Dear member,My term as EACTS Presidentnears its end, and so this is myfinal President’s Column. It hasbeen an exciting year. TheEACTS had a number of pro-ductive meetings with otherprofessional organizations.

The meeting with represen-tatives of the National Soci-eties, to discuss the futuretraining of cardiothoracic sur-geons in Europe was extremelysuccessful in identifying theneeds of the future. Councilmembers together with repre-sentatives of the National Soci-eties are continuing to work onthis project and produce a Eu-ropean Statement on Cardio-Thoracic Training andEducation.

Our collaboration with theEuropean Society for Cardiol-ogy resulted in the joint publi-cation of practical guidelineson myocardial revasculariza-tion. These guidelines are in-tended to serve as an unbiasedclinical guide for cardiothoracicsurgeons and cardiologists. We

continue to work togetherwith the ESC on creatingguidelines on the Manage-ment of Valvular Heart Disease.

The Hannes Meyer Cardio-thoracic Surgery Research and

Training Symposium organizedby EACTS International Co-op-eration Committee (ICC) inBloemfontein, South Africa forthe second time was a greatsuccess. Participants especially

valued the wetlab session onclosed mitral valvotomy andthe off-pump training coursein CABG surgery. In this issueof EACTS News you will learnmore about the work of theICC. In this issue you will alsofind reports on other success-ful EACTS courses, the RoboticCourse organized by the Tho-racic Domain and the RightVentricular Outflow Tract Man-agement from Neonates toAdults: An InterdisciplinaryView in Palma de MajorcaCourse organized by the Con-genital Domain in co-operationwith AEPC.

The Annual Meeting is onlya few weeks away. All do-mains have worked very hardto produce an outstanding sci-entific offering. The AnnualMeeting provides a unique op-portunity to discuss the latestdevelopments in our specialtyand for meeting friends andcolleagues. In this issue wehave noted some associatedhighlights that shouldn’t bemissed.

As I mentioned my termcomes to an end in Lisbon. Ithas been an honour to repre-sent you as President of theEACTS since last Septemberand I am grateful for the oppor-tunity to have worked soclosely with so many of you onso many issues facing our asso-ciation this past year. This pastyear has demonstrated that ateam of well-organized cardio-thoracic surgeons working to-gether with our staff membersin the Windsor, Freiburg andRotterdam offices can effec-tively meet the many challengesof an increasingly complexhealth care environment. Every-thing we have achieved is duedirectly to the energetic anddedicated teamwork of bothvolunteer membership andEACTS staff. Thanks to all ofyou who have contributed sovitally to the organization dur-ing this past year.

I look forward to see you allin Lisbon!Ottavio Alfieri, MD, PhDPresident

Presidential update

July 2011 Issue 3

The Big Question: Tricuspid valve – Ring or no ring? Page 8-9

In thisissue…

Thoracic education

A report fromThessalonika and theEuropean School two–dayhands-on ThoracoscopicWorkshop. 2

Joint EACTS andAEPC Course

Drs Comas and Sarrisoutline the benefits of thisfirst joint meeting inMallorca 4

ICC

EACTS Newstalks to pastpresidentsMarko Turinaand PaulSergeantabout the educationalwork of the ICC 6

The Residents’page

PeymanSardari Niaprovides anupdate of hisrole asResidents’representative 10

Lisbon 2011

An invitation from PieterKappetein 12

John Pepper discussesthe Adult Cardiacprogramme 12

Volkmar Falkoutlines this year’s Techno-College 13

Juan Comas presents theCongenital programme13

Peter KappeteinSecretary General, EACTS

Anew clinical trial, EXCEL (Evalu-ation of Xience Prime versusCoronary Artery Bypass Surgery

for Effectiveness of Left Main Revascu-larization), will compare drug-elutingstents to coronary artery bypass graftsurgery in patients with left main coro-nary artery disease,

While the SYNTAX trial suggested

that percutaneous coronary interven-tion (PCI) with drug-eluting stents maybe safe and effective in selected pa-tients with left main coronary arterydisease, the trial was not poweredspecifically to address this set of pa-tients. Since the SYNTAX trial, ad-vances have been made indrug-eluting stent technology, PCI pro-cedural guidance, bypass surgery tech-niques and optimal medical therapies.

The primary endpoint is the compos-ite incidence of death, myocardial in-farction (MI) or stroke at a medianfollow-up duration of three years, pow-ered for sequential non-inferiority andsuperiority testing. The major secondaryendpoint is the composite incidence ofdeath, MI, stroke or unplanned repeatrevascularization. Measures of cost-ef-fectiveness and quality of life at severaltime points also constitute importantsecondary endpoints. All patients willbe followed for a total of five years.

The global trial, will be academicallyorganized and run by four principal in-

vestigators (including two cardiac sur-geons and two interventional cardiolo-gists), along with many otherphysician scientists. Patients will beenrolled from the United States,Canada, Europe, South America (Braziland Argentina), and South Korea. TheEXCEL trial has started enrollment andis expected to complete it in Decem-ber 2012.

During the EACTS Annual Meetingin Lisbon there will be a conference toupdate the investigators on Mondaymorning 3 October at 7am in the con-gress venue.

The EXCEL trial

2 EACTS News

Copyright 2011 ©: Dendrite Clinical

Systems and the European

Association for Cardio-Thoracic

Surgery. All rights reserved. No part

of this publication may be

reproduced, stored in a retrieval

system, transmitted in any form or

by any other means, electronic,

mechanical, photocopying,

recording or otherwise without prior

permission in writing of the editor.

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SL4 1LU, UK

Phone: +44 1753 832166

Fax: +44 1753 620407

Email: info@eacts.co.uk

Web: www.eacts.org

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Website www.e-dendrite.com

The history of education is thehistory of teaching and oflearning, and the history of

what might be described as the cur-ricula. Education has taken place inmost communities since earliesttimes as each generation has soughtto pass on cultural and social values,traditions, morality, religion, knowl-edge and skills to the next genera-tion. As the customs andknowledge of ancient civilizationsbecame more complex, many skillswould have been learned from anexperienced person on the job, amentor. Historically, surgical traininghas followed an apprenticeshipmodel. Universal education hasbeen a recent development, not oc-curring in many countries until after1850 CE. Nowadays, formal educa-tion consists of systematic instruc-tion, teaching and training byprofessional teachers.

It is generally accepted that med-ical education is unfit for the millen-nium. Professional conservatism,inertia, and poor leadership have leftit struggling to cope with rapidlychanging health care systems. Someuniversities have adopted new edu-cational programs, but globally theyare a minority and their experienceshave mostly not been evaluated orwell disseminated. There are toomany educational programs at alllevels usually boring and only fewtrain doctors, both new and estab-lished, to acquire the skills that thenew trends in health care demand.

More emphasis has been placedon quantity than quality, despite thefact that ever more credence isbeing given to the role of continuingmedical education in maintainingprofessional standards.

Moreover, effective mentoring hasa valuable role in the developmentof surgeons at various levels and isfrequently perceived vital in achiev-

ing career success. However, the for-mal role of mentoring and learnersupport in surgical training remainsnon-existent, while modern educa-tion needs to be “vaccinated” withthe “deontology” of the professionin all fields.

One should not forget that todaythe new trends in professional train-ing are small individualized modules– programs that offer the necessaryspecialization and the update in thelatest evolutions. Also, motivatingdoctors to improve their perform-ance and adopt continuous learningas a way of life is very important.The fact that most current models of

continued medical education fallwell short of the ideal has fosteredthe conceptually broader paradigmof continued professional develop-ment. While continuing medical ed-ucation is largely designed to plugsupposed gaps in knowledge, con-tinuing professional development isrooted in self directed reflection.

Taking into account all the above,we decided to offer a totally differ-ent course in Thoracic Surgery withinthe European School, which is sys-tem based learning and focusing onadvances on specific subjects, princi-pally based on interaction betweenstudents and experts.

With a proportion of students/tu-tors 3:1, which is an internationalnovelty during this one week course,students are involved with theirteachers who are experts in theirfields. They can start in that waybuilding their career abroad by de-veloping communication in differentlevels with their tutors, especially ininformal occasions, and exchangeideas with the other students com-ing from different countries repre-senting diverse health care systems.Tutors and students work close to-gether for a week, teach and learnfrom each other, and develop rela-tionships and collaboration that

could last life-long promoting themedical science and the quality ofmedical care.

This year two courses are based onlung and mediastinum emphasizingall recent achievements in surgery,oncology and molecular biology.

In the earlier times we used to ad-dress the School to residents, butnowdays we extend it to “junior”surgeons along with organized visitsto centers of excellence in theirfields. Enrino Rendina in Rome wasthe first to accept a group of youngsurgeons at his department present-ing the area of his expertise in prac-tice and teaching along withThoracic Surgery, Organisation andLeadership in our specialty.

Apart from the theoretical ses-sions, a two–day hands-on Thoraco-scopic Workshop is organized forthe third time in Thessaloniki nextyear becoming more and more inter-national, where one can practice inthoracoscopic surgery in an animallab promoting his surgical skillsunder the supervision of experiencedtutors.

Among our future plans is tohave participants feedback in orderto create a network of collabora-tion and support which might bevery useful to its members on dif-ferent levels.

In conclusion, the University andthe surgical training today offersknowledge, we offer more thanthat, such as experienced surgeons,well known in their specialty whocan satisfy all educational needs.

EACTS educators strive to ad-vance your knowledge and medicalskills to help you provide the bestcare to your patients. Few academicinstitutions offer such vast experi-ence and extensive commitment toyour success.

Join us and meet the soul of theprofession!

The European School: Thoracic education

Above and below: EACTS Academy; Hands-on thoracoscopic workshop in Thessaloniki, 2011

4 EACTS News

February 23-26, 2011IRCAD Strasbourg (France)

Franca MA MelfiDirector of Robotic MultidisciplinaryCenter University Hospital of Pisa, Italy

The second Robotics Course(Level II) was held on 22 Febru-ary at IRCAD in Strasbourg.

The course provided skill trainingand familiarization with this newtechnology to cover important clini-cal aspects relating to the use ofrobot system in cardio-thoracic sur-gery. Lectures in this area focused onthe development of this new tech-nique covering technical aspects.The course provided an overview onthe rapid development of the surgi-cal robot system in the field of car-diac and thoracic surgery includingdidactic sessions, hands-on cadaverand large animal models. The use ofthis new technology in the labs,under the tutelage of faculty ex-perts, gave a great opportunity to alldelegates to learn practical informa-tion to perform complex surgicalprocedures such as robotic revascu-larization, MVR, major lung resec-tions, thymectomy , oesofagectomy,

A highly qualified internationalpanel of experts took part in themeeting, which was aimed at dis-cussing procedural steps, complica-tions and management of roboticprocedures in the field of cardio-tho-racic surgery. They gave valuable in-formation in terms of indicationsand technical surgical sequences

guaranteeing a high quality of thecourse. Operating room configura-tion, system set-up, port placement,instrumentation as well as pre-,intra- operative techniques using therobotic surgical system were well il-lustrated. The 4-day course drewresidents from the United States,Netherlands, Singapore, Greece, Ire-land , Italy, Belgium , Iran, Switzer-land, Portugal, Finland, CzechRepublic, Spain. All skilled surgeonsin conventional cardiothoracic sur-gery (open and or MIS), benefitedfrom the expertise of 13 speakersfrom different institutions :n Franca MA Melfi MD, Director of

Robotic Multidisciplinary CenterAOUP- University of Pisa (Italy);

n Ralph A. Schmid MD, PhD Univer-

sity Hospital of Berne (Switzer-land);

n Federico Rea MD, PhD Universityof Padua (Italy);

n Jens C. Ruckert MD, H Charite’Berlin (Germany);

n Giulia Veronesi MD, IEO (Euro-pean Oncological Institute) Milan(Italy);

n Kemp H. Kernstine MD, PhD Cityof Hope National Medical Centerand Beckman, Duarte (USA);

n Thierry A Folliguet MD, FACS Insti-tute Mutualiste Montsouris Paris(France);

n Roberto P Casula MD, Ph.D Impe-rial College Healthcare NHSTrust,St. Mary’s Hospital, London(UK).

n Marco Taurchini,MDGeneral Tho-

rac Surgery,Hosp. Forli’ (Italy)n Frank Van Praet M.D O.L. Vrouw

Ziekenhuis, Aalst (Belgium) n Nikolaos Bonaros,MD Ass Prof

Innsbruck Medical University Inns-bruck (Austria)

n Mark Dylewski, M.D. Medical Di-rector General Thoracic Surgeryand Robotic Surgery BaptistHealth of South Florida Miami

n David Douglas Intuitive ClinicalTechnician IRCAD – Strasbourg(France)

n L. Wiley Nifong, MD Director ofRobotic Surgery East CarolineHeart Institute Brody School ofMedicine Greenville NC USA

By the end of the training Level 2Programme all participants wereable to:

n Understand basic features and po-tential benefits of the robotic sur-gical system

n Articulate patient selection, pa-tient positioning, surgical tech-niques, indications andcontraindications;

n Interpret up-to-date literature onsurgical outcomes and techniquesin robotic surgery;

n Apply the principles in order to be asafe and efficient robotic surgeon.

