Abridged Program Book

W E S T E R N T H O R A C I C S U R G I C A L A S S O C I A T I O N

WWW.WESTERNTHORACIC.ORG

Hilton Waikoloa VillageW A I K O L O A , H A W A I I

Hilton Waikoloa VillageJUNE 22-25, 201642 nd

Annual Meeting42 ndAnnual Meeting

Scientific Program

WTSA

F U T U R EM E E T I N G S

43RD ANNUAL MEETINGJune 21–24, 2017The BroadmoorColorado Springs, Colorado

44TH ANNUAL MEETINGJune 27–30, 2018BacaraGoleta, California

V I S I O N

Build the foundation for the next generation of Cardiothoracic Surgeons

M I S S I O N

Educate in a collegial environment


42nd ANNUAL MEETINGJune 22–25, 2016

T A B L E O F C O N T E N T S

Offi cers and Council 22016–2017 Committees 3Schedule of Events 5CME Information 8General Information 12Acknowledgments/Exhibitors 14Guidelines for Speakers and Discussants 15Program Outline 16Scientifi c Program 38Constitution and By-Laws 164Guidelines for Expert Witness Testimony 183Roster

New Members 184Alphabetical 187Honorary Members 234Necrology 235Past Presidents 236Geographical 239

Samson Endowment Fund 245Samson Endowment Fund Contributors 246David J. Dugan Distinguished Service Award 249Donald B. Doty Educational Award 251Past Meeting Highlights 252Postgraduate Courses and Speakers 263Thoracic Surgery Foundation for Research and Education 268TSFRE 2016 Board of Directors 269TSFRE 2016 Research and Education Awards 270Author Index 275Membership Update 287

(Founded as the Samson Thoracic Surgical Society)

These sections available on-site in Waikoloa, Hawaii, or by logging into the Members Only Area of the WTSA Website at westernthoracic.org/members.

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OFFICERS AND COUNCILPresident, & Representative John D. Mitchellto the Board of Governors, Aurora, ColoradoAmerican College of Surgeons

Vice President James I. FannStanford, California

Immediate Past President Michael S. MulliganSeattle, Washington

Secretary Sean C. GrondinCalgary, Alberta

Treasurer Joseph C. Cleveland, Jr.Aurora, Colorado

Councillors-at-Large Craig J. Baker (2016)Los Angeles, California

Anthony P. Furnary (2018)Portland, Oregon

Richard I. Whyte (2017)Boston, Massachusetts

Councillor/Founder Arthur N. ThomasHillsborough, California

Historian Marvin PomerantzTucson, Arizona

Editor Richard D. WeiselToronto, Ontario

Hilton Waikoloa Village, Waikoloa, Hawaii 42ND ANNUAL MEETING

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2016–2017 COMMITTEESINDUSTRY RELATIONS James I. Fann, Chair (2016)COMMITTEE Steven R. DeMeester, Vice Chair (2016)

Robbin G. Cohen (2016)Sean C. Grondin (2016)John R. Mehall (2016)Surindra N. Mitruka (2016)Michael S. Mulligan (2016)

LOCAL ARRANGEMENTS Ross M. & Kathleen Bremner, Co-Chairs COMMITTEE Susan D. Moffatt-Bruce, Samson Fun Run

Joseph C. Cleveland, Jr., Golf TournamentRichard I. Whyte, Tennis Tournament

MEMBERSHIP COMMITTEE Donald E. Low, Chair (2017)Leah M. Backhus (2018)Anthony D. Caffarelli (2017)Michael M. Madani (2017)James M. Maxwell (2018)Paul H. Schipper (2016)

NOMINATING COMMITTEE Robbin G. Cohen, Chair (2016)Thomas A. Burdon (2019)John C. Chen (2018)Michael S. Mulligan (2020)Robert C. Robbins (2017)

PROGRAM COMMITTEE Michael J. Weyant, Chair (2016)Jessica S. Donington (2016)James Jaggers (2018)David M. McMullan (2017)Susan D. Moffatt-Bruce (2016)Nahush A. Mokadam (2017)Craig H. Selzman (2018)Sean C. Grondin, Ex-Offi cio (2016)John D. Mitchell, Ex-Offi cio (2016)Richard D. Weisel, Ex-Offi cio (2016)


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PROGRAM SUBCOMMITTEES

Adult Cardiac Gabriel S. Aldea (2016)Craig J. Baker (2016)Ramesh Singh (2016)Frederick A. Tibayan (2016)

Congenital Heart Bahaaldin AlSoufi (2016)Tara B. Karamlou (2016)Richard W. Kim (2016)Sunil P. Malhotra (2016)

General Thoracic Matthew G. Blum (2016)David T. Cooke (2016)Joseph B. Shrager (2016)Michael A. Smith (2016)

REPRESENTATIVES

Representative to the John D. MitchellBoard of Governors, Aurora, ColoradoAmerican College of Surgeons

Representative to the John C. ChenAdvisory Council for Honolulu, HawaiiCardiothoracic Surgery, American College of Surgeons U


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SCHEDULE OF EVENTSFor Registered Professional Attendees

WEDNESDAY, June 22, 2016

1:00 pm – 6:00 pm RegistrationGrand Promenade

1:00 pm – 6:00 pm Speaker Ready RoomWaikoloa 1

7:00 pm – 9:00 pm New Members/Welcome ReceptionKona Pool (Rain Backup – Waters Edge Ballroom)

THURSDAY, June 23, 2016

6:00 am Samson Fun RunLower Lobby Entrance

7:00 am – 8:00 am BreakfastQueen’s Ballroom

7:00 am – 12:00 pm ExhibitsQueen’s Ballroom

7:00 am – 12:30 pm RegistrationGrand Promenade

7:00 am – 12:30 pm Speaker Ready RoomWaikoloa 1

8:00 am – 9:00 am Scientifi c Session IMonarchy

9:00 am – 9:10 am New Member & Samson Prize Finalist IntroductionsMonarchy

9:10 am – 9:55 am Presidential AddressMonarchy

9:55 am – 10:20 am Coffee Break: Visit Exhibits & PostersQueen’s Ballroom

10:20 am – 10:25 am David J. Dugan Distinguished Service Award PresentationMonarchy

10:25 am – 11:45 am Scientifi c Session IIMonarchy

11:30 am – 12:30 pm Controversies Debate:Concurrent Surgery: Effi cient or Unethical?Monarchy


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1:30 pm Ocean Beach Blast*Depart from Lower Lobby Entrance

6:00 pm – 10:00 pm Legends of Hawaii Luau—Our Big Island StoryTheme Dinner Kamehameha Court

FRIDAY, June 24, 2016


6:00 am – 12:00 pm Speaker Ready RoomWaikoloa 1

6:30 am – 7:50 am Breakfast Session:*Public Reporting of Surgeon-Specifi c Data: Friend or Foe?Kings 1


7:00 am – 12:00 pm ExhibitsQueen’s Ballroom

8:00 am – 8:50 am Postgraduate Course:War Surgery in Iraq and AfghanistanMonarchy

8:50 am – 10:30 am Scientifi c Session IIIMonarchy

10:30 am – 11:00 am Coffee Break: Visit Exhibits & PostersQueen’s Ballroom

11:00 am – 12:00 pm Scientifi c Session IVMonarchy

1:20 pm Golf Tournament*Depart from Lower Lobby Entrance

2:00 pm Tennis Tournament*Tennis Club

Free Evening

*Separate Subscription Required


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SATURDAY, June 25, 2016

6:00 am – 11:30 am Speaker Ready RoomWaikoloa 1



6:30 am – 10:30 am ExhibitsQueen’s Ballroom

7:00 am – 8:45 am Concurrent Forums Adult Cardiac

Monarchy General Thoracic

Kings 1 Congenital Heart Disease

Kings 28:50 am – 10:30 am Scientifi c Session V

Monarchy10:30 am – 11:10 am Coffee Break: Visit Exhibits & Posters

Queen’s Ballroom 11:10 am – 12:00 pm C. Walton Lillehei Point/Counterpoint Session:

Surgeons on the Heart Team: Quarterbacks or Water Boys?Monarchy

12:00 pm – 12:30 pm Annual Business Meeting (Members Only)Monarchy

12:30 pm – 2:00 pm Family LuncheonLagoon Lanai

7:00 pm – 11:00 pm President’s Reception & BanquetGrand Promenade (Reception) & Monarchy (Banquet)

DRESS CODE

The dress code for the Annual Meeting is Resort Casual. Aloha shirts are fi ne; jackets and ties are not required. The President’s Reception and Banquet, too, is Resort Casual (for men, Aloha shirts and long pants).


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ACCREDITATION

This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of the American Association for Thoracic Surgery (AATS) and the Western Thoracic Surgical Association (WTSA). The American Association for

Thoracic Surgery is accredited by the ACCME to provide continuing medical education for physicians.

The American Association for Thoracic Surgery designates this live activity for a maximum of 12.50 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

CME MISSION STATEMENT

PurposeThe Western Thoracic Surgical Association (WTSA) is committed to improving patient care and enhanced patient quality of life through the provision of state-of-the-art continuing medical education (CME) to its members and non-member attendees at its sole CME activity, its annual meeting. The overarching goal of the WTSA CME program is to provide a high quality CME activity (its annual meeting) that will address the professional practice gap of its physician and allied health learners by facilitating change in participants’ competence and performance.

Content AreasThe content areas of the WTSA’s CME program annual meeting include but, are not limited to, acquired heart disease, thoracic oncologic issues, congenital heart disease, general thoracic disorders, pulmonary disorders, and adult car-diac disease. The scope of activities involves the body of knowledge and skills generally recognized and accepted by the profession and the specialty as within the basic medical/surgical sciences, surgical specialties, the discipline of clinical medicine, and providing healthcare to the public.

Target AudienceIn the context of WTSA’s role as a regional surgical membership association, the target audiences of the WTSA’s CME program are its current members, as well as a potential member base including physicians and other healthcare profes-sionals involved in the diagnosis and treatment of cardiothoracic disease. These include, among others, general thoracic surgeons, cardiothoracic surgeons, interventional radiologists, cardiologists, and cardiothoracic anesthesiologists, as well as allied healthcare professionals who may benefi t from team learning activities. The WTSA reaches throughout the western United States and the western provinces of Canada in its attempt to make the most current informa-tion available to as wide a medical/physician/surgical audience as possible.


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Types of Activities ProvidedThrough its sole CME activity, the annual meeting, the WTSA provides topic based abstract sessions, a breakfast session, a postgraduate course, a contro-versies in cardiothoracic surgery panel discussion, and a point/counterpoint debate session all of which foster audience participation through a designated question and answer period subsequent to the presentation. In addition, highly specialized techniques, protocols, and fi ndings are offered in each of the three subspecialties of adult cardiac surgery, general thoracic surgery, and congenital heart disease through individual breakfast sessions, moderated poster sessions, and/or concurrent brief communications symposia offered during the course of the annual meeting.

Expected ResultsThe success of the CME mission is measured by the extent to which participants in the WTSA annual meeting have gained an enhanced understanding of the latest techniques and current research specifi cally related to adult cardiac surgery, general thoracic surgery, and congenital heart disease, and have incorporated these lessons learned into their practice environment. Furthermore, through these changes and individual practice environments, it is expected that positive changes in physician/surgeons competence and performance in limited instances will be accomplished. The overarching expected result of the WTSA’s CME mission is improved patient care and enhanced patient quality of life through advanced medical education of the association’s membership and active participants in its CME program, the annual meeting.

OBJECTIVE

The Annual Meeting of the Western Thoracic Surgical Association is designed to provide two-and-a-half days of comprehensive educational experience for WTSA members and guest physicians in the fi eld of thoracic and cardiovascular surgery. It is the Association’s intent to bring together the leading surgeon scientists in these specialties to freely and openly discuss their latest clinical and research efforts.

The program begins with a half-day scientifi c plenary session of original papers and the Presidential Address by John D. Mitchell, and concludes with a Contro-versies Debate that asks Concurrent Surgery: Effi cient or Unethical?

The Friday scientifi c program features: a breakfast session on Public Reporting of Surgeon-Specifi c Data; plenary sessions of original papers; and a Postgraduate Course that examines War Surgery in Iraq and Afghanistan.


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The Saturday scientifi c program begins with concurrent moderated forums of shorter-form oral presentations addressing a far ranging fi eld of topics in each of the three subspecialties. The plenary science continues with: additional original papers; and the highly successful C. Walton Lillehei Point/Counter-Point Session, with this year’s debate asking Surgeons on the Heart Team: Quarter-backs or Water Boys?

At the conclusion of the Annual Meeting, participants should have an enhanced understanding of the latest techniques and current research specifi cally related to the fi elds of adult cardiac, general thoracic, and congenital heart disease clinical surgery, experimental surgery and related sciences, surgical education, and the socioeconomic aspects of surgical care. Through the open discus-sion periods for each of the fi ve plenary Scientifi c Sessions, the Controversies Debate, the Breakfast Session, the Postgraduate Course, the Concurrent Forums on Adult Cardiac, General Thoracic and Congenital Heart Disease, and the Point/Counterpoint session, participants will have the opportunity to hear the pros and cons of each paper and/or debate presented to gain an overall perspective of their current practices and utilize results presented to select appropriate surgical procedures and interventions for their own patients and integrate state-of-the-art knowledge into their current practice and/or research.

LEARNING OBJECTIVESAt the conclusion of this activity, participants will be able to:

• Discuss current investigations and novel approaches in the management of adult cardiac, general thoracic and congenital heart disease patients suffer-ing from an array of surgical conditions relating to the heart, lungs, organs of the thorax, and other airway/circulation diseases;

• Discuss current basic science investigations relating to advances in the treat-ment and management of cardiothoracic and/or congenital heart disease patients and conditions; and

• Discuss current investigative studies in clinical outcomes for patients with surgical cardiothoracic and/or congenital heart disease disorders or pathologies.


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DISCLOSURE STATEMENT

It is the policy of the Western Thoracic Surgical Association (WTSA) that any individual who is in a position to control or infl uence the content of an educa-tional activity to disclose all relevant fi nancial relationships or affi liations. All identifi ed confl icts of interest must be resolved and the educational content thoroughly vetted by the WTSA for fair balance, scientifi c objectivity, and appropriateness of patient care recommendations. In addition, faculty members are asked to disclose when any discussion of unapproved use of pharmaceutical or medical device occurs.

For further information on the Accreditation Council for Continuing Medical Education (ACCME) Standards of Commercial Support, please visit www.accme.org.

COMMERCIAL SUPPORT (Received as of June 1, 2016)This activity is being supported in part by an educational grants from Medtronic, Inc., and St. Jude Medical.


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GENERAL INFORMATION

REGISTRATIONThe Registration Desk will be open in the Grand Promenade during the fol-lowing hours:

Wednesday, June 22 1:00 pmWednesday, June 22 1:00 pm – – 6:00 pm6:00 pm

Thursday, June 23 7:00 amThursday, June 23 7:00 am – – 12:30 pm12:30 pm

Friday, June 24 6:00 amFriday, June 24 6:00 am – – 12:00 pm12:00 pm

Saturday, June 25 6:30 amSaturday, June 25 6:30 am – – 12:00 pm12:00 pm

SPEAKER READY ROOMThe Speaker Ready Room will be located in Waikoloa 1. Presenting authors are requested to turn in their PowerPoint slides to the technician in the Speaker Ready Room at least 30 minutes prior to the opening of the session at which they are to present (presentation slides can be turned in as early as Wednesday, June 22nd). All presentations must be submitted in PowerPoint format only.

EXHIBITSCommercial Exhibits are located in Queen’s Ballroom and open during the following hours:

Thursday, June 23 7:00 am – 12:00 pm

Friday, June 24 7:00 am – 12:00 pm

Saturday, June 25 6:30 am – 10:30 am

Breakfast is available for all registered professional attendees in the Exhibit Hall during the following hours:

Thursday, June 23 7:00 am – 8:00 am

Friday, June 24 7:00 am – 8:00 am

Saturday, June 25 6:30 am – 7:30 am

Coffee and other beverages will be available during scheduled breaks.


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BADGE IDENTIFICATION

Member and Spouse Cream

Guest Physician and Spouse Blue

Allied Personnel Green

Exhibitor Orange

INCLUDED IN THE REGISTRATION FEEIncluded in the registration fee are the New Members/Welcome Reception on Wednesday evening, the Thursday morning Samson Fun Run, the Legends of Hawaii Luau—Our Big Island Story Theme Dinner on Thursday evening, the Saturday Family Luncheon, the President’s Reception and Banquet on Saturday evening, and daily breakfasts (served in the Exhibit Hall for registered profes-sional attendees and in the Hospitality Suite for registered spouses, registered guests, and registered children). Supervised Kids & Teens Receptions, for ages 5–18, will provide dynamic, entertaining, and safe programs during Wednesday’s New Members/Welcome Reception and Saturday’s President’s Banquet. Please remember that individual tickets for events are not offered; full registration is required.

For descriptions of the events included with your registration fee, as well as of the separate-subscription Thursday optional tour/activity and Friday golf and tennis tournaments, please consult the Social Program. In that brochure you will also fi nd information on child care services.


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ACKNOWLEDGMENTSThe Western Thoracic Surgical Association wishes to thank the following companies, organizations, and individuals for their educational and marketing support of the 42nd Annual Meeting and related activities:

EDUCATIONAL GRANTS (Confi rmed through June 1, 2016)

Medtronic, Inc., for their support as a Silver Level Sponsor of the Annual Meeting

St. Jude Medical for their support of the Lillehei Point/Counterpoint

White Memorial Medical Center and Foundation, Lyman A. Brewer, III, Fund for their support of the Postgraduate Course

Thomas J. Fogarty, MD, for his support of the Postgraduate Course

Medtronic, Inc., for their support of the Donald B. Doty Education Award

MARKETING SUPPORT (Confi rmed through June 1, 2016)

Medtronic, Inc.

EXHIBIT SUPPORT (Confi rmed through May 28, 2015)

Abbott VascularAtriCure, Inc.Cardiac AssistCryoLife, Inc.Davol Inc., Subsidiary of C.R. Bard, Inc.Edwards LifesciencesGetinge GroupGore & AssociatesHeartware, Inc. Intuitive SurgicalKLS Martin, LPLivaNovaLSI Solutions

Mallinkrodt PharmaceuticalsMedtronic, Inc.MyriadrEVO BiologicsRTI Surgical, Inc.Scanlan International, Inc.St. Jude MedicalTerumo Cardiovascular SystemsThoracic Surgery FoundationVeran Medical TechnologiesVitalcor, Inc.Wexler Surgical


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GUIDELINES FOR SPEAKERS AND DISCUSSANTS

The Program Committee has determined that no slides are to be included in either the invited discussion or spontaneous discussion.

1. Scientifi c Session speakers will be allowed ten minutes for their presenta-tions, and primary discussants will be allowed two minutes. Concurrent Forum speakers will be allowed fi ve minutes for their presentations.

2. Speakers are requested to present their PowerPoint Presentations in the Speaker Ready Room located in Waikoloa 1, at least 30 minutes prior to the opening of the session at which they are to present (presentation slides can be turned in as early as Wednesday, June 22nd). All presentations must be submitted in PowerPoint format only. Speakers with a disclosure will be asked to state the nature of their disclosure prior to the presentation. No personal laptops will be allowed at the podium.

3. Discussion of Papers: Only members of the Association and invited guests have the privilege of discussing papers. Non members may discuss a paper at the invitation of a member. All discussions will be presented from fl oor microphones.

4. In publication, it is customary to group discussions together on a series of papers. Transcription of the discussions will be forwarded to discussants for review and correction. Any delay in the return of corrected discussions means that publication of all papers on the subject will be held up. Such a delay is manifestly unfair to those who are conscientious in the prompt submission of their remarks. Unreasonable delay will preclude publication.


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PROGRAM OUTLINE

WEDNESDAY, JUNE 22, 2016

1:00 pm – 6:00 pm REGISTRATION, Grand Promenade

1:00 pm – 6:00 pm SPEAKER READY ROOM, Waikoloa 1

7:00 pm – 9:00 pm NEW MEMBERS/WELCOME RECEPTION, Kona Pool (Rain Backup – Waters Edge Ballroom)

THURSDAY, JUNE 23, 2016

6:00 am SAMSON FUN RUN, Lower Lobby Entrance

7:00 am – 8:00 am BREAKFAST, Queen’s Ballroom

7:00 am – 12:00 pm EXHIBITS, Queen’s Ballroom

7:00 am – 12:30 pm REGISTRATION, Grand Promenade

7:00 am – 12:30 pm SPEAKER READY ROOM, Waikoloa 1

8:00 am – 9:00 am S C I E N T I F I C S E S S I O N I

Monarchy(10 minutes presentation, 10 minutes discussion)

Moderators: James I. FannJohn D. Mitchell

+1. Minimally Invasive Esophagectomy Provides Equivalent Survival to Open Esophagectomy: An Analysis of the National Cancer DatabaseBrian Mitzman1, Waseem Lutfi 2, Chi-Hsiung Wang2, Seth Krantz2, John A. Howington2, Ki-Wan Kim2

1University of Chicago, Chicago, IL; 2NorthShore University Health System, Evanston, IL

DISCUSSANT: ROSS M. BREMNER

+ Samson Resident Prize Essay


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2. Re-Engineering of Medicare Valve Patient’s Post-Discharge Thirty Day Clinical Management: Successful Strategies for Adapting to Bundled Payment ModelsMichael S. Koeckert, Patricia A. Ursomanno, Mathew R. Williams, Ramsey N. Abdallah, Michael Querijero, Elias A. Zias, Didier F. L oulmet, Kevin Kirchen, Eugene A. Grossi, Aubrey C. GallowayNYU School of Medicine, New York, NY

DISCUSSANT: ROBBIN G. COHEN

3. Pediatric Centers Passing on Cardiac Grafts Successfully Used by Adult Centers and Its ConsequencesFarhan Zafar, Raheel Rizwan, Angela Lorts, Chet Villa, Roosevelt Bryant, III, James S. Tweddell, Clifford Chin, David L. MoralesCincinnati Children’s Hospital, Cincinnati, OH

DISCUSSANT: DAVID M. MCMULLAN

9:00 am – 9:10 am NEW MEMBER & SAMSON PRIZE FINALIST INTRODUCTIONS, Monarchy

9:10 am – 9:55 am P R E S I D E N T I A L A D D R E S S

Monarchy

Introduction: James I. Fann

“Tuberculosis, History and the Arts” John D. Mitchell

9:55 am – 10:20 am COFFEE BREAK: VISIT EXHIBITS & POSTERS, Queen’s Ballroom

10:20 am – 10:25 am DAVID J. DUGAN DISTINGUISHED SERVICE AWARD PRESENTATION, Monarchy

Conferment: Robbin G. Cohen

Recipient: D. Craig Miller


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10:25 am – 11:45 am S C I E N T I F I C S E S S I O N I I


Moderators: Nahush A. MokadamMichael J. Weyant

+4. Implementation of Transcatheter Aortic Valve Replacement in California: Impact on Aortic Valve SurgerySteven Maximus1, *Jeffrey C. Milliken1, *Richard J. Shemin2, *Junaid Khan3, *Joseph S. Carey1

1UC Irvine, Orange, CA; 2UCLA School of Medicine, Los Angeles, CA; 3Alta Bates Summit Medical Center, Oakland, CA

DISCUSSANT: Y. JOSEPH WOO

+5. Induction Chemotherapy for T3N0M0 Non-Small Cell Lung Cancer Confers Superior Rates of Complete ResectionMichael S. Mulvihill, Babatunde A. Yerokun, Kevin L. Anderson, Jr., Paul J. Speicher, Betty C. Tong, David H. Harpole, Thomas A. D’Amico, Matthew G. HartwigDuke University, Durham, NC

DISCUSSANT: SUSAN MOFFATT-BRUCE

+6. Improved Intracoronary Stem Cell Delivery to the Right Ventricle: A Preclinical StudyBrody Wehman, Osama Siddiqui, Godly Jack, Tieluo Li, Mark Vesely, Rachana Mishra, Sudhish Sharma, Grace Bigham, Bradley Taylor, Bartley Griffi th, Sunjay KaushalUniversity of Maryland School of Medicine, Baltimore, MD

DISCUSSANT: PATRICIA A. THISTLETHWAITE

+ Samson Resident Prize Essay* WTSA Member


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+7. Induction Therapy Is a Safe and Effective Immunosuppressive Strategy for Bridging Patients with Left Ventricular Assist Devices to TransplantationAaron H. Healy, *Stephen H. McKellar, Ragheed Al-Dulaimi, Angela P. Presson, Stavros G. Drakos, Josef Stehlik, *Craig H. SelzmanUniversity of Utah, Salt Lake City, UT

DISCUSSANT: HARI MALLIDI

11:45 am – 12:30 pm CONTROVERSIES DEBATE, Monarchy

Concurrent Surgery: Effi cient or Unethical?

Moderator: Richard I. Whyte

Speakers:

Effi cient: Robert J. Cerfolio

Unethical: Sean C. Grondin

12:30 pm ADJOURN

1:30 pm OCEAN BEACH BLAST**, Depart from Lower Lobby Entrance

6:00 pm – 10:00 pm Legends of Hawaii Luau—Our Big Island Story THEME DINNER, Kamehameha Court

+ Samson Resident Prize Essay* WTSA Member** Separate Subscription Required


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FRIDAY, JUNE 24, 2016



6:30 am – 7:50 am BREAKFAST SESSION **, Kings 1

Public Reporting of Surgeon-Specifi c Data: Friend or Foe?

Moderator: Susan Moffatt-Bruce

Speakers:

Adult Cardiac: Joe C. Cleveland, Jr.

General Thoracic: Felix G. Fernandez

Congenital Heart: John E. Mayer



8:00 am – 8:50 am P O S T G R A D U AT E C O U R S E

MonarchySupported by: White Memorial Medical Center and Foundation’s Lyman A. Brewer, III, Fund, and Thomas J. Fogarty

War Surgery in Iraq and AfghanistanCameron D. WrightAssociate Chief of the Division of Thoracic Surgery & Associate Program DirectorMassachusetts General Hospital, Boston, MA

** Separate Subscription Required


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8:50 am – 10:30 am S C I E N T I F I C S E S S I O N I I I


Moderators: Sean C. GrondinCraig H. Selzman

+8. Is Re-Staging Positron Emission Tomography Required After Neoadjuvant Treatment for Esophageal Cancer?Camille L. Stewart, Kweku Hazel, Megan Boniface, Martin McCarter, Csaba Gajdos, Barish H. Edil, Robert A. Meguid, *John D. Mitchell, *Michael J. WeyantUniversity of Colorado School of Medicine, Aurora, CO

DISCUSSANT: DONALD E. LOW

+9. Pulmonary Function Tests Do Not Predict Mortality in Patients Undergoing Continuous Flow LVAD ImplantationEdo K.S. Bedzra, Todd F. Dardas, *Jay D. Pal, Claudius Mahr, *Jason W. Smith, Kent R. Shively, Richard K. Cheng, S. Carolina Masri, Wayne C. Levy, *Nahush A. MokadamUniversity of Washington, Seattle, WA

DISCUSSANT: SAGAR DAMLE

+10. Comparison of Right Ventricle-Pulmonary Artery Shunt Position in the Norwood Procedure: An Analysis of the Pediatric Heart Network Public DatabaseNicholas D. Andersen, James M. Meza, Matthew R. Byler, Kevin D. Hill, Christoph P. Hornik, Robert D.B. JaquissDuke University Medical Center, Durham, NC

DISCUSSANT: TARA B. KARAMLOU



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11. Concordance with Commission on Cancer Quality Measures in Lung Cancer Care: An Opportunity for ImprovementDavid D. Odell, Joseph Feinglass, Shari L. Meyerson, Ankit Bharat, Malcolm M. DeCamp, Karl Y. BilimoriaNorthwestern University, Chicago, IL

DISCUSSANT: LEAH M. BACKHUS

+12. Outcomes After Surgical Pulmonary Embolectomy for Acute Submassive and Massive Pulmonary Embolism: A Single Center ExperienceChetan Pasrija, Anthony Kronfl i, Sheelagh Pousatis, Michael Rouse, Mehrdad Ghoreishi, Shahab Toursavadkohi, Bartley P. Griffi th, Pablo G. Sanchez, Zachary N. KonUniversity of Maryland, Baltimore, MD

DISCUSSANT: MICHAEL S. MULLIGAN




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11:00 am – 12:00 pm S C I E N T I F I C S E S S I O N I V


Moderators: Jessica S. DoningtonT. Brett Reece

13. Analysis of Procedural Complications and Early Morbidity After Self-Expanding Transcatheter or Surgical Aortic Valve Replacement: Results from the Corevalve U.S. High-risk Clinical TrialJohn V. Conte1, Jon R. Resar1, G. Michael Deeb2, Thomas G. Gleason3, David H. Adams4, Jeffrey J. Popma5, Steven J. Yakubov6, Michael J. Reardon7

1Johns Hopkins University, Baltimore, MD; 2University of MIchigan, Ann Arbor, MI; 3University of Pittsburgh Medical Center, Pittsburgh, PA; 4Mount Sinai Medical Center, New York, NY; 5Beth Israel Deaconess Medical Center, Boston, MA; 6Riverside Methodist Hospital, Columbus, OH; 7Houston-Methodist DeBakey Heart and Vascular Center, Houston, TX

DISCUSSANT: JOSEPH E. BAVARIA

14. Flipping the Classroom: Case-Based Learning, Accountability, Assessment, and Feedback Leads to a Favorable Change in Culture*Nahush A. Mokadam, Joshua L. Hermsen, *Jay D. Pal, *Michael S. Mulligan, Lisa Myria Jacobs, *Douglas E. Wood, Todd F. Dardas, *Edward D. VerrierUniversity of Washington, Seattle, WA

DISCUSSANT: CRAIG J. BAKER

* WTSA Member


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+15. Regionalized Surgical Care: An Important Lack of Association Between Distance from Surgical Center and Post-Operative Outcomes in Children Undergoing Fontan PalliationBillie-Jean Martin, Mohammed Al Aklabi, Joyce Harder, John Dyck, *Ivan M. Rebeyka, David B. RossUniversity of Alberta, Edmonton, AB, Canada

DISCUSSANT: RAM KUMAR SUBRAMANYAN

12:00 pm ADJOURN

1:20 pm GOLF TOURNAMENT**, Depart from Lower Lobby Entrance via shuttle to Golf Club

2:00 pm TENNIS TOURNAMENT**, Tennis Club

FREE EVENING

SATURDAY, JUNE 25, 2016

6:00 am – 11:30 am SPEAKER READY ROOM, Waikoloa 1



6:30 am – 10:30 am EXHIBITS, Queen’s Ballroom

+ Samson Resident Prize Essay* WTSA Member** Separate Subscription Required


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7:00 am – 8:45 am CONCURRENT FORUMS(5 minutes presentation, 3 minutes discussion)

ADULT CARDIAC

Monarchy

Moderator: Ali Khoynezhad

CF1. Valve Replacement Surgery in Severe Chronic Kidney DiseaseJoon Bum Kim, Sung-Ho Jung, Suk Jung Choo, Cheol Hyun Chung, Jae Won LeeAsan Medical Center, Seoul, Korea, Republic of

CF2. Predicting Readmission Risk at the Time of Admission in CABG PatientsJose Benuzillo, *William Caine, R. Scott Evans, Colleen Roberts, James F. Lloyd, Donald Lappe, *John DotyIntermountain Healthcare, Salt Lake City, UT

