Plenary Session

Activity: 103rd Annual Meeting
*Yolonda Colson Moderator
Massachusetts General Hospital
Boston, MA 
United States
 - Contact Me

Dr. Colson is the past President of the American Association for Thoracic Surgery, having served in many roles since becoming a member in 2003, including as Co-chair of the 2015 Annual Meeting and Chair of the Advisory Council for the AATS Foundation.   She is the Chief for the Division of Thoracic Surgery at Massachusetts General Hospital and Hermes C. Grillo Professor of Surgery at Harvard Medical School. In addition to her cardiothoracic surgical training at Brigham and Women’s Hospital, her academic training includes a B.S. in Biomedical Engineering from Rensselaer Polytechnic Institute, an M.D. from Mayo Medical School, and a Ph.D. and general surgery residency at University of Pittsburgh.  Career awards include: the inaugural Michael A. Bell Family Chair in Healthcare Innovation, the George H.A. Clowes, Jr. Research Career Development Award from the American College of Surgeons, the Edward M. Kennedy Award for Health Care Innovation, and serving as the Exam Chair of the American Board of Thoracic Surgery from 2017-2021.  She is the current PI/co-PI on five NIH R01/U01 Grants and has recently been elected to the National Academy of Medicine.

She is co-inventor on three awarded patents and has received over twenty grants including the AATS Alton Ochsner Research Scholarship and eight "R" or "U" grants from the National Institutes of Health and National Cancer Institute. Dr. Colson's research focuses on the development of unique mechanisms of polymer and nanoparticle drug delivery aimed at preventing cancer recurrence, and the investigation of novel methods to identify hidden tumor that has spread to nearby lymph nodes. She has over 150 peer reviewed publications highlighting her previous work in transplantation and her most recent investigations in sentinel lymph nodes in lung cancer and polymer-mediated drug delivery. She has formally mentored well over 30 students, residents and junior faculty since becoming an attending thoracic surgeon. 

*Rosemary Kelly Moderator
University of Minnesota
Minneapolis, MN 
United States
 - Contact Me

Rosemary Kelly, MD currently serves as the Secretary of the AATS.  She is the C. Walton and Richard C. Lillehei Professor and Executive Vice-Chair of Cardiovascular and Thoracic Surgery at the University of Minnesota.  She completed medical school at the University of Chicago, Pritzker School of Medicine and General surgery training at Los Angeles County/University of Southern California Medical Center. She completed Thoracic surgery residency at the University of Minnesota and joined the faculty of the Cardiothoracic Surgery Division.  She is Program Director of the Thoracic Surgery Residency and Vice-Chair of Clinical Faculty Development for the Department of Surgery at the University of Minnesota. In addition, she is Chief of the Heart and Vascular Service Line for M Health Fairview.

Dr. Kelly is actively involved in basic and translational research. Her basic science work uses in vitro and in vivo models of chronically ischemic myocardium to study molecular and physiologic recovery following revascularization as well as in response to cell based reparative therapies. Clinically, she has been involved in numerous trials in coronary revascularization and lung transplantation. She participated in the CARP, RAVE, REGROUP, and VALOR trials, serving on the Executive Committees for RAVE and REGROUP. She also participated in ex vivo lung organ preservation INSPIRE and EXPAND trials. For the AATS, Dr. Kelly has served on the Membership Committee for 6 years and as Chair for two years. She is a current member of the AATS Foundation Board, the Leadership Academy Board, Publications Committee and Cardiothoracic Residents Committee. In these roles, she strives to improve educational experiences and professional opportunities for the next generations of cardiothoracic surgeons.

Saturday, May 6, 2023: 1:15 PM - 5:00 PM
Los Angeles Convention Center 
Posted Room Name: West Hall B 

Track

Adult Cardiac
Congenital
Multi-Specialty
Perioperative Care
Thoracic
103rd Annual Meeting

Presentations

Opening: Video and Remarks

Total Time: 20 Minutes 

Speaker

*Yolonda Colson, Massachusetts General Hospital  - Contact Me Boston, MA 
United States

Keynote Speaker: Judy Woodruff | No More Walter Cronkite: Looking for News We Can Trust in an Era of Misinformation and Disinformation


68. Donation After Circulatory Death Reduces Waitlist Times for Select Heart Transplant Recipients with Post-Transplant Outcomes Similar to Those Achieved with Standard Brain Dead Donors

Total Time: 20 Minutes 
Objective: The purpose of this study was to quantitate the impact of heart donation after circulatory death on waitlist times and post-transplant outcomes, including post-transplant peri-operative survival, in the United States.