During the next 25th EACTS Annualmeeting in Lisbon, 1-5 October2011, an interview in addition to aquestionnaire, will be evaluated bythe Faculty. This is an important pre-requisite to access the Robotic Level3 Course which will be held in Pisa(Italy), at Robotic MultidisciplinaryCenter of AOUP-University of Pisa.This Robotic Level 3 Course includesintegrated system training, live pro-cedure-observation, as well as train-ing at the console of the new daVinci System Si (Intuitive Surgical,Inc.,Mountain View, CA).

The dual console capability facili-tates teaching and enables surgeonsto collaborate during surgery.

In addition this feature allows sur-geons to exchange and coordinatecontrol of the instrument arms andthe endoscopic camera.

A successfully completed Level 2course with a structured curriculumand appropriate documentation oftraining, is required.

The complete program with 3Level course will give a great oppor-tunity to train surgeons in the fieldof high-technology applied to car-diothoracic surgery and EACTS playsan important role in this task

2nd EACTS Robotic Course Level II in Cardio-Thoracic Surgery

Franca Melfi (front row, centre left) and attendees of the 2nd EACTS Robotic Course Level II in Cardio-Thoracic Surgery

George Sarris and Juan V Comas

Apioneering initiativeof the Congenital Do-main of the the Euro-

pean Association forCardio-Thoracic Surgery(EACTS), namely, the firstPostgraduate Course organ-ized jointly with the Associa-tion of European PediatricCardiology (AEPC),entitled“RightVentricular OutflowTract Management fromNeonates toAdults: An Inter-disciplinary View”, tookplace in Palma de Mallorca(Spain) from 11-12 March2011.

The meeting’s rich two –day program focused on thenumerous unsettled issuesregarding management ofthe problematic RVOT, acommon theme in manycongenital heart defects, in-cluding but not limited toTetralogy of Fallot. The goalwas to bring together theknowledge, perspective andskills of many related disci-plines in exploring questionssuch as optimal means ofpalliation of RVOT obstruc-

tion, techniques of RVOT re-construction at the time ofprimary surgical repair, pre-vention of late complica-tions, indications andtechniques of percutaneousor surgical re-intervention,postoperative care, andtraining.

The faculty included bothsurgeons an cardiologists,members of AEPC andEACTS, renowned for theirexpertise in this field. Thecourse’s systematic and com-prehensive approach coveredallaspects of Right VentricularOutflow Tract Management-from Neonates to Adults, in-cluding basic knowledge(embryology, anatomy, physi-ology, evaluation), primarysurgery, reoperations and per-cutaneous options. A seriesof lectures focused on areasof special interest and innova-tive techniques.

A highlight of the coursewas the exploration ofstrategies to prevent longterm RVOT complications bycareful selection of timingand technique of initial sur-gical repair. Emphasis was

given on the optimal preser-vation of RVOT structure andfunction, including that ofthe pulmonary valve, at thetime of repair. Transatrial –transpulmonary repair,which avoids a right ven-triculotomy, with minimal oreven no incision of the pul-monary valve annulusemerges as a preferred tech-nique. Other approachespresented included recon-struction of pulmonary valvefunction with pericardial, ho-mograft, or PTFE monocuspvalves or native pulmonaryvalve cusp augmentation. In-novative approaches formanaging the RVOT in rarelesions, such as TOF with ab-sent pulmonary valve andvarious valved conduits werealso discussed.

Evaluation of late compli-cations and delineation of cri-teria for reintervention werediscussed in detail, and sig-nificant consensus on thegreat utility of CMRI in thiscontext was reached. Impor-tant information regardingthe development and patho-physiology of late (after early

surgical repair) life threaten-ing ventricular arrhythmiaswas presented, and guide-lines for preoperative electro-physiologic studies, possibleablation of these arrhythmiasby catheter or intraoperativetechniques and indicationsfor AICD placement werepresented.

Regarding pulmonaryvalve replacement, surgicaltechniques and options, in-cluding bioprosthetic valvesand homograft or hetero-graft valved conduits werepresented. Special emphasiswas given to the availablepercutaneous options, theirindications, criteria of appli-cability and early results.Future innovations underdevelopment in this areawere presented. An impor-tant emerging new strategyfavors the use of a biopros-thetic valve at first reopera-tion for pulmonary valvereplacement, as this is feltto create an optimal andvery safe “landing zone”for a future percutaneousvalve deployment, whenthe inevitable bioprosthetic

failure occurs. Important sessions were

also included on intensivecare management of pa-tients with RVOT dysfunc-tion or after intervention,focusing on optimal man-agement of the right butalso of the frequently co-morbid left ventricle. A spe-cial session on trainingattracted great interest byall, including senior staff,juniors, and trainees.

The final interactive ses-sion of the course brought allof the information and ex-pertise together in the discus-sion of case presentations,with major and active partici-pation of a large audience ofsurgeons, cardiologists, inter-ventional cardiologists, anes-thesiologists, intensivistsandnurses in the field of pe-diatric cardiology. At the end,the audience enthusiasticallyrequested that such jointmultidisciplinary courses berepeated in the future.

The leadership of the alsoAEPC expressed their satis-faction with this first jointcourse:

First European joint EACTS and AEPC CourseRight Ventricle Outflow Tract Management from Neonates to Adults: An Interdisciplinary View Palma de Mallorca (Spain) from 11–12 March

“I wanted to add my per-sonal thanks to you for or-ganizing such an excellentmeeting. I enjoyed it verymuch and it sets a good ex-ample to others about howeducational meetings be-tween surgeons and cardiol-ogists should be run.Shak Qureshi”President, AEPC

“Thank you for organizingthe Palma meeting. The pro-gram was excellent thanksto expert speakers. You cre-ated an atmosphere that fa-cilitated active discussions.Several delegates, juniorsand experts, have thankedfor the meeting and havetold that they earlier havenot seen so many surgeonsand cardiologists discussingtogether.The joint-meetings betweenEACTS and AEPC should def-initely get repeated in thefuture.Eero Jokinen”Secreatary General of theAEPC

6 EACTS News

The ICC is really a continuationof the former Eastern Euro-pean Committee, which was

created by Hans Borst at the timehe was Editor in Chief of the Euro-pean Journal of Cardio-ThoracicSurgery, said Professor Turina, whoexplained that the Committee wasestablished to help and assist East-ern European colleagues who didnot have the ability and opportuni-ties to travel. “As a result, scholar-ships were organised to enablethem to travel. That was really thebeginning of international co-oper-ation.”

Marko Turina, a past president ofthe Association, became Chair ofthe Committee in 2003 and re-alised that theCommittee wouldhave to change toreflect the chang-ing political climateand the committeewas subsequentlyrenamed the Inter-national Co-opera-tion Committee.“We were not re-ally interested in aprogramme that would organisetravel for a few colleagues. We re-ally wanted to encapsulate andutilise the ‘transfer of knowledge’techniques. So we selected leadingexperts in our field and organisedsymposia in the countries of theformer Eastern Europe. The firstsymposia were held in Prague(Czech Republic) and Krakow(Poland), and later in Moscow (Rus-sia).

We offered teaching courses, ad-vanced techniques in cardio-tho-racic surgery and we invitedprominent surgeons to attend thesession, provide lectures and per-form the techniques/operationwhich were transmitted to the au-ditorium so people could see theprocedure and ask questions di-

rectly to the operator afterwards,”added Marko Turina.

“The second format which is alsovery popular is Applied Science, inwhich we teach surgeons the basicscientific techniques. We havefound that there is a knowledgegap as some surgeons are not well-trained in analysing materials andsubmitting an abstract or paper,and we provide them with skillsnecessary.

Shortly afterwards, the ICC ex-plored the possibility of extendingthese activities outside of Europe,so, following a proposal by FrancisSmit, we began co-operation withour colleagues in South Africa. Inaddition, the ICC also organised

teaching courses jointly with theSaudi Heart Association in Riyadh.Overtime, this has extended to nu-merous countries including Syria,Iran, and in 2010, for the first timewe extended our co-operation toChina and India. “I believe it is par-ticularly important to reach out toisolated countries such as Iran, asthe people are appreciative andwelcome their European colleaguesand eagerly embrace our teachingmethods and techniques,” addedProfessor Turina.

Paul Sergeant, outlined the othermajor activities of the ICC commit-tee namely the awarding of schol-arships and visiting fellowships

Over the years, the ICC hasgrown and now allocates 30 schol-arships annually for the European

School for cardio-thoracic educa-tion, as well as allocating ten visit-ing scholarships for surgeons whoat a higher level of training wish tovisit a particular institution in West-ern Europe.

Scholarships at European SchoolThe ICC has widened its focus overthe years. At the beginning, the ICCaddressed cardio-surgical demands

for training for schol-ars coming from East-ern EuropeanCountries,” said PaulSergeant whereas wenow address cardio-thoracic surgical edu-cation in all countriesoutside of Europe.

The EuropeanSchool is a week of in-tensive training in

courses that are given by experts intheir respective fields. There arethree or four prominent mentorsand this enables one-to-one super-vision and contact with attendeesallowing effectivementoring of surgeonsin training.

Application forscholarships is throughthe EACTS websiteand is open to anyscholar. The ICC coversthe fee and accommo-dation at the EuropeanSchool value approxi-mately €2000. It is im-possible for the ICC committee toset criteria on age or qualification,due to the variability betweencountries added Professor Sergeant

Visiting fellowshipsThe ICC offers visiting fellowshipsto give the opportunity to surgeonswho have already completed or areabout to complete their training, togo to an institution of their choiceand spend a couple of weeks ob-serving, sometimes assisting, to fur-ther their education andexperience. “The fellowships givecredibility to the scholars in apply-ing for a visiting fellow positionand it helps the scholar to pay fortravel and lodging,” added Ser-geant. “Nearly all organisations ap-preciate these visits. I myself havehad many of these scholars in thepast and the discussions with themhave enriched me considerably.”

