The 2024 Latin American Cardiovascular Surgery Conference, held over three days in Buenos Aires, Argentina, attracted leading experts from Europe, Latin America, and North America to address topics in cardiovascular medicine, including coronary artery disease, congenital heart disease, atrial fibrillation, and heart failure.
"The conference provided a diverse range of sessions to accommodate surgeons at all stages of their careers," explained Program Chair Rafael Sadaba, MD, Navarra University Hospital, Pamplona, Spain. “Residents and early career surgeons benefited from dedicated sessions, while experienced surgeons had the opportunity to delve into complex procedures and cutting-edge techniques.”
The program offered a comprehensive overview of the latest advancements in cardiac surgery. It featured scientific abstracts, technical videos, and interactive discussions on a variety of topics, including the current state of heart transplantation in Latin America, the use of mechanical circulatory support devices, the role of ECMO in treating cardiogenic shock, and advanced surgical techniques for mitral and aortic valve repair.
“This year, I was particularly interested in the session on the Ross Procedure, an operation that has been around for a long time but has experienced renewed interest over the past few years," said EACTS Secretary General Patrick Meyers, MD, Lausanne University Hospital, Switzerland.
The three-day event highlighted women's cardiac health, particularly tailored approaches and complex treatments for women of reproductive age. Other sessions focused on managing aortic dissection, advancing transcatheter valve therapies, and providing lifelong care for patients with conditions such as aortic stenosis.
The conference concluded with hands-on workshops that allowed participants to practice skills such as mitral valve repair and ECMO cannulation, making it an essential platform for advancing cardiac care in Latin America.
A groundbreaking surgical achievement has been made by the team at West Virginia University (WVU) Heart and Vascular Institute, led by Dr. Vinay Badhwar, the executive chair of the WVU Heart and Vascular Institute and the second vice president of the Society of Thoracic Surgeons. On October 31, 2024, the team performed the world’s first combined robotic aortic valve replacement (AVR) and coronary artery bypass grafting (CABG) through a single small incision.
Image
Dr. Vinay Badhwar
The pioneering procedure was performed on 73-year-old Poppy McGee, a patient with a complex medical history, including a stroke, brain surgery, and significant weight loss. Referred to Dr. Badhwar for treatment of both aortic valve disease and coronary artery disease, McGee initially faced the prospect of traditional open-heart surgery. However, when she and her family learned of its risks—over a 10% chance of mortality and nearly 50% likelihood of complications—they inquired about alternative options.
Dr. Badhwar explained his team had developed a novel robotic approach that had yet to be tested on a patient. After a thorough discussion of the risks and benefits, McGee and her family agreed to proceed with the innovative robotic surgery.
The procedure involved both AVR and CABG, performed entirely robotically through a single incision on the far right of McGee’s chest. The success of the surgery has sparked optimism about the potential for broader adoption of robotic heart surgery for patients with complex conditions.
“While we are still in the early days of this latest innovation, the ability to perform valve surgery and coronary artery bypass surgery fully robotically through a single incision has the potential to open up a new era of robotic heart surgery,” Dr. Badhwar noted in a prepared statement. “We must always keep quality outcomes at the forefront of all innovation. However, if surgeons adopt and gain experience with techniques such as this one, they will tackle this last frontier that previously limited a robotic approach. One day in the near future, this may serve as a platform to perform nearly all types of heart surgery.”
This revolutionary procedure potentially paves the way for less invasive operations. Dr. Lawrence Wei, a professor at the WVU Department of Cardiovascular and Thoracic Surgery, remarked on the impact of this advancement: "Patients who have both valve disease and coronary artery disease have traditionally been treated by open-heart surgery performed through the breastbone. This new robotic technique could redefine how we approach these cases."
Dr. Goya Raikar, an assistant professor at WVU and a member of Badhwar’s robotics team, also underscored the procedure's significance: "Until now, the main exclusion for us to perform a robotic approach has been the coexistence of valve and coronary artery disease. Building on our experience with robotic aortic valve surgery, this new approach may help us extend robotic surgery options to many more patients."
