanical and transcatheter valves; irrigated RF
and cryo surgical ablation devices; aortic stent
graft systems; and OPCAB, MICS CABG, cannulae and perfusion products.
NeoChord
538
7700 Equitable Drive, Suite 206
Eden Prairie, MN 55344
www.neochord.com
NeoChord's CE Marked device enables beating
heart, sternal sparing impantation of neochordae and allows real time echo feedback of MR
correcting. The company is also developing
NeoNav, an "augmented reality" device navigation technology for mitral procedures. Caution:
The NeoChord device in not available for commercial use in the U.S.
Nordson MICROMEDICS
1229
1270 Eagan Industrial Road
St. Paul, MN 55121
www.nordsonmicromedics.com
Micromedics is the partner of choice to the
healthcare industry for custom biomaterial delivery solutions and provides innovative product
Olympus Medical Systems Group
On-X Life Technologies, Inc.
1730
1129
1300 E. Anderson Lane, Building B
Austin, TX 78752
www.onxlti.com
On-X® Heart Valves and MV Chordal Repair:
Patented natural design and On-X® Carbon offer reduced turbulence in a mechanical valve to
rival the clinical and hemodynamic performance of bioprostheses. FDA IDE approved
PROACT (Prospective Randomized On-X® Anticoagulation Clinical Trial) is in process. Chord-X
ePTFE Suture for MV chordae tendineae repair.
Orascoptic Research
1424
3225 Deming Way
Middleton, WI 53562
www.orascoptic.com
Orascoptic designs and manufactures high-performance magnification loupes for dentists, hygienists and other dental professionals.
Renowned for quality craftsmanship, Orascoptic
loupes deliver remarkable resolution over a
deep and wide viewing field. Superior visualization is achieved through innovative, lightweight
optics made from only the finest grade of glass.
With six different telescopes models to choose
from, each available on a variety of frame styles
and colors, Orascoptic offers one of the most
comprehensive portfolios of magnification eyewear in the healthcare industry.
Oscor Inc.
1115
3816 DeSoto Blvd
Palm Harbor, FL 34683
www.oscor.com
Oscor is a leading manufacturer of permanent
and temporary Cardiac Pacing and Stimulation
Leads, External Pacemakers, Peel Away and Hemostatic valved Introducers, Transseptal Guiding
Sheaths, Guiding Catheters, Diagnostic, Angiography and Balloon Catheters. Typical products
are Pacing and Stimulation Leads, Introducers,
Adaptors, Catheters and Shaft Assemblies. FDA
registered. ISO 13485:2003 certified.
Oxford University Press
1343
198 Madison Ave
New York, NY 10016
www.oup.com
OUP publishes some of the most respected
medical books and journals in the world, including the renowned trio of journals from the
European Association for Cardio-Thoracic
Surgery. Come and visit our stand to browse
books and pick up journal sample copies.
Pemco Inc.
1529
5663 Brecksville Road
Cleveland, OH 44131-1593
Péters Surgical
1528
42, Rue Benoit Frachon
Bobigny cedex, 93000 France
www.peters-surgical.com
Péters Surgical develops, manufactures and
distributes medical devices worldwide. This
French company was founded in 1926 and has
continued to grow. Today Péters Surgical has
four operating locations all maintaining a high
standard of quality and service. Offering specialized cardiac suture brands Corolene, Cardioxyl, Cardionyl, and now introducing
Cardioflon Evolution.
Pfizer Pharmaceuticals
413
235 E. 42nd St, 219 7 1
New York, NY 10016
Philips Medical Systems
1836
22100 Bothell-Everett Highway
Bothell, WA 98021
www.philips.com/hybridOR
TAVI procedures require high quality imaging
and workflow planning for device placement.
The Philips TAVI Suite takes integration to the
next level with its advanced imaging tools such
as HeartNavigator for procedure planning and
live image guidance and EchoNavigator, which
combines Live 3D TEE with fluoroscopy for enhanced visualization of complex anatomy.
Pioneer Surgical Technology
1610
375 River Park Circle
Marquette, MI 49855
www.pioneersurgical.com
Pioneer Surgical proudly offers Tritium SCP,
an FDA cleared sternal cable plating system.
Complementing their current cable system,
Tritium provides more options to surgeons
and addresses varying patient anatomies. Pioneer is a leading innovator in the design and
manufacturing of implants and instruments
used for chest closures following median sternotomies.
Qualiteam s.r.l.
1238
Casale Nassio Sopra 15A
Chiaverano TO, 10010 Italy
www.qualiteam.com
Qualiteam develops, manufactures and distributes unique products gentle to the human body
with focus on patient comfort and functional
convenience for staff. Come visit our booth for
an in-depth look at how our products could
help your patients recover sooner and ultimately decrease the costs of cure.