Teaching coursesPaul Sergeant stated that the ICCwill continue to provide teachingcourses and clinical courses on spe-cific subjects. “We propose tocountries and local organizers com-plete basic science courses coveringall aspects of creation and distribu-tion of knowledge,” explained Pro-

fessor Sergeant. In September 2008, the ICC is-

sued a ‘position statement’ outlin-ing the aims of the ICC and their

international activities. “At the timewe had too many people applyingfor assistance and help. We feltthat many people were mistakingthe ICC as a body that providedfree surgical care, equipment andfinanced healthcare in some coun-tries,” said Professor Turina.“Therefore, we felt we had tomake a very clear statement outlin-ing our role and emphasizing thatthis was not our duty or responsi-bility and that it was impossible forus to do this.”

“The intention of the positionstatement is to explain which activi-ties can be undertaken by theCommittee and which activities areout of our scope. The EACTS andits ICC committee does not want tocompete with non-governmentalorganizations,” explained ProfessorSergeant. “Neither does it want orhave the ability to organise fulltime, year round educational orclinical projects.”

The future“In the future, I think we will tryto extend our activities. Of coursewe are always wary of the chang-ing political landscape and prior tothe upheaval in the Middle Eastand North Africa we had plans forprogrammes in some Arab coun-tries. We also had plans to providecourses in Sudan, but again, thiswas postponed due to politicalevents,” said Professor Turina.“So, we are limited in where andwhat we can do, but the plan is toextend a similar programme ofhigh-level teaching, both in sci-ence and advanced techniques, toAsia.

Both Professor Turina and Profes-sor Sergeant urged mem-bers to attend the opensession of the ICC at theannual meeting and makeproposals and suggestions,give their opinion aboutcourses, and also if theywish, apply to work on theCommittee.

“I would also like tothank the Niarchos Foun-dation,” concluded Profes-

sor Turina. “Who continue to beextremely generous with their sup-port of the ICC and the work weundertake.”

An introductionto the ICCThe main objective of the EACTS is "to advance education inthe field of cardio-thoracic surgery. The annual meeting andthe scientific journals are the means by which the Associationfulfils this aim. In addition, the EACTS International Co-operation Committee (ICC) provides opportunities for cardio-thoracic surgical education in all countries outside of Europe.EACTS News discussed the work of the ICC with the formerand current Chairs of the Committee, Marko Turina and PaulSergeant.

Paul SergeantMarko Turina

INTERNATIONAL CO-OPERATION COMMITTEE

ApplicationsIf you are interested in applying fora visiting fellowship, scholarship orattending teaching courses pleasecontact the EACTS or visit the As-sociations website:

EACTS Executive Secretariat3 Park StreetWindsor, Berkshire SL4 1LU, UKTel: +44 1753 832166Fax: +44 1753 620407Email: info@eacts.co.uk

www.eacts.org/content/interna-tional-co-operation

“The intention of the position

statement is to explain which

activities can be undertaken by the

Committee and which activities are

out of our scope.”

Paul Sergeant

“We have found that there is a knowledge

gap as some surgeons are not

well-trained in analysing materials and

submitting an abstract or paper, and we

provide them with skills necessary.”

Marko Turina

8 EACTS News

the big

In patients with left sided valve dis-ease, functional tricuspid regurgita-tion (TR) occurs mainly from right

ventricular dilatation, enlargementand distortion of the tricuspid annu-lus and tethering of the tricuspidleaflets1-3. Tricuspid annular dilatationhas always been the primary target ofthe surgical treatment of secondaryTR4 and has usually been corrected bytwo main surgical methods: the ringannuloplasty and the suture annulo-plasty (mostly De Vega and Kay tech-niques). Either method does notconsistently eliminate functional TR.The recurrence rate of significant tri-cuspid insufficiency after tricuspid an-nuloplasty is around 8-15% alreadyone month after surgery5,6 and hasbeen attributed to several factors in-cluding the severity of preoperativeTR5-7, pulmonary hypertension7, pres-ence of pacemakers5, left ventricular(LV) dysfunction5, increased LV re-modeling6, severe tethering of the tri-cuspid leaflets and, particularlyimportant, the use of suture ratherthan ring annuloplasty5,6,8-10. Indeedmost of the published studies, bothrandomized and observational, havedemonstrated that ring annuloplastyrepairs are more durable than sutureannuloplasty, particularly in patientswith severe tricuspid annular dilation

or pulmonary hypertension5,6,8-14

(Table 1).A randomized study of 159 pa-

tients comparing Carpentier ring an-nuloplasty with De Vega sutureannuloplasty demonstrated a signifi-cantly higher rate of moderate or se-vere TR in the suture annuloplastygroup at 45 months (De Vega, 34%;Carpentier, 10%; p< 0.01)8.

Matsuyama et al.9 reported bythree years recurrence of 3+ or 4+ TRin 45% of patients inthe De Vega groupcompared with 6% ofpatients in the ringgroup (p = 0.027).

Among the differenttypes of prostheticrings, the semirigid orrigid ones (either stan-dard or 3-dimensional)have been associatedwith the best resultsand the least increaseacross time of recur-rent tricuspid insuffi-ciency. In two largeseries published by the ClevelandClinic group, the degree of postop-erative 3+ or 4+ TR remained stableacross time with the Carpentier-Ed-wards ring (12% at five years and 17% at eight years) and rose con-stantly with the De Vega procedurereaching the overall rate of 24% atfive years6 and 33% at eight years5.

Besides being more durable, ringrepairs provide also better long-term

survival and event-free survival up to15 years after surgery compared tosuture annuloplasty12. This is not sur-prising considering that moderateand severe TR is an important pre-dictor of late mortality independentof ventricular function and pul-monary artery pressure15.

In contrast with the above re-ported data favouring ring proce-dures, it is certainly possible to findin the literature a number of series

reporting early and late satisfactoryresults with both De Vega and Kaysuture annuloplasty16-20. Most ofthese studies have been published inthe late eighties and nineties andhave major limitations including theuse of freedom from reoperation asmarker of outcome and a very lim-ited number of echocardiographiccontrols with only a minority of thestudy patients, randomly selected,

investigated at follow-up by colordoppler echocardiography. An ex-ception in this scenario is the studyby Ghanta and co-workers7 whichenrolled 237 patients and used echodata to show that bicuspidization(Kay repair) and ring annuloplastywere equally effective and durable atreducing TR up to three years post-operatively (TR recurrence was 31%in the ring group and 25% in the“bicuspidization” one, P=0.18).

However, in this retrospec-tive study, patients treatedwith a ring had lowerejection fraction and moresevere TR compared tothose who received a bi-cuspidization procedure.Although a propensitymatching was used tocontrol for this discrep-ancy, this bias towardsusing a ring for worse pa-tients might have influ-enced the results. Inaddition a longer follow-up should be waited con-

sidering that recurrence of TR mayrequire many years to become evi-dent after the initial repair.

In conclusion we believe thatcompelling evidences have been ac-cumulated in the recent years show-ing that prosthetic ring annuloplastyrepresents the most effective anddurable method to treat severe TR,particularly in presence of severe an-nular dilatation and pulmonary hy-pertension. In these circumstancessuture annuloplasty should beavoided. Conversely, in the earlystage of functional TR, when initialannular dilatation is responsible formild to moderate degree of tricuspidinsufficiency, it cannot be excludedthat “no ring procedures” might stillplay a role including the modified DeVega repair, with pledgets betweenevery suture, which seems to lowerthe risk of suture dehiscence21. Fur-ther studies, possibly randomized,are necessary to clarify this issue. References1. Mikami T., Kudo T, Sakurai T, Sakamoto S, Tanabe Y, Ya-

suda H. Mechanisms for development of functional tri-cuspid regurgitation determined by pulsed Doppler andtwo-dimensional echocardiography. Am J Cardiol1984;53:160–163.

2. Ton-Nu TT, Levine RA, Handschumacher MD, Dorer DJ,

Yosefy C, Fan D, Hua L, Jiang L, Hung J. Geometric de-terminants of functional tricuspid regurgitation: insightsfrom 3-dimensional echocardiography. Circulation2006; 114:143–149.

3. Sukmawan R, Watanabe N, Ogasawara Y, Yamaura Y,Yamamoto K, Wada N, Kume T, Okura H, Yoshida K.Geometric changes of tricuspid valve tenting in tricus-pid regurgitation secondary to pulmonary hypertensionquantified by novel system with transthoracic real-time3-dimensional echocardiography. J Am Soc Echocar-diogr 2007;20:470–476.

4. Carpentier A, Deloche A, Hanania G, Forman J, Sellier P,Piwnica A, Dubost C, McGoon DC. Surgical manage-ment of acquired tricuspid valve disease. J Thorac Car-diovasc Surg 1974;67:53–65.

5. McCarthy PM, Bhudia SK, Rajeswaran J, Hoercher KJ,Lytle BW, Cosgrove DM, Blackstone EH. Tricuspid valverepair: durability and risk factors for failure. J ThoracCardiovasc Surg 2004;127:674-85.

6. Navia JL, Nowicki ER, Blackstone EH, Brozzi NA, NentoDE, Atik FA, Rajeswaran J, Gillinov AM, Svensson LG,Lytle BW. Surgical management of secondary tricuspidvalve regurgitation: annulus, commissure, or leaflet pro-cedure? J Thorac Cardiovasc Surg 2010;139(6):1473-1482.

7. Ghanta RK, Chen R, Narayanasamy N, McGurk S, Lip-sitz S, Chen FY, Cohn LH. Suture bicuspidization of thetricuspid valve versus ring annuloplasty for repair offunctional tricuspid regurgitation: midterm results of237 consecutive patients. J Thorac Cardiovasc Surg.2007;133(1):117-26.

8. Rivera R, Duran E, Ajuria M..Carpentier's flexible ringversus De Vega's annuloplasty. A prospective random-ized study. J Thorac Cardiovasc Surg. 1985;89(2):196-203.

9. Matsuyama K, Matsumoto M, Sugita T, Nishizawa J,Tokuda Y, Matsuo T, Ueda Y. De Vega annuloplasty andCarpentier-Edwards ring annuloplasty for secondary tri-cuspid regurgitation. J Heart Valve Dis. 2001;10(4):520-4.

10. Roshanali F, Saidi B, Mandegar MH, Yousefnia MA,Alaeddini F. Echocardiographic approach to the deci-sion-making process for tricuspid valve repair. J ThoracCardiovasc Surg. 2010;139(6):1483-7.

11. Anyanwu AC, Chikwe J, Adams DH, Tricuspid valve re-pair for treatment and prevention of secondary tricus-pid regurgitation in patients undergoing mitral valvesurgery. Curr Cardiol Rep 2008;10:110–117.

12. Tang GH, David TE, Singh SK, Maganti MD, ArmstrongS, Borger MA.Tricuspid valve repair with an annulo-plasty ring results in improved long-term outcomes. Cir-culation. 2006; 114(1 Suppl):I577-81.

13. Yada I, Tani K, Shimono T, Shikano K, Okabe M,Kusagawa M. Preoperative evaluation and surgicaltreatment for tricuspid regurgitation associated with ac-quired valvular heart disease. The Kay-Boyd method vsthe Carpentier-Edwards ring method. J Cardiovasc Surg(Torino)1990;31:771–777.

14. Konishi Y, Tatsuta N, Minami K, Matsuda K, YamazatoA, Chiba Y, Nishiwaki N, Shimada I, Nakayama S, FujitaS, et al. Comparative study of Kay-Boyd’s, DeVega’s andCarpentier’s annuloplasty in the management of func-tional tricuspid regurgitation. Jpn Circ J 1983; 47:1167–1172.