The patient’s daughter, Mollie Wilcosky, expressed gratitude for the groundbreaking care provided by the WVU team. “We are so thankful for Dr. Badhwar and the team at the WVU Heart and Vascular Institute for developing this robotic procedure to help my mother recover so well,” Wilcosky said. “She is getting stronger every day.”
The full details of the procedure will be in The Annals of Thoracic Surgery, highlighting how innovative approaches like this continue to redefine the future of cardiothoracic surgery.
References:
• Cardiovascular Business article on the WVU Heart and Vascular Institute's groundbreaking surgery.
• WV News article detailing the multidisciplinary team and procedural innovations at WVU Medicine’s WVU Heart and Vascular Institute.
The Society of Thoracic Surgeons (STS) and the Asian Society for Cardiovascular and Thoracic Surgery (ASCVTS) recently co-hosted the inaugural Aortic Summit 2024 in Tokyo, Japan. This international event brought together leading experts in the field to discuss advancements in the diagnosis and treatment of thoracic aortic lesions, including endovascular approaches.
The summit was designed to cater to a diverse audience, including cardiothoracic surgeons, cardiac anesthesiologists, CT residents, perfusionists, and ICU and OR nurses.
The comprehensive three-day program covered a wide range of topics, including root, arch, descending aorta, TEVAR, dissection, and hybrid procedures. Participants had the opportunity to learn from experts, network with colleagues, and gain valuable insights into the latest techniques and technologies.
"The sessions delved into the latest developments through a series of presentations, panel discussions, and hands-on workshops," said Yutaka Okita, MD, Congress President for the STS-ASCVTS Aortic Summit 2024. "The event featured a number of eminent speakers from all over the world, who shared their expertise and achievements with attendees.”
At the 2024 European Association for Cardio-Thoracic Surgery (EACTS) meeting in Lisbon, Portugal, leaders in cardiac surgery and interventional cardiology came together, signaling a newfound harmony over coronary revascularization practices for complex heart conditions. This session marked a significant change from the intense disagreements that followed the EXCEL trial controversy five years ago, which raised concerns about data interpretation in revascularization treatments for left main disease.
In a joint session between EACTS and the European Society of Cardiology (ESC), Dr. Alaide Chieffo (Vita Salute San Raffaele University, Milan) and Dr. Patrick Myers (Lausanne University Hospitals, Switzerland) presented a united front on revascularization strategy, referencing the ESC’s recent guidelines for managing chronic coronary syndromes (CCS) with a patient-centered approach. The guidelines, collaboratively crafted by cardiologists and surgeons, reflect a shared understanding of both PCI and CABG as valuable options for coronary artery disease based on individual patient conditions.
“We've gone full circle,” Dr. Myers told TCTMD. “The latest guidelines have a left main chapter that EACTS endorses because we all feel that this represents the evidence best. It's very positive to see that we've gone from surgeons unilaterally looking at the data and saying, ‘Wait a minute, this is not reasonable. We don't agree with this,’ to saying, ‘Okay, let's work on this together.’” His comments underscore the shift from discord to collaboration in developing best practices for patients with multivessel coronary artery disease, left main disease, and heart failure.
EACTS President Dr. Volkmar Falk (German Heart Center Berlin) echoed this sentiment, emphasizing that the endorsed guidelines demonstrate alignment with cardiologists and aim to serve patient needs effectively. He urged further collaboration by encouraging attendance at cardiology-focused conferences, saying, “Go to ESC, go to EuroPCR, be present at these meetings, and engage in the discussion there. It’s one thing to discuss this here at EACTS… We have to also join our cardiology friends and go to their meetings.”
In her presentation, Dr. Chieffo underscored that a “patient-centered” approach should guide heart team discussions for complex cases and highlighted that care recommendations depend on various factors—including hospital capabilities. She explained that CCS guidelines offer a Class I recommendation for CABG in low-surgical-risk patients and for PCI in low-anatomic-complexity cases, stressing that patient-centered care takes into account individualized patient needs rather than simply following patient preferences.