Quest Medical Inc.
634
One Allentown Parkway
Allen, TX 75002-4211
www.questmedical.com
Quest Medical, Inc. is a medical device manufacturer and worldwide distributor specializing in protecting the heart during cardiac
surgery with the Quest MPS 2® and Microplegia. Quest also offers a unique variety
of aortic punches, safety valves, vascular
loops, and an anesthesia line designed for
optimum cardiovascular surgery.
Richard Wolf Medical
Instruments Corp.
1511
353 Corporate Woods Parkway
Vernon Hills, IL 60061
www.richardwolfusa.com
Richard Wolf offers complete solutions for minimally invasive diagnostic and operative applications including bronchoscopy, thoracoscopy,
esophagoscopy and mediastinoscopy.
Rose Micro Solutions
942
4105 Seneca Street
West Seneca, NY 14224
Rultract
1529
5663 Brecksville Road
Cleveland, OH 44131-1593
www.rultract.net
Rultracts'’ surgical retractor provides gentle
and uniform lift allowing maximum exposure
for IMA dissection, re-do hearts, xiphoid entry, subxiphoid pericardial procedures, minimally invasive procedures (capable for use
with Thoratrak), Parasternal procedures, Pediatric/ASD, T-incisions, Trans-Abdominal GEA
midcab, Pectus, TEMLA, VAMLA, MICS,
CABG, LVAD and Pectus Excavcatum NUSS
Repair.
Sanofi Biosurgery
837
55 Cambridge Parkway
Cambridge, MA 2142
www.sanofi.us
Sanofi Biosurgery is a global strategic business
unit of Sanofi. It develops and markets innovative, biologically based products for osteoarthritis relief, adhesion prevention, temporary
5/6/2013
6:09 PM
Page 13
endovascular occlusion of blood vessels, cartilage repair, and severe burn treatment. Sanofi
Biosurgery is committed to transforming disease management through innovative medical
interventions.
Scanlan International, Inc.
1205
One Scanlan Plaza
St. Paul, MN 55107
www.scanlaninternational.com
Highest quality surgical products designed and
manufactured by the Scanlan family since
1921. Over 3000 titanium and stainless steel
precision instruments including: VATS/MIS thoracoscopic instruments, Scanlan® SUPER
CUT™ Scissors, and Scanlan® LEGACY titanium needle holders and forceps. Single-use
products include Aorta/Vein Punches, VASCUSTATT® bulldog clamps and graft markers.
Siemens Healthcare
1736
51 Valley Stream Parkway
Malvern, PA 19355
www.usa.siemens.com/surgery
The Siemens Healthcare Sector is one of the
world's largest suppliers to the healthcare industry and a trendsetter in medical imaging,
laboratory diagnostics, medical information
technology and hearing aids. With over 150 installations in US (over 300 worldwide),
Siemens is a leading provider of imaging systems for the Hybrid OR.
Society for Heart Valve Disease
937
500 Cummings Center, Suite 4550
Beverly, MA 1915
www.shvd.org
The SHVD, which promotes research and education regarding the causes, prevention, and
treatment of heart valve disease, is comprised
of individuals dedicated to improving heart
valve disease in the global population, including cardiologists, cardiothoracic surgeons, researchers, allied health professionals, students,
and institutional representatives. The Society
holds biennial meetings in conjunction with the
Heart Valve Society of America (HVSA).
Society of Thoracic Surgeons
404
633 N St Clair
Chicago, IL 60611
www.sts.org
The Society of Thoracic Surgeons represents
more than 6,400 surgeons, researchers, and
allied health care professionals worldwide
who are dedicated to ensuring the best possible outcomes for surgeries of the heart, lung,
and esophagus, as well as other surgical procedures within the chest. The Society offers a
wide variety of member benefits, including
reduced participation fees in the renowned
STS National Database, a complimentary
subscription to the prestigious Annals of Thoracic Surgery, dynamic educational offerings,
online patient information resources, and
much more. Stop by booth #404 or visit the
STS website, www.sts.org, to learn more
about The Society of Thoracic Surgeons
Sontec Instruments Inc.
405
7248 South Tucson Way
Centennial, CO 80112
www.sontecinstruments.com
Sontec offers headlights and loupes and the
most comprehensive selection of exceptional
hand held surgical instruments available to the
discriminating surgeon. There is no substitute
for quality, expertise and individualized service.
Sontec's vast array awaits your consideration at
our booth.
