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MINNEAPOLIS CONVENTION CENTER • MINNEAPOLIS, MN • MAY 4 – 8, 2013 AATS 93 RD ANNUAL MEETING 3 <strong>Surgery</strong> Symposium from previous page Gosta B. Pettersson, MD, recommended allografts for surgical reconstruction after endocarditis. MARTIN ALLRED The AATS Graham Research Foundation David J. Sugarbaker, MD Since its founding in 1973, the AATS Graham Research Foundation has served as the funding arm of the AATS’ research initiatives. The core mission of the Foundation is focused on driving leadership, learning and innovation in the pursuit of excellence. “As thoracic surgeons, each of us lives this mission every day by mentoring, supporting and guiding our colleagues,” said David J. Sugarbaker, MD, Foundation President. “The Foundation strives to advance the specialty by providing the bestpractice models in cardiothoracic surgery scholarship and research. Although the ways in which we fulfill our mission evolve as the specialty grows, we remain faithful to our values of academic exchange, innovation and collaboration, advancing patient care, fostering leadership, and trusted stewardship.” “We are pleased to announce this year’s recipients who have been identified as surgeons of unique promise who exhibit the potential for international thoracic surgical leadership.” Min Peter Kim, MD, of the United Methodist Hospital and United Methodist Hospital Research Center, Houston, Weill Cornell Medical School, New York, and The University of Texas MD Anderson Cancer Center, Houston, is the recipient of this year’s John W. Kirklin Research Scholarship. Dr. Kim will focus his research studying lung cancer microenvironment and metastasis. The 2013 Graham Traveling Fellow is Dr. Haifeng Wang, of Shanghai Pulmonary Hospital, Shanghai China. Dr. Wang’s fellowship goal is to gain an insight into leading techniques in current general thoracic surgery, such as airway surgery, thoracoscopic surgery and lung transplantation. He will be hosted by Dr. Douglas J. Mathisen, Massachusetts General Hospital, Dr. Alec Patterson, Barnes Jewish Hospital in St. Louis, and Dr. Robert McKenna, at Cedars-Sinai in Los Angeles. In the years ahead, the Foundation will continue to develop new initiatives of value to the cardiothoracic surgery specialty and to fulfill the AATS and AATS Graham Research Foundation’s mission. “We envision a dynamic and innovative future of continued excellence for cardiothoracic surgery,” concluded Dr. Sugarbaker. Michael R. Petracek, MD, reviewed strategies to avoid left ventricular rupture after mitral valve surgery. “The single most important criterion to save the aortic valve is the quality of aortic cusps, which have to be normal or have only minor abnormalities that can be satisfactorily corrected at the time of surgery without having to augment them with foreign materials,” Dr. David pointed out. Transesophageal echocardiography is the best diagnostic tool. The number of cusps, their thickness, the appearance of their free margins, and the excursion of each cusp during the cardiac cycle must be examined in multiple echocardiographic views. “If the aortic cusps are thin, mobile, and have smooth free margins, the feasibility of AVS is very high, even in the case of bicuspid aortic valves,” said Dr. David. Patients with abnormal cusps are best treated with aortic root replacement, he added. Michael R. Petracek, MD, of Vanderbilt University Medical Center, discussed the best means of preventing left ventricular rupture following mitral valve surgery, which he called “one of the most dreaded complications in cardiovascular surgery, with a mortality rate between 30% and 90%.” He gave a variety of prevention tips, including preserving as much of the mural leaflet and its chordae as possible; the careful removal of only as much calcium as is necessary to implant an adequate-sized valve; the use of bovine pericardium to repair the defect and implant the valve if the annulus is totally decalcified; the use of a low profile valve; and careful sizing, especially avoiding oversizing. Dr. Petracek also warned against placing valve sutures deeply below the annulus through the ventricular muscle or calcium, and he suggested using a pericardial skirt between the left atrium and the valve sewing ring. Gosta B. Pettersson, MD, of the Cleveland Clinic, presented the latest techniques and results for reconstructing the fibrous skeleton. “Surgical management of advanced endocarditis is difficult and requires an experienced cardiac surgeon,” Dr. Pettersson said, pointing out that radical debridement of all infected necrotic tissue and foreign material is the first step toward curing the infection. When it came to reconstruction, he recommended the use of allografts, which have shown benefits in both hospital mortality and mediumterm survival. “When an aortic allograft was used for reconstruction, mortality was 3.9% for prosthetic aortic valve endocarditis and 3.7% for infected ascending and arch prosthetic grafts,” Dr. Pettersson said. The session closed with an examination of the latest practice models in cardiac surgery, both private and academic, focusing on the benefits of an integrated cardiovascular practice. Dr. Bruce Lytle, of the Cleveland Clinic, discussed how traditional departments such as cardiovascular medicine, cardiovascular surgery, and vascular surgery (while retaining their department chairperson) can be integrated through the supervision of an “institute chair,” who is a physicianadministrator clinically involved with that pertinent organ system. Budget projections are based on both the departments and upon the institute as a whole, with strategic planning carried out mostly on the institute level, he said. “So far, the advantages of this system have included rationalization of resources, the sharing of resources among departments, programmatic development among departments and sections of departments, and rationalization of recruiting. The continual interaction also has appeared to lead toward increased collegiality,” concluded Dr. Lytle. Presidential Address Today The Presidential Address, “On Leadership and Scholarship – Unintended Consequences, Unexpected Opportunity,” will be given at 11:25 a.m. by Hartzell V. Schaff, MD. Dr. Schaff is the Stuart W. Harrington Professor of <strong>Surgery</strong> at HARTZELL V. SCHAFF, MD the Mayo Clinic in Rochester, Minn., and is a member of both the Cardiovascular <strong>Surgery</strong> and Pediatric and Adolescent Medicine Departments. MARTIN ALLRED
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