With the introduction of these guidelines, both EACTS and ESC reaffirm their commitment to improving outcomes through collaboration and shared expertise across disciplines, reflecting a renewed spirit of partnership in cardiovascular care.
It is time to reconsider the management of Aortic valve Disease (AVD) across the world. In South Asian and Sub-Saharan African nations, in low-income countries, AVD is treated with surgical aortic valve replacement (SAVR). Patients receive mechanical valves. The population is younger than in high-income countries and the disease is different, mostly of rheumatic origin.
The first session of the South Asia webinar series delves into valve repair strategies for rheumatic mitral valve disease. Expert panelists will provide an overview of the current state of rheumatic heart disease in South Asia’s developing countries, along with best practices for case selection tailored to early career surgeons. The webinar will also feature discussions on proven repair techniques for managing rheumatic mitral stenosis and regurgitation.
Moderators
Vinod H. Thourani, MD
Piedmont Heart Institute
Atlanta, GA
More than 100 cardiothoracic surgeons, fellows, residents, and advanced practice providers participated in the 2024 STS Mastering Valve Surgery Workshop in Chicago on Sept 20-21. The two-day event included lectures, case-based presentations, and breakout sessions focused on mastering modern-day valve surgery, including open and transcatheter procedures for aortic, mitral, and tricuspid valves.
Image
Attendees participate in a hands-on aortic valve surgery session.
"This workshop stands out for its unique blend of theoretical instruction and practical hands-on training, covering both surgical and transcatheter techniques for all valve types," said co-course director Tsuyoshi Kaneko, MD, of Washington University in St. Louis. "The active participation and insightful questions from both domestic and international attendees highlighted the course's relevance and impact."
Attendees honed their skills through small-group, hands-on experiences in wet lab settings to learn the latest in advanced valve techniques (aortic root enlargement, Ross Procedure, minimally invasive valve surgery), transcatheter therapies, and atrial fibrillation.
"I'm pleased that the valve surgery courses encompassed both traditional surgical techniques and emerging transcatheter procedures," said co-course director Katherine Harrington, MD, of Baylor Scott & White Health in Dallas. “To remain at the forefront of the latest technologies in the field, we must continually update our knowledge and ensure our outcomes are exceptional, fostering collaboration with structural heart experts."
Here's what a few attendees said about the Valve Surgery Workshop:
"I enjoyed the panel discussions at the end of each session and found the small-group wet labs extremely helpful.” — Alex Wang, physician assistant, Johns Hopkins Health System
"The best sessions were aortic root enlargement by Dr. Yang, mitral valve surgery by Dr. Badhwar, and TAVR explant by Dr. Kaneko."
"Overall, it was a valuable experience to interact with experts and directly view the pig heart. The catheter-based procedure simulators were also helpful for learning."
"Great courses and discussion topics, exemplary faculty, and I enjoyed the hands-on sessions."
"Moving forward, I will adopt the aortic root enlargement technique as explained by Dr. Yang, the mitral valve replacement technique of Dr. Badhwar, and the Ross Procedure technique detailed by Dr. El-Hamamsy. I also intend to incorporate the maze and atrial clip procedures more frequently into my practice."
With the emerging evidence, the use of SAVR in the era of TAVR expansion has been heavily debated. This webinar focuses on the latest science showing the benefit of SAVR over TAVR and will cover several key scenarios that could benefit from SAVR.
Moderators
George Arnaoutakis, MD
University of Texas at Austin Dell Medical School
Austin, TX
Puja Kachroo, MD
Washington University Physicians
St. Louis, MO
Panelists
Tsuyoshi Kaneko, MD
Washington University Physicians
St. Louis, MO
A Tech News article authored by Khalil Khalil, MD, Division of Cardiac Surgery, Department of Surgery, Université de Montréal, Montreal, Quebec, Canada, and Jessica Forcillo, MD, Department of Cardiac Surgery, Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montréal, Quebec.
This 8 in 8 session focuses on fast-tracking in CABG patients. The presentation examines incorporating elements of ERAS and other fast track principles, data regarding the safety and efficacy of fast tracking, and a real-world patient case.