Sorin Group
1019
14401 W. 65th Way
Arvada, CO 80004
www.sorin.com
Sorin Group is a world leader in the treatment
of cardiovascular diseases. Our innovative product portfolio includes aortic and mitral valve replacement and repair, perfusion equipment,
cannula and MICS instruments. For more information visit our web site at www.sorin.com.
Spec-Med
1214
113 Teal St.
St. Rose, LA 70087
www.spec-med.com
St. Jude Medical, Inc.
STS Advocacy Center
719
Sunshine Heart
619
12988 Valley View Road
Eden Prairie, MN 55344
www.sunshineheart.com
The C-Pulse Heart Assist System is a CE
Marked extra-aortic balloon pump using counterpulsation technology to treat Class III/Class
IVa Heart Failure. It is placed outside the
bloodstream, can be performed minimally invasively, and can be disconnected. It improves
heart function by, increasing coronary blood
flow, decreasing afterload and increasing cardiac flow.
superDimension, Inc.
542
161 Cheshire Lane, Ste 100
www.superdimension.com
superDimension, Inc. develops and manufactures software, hardware and disposables for
the lung disease market. superDimension’s
iLogic system is the total bronchial access and
navigation system that provides a safe pathway
to peripheral or central lung lesions, even for
patients with procedure-restricting conditions.
1534
3825 Commerce Drive
St. Charles, IL 60174
www.surgecardiovascular.com
Surge Cardiovascular designs, develops, manufactures, and markets a wide range of open
heart surgical products for cardiothoracic procedures. The company serves commercial acute
care hospitals, federal government facilities,
and provides OEM operations. The Surge Cardiovascular portfolio is CE Marked and distributed across North America, South America,
Europe, and Asia.
Surgical Acuity, Inc.
Welcome Reception Opens
Exhibit Hall
408
633 N. St Clair
Chicago, IL 60611-3658
www.sts.org
The STS Advocacy Center Booth #408 is the
best place to learn about STS government relations activities and to find out how you can
help your practice and the future of the specialty. Stop by Booth #408 where you can receive
timely information on federal legislation and
regulations impacting your practice, obtain
tools to engage members of Congress, and
learn about how to become a Key Contact for
cardiothoracic surgery.
Surge Cardiovascular /
MED Alliance Solutions, LLC
6300 Bee Cave Road Bldg 2 Ste 100
Austin, TX 78746
www.sjm.com
St. Jude Medical’s history of commitment to
cardiac surgery continues with our legacy of
market-leading heart valves, which continues
our passion of putting more control into the
hands of physicians to offer patients an improved quality of life.
638
3225 Deming Way
Middleton, WI 53562
Surgitel/General Scientific Corp
1328
77 Enterprise Drive
Ann Arbor, MI 48103
SurgiTel Systems is dedicated to offering the
best in ergonomics, vision, and comfort. Coupling SurgiTel Systems' High Definition Optics
with Oakley Frames, we offer the very best in
magnification systems. SurgiCam, our loupemounted camera system, is digital and lightweight allowing the viewers to see images at
the user’s perspective.
SynCardia Systems, Inc.
943
M ARTIN A LLRED
1992 E Silverlake Drive
Tucson, AZ 85713
www.syncardia.com
The SynCardia temporary Total Artificial Heart
(TAH-t) is the world’s only FDA, Health Canada
and CE approved Total Artificial Heart. It is approved as a bridge to transplant for patients dying from end-stage biventricular failure. Visit our
booth for updates on the Freedom™ portable
driver, 50cc TAH-t and destination therapy.
AATS members visited Exhibit Hall on Sunday evening. Exhibitors welcomed
members with food and drink and booths with a wide variety displays.
Teleflex Medical
1128
2917 Weck Rrive
Durham, NC 27709
www.teleflex.com
The Teleflex portfolio offers today’s cardiothoracic surgeon comprehensive resources including: Horizon™, Hemo-clip® ligation,
Hem-o-lok®, Tevdek®, Deklene® Maxx suture,
Pleur-evac® chest drainage. Weck, Deknatel, &
Pilling are recognized pioneer companies providing cardiovascular products enhancing patient outcomes.
Terumo Cardiovascular Systems
919
6200 Jackson Road
Ann Arbor, MI 48103
Thompson Surgical Instruments, Inc.
423
10170 East Cherry Bend Road
Traverse City, MI 49684
www.thompsonsurgical.com
Thompson Surgical is the original manufacturer
of table-mounted retractors .The Bolling Mitral
Valve Retractor System is a result of an extensive collaboration with Dr. Stephen Bolling, an
internationally renowned cardiac surgeon; offering low profile handles that are never in the
way and the frame and handles do not interfere
with sutures. The Bolling Retractor provides uncompromised exposure for a variety of procedures including Trans Septal Approach, Direct
Atrial Approach, Mitral Valve Repair, Mitral
Valve Replacement and MAZE.