Methods: A retrospective review utilizing the United Network for Organ Sharing database from October 18, 2018 to June 30, 2022 was performed. Adult recipients that underwent isolated heart transplantation within the United States utilizing either donation after brain death (DBD) or donation after circulatory death (DCD) were analyzed. The primary outcome was median waitlist time. Other outcomes included 90-day post-transplant survival, and post-transplant complications.

Results: Since 10/18/2018, a total of 10,368 isolated adult heart transplants were performed, including 9,954 (96.0%) utilizing DBD donors and 414 (4.0%) utilizing DCD. On average, DCD donors were younger (28 vs 32 years; P<0.001) and had a higher left ventricular ejection fraction (62% [IQR 60-66%] vs 60% [IQR 56-65]; P=0.002). Median donor-recipient hospital distances were farther with DCD donation [351 miles vs 224 miles; P<0.001) with a longer median total graft ischemic time (4.8 hours vs 3.4 hours; P<0.001). Overall, median waitlist time was shorter in recipients from DBD donors (47 days vs 33 days; P=0.001). However, the greatest proportion of DBD donors were allocated to Status 2 recipients across all blood types (Figure A) whereas the greatest proportion of DCD donors were allocated to Status 4 recipients across all blood types (Figure B). Of all recipients transplanted as a Status 1 or 2, there was a nonsignificant reduction in median waitlist times with DCD donation (15 days [IQR 5-48] vs 17 days [IQR 6-69]. Among Status 3 or 4 recipients, median waitlist time was significantly reduced with DCD donation (73 days [IQR 19-246] vs 91 days [IQR 24-314], P=0.040). 90-day survival was similar for recipients of DBD and DCD hearts (Figure C). Perioperative stroke was comparable between cohorts, as were rates of renal failure, and acute rejection within the first year.

Conclusions: DCD heart donation represents one means of alleviating the current shortage of donor hearts for transplantation. These data demonstrate that utilization of DCD hearts is particularly beneficial to select candidate populations, such as those with lower priority status. Further, use of DCD donors results in similar post-transplant outcomes compared to DBD donors. 

View Submission


Invited Discussant

*Ashish Shah, Vanderbilt University  - Contact Me Nashville, TN 
United States

Abstract Presenter

Nicholas Hess, University of Pittsburgh  - Contact Me Pittsburgh, PA 
United States

69. Intravenous Iron Administration Before Cardiac Surgery Reduces Red Blood Cell Transfusion in Non-Anemic Patients

Total Time: 20 Minutes 
Objective: Reducing need for blood transfusion among patients undergoing cardiac surgery has potential to reduce post-operative complications and mortality. Our study aimed to assess effects of pre-operative intravenous ferric carboxymaltose (FCM) on post-surgical red blood cell (RBC) transfusion requirements in non-anemic patients undergoing cardiac surgery.

Methods: A double-blind, randomized, single center, placebo-control trial conducted between Oct 2016-Nov 2019, with follow-up period of up to 6 weeks post-operation. Participants were non-anemic patients undergoing non-emergent on-pump cardiac surgery, received intravenous iron in form of FCM or placebo, administered once 24-72 hours before surgery.
Primary outcome- number of RBC units transfused during first 4 post-operative days. Secondary outcomes- Blood hemoglobin levels at 4-days and 6-weeks post-operation.