Speaker
Alison F. Ward, MD, Emory University, Atlanta, GA
On June 7-8, 2024, in Miami, more than 120 cardiothoracic surgeons and heart team members from around the world gathered for the third annual STS Coronary Conference. With a focus on the technical aspects of coronary surgery, attendees experienced case-based panel discussions, abstract sessions, practical tips and tricks, and interactive “How I Do It” video presentations featuring surgical techniques.
The two-day 2024 STS Coronary Conference brought together coronary surgery experts from throughout the world.
The two-day event covered a wide range of topics, including conduit selection and harvest, graft configuration, off- and on-pump CABG, and a stepwise approach to minimally invasive coronary surgery, from MIDCAB to advanced multivessel revascularization.
"Coronary surgery is a sub-specialty within cardiac surgery, so it’s important for future surgeons to be skilled in off-pump surgery, minimally invasive surgery, and traditional on-pump cross clamp surgical techniques,” said Chase Brown, MD, assistant professor of surgery at the University of Pennsylvania, and a course presenter. “Attendees were able to learn from experts leading the way in the field.”
"The most exciting things I learned about were the technical aspects of coronary sequential grafting," said cardiac surgery resident Dr. Kevin An from the University of Toronto. “It’s an area I’m interested in implementing into my practice.”
Here's what a few other attendees said about the Coronary Conference:
"I enjoyed the panel discussions at the end of each session – I learned as much from them as I did from each of the presentations."
"So many great presentations. I think the 'How to Prevent AKI After CABG' presentation by Dr. Daniel Engleman may have been my favorite."
"After attending the sessions, we will add certain changes in the steps for endoscopic harvesting of the saphenous vein, as well as measures to reduce and prevent sternal wound complications."
"In the future, I would like to see more perioperative content and learn how to implant an Impella 5.5."
"I really enjoyed the conference. It was worth coming to the US from Brazil to take the course."
"As a result of attending the conference, I would tend to perform MAG-TAG more often to more patients, use the skeletonization technique to decrease sternal wound infections, and practice the Y-T graft."
The STS Workshop on Robotic Cardiac Surgery held May 9-10 in Peachtree Corners, Ga., offered 80 surgeons from across the country two days of hands-on team training for mitral valve repair, coronary bypass, and other surgery procedures in a cardiac robotics simulation environment.
Workshop attendees gained insight into building a robotics program, as well as improving the effectiveness of their program.
Here are the top five benefits that surgeon attendees received from the experience:
1. Innovation: Attendees trained in robotic mitral valve procedures and robotic coronary revascularization using the latest techniques and technology. Multiple operating bays fitted with surgical robots allowed participants to sit at the console to control the robots.
2. Training: The program offered a variety of educational activities for surgeons, including real-world simulations, case videos, faculty discussions, emphasized patient selection, perioperative management and postoperative care, and operative techniques.
3. Collaboration: The workshop was designed for both beginner robotic surgical teams who are looking for fundamental information and guidance on how to build a program, as well as advanced robotic surgical teams already practicing cardiac surgery robotics and are looking to continually improve the efficiency and effectiveness of their program.
4. Access to luminary experts in the field: The workshop was led by world-renowned robotic heart surgeons. The surgeons who served as faculty not only mastered the use of robotics in cardiac surgery, but they also helped define it.
5. Networking: Robotic Cardiac Surgery Workshop attendees connected with surgeons from across the country who are on the cutting edge of robotic cardiac surgery.
Feedback on the conference was overwhelmingly positive. Here are a few highlights:
"The best presentation was the one on preoperative criteria and assessment for robotic mitral valve patients."
"The session content was helpful for those thinking about starting a robotic mitral valve program."
"The presentations given by early-stage faculty on difficult cases where they had to convert to open were very helpful."
"Dr. Joanna Chikwe's session on complications of mitral valve repairs was wonderful. I loved this presentation."
"The most valuable sessions were those that offered peer-to-peer interaction with the experienced surgeons, including the hands-on lab."
"I think the courses being part lecture and part hands-on gave the background and data to support what we are doing in the lab. Even more hands-on time would be great, as well."