Thoracic Surgery Foundation for Research
and Education
1105
633 N. St Clair
Chicago, IL 60611
www.tsfre.org
TSFRE was established in 1988 as a 501c(3)
not-for-profit charitable organization by the four
leading thoracic surgery societies: AATS, STS,
STSA, and WTSA. TSFRE’s mission is to foster
the development of surgeon scientists in cardiothoracic surgery; increasing knowledge and
innovation to benefit patient care.
Thoramet Surgical Products
944
301 Route 17 N, Suite 800
Rutherford, NJ 7070
www.thoramet.com
The Surgeon’s choice for VATS instrumentation!
We offer the most extensive catalog of pure thorascopic patterns available anywhere. The feel
you want, the actuation you need, the patterns
you demand! Come see our unique versatility
and new instruments!
Thoratec Corporation
504
6035 Stoneridge Drive
Pleasanton, CA 94588
www.thoratec.com
Thoratec is the world leader in mechanical circulatory support with the broadest product portfolio to
treat the full range of clinical needs for patients
suffering from advanced heart failure. Thoratec’s
products include the HeartMate LVAS, Thoratec
VAD, CentriMag and PediMag / PediVAS.
Transonic Systems Inc.
1139
34 Dutch Mill Rd.
Ithaca, NY 14850
www.transonic.com
What do you routinely think about when you're
leaving the O.R.? Are you hoping that the grafts
you just placed are patent after reversing anticoagulation? Obtain peace of mind by measuring blood flow just prior to approximation with
Transonic transit-time ultrasound flow measurement technology.
USB Medical, Ltd.
642
2000 Pioneer Road
Huntingdon Valley, PA 19006
Valves of Heart, Inc.
422
120 E 87th Street, Unit R14 B
New York, NY 10128
Vitalcor, Inc.
1111
100 E. Chestnut Avenue
Westmont, IL 60559
www.vitalcore.com
Latex Free Coronary Artery Balloon Canulae
with self-inflating Balloon (3-year shelf life).
Reusable Dingo (Bulldog) Clamp. Titanium and
stainless steel specialty instruments and retractors. Reusable stabilizer for Beating Heart
Surgery and Mitral Valve Retractor.
5/6/2013
6:09 PM
Page 14
Vitalitec
1413
10 Cordage Park Circle, Suite 100
Plymouth, MA 2360
www.vitalitec.com
Vitalitec Geister will be displaying all our
products, highlighting our Enclose® II Anastomosis Assist Device, Cygnet® Flexible
Clamps, Intrack® Atraumatic Temporary
Clamps and Inserts and Geister® ValveGate®
and Valvegate® PRO™ line of MIS CV instrumentation. You may view out products at
www.vitalitec.com and www.geister.com prior
to visiting at our booth.
Wake Forest/
Preclinical Surgical Services
442
200 East First Street
Winston-Salem, NC 27101
www.wakepreclinicalservices.com
Preclinical Surgical Services is a full-service
CRO focusing on proof-of-principle, method
development, and efficacy testing in the
preclinical medical technology research arena. Pre-surgical bench analysis, ex-vivo
modeling, dynamic imaging and surgical
models in all specialties. From concept to
clinical applications, PSS is your innovation
partner.
Wexler Surgical
527
11333 Chimney Rock Road, #110-120
Houston, TX 77035
www.wexlersurgical.com
Wexler Surgical designs and manufactures a
variety of titanium and stainless steel specialty surgical instruments and products for Cariac, Vascular, Thoracic, and Micro Surgery.
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Come see our new VATS/MICS instruments
and ask about out Optimus Series. Visit us
online at www.wexlersurgical.com for more information about our products and the services.
World Society for Pediatric and Congenital
Surgery
439
2300 Tupper St. C8-29
Montreal, QC H3H1P3 Canada
www.wspchs.org
The mission of the World Society for Pediatric and Congenital Heart Surgery is to
promote the highest quality comprehensive cardiac care to all patients with congenital heart disease, from the fetus to
the adult, regardless of the patient’s economic means, with an emphasis on excellence in teaching, research and
community service.
Worldwide Trends
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Cadence Pharmaceuticals
437
7436 West Shore Drive
Edina,MN 55435
www.cadencepharm.com
Cadence Pharmaceuticals, Inc. offers Ofirmev
(acetaminophen) injection 1000 mg/100 mL
(10mg/mL). Ofirmev is indicated for the management of mild to moderate pain; the management of moderate to severe pain with
adjunctive opioid analgesics; and the reduction of fever.