15. Nath J, Foster E, Heidenreich PA. Impact of tricuspid re-gurgitation on long-term survival. J Am Coll Cardiol2004;43:405-409.

16. Nakano S, Kawashima Y, Hirose H, Matsuda H, Shi-mazaki Y, Taniguchi K, Kawamoto T, Watanabe S,Sakaki S. Evaluation of long-term results of bicuspidal-ization annuloplasty for functional tricuspid regurgita-tion. A seventeen-year experience with 133 consecutivepatients. J Thorac Cardiovasc Surg 1988;95:340–345.

17. Katircioglu SF, Yamak B, Ulus AT, Ozsoyler I, Yildiz U,Mavitas B, Birincioglu L, Tasdemir O. Treatment of func-tional tricuspid regurgitation by bicuspidalization annu-loplasty during mitral valve surgery. J Heart Valve Dis1997;6:631–635.

18. Chidambaram M, Abdulali SA, Baliga BG, Ionescu MI.Long-term results of DeVega tricuspid annuloplasty.Ann Thorac Surg 1987;43:185–188.

19. Abe T, Tukamoto M, Yanagiya M, Morikawa M, Watan-abe N, Komatsu S. De Vega’s annuloplasty for acquiredtricuspid disease: early and late results in 110 patients.Ann Thorac Surg 1989;48:670–676.

20. Morishita A, Kitamura M, Noji S, Aomi S, Endo M, Koy-anagi H. Long-term results after De Vega’s tricuspid an-nuloplasty. J Cardiovasc Surg (Torino)2002;43:773–777.

21. Antunes MJ, Girdwood RW. Tricuspid annuloplasty: amodified technique. Ann Thorac Surg 1983; 35:676–678.

Michele De Bonis, MDDepartment of Cardiac Surgery, San Raffaele University Hospital, Milan, Italy

Ring

We believe that compelling evidences

have been accumulated in the recent

years showing that prosthetic ring

annuloplasty represents the most

effective and durable method to treat

severe TR, particularly in presence

of severe annular dilatation and

pulmonary hypertension

Tricuspid valve:

Table 1. Some of the most important studies comparing ring versus suture tricuspid annuloplasty Author Year n. of pts Annuloplasty technique Mean Fw-up (years) TR recurrence PRivera8 1985 76 Ring (CE) 5.3 10%

83 De Vega 34%<0.01

Matsuyama9 2001 17 Ring (CE) 3.3 6%28 De Vega 45% 0.02

McCarthy5 2004 139 Ring (CE) 8 17%116 De Vega 33% 0.06

Tang12 2006 209 Ring (CE/FB/D) 5.7 30%493 De Vega 36% 0.003

Ghanta7 2007 80 Ring (FB/CE/CA) 3 17%157 Kay repair 14% 0.18

Roshanali10 2009 53 Ring (CE) 1 14%52 De Vega 28%

<0.05

Navia6 2010 584 Ring (CE/MC3) 5 12% Not 129 De Vega 24% reported

C-E: Carpentier Edwards semirigid ring; MC3 : Edwards MC3 Annuloplasty System 3 dimensional ring; FB: Cosgrove Edwards Flexible Band; D: Duran Band (Medtronic).

EACTS News 9

question

The use of mechanical prosthe-ses in the tricuspid position inmulti-valvular procedures has

been associated not only with in-creased mortality but also with ahigher incidence of thrombotic com-plications. Although thrombolytictherapy has, in recent years, beensuccessfully applied in the treatmentof thrombosis of tricuspid mechani-cal prostheses, it remains a very seri-ous and often lethal problem.Several reports indicate that by fiveyears only about 35–45% of the pa-tients were alive free from reopera-tion after tricuspid valvereplacement.1

On the other hand, bioprosthesesdegenerate earlier rather than later,depending on the age of the pa-tient, requiring repeat surgery whichcarries a. significantly higher mortal-ity than in the primary operation. Al-though percutaneous valve-in-valveimplantation may alter this situation,it is too soon to predict outcomes.

But it appears that only exception-ally does the tricuspid valve need tobe replaced as a first procedure, be-cause the valve tolerates well a lessthan perfect repair, with less thanmoderate regurgitation or stenosis, incontrast to what happens with left-side heart valves where total compe-tence is of primordial importance.Hence, most people agree that annu-loplasty is the surgery of choice.

In the early 1970s, Deloche et al,2

from Carpentier’s group, showedthat dilatation of the tricuspid annu-lus occurs essentially in the muralportion of the annulus, correspon-ding to the anterior and posteriorleaflets, and DeVega3 developed theprocedure that bares his name,which consists of plication of theposterior and anterior portions ofthe annulus, preserving the septalportion, with a double continuoussuture (Figure 1).

The De Vega procedure has sincebeen used in tens of thousands ofcases throughout the world and it

appears to be safe and efficacious.The guitar-string syndrome, resultingfrom sutures tearing and pulling outof the tissues was the main compli-cation associated with this proce-dure. In order to avoid it, in 1987 wedescribed a modification of the DeVega annuloplasty which consistedof the interposition of Teflon pled-gets in each bite of the suture(Figure 2).4

Several total or partial tricus-pid annuloplasties were de-scribed, including thebicuspidization method whichconsists of a tight reduction ofthe posterior annulus segmentonly,5 but the DeVega annulo-plasty or its modifications havegained wider acceptance. Inthese situations, the valve isusually made mildly stenotic, but ithas been emphasised that tricuspidstenosis is usually well tolerated bythe patient.6 It is technically easy andreproducible, even by relatively inex-perienced surgeons.

The routine use of an annulo-

plasty ring has been considered su-perior and recommended by manygroups.7,8 However, in our experi-ence, the implantation of a ring isspecifically indicated when there isorganic involvement of the tricuspidvalve, usually with stenosis, where acommissurotomy is also necessary. Inthese circumstances, because re-

modelling of the annulus is probablyessential, we prefer the Carpentier-Edwards ring.9

Somewhat different is the prob-lem of late appearing tricuspid re-gurgitation, especially if anannuloplasty had already been per-

formed in a previous operation, butIf it had not been done previously,annuloplasty is, again, preferable tovalve replacement. In these cases,however, greater tendency for defor-mity of the whole valve mechanism,rather than isolated annular dilata-tion, and dilatation and dysfunctionof the right ventricle may dictatemore extended use of a prostheticring.10,11

ResultsIn our experience, the modified De-Vega tricuspid annuloplasty provedto be a safe and efficacious proce-dure for the management of sec-ondary tricuspid regurgitation. In ourview, it should be used in all patientswith more than mild ‘‘functional’’ re-gurgitation, when operating on theleft-side valves, especially the mitral.

We have followed this policyfor more than three decadesand close to one thousand pa-tients with encouraging re-sults, and we have observed alow rate of late reoperations.In this period, only a hand fullof patients required primarytricuspid valve replacement. ACarpentier ring was used inapproximately 10% of thecases. The operative mortality

is only slightly higher than in pa-tients without tricuspid valve surgery,but the excess mortality is related tothe pathology and not the proce-dure itself. No case of dehiscence ofthe annuloplasty suture was identi-fied. Others have also reported ex-

cellent long-term results with thisand other suture-annuloplasty tech-niques.12

On the other hand, reoperationfor late TR, whether isolated or inconjunction with repeat surgery ofanother valve, has an operative riskwhich is higher than that which oc-curs after other redo valve surgeryand may reach 10–20%, althoughmuch lower mortality rates have re-cently been reported. References1. Reed GE, Boyd AD, Spencer FC, Engelman RM, Isom

OW, Cunningham JN Jr.. Operative management oftricuspid regurgitation. Circulation 1976;54(suppl3):96–8.

2. Deloche A, Guerinon J, Fabiani JN, Morillo F, Caraman-ian M, Carpentier A, Maurice P, Dubost C. Anatomicalstudy of rheumatic tricuspid valve diseases: applicationto the study of various valvuloplasties. Ann Chir ThoracCardiovasc 1973;12:343–9.

3. DeVega NG. La anuloplastia selective, reguable y per-manente. Rev Esp Cardiol 1972;25:6–9.

4. Antunes MJ, Girdwood RW. Segmental tricuspid annu-loplasty: a modified technique. Ann Thorac Surg1983;35:676–8.

5. Kay JH, Maselli-Campagna G, Tsuji KK. Surgical treat-ment of tricuspid insufficiency. Ann Surg 1965;162:53-58.

6. Barlow JB. Aspects of mitral and tricuspid regurgita-tion. J Cardiol 1991;21:3–33.

7. McCarthy PM, Bhudia SK, Rajeswaran J, Hoercher KJa,Lytle BW, Cosgrove DM, Blackstone EH. Tricuspid valverepair: durability and risk factors for failure (see alsodiscussion). J Thorac Cardiovasc Surg 2004;127:674–85.

8. Tang GHL, David TE, Singh SK, Maganti MD, Arm-strong S, Borger MA. Tricuspid valve repair with an an-nuloplasty ring results in improved long-termoutcomes. Circulation. 2006;114:I-577 – I-581

9. Antunes MJ. DeVega annuloplasty of the tricuspidvalve. Operative Techniques in Thoracic and Cardiovas-cular Surgery 2003;8:169–76.

10. Xiao X, Huang H, Zhang J, Wu RB, He JG, Lu C, Li ZM.Surgical treatment of late tricuspid regurgitation afterleft cardiac valve replacement. Heart Lung Circ2004;13:65–9.

11. Park CK, Park PW, Sung K, Lee YT, Kim WS, Jun T. Earlyand midterm outcomes for tricuspid valve surgery afterleft-sided valve surgery. Ann Thorac Surg2009;88:1216-23

12. Ghanta RK, Chen R, Narayanasamy N, McGurk S, Lip-sitz S, Chen FY, Cohn LH. Suture bicuspidization of thetricuspid valve versus ring annuloplasty for repair offunctional tricuspid regurgitation: Midterm results of237 consecutive patients. J Thorac Cardiovasc Surg2007;133:117-26

Manuel J Antunes, Department of Cardiothoracic Surgery, University Hospital, Coimbra, Portugal

No ring

The modified DeVega

tricuspid annuloplasty proved

to be a safe and efficacious

procedure for the management

of secondary tricuspid

regurgitation.

ring or no ring

Figure 1

Figure 2

10 EACTS News

The Council of EACTS is com-posed of members of differentcommittees and the EACTS

Resident’s Representative on theCouncil is a member of the SurgicalTraining & Manpower Committee.

The Resident’s Representative wasrecently granted full rights (includingvoting) and according to Sardari Nia,this underlines the important roleand function residents performwithin the Association. “The resi-dents represent the next generationof cardio-thoracic surgeons and it iscrucial we, as an Association, have inplace the mechanisms and channelsfor residents to express their viewsand opinion, as well as promoting,at the highest level, their participa-tion in the decision-makingprocess,” he commented.

There are several issues of concernto residents particularly training pro-grammes and European WorkingTime Directive (EWTD). Every Euro-pean country currently has its owntraining programme and some coun-tries have different training path-

ways. “Ideally, we would like to havethe same curriculum in each Euro-pean country, based on the samestandards, and ultimately the samecertification. This will allow surgeonsto be trained to the same educa-tional and scientific quality through-out Europe, which is very importantfor patient care. Equally, it will alsofacilitate manpower and migration,”said Sardari Nia.

Regarding the EWTD, a recent sur-vey undertaken by the Committeeand published in the Interactive Car-dioVascular and Thoracic Surgery(Sabada et al: 2010;11:243-246) re-vealed that the vast majority of resi-dents believe that the 48 hourresulted in insufficient time alloca-tion for their training requirements.The survey also revealed that some60% of residents were not really sat-isfied with their training programme.