CF3. Increased Systolic Load Decreases Elastin Content and Increases Diameter of the Developing AortaSarah Walcott-Sapp1, Herbert M. Espinoza1, Isa Lindgren1, Kevin Kolahi1, Samantha Louey1, Sonnet S. Jonker1, George D. Giraud2, Kent L. Thornburg1, *Frederick Tibayan1

1Oregon Health & Science University, Portland, OR; 2Portland VA Health Care System, Portland, OR

CF4. Natural History of Medically Treated Ascending Aortic Aneurysms in the Era of Thoracic Aortic Clinics: Impact of Bicuspid Aortic Valve and Clinical ImplicationsFrancois Dagenais, Siamak Mohammadi, Pierre Voisine, Eric DumontLaval Hospital, Sainte-Foy, QC, Canada

* WTSA Member


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CF5. Regulation of Membrane Type-1 Matrix Metalloproteinase Activity and Intracellular Localization in Clinical Thoracic Aortic Aneurysms*John S. Ikonomidis, Elizabeth K. Nadeau, Adam W. Ackerman, Robert E. Stroud, Rupak Mukherjee, Jeffrey A. JonesMedical University of South Carolina, Charleston, SC

CF6. Myocardial Bridging Is Associated with Worsened Survival in Heart Transplant PatientsZachary E. Brewer, Calvin Strehl, Kiran K. Khush, Ingela SchnittgerStanford University Medical Center, Stanford, CA

CF7. Discordant Surgeon Views in the Management of Descending Thoracic Aortic Aneurysm: Justifi cation for Multidisciplinary Aortic TeamsPeter Chiu1, Anna M. Sailer2, Michael T. Baiocchi3, Andrew B. Goldstone1, Justin M. Schaffer1, Jeff Trojan1, Dominik Fleischmann2, *R. Scott Mitchell1, *D. Craig Miller1, Michael D. Dake1, *Y. Joseph Woo1, Jason T. Lee4, *Michael P. Fischbein1

1Department of Cardiothoracic Surgery, Stanford University, School of Medicine, Stanford, CA; 2Department of Radiology, School of Medicine, Stanford, CA; 3Stanford Prevention Center, School of Medicine, Stanford, CA; 4Division of Vascular Surgery, Stanford University, School of Medicine, Stanford, CA

CF8. Should Patients with Atrial Fibrillation Referred for Coronary Artery Bypass Grafting Undergo Concomitant Surgical Ablation?Matthew R. Schill, Spencer J. Melby, Hersh S. Maniar, Laurie A. Sinn, Richard B. Schuessler, Jennifer S. Lawton, Marc R. Moon, Ralph J. Damiano, Jr.Washington University in St. Louis, Saint Louis, MO

* WTSA Member


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CF9. Simvastatin Reduces the TLR4-Induced Infl ammatory Response in Human Aortic Valve Interstitial CellsNeil Venardos, Xin-Sheng Deng, *Michael J. Weyant, *Thomas B. Reece, Xianzhong Meng, *David A. FullertonUniversity of Colorado, Aurora, CO

CF10. Print, Practice, Perform: Combining 3D Printing and Surgical Simulation in Hypertrophic CardiomyopathyJoshua Hermsen1, Thomas Burke1, Stephen Seslar2, *Nahush Mokadam1, *Edward Verrier1

1University of Washington, Seattle, WA; 2Seattle CHildren’s Hospital, Seattle, WA

CF11. Thirty Year Experience with Bileafl et Mechanical Valve ProsthesisScott Johnson, Martha Stroud, John Kratz, Scott Bradley, Fred Crawford, *John IkonomidisMedical University of South Carolina, Charleston, SC

CF12. Elderly Patients Bridged from a Left Ventricular Assist Device to Heart Transplant Do Not Have an Increase in Adverse Events: A Multi-institutional AnalysisAnn C. Gaffey, Carol W. Chen, Mallory Irons, Jennifer J. Chung, Chantel M. Venkataraman, Jennifer Lee, Joyce Wald, Michael A. Acker, Pavan AtluriHospital of the University of Pennsylvania, Philadelphia, PA

CF13. A New Intraoperative Protocol for Reducing Perioperative Transfusions in Cardiac SurgerySarah A. Schubert, J. Hunter Mehaffey, Michael G. Gelvin, Eric J. Charles, Robert B. Hawkins, Lily Johnston, Gorav Ailawadi, Irving L. Kron, Leora T. YarboroUniversity of Virginia, Charlottesville, VA

* WTSA Member


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GENERAL THORACIC

Kings 1

Moderators: Matthew G. BlumDouglas E. Wood

CF14. Molecular Analysis of Thymic Epithelial Tumors Identifi es Novel Subtypes Associated with Distinct Clinical OutcomesHyun-Sung Lee, Rohan Shah, David Yoon, Ori Wald, Shawn S. Groth, David J. Sugarbaker, Bryan M. BurtBaylor College of Medicine, Houston, TX

CF15. The Expression of Programmed Death 1 Ligand (PD-L1) in the Tumor and Tumor Infi ltrating Macrophages Predicts Overall and Disease Free Survival in Surgically Resected Pathologic Stage I Non-Small Cell Lung CancerBoris Sepesi, Edwin Parra Cuentas, Jaime Rodriguez Canales, Carmen Behrens, Arlene Correa, Mara Antonoff, Don Gibbons, John Heymach, *Wayne Hofstetter, Reza Mehran, David Rice, Jack Roth, Ara Vaporciyan, Garrett Walsh, Annikka Weissferdt, Neda Kalhor, Cesar Moran, Stephen Swisher, Ignacio WistubaAnderson Cancer Center, Houston, TX

CF16. Innovative Pressure-Directed Ventilation Strategy During Ex Vivo Lung Perfusion Attenuates InjuryJ. Hunter Mehaffey, Eric J. Charles, Ashish K. Sharma, Dustin Money, Christine L. Lau, Curtis G. Tribble, Victor E. Laubach, Mark E. Roeser, Irving L. KronUVA, Charlottesville, VA

* WTSA Member


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CF17. Outcomes After Surgical Resection of Stage IV Non-Small Cell Lung CancerBabatunde Yerokun1, Chi-Fu Jeffrey Yang1, Shivani Shah2, Lin Gu3, Xiaofei Wang3, Thomas D’Amico1, Matthew Hartwig1, *Mark Berry4

1Duke University Medical Center, Durham, NC; 2Duke University, Durham, NC; 3Duke University, Department of Biostatistics, Durham, NC; 4Stanford University Medical Center, Stanford, CA

CF18. Robotically-Assisted Thoraco-Laparoscopic Esophagectomy Has a Higher 30-Day Readmission Rate Compared to Minimally Invasive Esophagectomy and Open EsophagectomyMichelle C. Nguyen, *Robert E. Merritt, Carl R. Schmidt, *Susan D. Moffatt-BruceThe Ohio State University Wexner Medical Center, Columbus, OH

CF19. Perspectives on Managing Incidental Pulmonary Nodules: A Survey of Primary Care PhysiciansGeena X. Wu, Martin Consunji, Kenny Yeung, Rebecca A. Nelson, Linus Kuo, Heeyong Kim, Can-Lan Sun, Jae Y. Kim, *Dan J. RazCity of Hope National Medical Center, Duarte, CA

CF20. Comparison of Uniportal and Multi-Incision VATS Lung Resection at a North American InstitutionWilliam J. Gibson, Scott G. Louis, Duke Pfi tzinger, Nirmal VeeramachaneniUniversity of Kansas, Kansas City, KS

* WTSA Member


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CF21. Failing to Plan or Planning to Fail: Lack of Adherence to Guideline Recommendations for Imaging Surveillance Among Early Stage Lung Cancer Patients in a Universal Access Healthcare SystemMathieu C. Rousseau1, Bharathi Lingala1, Laura Ferrara2, Jason Caucutt2, *Mark F. Berry1, *Joseph B. Shrager1, *Leah M. Backhus1

1Stanford University, Stanford, CA; 2University of Washington, Seattle, WA

CF22. Large Hiatal Hernia; Safe and Effective Repair by Laparoscopic Approach without the Need for Esophageal Lengthening and with Rare Symptomatic Recurrence*Farzaneh Banki1, Chandni Kaushik2, David Roife2, Munish Chawla3, Charles C. Miller2

1University of Texas Health Science Center at Houston, Memorial Hermann Southeast Esophageal Disease Center, Houston, TX; 2University of Texas Health Science Center at Houston, Houston, TX; 3Memorial Hermann Southeast Esophageal Disease Center, Houston, TX

CF23. En-Bloc Esophagectomy Is Curative Therapy for Most Patients with T1b Tumors Even with Lymph Node MetastasesKatrin Schwameis, Stephanie Worrell, Kyle M. Green, Jamil Samaan, Shannon Cooper, *Daniel Oh, *Jeffrey A. Hagen, *Steven R. DeMeesterKeck Hospital, USC, Los Angeles, CA

CF24. Surgical Management of Acquired Restrictive Thoracic DystrophyDaniel L. MillerWellStar Health System, Marietta, GA

* WTSA Member


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CF25. Conduit Revision Post-Esophagectomy – Strategic Management for a Rare ComplicationJessica Y. Rove, Alexander S. Krupnick, Frank A. Baciewicz, Bryan F. MeyersWashington University, St. Louis, MO

CF26. VATS Diaphragm Plication Using a Running Suture Is a Safe Technique with Durable EffectivenessDavid S. Demos, *Mark F. Berry, *Leah M. Backhus, *Joseph B. ShragerStanford University Hospital, Stanford, CA

CONGENITAL HEART DISEASE

Kings 2

Moderator: Irving Shen

CF27. Preclinical Study of Patient-Specifi c Nanofi ber Tissue Engineered Vascular Grafts Using Three-Dimensional Printing in a Sheep ModelTakuma Fukunishi1, Tadahisa Sugiura1, Cameron A. Best1, Justin Opfermann2, Toshiharu Shinoka1, Christopher K. Breuer1, Axel Krieger2, Jed Johnson3, Narutoshi Hibino4

1Nationwide Children’s Hospital, Columbus, OH; 2Children’s National Medical Center, Washington, DC; 3Nanofi ber Solutions Inc, Columbus, OH; 4Johns Hopkins University, Baltimore, MD

* WTSA Member


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CF28. Use of a Valved Segment of Femoral Vein Homograft for the Sano Shunt Results in Improved Pulmonary Artery Growth After the Norwood OperationMario Briceno-Medina1, Shyam Sathanandam1, T.K. Susheel Kumar1, Michael Perez1, David Zurakowski2, Umar Boston1, Michel Ilbawi3, Christopher Knott-Craig1

1University of Tennessee Le Bonheur Childrens Hospital, Memphis, TN; 2Harvard Medical School, Boston, MA; 3Advocate Christ Medical Center, Chicago, IL

CF29. Pulmonary Atresia with Ventricular Septal Defect and Major Aortopulmonary Collaterals: Comparison of Single-Stage Versus Multi-Stage Unifocalization StrategiesSophie C. Hofferberth, Yee Jim Loh, Christopher W. Baird, John E. Mayer, Pedro J. del Nido, Sitaram M. EmaniBoston Children’s Hospital, Harvard Medical School, Boston, MA

CF30. Prior Diaphragm Plication Does not Adversely Impact Hospital Course During Subsequent Stages of Palliation for Single Ventricle PhysiologyJassimran Bainiwal1, John D. Cleveland1, *Winfi eld J. Wells1, Nancy A. Pike2, *Vaughn A. Starnes1, *S. Ram Kumar1

1University of Southern California, Los Angeles, CA; 2Children’s Hospital, Los Angeles, Los Angeles, CA

CF31. To Cath or Not to Cath? Alternative Options in Preoperative Evaluation for Promotion to Second Stage PalliationLauren C. Kane, Luis De León, Pamela Deaver, Christine Nelson, Rajesh Krishnamurthy, Dhaval Parekh, Jeffery Heinle, Dean McKenzie, Carlos Mery, Charles Fraser, Jr.Baylor College of Medicine, Houston, TX

* WTSA Member


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CF32. Early Cardiac Catheterization Shortens Duration of Pediatric Extracorporeal Life SupportChristopher Burke, Titus Chan, Augustin Rubio, Fawwaz Shaw, *Jonathan M. Chen, *D. Michael McMullanSeattle Children’s Hospital, Seattle, WA

CF33. Relationship Between Outcomes and Approach in Repair of Coarctation of the Aorta and Arch Hypoplasia: A Value Improvement InitiativeConnor P. Callahan1, David Saudek2, Amanda J. Shillingford3, Sara Creighton2, Ray Hoffmann1, Mahua Dasgupta1, Michael E. Mitchell1, *Ronald K. Woods1

1Medical College of Wisconsin, Milwaukee, WI; 2Children’s Hospital of Wisconsin, Milwaukee, WI; 3Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE

CF34. Simultaneous Systemic to Pulmonary Shunt and Pulmonary Artery Banding Is a Viable Option for Neonatal Palliation of Single Ventricle PhysiologyLuke M. Wiggins, *Winfi eld J. Wells, *Vaughn A. Starnes, *S. Ram KumarUniversity of Southern California, Los Angeles, CA

CF35. Constant Treatment Dilemma in HOCM: Long-Term Outcomes Post TherapyFeras Khaliel1, Lucman Anwer2, Mohammad Alshammari1, Anas Abudan1, Adam Obad1, Jehad Alburaiki2, *Zohair Alhalees2

1London Health Science Center, Western University, London, ON, Canada; 2King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia

* WTSA Member


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CF36. Arteriovenous Fistulas Are an Effective Method to Increase Pulmonary Blood Flow and Curb Pulmonary Arteriovenous Malformation Development in Single Ventricle Patients Palliated with Superior Cavopulmonary AnastomosisSanjeet Patel, Amit Iyengar, Oh Jin Kwon, *Brian Reemtsen, *Hillel Laks, *Reshma BiniwaleUCLA, Los Angeles, CA

CF37. Long-Term Outcomes Following One-Stage Repair of Aortic Arch Obstruction Associated with Ventricular Septal DefectMehrdad Rahatianpur, *Farhad Bakhtiary, *Martin KostelkaHeart Center Leipzig, Leipzig, Germany

CF38. Extracorporeal Cardiopulmonary Resuscitation Simulation Improves Effi ciency of ECPR ActivationChristopher Burke, Titus Chan, Joan Roberts, Taylor Sawyer, *D. Michael McMullanSeattle Children’s Hospital, Seattle, WA

CF39. Differences in Clinical Outcomes and Cost Between Complex and Simple Arterial SwitchesEric R. Griffi ths, Nelangi M. Pinto, *Aaron W. Eckhauser, Angela P. Presson, Ragheed Al-Dulaimi, David K. Bailly, *Phillip T. BurchUniversity of Utah, Salt Lake City, UT

* WTSA Member


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8:50 am – 10:30 am S C I E N T I F I C S E S S I O N V


Moderators: David T. CookeFredereck A. Tibayan

16. Fate of Remnant Sinuses of Valsalva in Patients Undergoing Aortic Valve Replacement, Ascending Aorta and Aortic Arch ReplacementRita K. Milewski, Andreas Habertheuer, *Joseph E. Bavaria, Mary Siki, *Wilson Y. Szeto, *Nimesh D. Desai, *Prashanth VallabhosyulaUniversity of Pennsylvania, Philadelphia, PA

DISCUSSANT: JOHN S. IKONOMIDIS

+17. Is Tissue Still the Issue? Lobectomy for Suspicious Lung Nodules Without Confi rmation of MalignancySuha Kaaki, Lawrence Tan, Sadeesh Srinathan, Gordon BuduhanUniversity of Manitoba, Winnipeg, MB, Canada

DISCUSSANT: JOSEPH B. SHRAGER

+18. Percutaneous Device Closure of Atrial Septal Defects: The Price of FailureFawwaz R. Shaw, Sujatha Buddhe, Brian H. Morray, *Jonathan M. Chen, *David M. McMullanSeattle Children’s Hospital, Seattle, WA

DISCUSSANT: BAHAALDIN ALSOUFI



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19. Extracorporeal Membrane Oxygenation As a Bridge to Lung Transplantation: More Successful in the Present EraEmily M. Todd, *Samad A. Hashimi, *Rajat Walia, *Michael A. Smith, B.E. Steinbock, *Jasmine Huang, *Elbert Y. Kuo, *Ashraf Omar, *Vipul Patel, *Ross BremnerNorton Thoracic Institute, Phoenix, AZ

DISCUSSANT: JASLEEN KUKREJA

+20. The Costs of Our Traditional Yardsticks for Quality: Is Value Improving in Cardiac Surgery?Kenan W. Yount1, Jeffrey B. Rich2, Christine L. Lau1, Ravi K. Ghanta1, Leora T. Yarboro1, John A. Kern1, Clifford E. Fonner2, Alan M. Speir3, Gorav Ailawadi11University of Virginia Health System, Charlottesville, VA; 2Virginia Cardiac Surgery Quality Initiative, Charlottesville, VA; 3INOVA Heart and Vascular Institute, Falls Church, VA

DISCUSSANT: RICHARD J. SHEMIN

10:30 am – 11:10 am COFFE BREAK: VISIT EXHIBITS & POSTERS, Queen’s Ballroom

11:10 am – 12:00 pm C . W A LT O N L I L L E H E I P O I N T / C O U N T E R P O I N T S E S S I O N

Monarchy

Surgeons on the Heart Team: Quarterbacks or Water Boys?

Moderator: David A. Fullerton

Speakers:

Quarterbacks: Joseph E. Bavaria

Water Boys: T. Brett Reece



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12:00 pm – 12:30 pm ANNUAL BUSINESS MEETING (Members Only), Monarchy

12:30 pm – 2:00 pm FAMILY LUNCHEON, Lagoon Lanai

7:00 pm – 11:00 pm PRESIDENT’S RECEPTION AND BANQUET, Grand Promenade & Monarchy

Dress Code: The dress code for the Annual Meeting is Resort Casual. Aloha shirts are fi ne; jackets and ties are not required. The President’s Reception and Banquet, too, is Resort Casual (for men, Aloha shirts and long pants).


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WEDNESDAY, JUNE 22, 2016

1:00 pm – 6:00 pm REGISTRATION, Grand Promenade

1:00 pm – 6:00 pm SPEAKER READY ROOM, Waikoloa 1

7:00 pm – 9:00 pm NEW MEMBERS/WELCOME RECEPTION, Kona Pool (Rain Backup – Waters Edge Ballroom)

THURSDAY, JUNE 23, 2016

6:00 am SAMSON FUN RUN, Hotel Entrance





8:00 am – 9:00 am S C I E N T I F I C S E S S I O N I


Moderators: James I. FannJohn D. Mitchell

+1. Minimally Invasive Esophagectomy Provides Equivalent Survival to Open Esophagectomy: An Analysis of the National Cancer DatabaseBrian Mitzman1, Waseem Lutfi 2, Chi-Hsiung Wang2, Seth Krantz2, John A. Howington2, Ki-Wan Kim2

1University of Chicago, Chicago, IL; 2NorthShore University Health System, Evanston, IL

DISCUSSANT: ROSS M. BREMNER

BACKGROUND: The use of minimally invasive esophagectomy (MIE) is increasing, despite the fact that there is insuffi cient evidence to support its effi cacy. We sought to compare treatment trends, overall survival, and short term morbidity for MIE versus open esophagectomy (OE).



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METHODS: We queried the National Cancer Database (NCDB) for all patients having esophagectomy as the primary procedure for primary squamous cell cancer and adenocarcinoma for the years 2010 through 2012. A propensity score analysis was performed matching for 11 preoperative demographic and clinical variables. Post-operative pathology and quality metrics including margin status, length of stay, 30-day readmission, and 30-day and 90-day mortality as well as overall patient sur-vival outcomes were compared between OE and MIE.

RESULTS: The use of MIE increased from 25.4% in 2010 to 33.8% in 2012. Of 2,914 patients who were identifi ed, propensity score matching yielded 860 patients in each group. All non-metastatic clinical stages of esophageal cancer were well represented. Mean lymph nodes examined were higher in the MIE group (16.5 vs. 14.5, p < 0.001). Final pathologic nodal stage was not signifi cantly different in the matched sample. There was also no difference in pathologic upstaging between the groups. (14.4% vs 13.4%, p = 0.719). Positive margin status was not signifi cantly different (5.6%


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vs 6.5%, p = 0.418). All other postoperative variables were equivalent, including an average length of stay of approximately 14 days, unplanned readmission rate of 6.5%, and 30/90 mortality rates of 3% and 7% respectively (Table 1). There was no survival difference between the two groups with a median survival of 45.4 months for OE (95% confi dence interval [CI]: 38.6–51.9) and 46.6 (95% CI: 40.4–52.7) months for MIE (Figure 1, Kaplan-Meier analysis, p = 0.953).

CONCLUSIONS: During the 3-year period analyzed, there were no signifi cant differ-ences in postoperative outcomes and quality metrics between open esophagectomy and minimally invasive esophagectomy. Although acute outcomes are limited in the NCDB, MIE appears to have equivalent oncologic outcomes and survival when com-pared with the open approach.


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2. Re-Engineering of Medicare Valve Patient’s Post-Discharge Thirty Day Clinical Management: Successful Strategies for Adapting to Bundled Payment ModelsMichael S. Koeckert, Patricia A. Ursomanno, Mathew R. Williams, Ramsey N. Abdallah, Michael Querijero, Elias A. Zias, Didier F. Loulmet, Kevin Kirchen, Eugene A. Grossi, Aubrey C. GallowayNYU School of Medicine, New York, NY

DISCUSSANT: ROBBIN G. COHEN

BACKGROUND: Bundled Payments for Care Improvement (BPCI) initiatives were developed by Medicare (MC)/Medicaid Innovation Center to test payment and service delivery models with the potential to reduce expenditures while preserving or enhancing quality of care. Model 2 involves a bundled payment arrangement where actual expenditures are reconciled against a baseline target price for an episode of care, which includes the inpatient stay, post-acute care, readmissions, physician fees and all related services through 90 days after discharge. One of the challenges in caring for MC valve patients is the historically high (>35%) 90-day readmission rates present in this elderly, high risk population. Additionally, extended post discharge management and concomitant fi scal burden of complications are typically beyond the surgeon’s purview. We analyzed our institutional cardiac surgical service line (CSL) adaptation to this BPCI model.

METHODS: Participation in BPCI for MC valve surgery patients began in 1/13 with risk sharing phase starting in 10/13. Initial management strategy changes included a change in discharge disposition patterns away from inpatient rehabilitation (60% in FY12 to 12% in FY14) resulting in an average cost per benefi ciary savings of $7093. However, the 30/90-day readmission rates remained unchanged in 2013 (20%/31%) and 2014 (18%/39%) with a 30-day readmission in 2014 BPCI patient being associ-ated with a 50% cost increase. In response, CSL team developed a comprehensive discharge planning and management approach, which included pre-surgical risk stratifi cation assessments, standardized post-discharge management led by cardiac nurse practitioners (CNP), and post-discharge ED triage protocols. CNP’s maintain weekly contact, use telemedicine, and attempt to guide any post-discharge encoun-ters (PDE); whenever possible <48hr hospital observation was utilized instead of readmission. We analyzed the detailed PDE assessment for all valve patients, begin-ning in 5/15 with complete 30-day follow-up through 11/15.

RESULTS: During this period 344 valve patients were discharged; 217 surgical patients and 127 TAVR patients. The table includes demographic, length-of-stay (LOS) and discharge disposition data. Sixty-three patients had 77 hospital PDEs; additionally three planned encounters for staged procedures were excluded from our analysis. Of these 77 PDEs, 45 (58.4%) were guided by CNP. The 77 PDEs were due to fl uid overload (20, 26%), arrhythmia (17, 22%), falls/somatic complaints


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(14, 18%), and bleeding/thromboembolic events (9, 11.7%). Thirty-day readmission rate was 9.9% (34/344). TAVR patients had a higher rate of readmission that surgical patients, 15.0% vs 6.9% (p = 0.036). The median readmission length LOS was 2.0 days (IQR 1.0–5.0 days) and did not differ between TAVR and surgical patients. Com-pared to 2014, the 30-day readmission rate for BPCI decreased from 18% (44/248) to 11% (20/175), p = 0.049.

All Valve Patients(n = 344)

Surgical(n = 217)

TAVR(n = 127)

Age (years) 71.3 ± 14.2 64.9 ± 12.8 82.2 ± 8.6

Male 219 (63.7%) 137 (63.1%) 82 (64.6%)

STS Risk Score % 4.22 (0.20–28.00) 2.35 (0.20–28.00) 7.33 (0.90–21.40)

KCCQ-12 Score 46.5 ± 13.5 49.7 ± 13.0 41.5 ± 13.0

Katz Index 5.69 ± 0.87 5.89 ± 0.58 5.40 ± 1.12

Lives Alone 95 (27.6%) 55 (25.3%) 40 (31.5%)

BPCI Participant 175 (50.9%) 90 (41.5%) 85 (66.9%)

Index Admission LOS, days

Median (IQR) 5.0 (2.0–6.0) 6.0 (4.0–8.0) 2.0 (1.0–4.0)

Index Post-Operative LOS, days

Median (IQR) 4.0 (2.0–6.0) 5.0 (4.0-7.0) 2.0 (1.0–3.0)

DC Home with serviceDC to In-pt rehabDC to SNF

276 (80.2%)24 (7.0%)13 (3.8%)

165 (76.0%)21 (9.7%)9 (4.1%)

111 (87.4%)3 (2.4%)4 (3.1%)

Thirty-Day PDE (Rate) 77 (22.4%) 40 (18.4%) 37 (29.1%)

Readmissions (rate)Observation PDE Outpa-tient PDE

34 (9.9%)39 (11.3%)

4 (1.2%)

15 (6.9%)22 (10.1%)

3 (1.4%)

19 (15.0%)17 (13.4%)1 (0.8%)

CONCLUSIONS: Our approach of re-engineering post-discharge management of BPCI valve patients under tight CSL and CNP control has signifi cantly reduced costly 30-day readmissions in this high risk population. The full fi scal impact of this strat-egy on BPCI valve patients will be understood next year when the 90-day MC master claims data is reconciled.


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3. Pediatric Centers Passing on Cardiac Grafts Successfully Used by Adult Centers and Its ConsequencesFarhan Zafar, Raheel Rizwan, Angela Lorts, Chet Villa, Roosevelt Bryant, III, James S. Tweddell, Clifford Chin, David L. MoralesCincinnati Children’s Hospital, Cincinnati, OH

DISCUSSANT: DAVID M. MCMULLAN

OBJECTIVE: As stated by OPTN policy, donors less than 18 years old are offered to pediatric recipients in status 1A before being offered to adults in the same status. We aim to analyze differences in utilization of adolescent hearts and outcomes of pediat-ric candidates who refused it and of those adults who accepted it.

METHOD: All adolescent heart transplant donors (12–17 years old) from July 1, 2000 to June 30, 2015 were identifi ed using standard UNOS dataset and were matched against potential transplant recipient (PTR) dataset by donor ID. Pediatric candi-dates who refused adolescent donors were identifi ed and were matched against the standard UNOS dataset by waitlist ID. Candidate and donor characteristics and post-transplant survivals were compared.

RESULTS: Out of 3473 adolescent hearts, 71% (2457) went to adults. Of the 2457 adults, 35% (855) [AAD] received donor hearts previously offered to 844 pediatric candidates who refused them at least once. Of the 844 pediatric candidates, 76% (643) subsequently underwent transplantation [PCT] and 24% (201) were never transplanted [PCNT]. 10% (87) of 844 [PCT + PCNT] candidates died without a transplant. These 87 PCNT refused 256 hearts that were later accepted by AAD. The PCT were better than AAD at listing in terms of functional status and VAD use; moreover, the PCT donors had better left ventricular ejection fraction and glomeru-lar fi ltration rate than the fi rst ones they rejected. [Table]. AAD had similar overall post-transplant survival as compared to PCT (p = 0.251), all pediatric transplants (p = 0.101) and all adult transplants (p = 0.114). The 256 adults [AAD] who accepted hearts refused by PCNT cohort who died on the waiting list, had 1 and 5 year survival of 87% and 75% respectively; which is similar to all pediatric (p = 0.112) as well as all adult (p = 0.720) post transplant survival. A breakdown of adolescent heart donors by years shows a trend towards better utilization by pediatric candi-dates. [Figure]


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Table: Characteristics of Adult and Pediatric Candidates

Median [IQR] for Continuous Variables; Count (%) for Categorical Variables

AAD(n = 855)

PCT(n = 643) p-value

PCNT (n = 201) p-value

Recipient Diagnosis <0.001 <0.001

Cardiomyopathy 686 (80%) 320 (50%) 93 (46%)

CHD* 48 (5.6%) 209 (32.5%) 82 (41%)

Re transplant 41 (4.8%) 78 (12%) 0 (0%)

Other 80 (9.4%) 36 (5.6%) 26 (13%)

Recipient FS* <50%** 314 (49%) 172 (37%) <0.001 40 (31%) <0.001

VAD* use** 126 (15%) 63 (10%) 0.004 16 (8%) 0.011

Recipient GFR* (mg/dl)** 72.9[54.1–94.8]

94.4[74.5–115.4]

<0.001 83.6 [66–105.4]

0.003

<90 mg/dl** 575 (70%) 264 (44%) <0.001 105 (59%)

0.007

<60 mg/dl** 270 (33%) 74 (12%) <0.001 39 (22%) 0.005

Donor CVA* 46 (5.4%) 70 (11%) <0.001 –

Donor GFR* 77.5[58.7–98.4]

79.7[62.8–106.9]

0.003 – –

<90 mg/dl 562 (66%) 389 (61%) 0.046 – –

<60 mg/dl 224 (26%) 134 (21%) 0.018 – –

Donor LVEF* (%) 60[55–60]

63[57–68] <0.001 – –

Donor LVEF* categories 0.005

< = 40% 17 (2.1%) 9 (1.5%) – –

41-69% 669 (82%) 464 (75%) – –

= >70% 134 (16%) 142 (23%) – –

* CHD = Congenital Heart disease, FS = Functional Status, VAD = Ventricular Assist Device, CVA = Cerebrovascular accident, GFR = Glomerular Filtration Rate, LVEF = Left Ventricular Ejection Fraction**variable were recorded at listing; AAD are adults accepting adolescent donors, PCT are pediatric candidates that refused adolescent donors and were later transplanted and PCNT are pediatric candidates that refused adolescent donors and were never transplanted


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Figure: Adolescent heart-transplant donors utilized by year (n = 3473)

CONCLUSION: A signifi cant number of adolescent donor hearts are refused by pediatric centers that result in excellent post-transplant outcomes in adult recipients. One in 10 of pediatric candidate refusals resulted in death on the wait list. This war-rants careful evaluation of refusal criteria by pediatric transplant centers. Encourag-ingly, there appears to be a trend towards better utilization of adolescent donors by pediatric centers.


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9:00 am – 9:10 am NEW MEMBER & SAMSON PRIZE FINALIST INTRODUCTIONS, Monarchy

9:10 am – 9:55 am P R E S I D E N T I A L A D D R E S S

Monarchy

Introduction: James I. Fann

“Tuberculosis, History and the Arts”John D. Mitchell


10:20 am – 10:25 am DAVID J. DUGAN DISTINGUISHED SERVICE AWARD PRESENTATION, Monarchy

Conferment: Robbin G. Cohen

Recipient: D. Craig Miller


47

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10:25 am – 11:45 am S C I E N T I F I C S E S S I O N I I


Moderators: Nahush A. MokadamMichael J. Weyant

+4. Implementation of Transcatheter Aortic Valve Replacement in California: Impact on Aortic Valve SurgerySteven Maximus1, *Jeffrey C. Milliken1, *Richard J. Shemin2, *Junaid Khan3, *Joseph S. Carey1

1UC Irvine, Orange, CA; 2UCLA School of Medicine, Los Angeles, CA; 3Alta Bates Summit Medical Center, Oakland, CA

DISCUSSANT: Y. JOSEPH WOO

BACKGROUND: Transcatheter aortic valve replacement (TAVR) procedures were introduced in 2011. Initially, procedures were limited to patients who were not surgi-cal candidates, but subsequently “high risk” surgical candidates were considered for TAVR. The impact on aortic valve surgery in California is unknown.