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1614
700 Collip Circle
London, Ontario, Canada
www.lifelikebiotissue.com
530
440 Louisiana #1212
Houston TX 77002
www.mesocare.org
Our mission at Mesocare.org is to empower
mesothelioma patients, family members, and
caregivers through education about the disease and its treatment and through awareness
of the services and resources available to
them wherever they may live. The stakes in
the battle against this cancer are high, and
we hope that we provide everyone with access
to the most current and accurate information
available.
St. Cloud Hospital
9LVLWXVDW$$76%RRWK
1513
4101 Research Commons,
79 T.W. Alexander Drive
Research Triangle Park, NC 27709
www.thrombate.com
Grifols is a multinational pharmaceutical and
chemical company. Principally a producer of
blood plasma-based products and also supplies devices, instruments and reagents for
clinical testing laboratories. Product description for Thrombate can be found on
www.thrombate.com.
Mesocare.org
6XUJL7HO/('
638
9900 Innovation Dr.
Wauwatosa, WI 53103
www.gehealthcare.com
GE is making a new commitment to health.
Healthymagination will change the way we
approach healthcare, with more than 100 innovations all focused on addressing three
critical needs: lowering costs, touching more
lives and improving quality.
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1507
2120 Prospect St
Menlo Park, CA 94025
Worldwide Trends is a network of experienced
market professionals working with medical device global companies.
1406 6th Ave. N
St. Cloud , MN 56303
www.centracare.com
1538
5/4/2013
4:48 PM
Page 15
VISIT US AT AATS BOOTH #419
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With the ON-Q* non-narcotic pain relief system, patients:
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See how ON-Q* can help you. Call your ON-Q* representative
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Visit iflo.com today to view our extensive online library of peer-reviewed journal articles, papers, posters and additional clinical trial information.
There are inherent risks in all medical devices. Please refer to the product labeling for Indications, Cautions, Warnings, and Contraindications. Failure to follow the product labeling could directly impact patient
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I-Flow*, LLC, A Kimberly-Clark Health Care Company
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MK-00430 AATS 2013 Ad indd 1
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4/12/13 11:40 AM
5/6/2013
8:41 PM
Page 16
n Monday’s General Thoracic
Surgery Simultaneous Scientific
Session, Mark K. Ferguson, MD,
of the University of Chicago, presented a modified scoring system to
predict major cardiovascular events
after lung resection, which was developed using the Society of Thoracic Surgeons General Thoracic
Database. “We analyzed outcomes
for the period 2003 to 2011 for patients having elective major lung resection, applying the ThRCRI Risk
scoring system. We found that
ThRCRI successfully stratified patients at risk for major postoperative cardiovascular complications,”
Dr. Ferguson said.
The ThRCRI Risk score was based
on weighted values for serum creatinine, coronary artery disease, cerebrovascular disease, and extent of
lung resection, and was stratified into
four risk categories: 0 (A), 1-1.5 (B),
2-2.5 (C), and greater than 2.5 (D).
The major cardiovascular complications followed included myocardial
infarction, ARDS, ventricular arrhythmia requiring treatment, and
all-cause death.
The four scoring categories
demonstrated significantly different
I
Mark K. Ferguson, MD, presented a
scoring system for major lung resection.
incremental risks of major cardiovascular complications, ranging from
around 3% for category A, nearly 6%
for category B, to over 11% for categories C and D. This expected risk
calculated in the study group was
found to be similar to the actual observed risk, indicating that ThRCRI
accurately predicted specific risk
rather than just relative risk, said Dr.
Ferguson.
This finding could have important
clinical relevance. “Using the ThRCRI
scoring system may help in identifying patients who may benefit from
additional preoperative evaluation
and from closer perioperative monitoring,” Dr. Ferguson concluded.
Pradheep Krishnamohan, MD, and
his colleagues from the Mayo Clinic,
performed a retrospective record review of around 500 patients who underwent laparoscopic myotomy
between April 1998 and June 2011.
Patients’ follow-up was performed
using a standardized dysphagia questionnaire.
Laparoscopic myotomy with partial fundoplication was performed in
over 95% of the patients, the rest receiving myotomy alone. There was
no operative mortality. Complications were relatively low.
Analysis of all patients that returned the questionnaires revealed
that around 70% reported heartburn,
more than one-third had regurgitation, and around 68% took antacids,
H2 blockers or PPIs within the past
30 days of the survey.
“Our study shows that laparoscopic
myotomy with partial fundoplication
is a safe operation with extremely effective outcomes in about one-third
of patients, with those patients who
PATRICE W ENDLING /IMNG M EDICAL M EDIA
Lung Cancer and More at GT Surgery Session
Pradheep Krishnamohan, MD, studied
patients who had laparoscopic myotomy.
were older than 65 years tending to
have better outcomes,” Dr. Krishnamohan concluded.