“Of course, EACTS can only offeritself in an advisory and conciliatoryrole, but cannot change national cur-riculums”, explained Sardari Nia.Subsequently, earlier this year, the

EACTS organised a meeting with thenational societies, the ESCVS and theESTS to discuss the role of the Euro-pean Board for Thoracic and Cardio-vascular Surgery, the BoardExamination the role of the UEMSand the harmonisation of cardio-tho-racic training and education pro-grammes in Europe. Members of theSurgical Training & Manpower Com-mittee were present, and they wereable to represent the views and vi-sion of residents and express opin-ions concerning the proposal of acommon curriculum. “It was decidedthat the EACTS will publish guide-lines that will set out the basis of aEuropean-wide curriculum on train-ing, which is a very important devel-opment, especially for Residents.”

Residents meeting in LisbonThe Resident’s Committee, the Sur-gical Training & Manpower Com-mittee, is responsible for puttingtogether the Resident’s programmefor the Annual Meeting. “Tradition-ally there are three people responsi-ble, myself, the Chair of theResident’s Committee Rafa Sabadaand Mathias Siepe (the previousResident’s representative on theEACTS Council),” he added. “Theresident’s programme has devel-oped substantially in the last few

years, previously it was outside themain EACTS programme but sincelast year it has been incorporatedinto the main programme.

The title for this year resident’smeeting is “Future of Cardio-ThoracicSurgery: How to be trained and mas-ter the minimal invasive techniques,”and this subject was chosen todemonstrate the changing nature ofcardio-thoracic surgery. “We cannotexpect to use the same surgical proce-dures we have used for the past 40years. Cardio-thoracic surgery ischanging and we must adapt to thesechanges and adopt new techniquesand technologies. I believe that thefuture of our specialty will be depend-ent on our ability to lead innovationand to teach the young generationthe minimal invasive techniques.”

The session consists of four lec-tures that will cover the history ofminimal invasive techniques in car-diothoracic, future perspectives andnew developments of minimal inva-

sive techniques, cardiothoracic train-ing and place of minimal invasivetechniques and the survival of car-diothoracic specialty: training and in-novation.

Residents at EACTSEACTS News discusses the role of residents within theAssociation with the Resident’s representative,Peyman Sardari Nia, who outlines his role andresponsibilities as well as looking forward to thisyear’s Resident’s programme in Lisbon.

Annals ofThoracicSurgery

The STS, with an educa-tional grant from Ma-quet, are pleased to

offer EACTS trainee membersand trainee applicant mem-bers (who have paid their sub-scription by 1 July) the Annalsof Thoracic Surgery in printand online from August 2011until July 2012.

Peyman Sardari Nia

EACTS Residents special luncheon

This year we will be having a special luncheon meeting next to the regular session. The lunch-eon consists of seven tables and each table has its own subject, we hope that young surgeonswill find meeting their peers stimulating, so residents will be take part in roundtable discus-

sions with prominent surgeons and the idea is to create an environment for informal discussion,one-to-one tuition and also to develop and foster networking.

REsIdENT’s COMMITTEE

Organiser: EACTS – Surgical Trainingand Manpower Committee

Venue: St Antonius Hospital,Nieuwegein, Netherlands

Dates: 13-15 February 2012Length: 2.5 daysSubjects: Heartport, TAVI, mini-maze,

mini-AVR and TEVARFocus: Technical aspects, how to

do it?Target audience:

Residents in advanced stageof training and youngsurgeons

Cardiothoracic surgery is a relativelyyoung specialty dependent on develop-ments and innovations in the field of

related specialties. The success of our specialtyis based on the consistency and safety of con-

ventional techniques developed in the pastfour decades.

Although the incidence and prevalence ofcardiovascular and pulmonary diseases in-creased substantially during the past decades,the share of our specialty in treatment of thesediseases did not substantially increase. Thereare four possible factors for this. Firstly, theconservative view that the boundaries of surgi-cal specialty are defined by the surgeon’ knife,and this view could be why we lost the oppor-tunity in the percutaneous treatment of is-chemic heart disease. Secondly, investment inthe field of research cardiology and pneumol-ogy is greater than the device industry. Thirdly,our cautious approach in embracing new de-velopments and techniques preferring consis-tent, safe conventional techniques withknown long-term results. And finally our fail-ure to incorporate the new developments and

techniques in the basic training program.It would be naïve to think that techniques

that have been developed over 30 years agowill continue to compete effectively with newdevelopments and treatments evolving in thefuture. The survival and growth of our spe-cialty will depend on our ability to lead innova-tion and research in the field of cardiovascularand lung diseases, and our ability to take thelead in training future practitioners in minimalinvasive techniques.

With the guidance of the Acquired CardiacDisease Domain, the Surgical Training andManpower committee of EACTS has createdan advanced level of the curriculum offered atthe European School on minimal invasive tech-niques in adult cardiac surgery. The course willfocus on technical aspects of minimal invasiveor minimal access techniques and aims toteach the participants how to do and start

such a program at their institutions.The venue of the course is St Antonius Hos-

pital in Nieuwegein, Netherlands. The depart-ment of cardiothoracic surgery at St Antoniusis the largest cardiothoracic department in theBenelux with high volume of all the availableminimal invasive techniques at one venue.The course length is 2.5 days and it is de-signed for residents in advanced stage oftraining and young surgeons. During thecourse there are going to be case demonstra-tions of each technique with technical aspectspresented by local surgeons and invited fac-ulty through live-in-a-box and live-presenta-tions. The maximum number of participants isset to be 100 and the full program and regis-tration will be available during the EACTS An-nual Meeting in Lisbon.Peyman Sardari Nia, MD, PhDCourse Coordinator

Course of minimal invasive techniques in adult cardiac surgery

Residents’ viewsIf you would like to comment on any of the aspectsconcerning training and education, EA CTS News wouldbe delighted to publish your views.

Please send your comments to: communications@e-dendrite.com.We will publish as many of your comments as possible.

EACTS News 11

5

2 346

7 1European Cardio-ThoracicResident’s meeting 2011

EACTS is grateful to St. Jude Medicalfor it’s educational grant in support of

this programme

EACTS is grateful to St. Jude Medical for it’s educational grant in support of this programme

History of minimal invasive techniques in cardio-thoracic surgeryRoberto Lorusso – Brescia

Future perspectives and new developments ofminimal invasive techniquesVolkmar Falk – Zurich

Cardio-thoracic training and place of minimalinvasive techniquesA Pieter Kappetein – Rotterdam

Survival of cardio-thoracic specialty: training andinnovation J Rafael Sadaba – Pamplona

Register on siteThis year the first residentluncheon will be organized at25th EACTS annual meeting. The luncheon consists of seventables with prominentcardiothoracic surgeons havinglunch with residents and talkinginformally about specificsubjects. The residents whowould like to attend theluncheon have to register on site in Lisbon. The residents haveto indicate three tables of choiceand must be registered forattendance of annual meeting.

1st European Cardio-Thoracic Resident’s LuncheonTuesday 4 October 201112:45 – 14:00

Editors tableInvited Surgeons:

Friedhelm BeyersdorfEditor: EJCTS

L Henry Edmunds Jr , Editor: Ann Thorac Surg

Lawrence H CohnEditor: JCTVS

Revascularisation table

Invited Surgeons:

Paul SergeantLeuven

David P. Taggart Oxford

Rugero De PaulisRome

Mitral Valve tableInvited Surgeons:

Ottavio AlfieriMilan

Hugo K VanermenAalst

Minimal Invasive Aortic Valve Surgery table

Invited Surgeons:

A.Pieter KappeteinRotterdam

Alaaddin Yilmaz,Nieuwegein

Francesco Maisano,Milan

Congenital tableInvited Surgeons:

Prof. Pascal VouhéParis

Juan V. ComasMadrid

Extensive Aortic Surgery table

Invited Surgeons:

Marc A.A.M. Schepens Brugge

Roberto Di Bartolomeo Bologna

Thorsten C.W. WahlersKoln

Thoracic TableInvited Surgeons:

Philippe G Dartevelle Paris

Erino A. Rendina

Rome

Chairs: Peyman Sardari Nia – Nieuwegein; Matthias Siepe – Freiburg

Future of Cardio-Thoracic Surgery: How to be trained and master the minimal invasive techniques

Tuesday 4 October15:30–17:00 during the

EACTS Annual Conferencemain programme

12 EACTS News

Dear Friends andColleagues,We are delighted to invite youto Lisbon for the world’s lead-ing cardiothoracic surgeryevent. The EACTS AnnualMeeting offers you the oppor-tunity to network with peersand connect with world-classfaculty. Every member of thecardiothoracic communityshould take advantage of thisyear’s dynamic and engagingprogramme to learn the latesttechnologies and techniques incardiothoracic surgery.

Improving the care of pa-tients with cardiothoracic dis-eases is one of the world’sbiggest challenges and theguiding mission of the Euro-pean Association for Cardio-Thoracic Surgery. The 2011scientific programme will fur-ther this goal by bringing to-gether all professionalsinvolved in cardiothoracic sur-

gery, from surgeons and otherclinical practitioners to basicscientists, epidemiologists,nurses, technicians, health careindustry, care opinion leadersand policy makers.

Our programme will containthe variety and quality youhave come to expect from theEACTS and our aim is to con-stantly develop and improve itto accommodate changingneed and demand. As it is our25th Anniversary Annual Meet-ing our annual meeting has aspecial theme this year: ‘Team-work’. It goes without sayingthat not only a surgeon isneeded for improving the careof patients with cardiothoracicdiseases but a whole team ofhealthcare professionals fromcardiologists, radiologists andother clinical practitioners tonurses, technicians and scien-tists. Teamwork sessions will befound throughout the whole

programme. We also organizefor the second time the Post-graduate Course for nurses,nurse practitioners and physi-cian assistants on the Sunday.Techno College will be as al-ways on the Saturday and ourThoracic, Cardiac, Vascular andCongenital PostgraduateCourses on the Sunday. Newthis year will be our Profes-sional Challenges Sessions.During these sessions one spe-cific topic will be highlightedby video presentation, ab-stracts, keynote lectures and“learning from experience”cases.

On Wednesday morning weorganize the Advanced Tech-niques sessions including wet-lab sessions.

Last but not least I want yourspecial attention for our 25thAnniversary Party on Tuesdayevening. Since the EACTS wasfounded 25 years ago the An-

nual Meeting is now the largestcardiothoracic meeting in theworld. We could not have donethis without the help of you, ourmembers and of course theEACTS Staff. To mark this SilverJubilee and to thank you all forvolunteering throughout theseyears we have planned a specialAnniversary Party where you canrelax and enjoy the company offriends and colleagues fromaround the globe in an informalatmosphere and in the elegantsurroundings of the Conventodo Beato. This event will be verydifferent from the formal dinnerthat we had in the past on theTuesday evening. The highlightof the evening will be thatEACTS ‘House’ Band will playuntil the wee hours.

Join us in Lisbon, lookingforward to welcoming you all!A Pieter Kappetein, MD,PhDSecretary General

An invitation to help celebrate the 25th Annual Meeting of the EACTS

25Th ANNuAL MEETINg

JOIN us IN LIsbON

In this issue, EACTS News continuesthe preview of this year’s EACTSmeeting in Lisbon. We begin by

featuring an interview with ProfessorJohn Pepper, London UK, who out-lines the highlights from the AdultCardiac programme.

“This year, the PostgraduateCourse begins with a four year re-sults from the SYNTAX trial, probablyone of the most important clinicaltrials in cardiac surgery,” said Pepper.“This will be followed by an exami-nation of interpretation of guidelinesfor coronary bypass surgery, becauseguidelines have been so importantan affect every day clinical practice.”