METHODS: The California Offi ce of Statewide Health Planning and Development hospitalized patient discharge database was queried for the years 2009 through 2014. Isolated Surgical Aortic Valve and Aortic Valve/CABG (SAVR) and TAVR pro-cedures were identifi ed by ICD-9-CM procedure codes. Seven TAVR programs were introduced in 2011, 12 in 2012, 3 in 2013, and 6 in 2014. SAVR procedure volumes were compared from the two years prior, to SAVR volumes in the year(s) after institu-tion of the TAVR program in these 28 hospitals.

RESULTS:

SAVR + SAVR/CABG TAVR

#Hospitals

Prev 2 Year

Average Year 1 Year 2 Year 3 Year 4

28 2497.5 2566 (+2.7%) 455 (yr 1)

22 2084.5 2179 (+4.6%) 2260 (+8.4%) 994 (yr 2)

19 1953.5 2018 (+3.3%) 2115 (+8.3%) 2090 (+7.0%) 1338 (yr 3)

7 754 830 (+10.1%) 805 (+6.8%) 871 (+15.5%) 811 (+7.6%) 1011 (yr 4)



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Overall, surgical volumes increased during the fi rst, second and third years after implementation of TAVR procedures. Among seven hospitals with four year pro-grams, surgical volumes increased to a maximum of 15.5% in the third year, then began to decrease. The hospital performing the largest number of TAVR procedures showed a marked decrease in SAVR volume by the fourth year, suggesting a shift of SAVR candidates to TAVR. Among all hospitals with four year programs, TAVR exceeded SAVR procedures by the fourth year. In California overall, SAVR increased during 2011 through 2013, due primarily to increasing isolated SAVR procedures. Statewide, isolated SAVR increased from a yearly average of 3111 procedures in 2009–2010 to 3592 (+15.5%) in 2013, then decreased slightly in 2014. SAVR+CABG procedures decreased during the same time period.

CONCLUSIONS: After implementation of TAVR, hospital SAVR volumes increased moderately, then began to decrease by the fourth year, when TAVR volume exceeded SAVR. Surgical candidates may be identifi ed during evaluation for TAVR, resulting in increased SAVR volume. Increasing SAVR volume may also be related to improved patient and provider awareness of aortic valve disease.


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+5. Induction Chemotherapy for T3N0M0 Non-Small Cell Lung Cancer Confers Superior Rates of Complete ResectionMichael S. Mulvihill, Babatunde A. Yerokun, Kevin L. Anderson, Jr., Paul J. Speicher, Betty C. Tong, David H. Harpole, Thomas A. D’Amico, Matthew G. HartwigDuke University, Durham, NC

DISCUSSANT: SUSAN MOFFATT-BRUCE

OBJECTIVES: Complete surgical resection is the preferred approach to cT3N0M0 disease for patients who are surgical candidates. However, on account of the hetero-geneity inherent in cT3 disease, a range of treatment strategies are employed, and a signifi cant fraction of patients undergo induction therapy prior to resection. We tested the hypothesis that the use of induction therapy confers a survival advantage in patients with cT3 NSCLC.

METHODS: Patients diagnosed with cT3N0M0 NSCLC from 2006 to 2011 in the National Cancer Data Base and who were treated with either lobectomy or pneumo-nectomy were stratifi ed by treatment strategy: surgery fi rst vs. induction chemother-apy. Baseline characteristics were compared with standard statistical tests. Propensity scores were developed and matched with a 2:1 nearest neighbor algorithm. Short-term outcomes included margin status, 30- and 90-day mortality, readmission, and length of stay. Survival analyses using Kaplan-Meier methods were performed on both the unadjusted and propensity score-matched cohorts.

RESULTS: A total of 2,815 cT3N0M0 patients were identifi ed for inclusion, of which 535 (19%) were treated with induction chemotherapy. Prior to adjustment, patients treated with induction chemotherapy were younger, had higher comorbidity burden, and were more likely to have private insurance (all P < 0.001). Following propen-sity score matching, there were no signifi cant differences in patient characteristics. Patients receiving induction chemotherapy were more likely to obtain R0 resection (p = 0.001), and thereby less likely to have positive margins at the time of resection (p < 0.001). Tumors of those receiving induction therapy were signifi cantly down-staged at pathological assessment, with 34.7% staged pT3 vs 77.2% in the surgery-alone group (p < 0.001). Patients receiving induction therapy were less likely to require pneumonectomy at the time of resection (p = 0.023) and conversion to an open procedure was required less frequently (p = 0.011). Short term outcomes were similar between groups (Table), without signifi cant differences. There was no differ-ence in long-term survival between groups (Figure).



50

CONCLUSIONS: Induction chemotherapy for cT3N0M0 NSCLC is associated with superior rates of complete resection. Though the increased rate of R0 resection and evidence of successful downstaging did not translate to a benefi t in overall survival, further studies are warranted to better elucidate sub-populations that may stand to benefi t from induction therapy.


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+6. Improved Intracoronary Stem Cell Delivery to the Right Ventricle: A Preclinical StudyBrody Wehman, Osama Siddiqui, Godly Jack, Tieluo Li, Mark Vesely, Rachana Mishra, Sudhish Sharma, Grace Bigham, Bradley Taylor, Bartley Griffi th, Sunjay KaushalUniversity of Maryland School of Medicine, Baltimore, MD

DISCUSSANT: PATRICIA A. THISTLETHWAITE

OBJECTIVES: Clinical protocols for stem cell-based therapies are currently under development for patients with hypoplastic left heart syndrome (HLHS). An ideal cell delivery method should have minimal safety risks and provide a wide distribution of cells to the non-ischemic right ventricle (RV). However, the optimal strategy for stem cell delivery to the RV has yet to be explored in a preclinical model, necessary for an HLHS trial.

METHODS: Human c-kit+ cardiac stem cells (CSCs) were isolated from the right atrial appendage of adult patients undergoing routine cardiac surgery and expanded ex-vivo. Isolated cells were sorted for c-kit, CD31, CD34, CD45, CD90, CD105 and tryptase using fl ow cytometry. c-kit+/CD34– CSCs were then delivered to healthy Yorkshire swine via the proximal right coronary artery (RCA) with a stop and re-fl ow technique. The effect of pre-medication with anti-arrhythmic medications in this model was retrospectively reviewed, with the primary outcome of immediate survival. One group underwent CSC delivery to the RV without prophylactic anti-arrhythmic infusion (n = 7), while the second group was pre-medicated with a loading dose and intravenous infusion of amiodarone and lidocaine (n = 13). Cardiac biopsies were obtained from the right ventricle free wall, outfl ow tract (RVOT) and septum to ascer-tain the biodistribution of CSCs. Immunohistochemistry was used to identify human c-kit+ CSCs within swine myocardium. Results are presented as mean ± standard error of the mean.

RESULTS: Flow cytometric analysis revealed 84.5 ± 2.1% of isolated cells were posi-tive for c-kit. There were no differences in baseline hemodynamic parameters between the two groups. Survival was signifi cantly greater in the group receiving prophylac-tic amiodarone and lidocaine infusions as compared to the group without (13/13 (100%) versus 1/7 (14.3%), p < 0.0001). Cardiac arrest during balloon infl ation was the cause of death in each of the non-medicated animals. In the pre-medicated group, 9 (69.2%) pigs experienced transient ST segment changes in the precordial leads during c-kit+ CSC delivery, which resolved spontaneously. The majority of c-kit+



52

CSCs were distributed to lateral segments of the RV free wall, consistent with the anatomic course of the RCA (lateral RV, 19.2 ± 1.5 CSCs/fi eld of view (FOV) versus medial RV, 10.4 ± 1.3 CSCs/FOV, p < 0.0001, Figure). Few c-kit+ CSCs were identifi ed in the right atrium, septum or left ventricle.

CONCLUSIONS: Prophylactic infusion of amiodarone and lidocaine enhances survival in swine undergoing intracoronary delivery of human c-kit+ CSCs to the RV. Additionally, intracoronary delivery results in a limited biodistribution of c-kit+ CSCs to the RV. Human clinical protocols can be optimized by requiring infusion of anti-arrhythmic medications prior to cell delivery. Alternative cell delivery strategies, such as intramyocardial injection at the time of planned surgical intervention, may provide a more homogenous distribution of cells to the RV.


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+7. Induction Therapy Is a Safe and Effective Immunosuppressive Strategy for Bridging Patients with Left Ventricular Assist Devices to TransplantationAaron H. Healy, *Stephen H. McKellar, Ragheed Al-Dulaimi, Angela P. Presson, Stavros G. Drakos, Josef Stehlik, *Craig H. SelzmanUniversity of Utah, Salt Lake City, UT

DISCUSSANT: HARI MALLIDI

OBJECTIVES: Induction therapy for heart transplantation remains controversial, and, in particular, its role in patients bridged to transplant with a left ventricular assist device (LVAD) is unknown. Induction therapy carries a potential risk of over-immunosuppressing patients that are having a bigger operation at the time of transplant (with LVAD explantation) and theoretically, may increase the incidence of infection and lymphoproliferative disease. We sought to determine the clinical effi cacy and safety of induction therapy in transplant patients supported with LVADs.

METHODS: Using the International Society for Heart and Lung Transplantation Transplant Registry, a retrospective analysis of all heart transplants in patients sup-ported with a continuous-fl ow (CF) LVAD between 2008 and 2013 was performed. Patients were grouped according to induction status at the time of transplant. Stan-dard statistical analyses were performed to determine the effect of induction therapy on rates of rejection after transplantation.

RESULTS: During the study period, 2,973 patients were transplanted after being bridged with a CF LVAD, of which 2,271 (77%) underwent induction at the time of transplant while 672 (23%) did not. Induction regimens varied, but generally consisted of an interleukin-2 receptor antagonist or a polyclonal anti-lymphocyte or anti-thymocyte globulin. There were no differences between the two groups with regard to age, gender, etiology of heart failure, or medical condition at transplant. Freedom from rejection at one, three, and fi ve years post-transplant was 87%, 60%, and 52% in the induction group compared with 87%, 48%, and 39% in the non-induction group (p < 0.001). Overall survival at fi ve years post-transplant was 79% in the induction group and 84% in the non-induction group (p = 0.11). After transplant, patients in the induction group had higher rates of drug-treated hypertension (54% vs. 48%, p = 0.009) and hyperlipidemia (55% vs. 47%, p = 0.002). There were no differences between the induction and non-induction groups with regard to the rates of post-transplant coronary artery disease (10% vs. 11%, p = 0.64), renal dysfunction (17% vs. 20%, p = 0.11), malignancy (4% vs. 5%, p = 0.39), or hospitalization for infection (39% vs. 39%, p = 0.91).



54

CONCLUSIONS: In the current era, induction therapy is the primary mode of immu-nosuppression for LVAD-supported transplant patients. For at least the fi rst fi ve years post-transplant, immunosuppressive strategy does not infl uence survival. However, induction therapy has lower rates of rejection while affording equivalence in safety compared to traditional therapy. Longer follow-up will be required to determine if this strategy maintains this safety and effi cacy profi le over the long term.


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THU

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11:45 am – 12:30 pm CONTROVERSIES DEBATE, Monarchy

Concurrent Surgery: Effi cient or Unethical?

Moderator: Richard I. Whyte

Speakers:

Effi cient: Robert J. Cerfolio

Unethical: Sean C. Grondin

12:30 pm ADJOURN

1:30 pm OCEAN BEACH BLAST**, Depart from Lower Lobby Entrance

6:00 pm – 10:00 pm Legends of Hawaii Luau—Our Big Island Story THEME DINNER, Kamehameha Court



56

FRIDAY, JUNE 24, 2016



6:30 am – 7:50 am BREAKFAST SESSION **, Kings 1

Public Reporting of Surgeon-Specifi c Data: Friend or Foe?

Moderator: Susan Moffatt-Bruce

Speakers:

Adult Cardiac: Joe C. Cleveland, Jr.

General Thoracic: Felix G. Fernandez

Congenital Heart: John E. Mayer



8:00 am – 8:50 am P O S T G R A D U AT E C O U R S E

MonarchySupported by: White Memorial Medical Center and Foundation’s Lyman A. Brewer, III, Fund, and Thomas J. Fogarty

War Surgery in Iraq and AfghanistanCameron D. WrightAssociate Chief of the Division of Thoracic Surgery & Associate Program DirectorMassachusetts General Hospital, Boston, MA



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8:50 am – 10:30 am S C I E N T I F I C S E S S I O N I I I


Moderators: Sean C. GrondinCraig H. Selzman

+8. Is Re-Staging Positron Emission Tomography Required After Neoadjuvant Treatment for Esophageal Cancer?Camille L. Stewart, Kweku Hazel, Megan Boniface, Martin McCarter, Csaba Gajdos, Barish H. Edil, Robert A. Meguid, *John D. Mitchell, *Michael J. WeyantUniversity of Colorado School of Medicine, Aurora, CO

DISCUSSANT: DONALD E. LOW

OBJECTIVES: Esophageal cancer is frequently staged using positron emission tomography (PET) along with computerized tomography (CT) to assist in the identi-fi cation of metastatic disease. When being considered for defi nitive surgical interven-tion after neoadjuvant therapy, these patients often receive a second re-staging PET/CT scan. We hypothesized that the addition of PET for re-staging is unnecessary, and that clinically signifi cant fi ndings can be adequately visualized on CT alone.

METHODS: We prospectively identifi ed patients with a new diagnosis of esophageal cancer who presented to our esophageal multidisciplinary conference from 12/2013–9/2015 and were initially staged with PET/CT, treated with neoadjuvant therapy, and then had subsequent re-staging PET/CT. Additional information was queried from the medical charts. Changes in management were defi ned as fi ndings on imaging that prompted additional studies or the decision to not proceed with defi nitive surgery. Averages are presented as the mean ± standard deviation.

RESULTS: We identifi ed 42 patients who met study criteria; 37 (88%) were male, with an average age of 61.4 ± 9.9 years old. Of these patients, 34 (81%) were treated with chemotherapy and radiation, and 8 (19%) were treated with chemotherapy alone. The average time between PET/CT scans was 89 ± 27 days. Re-staging PET/CT was felt to change management in 7 patients (17%). All abnormalities on imaging, however, were visualized on both PET and CT. Changes in management occurred with 2 patients who had biopsies that were negative for malignancy, and 5 patients



58

who were determined to have distant metastases. There were 36 patients (86%) who ultimately had an esophagectomy. Three patients (8%) had a complete pathologic response to treatment, and 14 patients (39%) had disease metastatic to lymph nodes; these lymph nodes were evident on re-staging imaging in only three patients (21%).

CONCLUSIONS: Re-imaging appears necessary after neoadjuvant treatment of esophageal cancer, since it alters management in a signifi cant number of patients. The addition of PET for re-staging, however, is not required to identify clinically signifi cant abnormalities, since CT scanning alone appears to be suffi cient to evaluate for inoperable and distant metastatic disease. This may have implications for overall cost and effi ciency of care.


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+9. Pulmonary Function Tests Do Not Predict Mortality in Patients Undergoing Continuous Flow LVAD ImplantationEdo K.S. Bedzra, Todd F. Dardas, *Jay D. Pal, Claudius Mahr, *Jason W. Smith, Kent R. Shively, Richard K. Cheng, S. Carolina Masri, Wayne C. Levy, *Nahush A. MokadamUniversity of Washington, Seattle, WA

DISCUSSANT: SAGAR DAMLE

BACKGROUND: Pulmonary function testing has been used for risk stratifi cation of patients undergoing cardiac surgery, and the presence of lung disease is associated with worse outcomes in the STS risk calculator. Research has been equivocal regard-ing predictive value of specifi c tests with both negative correlation and absence of correlation noted. In heart failure patients, PFT abnormalities may also be secondary to underlying heart failure, cardiomegaly or both. This study investigates the effi cacy of percent-predicted FEV1 and DLCO in predicting mortality in heart failure patients who undergo implantation of a continuous fl ow left ventricular assist device.

METHODS: 310 sequential patients who underwent continuous fl ow LVAD implanta-tions for all indications between July 2005 and September 2015 were retrospectively evaluated using Kaplan Meier survival analysis, negative binomial and multivariable Cox regressions. Associations between PFTs and outcomes were investigated. Patients were evaluated as a single cohort, and as members of one of fi ve FEV1 and DLCO based groups. The group with highest observed values was used as the reference for comparison. Primary outcome measure was mortality. Secondary outcomes of post-operative intensive care unit and hospital lengths of stay were evaluated with negative binomial regressions.

RESULTS: FEV1 ranged from 23 to 113% predicted while DLCO ranged from 28 to 101% predicted. There is no association of FEV1/DLCO with survival (Figures 1 and 2, Table 1). Moreover, there is no signifi cant difference in mortality at one and three years between the different groups and the reference group (p = 0.848 and 0.837 for FEV1 and DLCO respectively). There is a negative association of FEV1/DLCO with hospital length of stay. While neither FEV1 nor DLCO was predictive of postop-erative intensive care unit stay over the entire cohort (Table 1), decreased DLCO was generally associated with increased ICU length of stay in the group analysis (p = 0.001).



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Table 1. Outcomes of Patients After LVAD Implantation

Outcomes FEV1 p-value DLCO p-value

Mortality (Hazard Ratio per 10% change)

Unadjusted 0.99 0.925 0.91 0.435

Adjusted 1.08 0.396 0.98 0.892

Hospital Length of Stay (Ratio of Means per 10% change)

Unadjusted 0.93 0.001 0.93 0.008

Adjusted 0.94 0.004 0.93 0.010

ICU Length of Stay (Ratio of Means per 10% change)

Unadjusted 1.00 0.936 0.96 0.286

Adjusted 1.00 0.989 0.96 0.305


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CONCLUSIONS: The common PFTs such as FEV1 and DLCO are not associated with operative or long-term mortality in patients undergoing continuous fl ow LVAD implantation. These fi ndings suggest that abnormal PFTs alone should not preclude the offer of advanced heart failure therapies.


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+10. Comparison of Right Ventricle-Pulmonary Artery Shunt Position in the Norwood Procedure: An Analysis of the Pediatric Heart Network Public DatabaseNicholas D. Andersen, James M. Meza, Matthew R. Byler, Kevin D. Hill, Christoph P. Hornik, Robert D.B. JaquissDuke University Medical Center, Durham, NC

DISCUSSANT: TARA B. KARAMLOU

OBJECTIVE: Placement of a right ventricle-pulmonary artery (RVPA) shunt to the left or right of the neo-aorta may infl uence survival, re-interventions, and pulmonary artery growth following the Norwood procedure due to differences in shunt geom-etry and pulmonary artery blood fl ow. We sought to compare outcomes between patients who received a left- or right-sided RVPA shunt in the Pediatric Heart Network Single Ventricle Reconstruction trial.

METHODS: We analyzed The Single Ventricle Reconstruction Trial public use dataset. Baseline and operative characteristics, transplantation-free survival, serious adverse events, shunt and pulmonary artery re-interventions, and angiographic pul-monary artery measurements were compared between patients who received a left- or right-sided RVPA shunt.

RESULTS: A total of 281 patients underwent RVPA shunt placement during the Norwood procedure; the position of the shunt relative to the neo-aorta was recorded for 274 (98%) patients. A left-sided RVPA shunt (L-RVPA) was placed in 168 (61%) patients and a right-sided RVPA shunt (R-RVPA) was placed in 106 (39%) patients. There were no differences in baseline characteristics between groups. L-RVPA shunts were used more commonly at high-volume centers and were associated with shorter cardiopulmonary bypass and cross-clamp times but longer circulatory arrest times (Table 1). During follow-up, there were no differences in transplantation-free survival (74% vs. 77% at 12 months, P = 0.51, Figure) or serious adverse events (60 vs. 49 events per 100 infants at 12 months, P = 0.27) between L-RVPA and R-RVPA shunt patients. The rate of pulmonary artery intervention prior to 12 months of age was similar between groups (Table 2). However, the R-RVPA shunt was associated with fewer surgical shunt revisions compared to the L-RVPA shunt (P = 0.05, Table 2). Pre-stage II catheterization demonstrated larger indexed central pulmonary artery measurements with the R-RVPA shunt (P = 0.05) but similar indexed peripheral pulmonary artery measurements between groups (P = 0.41, Table 3).



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Table 1. Stage 1 Operative Parameters

Left RVPA(n = 168)

Right RVPA(n = 106) P Value

Center Norwood volume <0.0001

≤15/yr 18 (11%) 28 (26%)

16 to ≤20/yr 15 (9%) 45 (42%)

21 to ≤30/yr 73 (43%) 19 (18%)

>30/yr 62 (37%) 14 (13%)

Surgeon Norwood volume <0.0001

≤5/yr 11 (7%) 39 (37%)

6 to ≤10/yr 38 (23%) 17 (16%)

11 to ≤15/yr 74 (44%) 50 (47%)

>15/yr 45 (27%) 0

Cross-clamp time (min) 51 [41, 61] 66 [49, 80] <0.0001

Cardiopulmonary bypass time (min) 128 [96, 158] 166 [130, 185] <0.0001

Use of circulatory arrest 161 (96%) 95 (90%) 0.04

Circulatory arrest time (min) 41 [28, 53] 16 [9, 40] <0.0001

Data presented as counts(%) or median [25th, 75th percentile].


64

Table 2. Interventions Prior to 12 Months of Age

Left RVPA(n = 168)


PA INTERVENTIONS

– Balloon dilation or stent 13 (7.7) 13 (12.3) 0.33

– Surgical augmentation 56 (33.3) 28 (26.4) 0.37

Total PA interventions 69 (41.1) 41 (38.7) 0.84

SHUNT INTERVENTIONS

– Balloon dilation or stent 20 (11.9) 9 (8.5) 0.52

– Surgical revision 14 (8.3) 2 (1.9) 0.05

– Conversion to MBTS 3 (1.8) 3 (2.8) 0.86

Total shunt interventions 37 (22.0) 14 (13.2) 0.12

Data presented as # of events (event rate/100 infants). MBTS = modifi ed Blalock-Taussig shunt. PA = pulmonary artery.

Table 3. Pre-Stage II Catheterization Pulmonary Artery Measurements

Left RVPA(n = 114)


Body surface area (m2) 0.31 [0.28–0.34] 0.31 [0.30–0.34] 0.13

CENTRAL PA MEASUREMENTS

Mid-main left PA diameter (mm) 4.2 [3.4–5.2] 4.8 [3.6–5.8] 0.16

Mid-main right PA diameter (mm) 4.1 [3.2–5.1] 4.4 [3.6–5.6] 0.12

Pulmonary artery (Nakata) index (mm2/m2)

91 [59–135] 118 [72–158] 0.05

PERIPHERAL PA MEASUREMENTS

Proximal left lower lobe diameter (mm) 4.9 [4.2–6.3] 4.8 [4.2–5.7] 0.29

Proximal right lower lobe diameter (mm) 4.8 [4.1–5.8] 5.2 [4.2–5.9] 0.28

Total lower lobe index (mm2/m2) 135 [100–193] 134 [100–164] 0.41

Data presented as median [25th, 75th percentile]. PA = pulmonary artery.

CONCLUSIONS: In the Single Ventricle Reconstruction trial, RVPA shunt position relative to the neo-aorta was not associated with transplantation-free survival or serious adverse events. However, RVPA shunt placement to the right of the neo-aorta was associated with fewer shunt revisions and improved central pulmonary artery growth.


65

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11. Concordance with Commission on Cancer Quality Measures in Lung Cancer Care: An Opportunity for ImprovementDavid D. Odell, Joseph Feinglass, Shari L. Meyerson, Ankit Bharat, Malcolm M. DeCamp, Karl Y. BilimoriaNorthwestern University, Chicago, IL

DISCUSSANT: LEAH M. BACKHUS

BACKGROUND: Lung cancer is the leading cause of cancer-related death in the United States with an incidence of 221,200 new cases and 158,040 deaths annually. Guidelines for management of non-small cell lung cancer (NSCLC) have been devel-oped based on outcomes data, but few assessments of concordance with lung cancer care guidelines have been reported. We sought to: 1) describe the rates of adherence to the 3 lung cancer specifi c quality measures defi ned by the Commission on Cancer (CoC) and 2) identify factors which predispose to non-adherence.

METHODS: The National Cancer DataBase (NCDB) was queried to identify all patients with NSCLC treated between 1997 and 2012. Patient-level adherence to each of 3 CoC-defi ned quality measures [1) sampling of at least 10 regional lymph nodes at the time of surgery; 2) surgery not used as primary therapy in patients with N2 disease; 3) surgery performed within 90 days of neoadjuvant chemotherapy and 120 days of adjuvant chemotherapy]. Due to the presence of different inclusion and exclu-sion criteria for each measure, analyses were performed for the 3 cohorts separately. Overall rates of measure adherence were calculated and individual factors contribut-ing to failures of measure concordance were analyzed using univariate statistics. A logistic regression model was then constructed to identify factors that independently infl uence measure adherence.

RESULTS: During the study period, a total of 386,866 patients underwent surgery for NSCLC. Appropriate regional lymph node sampling was performed in only 74.5% of cases (n = 288,375 vs. n = 98,511; p < 0.0000). Of patients who required adjuvant chemotherapy following surgery 28.7% (22,194 of 77,398; p < 0.0000) did not begin within the 120 day window defi ned as appropriate. However, 96.5% (30,967 of 32,098) of patients who received chemotherapy in the neoadjuvant setting pro-ceeded to surgery within the defi ned120 day window (p = 0.023). Finally, surgery was generally used appropriately in the setting of N2 disease, with only 3.7% (6,196 of 167,603; p < 0.000) of patients undergoing surgical resection as fi rst line therapy.

Uninsured or Medicaid status was an independent risk factor for a prolonged delay between neoadjuvant chemotherapy and surgery [OR 1.36; 95% CI 1.08–1.72; p = 0.009] and between surgery and adjuvant treatment [OR 1.92; 95% CI 1.69–2.19; p < 0.000]. Surgery was more likely to be performed as fi rst line therapy in patients with N2 disease who were male [OR 1.11; 95% CI 1.05–1.18; p < 0.000] or over the age of 70 [OR 1.33; 95% CI 1.22–1.47; p < 0.000]. No trends toward improved performance were seen throughout the study period. Nodal undersampling was more likely in


66

male patients [OR 1.04; 95% CI 1.02–1.06; p < 0.000] and those with tumors greater than 2 cm [OR 1.22; 95% CI 1.16–1.27; p < 0.000].

CONCLUSIONS: Understanding performance in cancer care delivery allows for targeted interventions which may improve patient outcomes. Currently, rates nodal sampling at the time of surgery and rates of patient referral for adjuvant chemo-therapy fall below defi ned quality standards. Improvement efforts in these areas may improve the delivery of lung cancer care nationally. Development of robust and meaningful quality measures is needed to more accurately assess performance in lung cancer care delivery.


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+12. Outcomes After Surgical Pulmonary Embolectomy for Acute Submassive and Massive Pulmonary Embolism: A Single Center ExperienceChetan Pasrija, Anthony Kronfl i, Sheelagh Pousatis, Michael Rouse, Mehrdad Ghoreishi, Shahab Toursavadkohi, Bartley P. Griffi th, Pablo G. Sanchez, Zachary N. KonUniversity of Maryland, Baltimore, MD

DISCUSSANT: MICHAEL S. MULLIGAN

BACKGROUND: Ideal treatment strategies for submassive (SPE) and massive pulmonary embolism (MPE) remain unclear. Recent reports of surgical pulmonary embolectomy have demonstrated good outcomes, but with variable mortality rates as surgical and perioperative factors continue to be refi ned. Additionally, post-embolec-tomy right ventricular function has yet to be well-defi ned.

METHODS: All patients undergoing surgical pulmonary embolectomy (2011–2015) were retrospectively reviewed. Patients were stratifi ed as SPE, MPE without cardiac arrest, or MPE with cardiac arrest. Change in right ventricular (RV) dysfunction was assessed by pre- and post-operative transthoracic echocardiography, quantifi ed as: 0 = none, 1 = mild, 2 = moderate, 3 = severe. Primary outcomes were in-hospital and one-year survival. Secondary outcomes included post-operative stroke, renal failure requiring hemodialysis (HD), deep sternal wound infection (DSWI), and sepsis.

RESULTS: 55 patients were identifi ed: 28 patients with SPE, 18 with MPE without arrest, and 9 with MPE with arrest. Median age was 53 (IQR: 44–65) years. Common risk factors included DVT in 80% of patients, obesity in 64%, and recent surgery in 38%. Median pre-operative troponin was 0.45 (IQR: 0.20–1.01) ng/mL, and all patients had an RV/LV ratio >1.0. Median RV dysfunction decreased from 2 (mod-erate) preoperatively to 0 (none) prior to discharge (p < 0.001, Figure 1). Overall, in-hospital and one-year survival was 93%. No patients developed renal failure requiring HD at discharge or suffered a post-operative stroke. One patient developed a DSWI, and another developed post-operative sepsis. Subset analyses for SPE, MPE without arrest, and MPE with arrest are listed in Table 1.



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CONCLUSIONS: In this single institution experience, survival after pulmonary embolectomy for SPE and MPE is higher than published survival for these conditions treated with medical therapy. Furthermore, RV function approached normalization after embolectomy. A prospective trial comparing surgical therapy to medical therapy may be warranted to further elucidate the role of surgical pulmonary embolectomy in the treatment of SPE and MPE.



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11:00 am – 12:00 pm S C I E N T I F I C S E S S I O N I V


Moderators: Jessica S. DoningtonT. Brett Reece

13. Analysis of Procedural Complications and Early Morbidity After Self-Expanding Transcatheter or Surgical Aortic Valve Replacement: Results from the Corevalve U.S. High-risk Clinical TrialJohn V. Conte1, Jon R. Resar1, G. Michael Deeb2, Thomas G. Gleason3, David H. Adams4, Jeffrey J. Popma5, Steven J. Yakubov6, Michael J. Reardon7

1Johns Hopkins University, Baltimore, MD; 2University of MIchigan, Ann Arbor, MI; 3University of Pittsburgh Medical Center, Pittsburgh, PA; 4Mount Sinai Medical Center, New York, NY; 5Beth Israel Deaconess Medical Center, Boston, MA; 6Riverside Methodist Hospital, Columbus, OH; 7Houston-Methodist DeBakey Heart and Vascular Center, Houston, TX

DISCUSSANT: JOSEPH E. BAVARIA

BACKGROUND: Procedural complications following transcatheter or surgical aortic valve replacement (TAVR or SAVR) have largely been reported as retrospective analyses. We report the fi rst in depth direct comparison of complications following placement of a SAV or a self-expanding TAV from a prospectively randomized study of patients deemed high risk for SAVR.

METHODS: A total of 391 TAVR and 359 SAVR pts were prospectively enrolled and randomized 1:1 to TAVR with a CoreValve bioprosthesis or a SAVR prosthetic valve. The cumulative incidence of major procedural complications at 3 days and 30 days were reviewed for TAVR vs SAVR patients (table) and for TAVR iliofemoral access (n = Log-Rank test. A p-value <0.05 was considered signifi cant.