Outcomes for sub-lobar resection
(SLR) were equivalent to those for
lobectomy for treatment of early
stage non–small cell lung cancer
(NSCLC), according to a large,
prospective study presented by Nasser K. Altorki, MD, of the Weill Cornell Medical Center.
He and his colleagues compared
Continued on following page
SAVE THE DATE
The Duke Endosurgery Center
PRESENTS
September 19–21, 2013
Waldorf Astoria Orlando
Orlando, Florida
Course Director:
Thomas D’Amico, MD
Professor of Surgery
Duke University Medical Center
Registration/Information:
endo.surgery.duke.edu/courses
Co-sponsored by
American Association
for Thoracic Surgery
REGISTER NOW
Masters of Minimally Invasive
Thoracic Surgery
TOPICS:
Learn about the most recent advances in minimally invasive thoracic surgery,
discuss the technical aspects of the most challenging procedures with
international experts, and share your most difficult cases with knowledgeable
and skilled faculty. This postgraduate course emphasizes the use of video-based
education and detailed discussion of technical details to meet the continuing
educational needs of surgeons who routinely practice thoracoscopic surgery.
AUDIENCE:
This program is designed to meet the continuing educational needs of thoracic
surgeons, as well as others who may assist thoracic surgeons in practice. Although
the curriculum focuses on the most challenging and complex procedures, fellows
and residents in thoracic and surgical training programs have also benefited from
previous courses, as have physician assistants and other operative personnel.
REGISTRATION:
By July 19, $695; after July 19, $795
To register or get more information, visit us at endo.surgery.duke.edu/courses.
5/6/2013
8:47 PM
Page 17
Congenital Simultaneous Session Focuses on TOF
onday’s Congenital Heart
Surgery Simultaneous Session addressed attempts to
improve Tetralogy of Fallot repair
and on using left ventricle assist device (LVAD) technology to treat
children with a single functional
ventricle, as well as studies to limit
complications in treating other important congenital heart conditions.
Despite hopes that the use of a
more limited right ventriculotomy
would lead to a lowered incidence
of ventricular dilatation and dysfunction in patients undergoing
transannular repair of Tetrology of
Fallot (TOF), there were no benefits
seen for using this procedure compared with the standard operation,
said Cheul Lee, MD, of the Sejong
General Hospital.
Because long-term complications
of conventional transannular repair
with a large right ventriculotomy
(RV-tomy) in patients with TOF are
common, many centers adopted the
use of transatrial and transpulmonary approach with a limited (less
than 1 cm) transannular RV-tomy in
hopes of getting better results, despite a lack of evidence of long-term
results.
Dr. Lee and his colleagues performed a study in more than 113 patients to test whether the use of a
more limited RV-tomy would, in fact,
result in less right ventricular (RV) dilatation and dysfunction, compared
with conventional RV-tomy.
Between June 2002 and April 2012,
patients who had transannular repair
Continued from previous page
lung cancer–specific (LSC) survival
in more than 500 patients with clinical stage 1A NSCLC who had either lobectomy or SLR resection in
the International Early Lung Cancer Action Program (I-ELCAP)
from 1993 to 2011. They evaluated
differences in the demographic and
clinical characteristics between the
lobectomy and SLR groups and determined the LCS survival asymptote using Kaplan-Meier.
“We identified patients in whom
the cancer presented as a solid
nodule (with the greater majority
of tumors less than or equal to 2
cm as determined by CT screening) who were treated with either
lobectomy or SLR and found that
there was no difference between
the two groups in median age [63
years], sex, presence of hypertension, COPD, cardiac disease, or
M ARTIN
ALLRED
M
Cheul Lee, MD discussed the longterm results of a limited RV-tomy.
of TOF at a mean age of 2.8 years
underwent magnetic resonance imaging (MRI) for evaluation of pulmonary regurgitation at a mean age
of around 19 years.
Patients were divided into limited
RV-tomy group (about one-third) and
conventional RV-tomy group (about
two-thirds).
An equal number of patients
from each group were matched for
comparison using propensity score
matching with covariates of sex,
age at repair, and history of prior
shunt.
There was no difference in these
propensity score–matched comparisons, even though there was a longer
interval between repair and MRI exother major comorbidities,” said
Dr. Altorki.
Overall, there was no significant
difference found in the 14-year
LCS survival rates for SLR and
lobectomy, with both slightly over
90%. For those with tumors less
than or equal to 2 cm, the LCS
survival was also in the low 90%
range for both procedures, a nonsignificant difference.