He explained that the ‘science’ be-hind the guidelines would look athow the guidelines were constructedand who was involved in their devel-opment (ie cardiologists, cardiac sur-geons, etc). This to present a balanceof the evidence to physicians andsurgeons, but also provide patientswith sufficient knowledge to makean informed opinion when they arefacing possible intervention (whetherthis is percutaneous and surgical).

Cardiac surgery trials“We will then have a review of someof the most important clinical trialsin cardiovascular disease, such as theADVANCE (HeartWare device)bridge-to-transplant trial, one of thefirst to report on a 2nd generation

device. Importantly, we will also lookat the STICH trial, which produced aresult that many surgeons did notexpect,” explained Pepper. “This trialillustrates the problems with settingup a clinical trial in surgery.” Thefinal trials under the microscope willbe the PARTNER trial, both the Aand B cohorts. “The results fromPARTNER showedastoundingly goodoutcomes of thosepatients who re-ceived transcatheteraortic valve implan-tation (TAVI) with al-most no ‘learningcurve’. So, ratherlike STICH, there arelessons and implica-tions from both trialsin how to establishand run cardiac sur-gery trials.” The ses-sion will concludewith a discussion ofthe TAVI European Registries.

’Heart Team’ approachMonday’s programme will be fo-cused around specially designed ses-sions and begin with how the ‘HeartTeam’ approach seeks to inform par-ticipants of how a multi-disciplinarymeeting in ischaemic heart diseaseactually works in practice. “We willalso be looking at the EXCEL trial,

which is the successor to SYNTAX.Whereas the latter excluded leftmain stem disease, the EXCEL trialwill look specifically at stenting ver-sus surgery for left main stem dis-ease. So we will be hosting a debateand looking at the arguments onboth sides, which we hope will beinformative and assist participants in

making informed decisions.” Therewill be three or four case presenta-tions, with live discussion of decisionmaking based on presented an-giograms, echo, Magnetic Reso-nance Imaging and a panel willdiscuss the merits of percutaneousor surgical intervention in the lightof the current guidelines and comor-bidities. “Essentially, we are going totry and see how PARTNER A and B

works in practice.”Another session will look at the

future training and how young car-diac surgeons can become fully-in-volved in transcatheter valveimplantation, which incorporates acombination of conventional surgicaland endovascular skills.

On Tuesday there will be a focuson ‘Professional Challenges’ withspecific attention on ‘Total ArterialGrafting’. “We will be looking at thereasons behind the disparity be-

tween science, which sug-gests that total arterialgrafting is the best treat-ment for surgical coronarydisease and the practice,which shows it is rarelyutilised. We hope to estab-lish why this is the case.”

There will also be two ses-sion on ‘Surgery for HeartFailure’, the first will exam-ine the merits of left ventric-ular assist devices,destination therapy withmechanical support, newmicropumps, as well asbridge to transplant. In addi-

tion, the second session will look atnew developments in the treatmentof advanced heart failure and the ar-rhythmia aspects of surgery (atrialfibrillation and ventricular tachycar-dia), as well as the role of short termsupport in acute heart failure(ECMO).

Tuesday will also see a company-sponsored session on antiplatelettherapy examining platelet function

and antiplatelet therapy in acutecoronary syndrome, and tips andtricks when operating under an-tiplatelet therapy. In addition, partici-pants will also have the chance tolook at new developments in extra-corporeal circulation such as minicardiopulmonary bypass, long termoxygenators and portable systems.

There will also be a dedicated ses-sion for academic cardiac surgery re-search that will highlight how towrite an academic paper, how toapply for grants, how to get Euro-pean grants, encompassing thewhole range of academic cardiacsurgery.

ControversiesWednesday’s programme will con-centrate on the conventional aorticvalve surgery and aortic valve androot surgery. There will be an exami-nation of classical aortic valve re-placement surgery, aortic valveendocarditis, aortic root in bicuspidvalves, aortic valve in acute aorticdissection type A, as well as newtechnologies in aortic valve replace-ment. “And finally, there will be anoverview of the worldwide experi-ence with the Ross operation detail-ing different surgical techniques, toenable participants to define indica-tions and contra-indications for theRoss procedure, compare the Rossprocedure with other options on thesurgical menu and, ultimately definethe requirements for optimal clinicalapplication of the Ross procedure,”concluded Pepper.

Adult cardiac – this year’s highlights

Postgraduate Course… Professional Challenges… Advanced Techniques

So we will be hosting a debate and

looking at the arguments on both

sides, which we hope will be

informative and assist participants in

making informed decisions…

essentially, we are going to try and

see how PARTNER A and B

works in practice

John Pepper

EACTS News 13

The Congenital Domain was es-tablished three years ago,” saidDr Comas. “Previously the

Techno-College programme wasdominated by the Adult Cardiac andThoracic Domains, and we felt it wasimportant for the Congenital Do-main to have a presence within theTechno-College.”

This year, the Congenital Techno-College programme will concentrat-ing on innovation and new ways ofclosing interventrical holes. DrComas explained that traditionally,the cardiac surgeon performed anopen procedure to close the defect.Today, interventional cardiologistsare also performing many proce-

dures to close these defects. There-fore, to reflect these changes intreatment paradigms, we have in-vited both cardiac surgeons, inter-ventional cardiologists andanaesthesiologists to discuss themerits and limitations of open andinterventional procedure. “DrFengwe (Linyi, China) will outlineoff-pump perventricular closure ofventricular septal defects (VSDs) andDr Tsang (London, UK) will assesswhether surgery is still the gold stan-dard for VSD closures. The afternoonsession will concentrate on the ad-vances in fetal treatments with a re-view of interventional and surgicalprocedures, as well as improving

outcomes for heart hypoplasia. Byincluding these differing specialistswe are endorsing the whole multi-disciplinary approach and are refer-ring to this year’s special theme‘Teamwork’.”

The Congenital PostgraduateCourse reflects the multidisciplinarynature of patient care in congenitalheart surgery. The programme willexamine the technical detail of my-ocardial protection and leakage.“One of the great pioneers of ourspecialty is Roger Mee (Royal Mel-bourne Children's Hospital, Australia),and he was asked last year at a meet-ing to recognise his achievements,why he had such good results? Heanswered that is was not because hewas a great surgeon, but because hehad anaesthesiologists, intensive careunits, nurses and others around him

and this helps achieve practice effi-cacy and practice efficiency for thewhole of healthcare.”

The second session will look at thepathology of the interrupted aorticarch in association with other majormalfunctions (eg. truncus), as well asa video session where the audienceare asked to vote anonymously onneonatal Ross procedures.

Professional ChallengesThis year the Congenital programmewill include a ‘Professionals Chal-lenges’ session. The objective onthis session will be to understandthe different surgical options for pa-tients with this pathology and un-derstand the current controversiesand complications. The session iscomprised of a video and an ab-stract session, and a keynote lecture

by Dr Tom Spray (Phildelphia, US).Then there will be a cases sessionfocused on learning from experi-ence and will examine when oneneeds to go back to the operatingroom or the cath lab depending onwhat type of procedure is required,and a two part lecture from a sur-geon and cardiologist entitled,‘What to expect’. The afternoonsession will consist of two abstractsessions.

The Tuesday morning will also bedifferent.

In Lisbon, there will be anotherjoint session with a focus on extra-cardiac Fontan controversies. As thisis the 25th Annual Meeting of theEACTS, Tuesday will finish with anhistoric lecture of how EACTS hashelped to contribute to the treat-ment of congenital heart disease.Wednesday’s programme will be aninteractive discussion on congenitalventricular assist devices forneonates, infants and children.

Professor Volkmar Falk discussessome of the key presentations andhighlighted the technological ad-

vances at this year’s Techno-Collegeevent…

“The aim of the Techno-College is tomake participants aware of what is newin the specialty, a technique or a deviceand focus on a disease area. Last year,there was a specific focus on atrial fibril-lation, this year the focus will be on aorticstenosis,” Falk explained. “We feel thatthis is a hot topic due to the widespreadapplication of catheter-based proceduresin recent years and an increase in deviceswith numerous advantageous and disad-vantages.”

Along with presentations featuring su-tureless, the session will also feature avideo presentation of a new transcathetervalve (developed by St Jude Medical),which will be the first time this device has

been presented. In addition, there willalso be an examination of new access de-vices with a live demonstration of a newexpandable sheath that could expand theindication for the transfemoral aorticvalve implantation. “As in recent years,we will also show developments in a pre-clinical stage and what is in the pipeline.”

According to Falk, one of the high-lights will be Dr Galadja’s presentation ontransapical endoscopic mitral repair ap-proach and he added that he would bevery interested to see what participantsthought of the technique. “It is certainlysomething that deserves attention anddiscussion,” he added.

Techno-College Innovation AwardThe Techno-College invites surgeons, en-gineers and individuals from companiesactive in the field of Thoracic and Cardio-

vascular Surgery to apply for The Techno-College Innovation Award. In particular,the winner will demonstrate a technolog-ical breakthrough in an area related tothoracic and cardiovascular.

“Over the year’s we have seen an in-crease in the Techno-College Award and Ithink it is because it is fundamentally dif-ferent as it is open to industry submis-sions and it is not limited to technology,”commented Falk. “So it could be a newprocedure, device, implant, software oradministration skill.”

The winner will be chosen on behalf ofthe EACTS by the members of the NewTechnology Committee and he/she willhave the opportunity to present his/herwork during the Annual Techno-Collegeon Saturday 1st October 2011, where theprize, €5,000, will also be awarded. Submissions will close on 1 August2011.

EACTS News talked to Congenital Domain Chair, JuanComas, who outlined some of the highlights plannedfor this year’s Congenital programme

Techno-College to Fontan controversies

Innovations of the future in Lisbon

“

25Th ANNuAL MEETINg

JOIN us IN LIsbON

Previewing – the Congenital Programme

Previewing – Techno-College

Volkmar Falk

14 EACTS News

Post-graduate Course:Sunday 2nd October

Leslie HamiltonConsultant Cardiothoracic SurgeonProgramme Chair PostgraduateCourse Nurses

The theme of this, the 25th an-nual EACTS meeting, is “Team-work”. It seems obvious

therefore that a specific programme

should be organised during the Post-graduate day (Sunday) to explore indepth, the vital contribution madeby the members of the team from anursing background.

This is a rapidly expanding area ofpractice and their value is becomingincreasingly obvious. Having skilled,knowledgeable nurses who have de-veloped their roles and are permanentmembers of the team is of great ben-efit in providing continuity of care.

This contrasts with trying to maintaina service workforce based on doctorsin training with unpredictable levels ofexperience who come to the depart-ment for a variable period of time forsurgical training.

The programme for the day ex-tends over six sessions. The aim is tocover general themes of advancednursing practice and includes pre-sentations by nurses on specific proj-ects. The challenges of wound care

are addressed and issues aroundtransplantation will be explored (in-cluding LVADs and ex-vivo lung per-fusion). Advances in our specialtywill be considered (hybrid revascular-isation and TAVI) and we will discussresearch and publication. The daywill finish with a discussion of theEACTS Guidelines on Resuscitationin the ICU and will include a livedemonstration of the protocol.

We would ask that you encourageyour nursing colleagues to attendand specifically support them in ob-taining funding. In doing so you willboth encourage your team and helpmake this day a success.