RESULTS: Baseline demographics were similar for TAVR and SAVR patients with ages of 83.2 ± 7.1 vs. 83.3 ± 6.4 years and STS PROM of 7.3% ± 3.0% vs. 7.5% ± 3.3% (p = NS). Intra-operative mortality was seen in 1.28% of the TAVR group (5/391). The causes were wire perforation of the left ventricle (2), coronary occlusion (1), aortic insuffi ciency (1) and annular rupture (1). There were no intraoperative deaths in the SAVR group. All-cause mortality and stroke were not statistically different at 3 or 30 days. (Table). Major vascular complications were signifi cantly higher in the TAVR patients (p < 0.0001); life-threatening or disabling bleeding by VARC1 criteria and acute kidney injury were signifi cantly higher in SAVR patients (both p < 0.0001). New pacemaker requirement was greater for patients after TAVR than


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after SAVR (p < 0.0001). Non iliofemoral TAVR approaches had a higher incidence of major or life threatening/disabling bleeding at all timepoints compared with the iliofemoral approach (p < 0.05). Major infections were signifi cantly higher in SAVR patients between 0 and 30 days. Pulmonary infections accounted for most of the 0–3 day major infections (1 in the TAVR group and 6 in the SAVR group). Procedural complications unique to TAVR included: coronary occlusion 0.5% (2) which required conversion to a surgical AVR and TAVR pop outs 2.8% (11) with no valve emboliza-tions. Pop outs were similar between iliofemoral 2.8% (9/324) and non-iliofemoral approaches 3.0% (2/66). Procedural complications unique to SAVR include aortic dissection 0.8% (3/357) and injury to other heart structures 2.0% (7/357).

Procedural Complications TAVR vs. SAVR

Event0–3 Days

TAVR0–3 Days

SAVR P-value0–30 Days

TAVR0–30 Days

SAVR P-value

All-cause mortality

7 (1.8%) 4 (1.1%) 0.4386 13 (3.3%) 16 (4.5%) 0.4306

All stroke 14 (3.6%) 16 (4.5%) 0.5592 19 (4.9%) 22 (6.2%) 0.4602

TIA 2 (0.5%) 1 (0.3%) 0.6093 3 (0.8%) 1 (0.3%) 0.3567

Major vascular complication

21 (5.4%) 5 (1.4%) 0.0029 24 (6.2%) 6 (1.7%) 0.0018

Life threaten-ing or disabling bleed

47 (12.0%) 122 (34.0%) <0.0001 53 (13.6%) 126 (35.1%) <0.0001

Major bleeding 105 (26.9%) 118 (32.9%) 0.0710 113 (29.0%) 123 (34.3%) 0.1102

Acute kidney injury

24 (6.2%) 54 (15.1%) <0.0001 24 (6.2%) 54 (15.1%) <0.0001

New perma-nent pace-maker implant*

47 (12.2%) 6 (1.7%) <0.0001 77 (20.0%) 25 (7.1%) <0.0001

Major infection**

2 (0.5%) 7 (2.0%) 0.0731 8 (2.1%) 19 (5.4%) 0.0175

*Subjects with pacemaker or ICD at baseline are included.**Major infection includes endocarditis, sepsis, septic shock, bacteremia and pulmonary


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CONCLUSIONS: The procedural complication profi les of TAVR and SAVR are unique. Intraoperative deaths were seen in TAVR but not SAVR, however, mortal-ity at 3 and 30 days were equivalent. There was an increased incidence of vascular complications and new pacemakers for TAVR and greater rates of life-threatening or disabling bleeding, acute kidney injury and major infection following SAVR. The higher incidence of some complications likely refl ects the greater invasiveness of SAVR in this aged high risk population.


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14. Flipping the Classroom: Case-Based Learning, Accountability, Assessment, and Feedback Leads to a Favorable Change in Culture*Nahush A. Mokadam, Joshua L. Hermsen, *Jay D. Pal, *Michael S. Mulligan, Lisa Myria Jacobs, *Douglas E. Wood, Todd F. Dardas, *Edward D. VerrierUniversity of Washington, Seattle, WA

DISCUSSANT: CRAIG J. BAKER

OBJECTIVES: The JCTSE 88-week curriculum, based upon ABTS requirements, has content which includes book chapters, peer-reviewed journals, lectures, and reviews. Coverage of the accumulated content in any given week may be challeng-ing in a traditional conference format. This study investigates fl ipping the classroom by using a case-based format designed to stimulate resident preparation and faculty engagement.

METHODS: In a prospective fashion, over the course of 10 educational sessions (4 cardiac, 6 thoracic), the regularly scheduled didactic conference format was altered. A resident-faculty dyad was created for each conference. Together, they uniquely prepared or enhanced a current case from the thoracic surgery curriculum to cover the topic. Reading assignments, based upon the curriculum, and focused upon the case, as well as the case itself, were distributed to the remaining residents (6 integrated, 4 traditional) and faculty for preview and preparation. Using an interactive format, these topics were dissected by all participants of the educational session. At the end of conference, all the residents, whether or not they were at con-ference, and subspecialty faculty members, as control, were administered a 10-ques-tion assessment quiz based upon the content in the curriculum (beyond the case presentation alone). Logistic regression with a random effects model for individual respondents’ performance was used to evaluate the association between resident or faculty status and quiz performance. Residents were also polled more specifi cally on their preparation. A reporting tool was constructed for the resident and program director. A resident survey was administered to determine impressions of this educa-tional technique.

RESULTS: 70% of the residents viewed this conference format as superior to formal resident or faculty didactic sessions, review of standardized questions, or guest lectures. A majority of residents studied (60–100%) the case presentations prior to conference and reviewed (70–100%) the case presentations after conference prior to their assessment. Quiz performance improved with resident seniority, and with time as residents gained experience with the system (Figure 1). Residents compared favorably to faculty control across all quizzes (p = 0.198), suggesting robust resident preparation (Figure 2). Residents commented upon faculty involvement in this con-ference format to be the most benefi cial aspect.

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CONCLUSIONS: This novel prospective method stimulated increased resident and faculty engagement. Assessment scores increased with both resident level, and experi-ence with the case-based format. The majority of residents had a favorable impres-sion of this process and reported that it motivated them both to prepare before, and review after the weekly teaching conferences. This format was more effective for junior residents than senior residents who may benefi t more from accumulated and concomitant clinical experience. Flipping the classroom in this manner has had demonstrable improvement in educational culture by enhancing accountability, assessment, and feedback.


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+15. Regionalized Surgical Care: An Important Lack of Association Between Distance from Surgical Center and Post-Operative Outcomes in Children Undergoing Fontan PalliationBillie-Jean Martin, Mohammed Al Aklabi, Joyce Harder, John Dyck, *Ivan M. Rebeyka, David B. RossUniversity of Alberta, Edmonton, AB, Canada

DISCUSSANT: RAM KUMAR SUBRAMANYAN

OBJECTIVES: Complex pediatric cardiac surgery requires coordinated efforts of a team of providers to optimize results. Evidence suggests that outcomes are improved by consolidating care into large volume centers of excellence. Our objective was to determine if outcomes are equivalent in patients across a large regional referral base, or if patients from centers without surgery on site are at a disadvantage.

METHODS: Since 1996, all pediatric cardiac surgery has been offered at a single center within the large geographical region assessed. All pediatric patients from 5 referral centers in who underwent a Fontan procedure at this single surgical institute between 1996 and 2014 were included. Follow-up clinical data was obtained from the Regional Heart Network Database. Outcomes of interest included post-operative length of stay, early mortality, and long term transplant free survival. Baseline characteristics were compared between referring centers and the association between post operative outcomes and home center were assessed using Kaplan-Meier survival analysis and Cox proportional Hazards models.

RESULTS: A total of 279 children (median age 3.3 years, inter quartile range (IQR) 2.8–3.9 years; 121 (43.4%) female) underwent a Fontan procedure over the course of the study. Children came from distances of up to 1200 miles away; 105 (37.6%) had the surgical center (Center 1) as their home center. Original cardiac anatomy was hypoplastic left heart syndrome (HLHS) in 102 (36.6%) subjects. Median hospital length of stay was 10 days (IQR, 7–16), and there were 2 early deaths. Median follow-up was 6.6 years (IQR, 3.6–12.1 years), There were a total of 16 deaths and 10 transplants over the course of follow-up. Five-year transplant free survival was 92.3%. There was no difference in survival by referral center (Figure; log-rank p = 0.53). In multivariable analysis, home center (the surgical center vs others) was not predic-tive of either LOS (R2 = –0.53, p = 0.75) or transplant free survival (HR 1.41, 95% CI 0.59, 3.40).



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CONCLUSIONS: In children with complex congenital heart disease, a regionalized care model achieves excellent outcomes, which do not differ according to a patient’s home base. Further study is required to determine the cost effectiveness of this approach as well as impacts on patient and family quality of life.


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12:00 pm ADJOURN

1:20 pm GOLF TOURNAMENT**, Depart from Lower Lobby Entrance via shuttle to Golf Club

2:00 pm TENNIS TOURNAMENT**, Tennis Club

FREE EVENING



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SATURDAY, JUNE 25, 2016

6:00 am – 11:30 am SPEAKER READY ROOM, Waikoloa 1



6:30 am – 10:30 am EXHIBITS, Queen’s Ballroom

7:00 am – 8:45 am CONCURRENT FORUMS(5 minutes presentation, 3 minutes discussion)

ADULT CARDIAC

Monarchy

Moderator: Ali Khoynezhad

CF1. Valve Replacement Surgery in Severe Chronic Kidney DiseaseJoon Bum Kim, Sung-Ho Jung, Suk Jung Choo, Cheol Hyun Chung, Jae Won LeeAsan Medical Center, Seoul, Korea, Republic of

BACKGROUND: While the outcomes of valve replacement surgery in patients with severe chronic kidney disease (CKD) are reportedly poor, the impact of prosthetic choices on long-term survival has not been well established in these patients.

METHODS: From our prospective cardiac surgical database, we identifi ed 5,694 patients (age ≥ 18 yrs) undergoing heart valve surgery between January 2001 and September 2015. Of these, the study involved 131 patients (62.4 ± 14.1 yrs; 54 females) who had stage 4 (severe; reduction in GFR to 15–29 ml/min/1.73 m2; n = 73) or stage 5 CKD (end-stage; n = 58) based on Kidney Disease Outcomes Qual-ity Initiative Guidelines. To reduce the impact of selection bias between mechanical and bioprostheses, propensity score analyses were conducted based on 21 baseline variables.

RESULTS: Mechanical and bioprosthetic valves were implanted in 75 (57.3%, Mechanical-group) and 56 patients (42.7%, Bio-group), respectively. Twenty patients (15.3%) presented with active endocarditis, 12 (9.1%) had history of prior cardiac surgery and 8 cases (6.1%) were emergent surgery. The Bio-group patients were signifi cantly older and had lower LVEF compared with the Mechanical-group patients. (Table) Aortic valve replacement was the most common procedure in the Bio-group while mitral replacement was more common in Mechanical-group. (Table)


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Other baseline profi les did not show signifi cant differences between the two groups (P values, 0.086–0.99). Thirty-day mortality rates were 10.7% in the Bio-group and 8.0% in the Mechanical-group (P = 0.82). During a median follow-up of 59.1 months (Quartile 1–3, 20.7–92.6 months), 60 patients died. Five- and 10-year survival rates were 65.7 ± 5.8% and 62.2 ± 6.4% in the Mechanical-group, and 41.5 ± 7.4% and 25.2 ± 7.3% in the Bio-group, respectively (P = 0.001). After propensity-score adjust-ment by inverse-propensity-weighting (baseline P values after adjustment, 0.12–0.99), types of valve prostheses (mechanical over bioprostheses) were not signifi cantly asso-ciated with the risks of early death (odds ratio, 0.71; 95% confi dence interval [CI], 0.15–3.24; P = 0.66) or overall death (hazard ratio [HR], 0.67; 95% CI, 0.42–1.06; P = 0.088) in overall cohort (Figure, left). The impact of prosthetic types on survival, however, had a signifi cant interaction with patient’s age, in which mechanical valves showed lower risks in younger patients and higher risk in older patients with a crossover at 60–70 years (P = 0.003; Figure, right). On stepwise Cox-hazard models, independent predictors of death were age (HR, 1.31; 95% CI, 1.06; P = 0.013), GFR (HR, 0.67; 95% CI, 0.48–0.95; P = 0.025), LVEF (HR, 0.75; 95% CI, 0.60–0.93; P = 0.011) and diabetes mellitus (HR, 1.73; 95% CI, 1.02–2.96; P = 0.043).

Baseline Characteristics

Mechanical(N = 75)

Bioprostheses(N = 56) P values

Age, yr 54.9 ± 12.1 72.5 ± 9.5 <0.001

Female, n (%) 33 (44.0%) 21 (37.5%) 0.570

Emergency, n (%) 2 ( 2.7%) 2 ( 2.7%) 0.125

Estimated GFR, mL/min/1.73m2 16.7 ± 9.0 19.1 ± 8.8 0.137

Dialysis dependent, n (%) 30 (40.0%) 15 (26.8%) 0.165

LVEF, % 56.4 ± 9.5 51.3 ± 14.0 0.019

Aortic valve replacement, n (%) 31 (41.3%) 39 (69.6%) 0.002

Mitral valve replacement, n (%) 33 (44.0%) 13 (23.2%) 0.023

Aortic and mitral valve replacement, n (%)

11 (14.7%) 4 ( 7.1%) 0.289


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CONCLUSIONS: Outcomes following valve replacement surgery in severe CKD patients were poor with nearly 10% early mortality and overall less than 50% 10-year survival rate. The long-term survival was mainly determined by several baseline risk profi les. The impact of prosthetic types had signifi cant interaction with age—survival benefi ts with bioprostheses in patients age > 70 years and with mechanical prosthe-ses in younger patients (≤60 years).


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CF2. Predicting Readmission Risk at the Time of Admission in CABG PatientsJose Benuzillo, *William Caine, R. Scott Evans, Colleen Roberts, James F. Lloyd, Donald Lappe, *John DotyIntermountain Healthcare, Salt Lake City, UT

OBJECTIVES: Readmissions within 30 days after coronary artery bypass surgery (CABG) often are preventable and contribute to unnecessary healthcare costs. Fur-thermore, the Centers for Medicare and Medicaid Services (CMS) has added 30-days readmission after coronary artery bypass surgery CABG to the list of publically reported quality outcomes. Consequently, minimizing unplanned hospital readmis-sions has become a priority. The main objective of this study was to develop and vali-date a predictive model based on electronic data that are available upon admission.

METHODS: Fifty-nine potential readmission predictors available at the time of admission found in the Society of Thoracic Surgeons Adult Cardiac Surgery Database were included in a univariate analysis. Fifteen of which were signifi cantly associated (p < 0.05) with readmissions. These predictors can be grouped into demographic characteristics, biometric data, life-style data, laboratory results, preoperative cardiac status, preoperative medications, hemodynamic data, and previous cardiac interven-tion data. All 15 predictors that showed a signifi cant level of association were entered into a multivariate logistic regression model and removed stepwise, using backward elimination procedures. The model was validated on 539 prospective CABG cases.

RESULTS: Of 2,589 Isolated CABG patients identifi ed between 01/01/2010 and 06/30/2014, 237(9.15%) were readmitted within 30-days.The multivariate analysis resulted in 5 variables that remained signifi cant and were predictive of 30-day all-cause readmissions: age (OR = 1.03; 95% CI: 1.01–1.05; p = 0.004), prior heart failure (HF) (OR = 1.55; 95% CI: 1.07–2.24; p = 0.020), total albumin prior to surgery (OR = 0.68; 95% CI: 0.05–0.94; p = 0.021, previous myocardial infarction (MI) (OR = 1.44; 95% CI: 1.00–2.08; p = 0.50), and history of diabetes (OR = 1.54; 95% CI: 1.09–2.19; p = 0.015). The fi nal model showed good discrimination for 30-day all-cause readmission with an area under the curve c-statistic of 0.63. This model’s c-statistic is comparable to the predictive capabilities of the CMS model developed to predict readmission among CABG patients. The predicted risk of readmission obtained from the validation sample was signifi cantly higher among readmitted CABG patients [F(1,497) = 4.67, p = 0.031].

* WTSA Member


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CONCLUSIONS: The likelihood of readmission can be predicted at the time of admission. Given national pressures to improve CABG care and reduce readmissions, assessing variables associated with an increased risk in a meaningful manner is not only timely, but of clinical importance. Defi ning areas of higher acuity -prior HF, previous MI, and total albumin prior to surgery- should trigger heightened awareness of risk and customized advanced strategies. Creating actionable tools that may be tested and validated in the clinical setting will be the next step in making a difference in CABG care.


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CF3. Increased Systolic Load Decreases Elastin Content and Increases Diameter of the Developing AortaSarah Walcott-Sapp1, Herbert M. Espinoza1, Isa Lindgren1, Kevin Kolahi1, Samantha Louey1, Sonnet S. Jonker1, George D. Giraud2, Kent L. Thornburg1, *Frederick Tibayan1

1Oregon Health & Science University, Portland, OR; 2Portland VA Health Care System, Portland, OR

BACKGROUND: Adult cardiovascular disease has origins in fetal and neonatal life, but the developmental roots of aortic pathology remain largely unexplored. We have recently shown in a fetal sheep model that increased systolic load during late gestation leads to mitral annular dilation and decreased elastin expression. Similar changes in the developing aorta could create vulnerability for aortic aneurysms or dissections in adult life through increased wall stress and decreased wall strength. We hypothesized that increased systolic load during late gestation would alter aortic development and perturb aortic geometry, stiffness, and extracellular matrix composition.

METHODS: Fetal sheep underwent surgery to implant sonomicrometry crystals on the ascending aorta and intravascular catheters for infusions and ongoing hemody-namic monitoring. Each fetus received either a continuous infusion of adult sheep plasma to increase fetal blood pressure (HTN, n = 5) or Lactated Ringers (Control, n = 5) for 8 days beginning on day 126 ± 4 of gestation (term = 147 days). Sonomi-crometry crystals were used to measure in vivo ascending aortic diameter throughout the cardiac cycle. Aortic stiffness was calculated as the change in diameter per change in pressure during each beat. Ascending aortic tissue was harvested at post-mortem on day 8 and stained to quantify elastin and collagen content. Aortic wall thickness was measured directly at post mortem. Wall stress on day 8 was estimated using the Laplace equation: wall stress = pressure � radius/(2 � wall thickness).

RESULTS: The HTN group showed notably more aortic growth after 8 days (greater increase in both maximum (max) and minimum (min) aortic diameter) compared to Controls. Wall thickness and aortic stiffness were not different. Elastin content was decreased in the HTN group, while collagen content was the same. Data were analyzed by t-test and are presented as mean ± standard deviation with * denoting p < 0.05.

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Control HTN

MAP day 0 (mmHg) 40 ± 1 39 ± 1

MAP day 8 (mmHg) 43 ± 1 61 ± 3*

dL/dP day 0 (mm/mmHg) 0.038 ± 0.026 0.035 ± 0.013

dL/dP day 8 (mm/mmHg) 0.039 ± 0.027 0.034 ± 0.013

Min Aorta Diameter day 0 (mm) 13.7 ± 2.7 13.3 ± 1.6

Max Aorta Diameter day 0 (mm) 14.4 ± 1.3 13.8 ± 1.6

Min Aorta Diameter day 8 (mm) 14.0 ± 1.8 15.1 ± 1.6

Max Aorta Diameter day 8 (mm) 14.8 ± 2.1 15.7 ± 1.7

Change in Min Aorta Diameter (mm) 0.6 ± 0.2 1.8 ± 0.5*

Change in Max Aorta Diameter (mm) 0.5 ± 0.2 1.9 ± 0.6*

Wall Thickness (mm) 1.0 ± 0.3 0.9 ± 0.1

Wall Stress (N/cm2) 2.2 ± 0.5 3.7 ± 0.4*

% Area Stained for Elastin 47 ± 3 36 ± 7*

% Area Stained for Collagen 47 ± 13 42 ± 7

CONCLUSIONS: The hemodynamic environment in utero is critical for establish-ing normal aortic structure and composition. Elevated systolic load in late gestation (which occurs in aortic coarctation and intrauterine growth restriction) leads to aortic dilation and decreased elastin content. Stiffness was not different in these fetal aortas, but such developmental alterations may have adverse consequences later in life. Aortic dilation without compensatory wall thickening leads to increased wall stress and a vicious cycle of pathological remodeling. Because elastin deposition in the aorta occurs mainly in late gestation and early development, the observed defi cit in elastin portends a vulnerability to aortic disease later in life. Identifying the devel-opmental mechanisms affecting aortic composition and structure will enable the implementation of preventative care strategies and discovery of therapeutic targets in adult aortic disease.


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CF4. Natural History of Medically Treated Ascending Aortic Aneurysms in the Era of Thoracic Aortic Clinics: Impact of Bicuspid Aortic Valve and Clinical ImplicationsFrancois Dagenais, Siamak Mohammadi, Pierre Voisine, Eric DumontLaval Hospital, Sainte-Foy, QC, Canada

BACKGROUND: Growth rate of ascending aortic aneurysms is based on studies of the 1980–90s. Furthermore the impact of a bicuspid aortic valve (BAV) on the growth of an ascending aortic aneurysm is poorly investigated.

METHODS: To evaluate the natural history of medically treated ascending aortic aneurysms and the impact of BAV, 241 patients (55 pts BAV; 196 pts with tricuspid (TAV) aortic valve) with 40–50 mm ascending aortic aneurysms (all other aortic segments <40 mm) were followed prospectively in a dedicated thoracic aortic clinic. Serial (12–18 months interval) thoraco-abdominal CTs, tight BP control (24 h ABPM) and isometric and exercise blood pressure monitoring were performed.

RESULTS: Patients with BAV were younger (BAV:55.2 ± 9.6 vs TAV:68.2 ± 9.4; p < 0.0001), had less high blood pressure (BAV:40%vs TAV:64.2%; p = 0.005), hypercholesterolemia (BAV:27.3% vs TAV:50%; p0.01) and coronary artery disease (BAV:5.6% vs TAV:19.3%; p = 0.03). Maximal ascending aortic diameter at the fi rst CT tended to be greater in BAV vs TAV patients (46.7 ± 2.3 vs 45.9 ± 2.7; p = 0.06). Mean follow-up was 4.3 ± 2.5years; mean of 2.8 ± 1.1 CTs/pt. Increase in aortic size (mm/yr of follow-up) was comparable in BAV and TAV patients for the ascending aorta (BAV:0.56 ± 1.18mm/yr vs TAV: 0.39 ± 0.9mm/yr; p = 0.18) and arch (BAV:0.61 ± 1.05mm/yr vs TAV: 0.62 ± 1.09mm/yr; p = 0.92) and tended to be less with BAV at the isthmus (BAV:0.23 ± 0.36mm/yr vs TAV: 0.62 ± 1.57mm/yr; p = 0.06) and the mid descending aorta levels (BAV:0.25 ± 0.41mm/yr vs TAV: 0.56 ± 1.22mm/yr; p = 0.06). Signifi cantly more patients were operated during follow-up for the ascending aorta or aortic valve disease progression in the BAV group (BAV: 21.8% vs TAV: 9.2%; p = 0.02). Only one patient with TAV was operated emergently for an intramural hematoma of the ascending aorta. Operative mortality was 0%. However, freedom of ascending aortic aneurysm progression > 50 mm was comparable for both groups (BAV: 91.5% vs TAV: 93.2%; p = 0.29). Survival at 5 years was comparable for both groups (BAV: 94.7% vs TAV: 98.6%; p = 0.21)

CONCLUSIONS: In the current era of dedicated thoracic aortic clinics, medically treated 40–50 mm ascending aortic aneurysms show slow growth rate. Ascending aorta growth is comparable for BAV and TAV patients and tends to be less in BAV patients for the descending aorta. At mid-term, signifi cantly more patients with BAV require operation for the ascending aorta and aortic valve. Freedom from acute aortic-related events is very high in BAV and TAV patients. Survival is high thus mandating long-term follow-up.These results challenge current yearly imaging guidelines for patients with 40–50 mm aneurysms of the ascending aorta.


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CF5. Regulation of Membrane Type-1 Matrix Metalloproteinase Activity and Intracellular Localization in Clinical Thoracic Aortic Aneurysms*John S. Ikonomidis, Elizabeth K. Nadeau, Adam W. Ackerman, Robert E. Stroud, Rupak Mukherjee, Jeffrey A. JonesMedical University of South Carolina, Charleston, SC

OBJECTIVE: Thoracic aortic aneurysms (TAAs) are infl uenced by both intracellular and extracellular mechanisms that function to regulate matrix deposition and degra-dation, in part through the activation of the matrix metalloproteinases (MMPs). One specifi c MMP, membrane type-1 MMP (MT1-MMP) was elevated in aortic specimens form patients with TAA. MT1-MMP is activated intracellularly and plays an impor-tant role in the activation of MMP-2 and release of ECM bound growth factors like TGF-�. Accordingly, understanding the mechanisms regulating MT1-MMP abundance and activation during TAA development may provide therapeutic insights. Recent evidence suggests that MT1-MMP may be subject to protein kinase C (PKC)-mediated mechanisms, which regulate traffi cking and intracellular localization of MT1-MMP. Therefore, this study tested the hypothesis that PKC-mediated phosphorylation of MT1-MMP regulates cellular localization and function, which is altered in TAA.

METHODS: The abundance of MMP-2, the native and phosphorylated forms of MT1-MMP, and PKC-delta (PKC-�) were measured in aortic tissue from patients with small TAAs (<5 cm; n = 10) and large TAAs (>7 cm; n = 10) and compared to normals (n = 10; healthy heart donors). The cellular localization of MT1-MMP was examined in aortic fi broblasts obtained from control mice and after 4-weeks of TAA induction. Cells were transfected with green fl uorescent protein (GFP) tagged MT1-MMP. Cells were fi xed and imaged by confocal microscopy. Effects of PKC-mediated phosphory-lation on MT1-MMP cellular localization, in normal aortic fi broblasts was determined with a pan-PKC activator (phorbol myristate acetate: PMA; 100 nM), and a PKC-�-specifi c inhibitor (Rottlerin, 3 uM) for imaging and quantifi cation of the abundance of MMP-2 and phospo-Smad-2, a downstream marker of TGF-� activation.

RESULTS: MT1-MMP abundance increased in the aortic tissue from both the small and large TAAs when compared to controls suggesting MT1-MMP is associated with TAA development (Panel-A). The abundance of active MMP-2 was increased only in large TAA specimens, in spite of an increase in latent MMP-2 in small TAAs, which suggests MT1-MMP may be post-translationally regulated (Panel-B). MT1-MMP phos-phorylation in clinical TAA specimens, identifi ed by immunoprecipitation showed enhanced phosphothreonine phosphorylation in the small versus large TAAs (Panel-C, D). Moreover, activation of PKC-� was increased in the small versus large TAAs (Panel-E), suggesting PKC-� may regulate MT1-MMP localization. Confocal images

* WTSA Member


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showed that MT1-MMP was localized on the plasma membrane in aortic fi broblasts isolated from control mice and in endosomes from TAA mice. PMA treatment of aortic fi broblast induced internalization of MT1-MMP GFP. Immunoblotting revealed that PMA treatment enhanced phosphorylated-Smad-2 while zymography showed that PMA reduced MMP-2 activation. Importantly, pretreatment with Rottlerin inhib-ited these effects.

CONCLUSION: Taken together, these clinical and experimental data strongly support that the post-translational modifi cation of MT1-MMP mediates its activity through cellular localization; shifting its role from pericellular proteolysis (unphos-phorylated; activation of MMP-2) to intracellular signaling (phosphorylated; TGF-� pathway activation). Therefore, targeted inhibition of MT1-MMP phosphorylation/internalization may hold therapeutic relevance as a means to attenuate TAA development.


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CF6. Myocardial Bridging Is Associated with Worsened Survival in Heart Transplant PatientsZachary E. Brewer, Calvin Strehl, Kiran K. Khush, Ingela SchnittgerStanford University Medical Center, Stanford, CA

OBJECTIVE: Myocardial bridging can cause anatomic and functional coronary artery abnormalities, including accelerated proximal plaque development and endothelial dysfunction. The clinical outcomes of patients with myocardial bridging after heart transplantation are unknown. This study aimed to explore the donor characteristics and impact of myocardial bridging on clinical outcomes and long-term graft survival after heart transplantation. We hypothesized that myocardial bridging may have a sig-nifi cant effect on clinical outcomes and event-free survival after heart transplantation.

METHODS: In 100 heart transplant recipients, donor characteristics, recipient demo-graphics, and clinical outcomes after transplantation were collected. The patients were compared based on the presence or absence of myocardial bridging, for those in which intravascular ultrasound data was available (53 of 100). Myocardial bridg-ing was defi ned by intravascular ultrasound as an echolucent band surrounding the artery. The primary endpoint was composite death or re-transplantation, assessed for up to 13.8 years.

RESULTS: Myocardial bridging was identifi ed in 63 percent of the study population in which intravascular ultrasound data was available, with similar characteristics among myocardial bridging vs. non-myocardial bridging patients. Donor characteris-tics were similar among transplanted grafts, however the number of inotropic agents prior to graft harvesting was higher in myocardial bridging donors (0.4 vs. 1.0, p = 0.03). Additionally, electrocardiogram evidence of ischemia prior to graft harvesting was higher in myocardial bridging patients (25 vs. 54 percent, p = 0.05). Caucasian race was more common in donors without myocardial bridging (80 vs. 53 percent, p = 0.03). Hispanic race was more common in donors with myocardial bridging (0 vs. 26 percent, p = 0.01). Hypertension was more common in donors without myocardial bridging (20 vs. 3 percent, p = 0.04). Myocardial bridging patients demonstrated a higher incidence of postoperative arrhythmias after transplantation (5 vs. 21 percent, p = 0.05). Rates of need for permanent pacemaker implantation were similar (5 vs. 9 percent, p = 0.68). Higher rates of death from cardiovascular causes were observed for myocardial bridging patients, but this was not signifi cant (10 vs. 18 percent, p = 0.43). Kaplan-Meier analysis revealed signifi cantly lower event-free survival in myocardial bridging patients (hazard ratio = 1.8, p < 0.001).