“In addition, regression analysis
showed there was still no significant difference in survival of
those who had lobectomy and
SLR,” he said.
The session, which also included papers on topics as diverse as
pulmonary hypertension and postsurgical follow-up, was moderated
by Harvey I. Pass, MD, of the
New York University Medical
Center, and David R. Jones, MD,
of the University of Virginia
Health System.
amination in conventional RV-tomy
group.
“Our study couldn’t demonstrate
any long-term benefits of using limited RV-tomy, compared with conventional RV-tomy in patients, at least in
terms of RV size and function,” he
concluded, stating that further studies
were necessary to determine whether
there was a beneficial role of using
limited RV-tomy for patients who undergo transannular TOF repair.
In another examination of the
problems encountered after repair
of TOF, Vladimiro Vida, MD, of the
University of Padua, and his colleagues did a study to examine
whether balloon dilation to preserve
the pulmonary valve could be used
to prevent progressive pulmonary
valve regurgitation leading to right
ventricular failure after repair.
Since 2008, more than 69 patients
with TOF were enrolled. There
were 34 patients assigned to pulmonary valve preservation using a
combination of early trans-atrial repair and intra-operative balloon dilation of the pulmonary valve annulus
(Group 1).
The remaining 35 patients underwent an early trans-atrial repair with
transannular patch repair and pulmonary valve (PV) cusp reconstruction (Group 2), Dr. Vida stated.
The degree of pulmonary valve regurgitation was none/mild in the majority of the Group 1 patients, which
was statistically better than in the
Group 2 patients. Follow-up was unequal between the 2 groups.
“Pulmonary valve preservation using intra-operative balloon dilation
yielded better pulmonary valve function and leads to improved right ventricular function in the mid term,
compared to patients who underwent
a classical trans-annular patch,” Dr.
Vida concluded.
Despite a rapidly increasing and favorable experience with pediatric-specific ventricular assist devices (VAD) to
bridge children with severe heart failure to transplant or recovery, there is
very little data concerning the use of
VADs in children with functional single ventricle, according to Samuel Weinstein, MD, of the Montefiore
Medical School, and his colleagues.
Dr. Weinstein presented their large
prospective database study of children with a single functional ventricle supported with the Berlin Heart
Pediatric EXCOR VAD, compared
with the results of those supported
with biventricular circulation.
The researchers reviewed the EXCOR Investigational Device Exemp-
tion (IDE) study database of over
200 patients implanted between May
2007 and December 2010. Around
10% of the patients had a single
functional ventricle, with the majority of these having a diagnosis of hypoplastic left heart syndrome
(HLHS).
The difference in support days for
single ventricle patients and the biventricle patients was non-significant.
Transplantation occurred in around
42% of the 26 single ventricle patients,
compared with 73% of the biventricle
patients who were transplanted or
weaned.
“The EXCOR device can provide a
bridge to transplant for children with
single ventricle physiology, albeit less
successfully than in children with
biventricular circulation. Further
evaluation of this challenging patient
population is warranted,” Dr. Weinstein concluded.
The session was moderated by Pedro J. del Nido, MD, of Boston Children’s Hospital, and Christopher A.
Caldarone, MD, of the Hospital for
Sick Children.
The AATS Daily News
The Official Newspaper of the AATS
93rd Annual Meeting
AATS Staff
Executive Director:
Cindy L. VerColen
Managing Editor:
Lorraine M. O’Grady
Publication Staff
Director, IMNG Society Partners
Mark Branca
Advertising Sales:
Betty Ann Gilchrist, 203-938-3156
Manager, Onsite News Products:
Mark Lesney
Publication Editors:
Therese Borden, Lora McGlade
Designer:
Elizabeth Lobdell
Photographers:
Martin Allred, Nick Piegari
Production Specialist:
Maria Aquino
Cover photo courtesy Meet Minneapolis
©Copyright 2013, American
Association for Thoracic Surgery, 500
Cummings Center, Suite 4550, Beverly,
MA 01915
Produced and distributed for AATS by
IMNG Society Partners, Frontline Medical
Communications. All rights reserved. No
part of this publication may be reproduced or transmitted in any form, by any
means, without prior written permission
of the AATS. The opinions expressed in
this publication are those of the presenters and authors, and do not necessarily
reflect the views of the Association.
5/6/2013
7:21 PM
Page 18
Presidential Address from page 1
“People don’t care how much you
know until they know how much
you care.”
Inevitably, as a leader, you will have
to make difficult decisions, and you
will have those difficult conversations
with staff. The ability to persuade is
important, rather than just using the
power of your position, he said.
Dr. Schaff then listed four key
characteristics of leadership.
씰 You must live and adhere to the
values of your group.
