In patients undergoing coronary artery bypass grafting (CABG), a novel analysis evaluating surgeon preference for multi- versus single-arterial grafting may help explain the differing results between prior retrospective analyses and randomized controlled trials regarding long-term survival.
A novel study to be presented on Friday, Jan. 24, at The Society of Thoracic Surgeons’ 61st Annual Meeting by lead author Justin Schaffer, MD, a cardiothoracic surgeon at Baylor Scott & White Health, offers fresh insights into the long-debated question of whether multi-arterial grafting (MAG) improves long-term survival compared to single-arterial grafting (SAG) in patients undergoing CABG. The analysis evaluates over one million Medicare beneficiaries and incorporates an innovative approach using surgeon preference as a tool to address unmeasured variables.
While the findings highlight nuances in interpreting retrospective and randomized trial data, they also underscore the need for future randomized studies, such as the forthcoming results of the ROMA trial, to definitively guide clinical decision-making.
The researchers emphasized that understanding the survival benefit of MAG over SAG requires randomized data, and it remains an important and open clinical question.
In a landmark achievement for healthcare in Southeast Asia, St. Luke's Medical Center has launched the region's first robotic cardiac surgery program. This historic initiative was made possible through a collaborative effort between St. Luke's multidisciplinary team, led by Drs. Marvin Martinez and Ramiro Pablo, and the expert team from West Virginia University's (WVU) Heart and Vascular Institute, including Dr. Vinay Badhwar, Dr. Lawrence Wei, and physician assistant Herald Fe.
The program debuted with a series of innovative robotic-assisted cardiac procedures, showcasing the transformative potential of this advanced technology. Among the groundbreaking surgeries performed were:
Robotic MIDCAB (Minimally Invasive Direct Coronary Artery Bypass)
Robotic bileaflet mitral valve repair for severe mitral regurgitation (MR) due to bileaflet myxomatous disease
Robotic mitral valve repair for endocarditis, including anterior mitral leaflet perforation
Robotic adult congenital atrial septal reconstruction using a bovine patch for a patient with a common atrium
Robotic aortic valve replacement (AVR) for a patient from Papua New Guinea
The first robotic valve surgery—a repair of a severely regurgitant mitral valve in a 40-year-old patient—marked a defining moment in the program's success. With guidance from WVU's Heart and Vascular Institute, the procedure was completed with precision and excellence, underscoring the collaboration's impact.
Dr. Pablo expressed his excitement, saying, "This is a monumental step forward for cardiac care in Southeast Asia. Our partnership with the WVU team has empowered us to provide patients with less invasive, highly precise procedures and faster recoveries."
Dr. Martinez added, "Establishing this robotic cardiac surgery program has been a dream realized through our team's dedication and the invaluable expertise of our WVU partners. This is just the beginning of a new era in cardiac care."
Reflecting on the collaboration, Dr. Badhwar remarked, "Teamwork truly makes the dream work. The exceptional multidisciplinary team at St. Luke's has shown that vision, determination, and collaboration can achieve extraordinary outcomes."
St. Luke's Robotic Cardiac Surgery Program is set to advance care across the region, offering minimally invasive options that reduce pain, recovery time, and the risk of complications.
Stand Out From the Competition—Maximize Your Impact
Increase your company’s opportunity for personalized interactivity with attendees by exhibiting at the Workshop. Several breaks will take place in the exhibit area and have been scheduled so that attendees have plenty of time to visit your booth. The intimate size of the exhibition will help ensure that you have quality access to meeting attendees.
Exhibitors also are eligible to purchase symposia, email blast communications, and/or to support the meeting with an educational grant.
Stand Out From the Competition—Maximize Your Impact
Enhance your company’s visibility and connect with more than 100 attendees by exhibiting at the STS Coronary Conference. Strategically scheduled breaks in the exhibit area will give attendees ample time to visit your booth, ensuring valuable networking and engagement opportunities. The intimate setting of the exhibition fosters meaningful interactions with key decision-makers.
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.
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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.”
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.
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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."