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TABLE 1. Summary of Recipient and Donor Characteristics

All Patients (n = 54)

Non-MB (n = 20)

MB (n = 34) p

Recipient profi le

Mean age (yr) 50 46 53 0.19

Sex (male, %) 70 65 74 0.53

Race

Caucasian (%) 43 55 35 0.08

Asian (%) 9 5 12 0.41

Black (%) 9 0 15 0.02

Latino (%) 19 15 18 0.68

Other (%) 4 5 3 0.70

Unlisted (%) 17 20 18

Blood type

A (%) 35 50 26 0.08

B (%) 19 10 24 0.18

O (%) 31 25 35 0.42

Unlisted (%) 15 15 15

CMV status (positive, %) 50 45 50 0.38

EBV status (positive, %) 43 30 50 0.78

Calcium channel blocker use (%) 31 40 26 0.23

Mean graft ischemic time (min) 242 245 240 0.78

Donor profi le

Mean age (yr) 31 33 30 0.43

Sex (male, %) 67 70 65 0.88

Mean Weight (kg) 82 80 82 0.69

Mean Height (cm) 177 177 177 1.00

Race

Caucasian (%) 63 80 53 0.03

Asian (%) 0 0 0 1.00

Black (%) 6 10 3 0.37

Latino (%) 17 0 26 0.01

Other (%) 2 0 3 0.33

Unlisted (%) 13 10 15


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Non-MB (n = 20)

MB (n = 34) p

Blood type

A (%) 11 10 12 0.69

B (%) 6 0 9 0.08

O (%) 19 15 21 0.73

Unlisted (%) 65 75 59

CMV status (positive, %) 48 45 50 0.73

EBV status (positive, %) 41 35 44 0.40

Diabetes (%) 0 0 0 1.00

Cancer (%) 2 0 3 0.33

Hypertension (%) 9 20 3 0.04

Coronary artery disease (%) 0 0 0 1.00

Gastrointestinal disease (%) 6 0 9 0.08

Chest trauma (%) 4 0 6 0.16

Cigarette use (%) 19 20 18 0.90

Cigarettes use in last 6 months (%) 15 20 12 0.17

Alcohol abuse (%) 15 10 18 0.46

IV drug use (%) 0 0 0 1.00

Donor cause of death

Head Trauma (%) 54 50 56 0.61

Anoxia (%) 17 25 12 0.26

CVA (%) 17 15 18 0.78

Other (%) 2 0 3 0.33

Unknown (%) 11 10 12

Mechanism of injury

Blunt injury (%) 31 35 29 0.71

Gunshot wound (%) 22 15 26 0.29

Drug intoxication (%) 4 10 0 0.16

Intracranial hemorrhage/stroke (%) 19 15 21 0.58

Cardiovascular (%) 9 10 9 0.91

Other (%) 15 15 15 0.33

Unlisted (%) 0 0 0

Cardiac arrest (%) 13 15 12 0.80

Continued


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Non-MB (n = 20)

MB (n = 34) p

Mean peak troponin 1.5 1.9 1.3 0.56

Mean number of inotropes 0.7 0.4 1.0 0.03

Pre-procurement Angiogram (yes, %) 7 5 9 0.51

EKG fi ndings positive for ischemia (%) 35 25 54 0.05

Table 2. Clinical Outcomes


Non-MB (n = 20)

MB (n = 34) p

Postoperative arrhythmias (%) 15 5 21 0.05

Vasospasm (%) 4 5 3 0.70

Permanent pacemaker (%) 7 5 9 0.68

Death (%) 24 15 29 0.05

Cause of death

Cardiovascular (%) 15 10 18 0.43

Cancer (%) 2 5 0 0.33

Chronic rejection (%) 2 0 3 0.32

Drug overdose (%) 2 0 3 0.32

Sepsis (%) 2 0 3 0.32

Small bowel obstruction (%) 2 0 3 0.32

Re-transplantation (%) 2 5 0 0.33


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CF7. Discordant Surgeon Views in the Management of Descending Thoracic Aortic Aneurysm: Justifi cation for Multidisciplinary Aortic TeamsPeter Chiu1, Anna M. Sailer2, Michael T. Baiocchi3, Andrew B. Goldstone1, Justin M. Schaffer1, Jeff Trojan1, Dominik Fleischmann2, *R. Scott Mitchell1, *D. Craig Miller1, Michael D. Dake1, *Y. Joseph Woo1, Jason T. Lee4, *Michael P. Fischbein1

1Department of Cardiothoracic Surgery, Stanford University, School of Medicine, Stanford, CA; 2Department of Radiology, School of Medicine, Stanford, CA; 3Stanford Prevention Center, School of Medicine, Stanford, CA; 4Division of Vascular Surgery, Stanford University, School of Medicine, Stanford, CA

OBJECTIVES: Thoracic Endovascular Aortic Repair (TEVAR) has become a popular alternative to open surgical repair (OSR) given lower perceived risks. Technologi-cal refi nements have facilitated the use of endovascular therapy among patients with descending thoracic aortic aneurysms (DTAA) traditionally treated with OSR. Despite published guidelines, whether consensus exists regarding the optimal treat-ment of patients with DTAA is unknown.

METHODS: Retrospective analysis of patients who underwent operation for isolated DTAA (excluding dissection and trauma) between 1/05 and 10/15 was performed. For outcome analysis, propensity scores were generated for OSR vs. TEVAR; incom-parable patients were excluded. Logistic regression was used to evaluate periopera-tive outcome controlling for baseline differences in treatment groups with inverse probability of treatment weighting (IPTW). The composite primary adverse outcome included perioperative death, stroke, paraplegia, myocardial infarction, or limb isch-emia. Separately, treatment preference was evaluated by asking four cardiovascular surgeons, 1 vascular surgeon, and 1 interventional radiologist to review representa-tive CTA or MRA images and a brief clinical history. Each surgeon’s preference for OSR or TEVAR was recorded on a fi ve-point scale (strongly prefer TEVAR, weakly prefer TEVAR, either, weakly prefer OSR, strongly prefer OSR), and review-time was recorded. Ratings were compared using non-parametric methods. K-means non-hier-archical clustering delineated groups of similar rating patterns. These clusters were then characterized as concordant or discordant.

RESULTS: Isolated DTAA was present in 93 patients, and 78 patients were included in the outcome analysis (Table 1). Perioperative mortality was low, 2.6% (2/78) overall. Odds of the primary adverse outcome were increased among ruptured OSR patients compared with TEVAR patients (OR 45.185, 95% CI 1.285, ∞), but no differ-ence was found between the two modalities in patients with unruptured aneurysms (OR 4.534, 95% CI 0.596, 34.483).

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Preoperative imaging studies were available in 77 of the 93 patients; substantial differences in opinions existed among evaluators (Friedman test P <0.001). Inter-observer agreement was only fair (median weighted Kappa 0.270 [IQR 0.211, 0.404]). K-means clustering produced 6 distinct patterns of recommendation: Open (n = 7, 10%), Endovascular (n = 28, 36%), and 4 discordant patterns (n = 42, 55%) (Figure 1). Discordant patterns were associated with greater mean normalized review time (p = 0.007). In univariate logistic regression, only history of stroke predicted concordant recommendation.

Table 1, Demographic Information: (Left) Baseline, n = 93; (Right) After Restriction and IPTW, n = 78

TEVAR OSRStandardized

Difference TEVAR OSRStandardized

Difference

74.1 63.4 –0.837 Age 68.8 68.8 –0.001

26.47 26.81 0.071 BMI 27.2 27.1 –0.014

31.1% 25.0% –0.137 COPD 35.20% 36.40% 0.024

43%/57% 34%/66% –0.170 Female/Male 39%/61% 40%/60% 0.021

16.4% 18.8% 0.062 Heart Failure 14.00% 13.40% –0.020

1.6% 3.1% 0.098 Marfan 1.60% 1.80% 0.019

1.42 1.34 –0.058 Preoperative Creatinine

1.25 1.26 0.005

19.7% 12.5% –0.196 Rupture at presentation

14.10% 14.10% –0.001

14.8% 6.3% –0.280 Prior History of Stroke

9.30% 9.10% –0.006


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CONCLUSIONS: Management of DTAA is complex and requires experience, special expertise, and seasoned judgment, especially as the ideal treatment strategy contin-ues to evolve. At a tertiary thoracic aortic referral center, six independent evaluators disagreed on which approach would be optimal in the majority of cases, and biases were not readily predictable. Given the nuances of management, regionalizing care of these patients where an experienced multidisciplinary thoracic aortic team discusses all options jointly may decrease variability in practice, neutralize bias, and potentially improve outcomes.


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CF8. Should Patients with Atrial Fibrillation Referred for Coronary Artery Bypass Grafting Undergo Concomitant Surgical Ablation?Matthew R. Schill, Spencer J. Melby, Hersh S. Maniar, Laurie A. Sinn, Richard B. Schuessler, Jennifer S. Lawton, Marc R. Moon, Ralph J. Damiano, Jr.Washington University in St. Louis, Saint Louis, MO

OBJECTIVES: Multiple studies have shown that the Cox-Maze IV (CMIV) procedure performed concomitantly with other cardiac surgical procedures is safe and effective. Despite this, most patients with atrial fi brillation (AF) undergoing cardiac surgery do not receive concomitant ablation, particularly patients undergoing coronary artery bypass grafting (CABG), where up to 10% have AF at the time of surgery. The objec-tive of this study was to review outcomes of patients with AF undergoing CABG with and without concomitant CMIV at our institution.

METHODS: Between March 2002 and July 2015, 136 patients underwent left- or bi-atrial CMIV with concomitant CABG. During the same period, 425 patients with preoperatively diagnosed AF underwent CABG without surgical ablation. Patients undergoing other cardiac procedures, except for mitral valve repair for ischemic regurgitation, and patients who had emergent, reoperative or off-pump procedures were excluded, leaving 84 patients in the CMIV group and 174 patients in the control group. Data from our STS and Maze databases were prospectively collected and retrospectively analyzed. Nearest-neighbor propensity score matching was per-formed. Outcomes were evaluated using Fisher’s exact test for categorical variables and the Kruskal-Wallis test for continuous variables. In CMIV patients, freedom from AF (FFAF) was ascertained using EKG, Holter monitor, and/or pacemaker interrogations.

RESULTS: All patients who underwent CABG with CMIV were matched with 84 patients who underwent CABG without ablation. Preoperative variables were similar between groups after matching, with the exception of a lower number of diseased vessels in the ablation group (2.00 vs. 2.49, p < 0.001). Concomitant mitral valve repair was performed in 25/84 CMIV patients and 18/84 control patients (p = 0.29). Cardiopulmonary bypass time was higher in the CMIV group (190 vs. 119 min., p < 0.001), as was cross-clamp time (91 vs. 81 min., p = 0.026). CMIV patients had signifi cantly higher rates of renal failure (12/84 vs. 2/84, p = 0.010) and atrial arrhythmias (48/84 vs. 17/84, p < 0.001) and a slightly longer hospital length of stay (9 vs. 8 days, p = 0.001). Other perioperative outcomes were similar between groups, including pacemaker implantation, renal failure requiring dialysis, and 30-day mortal-ity. One-year follow-up data were available for 54 of 67 eligible CMIV patients (81%). FFAF at 1 year was 98%, with 87% off antiarrhythmic drugs (AADs) (Figure).


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CONCLUSIONS: In our experience, the addition of CMIV to CABG is associated with prolonged bypass time, some added risk of renal failure and one extra day in the hospital. However, the addition of a CMIV in selected patients resulted in an excellent freedom from AF and AADs at one-to-four years postoperatively. Our results would argue for a more aggressive surgical approach to AF in patients referred for CABG.


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CF9. Simvastatin Reduces the TLR4-Induced Infl ammatory Response in Human Aortic Valve Interstitial CellsNeil Venardos, Xin-Sheng Deng, *Michael J. Weyant, *Thomas B. Reece, Xianzhong Meng, *David A. FullertonUniversity of Colorado, Aurora, CO

BACKGROUND: Calcifi c aortic stenosis is a chronic infl ammatory disease. When stimulated by pro-infl ammatory stimuli that are mediated by Toll-like receptor 4 (TLR4), the aortic valve interstitial cell (AVIC) undergoes a phenotypic change. It fi rst assumes an infl ammatory phenotype characterized by the production of infl am-matory mediators such as intercellular adhesion molecule-1 (ICAM-1) and mono-cyte chemoattractant protein-1 (MCP-1). It then further changes to an osteogenic phenotype. To date, no clinically approved pharmacological agent has been identifi ed to prevent this pro-infl ammatory signaling. However, in addition to their cholesterol-lowering properties, statins have recently been shown to have anti-infl ammatory properties as well. We therefore hypothesized that statins down-regulate TLR4-stim-ulated infl ammatory responses in human AVICs. Our purposes were (1) to deter-mine the effect of statins on TLR4-induced expression of infl ammatory mediators in human AVICs, and (2) to determine the mechanism(s) through which statins exert this effect.

METHODS: AVICs were isolated from normal aortic valve leafl ets from the explanted hearts of four patients undergoing heart transplant. Cells were treated with simvas-tatin (10, 30, 50 μM) and atorvastatin (10, 30, 50 μM) for 1 hour prior to stimulation with TLR4 agonist lipopolysaccharide (LPS, 0.2 μg/mL). Immunoblotting was used to analyze cell lysate for ICAM-1 expression, and ELISA was used to detect MCP-1 in cell culture media. AVICs were treated with LPS for 1 hour, and lysates were analyzed for phospho- and total nuclear factor-kappa B (NF-kB). Cells were also treated with simvastatin alone, and TLR4 levels were analyzed by immunoblotting. Statistics were by t-test (p < 0.05).

RESULTS: Treatment with simvastatin, but not atorvastatin, reduced TLR4-induced ICAM-1 and MCP-1 expression in AVICs (see Figure). Simvastatin down-regulated TLR4 levels and suppressed TLR4-induced phosphorylation of NF-kB.

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CONCLUSIONS: This study demonstrated that a clinically-approved drug, simv-astatin, signifi cantly reduced the TLR4-induced infl ammatory response in isolated human AVICs. This effect was mediated by down-regulation of cellular TLR4 levels and modulation of NF-kB activation. To our knowledge, these data are the fi rst to demonstrate the potential of a medical therapy to impact the pathogenesis of aortic stenosis.


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CF10. Print, Practice, Perform: Combining 3D Printing and Surgical Simulation in Hypertrophic CardiomyopathyJoshua Hermsen1, Thomas Burke1, Stephen Seslar2, *Nahush Mokadam1, *Edward Verrier1

1University of Washington, Seattle, WA; 2Seattle CHildren’s Hospital, Seattle, WA

OBJECTIVES: Three-dimensional printing (3Dp) is an emerging medical technology. Static 3Dp models have been used in cardiothoracic surgery for planning and intra-operative reference, particularly for challenging congenital anatomy. We sought to develop a functional 3Dp model for improved anatomic understanding and surgical practice in hypertrophic cardiomyopathy (HCM) patients undergoing myectomy.

METHODS: 3Dp models were constructed pre-operatively for 2 patients. Stereo-lithography (.stl) fi les were generated by segmentation (ITK-SNAP open source software) of an electrocardiogram-gated, contrasted-enhanced chest computed tomography scan. 3Dps were made using a proprietary hydrogel material yielding a tissue-like model that can be surgically manipulated. Septal myectomy of the model was performed in standard trans-aortic fashion the day before operation in the simulation lab (Figure, left). Volumes of model and patient specimens were measured by liquid displacement for comparison. Clinical echocardiographic correlates were obtained and analyzed.

RESULTS: The 3Dp models were judged subjectively useful by two surgeons for pre-operative visualization and planning. There was good agreement between volumes of model and patient resection specimens (Figure, right; patient 1: 3.5 cm3 and 3.0 cm3 respectively; patient 2: 4.0 cm3 and 4.0 cm3, respectively, not shown). Intraoperative echocardiographic assessment showed decrease in peak left ventricular outfl ow tract gradients from 80 to 18 (patient 1) and 96 to 9 mmHg (patient 2) respectively. Both patients report symptom improvement from NYHA class III to class I.

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CONCLUSIONS: 3Dp of functional HCM heart models allows for patient-specifi c pre-operative simulation. Model resection volume provides a target for intra-operative resection volume. This relationship was congruous on both specimens and suggests evidence of construct validity. Both patients received excellent echocardiographic results. This model also holds educational promise for high fi delity simulation of a low-volume, high-risk operation that is traditionally diffi cult to teach.


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CF11. Thirty Year Experience with Bileafl et Mechanical Valve ProsthesisScott Johnson, Martha Stroud, John Kratz, Scott Bradley, Fred Crawford, *John IkonomidisMedical University of South Carolina, Charleston, SC

BACKGROUND: To evaluate the long term outcomes of patients who received a bileafl et mechanical valve prosthesis at a single center.

METHODS: Our institution began implanting bileafl et mechanical valves prosthesis in 1979. Since then, every patient receiving a bileafl et mechanical valve prosthesis has been followed, annually. We have actively tracked our prospectively obtained cohort, identifying valve issues, thromboembolism rates, bleeding risk, reoperations, and overall morbidity and mortality. Here we present the 30 year results of this annually followed cohort.

RESULTS: Total number of patients surveyed was 1023, from January 1979 through December 2014. Ages ranged from 18 to 85 years old. Male patients represented 70% (411/584) of the aortic valve recipients and 41% (179/439) of the mitral valve recipients. Seventy-seven percent (450/584) of the aortic valve recipients and 89% (389/439) of the mitral valve recipients were in New York Heart Association class III or IV. Nineteen and 21mm valves accounted for 41% (238/584) of aortic implants. Concomitant coronary artery bypass was carried out in 31% (179/584) of aortic valve recipients and 19% (82/439) of mitral valve recipients. Operative mortality was 3% (17/584) in the aortic valve recipients and 4% (18/439) in the mitral valve recipi-ents. Ninety-fi ve percent of the patients had complete follow-up. Amongst aortic valve recipients, late actuarial survival was 82 ± 2%, 62 ± 2%, 45 ± 2%, 32 ± 2%, 22 ± 3%, and 14 ± 3% at 5, 10, 15, 20, 25 and 30 years respectively. Thirty year freedom from reoperation, thromboembolism, bleeding and endocarditis was 92 ± 2%, 76 ± 3%, 56 ± 5%, 92 ± 2% respectively. Amongst mitral valve recipients, late actuarial survival was 84 ± 2%, 64 ± 3%, 44 ± 3%, 28 ± 3%, 19 ± 3%, and 14 ± 3% at 5, 10, 15, 20, 25, and 30 years, respectively. Thirty year freedom from reoperation, thromboembolism, bleeding and endocarditis was 85 ± 5%, 54 ± 6%, 57 ± 6%, and 95 ± 2%, respectively. Freedom from valve related mortality/morbidity at 30 years was 29 ± 6% and 27 ± 4% for aortic and mitral valve replacements, respectively. Incidence rate of bleeding was 2.5% and 2.0% per patient-year for aortic and mitral valve recipients, respec-tively. Incident rate of thromboembolism was 1.6% and 2.89% per patient-year for aortic and mitral valve recipients, respectively. Freedom from valve related mortality was 76 ± 4% and 79 ± 5% for aortic and mitral valve replacement, respectively.

CONCLUSIONS: With all of our bileafl et mechanical valves prosthesis followed annually since 1979, we have allowed for closer follow up to better identify valve related issues and events. After three decades of observation with close follow-up, the bileafl et mechanical valve prosthesis continues to be a reliable prosthesis.

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CF12. Elderly Patients Bridged from a Left Ventricular Assist Device to Heart Transplant Do Not Have an Increase in Adverse Events: A Multi-institutional AnalysisAnn C. Gaffey, Carol W. Chen, Mallory Irons, Jennifer J. Chung, Chantel M. Venkataraman, Jennifer Lee, Joyce Wald, Michael A. Acker, Pavan AtluriHospital of the University of Pennsylvania, Philadelphia, PA

OBJECTIVE: Survival of patients bridged to transplant (BTT) with left ventricular assist devices (LVADs) has improved. Skepticism remains, however, in utilizing LVADs in older patients given concerns of morbidity and mortality at transplant. We investigated the association of pre-transplant LVAD and post-transplant outcomes using the United Network for Organ Sharing database (UNOS).

METHODS: We retrospectively analyzed the UNOS adult heart transplant donor and recipient data from June 2004 to December 2012 during which 37,408 orthotopic heart transplants (OHT) were performed in patients older than 65 years of age. Pres-ence or absence of mechanical support was noted in 3,951 patients. The recipients were divided into two cohorts BTT (n = 428) or non-BTT (3,479). Patients with an RVAD, total heart, or biventricular device were excluded (n = 44). Analysis of morbid-ity and mortality was conducted.

RESULTS: No differences existed with regard to recipient age (p = 0.52), gender (p = 0.85), or presence of diabetes (p = 0.53), cerebral vascular disease (p = 0.18), and kidney (p = 0.25) or liver dysfunction (p = 0.39). Hypertension was more com-mon in the non-BTT cohort (p = 0.004). Donors did not differ in age (p = 0.21), gender (p = 0.19), left ventricular ejection fraction (p = 0.54) or allograft ischemic time (p = 0.20). Post-operatively, there was a signifi cantly higher incidence of stroke in BTT (4.5%) versus non-BTT cohorts (2.1%, p < 0.00001). The incidence of re-operation (p = 0.19), dialysis (p = 0.60), infection (p = 0.07), and heart block (p = 0.06) were similar. The rate of rejection was low but signifi cantly higher in the BTT cohort (6.0% vs 7.5%, p = 0.02). There was no difference in length of hospital stay (p = 0.56). One year (85.0% vs 86.9%), fi ve year (70.1% and 68.5%), and 10 year (45.4% vs. 44.5%) survival were similar in the BTT and non-BTT cohorts, using Kaplan-Meier Survival Analysis (log rank p = 0.4303).


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CONCLUSIONS: Elderly patients bridged with an LVAD have a survival comparable to those patients without an LVAD. There is a higher incidence of stroke and biopsy proven rejection following implant of an LVAD in this cohort. The benefi ts of VAD as BTT should be considered in patients 65 and older to allow stabilization for subse-quent OHT.


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CF13. A New Intraoperative Protocol for Reducing Perioperative Transfusions in Cardiac SurgerySarah A. Schubert, J. Hunter Mehaffey, Michael G. Gelvin, Eric J. Charles, Robert B. Hawkins, Lily Johnston, Gorav Ailawadi, Irving L. Kron, Leora T. YarboroUniversity of Virginia, Charlottesville, VA

OBJECTIVES: Both perioperative anemia and transfusion of blood products during and after cardiac surgery have been shown to increase short and long-term morbid-ity and mortality; yet, specifi c interventions to correct perioperative anemia and coagulopathy while still reducing transfusion rates have not been well elucidated. This study examined the effects of a streamlined cardiopulmonary bypass circuit and rotational thromboelastometry (ROTEM) on perioperative hematocrit and transfu-sion rates, as well as observed to expected (O/E) ratios of morbidity and mortality in cardiac surgery. We hypothesized that these two interventions reduced blood product usage both independently and in combination to improve outcomes.

METHODS: We retrospectively evaluated all patients with Society of Thoracic Sur-gery Predicted Risk of Morbidity and Mortality (PROM) undergoing cardiac surgery at our institution from January 2013 through June 2015. They were chronologically stratifi ed according to institutional changes that were made within our cardiac sur-gery program: patients who underwent surgery using a standard cardiopulmonary bypass circuit and without ROTEM (control), patients who underwent surgery using a streamlined circuit but prior to the institution of ROTEM, and patients who under-went surgery using a streamlined circuit and ROTEM-guided transfusion. Intraopera-tive and total transfusions, hematocrit, and PROM O/E were compared between the groups using appropriate parametric and non-parametric statistical measures.

RESULTS: Patients were defi ned as either control group (533 patients over 12 months) or intervention group (804 patients over 18 months),. The intervention group was further subdivided into those who used a streamlined circuit (290 patients over 6 months) and those who used ROTEM (514 patients over 12 months). The use of a streamlined bypass circuit signifi cantly reduced the percentage of patients receiving intraoperative transfusion of packed red blood cells (pRBC) (23.8% vs 17.9% p = 0.05) and platelets (28.0% vs 19.3% p = 0.01) with improve-ment in lowest intraoperative hematocrit (26.0 vs 26.9 p = 0.02). ROTEM implemen-tation further reduced the percentage of patients receiving intraoperative pRBCs (17.9% vs 11.28% p = 0.01) and postoperative transfusion pRBCs (38.3% vs 23.5% p = 0.02). The combination reduced all intraoperative (44.6% vs 34.1 p < 0.001) and postoperative transfusions (45.6% vs 40.1 p < 0.001) in the intervention group, while maintaining a higher hematocrit at discharge (28.1 vs 29.1 p < 0.001). Finally, the intervention resulted in a statistically signifi cant reduction in the O/E for reoperation (p = 0.003).


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CONCLUSION: Using a streamlined cardiopulmonary bypass circuit and ROTEM reduce transfusion rates and improve perioperative anemia and reoperation rates in cardiac surgical patients. This study demonstrates reproducible intraoperative meth-ods for reducing blood product usage and improving outcomes.


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GENERAL THORACIC

Kings 1

Moderators: Matthew G. BlumDouglas E. Wood

CF14. Molecular Analysis of Thymic Epithelial Tumors Identifi es Novel Subtypes Associated with Distinct Clinical OutcomesHyun-Sung Lee, Rohan Shah, David Yoon, Ori Wald, Shawn S. Groth, David J. Sugarbaker, Bryan M. BurtBaylor College of Medicine, Houston, TX

OBJECTIVES: Thymic epithelial tumors (TETs) are enigmatic tumors comprised of variable proportions of epithelial and lymphocytic components. TET biology is complex, resulting in heterogeneous clinical outcomes even amongst patients of similar stage and histology. To reconcile the heterogeneity of these tumors and to gain deeper understanding of the molecular determinants of these tumors, we set out to establish a clinically relevant molecular classifi cation system.

METHODS: Molecular subgrouping of TETs was performed in 120 patients from The Cancer Genome Atlas using a multidimensional approach incorporating DNA mutational analyses, unsupervised clustering of mRNA expression data, and somatic copy number alterations (SCNA). Univariable and multivariable logistic regression analyses were performed to evaluate recurrence-free survival (RFS) and overall sur-vival (OS). Two independent cohorts from the NCBI Gene Expression Omnibus were used to validate our results [validation cohort 1: GSE57892 (n = 22) and validation cohort 2: GSE29695 (n = 36)].

RESULTS: Four distinct molecular subtypes of TETs were identifi ed (Figure 1A-B). The most commonly identifi ed gene mutation in TETs was a missense mutation in General Transcription Factor II-I (GTF2I). A GTF2I mutation was present in 46 (38%) of patients and defi ned GTF2I Group. Group 2 was identifi ed by unsuper-vised mRNA clustering of GTF2I wild type tumors and represented TETs signifi cantly enriched in expression of genes associated with T cell activation, hereafter referred to as the TCA group (n = 39, 33%). The remaining 2 groups were distinguished by their degree of chromosomal stability (CS; n = 10, 8%) or instability (CIN; n = 25, 21%) based upon SCNA analyses Considering these molecular subtypes as a spectrum (ranging from GTF2I to TCA to CS to CIN), the GTF2I group was associated with more favorable WHO histology, less advanced Masaoka stage, and the absence of myasthenia gravis (MG); and the CIN group was associated with less favorable WHO histology, more advanced Masoaka stage, and the presence of MG (Figure 1C). The presence of a GTF2I mutation was associated with strikingly good RFS and OS, as was the TCA gene expression signature. Patients in the CIN group had signifi cantly unfavorable RFS and OS (Figure 1D). In univariable and multivariable analyses of


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OS incorporating variables of sex, age, MG, WHO histology, Masaoka stage, and molecular subtypes, molecular classifi cation was the only signifi cant independent predictor of OS (HR 2.04, p = 0.03). Further, among patients with advanced TETs (stage III and IV), all patients with GTF2I mutations (n = 5) and all patients with a TCA gene expression signature (n = 4) showed 100% OS during follow-up (Figure 1D). Validation of our molecular classifi cation in two independent cohorts demon-strated the same patterns of molecular subtypes and corresponding clinical features as the discovery cohort.

CONCLUSIONS: The GTF2I mutation is the most common TET mutation and is correlated signifi cantly with favorable OS and RFS. This TET molecular stratifi cation framework can aid in deeper understanding of TET biology, and in the discovery and development of rational treatment options for TET patients.


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CF15. The Expression of Programmed Death 1 Ligand (PD-L1) in the Tumor and Tumor Infi ltrating Macrophages Predicts Overall and Disease Free Survival in Surgically Resected Pathologic Stage I Non-Small Cell Lung CancerBoris Sepesi, Edwin Parra Cuentas, Jaime Rodriguez Canales, Carmen Behrens, Arlene Correa, Mara Antonoff, Don Gibbons, John Heymach, *Wayne Hofstetter, Reza Mehran, David Rice, Jack Roth, Ara Vaporciyan, Garrett Walsh, Annikka Weissferdt, Neda Kalhor, Cesar Moran, Stephen Swisher, Ignacio WistubaAnderson Cancer Center, Houston, TX

BACKGROUND: Checkpoint inhibitors targeting the interaction between the programmed cell death protein 1 (PD1) and programmed cell death ligand (PD-L1) proteins have demonstrated encouraging results in metastatic non-small cell lung cancer (NSCLC), suggesting the importance of PD-L1 in regulating a host’s immune response to lung cancer. We investigated whether the level of PD-L1 expression in the whole tumor and tumor infi ltrating macrophages is associated with long-term outcomes in surgically resected pathologic stage I NSCLC.

METHODS: Pathologic specimen from 113 patients with stage I (pT1-2a, N0, M0, tumor size 1–5 cm) NSCLC (79 adenocarcinoma, 34 squamous cell carcinoma) were analyzed for PD-L1 expression in the tumor and in the tumor infi ltrating macro-phages utilizing immunohistochemistry and image analysis. Percent (%) PD-L1 expression and H-scores were recorded. Statistics included recursive partitioning, to identify the level of PD-L1 expression that discriminated overall and disease free survival (OS and DFS), univariable, multivariable, and Kaplan Meier analyses.

RESULTS: Patients whose tumors expressed <5% PD-L1 (N = 87) or H score <3.2 (N = 85) experienced signifi cantly better OS (p = 0.001, p = 0.002 respectively), than patients with PD-L1>5% (N = 28) or H score (N = 26) > = 3.2 (Figure 1). Patients with < 6.3% of PD-L1 expression in tumor infi ltrating macrophages also experienced signifi cantly better (p < 0.05) OS than patients with > 6.3% PD-L1 macrophage expression. Similar results were observed in the analysis of DFS. Patients with <5% PD-L1 or H score <3.2 in the tumor demonstrated signifi cantly better DFS (p = 0.012 and p = 0.019), compared to patients with higher PD-L1 values. The best outcomes were observed in patients with low PD-L1 expression in both tumor and macro-phages with 5-year overall survival of 94% (N = 17). Contrary, patients with high PD-L1 expression in both tumor and macrophages experienced 5-year OS of 20% (N = 19) Multivariable analysis identifi ed percent PD-L1 expression in the tumor

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(HR 3.5, p = 0.001) and macrophages (HR 4.1, p = 0.004), and age (HR 1.1, p = 0.002) to be independently associated with both OS and DFS, while histology, tumor size or CD8 cell tumor infi ltration were not associated with either overall or disease free survival.

CONCLUSIONS: Lower PD-L1 expression in the tumor and tumor macrophages is associated with signifi cantly better OS and DFS compared to patients with higher tumor or macrophages PD-L1 expression. PD-L1 is also a stronger predictor of out-come than tumor size in surgically resected Stage I lung cancer, and may become a novel prognostic biomarker. If validated by additional studies, these results may have an implication in the design of clinical trials utilizing checkpoint inhibitor therapy in surgically resectable NSCLC.


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CF16. Innovative Pressure-Directed Ventilation Strategy During Ex Vivo Lung Perfusion Attenuates InjuryJ. Hunter Mehaffey, Eric J. Charles, Ashish K. Sharma, Dustin Money, Christine L. Lau, Curtis G. Tribble, Victor E. Laubach, Mark E. Roeser, Irving L. KronUVA, Charlottesville, VA

OBJECTIVES: Critical organ shortages have resulted in Ex Vivo Lung Perfusion (EVLP) gaining clinical acceptance for lung evaluation and rehabilitation to expand the use of Donation after Circulatory Death (DCD) organs for lung transplantation. The purpose of this study was to modify the current ventilation and perfusion proto-col used during EVLP to optimize rehabilitation of DCD lungs. We hypothesized that an innovative use of airway pressure release ventilation (APRV) during EVLP would improve function and attenuate barotrauma and ischemia-reperfusion injury after lung transplantation.

