Presidential Plenary Session

Activity: 103rd Annual Meeting
*Lars Svensson Moderator
Cleveland Clinic
Cleveland, OH 
United States
 - Contact Me

Dr. Svensson is the Chairman of the Sydell and Arnold Miller Family Heart, Vascular & Thoracic Institute at Cleveland Clinic and served on the Cleveland Clinic Health System Operations Council. Dr. Svensson is an internationally known cardiovascular and thoracic surgeon. His research has led to many innovative surgical treatments and techniques. He is a Professor of Surgery at Cleveland Clinic Lerner College of Medicine of Case Western Reserve University. Dr. Svensson previously served on the AATS Council, has Chaired the AATS Guidelines Committee. He has chaired multispecialty guidelines writing committees for endovascular treatment with stents for the thoracic aorta, aortic valve surgery, and for the treatment of thoracic aortic disease.Dr. Svensson was born in Barberton, South Africa. He completed his undergraduate work at Treverton College in Mooi River, South Africa. He earned his medical degree and PhD in blood flow pathophysiology from the University of Witwatersrand in Johannesburg, where he received numerous fellowships and awards. He received his training in cardiology and general surgery at the Johannesburg Hospital, South Africa, and his training in cardiothoracic surgery at Cleveland Clinic, Cleveland, OH, for which he received a fellowship. He also completed a cardiovascular surgery fellowship and residency at Baylor College of Medicine in Houston, TX. In 2005, Dr. Svensson was named King James IV Professor of Surgery of the Royal College of Surgeons of Edinburgh. His academic appointments have included Chief of Cardiothoracic Surgery at the Veterans Administration Hospital in Houston, TX; Clinical Instructor in Surgery at Harvard Medical School, Boston, MA; Clinical Professor of Cardiothoracic Surgery at Tufts University, Boston; and Assistant Professor of Surgery at Baylor College of Medicine, Houston. 

*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.

Monday, May 8, 2023: 9:15 AM - 12:00 PM
Los Angeles Convention Center 
Posted Room Name: West Hall B 

Track

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

Presentations

Welcome and AATS C. Walton Lillehei Resident Forum Winner Announcement

Total Time: 5 Minutes 

David J. Sugarbaker Memorial Lecture

Total Time: 40 Minutes 

Guest Lecturer

*Toni Lerut, UZ Gasthuisberg  - Contact Me Leuven, oost brabant 
Belgium

5. Outcomes of Heart Transplantation Using Donation after Circulatory Death: Up-To-Date US Experience

Total Time: 20 Minutes 
Objective: Recently, a number of centers in the US have begun performing donation after circulatory death (DCD) heart transplants (HTx) in adults with heart failure. We sought to characterize the recent national trends in HTx DCD donor utilization and outcomes in comparison with donation after brain death (DBD).

Methods: Using the United Network for Organ Sharing (UNOS) database, 11,206 adult (>18yo) HTx recipients from January 2019 to June 2022 were identified, of which 454 (4%) were DCD recipients and 10,752 (96%) were DBD recipients. Comparisons between groups were done using Student's t-test & Pearson's chi-squared test, & logistic regression. Univariable (Kaplan Meier) and multivariable (Cox hazards) regression was used to analyze post-transplant survival in DCD group.

Results: DCD recipients were older (57 vs 56y, P<0.001), more likely to be listed as status 2 (p<0.001), had longer wait times (44.0 vs 32.0 d, p=0.002), and more VAD use (p=0.002). DCD donors were younger (29 vs 32y, p<0.001), had longer ischemic time (4.9 vs 3.4 hrs, p<0.001), less renal dysfunction (p<0.001) in comparison with DBD group. Logistic regression analysis showed DCD recipients are more likely to be male (p=0.010) and heavier (p<0.001) and less likely to require ECMO or inotropes (p=0.034 & p<0.001, respectively). On multivariable regression, only longer waitlist time (30-150) was associated with post-transplant survival in DCD group (HR=2.071 [1.095–6.660]). Post-transplant length of stay was shorter in DCD cohort (16 vs 17, p=0.023). One and two-year survival were similar in both groups (P=0.700).

Conclusions: In this UNOS registry, DCD recipients had shorter length of hospital stay and similar post-transplant survival compared to DBD group. DCD recipients were less ill at transplant with greater VAD use. Long waitlist time is a risk factor for poor outcomes post DCD heart transplantation. Given early success with post-transplant survival, effort should be made to expand the pool of eligible recipients. 

View Submission


Invited Discussant

*Edward Soltesz, Cleveland Clinic  - Contact Me Cleveland, OH 
United States

Abstract Presenter

Hosam Ahmed, Cincinnati Children's Hospital Medical Center  - Contact Me Cincinnati, OH 
United States

LB8. Lobar versus Sublobar Resection for Peripheral Clinical T1aN0 Non-small Cell Lung Cancer (NSCLC): A Post-hoc Analysis of CALGB/Alliance 140503