씰 Leaders should be expert in some
domain of the group that they lead.
씰 The leader must have a vision and
plan.
씰 The leader must consider the interests of colleagues first.
“You need to have their back, and
not because leadership is a popularity
contest. Your colleagues will be persuaded because they know you
watch out for them. They will go
along with your decisions, even with
misgivings if they trust that you consider their interests first.” And finally,
the leader should be a role model,
not a mentor. Mentoring involves
multiple individuals and has become
synonymous with counselor or
guide.
Role models, however, are people
that individuals compare themselves
to and who occupy the professional
and social roles to which the individual aspires, he said.
Thoracic surgery is recovering
from a minor crisis in confidence because of a diminishing applicant
pool, and needs role models because
of this, he said. “Role models are the
surgeons who by dedication, skill and
character, drew you to our specialty,”
said Dr. Schaff. “Don’t settle for being a mentor, but rather, be a role
model.”
The second important aspect of
the AATS that Dr. Schaff addressed
was scholarship, the knowledge that
results from study and research.
“It is my strong belief that the best
research is done by those who achieve
clinical excellence, because a clinician
knows the important questions to ask
and has insights into the best avenues
for investigation. Likewise, the best
clinicians not only have busy practices
but have thought about and written
about their experiences, so that others
will use their methods and avoid the
pitfalls they have observed,” he said.
Dr. Schaff emphasized that research in thoracic surgery is very
broad; it may involve molecular biology, integrated physiology, device development, or outcomes research. All
of these domains are important to
our specialty, but what are the benefits to the trainee?
씰 The first benefit to the resident
might be something as simple and
practical as career advancement.
씰 A second benefit of research is the
satisfaction of discovery and recognition of the work through presentation and publication.
씰 And thirdly, in some instances the
laboratory experience will be a direct
lead into a career in investigation as a
surgeon/scientist.
씰 Often, the techniques learned and
the concepts mastered while doing
research can be applied later to problems that are wholly unrelated to the
original project.
He gave an example from his own
life, where in the research laboratory,
he learned an important implication
from extensive research on the effect
of ventricular volume on diastolic
function. “I remember with crystal
clarity the day the cardiologist who
refers many HOCM patients for
surgery showed me the echocardiogram of a patient with apical disease
and said, ‘too bad we don’t have a
procedure for diastolic dysfunction…
this patient’s heart is too stiff.’ At
that time I immediately recalled the
diastolic dysfunction in reperfused
hearts and thought that the problem
in this patient was not muscle stiffness per se, but reduced ventricular
volume. And this extrapolation to an
operation for diastolic dysfunction
was an unexpected benefit of research, 20 years after my laboratory
experience.
“As I look out to you in the audience, I see present and future leaders
in thoracic surgery. I hope you will
take some time to think about the
defining qualities of leadership, and
especially the importance of role
models,” said Dr. Schaff. “And remember, too, of the unexpected benefits of scholarly activity,” he urged.
AATS Mitral Conclave in New York: A Resounding Success
Francis C. Wells, Papworth Hospital,
United Kingdom, kicked off his
presentation on “The Bishop’s Mitre” with
a bit of British wisdom.
On behalf of the AATS, Hartzell V. Schaff,
AATS President, welcomed attendees to
the Mitral Conclave and presented several
talks, including “Pathophysiology of Mitral
Valve Regurgitation.”
AATS
Almost 1,000 cardiothoracic surgery professionals attended the
2013 Mitral Conclave held on May 2-3 at the Hilton New York. The
Conclave, directed by David H. Adams, gathered the world's leading
figures in mitral valve disease to discuss the latest information
regarding management guidelines, imaging, pathology, minimally
invasive approaches, percutaneous approaches, surgical techniques,
devices, and long term results. Complete coverage of the 2013 Mitral
Conclave will appear in the June issue of Thoracic Surgery News.
The Friday morning Breakfast Breakout Session at 7:15 on “Leaflet Augmentation in Complex
Valve Repair” attracted a “standing room only” crowd. The session, co-chaired by Tirone E.
David and Robert A. Dion, included Gilles D. Dreyfus - Pericardial Patch Augmentation in
Tricuspid Valve Repair; David H. Adams - Pericardial Patch Augmentation in Mitral Valve
Repair; and Pedro J. del Nido - Biological Scaffolds for Leaflet Regeneration.
David H. Adams, Program Director, welcomed
attendees and thanked the Program Committee for
their efforts: Anelechi C. Anyanwu, Michael A.
Borger, Pedro J. del Nido, Robert J.M. Klautz, Irving
L. Kron, Tomislav Mihaljevic, and D. Craig Miller.
5/4/2013
4:49 PM
Page 19
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Page 20
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