METHODS: Using controls operated on by the same surgical team within a three-month window, we tested an APRV strategy for ventilation of four porcine lungs while on EVLP. Both groups (n = 4 animals/group) of DCD donor lungs were procured after hypoxic cardiac arrest and a 2-hour period of warm ischemia, followed by a 4-hour period of EVLP rehabilitation with either standard conventional volume-based ventilation or pressure-based APRV. Left lungs were subsequently transplanted into recipient animals and reperfused for 4 hours. Systemic, left superior, and left inferior pulmonary vein gas samples were obtained at 2 and 4 hours of reperfusion to measure PaO2/FiO2 ratios. Airway pressures were recorded for calculation of dynamic lung compliance, and percent wet weight gain during EVLP and reperfusion was measured.

RESULTS: Ventilation with APRV during EVLP signifi cantly improved left-lung oxygenation at 2 hours (561.5 ± 83.9 mmHg vs 341.9 ± 136.1 mmHg) and 4 hours (569.1 ± 18.3 mmHg vs 463.5 ± 78.4 mmHg) after transplantation (see Figure). Similarly dynamic compliance was signifi cantly improved at 2 hours (26.0 ± 5.2 mL/cmH2O vs 15.0 ± 4.6 mL/cmH2O) and 4 hours (30.6 ± 1.3 mL/cmH2O vs 17.7 ± 5.9 mL/cmH2O) after transplantation. Finally, APRV signifi cantly reduced lung edema during EVLP based on percentage weight gain (36.9 ± 14.6% vs 73.9 ± 4.9%) while there was no difference 4 hours after reperfusion.


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CONCLUSIONS: Pressure-directed APRV ventilation strategy during EVLP improves rehabilitation of severely injured DCD lungs. After transplant these lungs demon-strate superior lung specifi c oxygenation and dynamic compliance compared to lungs ventilated with standard conventional ventilation. This strategy, if implemented into current clinical EVLP protocols, could advance the fi eld of DCD lung rehabilitation to expand the lung donor pool and address the critical donor organ shortage.


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CF17. Outcomes After Surgical Resection of Stage IV Non-Small Cell Lung CancerBabatunde Yerokun1, Chi-Fu Jeffrey Yang1, Shivani Shah2, Lin Gu3, Xiaofei Wang3, Thomas D’Amico1, Matthew Hartwig1, *Mark Berry4

1Duke University Medical Center, Durham, NC; 2Duke University, Durham, NC; 3Duke University, Department of Biostatistics, Durham, NC; 4Stanford University Medical Center, Stanford, CA

BACKGROUND: Pulmonary resection is generally accepted as appropriate for very select patients with stage IV non-small cell lung cancer (NSCLC), but very few small studies have reported outcomes. This study evaluated the use of and long-term outcomes after pulmonary resection for stage IV NSCLC patients using the National Cancer Data Base (NCDB).

METHODS: Stage IV NSCLC patients from 2003–2011 in the NCDB who otherwise had primary tumors that were clinical stage I-II (cT1-2N0-1M1 and cT3N0M1) and potentially appropriate for surgical resection were identifi ed. Outcomes were evalu-ated using Kaplan-Meier and Cox proportional hazard analysis.

RESULTS: During the study period, 23,593 patients underwent chemotherapy, radiation, chemoradiation or surgery for cT1-2N0-1M1 or cT3N0M1 NSCLC. Surgery was used in 9.2% (n = 2162) of patients. In the surgery group, pneumonectomy was performed in 5.7% (n = 124) of patients, sublobar resection in 34.7% (n = 750) of patients, and lobectomy in 59.6% (n = 1288) of patients. The fi ve-year survival of patients who underwent surgical resection was 28.2%, while the fi ve-year survival was 4.8% for patients treated with combined chemotherapy and radiation (n = 8714) and 4.1% for all other patients (n = 12,717). Factors associated with increased sur-vival in patients who underwent surgery include chemotherapy (HR 0.74, 95% CI: 0.66–0.82) and female sex (HR 0.72, 95% CI: 0.64–0.80) while increasing age (HR 1.01, 95% CI: 1.00–1.02), T status (HR 1.24, 95% CI: 1.11–1.40 and HR 1.54, 95% CI: 1.27–1.87 for T2 and T3 tumors respectively, compared to T1), and N status (HR 1.42, 95% CI: 1.24–1.63 for N1 compared to N0) were associated with decreased survival. In addition, among patients who underwent surgery, sublobar resection (HR 1.52, 95% CI: 1.35–1.71) and pneumonectomy (HR 1.42. 95% CI: 1.13–1.77) were associated with decreased survival when compared to lobectomy in multivari-able analysis.

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CONCLUSIONS: Aggressive curative-intent therapy that includes pulmonary resec-tion is warranted in select patients with stage IV NSCLC. Outcomes are best for patients whose primary lung tumors are small, N0, and are treated with lobectomy. Further study is needed to better defi ne the location and distribution of metastatic disease for which surgery is most likely to provide long-term benefi ts.


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CF18. Robotically-Assisted Thoraco-Laparoscopic Esophagectomy Has a Higher 30-Day Readmission Rate Compared to Minimally Invasive Esophagectomy and Open EsophagectomyMichelle C. Nguyen, *Robert E. Merritt, Carl R. Schmidt, *Susan D. Moffatt-BruceThe Ohio State University Wexner Medical Center, Columbus, OH

OBJECTIVES: While it is known that readmission rates are high in post esopha-gectomy patients, there are currently few studies comparing the readmission rates between open esophagectomy (OE), minimally invasive esophagectomy (MIE), and robotically-assisted thoraco-laparoscopic esophagectomy (RATE). Our objective was to compare readmission rates of OE, MIE, and RATE and determine perioperative variables associated with increased readmission.

METHODS: All esophagectomies performed at a single institution between calendar years 2011 and 2015 were included for review. Patient demographics, comorbidities, tumor characteristics, surgeon, surgical approach, and hospital complications were analyzed with 30-day readmission rates for association. Length of stay, total OR time, total red blood cell (RBC) transfusions, total days in ICU, and tumor/nodal character-istics were analyzed with surgical approach for association. Analysis was performed using Fisher’s exact test and multivariate logistic regression.

RESULTS: 128 esophagectomies were performed. 78 (61%) were performed using OE approach, 16 (12.4%) using MIE approach, and 34 (27%) using RATE approach. 21 of 128 were readmitted within 30 days resulting in a readmission rate of 16%. Patients with postoperative pleural effusion had a higher likelihood of readmission (p = 0.032). The readmission rates of OE, MIE, and RATEs were 10%, 19%, and 29%, respectively. After adjusting for surgeon, BMI, HTN, CAD, DM, COPD, and smoking, RATE approach was found to have higher odds of readmission compared to OE or MIE (OR 3.70, CI 1.31, 10.45). Reasons for 30-day post-RATE readmissions included 2/10 anastomotic, 4/10 pulmonary, and 4/10 gastrointestinal complications. Remain-ing patient demographics, remaining hospital complications, length of stay, total OR time, total RBC transfusions, total days in ICU, and tumor/nodal characteristics were not associated with 30-day readmission or surgical approach in a statistically signifi cant way.

CONCLUSIONS: RATE has a higher 30-day readmission rate compared to MIE and OE. Large, multi-institution analyses need to be performed to evaluate perioperative outcomes and readmission rates following RATE to determine the learning curve, feasibility and effi ciency of this technology in an era of increased accountability for value-based care.

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CF19. Perspectives on Managing Incidental Pulmonary Nodules: A Survey of Primary Care PhysiciansGeena X. Wu, Martin Consunji, Kenny Yeung, Rebecca A. Nelson, Linus Kuo, Heeyong Kim, Can-Lan Sun, Jae Y. Kim, *Dan J. RazCity of Hope National Medical Center, Duarte, CA

BACKGROUND: The detection of incidental solitary pulmonary nodules will become increasingly common with dissemination of lung cancer screening. Primary care physicians, pulmonologists, oncologists, and thoracic surgeons may be involved in the evaluation of solitary pulmonary nodules. Primary care physicians are typi-cally the gatekeeper for referring patient for lung cancer screening and may choose self-management of solitary pulmonary nodules or referral to specialists but little is known about their perspectives on management of solitary pulmonary nodules.

METHODS: We randomly surveyed 1,500 primary care physicians in a large metro-politan county regarding their perspectives on lung cancer screening. Preliminary response rate from the ongoing survey was 14.1% (n = 212). We performed a subset analysis on a section of the survey pertaining to the management of pulmonary nodules and referral practices of primary care physicians. These results as well as those relating to practice characteristics such as years in practice, and size of practice as well as patient population were analyzed and compared among family practice physicians and internal medicine physicians.

RESULTS: Among survey respondents, 113 (53.3%) primary care physicians reported feeling somewhat or very confi dent in managing the workup of a pulmo-nary nodule detected on imaging. Internal medicine physicians (n = 76, 67.3%) were more likely to express confi dence than family practice physicians (n = 33, 29.2%), p = 0.027. However, only 41 (19.3%) primary care physicians were inclined to man-age the evaluation and follow up of pulmonary nodules themselves, while the major-ity (n = 128, 60.4%) preferred to refer to a specialist. Family practitioners (n = 54, 42.2%) and internists (n = 70, 54.7%) similarly disagreed to self-managing solitary pulmonary nodules (p = 0.68). Among all primary care physicians, 73.1% (n = 155) agreed to most commonly referring management of a pulmonary nodule or mass to a pulmonologist. Additionally, 26.9% (n = 57) cited that they might also refer the patient to a surgeon and 21.7% (n = 46) might refer to an oncologist. There was no signifi cant difference between family practice and internal medicine physicians with regards to years in practice, size of practice, or referrals to specialists.

CONCLUSIONS: Although more than half of primary care physicians express confi dence in the work-up of solitary pulmonary nodules, a large majority of these providers prefer specialists to manage solitary pulmonary nodules. The reason for this is unclear. As lung cancer screening becomes more prevalent, understanding the perceptions of primary care physicians in the management of solitary pulmonary nodules found incidentally during lung cancer screening will become increasingly important.

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CF20. Comparison of Uniportal and Multi-Incision VATS Lung Resection at a North American InstitutionWilliam J. Gibson, Scott G. Louis, Duke Pfi tzinger, Nirmal VeeramachaneniUniversity of Kansas, Kansas City, KS

OBJECTIVES: VATS (video assisted thoracic surgery) lobectomy for lung cancer has been demonstrated to not only have equivalent results to thoracotomy for lung cancer resection, but also has been demonstrated to improve patient recovery with less physiologic insult to the patient. Since 2010, as an evolution in minimally inva-sive technique, uniportal VATS lung resection has been reported by some European institutions to not only be feasible, but provide excellent results for the patient. The objective of this study was to analyze the outcome of patients undergoing anatomic lung resection by either uniportal or multiport VATS technique.

METHODS: We reviewed the outcomes of all consecutive anatomic lung resections performed via uniportal or multiport technique VATS from August 2013 through September 2015 from a single surgeon at a North American National Cancer Institute designated cancer center. The patient demographics, pathologic data, hospital length of stay, chest tube duration, postoperative complications, and oncologic results were assessed and compared between the 2 groups.

RESULTS: The records of 95 patients were retrospectively reviewed. 37% (n = 35) underwent multiport VATS: 33 lobectomies, and 2 segmentectomies were performed. 63% (n = 60) underwent resection by uniportal technique: 50 lobectomies, 6 seg-mentectomies, 1 bilobectomy, and 3 pneumonectomies were performed.

Of the 60 patients undergoing uniportal lung resection, 5% (n = 3) underwent conversion to multi incision VATS technique, and 2% (n = 1) required conversion to thoracotomy. Of 35 patients undergoing traditional multiport VATS, 3% (n = 1) underwent conversion to thoracotomy. There were no differences between groups with regard to baseline demographics and tumor size (Table 1). The groups were sim-ilar with regard to chest tube duration, number of N2 lymph node stations assessed and total number of lymph node stations assessed. There was a trend toward shorter length of post-operative hospitalization and chest tube duration (Table 2, Figure 1). 43% (n = 25) of patients undergoing uniportal resection were discharged home by post-operative day 2, versus 21% (n = 7) of patients undergoing multi-port resection.


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Demographics

Multiport VATSn = 35

Uniportal VATSn = 60 p-value

Male 20 (57%) 24 (40%) 0.122

Age in years 64 ( ± 8.9) 67 ( ± 8.2) 0.101

Tumor Size (cm) 2.67 ( ± 1.4) 2.17 ( ± 1.4) 0.102

data expressed as mean (SD)

Outcomes of Multiport and Uniportal VATS

Multiport VATS

Uniportal VATS p-value

# lymph node stations assessed 5.5 (5,6) 5.0 (4.25, 6) 0.357

# N2 lymph node stations assessed

4.0 (3,4) 4.0 (3, 4) 0.074

chest tube duration in hours 41 (23,68) 33.5 (24, 69) 0.672

length of stay in days 3 (3,5) 3 (2,4) 0.093

data expressed as median (inter-quartile range)


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CONCLUSIONS: In this retrospective study, uniportal VATS lung resection demon-strated comparable oncologic outcomes to traditional multi-incision VATS technique. In addition, there was a trend toward shorter hospitalization and thoracostomy duration after uniportal resection. Uniportal VATS surgery has become our standard technique for all lung resections; however, further investigation regarding longterm outcomes is necessary.


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CF21. Failing to Plan or Planning to Fail: Lack of Adherence to Guideline Recommendations for Imaging Surveillance Among Early Stage Lung Cancer Patients in a Universal Access Healthcare SystemMathieu C. Rousseau1, Bharathi Lingala1, Laura Ferrara2, Jason Caucutt2, *Mark F. Berry1, *Joseph B. Shrager1, *Leah M. Backhus1

1Stanford University, Stanford, CA; 2University of Washington, Seattle, WA

OBJECTIVES: A minority of early stage non-small cell lung cancer (NSCLC) patients receive surveillance imaging consistent with national guidelines following defi ni-tive treatment. Poor adherence rates may be due to lack of intentional surveillance planning as well as reliance upon inappropriate surveillance strategies. We examined post-treatment imaging surveillance strategies and concordance with national surveil-lance guidelines among veterans in a universal access system.

METHODS: All patients at a single VA who had surgical resection as defi nitive treatment for stage I-II (AJCC 7th) NSCLC between 2001–2011 were retrospec-tively reviewed using VA Cancer Registry data and electronic medical record chart abstraction. Initial surveillance plan documentation and post-operative imaging studies performed were examined. Surveillance plans in concordance with National Comprehensive Cancer Network (NCCN) guidelines for 2001–2010 were defi ned as chest computerized tomography (CT) every 4–6 months for the fi rst 2 years. Adher-ence with guidelines was defi ned as initial CT scan performed within 4–8 months of treatment.

RESULTS: Of 208 patients who met study criteria (mean age 67.8, 96.2% male), an imaging surveillance plan was documented in 28% (n = 58). Of patients with a docu-mented surveillance plan, 60% relied on chest x-ray (CXR) and 36% on CT scan. The most frequent documented strategy was CXR every 4 months (44.8%). Plans in concordance with guidelines were documented in only 29% of patients. (Table 1) Of the entire cohort, 42% of patients received a CXR and 29% received a CT for surveil-lance between 4–8 months. Receipt of surveillance CT increased to only 44% by 12 months. The majority of CXR (78.7%) and CT (90.6%) scans were performed with the intent for surveillance. For those patients with documented guideline concordant plans, 65% received a surveillance CT between 4–8 months consistent with NCCN guidelines which was signifi cantly higher than those with guideline discordant plans (21%, p = 0.002). There was no difference in rates of guideline adherence for surveil-lance CT between those patients with surveillance plans discordant with guideline recommendations compared to those patients with no plan documentation (24%, p = 0.64).

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CONCLUSIONS: A minority of patients who undergo surgical resection of early-stage lung cancer have a documented plan for imaging surveillance. Most clinicians who do plan surveillance use strategies that are inconsistent with NCCN recommen-dations. Documentation of a surveillance plan that is guideline concordant correlates with actual receipt of guideline adherent care. The quality gap highlighted in this study appears to be at the provider and not system level highlighting the need to improve provider education, structured surveillance programs, and prospective data linking surveillance to improved outcomes.


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CF22. Large Hiatal Hernia; Safe and Effective Repair by Laparoscopic Approach without the Need for Esophageal Lengthening and with Rare Symptomatic Recurrence*Farzaneh Banki1, Chandni Kaushik2, David Roife2, Munish Chawla3, Charles C. Miller2

1University of Texas Health Science Center at Houston, Memorial Hermann Southeast Esophageal Disease Center, Houston, TX; 2University of Texas Health Science Center at Houston, Houston, TX; 3Memorial Hermann Southeast Esophageal Disease Center, Houston, TX

OBJECTIVES: To assess the outcomes of patients who underwent laparoscopic repair of large hiatal hernias.

METHODS: Retrospective chart review, clinic visit data and a follow up symptomatic questionnaire via phone. All the procedures were performed by the same surgical and anesthesia team. The postoperative care was provided by a trained team of thoracic nurses.

RESULTS: From 09/16/2009 to 09/08/2015, there were 215 laparoscopic hernia repairs.

We excluded redo procedures (n = 35) and type I hernias < 4cm (n = 49) giving a study population of 131 patients. There were 36 type I hiatal hernias ≥ 4 cm: size 5 (4–5.25) cm, 4 type II: 6 (5–8) cm, 37 type III, and 54 type IV [26 of whom had the entire stomach in the chest]. Values are presented as median and interquartile range (IQR). There were 29 males and 102 females with median age of 63 (56–74). The median duration of operation was 138 (119–172) min. There were 28 Nissen, 102 Toupet and one Dor fundoplication. Tension free esophageal length was obtained by mediastinal mobilization in all, without need for Collis gastroplasty. Vicryl mesh for crural closure reinforcement was used in 106 patients. There was one conversion due to esophageal perforation by bougie in a patient with Nissen. Delayed esophageal leak occurred in two patients with Toupet. The median length of stay was 2 (1–3) days.

The post-operative complications included atrial fi brillation in fi ve, reintubation in three, heparin induced thrombocytopenia resulting in stroke in one, gastric distension or ileus requiring nasogastric tube in fi ve and temporary dialysis in one patient. There was no 30 day mortality. In-person clinical follow up was obtained in 121/131(92%) patients at a median of 3.5 (0.5–7.3) months. Heartburn was reported in fi ve, regurgitation in 11 and dysphagia in 20. The median weight loss was 7 (2.6–12) lbs.

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A follow up symptomatic questionnaire via phone was obtained in 99/131(76%) patients. At 24 (9–38) months, 85/99 (86%) were free of preoperative symptoms, 91/99 (92%) were satisfi ed with the operation and 87/99 (88%) would undergo the operation again. Heartburn was reported in seven, regurgitation in 11, dysphagia in 12, diarrhea in 15, gas bloating in 19, excessive gas in 26 and 26/99 (26.3%) were on PPI. The median weight change was 0 (–18 to 12) lbs. There was one late death in a patient with aspiration pneumonia who died from head trauma in a rehabilita-tion facility 63 days after repair of type III hiatal hernia. Reoperation for symptom-atic recurrent hiatal hernia was performed in 8/131 (6%) patients, two in the early perioperative period and six at median of 25 (8–31) months.

CONCLUSIONS: Laparoscopic repair of large hiatal hernia is a safe and effective approach with excellent patient satisfaction and low morbidity. Tension free esopha-geal length can be achieved laparoscopically without Collis gastroplasty. Reoperation for symptomatic recurrence is rare.


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CF23. En-Bloc Esophagectomy Is Curative Therapy for Most Patients with T1b Tumors Even with Lymph Node MetastasesKatrin Schwameis, Stephanie Worrell, Kyle M. Green, Jamil Samaan, Shannon Cooper, *Daniel Oh, *Jeffrey A. Hagen, *Steven R. DeMeesterKeck Hospital, USC, Los Angeles, CA

OBJECTIVES: Endoscopic therapy is replacing esophagectomy in many patients with intramucosal esophageal adenocarcinoma since these patients seldom have lymph node metastases. Increasingly endotherapy is also being applied for submucosal tumors in part because of the presumed high mortality of esophagectomy and poor prognosis for patients with nodal disease. The aim of this study was to assess sur-vival following primary en-bloc esophagectomy (EBE) in patients with submucosal esophageal adenocarcinoma.

METHODS: Retrospective chart review of all patients who underwent EBE for submucosal esophageal adenocarcinoma between 1998 and 2015. No patient had neoadjuvant therapy.

Figure: Disease specifi c survival based on N-stage

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RESULTS: There were 32 patients (28M/4F) with a median age of 64 years (43–83). The median tumor size was 2.2 cm (0–8) and the median number of resected nodes was 49 (23–85). There was one operative death. Lymph node metastases were pres-ent in 8 patients (25%).

There was 1 involved node in four patients, and 2, 3, 12 and 31 nodes in one patient each. The two N3 patients received adjuvant therapy. The median follow up was 89.5 months. Overall survival at 5 and 10 years was 84.2% and 63.4%. Disease specifi c survival at 5 and 10 years was 89.9% and 79.9%, respectively. Nine patients (28.1%) died and 4 deaths were related to EAC (12.5%). Survival by lymph node stage is shown in the Figure.

CONCLUSIONS: There was low operative mortality after en-bloc esophagectomy for submucosal tumor and survival was excellent. Pessimism about poor survival with limited nodal disease in these patients is unwarranted since disease specifi c 10 year survival was 80% following en-bloc esophagectomy. En-bloc esophagectomy should be considered the preferred therapy for patients with submucosal adenocarcinoma at risk for lymph node metastases.


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CF24. Surgical Management of Acquired Restrictive Thoracic DystrophyDaniel L. MillerWellStar Health System, Marietta, GA

BACKGROUND: Acquired restrictive thoracic dystrophy (RTD) is a rare severe iatrogenic deformity of the thoracic cavity following early (usually less than 10 years of age) open (Ravitch) pectus repair. We report the fi rst series in adults who had surgical correction of acquired RTD utilizing external scaffolding with absorbable (BioBridge) bars of the thoracic cavity.

METHODS: We reviewed medical records of all patients (32) who under pectus repair at our institution (Jan 2014–Dec 2015). Eleven patients (34%) underwent repair of acquired RTD. Eight men and three women had their initial open pectus repair at the mean age of 7 years (6–12 years of age). Symptoms were worsening SOB, DOE and persistent pleuritic chest pain. RTD repair was at the mean age of 32 years (21–49 years of age). Surgical correction was bilateral in eight patients and unilat-eral in three. The thoracic expansion technique was bilateral or unilateral release of multiple sternochondrial and osteochondrail junctions, anterior wedge osteotomy of sternum, and external anterolateral support of the freed thoracic skeleton with multiple absorbable bars at each rib level. The external biological scaffolding allowed for extra expansion of the patient’s thoracic cavity by 10 to 16 cm at each rib level of correction.

RESULTS: There were no operative deaths. Complications occurred in three patients (27%); pneumothorax, seroma, temporary epidural paresis in one patient each. Hos-pital stay was a mean of 7 days (range, 5–13 days). Median follow-up was 14 months (3–24 months); improvements in cosmetic appearance, respiratory symptoms and quality of life were reported in all 11 patients. Postoperative percent FEV1 and FVC increased by a median of 21% and 36%, respectively.

CONCLUSIONS: External expansion of the thoracic cavity with absorbable bars is an effective treatment for acquired RTD. Biological scaffolding of the chest cavity allows for signifi cant improvement in functional pulmonary dynamics and quality of life of patients with this rare acquired chest deformity.


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CF25. Conduit Revision Post-Esophagectomy – Strategic Management for a Rare ComplicationJessica Y. Rove, Alexander S. Krupnick, Frank A. Baciewicz, Bryan F. MeyersWashington University, St. Louis, MO

BACKGROUND: Conduit dysfunction after esophagectomy is a rare but vexing problem. There is a paucity of literature on the management of patients with chronic gastric conduit dysfunction, specifi cally the choice and timing of interventions rang-ing from esophagoscopy with dilation, to reoperation. This case series examines the assessment and management of conduit dysfunction after esophagectomy and details techniques for conduit revision for symptom improvement.

METHODS: We retrospectively reviewed patients at our institutions who underwent esophagectomy between September 2008 and October 2015. Patients who under-went conduit revision were included in the study.

RESULTS: Over 400 patients underwent either Ivor-Lewis or Transhiatal esopha-gectomies during this seven-year period. Eight patients underwent reoperation for functional revision of the conduit. In these eight patients, esophageal cancer was the indication for the original operation in fi ve. The other diagnoses included an esopha-geal perforation, a leiomyoma, and parathyroid cancer involving the esophagus. Two patients had a minimally invasive esophagectomy. One had a cervical anastomosis at their original operation, the remainder were in the thorax. There was wide variety in the initial management of the pylorus (Botox, pyloroplasty, pyloromyotomy, no pyloric intervention) and type of initial anastomosis (stapled side-to-side, stapled end-to-end, hand sewn end-to-end). All eight patients were symptomatic with dyspha-gia, delayed emptying, aspiration, or weight loss. Three patients had associated para-conduit hiatal hernias. Diagnosis and management included esophagram, computed tomography, repeated esophagoscopy with pyloric intervention (dilation or Botox injection) with the addition of anastomotic dilation in one patient. Average time to reoperation was 3.8 years (range 2 weeks–6.5 years). All reoperations included a thoracotomy and a laparotomy. Redundant conduit was reduced with a series of plication stitches in three patients and with the stapler in three patients. The esopha-gogastric anastomosis was revised in all but two patients. One patient presented with a very low esophagogastric anastomosis and the reoperation placed the conduit in the upper chest. There were no mortalities. One patient was found at exploration to have a large liver metastasis causing extrinsic compression of his gastric conduit and therefore the revision was aborted. A second patient had a contained leak requiring replacement of a J tube. Average length of stay for the reoperation was 9 days (range 4–21). Average follow up has been 10 months (range 1–36). All seven completed revi-sions led to restoration of a regular diet with improved patient satisfaction.


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CONCLUSION: Severe gastric conduit dysfunction after esophagectomy is rare. Symptoms, esophagram fi ndings and response to interventional esophagoscopy guide the decision to revise the conduit. Computed tomography imaging is essential in ruling out extrinsic factors leading to conduit dysfunction. Principles of conduit revision include reducing paraconduit hernias, plication or stapled excision of redun-dant conduit, and defi nitively addressing the pylorus. Conduit revision has been performed selectively with minimal morbidity and provides patients with durable improvement in symptoms of dysphagia and refl ux.


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CF26. VATS Diaphragm Plication Using a Running Suture Is a Safe Technique with Durable EffectivenessDavid S. Demos, *Mark F. Berry, *Leah M. Backhus, *Joseph B. ShragerStanford University Hospital, Stanford, CA

OBJECTIVES: Diaphragm plication (DP) is an established treatment for diaphragm paralysis. Although thoracotomy itself causes diaphragm dysfunction, many surgeons have hesitated to adopt minimally invasive diaphragm plication (DP) techniques due to technical limitations that render the procedure cumbersome or, it has been feared, may lead to early failure or reduced effi cacy. We sought to demonstrate the short and longer-term effi cacy of an effi cient, standardized video-assisted thoracoscopic (VATS) technique for DP that uses a single, running suture for the main plication.

METHODS: We retrospectively reviewed all patients who underwent our standard-ized VATS technique for DP since its adoption in 2008. The technique uses a single, buttressed, double-layered, to-and-fro, running suture with a mean of 2.1 additional plicating horizontal mattress sutures. The benefi ts of the procedure were quantifi ed both by changes in pulmonary function tests (PFTs) after DP and changes in self-reported dyspnea using the validated “Baseline and Transitional Dyspnea Indices” (BDI/TDI; Figure). Outcomes were also compared to previously published studies of open and minimally invasive plication approaches.

RESULTS: 18 patients had VATS DP completed by the described technique from 2008 to 2015. There was no 90-day mortality and 2 late deaths unrelated to the plica-tion. Median hospital stay was 3 days (range 1–15). Postoperative complications were uncommon, with atrial fi brillation in 1 patient (5.5%), Pneumonia in 2 (11%), reintu-bation in 1 (5.5%), ileus in 1 (5.5%); 15 patients (83.3%) suffered no complications. Mean follow-up time was 38.4 months (range 3.4–84.7). Postoperative PFTs were available in 14 (87.5%) of surviving patients and dyspnea surveys were completed by 12 (75.0%). Statistically signifi cant increases between preoperative and postoperative PFTs (% predicted values) were found for mean FEV1 (68.3 ± 4.0% to 84.3 ± 4.1%, p = 0.005) and mean FVC (65.6 ± 4.0% to 80.6 ± 3.1%, p = 0.014). An observed increase in mean DLCO from 72.0 ± 4.6% predicted preoperatively to and 86.0 ± 6.5% predicted postoperatively was not statistically signifi cant (p = 0.13). Preopera-tive mean BDI score was 7.8 ± 0.7, where 12 represents most severe dyspnea. The mean TDI score 6 months postoperatively was 7.1 ± 0.6, representing a moderate to major improvement in all 3 subcategories. The repeat mean TDI at last contact (mean 38.4 months postoperatively) was 7.2 ± 0.7, not signifi cantly different from at 6 months(p = 0.38), demonstrating stable long-term benefi ts. Compared to previously published techniques/results, these outcomes are superior to open thoracotomy and laparoscopic approaches and are at least equivalent to other VATS techniques.

* WTSA Member


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CONCLUSIONS: VATS DP with this running suture technique has an excellent safety profi le and achieves maximal early and long-term improvements in patients’ respiratory status. The technique solves the technical challenge of tying multiple interrupted sutures by VATS without compromising effi cacy or durability.


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CONGENITAL HEART DISEASE

Kings 2

Moderator: Irving Shen

CF27. Preclinical Study of Patient-Specifi c Nanofi ber Tissue Engineered Vascular Grafts Using Three-Dimensional Printing in a Sheep ModelTakuma Fukunishi1, Tadahisa Sugiura1, Cameron A. Best1, Justin Opfermann2, Toshiharu Shinoka1, Christopher K. Breuer1, Axel Krieger2, Jed Johnson3, Narutoshi Hibino4

1Nationwide Children’s Hospital, Columbus, OH; 2Children’s National Medical Center, Washington, DC; 3Nanofi ber Solutions Inc, Columbus, OH; 4Johns Hopkins University, Baltimore, MD

OBJECTIVE: Cardiovascular reconstruction for congenital heart disease using synthetic materials and homograft or xenograft tissue is limited by thrombogenic-ity, immune responses causing functional deterioration, and lack of growth poten-tial. Tissue engineered vascular grafts (TEVGs) offer potential to overcome these complications by providing a biodegradable scaffold on which the patient’s own cells proliferate and provide physiologic functionality. However, current TEVGs do not directly address the diverse anatomic requirements of individual patients. Combining axial imaging technology with advances in 3D printing and advanced biomaterials could facilitate creation of preoperatively designed, patient-specifi c TEVGs that could improve functional results of surgery. This study explores the feasibility of a patient-specifi c nanofi ber TEVG created from pre-operative images using computer aided design (CAD) and 3D printing technology in a sheep model.

METHODS: A nanofi ber TEVG was created from co-electrospun polyglycolic acid (PGA) and polylactide-co-caprolactone (PLCL) using CAD designed 3D printed mandrels based on preoperatively acquired imaging data. The TEVGs were implanted in sheep (n = 6) as inferior vena cava (IVC) interposition conduits without cell seed-ing onto the graft. Angiography was performed at 3 and 6 months. The TEVGs were explanted at 6 months for evaluation of neotissue formation, biocompatibility, and mechanical properties.