Vital team members: Nurses, nursepractitioners, physician assistants

EACTS News continues to preview the25th Annual Meeting and we discussedthe Vascular programme with Domain

Chair, Martin Grabenwöger, who outlinedsome of the highlights planned for this year’sprogramme…

“The EACTS structure of Domains was es-tablished by Paul Sergeant three years ago andI was the first Vascular Domain Chair, themeeting in Lisbon will be my last as chair ofthe domain,” said Grabenwöger. “Over thelast three years, I have seen a change in theprofessionalism of the EACTS and we havealso been able to establish EACTS VascularCourses. It has been a very enjoyable experi-ence.”

He explained that the process creating aprogramme begins in almost as soon as theannual meeting finishes, with the DomainChairs meeting in November 2010. This year,the Vascular Domain programme will have

two parts; invited speakers and abstracts pre-sentations. The abstracts are assessed andmarked, and then assigned to a relevant ses-sion. “We received over 90 abstracts concern-ing aortic disease specifically for the vasculardomain. The quality of the abstracts is improv-ing every year,” he added. “Obviously, we in-clude the abstracts that receive high marks butabstracts that fit together so there is a themeor subject central to each session.”

This year’s programme highlights includesessions on the acute aortic dissection type Aand a focus on complex aortic disease, whereone has to treat the ascending, the arch andthe descending aorta. “So participants in thesession will be able to watch and comment onvideos of these procedures. This will be fol-lowed by a keynote lecture and five abstractpresentations that will fit to this topic, but mayoffer different solutions,” commentedGrabenwöger. “There are different ways to

treat the same pathology. So we hope thatvideo presentations, keynote speakers and ab-stracts will raise many talking points and fur-ther discussion.”

Professional challengesThe Vascular Domain programme on the Mon-day will this year feature a special focus ses-sion on acute aortic dissection type A. “This isa very important topic in emergency surgery asthe majority of the patients who present withthis condition will die if they are not treatedsurgically within the first 24 hours,” he ex-plained. “There is a lack of evidence concern-ing acute aortic dissection type A becausethere are no prospective randomised trialsavailable. We in the Domain believe the prob-lem is because people are using differentmethods, for example for cannulation, sothese differences will be highlighted in thisProfessional Challenges session.”

Grabenwöger then explained the benefitsof working within EACTS and how the struc-ture of the EACTS Domains has gathered to-gether the experts in their fields who not onlywork on the programme for the annual meet-ing, but also, in cooperation with the Euro-pean Society of Cardiology, form a Taskforceon the use of stent grafting for aorticaneurysms. Together, the society and associa-tion will be researching and writing a manu-script for stent grafting. “In addition, ErnstWeigang has established the European Reg-istry of Aortic Disease (EuRADa) that we hopewill collect much need standardised informa-tion on patients with aortic diseases that willaid in the treatment of patients with aortic dis-ease. EuRADa is supported by the Vascular Do-main and the EACTS Council. The collection ofdata and establishing guidelines are valuableroles the Domains within the EACTS can per-form.

Acute aortic dissection to complex aortic disease

Nurses Course at the 25th Annual Meting of the EACTS

Previewing Lisbon 2011 – the Vascular programme

25Th ANNuAL MEETINg

JOIN us IN LIsbON

Come and join the party!

We shall be celebrating our 25th Anniversary at one of Lisbon’s mostremarkable and historical buildings – the Convento do Beato. Withinthe various wings of this 15th Century convent, recognized over the

years for its magnificient construction, we will provide you with a variety ofculinary and musical delights!

In the main Cloiser Hall we will celebrate the decade in which the Associa-tion was founded - the 80’s – by showcasing some of the most famous stagemusicals from that period. Our performers will sing and dance their waythrough internationally renowned hit stage musicals such as Les Miserablesand Cats. The programme on the main stage will culminate in a performanceby our EACTS ‘house’ band, made up of our own group of surgeons. The bandwill perform some well known cover songs, enticing everyone onto the dancefloor.

In the more tranquil setting of the Library, our soloists will perform a rangeof classical music and operatic arias written by European composers, and in theUpper Foyer area we will celebrate the best traditional and folk music anddance that Europe has to offer.

For those of you seeking even more excitement, we plan to run an EACTScasino where you will have the opportunity to join your colleagues for a flutteron the gaming tables.

Finally, if you just want to sit and take in the beautiful surroundings of thiswonderful building, we will provide an area where you can relax and enjoy aquiet drink and a bite to eat in the company of friends and colleagues.

16 EACTS News

SCIENTIFIC MEETINGMonday 3 October 2011:

Presidential Address: The beauty of thedifferences Ottavio Alfieri, Milan:

Tuesday 4 October 2011

The Honoured Guest: Tissue specific adult stemcells Piero Anversa, Boston

Domain of acquired cardiac diseaseMonday 3 October 2011

Professional Challenges Wire Skills: Part 1 Video 1: Transfemoral aortic valve replacement

F Maisano, Milan Keynote lecture: Weird wires?

J Bavaria, Philadelphia Imaging (Fluoroscopy, Intravascular ultrasound

and intracardiac echocardiography C DiMario, London

Guide wire/catheter nomenclature L Lonn, Copenhagen

Arterial access and closure C Di Mario, London Trans septal approach M Rigby, London Wire Skills: Part II: Abstracts

Focus SessionsHeart Team at Work

On-stage Syntax scoring will be demonstrated live. Indi-cation for percutaneous coronary intervention (PCI) orcoronary artery bypass graft (CABG) (or nothing will bediscussed by the panel in the light of the current guide-lines and co-morbidities 3/4 case presentations, with livediscussion of decision making based on presented an-giograms, echo, magnetic resonance imaging,

Functional Mitral Regurgitation Understanding mitral regurgitation in heart

failure – Do you? M De Bonis, Milan Imaging of functional mitral regurgitation

V Delgado, Leiden Surgical repair – mitral and ventricular level

H J Schaefers, Homburg/Saar Interventional treatment (MitraClip and beyond)

M Mack, DallasTAVI from inception to implantation The Original Idea L von Segesser, Lausanne

The Capital Investment P Pouletty, Paris The Animal Stage N Borenstein, Paris

The R&D Accomplishment S Delaloye, Ecublens The Physician / R&D Collaboration

J Kempfert, Bad Nauheim The Clinical Path to CE Mark H Treede, Hamburg TAVI in Perspective T Walther, Bad NauheimTraining for transcutaneous aortic valve replacement Transcatheter valve implantation (TAVI) should

be performed by surgeons The Surgeon’s View and The Cardiologists View How did I train? The experience of three

leading surgeonsAbstract Sessions: Aortic Valve I; Coronary I: Heart Transplant I;

Cardiac General I; Mitral Valves I, Assist I;: Mitraland Tricuspid Valves; Coronary II; TAVI I ;Cardiac General II; Experimental

Tuesday 4 October 2011

Professional Challenges

Total Arterial Grafting: Part 1 Video and Keynote Lecture – No touch all

arterial grafting D Glineur, Louvain Keynote lecture: Arterial grafting for everyone?

B Buxton, VictoriaAbstracts Total Arterial Grafting: Part II Video Arterial conduits in redo coronary artery

surgery G Tavilla, Nijmegen Learning from Experience

Professional ChallengesMitral Valve and beyond: Part I Videos: Valve-in-ring implantation R Klautz, Leiden;

F Maisano, Milan; H Vanermen, Aalst

Abstracts Mitral Valve and beyond: Part I Transfemoral mitral valve-in-valve procedure:

clinical experiences: A Colombo, Milan; A.Vahanian, Paris

Abstracts Percutaneous re-revalvulation of the tricuspid

valve M Gewillig, Leuven New perspectives for the tricuspid valve

H Vanermen, Aalst

Focus SessionsAntiplatelet therapy Platelet function J Carvalho de Sousa, Lisbon

Clopidogrel N van Mieghem, Rotterdam Prasugrel P Smith, Durham

Ticagrelor F Verheugt, Amsterdam Antiplatelet therapy in stable coronary artery

disease M Heras, Barcelona Antiplatelet therapy in unstable coronary artery

disease A P Kappetein, Rotterdam Operating under antiplatelet therapy – Tips and

tricks M Sousa Uva, Lisbon Postoperative use of ant platelet therapy

(mono, double, tripple...) F Verheugt, AmsterdamFunctional Tricuspid Regurgitation (TR): state of the art and new perspectives Understanding functional TR: which implications Anatomy, pathophysiology and assessment of

functional TR M Sarano, Rochester Implications in tricuspid annuloplasty rings

M Jahangiri, London Deciding about functional TR: timing of repair Why so many MR patients with functional TR are

still not treated? R Klautz, Leiden Which patients should be treated?

L van Herwerden, Utrecht Treating functional TR: beyond daily practice How to prevent progression of functional TR?

S Geidel, Hamburg Is prophylactic annuloplasty for less than severe

functional TR really necessary? M Antunes, Coimbra Tailoring the surgical approach to the stage of

the disease G Dreyfus, MonacoSurgery for heart failure – Medical Medical Therapy (Trial Update / Insight new

guideline) T McDonagh, London Resynchronization Therapy

F Braunschwieg, Stockholm Electrical Treatment Cardiac Resynchronisation

Therapy (CRT); Atrial Fibrillation Ablation (AF); Ventricular Tachycardia (VT) M Czesla, Stuttgart

Role of Short term support in acute heart failureextracorporeal membrane oxygenation F Beyersdorf, Freiburg

Surgery for heart failure; MECC Weaning from left ventricular assist device:

How and when? E Birks, London Destination therapy with mechanical support

R Hetzer, Berlin Micropumps A Simon, London Bridge to Transplant M Morshuis, Bad OeynhausenPerfusion Problems & Opportunities Mini cardiopulmonary bypass J Mulholland, London

Long term oxygenators F De Somers, Gent Portable systems: A Philip, Regensburg –

Extracorporeal Membrane OxygenationGuidelines C Benk, FreiburgNew ideas in Myocardial Protection D Chambers, London

Abstract Sessions: TAVI II Mitral Valves II; AssistII; Aortic Valve II; Blood; Heart Transplant II;Aortic Valve III; TAVI III: Cardiopulmomarybypass; Arrhythmia

Wednesday 5 October 2011

Advanced Techniques Controversies Adult Cardiac Surgery: Aortic

Valve and Root Surgery New Technologies in aortic valve replacement:

The cardiologist’s view A Vahanian, Paris Classical aortic valve replacement:

Surgery, still the gold standard G Berg, Glasgow Aortic valve endocarditis: What to do

C Mestres, Barcelona Aortic root in bicuspid valves: What to doR De

Paulis, Rome

Aortic valve in acute aortic dissection type A:What to do M Shrestha, Hannover

Minimally invasive aortic valve replacement M Glauber, Massa

New Technologies in aortic valve replacement:Positive trend T Folliguit, Paris

View from the medical industry: Aortic valvereplacement J McKenna, Vascutec, UK

View from the research: Aortic valvereplacement: tissue engineered valves thefuture? A Haverich, Hannover

Transcatheter Aortic Valve Implantation – The goldstandard for the treatment of aortic valve stenosis Implantability and short term complications

J Goiti, Bilbao Haemodynamics and the relevance of aortic

regurgitation N Moat, London Mid-term results, insights from the Partner trial

C Smith, New York Next developments in technology. Surgical

implications V Falk, Zurich Indications and patterns for referral for

transcatheter aortic valve implantation in 2020 A Vahanian, Paris

The future market for transcatheter aortic valveimplantation Philip Ebeling, VP, Research & Development, St Jude Medical