Results: We randomized 200 patients, where 194 were included, 99 patients in FCM group vs 95 in placebo group; mean age (62.9±9.1 and 62.9±9.1 respectively) and gender (87% males) equally distributed between the groups. By day 4 post-surgery, a significantly lower mean number of RBC units were transfused in FCM than placebo group (0·3±0·9 vs 1·6±4·5, respectively; p=0·006). Number of patients receiving RBCs in FCM and placebo groups was 19 (19%) and 34 (36%), respectively [OR 0·42(95%CI 0·22-0·88); p=0·01]. Mean hemoglobin levels on day 4 post-surgery were 9·7±1 g/dl vs. 9·3±1 g/dl, respectively (p=0·03). Corresponding values at 6-weeks post-surgery were 12·6±1·4 g/dl vs. 11·8±1·5 g/dl, respectively (p=0·012).

Conclusion: In non-anemic patients undergoing on-pump cardiac surgery, pre-treatment with single FCM dose of 1000 mg within 1-3 days pre-surgery significantly reduced the need for postoperative RBC transfusions and improved both serum iron level, transferrin saturation and hemoglobin levels. 

View Submission


Invited Discussant

Victor Ferraris, Lexington VAMC  - Contact Me Lexington, KY 
United States

Abstract Presenter

Tom Friedman, Rambam Health Care Campus  - Contact Me Haifa, Israel 
Israel

Break

Total Time: 15 Minutes 

70. A National Survey of Occupational Musculoskeletal Injuries in Cardiothoracic Surgeons

Total Time: 20 Minutes 
Objective:
Over the past several years, there has been growing concern that surgeons are at increased risk for work-related orthopedic injuries due to poor ergonomics. We sought to conduct a survey of cardiothoracic surgeons in the U.S. and Canada to evaluate the incidence of occupational injury among cardiothoracic surgeons, as well as cardiothoracic surgeons' perceptions of and use of ergonomic techniques in the operating room (OR) and office.

Methods:
Cardiothoracic surgeons identified through the Cardiothoracic Surgery Network were asked to complete a 33-question survey assessing their musculoskeletal health, as well as their perceptions and use of ergonomic techniques in the OR and office. Results were analyzed using Wilcoxon rank sum and Pearson's chi square tests. Multivariable logistic regression was used to identify characteristics of surgeons associated with an increased odds of experiencing a work-related injury.

Results:
Of the 602 surgeon respondents, the majority were male (92%) and between 56-65 years of age. With regards to specialization, 40% practiced thoracic surgery, 48% cardiac surgery, and 12% reported having mixed practices. The overall incidence of work-related musculoskeletal injuries was 64%, with 30% of injured surgeons requiring time off from work and 20% requiring surgery or the use of narcotics. Cervical spine injury (n=216) was the most common orthopedic injury attributed to operating, followed by lumbar spine injury (n=180) and neck tension (n=171). In multivariable-adjusted analysis, surgeons who predominately practiced cardiac surgery were significantly more likely to experience work-related orthopedic injury than thoracic surgeons (aOR: 3.4, p<0.01). Notably, 90% of surgeons reported that they felt that their institution did not provide sufficient ergonomics education and support for cardiothoracic surgeons and only 35% felt that the cardiothoracic surgical community is supportive of implementing ergonomics techniques in the OR and office.

Conclusions:
In this survey, North American cardiothoracic surgeons reported experiencing work-related orthopedic injuries at an alarmingly high rate, leading to significant time away from work and for many to retire from over a decade early from surgical practice. These findings illustrate a critical need for institutions to prioritize ergonomics education and implement ergonomics-directed techniques in the OR and office. 

View Submission


Invited Discussant

*Michael Maddaus, University of Minnesota  - Contact Me Minneapolis, MN 
United States

Abstract Presenter

Camille Mathey-Andrews, Massachusetts General Hospital  - Contact Me Boston, MA 
United States

71. PROACT Xa: A Multicenter, Randomized Clinical Trial to Evaluate the Efficacy and Safety of Apixaban vs. Warfarin in Patients with a Mechanical Bileaflet Aortic Heart Valve

Total Time: 20 Minutes 
Objective: Vitamin K antagonists are the only approved oral anticoagulants to prevent valve thrombosis and thromboembolism in patients with mechanical heart valves. The PROACT Xa trial assessed whether patients with bileaflet aortic valves can be safely anticoagulated with apixaban, a direct factor Xa inhibitor, as an alternative to warfarin.