RESULTS: All sheep survived without complications. All grafts were patent, with no aneurysm formation or ectopic calcifi cation. By catheterization, pressure gradients (PG) across the grafts decreased signifi cantly over time due to tissue remodeling (3 month PG: 6.29 ± 1.97mmHg, 6 month PG: 2.08 ± 2.15mmHg, p = 0.005). At 6 months, the nanofi ber scaffold was nearly completely resorbed (remaining scaffold area: 2.09 ± 0.69%). Histological analysis demonstrated formation of an organized smooth muscle cell layer and extracellular matrix as well as endothelialization,


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mimicking native IVC. There was no signifi cant difference in elastin and collagen content between the TEVG and native IVC. The TEVG at 6 months showed similar mechanical properties to that of native IVC. There was a signifi cant positive correla-tion between TEVG wall thickness and CD68 positive macrophage infi ltration into the scaffold (R2 = 0.90, p < 0.01).

CONCLUSION: The creation of a patient-specifi c nanofi ber TEVG from pre-operative images using a CAD model and 3D printing technology is feasible in a sheep IVC graft implantation model. Controlling macrophage infi ltration into the scaffold is a key factor for better neotissue formation. Further studies in clinical applications involving more complex anatomical shapes are warranted.


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CF28. Use of a Valved Segment of Femoral Vein Homograft for the Sano Shunt Results in Improved Pulmonary Artery Growth After the Norwood OperationMario Briceno-Medina1, Shyam Sathanandam1, T.K. Susheel Kumar1, Michael Perez1, David Zurakowski2, Umar Boston1, Michel Ilbawi3, Christopher Knott-Craig1

1University of Tennessee Le Bonheur Childrens Hospital, Memphis, TN; 2Harvard Medical School, Boston, MA; 3Advocate Christ Medical Center, Chicago, IL

BACKGROUND: To evaluate the difference in interstage growth of branch pul-monary arteries (BPA) between a valved segment of cryopreserved femoral vein homograft (FVH) and polytetrafl uoroethylene (PTFE) as the Sano shunt following Norwood stage 1 operation.

METHODS: This is a retrospective review of all patients with diagnosis of hypoplas-tic left heart syndrome (HLHS) who underwent the Norwood-Sano operation in two institutions between 2010–2015. Either FVH or PTFE was used as material for con-struction of the RV-PA shunt. The size of the BPA at birth and just prior to the Glenn operation, as measured by the Nakata index and the interstage velocity of growth of the BPA, were compared between the two groups of patients.

RESULTS: Forty-eight neonates with diagnosis of HLHS or its variants underwent the Sano-Norwood operation. FVH was used in 14 patients (14/48, 29%) and PTFE graft in 34 (34/48, 71%). The two groups of patients were comparable in terms of preoperative demographics and operative variables. The diameter of the FVH and the PTFE graft ranged between 5–6 mm. The FVH included a valved segment. The patients in the FVH subgroup demonstrated signifi cantly larger pre Glenn Nakata index (364 ± 299 vs 162 ± 74, p = 0.02). The diameters of the right and left pulmo-nary arteries (RPA and LPA) were also signifi cantly larger in the FVH subgroup (RPA 7.8 ± 3.6 vs 5.0 ± 1.2 and LPA 7.2 ± 2.1 vs 5.6 ± 1.9, p = 0.03). The FVH subgroup showed faster growth velocity of the RPA (0.22 ± 0.1 vs 0.13 ± 0.1 mm/wk, p = 0.03), and higher Qp/Qs compared to the PTFE group. There was no difference at pre-Glenn evaluation between the subgroups in terms of age at Glenn operation, cardiac index, pulmonary arteriolar resistance index, ventricular end-diastolic pressure, or systemic oxygen saturations.

CONCLUSIONS: Utilization of a valved segment of FVH as RV-PA conduit during the Norwood Sano operation confers better growth and development of the branch pulmonary arteries compared to PTFE graft without recognizable adverse effects.


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Comparison of the Two Groups of Patients

VariableValved Femoral Vein Homograft (n = 14)

Gore-Tex Graft (n = 34)

p-Value (<0.05)

Age at pre Glenn (weeks) 16.55 ± 4.34 14.59 ± 3.45 NS

Nakata Indexat birthat pre Glenn

110.19 ± 45.64364.84 ± 299.13

83.8 ± 23.67162.46 ± 74.5

NS0.02

PA size (mm)RPALPA

7.81 ± 3.627.22 ± 2.07

5.05 ± 1.195.66 ± 1.96

0.020.03

PA growth velocity (mm/week)RPALPA

0.22 ± 0.160.2 ± 0.12

0.13 ± 0.070.17 ± 0.11

0.03NS

Qp:QsCardiac Index 1.31 ± 0.87

3.5 ± 1.11.04 ± 0.16

3.7 ± 0.5NSNS

Ventricular end diastolic pressure

9 ± 2.04 8 ± 2.53 NS

Pulmonary artery pressure 15 ± 4 11 ± 2 NS

Pulmonary artery resistance indexed (WU.m2)

1.65 ± 0.7 1.19 ± 0.3 NS

Arterial O2 saturation 75 ± 6 74 ± 5 NS


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CF29. Pulmonary Atresia with Ventricular Septal Defect and Major Aortopulmonary Collaterals: Comparison of Single-Stage Versus Multi-Stage Unifocalization StrategiesSophie C. Hofferberth, Yee Jim Loh, Christopher W. Baird, John E. Mayer, Pedro J. del Nido, Sitaram M. EmaniBoston Children’s Hospital, Harvard Medical School, Boston, MA

OBJECTIVES: Repair of pulmonary atresia with ventricular septal defect and major aortopulmonary collateral arteries (PA/VSD/MAPCAs) includes unifocalization of MAPCAs, VSD closure, and right ventricle to pulmonary artery (RV-PA) conduit. Uni-focalization of MAPCAs can be approached by either; I) Single-stage unifocalization through midline sternotomy, or II) Multi-stage repair, consisting of staged unifocaliza-tion procedures performed via bilateral thoracotomies. Concern for branch pulmo-nary artery (BPA) re-stenosis following single stage repair has driven several groups to prefer the multi-stage repair strategy in an effort to minimize reinterventions. To date, there is limited data directly comparing these two approaches. Therefore, in this study we sought to investigate single versus multi-stage unifocalization in infants with PA/VSD/MAPCAs.

METHODS: Patients with PA/VSD/MAPCAs who underwent unifocalization at a single center were retrospectively reviewed. Between 1996 and 2012, 69 consecutive patients were identifi ed. Thirty-six (52%) received single stage unifocalization and complete repair (Group 1), while 33 (48%) underwent multi-stage repair (Group 2). Baseline pulmonary vasculature was carefully evaluated to ensure the two groups were anatomically comparable. Primary endpoints were overall mortality, freedom from branch pulmonary artery reintervention, ability to close the VSD, and RV/LV pressure ratio (RVPR) at latest follow up.

RESULTS: Pre-operative characteristics were similar (median age at 1st operation: Group 1 = 75 days; Group 2 = 79 days, p = 0.22) between the two cohorts. There were no signifi cant differences in pulmonary vascular anatomy; 17 (47%) Group 1 and 11 (33%) Group 2 patients had absent central pulmonary arteries (p = 0.327), and the median number of MAPCAs/patient based on initial angiogram was 4 in each group. Overall mortality was 6 (17%) in Group 1 versus 7 (21%) in Group 2 (p = n/s). Median follow up was 6.1 and 6.7 years for Groups 1 and 2, respectively (p = n/s). Group 1 had fewer catheter-based reinterventions for BPA stenosis, with 2 balloon dilations per patient, and a total of 4 (17%) children undergoing BPA stent-ing, comparatively, Group 2 had 5 balloon dilations per patient, and 17 (65%) who required BPA stenting, p = 0.0001. Although the VSD closure rate was not signifi -cantly different in each group (see table 1), median RVPR was 0.65 in Group 1 versus 0.80 in Group 2 (p = 0.01) at latest follow up. The relationship between VSD status and RV/LV pressure ratio at latest follow-up is outlined in the Table.


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CONCLUSIONS: Singe-stage unifocalization and complete repair is associated with fewer reinterventions for branch pulmonary artery stenosis and superior long-term hemodynamics compared to multi-stage repair of PA/VSD/MAPCAs. When feasible, this strategy should be implemented as it may offer better long-term outcomes for patients with PA/VSD/MAPCAs, irrespective of native pulmonary vascular anomalies.


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CF30. Prior Diaphragm Plication Does not Adversely Impact Hospital Course During Subsequent Stages of Palliation for Single Ventricle PhysiologyJassimran Bainiwal1, John D. Cleveland1, *Winfi eld J. Wells1, Nancy A. Pike2, *Vaughn A. Starnes1, *S. Ram Kumar1

1University of Southern California, Los Angeles, CA; 2Children’s Hospital, Los Angeles, Los Angeles, CA

OBJECTIVES: Phrenic nerve injury is a known cause of morbidity following single ventricle palliation. Previous studies have shown that hemi-diaphragm plication improves short-term outcomes. The effect of plication on hospital course during subsequent stages of single ventricle palliation is not known.

METHODS: Between 1997 and 2014, 962 patients underwent surgical manage-ment of single ventricle physiology at our institution. We reviewed the records of 32 patients who underwent diaphragm plication for phrenic nerve injury prior to establishment of Fontan circulation. Each patient was compared to two propensity-matched controls identifi ed from patients who underwent Glenn or Fontan proce-dure and did not require diaphragm plication. Propensity matching was achieved for each test subject using nearest neighbor algorithm. Data is presented as median and interquartile range or number and percentage.

RESULTS: The cohort includes 19 boys (59%). There were 15 Glenn patients (48%) who had undergone diaphragm plication following fi rst stage palliation. Of these, 8 have had completion Fontan, 6 are awaiting Fontan, and 1 expired. An additional 9 patients underwent diaphragm plication after Glenn, accounting for 17 patients with diaphragm plication who underwent Fontan completion. There was no difference in pulmonary pressure or resistance between the two groups. Both groups had compa-rable chest tube drainage and hospital length of stay. At discharge, equal proportion of patients required sildenafi l therapy and/or supplemental oxygen in both groups (Table).

CONCLUSIONS: Prior diaphragm plication does not adversely impact course to Fontan circulation in children with single ventricle physiology. Their hospital course during subsequent stages of palliation for plicated patients is no different than that of matched controls.

* WTSA Member


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Clinical Parameters and Hospital Course Amongst Plicated Patients and Matched Controls

Parameter

GlennPlication(n = 15)

GlennNo plication

(n = 30)

FontanPlication(n = 17)

FontanNo plication

(n = 34)

PVR (woods/sq.m) 1.8 (1.6–2.1) 1.8 (1.5–2) 1.8 (1.2–2.1) 1.9 (1.2–2.2)

Mean PAP (mm Hg) 11.5 (10.1–13) 12.1 (9.8–13) 11 (10–13) 11.5 (9.5– 14)

CT output last 24h (ml)

70 (37–136) 67 (42–137) 122 (62–169) 131 (54–180)

Hospital LOS (days) 12 (7.5–22.5) 10 (8–27) 7 (7–8) 8 (6–13)

Supplemental oxygen at discharge, n (%)

3 (20) 7 (23) 0 0

Sildenafi l at discharge, n (%)

4 (27) 7 (23) 3 (18) 4 (12)


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CF31. To Cath or Not to Cath? Alternative Options in Preoperative Evaluation for Promotion to Second Stage PalliationLauren C. Kane, Luis De León, Pamela Deaver, Christine Nelson, Rajesh Krishnamurthy, Dhaval Parekh, Jeffery Heinle, Dean McKenzie, Carlos Mery, Charles Fraser, Jr.Baylor College of Medicine, Houston, TX

OBJECTIVE: Multiple options are available to assess suitability for promotion to Stage II palliation in the single ventricle population. The purpose of this study was to assess non-invasive imaging as an alternative to cardiac catheterization.

METHODS: A retrospective review of all patients undergoing preoperative evaluation at a single institution prior to stage II palliation between January 2007 and Decem-ber 2014 was conducted. Patients were separated into three groups: the noninvasive group (Group I) included patients who underwent cardiac magnetic resonance imaging (CMR) or computed tomography (CT). Group II (Cath) underwent cardiac catheterization alone. Group III patients underwent both cardiac catheterization and non-invasive imaging and are considered in a sub-analysis. Patients with severe atrio-ventricular valve regurgitation, ventricular dysfunction, pulmonary hypertension, aortic obstruction, pulmonary vein stenosis, or large arterio-venous or veno-venous collaterals were classifi ed as high-risk patients. Measured outcomes included adverse events, requirement for general anesthesia at diagnostic testing, re-intervention and mortality. Continuous variables were compared using the Student’s t-test, and cat-egorical variables using the Fisher´s exact test.

RESULTS: 148 patients were studied: Group I comprised 56 patients who underwent non-invasive imaging (39 MRI and 17 CT), Group II comprised 71 patients who underwent cardiac catheterization, and Group III comprised 21 patients who had combined imaging (7 catheterization plus CT and 14 catheterization plus MRI). Eight patients (5%) were considered high risk (2 in group I, 5 in group II, and 1 in group III). Demographic and clinical characteristics were similar between groups (Table 1). There were 8 adverse events observed in the catheterization group and 1 in the non-invasive group (12% vs 2%, p = 0.77). There were no signifi cant differences in hospi-tal course, mortality or other measured outcomes between Groups I and II. Patients in Group I required general anesthesia for their diagnostic procedure signifi cantly less often (p = <0.001) and incurred signifi cantly lower hospital charges than group II patients (p = <0.001). At a median of 5-year follow-up, patients in Group I underwent fewer reinterventions than patients in group II (25% versus 52%; p = 0.003) (Table 2). Five patients in Group III (24%) required interventional cath procedures after an anatomic lesion was identifi ed with non-invasive imagining.


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Table 1. Demographic and Clinical Characteristics of Patients Undergoing Evaluation for Second Stage Single Ventricle Palliation

Overall(n = 148)

Group I Non-Invasive

(n = 56)

Group IICardiac Cath

(n = 71) p

Group IIICombined Imaging(n = 21)

Female 59 (40) 23 (41) 26 (37) 0.71 10 (48)

Weight 6.1 (4.3–15.2) 6.1 (4.4–9.55) 6.3 (4.4–15.2) 0.08 6.0 (4.3–12.2)

Age at BDG 5m (2m–4y) 5m (2m–3y) 6m (3m–4y) 0.33 5m (3m–2y)

Heterotaxy 22 (15) 5 (9) 8 (11) 0.77 9 (43)

HLHS 54 (36) 18 (32) 26 (37) 0.70 10 (47)

Table 2. Adverse Events, Reintervention and Anesthesia Use by Diagnostic Group

Overall (n = 148)

Group INon-Invasive

(n = 56)

Group IICardiac Cath

(n = 71) p

Group IIICombined Imaging*(n = 21)

Adverse events

CPR 5 (3) 0 2 (3) 0.5 3 (14)

Sustained Desaturations

2 (1) 0 2 (3) 0.5 0

Arrhythmia 7 (5) 0 4 (6) 0.13 3 (14)

Unplanned ICU Admission

3 (2) 1 (2) 0 0.44 2 (10)

Reinterventions

Patients requiring reintervention

57 (39) 14 (25) 37 (52) 0.003 6 (29)

Median time to reintervention

2.7y

(2m–4.6y) 2.8y

(1.3y–4y) 2.8y

(7m–4.6y) 0.40 1.2y

(2m–3y)

Anesthesia

General Anesthesia 129 (587) 37 (66) 71 (100) <0.001 21 (100)

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CONCLUSION: Non-invasive imaging is a safe alternative to cardiac catheterization in the pre-operative evaluation of selected patients undergoing second stage single ventricle palliation. A non-invasive strategy may be associated with fewer subse-quent re-interventions, lower hospital charges, and reduced requirement for general anesthesia.


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CF32. Early Cardiac Catheterization Shortens Duration of Pediatric Extracorporeal Life SupportChristopher Burke, Titus Chan, Augustin Rubio, Fawwaz Shaw, *Jonathan M. Chen, *D. Michael McMullanSeattle Children’s Hospital, Seattle, WA

BACKGROUND: Cardiac catheterization in patients receiving extracorporeal life sup-port (ECLS) has previously been shown to be safe and, in many cases, therapeutic. However, the infl uence of cardiac catheterization on clinical outcomes in this patient population has not been clearly defi ned. The goal of this study was to determine the impact of cardiac catheterization during ECLS on survival and to determine whether timing of catheterization is a modifi able risk factor.

METHODS: A single institution, retrospective review of all pediatric cardiac ECLS patients who underwent cardiac catheterization between January 2006 and Septem-ber 2015 was performed. Patients who underwent catheter-based left atrial decom-pression or endomyocardial biopsy were excluded from analysis. Information was abstracted from electronic medical records, cardiac catheterization reports, operative reports, and ECLS data forms. Univariate and multivariate analyses were performed to determine risk factors for death.

RESULTS: Eighty-two interventional cardiac catheterization procedures were per-formed on 74 consecutive patients (median age 18 d). Catheterization fi ndings directly led to catheterization-based or surgical intervention in 54 (73%) patients. Thirty-three (61%) patients who ultimately required catheter-based or surgical intervention did not have defi nitive clinical or echocardiographic evidence of anatomic abnormalities iden-tifi ed by catheterization. One (1.2%) catheterization-related complication occurred (pulmonary artery rupture), which ultimately resulted in death. Patients who underwent early catheterization (≤72 hours of ECMO initiation; median 24 hours) required shorter total duration of ECLS than patients who underwent catheterization > 72 hours (median 6 days) after ECLS initiation (136 hours vs. 227 hours, p < 0.01). Study groups were similar with regard to age, sex, weight, proportion with single ven-tricle physiology, post-operative status, ECLS modality, and ECPR status. The groups experienced similar rates of interventions based on catheterization fi ndings (72% early vs. 74% late, p = 0.81). No difference in time from catheterization to separation from ECLS was observed (4 days early vs. 3 days late, p = 0.62). Survival to hospital discharge was higher in the early catheterization group (74% vs. 51%, p = 0.04). In multivariate models adjusting for covariates, early catheterization was associated with a reduction in ECLS duration by approximately 150 hours (p < 0.01).

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CONCLUSIONS: Cardiac catheterization is safe in pediatric ECLS patients and an earlier catheterization is associated with shorter duration of ECLS and improved hospital survival. Diagnostic cardiac catheterization should be considered in patients who remain dependent on ECLS after 3–5 days, even without echocardiographic evidence of structural abnormalities. Early diagnostic catheterization frequently identifi es correctable structural abnormalities that, when appropriately addressed, may reduce patient exposure to ECLS complications, decrease duration of ECLS, and improve survival.


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CF33. Relationship Between Outcomes and Approach in Repair of Coarctation of the Aorta and Arch Hypoplasia: A Value Improvement InitiativeConnor P. Callahan1, David Saudek2, Amanda J. Shillingford3, Sara Creighton2, Ray Hoffmann1, Mahua Dasgupta1, Michael E. Mitchell1, *Ronald K. Woods1

1Medical College of Wisconsin, Milwaukee, WI; 2Children’s Hospital of Wisconsin, Milwaukee, WI; 3Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE

OBJECTIVE: We sought to compare the value of thoracotomy(T) vs median sternotomy(S) with cardiopulmonary bypass (CPB) for repair of coarctation of the aorta (CoA) and arch hypoplasia. Many view proximal arch hypoplasia as an indica-tion for median sternotomy. As this requires CPB, hypothermia, and other adjuncts, it may be associated with increased resource utilization. If T affords non-inferior results of arch repair, it may represent a higher value approach.

METHODS: This was a retrospective chart review of 239 consecutive infants under-going repair of CoA from Jan 1, 2000 to Jan 1, 2014 at a single center with exclusion of single-ventricle palliated patients. Primary outcome (quality) was arch re-interven-tion. Secondary outcomes of resource utilization (cost) included total length of stay (LOS), duration of postoperative mechanical ventilation, and hospital charges (sum of day of surgery charges, postoperative charges, and total hospital charges for any re-admission for arch re-intervention). Preoperative echocardiograms were re-read by two attending cardiologists blinded to the outcomes. Multivariate analysis included multiple patient and operative characteristics with potential to confound outcomes.

RESULTS: Of 239 patients, 13 were repaired through a median sternotomy (S) with CPB and 226 were repaired off-pump through a left thoracotomy (T). Con-comitant other repairs were performed in 9 patients in the S group and 9 patients in the T group (repositioned for median sternotomy). Arch re-intervention occurred in 2 (15.4%) in the S group and 18 (8.0%) in the T group, p = 0.3. In multivariate analysis, the only factor associated with arch re-intervention was operative weight (OR–0.59; 95% CI 0.37–0.95; p = 0.03). Surgical approach (OR – 2.1; 95% CI 0.43–10.22; p = 0.36) and proximal arch Z score (OR–1.005; 95% CI 0.80–1.27; p = 0.97) were not signifi cant factors. Certain preoperative patient characteristics (operative weight, mechanical ventilation, prematurity, renal failure, infection) were signifi cantly associated with increased LOS and duration of mechanical ventilation (all p values < 0.03). However, only surgical approach S (OR–2.31; 95%CI 1.70–3.16; p < 0.0001), preoperative renal failure (OR–2.38; 95%CI 1.51–3.76; p = 0.0002), and preoperative

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infection (OR–1.42; 95% CI 1.10 – 1.82; p = 0.007) were signifi cantly associated with hospital charges. Evaluation of a group of 4 S patients with isolated arch repair and similar patients in the T group revealed that median LOS and charges were 24 days and $157,935 in the S group vs 9 days and $41,775 in the T group. In the T group, arch re-intervention was not associated with proximal arch Z score (see Figure 1).

CONCLUSION: Repair of CoA with arch hypoplasia through a left thoracotomy may be associated with a higher value of care by offering non-inferior arch outcomes at reduced charges.


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CF34. Simultaneous Systemic to Pulmonary Shunt and Pulmonary Artery Banding Is a Viable Option for Neonatal Palliation of Single Ventricle PhysiologyLuke M. Wiggins, *Winfi eld J. Wells, *Vaughn A. Starnes, *S. Ram KumarUniversity of Southern California, Los Angeles, CA

OBJECTIVES: A subset of neonates with single ventricle (SV) physiology has ante-grade pulmonary blood fl ow that is deemed unlikely to be reliable until Glenn. We have used systemic to pulmonary shunt (SPS) with pulmonary artery banding (PAB) to ensure adequate pulmonary blood fl ow. This strategy ensures reserve antegrade blood fl ow that mitigates the potential problem of shunt thrombosis, while maintain-ing supply of hepatic factors to the lungs and can be accomplished without the rou-tine need for cardiopulmonary bypass (CPB). We hypothesized that this is a viable option for fi rst stage single ventricle palliation in this population of neonates.

METHODS: We retrospectively reviewed the records of 60 neonates who underwent combined SPS+PAB between 2004–2014. Data is presented as median with interquar-tile ranges.

RESULTS: Children were 8 (4–19) days old at surgery and included 38 (63%) boys. Atresia or severe stenosis of the sub-pulmonary atrioventricular (AV) valve associ-ated with pulmonary blood fl ow across a bulbo-ventricular foramen was present in 37(62%). In 20 (33%), heterotaxy associated unbalanced AV canal with pulmo-nary stenosis with or without anomalous pulmonary venous drainage was present. Palliation was accomplished without CPB in 50 patients (83%). There were seven (12%) hospital deaths, four amongst the 20 (20%) with heterotaxy. 53 children were followed for a median 5.1 (1.8–8.2) years. Three early re-interventions were required (one PAB adjustment, two SPS balloon angioplasties). Two additional heterotaxy patients experienced late mortality, one from abdominal complications in the inter-stage period and one from complications related to AV valve insuffi ciency. There were no early or emergent Glenns. 39 patients have reached Fontan circulation, median pre-Fontan PA pressure of 14 (12–18) mmHg. One patient was converted to bi-ventricular physiology and the remaining await completion Fontan. Heterotaxy was the only independent predictor of mortality (hazard ratio 2.8 (1.6–13.4, p < 0.01)).

CONCLUSIONS: In SV patients with unreliable antegrade PA fl ow, SPS+PAB is an effective fi rst stage palliation. Patients with heterotaxy-related defects are at increased risk for mortality.

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CF35. Constant Treatment Dilemma in HOCM: Long-Term Outcomes Post TherapyFeras Khaliel1, Lucman Anwer2, Mohammad Alshammari1, Anas Abudan1, Adam Obad1, Jehad Alburaiki2, *Zohair Alhalees2

1London Health Science Center, Western University, London, ON, Canada; 2King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia

INTRODUCTION: The ideal approach In Hypertrophic Obstructive Cardiomyopa-thy (HOCM) management still remains an ambiguous topic. Recent studies have shown lower long-term mortality rates in surgically managed HOCM patients when compared with the overall mortality rates. Our single center experience compares the immediate and long-term outcomes of surgically treated patients with their medically treated counterparts.

METHODS: We retrospectively studied a total of 64 adult HOCM patients between 2000–2014, out of which 8 patients underwent surgery while the remaining were managed medically. The mean age of our population was 36.59 ± 14.9 and male to female distribution was in the ratio of 2:1. Mean NYHA class 2, along with a mean LVEF of 53% ± 22%, LVOT 1.2cm2, LVESD/LVEDD was 4.9/6.1cm. Positive family history for HOCM in 14%, and history for sudden cardiac death was found in 6% of our patients. Around 8% of the patients had a documented episode of syncope and around 25% of the non-surgical patients had a permanent pacemaker. The preva-lence of heart related comorbidities included angina in 12.7%, MI in 3.1%, CKD in 11%, Cancer in 17%, Chemotherapy& radiotherapy in 5% each, CHF in 3.1%, syncope in 8%, atrial fi brillation in 1.5% of the patients. The prevalence of chronic disease such as SCD, HTN, DM and dyslipidemia, were 6.3%, 17%, 9.2%, and 7.7% respectively. Follow-up was done with 97% in over 15-year period.

RESULTS: Overall operative mortality was 1.6%, which was in the medical group. One, fi ve and ten-year mortality were, 3.1% due to (multiple myeloma, heart failure and CRF) (p = 07).

Malignant arrhythmia was present in 12.3%, thus 23-patients in medical group received implantable ICD, and one-patient in surgical received PPM. AV surgery was in 6.3%. Aortic, mitral and Tricuspid regurgitation was present in four, one, and one-patient, respectively however, aortic regurgitation was diminished to one patient at 10-year follow-up in the surgical group(p = 0.08). Mean LV hypertrophy has signifi -cantly diminished to mild from moderately severe (p = 0.01) in the surgical group, and down to moderate in the medical group (p = 0.1).

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One patient had to undergo Redo Myomectomy in the 7th year follow-up. No iatrogenic VSD in the surgical group. The mean LVEF in the surgical group was 68% ± 16% (p = 0.001), their LVOT went up to 2.5 cm2 (p = 0.001). Their LVESD/LVEDD went down to 2.8/4.4 cm (p = 0.001) during the follow-up period. SAM was presented in the medical therapy with 66%, compare to 30% in the surgical group (p = 0.01).

Surgical group were discharged home with Aspirin and Tenormin, while multiple blockade therapy was given-to medical group.

CONCLUSION: Both surgical and medical techniques are discussed and compared. Operative, and long-term mortality are signifi cantly equal, with a trend to a better survival in the surgical group. However, MACE free-survival in the long-term out-comes seems to be signifi cantly higher in the surgical group. Final decision concern-ing therapy for patients with obstructive HCM must be individualized to each patient depending on his/her wishes and expectations, way of life, signifi cant LV hypertro-phy, in addition to involvements of aortic valve, anterior MV length, as well as the experience of the treating center.


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CF36. Arteriovenous Fistulas Are an Effective Method to Increase Pulmonary Blood Flow and Curb Pulmonary Arteriovenous Malformation Development in Single Ventricle Patients Palliated with Superior Cavopulmonary AnastomosisSanjeet Patel, Amit Iyengar, Oh Jin Kwon, *Brian Reemtsen, *Hillel Laks, *Reshma BiniwaleUCLA, Los Angeles, CA

BACKGROUND: In patients with cyanotic heart disease after superior cavopulmo-nary anastomosis (CPA), progressive hypoxia with exercise intolerance often leads to marked delays in achieving the fi nal palliative procedure (Fontan). Moreover, the loss of hepatic venous blood return to the lung ipsilateral to the CPA results in the devel-opment of pulmonary atrteriovenous malformations. Arteriovenous (AV) fi stulas have been described in the literature to augment pulmonary blood fl ow and poten-tially quell the development of PAVMs. We investigated the effectiveness of axillary arteriovenous fi stulas as a palliative procedure for hypoxemic single ventricle patients with cavopulmonary anastomoses unsuitable to progress to completion Fontan.

METHODS: We retrospectively reviewed 10 patients with cavopulmonary anasto-mosis who underwent side-to-side axillary arteriovenous fi stulas for progressive hypoxemia and exercise intolerance.

RESULTS: The median age at the time of AV fi stula creation was 8.5 years old (2–17 years of age). None of the ten patients were candidates for Fontan, and 2 of them had a previous one taken down. The median oxygen saturation increased from 72% to 82% (p = 0.01). The median hemoglobin did not change appreciably in the 6 months postoperative (18.5 mg/dL to 18.35 mg/dL; p > 0.05). We found that during the fol-low up period, there was a dramatic reduction in the formation of Aortopulmonary collaterals (p < 0.05). Nine of the ten patient had preoperative PAVMs, which were coiled embolized prior to fi stula placement. Only 1 patient had persistent PAVM post-operatively due to a narrowed, low fl ow fi stula. There were no operative mortalities, and only 1 patient had postoperative arm swelling. The patients were followed for a median of 3.5 years, in which four patients were able to proceed to a Fontan, and one to heart transplantation.

CONCLUSIONS: Patients who become unsuitable for Fontan procedure second-ary to exercise intolerance and hypoxemia can be further palliated successfully with systemic AV fi stulas. We identifi ed in our cohort of patients that the creation of these fi stulas both augments pulmonary blood fl ow and allows for regression of PAVMs. Our results are congruent with the reported literature and we believe this technique warrants larger prospective investigation.

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CF37. Long-Term Outcomes Following One-Stage Repair of Aortic Arch Obstruction Associated with Ventricular Septal DefectMehrdad Rahatianpur, *Farhad Bakhtiary, *Martin KostelkaHeart Center Leipzig, Leipzig, Germany

OBJECTIVES: The aim of the present study was to evaluate the current outcome and reoperation rate after applying a one-stage correction strategy for interrupted aortic arch (IAA) with ventricular septal defect (VSD) and also for aortic coarctation and hypoplastic aortic arch (CoA-HyAA) with VSD beginning November 1999.

METHODS: Eighty consecutive patients with IAA (n = 45) or CoA-HyAA (n = 35) with VSD underwent early one-stage correction. Patients´ mean age was 29 days (range, 2 to 912); mean weight was 3.4 kg (range, 1.5 to 13.5), 7 patients were less than 2.5kg. Associated anomalies included a large VSD in all, persistent truncus arteriosus (PTA) in 7, transposition of the great arteries in one, aortopulmonary window in 4 and double-outlet right ventricle in one patient. Selective brain perfu-sion through innominate artery and selective coronary perfusion through aortic root during aortic arch reconstruction was used in all patients. Mean follow-up was 8.4 ± 4.2 years. Statistical analysis was performed using SPSS version 20.0 software (SPSS Inc., Chicago, IL USA).