Total Time: 20 Minutes 
Objective
We have recently reported the primary results of CALGB/Alliance 140503, a randomized trial in patients (pts) with peripheral cT1aN0 NSCLC (AJCC 7th) treated with either lobar (LR) or sublobar resection (SLR). Here we report differences in DFS, OS and recurrence free survival (RFS) between LR, segmental (SR) and wedge resections (WR). We also report differences between WR and SR in surgical margins, rates of locoregional recurrence (LRR) and expiratory flow rates at 6 months postoperatively.
Methods
Between 6/07 and 3/17, 697 pts were randomized to LR (357) or SLR (340) stratified by clinical tumor size (1cm,1-1.5 cm,>1.5-2.0cm), histology and smoking history. 10 patients were converted from SLR to LR and 5 from LR to SLR. Surgical margins in the SLR group were measured intraoperatively by the surgeon. LRR was defined as recurrent disease in the lung or the hilar nodes of the index lobe. Survival end points were estimated by the Kaplan–Meier estimator, and tested by logrank test. Kruskal-Wallis test was used to compare margins and FEV1 changes between groups; and Chi-square test was used to test the association between recurrence and groups.
Results
362 pts had LR, 131 had SR and 204 had WR. Baseline demographic and clinical characteristics were similar between all three groups. 5-year DFS was 64.7% after LR [95% CI; 59.6-70.1%], 63.8% after SR [ 95% C; 55.6 − 73.2%] and 62.5% after WR [95% CI; 55.8 − 69.9%] (Logrank, p = 0.888). Five year OS was 78.7% after LR, 81.9% after SR and 79.7% after WR (Logrank, p = 0.873). RFS was 72% after LR, 68.5% after SR and 69.8% after WR (Logrank, p = 0.709). There were no differences between groups in the cumulative incidence of lung cancer deaths or competing causes of death. LRR occurred in 10% of pts after LR, 12% after SR and 14% after WR (p=0.295). Information on surgical margins was available for 136 patients after WR (66%) and 76 after SR (58%). Median margin length was 1.6 cm after WR and 2.0 cm after SR (p=0.03). Median margin/clinical tumor ratio was 1.2 after WR and 1.3 after SR (p=0.07) A positive surgical margin was present in 3 patients after LR (0.8%), 2 patients after SR (1.5%) and 10 patients after WR (4.9%) (Fisher's exact, p=0.007). At 6 months postoperatively, the median reduction in % FEV1 was 5% after WR and 3% after SR (p=0.9304)
Conclusions
In this large randomized trial, LR, SR and WR were associated with similar survival outcomes. Although LRR was numerically higher after both modalities of SLR compared to LR, the difference was not clinically meaningful. There was no significant difference in the reduction of FEV1 between the SR and WR groups.
Support: U10CA180821, U10CA180882; https://acknowledgments.alliancefound.org ClinicalTrials.gov Identifier: NCT00499330 

View Submission


Invited Discussant

*Valerie Rusch, Memorial Sloan Kettering Cancer Center  - Contact Me New York, NY 
United States

Abstract Presenter

*Nasser Altorki, New York Presbyterian  - Contact Me New York, NY 
United States

211. Bilateral Pulmonary Artery Banding Palliation (Hybrid Procedure) Versus Other Management Strategies for a Multi-Institutional Cohort of Infants with Critical Left Heart Obstruction

Total Time: 20 Minutes 
Objective: We sought to determine the difference in patient characteristics and overall survival for infants with critical left heart obstruction (CLHO) who received bilateral pulmonary artery banding (bPAB) ± ductal stent palliation versus those who received other management strategies (e.g. Norwood, primary transplant, biventricular repair, or surgical/transcatheter aortic valvotomy).
Methods: From 2005-2019, 214 of 962 (22%) infants enrolled in the Congenital Heart Surgeons' Society CLHO cohort underwent bPAB ± ductal stent palliation at 24 institutions. Median follow-up was 8.6 years (range: 0.01-17.4 years). Using a weighting method based on propensity analysis, infants who had bPAB were matched to infants who received other management strategies on variables significantly associated with mortality and variables noted to be significantly different between the two groups. Applying the propensity weighting method, parametric hazard modeling for overall survival was performed (data from all 962 infants were incorporated and weighted) and bootstrap resampling was used to compare risk-adjusted survival between groups.
Results: Compared to infants who received other management strategies, infants who underwent bPAB had higher prevalence of prenatal interventions, non-cardiac comorbidities (e.g. genetic syndromes), preoperative intubation, absent interatrial communication, moderate or severe mitral valve stenosis, lower birth weight, and younger gestational age (all p-values <0.03). For survivors after bPAB, 10% (21/214) had primary transplant, 9% (19/214) had biventricular repair, and 65% (138/214) had univentricular palliation. For the 748 infants who received other management strategies, 1% (10/748) had primary transplant, 14% (104/748) had biventricular repair, and 84% (625/748) had Norwood operation. After applying propensity weighting to both groups, the 12-year risk-adjusted survival after bPAB versus other management strategies was 58% and 63%, respectively (early hazard phase p=0.36, late hazard phase p=0.96; Figure 1).
Conclusions: Infants born with CLHO who underwent bPAB have more high-risk patient-related and anatomic characteristics versus infants who received other management strategies. However, after risk-adjustment, overall survival was similar between the two groups. Mortality remains high for infants born with CLHO, especially for those who have high-risk characteristics, and a bPAB palliation strategy has not diminished this risk 

View Submission


Invited Discussant

*Pedro del Nido, Boston Children's Hospital  - Contact Me Boston, MA 
United States

Abstract Presenter

Madison Argo, Congenital Heart Surgeons' Society Center for Research and Quality  - Contact Me
United States

Presidential Address: The Dreamer & The Pragmatist

Total Time: 50 Minutes 

Speaker

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