Methods: PROACT Xa was a randomized, multicenter, open-label trial comparing apixaban with warfarin in patients with bileaflet carbon aortic valves. Patients at least 3 months out from AVR were randomized 1:1 to receive apixaban 5 mg twice daily or warfarin with a target INR of 2–3. Primary efficacy outcome is composite of valve thrombosis and valve-related thromboembolism; primary safety outcome is major bleeding. All events are independently adjudicated by a clinical events committee blinded to study drug assignment. A planned sample size of 1000 patients allowed >90% power to assess noninferiority of apixaban to warfarin, assuming the primary efficacy outcome occurs in warfarin-treated patients at a rate of 1.75%/pt-yr with an absolute noninferiority margin of 1.75%/pt-yr. A co-primary efficacy analysis was to compare hazard rate for the apixaban arm to twice the objective performance criterion (3.4%/pt-year).

Results: A total of 863 patients from 60 sites were randomized from May 2020–Sep 2022. Enrolled patients had a median age of 56 years; 24% were female. Among participants, 46% had AVR in the 12 months prior to randomization, 17% had AVR along with an aortic root graft, and 16% were reoperations on the aortic valve. Most (93%) patients received aspirin 81 mg daily with the assigned anticoagulant. Median time in therapeutic range for warfarin-treated patients was 71.4% [55.1, 82.9]. On Sep 21, 2022, the DSMB recommended discontinuation of enrollment based on observed higher rate of thromboembolic events in patients randomized to apixaban than warfarin. All patients were transitioned off study drug and will be followed for at least 30 days after study drug discontinuation for all pre-specified outcomes.

Conclusions: Complete data on primary efficacy and safety outcomes will be available for presentation at the AATS Meeting in May 2023. While final data collection is ongoing, the PROACT Xa trial is likely to conclude that apixaban does not provide a safe alternative to warfarin for the prophylaxis of valve thrombosis or valve-related thromboembolism in patients with bileaflet mechanical aortic valves. 

View Submission


Invited Discussant

*Leonard Girardi, Weill Cornell Medical Center  - Contact Me New York, NY 
United States

Abstract Presenter

*Lars Svensson, Cleveland Clinic  - Contact Me Cleveland, OH 
United States

Pioneer Panel: Speedbumps, Detours and Road Construction

Total Time: 40 Minutes 
Did you know that if a female surgeon has a patient death, that referrals to all women in the group can decreased by over 50%? Did you know that top universities turn out black and Hispanic computer science and computer engineering graduates at twice the rate that leading technology companies hire them, casting doubt on the "pipeline" being the issue? Dr. Gilda Barabino, a national leader in the efforts to engage engineers in the development of solutions to health disparities, will open the session with data that speaks to the disparity around us in science and healthcare and ways to move forward.

Drs. Yolonda Colson and Lars Svensson, AATS President and President-Elect, will moderate a subsequent discussion with Gilda Barabino and Judy Woodruff, an award-winning journalist and former major network news anchor, comparing and contrasting the challenges in journalism, STEMM, education and cardiothoracic surgery that make effective sustainable change difficult to achieve.

The panel aims to identify unappreciated obstacles in recruitment & retention, finances, culture, and safety, that undermine the success of programmatic initiatives to increase diversity, thereby challenging our efforts to attract and support excellent surgical partners & trainees. Whether a department chair, division chief, or fellow cardiothoracic surgeon, each of us has a vital stake in the success of all of us. By including a broad range of experiences and perspectives in this conversation it is hoped that valuable insights and practical strategies may be identified that will improve not only the health and wellbeing of our surgeons, staff and patients but also the cultural and financial health of our surgical practices.  

Panelist(s)

*Yolonda Colson, Massachusetts General Hospital  - Contact Me Boston, MA 
United States
*Lars Svensson, Cleveland Clinic  - Contact Me Cleveland, OH 
United States
Gilda Barabino, President, Olin College of Engineering  - Contact Me Needham, MA 
United States
Judy Woodruff, Senior Correspondent for the PBS NewsHour  - Contact Me