Minimally Invasive Therapies for Atrial Fibrillation Surgical atrial fibrillation therapy in port-access

surgery M Czesla, Stuttgart Isolated lone atrial fibrillation ablation through

right minithoracotomy G Nasso, Bari Two-staged hybrid procedure for long-standing

lone atrial fibrillation B Gersak, Ljubljana One-stage hybrid procedure for long-standing

lone atrial fibrillation M La Meir, Brussels Minimally invasive left appendage

management in patients with atrial fibrillation: S Salzberg, Zurich

25Th ANNuAL MEETINg OF ThE EACTs –

Full details of all programmes at www.eacts.org

(Programmes subject to change)

EACTS News 17

The role of the Ross Operation on the surgical menu Ross root replacement: indications, contra-

indications and results I El-Hamamsy, Montreal Video – Ross procedure root replacement

I El-Hamamsy, Montreal Video – Ross subcononary implantation

technique Hans Sievers, Luebeck Training requirements for the Ross procedure

W F Northrup III, Kennesaw Mechanical AVR: indications, contra-indications

and results H Körtke, Bad Oeynhausen Stentless bioprosthetic AVR: indications, contra-

indications and results R J M Klautz. Leiden Aortic valve repair: indications, contra-

indications and results H J Schäfers, Homburg/Saar Optimized decision making for prosthetic AV

selection J J M Takkenberg, Rotterdam Discussion: The surgical menu for aortic valve

disease in (young) adultsWet Labs Strategies to deal with Small Aortic Root Valve Sparing Root Surgery CABG anastomotic techniques

Domain of vascular diseaseMonday 3 October 2011

Professional Challenges Type A Aortic Dissection Part I Film: Acute Type A dissection AbstractsType A Aortic Dissection Part II Different cannulation sites in acute type A

aortic dissection C Mestres, BarcelonaVideos Carotid cannulation P Urbanski, Bad Neustadt

Direct aortic cannulationK Kallenbach, Heidelberg Subclavian cannulation S Folkman

Direct axillary cannulation D Pacini, Bologna Direct true lumen cannulation

L Conzelmannm Mainz Panel Discussion What have we learned so far from GERAADA

concerning cannulation site and perfusion E Weigang, Mainz

Focus SessionNeuroprotection Pharmacological protection J Strauch, Bochum Perfusion and temperature management in

type A aortic dissection (insights fromGERAADA) T Krueger, Tübingen

Haemodynamic and brain monitoring in type Aaortic dissection R Bonser, Birmingham

Monitoring and surgical aspects in thoraco-abdominal repair M Schepens, Brugge

Role of distal aortic perfusion G Esposito, Bari Experimental aspects of spinal cord protection

C Etz, Leipzig Abstract Sessions:

Acute and Chronic Ascending Aortic Disease

Tuesday 4 October 2011

Focus SessionConnective Tissue disease Hereditary Aortic syndromes

Y von Kodolitsch, Hamburg Pathological correlates of genetic aortic

syndromes O Leone, Bologna Indications for open surgery and surgical

techniques T Carrel, Berne The Thoraco-abdominal aorta in Marfan

syndrome M Schepens, Brugge Pharmacological treatment in connective tissue

disease J Pepper, London TEVAR in herdeditary aortopathy

M Funovics, ViennaAbstract Sessions

Complex Aortic Arch Pathology: Acute Type BAortic Dissection; Descending Aorta

Wednesday 5 October 2011

Advanced Techniques Novel Strategies for the Treatment of the Thoracic Aorta Functional imaging of the aorta

M Czerny, Berne/ E Weigang, Mainz Redo operations of the aortic root

M Di Eusanio, Bologna One, two or three vessel perfusion during

selective antegrade cerebral perfusion J Bachet, Abu Dhabi

Novel surgical techniques in acute complicatedtype B aortic dissection M Grabenwoger, Vienna

Preventing paraplegia in thoracic endovascularaortic repair – EUREC II M Czerny, Berne

Thoracic endovascular aortic repair inthoracoabdominal aneurysm – Risk ofendoleaks M Funovics , Vienna

Introduction to EURADA E Weigang, Mainz

Domain of thoracic diseaseMonday 3 October 2011

Abstract Sessions Lung Cancer; Mesothelioma, Lung Cancer and

Rare Disorders; Esophagus and Mediastinum;Experimental

Tuesday 4 October 2011

Focus SessionChest Wall Sternal reconstruction with cadaver bone

(video) F Rea, Padua Minimally invasive pectus excavatum repair

H Pilegaard, Copenhagen Minimally invasive pectus carinatum repair

M Yuksel, Istanbul Minimally invasive first rib resection

M C Ghefter, Sao Paulo Chest wall resection and reconstruction

C Deschamps, Rochester Sternal dehiscence M Tocco, Rome Abstract Sessions: Minimally Invasive Techniques

and Risk Factors; Non Oncology; Special Topics

Wednesday 5 October 2011

Advanced TechniquesLearning from Experience

Domain of congenital heart diseaseMonday 3 October 2011

Professional Challenges Hypoplastic left heart syndrome Part I Classical Norwood W Gaynor, Philadelphia Modified Sano D Barron, Birmingham Hybrid Procedure R Pretre, Lausanne Abstracts Surgery for HLHS: T Spray, Philadelphia Hypoplastic left heart syndrome Part II Learning from experience Extreme form of hypoplastic left heart

syndrome C Schreiber, Munich One or two ventricles L Galletti, Bergamo After Norwood: Surgical or Cath-lab revision

E Da Cruz, Denver Keynote Lecture: Treatment of HLHS What to

expect D Schranz, GiessenAbstract Sessions Aortic Root / LVOT Right Ventricular Outflow

Tract

Tuesday 4 October 2011

Focus SessionFontan controversies Surgical view of controversies

W Brawn, Birmingham Cardiology view of controversies F Berger Panel Discussion: B Maruszewski, Warsaw; J Fragata,Lisbon;

M. Reddy, Stanford; Nico Blom, Marc Gewilling, OrnelaMilanese, Dietmar Schranz

Controversies: Optimal age; Management ofpulmonary pulsative flow; Management of AV-valve regurgitation; Fenestration;Anticoagulation; Arrhythmia

AbstractsAbstract Sessions

Domain Initiatives and Abstracts; Transpositionof the great arteries: Mixed

Wednesday 5 October 2011

Advanced TechniquesVentricular Assist Devices for neonates, infants, and :children, Interactive demonstration Theoretical Background Indications and contraindications for VADs

D L S Morales, Houston Review of centrifugal and roller pump

technologies C Haun, Sankt Augustin Developing Ventricular Assist Devices

B W Duncan, Houston Hands-on Practice and Troubleshooting

There will be 6 stations with different devices. The atten-dees will be in 6 groups that will rotate for a total of 30minutes per station. Each station will offer a short lecture(5 minutes) about the device, followed by 25 minutespractice.

– sCIENTIFIC PROgRAMME – LIsbON 2011

Full details of all programmes at www.eacts.org

(Programmes subject to change)

18 EACTS News

27-31 AugustEuropean Society ofCardiology Congress 2011 Paris, FranceContact: Congress Secretariat Phone: (+33) 4 9294 7600 Fax: (+33) 4 9294 8629

7-11 November TranscatheterCardiovascularTherapeutics (TCT 2011) San Francisco, US Contact Cardiovascular Research

Foundation Phone: 646-434-4500 Email: info@crf.org

10-16 NovemberAmerican HeartAssociation ScientificSessions (AHA 2011) Orlando, FLContact Conference Secretariat –

AHA Email: scientificconferences@

heart.org

Key International Events in 2011

If you would like to list your events hereplease email the details to: communications@e-dendrite.com

EACTS was representedby Professor Paul Ser-geant, chairman of the

ICC of EACTS, ProfessorMarko Turina, past –chair-man of the ICC and Profes-sor Charles Yanka from theBerlin Heart Institute. Theprogram was jointly organ-ised with Professor Francis Smit, head of thedepartment of Cardiothoracic Surgery at theUniversity of the Free State in Bloemfonteinand also a member of the ICC of EACTS. Acompliment of South African surgeons com-pleted the faculty.

The course was attended by all heads ofdepartments of training institutions (sevenUniversities) in South Africa, as well as regis-trars and perfusion technologists. In all, 10delegates from six other African countries at-tended the course aswell as 70 delegatesfrom South Africanunits. In addition 30perfusionists at-tended the parallelperfusion course on 4and 5 June.

The first day con-sisted of a researchmethodology sessionand a discussion of open mitral valvotomy,concluded with a successful wet-lab under thedirection of Prof Yankah and heads of depart-ments from South Africa.

The course also included a session on off-

pump coronary artery surgery and its possibleapplication in Africa. It also included two drylab sessions on off pump CABG techniquesconducted by Paul Sergeant.

Palliative paediatric surgical procedures (PA-banding and shunts), co-arctataion and PDAwere discussed in the paediatric session. Anapproach to the surgical management of in-flammatory lung disease was addressed in thethoracic session, and specific conditions wereaddressed in an interactive session.

Population studies were discussed and dele-gates developed basic protocols to hopefullyconduct these studies at their own institutions.

Delegates from African countries, otherthan South Africa, discussed their programsand the challenges facing the development ofcardiac surgical programs in Africa. The impor-tant role of a solid grounding in diagnostics(and echocardiography) as part of surgical

training programs was emphasised. The exten-sive development of palliative and off pumpcardiac surgery programs as a basis for the de-velopment of cardiac surgical programs inAfrica was discussed during panel discussion

in the paediatric and adult cardiac sessions.A parallel session on perfusion was con-

ducted on 4 June, and was attended by MrFrank Merkle, chairman of theEuropean Society for Cardio-vascular Perfusionists currentpresident of the EuropeanBoard of Cardiovascular perfu-sionists (EBCP). The programincluded sessions on trainingprograms for perfusionists,hemodynamic monitoring, in-cluding peri-operative TEEuse. A session on coagulation

and transfusion challenges in cardiac surgeryincluding cell saving was well received. Wet–lab sessions were conducted on cell saving,mini- bypass systems and ECMO circuits on5 June.

Lectures are available on ourdepartmental website atwww.heartcentre.info. We want to thank our sponsors VikingMedical, Philips and Ethicon.

Left to right: Professors Charles Yankah,Francis Smit, Paul Sergeant, Hannes Meyer

and Marko Turina.

Left to right, Dr S M Mogaladi from Pretoria, Dr Paul Sergeant, Chairperson of theInternational Cooperation Committee of the European Association of Cardiothoracic

Surgery (also immediate past president of EACTS) and Dr Richard Schulenburg from the UFS

Successful EACTS training course in Bloemfontein

INTERNATIONAL CO-OPERATION COMMITTEE

EACTS Events in 2011–2012

1-5 October 201125th EACTS AnnualMeetingLisbon, Portugal

24-26 November 2011Multidisciplinary TeachingCourse on Lung CancerMalaga, Spain

(jointly organised by ESTRO, ESMO, EACTS,

ESTS, ESSO)

16-20 January 2012 (new date)2nd Leadership Course forCardiovascular andThoracic SurgeonsWindsor, UK

8-9 February 20121st IACTS-EACTS JointWorkshopKolkata, India

13-15 February 2012Course of Minimal InvasiveTechniques in AdultCardiac SurgeryNieuwegein, The Netherlands

The International Co-operation Committee (ICC) of EACTS co-organised atraining course at the University of the Free State in Bloemfontein, SouthAfrica held over two and a half days from 3–5 June 2011. This course, knownas the Hannes Meyer Registrar Conference, is also supported by the Societyof Cardiothoracic Surgeons of South Africa. Hannes Meyer was the foundinghead of the Cardiothoracic Surgery department at the UFS and also attendedthis year’s course.

The extensive development of palliative and

off pump cardiac surgery programs as a basis

for the development of cardiac surgical

programs in Africa was discussed