RESULTS: The early mortality was one premature neonate who died in the hospital with extracorporeal membrane oxygenation (ECMO) after CoA plus VSD repair. There was no late mortality and no postoperative neurologic complications. Mean crossclamp duration was 67 ± 36 minutes, lowest temperature 23.5 ± 5° C and selec-tive brain and coronary perfusion duration was 37 ± 24 minutes. Forty-eight patients required delayed sternal closure at 2.4 days postoperatively. New perioperative man-agement reduced the overall morbidity. Reintervention occurs in 36 (45%) patients. The median time to re-interventions was 0.56 ± 0.83 years (range 0.02 to 4.28 years). Re-intervention included balloon angioplasties (n = 16, 20%), re-operation (n = 8, 10%) and both procedures (n = 12, 15%). The main indication of reintervention after IAA and CoA with VSD repair was aortic arch restenosis (n = 28, p = 0.0001). All patients are asymptomatic and developing normally.

CONCLUSION: One-stage complete correction can be performed with excellent sur-gical results and good functional outcomes in newborns with aortic arch obstruction with VSD. Complex cardiac anatomy presents no additional risk for the procedure. Although, patients are doing well in the long term, many of them require reinterven-tion in the future. A regular life-long cardiac follow-up is, therefore,recommended.

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CF38. Extracorporeal Cardiopulmonary Resuscitation Simulation Improves Effi ciency of ECPR ActivationChristopher Burke, Titus Chan, Joan Roberts, Taylor Sawyer, *D. Michael McMullanSeattle Children’s Hospital, Seattle, WA

BACKGROUND: When implemented expeditiously, extracorporeal life support dur-ing cardiopulmonary resuscitation (ECPR) is an effective rescue therapy for patients who have experienced refractory cardiac arrest. Previous studies suggest that main-taining a 24/7 in-house surgical team may reduce ECPR initiation time and improve patient outcomes, especially during nights and weekends. Although simulation is currently used in many centers to increase preparedness for ECPR events, the effec-tiveness of ECPR simulation on improving surgical profi ciency and clinical outcomes has not been well defi ned. We hypothesized that simulation training has a greater impact on multidisciplinary team process outcomes than surgical profi ciency.

METHODS: A standardized, bi-monthly hospital-wide ECPR simulation program was instituted in February 2014. The ECPR simulation program included scripted ECPR simulation scenarios and high-fi delity surgical simulation. All nursing, intensive care specialist, perfusion, and surgical ECLS care providers participated in simulation training sessions. A detailed analysis of cardiac arrest and ECPR events before and after implementation of the ECPR simulation program was performed. Primary end-points were appropriate adherence to a standardized ECPR activation protocol, time to ECPR cannulation, duration of cannulation procedure, and clinical outcomes.

RESULTS: During the study period from December 2012 to August 2015, 155 cardiac arrest events occurred (58 before ECLS simulation; 97 after simulation). Appropriate adherence to an ECPR activation protocol increased from 82.8% before simulation to 94.9% after simulation (p = 0.02). The time interval from initiation of standard cardiopulmonary resuscitation to ECPR activation decreased from 7 min to 2 min (p < 0.01). Despite the observed reduction in time to ECPR activation, the proportion of inappropriate ECPR activations did not change after implementation of an ECPR simulation program (6% vs. 7%, p = 0.92). ECPR initiation time did not signifi cantly change (41 min before simulation vs. 46 min after simulation, p = 0.33) since the inception of our ECPR program despite signifi cantly higher frequency of night and weekend ECPR events after initiation of a simulation program (55% before vs. 92% after, p = 0.02). Surgical cannulation time did not signifi cantly change after simulation training (17 min before vs. 24 min after, p = 0.21). No simulation-related differences in ECLS survival (71% before vs. 58% after, p = 0.49) or survival to dis-charge (50% before vs. 42% after, p = 0.75) were observed.

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CONCLUSIONS: Implementation of a standardized, hospital-wide ECPR simulation program reduces ECPR activation protocol deviations and improves effi ciency of ECPR activation but does not result in an increased number of inappropriate ECPR activations. ECLS procedural time and overall ECLS initiation time did not change, despite an increased proportion of nighttime and weekend ECPR activations follow-ing implementation of an ECPR simulation program. The primary benefi t of routine ECPR simulation training appears to be increased overall care team preparedness and adherence to standardized activation protocols rather than improved surgical profi -ciency. These fi ndings support the use of multidisciplinary ECPR simulation training but suggest that 24/7 in-house surgical coverage is unnecessary.


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CF39. Differences in Clinical Outcomes and Cost Between Complex and Simple Arterial SwitchesEric R. Griffi ths, Nelangi M. Pinto, *Aaron W. Eckhauser, Angela P. Presson, Ragheed Al-Dulaimi, David K. Bailly, *Phillip T. BurchUniversity of Utah, Salt Lake City, UT

BACKGROUND: This study evaluates the morbidity, mortality, and cost differences between patients that underwent either a simple or complex arterial switch operation (ASO).

METHODS: We performed a retrospective study of all patients undergoing an ASO at our institution from January 1, 2004, to December 31, 2014. Simple ASO was defi ned as patients with d-transposition of the great arteries (d-TGA) with usual coronary anatomy or circumfl ex artery originating from the right coronary artery with either intact ventricular septum or ventricular septal defect (VSD). Complex cases included all other forms of coronary anatomy, aortic coarctation or arch hypoplasia, and Taussig-Bing anomalies. Costs were acquired using an institutional activity-based accounting system.

RESULTS: A total of 98 patients were identifi ed, 68 patients in the simple ASO and 30 in the complex ASO cohort. In the simple group, 25 (37%) of the patients had a VSD. In the complex group, 15 patients (50%) had a VSD, 23 patients (77%) had aortic arch anomalies, 10 patients (33%) had coronary anomalies, and 6 (20%) patients had a Taussig-Bing anomaly (counted separately from the group with a VSD). The median gestational age for both groups was 39 weeks. There were no dif-ferences in birth weight (3.3 kg), rates of balloon atrial septostomy, or pre-operative coronary catheterizations. Simple ASO patients had shorter cross clamp (80 min vs. 113 min, p <0.001) and bypass times (152 min vs. 175 min, p <0.001). The rate of delayed sternal closure was higher in the complex ASO group versus the simple group (90 vs 68%, p = 0.02).

The mortality rate was similar in the two groups with one death in the simple group and two deaths in the complex group (2% vs 7%, p = 0.23). There was no difference in freedom from major complications by Kaplan Meier analysis. A major morbidity composite variable including cardiac arrest, ECMO, major coronary event, surgical or catheter based reintervention, stroke, or permanent pacemaker placement did not differ between the simple and complex ASO groups (0.33 events/pt vs 0.54 events/pt, p = 0.14). There was a slight increase in post-operative bleeding requir-ing re-exploration in the complex group (10% vs 0%, p = 0.03). A minor morbidity composite variable including non-cardiac surgical procedures, bleeding requiring re-exploration, mediastinitis and sepsis showed no difference with simple ASO at 0.33 events/pt versus complex ASO with 0.22 events/pt.

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Complex ASO postoperative ICU length of stay was 194 hours versus 171 hours, (p = 0.68) and postoperative hospital length of stay was 297 hours versus 299 hours, (p = 0.68). Analysis of hospital costs showed higher postoperative ($70,132 vs $60,192, p = 0.02) and overall costs ($97,387, vs $80,749, p = 0.01) for complex ASO patients.

Conclusion: Complex ASO can be safely performed with similarly low rates of morbidity, mortality, and freedom from major complications as those patients under-going simple ASO. Complex ASO patients do not require signifi cantly increased hospital or ICU lengths of stay. Increased post-operative bleeding, longer bypass times and higher rates of delayed sternal closure may contribute to the increased postoperative and total hospital charges of the complex ASO group.


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8:50 am – 10:30 am S C I E N T I F I C S E S S I O N V


Moderators: David T. CookeFredereck A. Tibayan

16. Fate of Remnant Sinuses of Valsalva in Patients Undergoing Aortic Valve Replacement, Ascending Aorta and Aortic Arch ReplacementRita K. Milewski, Andreas Habertheuer, *Joseph E. Bavaria, Mary Siki, *Wilson Y. Szeto, *Nimesh D. Desai, *Prashanth VallabhosyulaUniversity of Pennsylvania, Philadelphia, PA

DISCUSSANT: JOHN S. IKONOMIDIS

OBJECTIVE: In patients presenting with aortic valvulopathy with concomitant ascending aorta/ arch aneurysm requiring surgical intervention, the management of the sinus of Valsalva segments remains undefi ned, especially for moderately dilated aortic roots. In patients with this pathology undergoing aortic valve replacement with supracoronary ascending aorta replacement (AVRSCAAR), we assessed the fate of the remnant, preserved sinus of Valsalva segment stratifi ed by aortic valve type and pathology.

METHODS: From 2002 to 2015, 389 patients underwent AVRSCAAR electively for valvular and aneurysmal pathology, of which 251 (64.5%) had BAV and 138 (35.5%) had TAV. Patients were divided into 4 groups based on valve type and valvular pathology: BAV with aortic stenosis (BAVAS, n = 209), BAV with aortic insuffi ciency (BAVAI, n = 42), TAV with aortic stenosis (TAVAS, n = 52), and TAV with aortic insuffi ciency (TAVAI, n = 86). Patients with known connective tissue disorders, aortic dissection, and emergencies were excluded. A prospectively maintained database was retrospectively reviewed.

RESULTS: Mean age was 71.7 ± 9.7 years for TAV (54% male) and 59.2 ± 11.4 years for BAV (78.1% male) patients (p < 0.01). Mean preoperative ascending aorta dimension was 52 ± 11 mm (TAV) versus 52 ± 3.6 mm (BAV) (p = 0.9). Mean sinus of Valsalva dimensions were as follows: TAVAS 36 ± 5 mm, TAVAI 39 ± 6 mm, BAVAS 38 ± 5 mm, and BAVAI 38+/4 mm.

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Postoperative in-hospital/30 day mortality was 3.1% (n = 12) for TAV and 0.5% (n = 2) for BAV patients. In the entire cohort 4.6% (n = 18) of patients underwent mechanical valve replacement, 95.4% (n = 371) tissue valve, and 100% of patients underwent hemiarch or total arch replacement. In both groups presenting with aortic insuffi ciency, left ventricular remodeling was noted postoperatively [dia-stolic dimension decrease of 9 mm (TAVAI, p < 0.01) and 9 mm (BAVAI, p < 0.01)]. Median clinical follow-up was 57 months (interquartile range 22–87 months), and median imaging follow-up for sinus segment dimension was 23 months (range 4–54 months). At 10 years clinical follow-up, survival was 62% for TAVAS, 85% for TAVAI, 95% for BAVAS, and 90% for BAVAI. Average sinus segment dimension compared to preoperative value at follow-up for each group was as follows: TAVAS 31 ± 4 mm (change –5mm, p = 0.02), TAVAI 39 ± 5 mm (change 0mm, p = 0.917), BAVAS 40 ± 4 mm (change +2mm, p = 0.531), and BAVAI 36 ± 5 mm (change –2mm, p = 0.195).

CONCLUSIONS: In patients with non-aneurysmal sinuses of Valsalva undergoing AVRSCAAR, the sinus segment can be preserved irrespective of the type of valvular pathology (aortic stenosis versus insuffi ciency) or valvular type (BAV versus TAV). Aortic valve replacement with supracoronary ascending aorta replacement stabilizes the sinus segment over midterm follow-up, in both TAV and BAV patients.


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+17. Is Tissue Still the Issue? Lobectomy for Suspicious Lung Nodules Without Confi rmation of MalignancySuha Kaaki, Lawrence Tan, Sadeesh Srinathan, Gordon BuduhanUniversity of Manitoba, Winnipeg, MB, Canada

DISCUSSANT: JOSEPH B. SHRAGER

OBJECTIVES: While histologic confi rmation of malignancy has traditionally been indicated for a suspicious lung nodule prior to resection, invasive diagnostic proce-dures are expensive, time consuming, potentially morbid and not always diagnos-tic. The purpose of this study was to determine whether or not foregoing routine preoperative and intraoperative tissue biopsy for suspected malignant lung nodule increased the incidence of lobectomy for benign lesions.

METHODS: Retrospective cohort of 256 adult patients who underwent thoraco-scopic or open lobectomy for a confi rmed or suspected pulmonary malignancy, with or without tissue diagnosis. Clinical, radiographic and pathologic data were compared.

A priori sample size calculation was done. Using a one-sided signifi cance level of 5%, and statistical power 80% to detect a 5% difference in incidence of benign pathology post lobectomy in the “biopsy” and “no biopsy” groups.

RESULTS: Among 256 patients who underwent lobectomy for confi rmed / suspected lung malignancy, 127 had attempted tissue biopsy (group A) and 129 had no biopsy procedure (group B). There was no signifi cant difference in the incidence of benign resections between the groups (Group A = 4 patients (3.2%) benign pathology vs. group B = 9 patients (7.0%); p = 0.16). Compared to group A, group B had signifi -cantly lower operative time (127.1 vs. 112.3 minutes; p = 0.004) and intraoperative complications (23 vs. 37 patients; p = 0.03). There was trend toward longer hospital stay and surgical waiting time in group A vs. B (6.6 vs. 5.2 days, p = 0.24; 92.4 vs. 66.2 days; p = 0.14).

CONCLUSIONS: Foregoing invasive biopsies and proceeding directly to lobec-tomy in selected patients with suspicious lung nodules is safe, did not increase the incidence of resected benign pathology, and may decrease surgical wait time. Patients should be carefully evaluated and counseled after review of all clinical and imaging characteristics.



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+18. Percutaneous Device Closure of Atrial Septal Defects: The Price of FailureFawwaz R. Shaw, Sujatha Buddhe, Brian H. Morray, *Jonathan M. Chen, *David M. McMullanSeattle Children’s Hospital, Seattle, WA

DISCUSSANT: BAHAALDIN ALSOUFI

BACKGROUND: Primary percutaneous device closure of atrial septal defects is gen-erally considered to be a safe and less expensive alternative to open surgical repair. Despite the fact that thousands of percutaneous procedures are performed each year, the incidence of unsuccessful percutaneous procedures that ultimately requite surgical intervention and the reasons for failure have not been well described. Fur-thermore, the cost of failed percutaneous device closure of atrial septal defects has not been previously reported. This study examines reported indications, anatomic features, and costs associated with unsuccessful percutaneous atrial septal defect closure.

METHODS: A single-center, retrospective review of all pediatric patients who under-went surgical atrial septal defect closure between March 2007 and July 2015 was performed. Patients who underwent unsuccessful preoperative percutaneous device closure were identifi ed and preoperative echocardiographic and cardiac catheteriza-tion data was analyzed. Independent blind review of pre-operative echocardiographic data was performed to characterize anatomic features associated with reduced likelihood of successful device closure. Additional data related to reason for referral, reason for unsuccessful device closure, use of intracardiac echocardiography, and hospital cost was analyzed.

RESULTS: Percutaneous device closure of atrial septal defects was performed or attempted in 505 patients and surgical atrial septal defect closure was performed on 381 patients during the study period. Of these, 37 patients (7.3% of catheterization patients) underwent preoperative cardiac catheterization and unsuccessful percuta-neous device closure prior to successful surgical closure. Intracardiac echocardiogra-phy was utilized in 35 (94.5%) of these patients. Pre-catheterization echocardiograms from 32 (86.4%) patients were available for review. Pre-catheterization fi ndings associated with reduced likelihood of successful device closure included atrial septal defect rim defi ciency in 16 (50%) patients, defect size >20 mm in 14 patients (43.7%), and presence of interrupted inferior vena cava (no delivery access) in 2 patients (5.4%). Unrecognized sinus venosus type atrial septal defect was identifi ed in 4 patients (10.8%) at the time of surgery. Overall, 26 patients (81.3%) had echocar-diographic risk factors for unsuccessful percutaneous closure on pre-catheterization imaging. One patient required urgent surgical intervention for device embolization.



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Nine patients (24.3%) underwent attempted closure at the request of the referring cardiologist or family despite unfavorable pre-procedure echocardiographic features. Total hospital charges associated with unsuccessful cardiac catheterization were US $480,704 (average $12,992 per patient) during the eight-year study period.

CONCLUSIONS: Anatomic features that preclude successful percutaneous device closure of atrial septal defects are frequently present on imaging studies obtained prior to unsuccessful cardiac catheterization. Despite this, a large number of these patients are subjected to attempted percutaneous closure prior to being referred for surgical therapy. While defi nitive contraindications to attempted catheter-based therapy do not exist, more rigorous adherence to existing guidelines may prevent unnecessary invasive medical procedures and reduce healthcare costs. Multidisci-plinary approaches to treatment planning and improved physician education may reduce the number of unnecessary procedures.


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19. Extracorporeal Membrane Oxygenation As a Bridge to Lung Transplantation: More Successful in the Present EraEmily M. Todd, *Samad A. Hashimi, *Rajat Walia, *Michael A. Smith, B.E. Steinbock, *Jasmine Huang, *Elbert Y. Kuo, *Ashraf Omar, *Vipul Patel, *Ross BremnerNorton Thoracic Institute, Phoenix, AZ

DISCUSSANT: JASLEEN KUKREJA

BACKGROUND: Extracorporeal membrane oxygenation (ECMO) has been used as a bridge to lung transplantation in patients whose pulmonary function has rapidly deteriorated. Measures to improve the safety and risk profi le of this interim treatment are evolving. We reviewed our recent experience using ECMO as a bridge to lung transplantation at a high-volume transplant center.

METHODS: We performed a retrospective review of all patients who underwent lung transplantation at our institution between 01/01/15 and 12/31/15.

RESULTS: Of the 93 patients who underwent lung transplantation during this period, 12 (13%) suffered severe pulmonary deterioration and required ECMO as bridge to transplantation. The primary underlying diseases in these 12 patients were pulmonary fi brosis in 11 and cystic fi brosis in one. Eleven patients (92%) received venovenous ECMO despite elevation of pulmonary arterial pressures; of these, 10 had a single-site, percutaneous bicaval dual lumen catheter placed in the right internal jugular vein, and 1 received a two-site cannulation technique of the right femoral and right internal jugular veins. One patient (8%) received femoral-femoral venoarterial ECMO for lung and cardiac support. A portable ECMO circuit was used in all 12 cases.

The mean duration of ECMO support before transplant was 107 hours (range, 16–395). While on ECMO three patients were awake and communicating and one was able to transition from bed to a chair, but none could ambulate. The median length of stay after transplant for ECMO patients was 30.5 days, compared with median 14.5 days for the 81 non-ECMO patients (p < 0.05).

Major complications in the ECMO subset were myopathy (n = 10, 83%), bleeding (n = 7, 58%), and thrombotic events (n = 7, 58%). Bleeding occurred at cannulation, tracheostomy, or gastrostomy sites. All 7 patients who experienced thrombotic events during or after ECMO had low antithrombin levels before ECMO, but there were no circuit thrombotic events despite suspension of heparin when bleeding occurred. Other complications included delirium and atrial fi brillation. There were no wound or systemic infections. ECMO was terminated in all patients in the operating suite immediately after transplant.

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All 12 patients who received ECMO as a bridge to lung transplantation (100%) sur-vived to transplantation and all survived to discharge. Allograft rejection, incidence of bronchiolitis obliterans syndrome, and long-term functional status are prospectively being assessed.

CONCLUSION: The results of our very recent experience using ECMO as a bridge to transplant in critically ill patients suggest that, despite an increased hospital stay, early outcomes for these patients are excellent. Patients who undergo ECMO as a bridge to lung transplantation commonly face deconditioning and myopathy. Incidence of thrombosis may be reduced by monitoring and replacing antithrombin levels after ECMO and lung transplantation. The success of ECMO and the subse-quent transplant is due in part to improved instrumentation and equipment, as well as thorough training for all medical staff at the center. All specialties should undergo additional education to emphasize the importance of wakefulness and ambulation of ECMO patients, as this would likely reduce delirium, myopathy, and length of stay.


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+20. The Costs of Our Traditional Yardsticks for Quality: Is Value Improving in Cardiac Surgery?Kenan W. Yount1, Jeffrey B. Rich2, Christine L. Lau1, Ravi K. Ghanta1, Leora T. Yarboro1, John A. Kern1, Clifford E. Fonner2, Alan M. Speir3, Gorav Ailawadi11University of Virginia Health System, Charlottesville, VA; 2Virginia Cardiac Surgery Quality Initiative, Charlottesville, VA; 3INOVA Heart and Vascular Institute, Falls Church, VA

DISCUSSANT: RICHARD J. SHEMIN

OBJECTIVE: Experts advocate reorienting health care delivery to maximize value, defi ned as outcomes achieved per dollars spent, but institutions rarely report results in this context. Our objective was to analyze statewide performance in coronary artery bypass grafting (CABG) to ascertain if value had improved.

METHODS: A total of 24,598 patients (2008–2014) undergoing isolated CABG at 18 centers were reviewed using a multi-institutional statewide database linked to cost data. Observed-to-expected (O:E) ratios using Society of Thoracic Surgeons (STS) 30-day mortality and morbidity (stroke, renal failure, reoperation, prolonged ventilation, deep wound infection) were calculated for each year. To create a surrogate for quality, value was calculated as the inverse of O:E divided by cost per patient, adjusted for infl ation using the market basket for the Inpatient Prospective Payment System (IPPS) used by the Centers for Medicare and Medicaid Services (CMS) for reimbursement and reported in year 2015 (present) dollars. The ratio was then trans-formed by a constant and analyzed to demonstrate value trends.

RESULTS: Between 2008–2014, value, in terms of 30-day mortality and morbidity per dollar spent, remained relatively fl at (+2.1 units/year and +1.7 units/year, R2 = 0.14 and 0.21, respectively). Consistent improvements in O:E mortality (0.89 in 2008 to 0.74 in 2014, R2 = 0.57) and morbidity (1.12 in 2008 to 0.8 in 2014, R2 = 0.74) were mostly offset by continued increases in infl ation-adjusted costs per patient (+$1672/year, R2 = 0.86) [see Figure]. STS Predicted Risk of Mortality (PROM) for all patients undergoing CABG increased each year (+0.05%/year, R2 = 0.71). Annual spending increases were most pronounced for patients who suffered a major compli-cation (n = 3623, +$3069/year, R2 = 0.52). Although the increase in costs was higher for intermediate (STS PROM 1–4%, n = 9478, +$2435/year, R2 = 0.90) and high (STS PROM >4%, n = 5452, +$1396/year, R2 = 0.40) risk patients, infl ation-adjusted costs still increased signifi cantly for low-risk patients (STS PROM < 1%, n = 12,727, +$1125/year, R2 = 0.83). Ultimately, these data translate into an increased $240K/year per extra patient who avoids a major complication and $1.9M/year per extra patient who survives 30 days.



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Figure: Value trends in isolated CABG (2008–2014).

CONCLUSION: CABG outcomes remain better than expected and continue to improve, and increasingly high-risk patients are not only surviving but experiencing fewer major complications. However, costs consistently outpace infl ation. While these higher costs may be explained by the increasing risk of patients undergoing CABG and increased spending on managing the major complications that do still occur, costs have also increased for all patients. As pay-for-performance and public reporting continue to be implemented, these data and the proposed framework should guide careful incentive selection with greater emphasis on rewarding value to avoid ill-advised cost escalation at the expense of maintaining 30-day mortality outcomes.


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10:30 am – 11:10 am COFFE BREAK: VISIT EXHIBITS & POSTERS, Queen’s Ballroom

11:10 am – 12:00 pm C . W A LT O N L I L L E H E I P O I N T / C O U N T E R P O I N T S E S S I O N

Monarchy

Surgeons on the Heart Team: Quarterbacks or Water Boys?

Moderator: David A. Fullerton

Speakers:

Quarterbacks: Joseph E. Bavaria

Water Boys: T. Brett Reece

12:00 pm – 12:30 pm ANNUAL BUSINESS MEETING (Members Only), Monarchy

12:30 pm – 2:00 pm FAMILY LUNCHEON, Lagoon Lanai

7:00 pm – 11:00 pm PRESIDENT’S RECEPTION AND BANQUET, Grand Promenade & Monarchy

Dress Code: The dress code for the Annual Meeting is Resort Casual. Aloha shirts are fi ne; jackets and ties are not required. The President’s Reception and Banquet, too, is Resort Casual (for men, Aloha shirts and long pants).


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CONSTITUTION AND BYLAWSTHE WESTERN THORACIC SURGICAL ASSOCIATIONFounded as The Samson Thoracic Surgical Society

CONSTITUTION

ARTICLE I. NAMEThe name of this Corporation is The Western Thoracic Surgical Association (hereinafter “the Association”).

ARTICLE II. CORE VALUESThe core values of the Association shall be:

• Scientifi c Endeavor in a Collegial Environment;

• Education and Progress;

• The Development of Young Surgeons;

• Professionalism; and

• Family and Friendship.

ARTICLE III. PURPOSESThe purposes of the Association shall be:

To succeed to, and to continue to carry on, the activities formerly conducted by The Samson Thoracic Surgical Society, a corporation.

To associate persons residing in the western United States and Canada who desire to advance the quality and practice of thoracic and cardiovascular surgery as a specialty.

To encourage research and study of thoracic and cardiovascular functions and disorders so as to increase knowledge and improve treatment.

To hold scientifi c meetings for the presentation and discussion of topics of interest to thoracic and cardiovascular surgeons and to encourage publication to these proceedings.


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ARTICLE IV. MEMBERSHIPSection 1.The membership of this Association shall consist of surgeons whose principal professional activities are devoted to the practice of thoracic and cardiovascular surgery, and who either fulfi ll the qualifi cations specifi ed in Section 4 below or both fulfi ll the qualifi cations specifi ed in Section 3 below and who are admitted to membership pursuant to the procedure specifi ed in the By-Laws.

Section 2.There shall be fi ve types of membership: Active, Senior, Honorary, Charter, and Candidate, as defi ned in the By-Laws.

Section 3.A candidate for active membership must:

a. Be a Diplomat of the American Board of Thoracic Surgery of the United States, a Fellow in the Cardiovascular and Thoracic Surgery in the Royal College of Surgeons of Canada, or possess such educational credentials as judged equivalent by the Council.

b. Reside within or have completed a cardiothoracic residency training program within the geographic limits of the Association, which are the states of Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, and Wyoming, and the provinces of Alberta, British Columbia, Manitoba, and Saskatchewan.

c. Have been engaged in the practice of thoracic and cardiovascular surgery either outside of or within the geographic limits of the Asso-ciation for at least three years following completion of postgraduate training. One year of this three-years-in-practice requirement may be fulfi lled by completion of either a thoracic surgical residency in an institution within the geographic limits of the Association or a one-year clinical fellowship in an institution within the geographic limits of the Association.

d. Have demonstrated interest in advancing the practice of thoracic and cardiovascular surgery through continuing professional contributions and scientifi c publications.

e. Have obtained the sponsorship of members of the Association as pro-vided in the By-Laws.


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Section 4.All members in good standing of The Samson Thoracic Surgical Society in June, 1983 shall become members of the Association.

Section 5.Charter members. Charter membership in the Association shall be accorded to those members who were charter members in good standing of The Samson Thoracic Surgical Society in June, 1983.

Section 6.The privilege of continuing membership shall be subject to adherence to the provisions of the Constitution and By-Laws of the Association.

ARTICLE V. OFFICERSSection 1.The offi cers of the Association shall be a President, a Vice President, a Secretary, a Treasurer, an Editor, and an Historian.

Section 2.The term of offi ce of the President, Vice President, Secretary and Treasurer shall be one year. The President and Vice President shall not be eligible for re-election. The Secretary and Treasurer shall be eligible for re-election but may serve for no more than four (4) consecutive years. The term of Editor and Historian shall be defi ned in the By-Laws.

Section 3.Neither the Secretary nor the Treasurer may serve concurrently as the President.

Section 4.The Offi cers shall be elected at the Annual Meeting of the Association in accor-dance with the procedures set forth in the By-Laws.

ARTICLE VI. COUNCILSection 1.The governing body of the Association shall be the Council and its composition shall be as provided in the By-Laws.


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ARTICLE VII. MEETINGSSection 1.The Association shall hold Annual Business and regular Scientifi c Meetings, the time and place to be determined by the Council. Only members of the Associa-tion may attend the Business Meetings.

Section 2.Special meetings of the Council or of the members may be called as provided in the By-Laws.

ARTICLE VIII. AMENDMENTSProposed amendments to the Constitution shall be submitted in writing to the members at least 30 days prior to a regular business meeting at which the proposed amendments shall be presented to the membership. Notice of such proposed amendments shall be mailed to each member at least thirty days prior to the next regular meeting at which the vote shall be taken. An affi rmative vote of two-thirds of the members present is required to adopt an amendment to the Constitution.


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BY-LAWS

ARTICLE I. APPLICATION FOR ACTIVE MEMBERSHIPSection 1. Applicant.

a. An applicant for Active membership shall obtain a sponsor who is a member of the Association and who, attesting to the applicant’s profes-sional competence and ethical behavior, shall obtain for him from the Chairman of the Membership Committee the application form and a list of the qualifi cations for Active membership.

b. An applicant for Active Membership shall (1) have a full and unre-stricted license to practice medicine in his or her respective state or province, and (2) have a current appointment on the surgical staff of a hospital with no reportable action pending which could adversely affect such applicant’s staff privileges at any hospital.

c. Any applicant for Active Membership must possess ethical and moral fi tness, as well as professional profi ciency, as determined, in part, on the basis of reports from members consulted as references, reports from other references and other information.

Section 2. Candidate for Membership.An applicant shall become a candidate for membership upon receipt by the Chairman of the Membership Committee of a properly executed application form and the written recommendation of three members, including his sponsor, attesting to his professional competence and ethical behavior. The names of all candidates shall be included in the notice of the regular meeting.

Section 3. Election to Membership.Candidates recommended by the Membership Committee and approved by the Council shall be submitted to a vote at the Annual Business Meeting. Election to Active membership shall require an affi rmative vote of the majority of members present.

Section 4. Notice of Election.Every newly elected member shall be furnished by the Secretary with an offi cial notice of election, accompanied by a copy of the Constitution and By-Laws. A Certifi cate of Membership signed by the President, the Secretary, and the Chair-man of the Membership Committee bearing the Seal of the Association shall be presented to the newly elected members at the fi rst session of the next regular meeting immediately following their election.


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Section 5. Candidates Not Elected.The Secretary shall notify the primary sponsor of candidates not recommended for election and separately notify the candidate.

Section 6. Re-application.An unsuccessful candidate may reapply for membership by submitting a written request and obtaining new sponsor letters, which may be obtained from the same persons who previously submitted sponsor letters. Re-application shall not be permitted more than two times.

ARTICLE II. MEMBERSSection 1. Active Members.

a. Duties and Rights. It shall be the duty of each Active member to attend regularly the meetings of the Association, to participate in the Scientifi c Programs, and to uphold the ideals and objectives of the Association. Each Active member shall be entitled to one vote and may hold any offi ce in the Association.

b. Dues. All Active members shall pay dues. The amount of dues may be changed upon the recommendation of the Council and approval of the majority of the members present at the Annual Business Meeting. Dues shall be payable on April 16th of each year. Members may not attend a meeting unless their dues are current.

c. Number of Members. The number of Active members residing within the geographic limits of the Association shall be limited to two hun-dred and fi fty (250).

d. Moving Outside Geographic Limits. Active members who move outside the geographic limits of the Association may maintain their status and shall not be limited in number. They shall be exempt from the Annual Meeting attendance requirement under Section 1(f) below.

e. Delinquency. The Treasurer shall submit to the Council a list of the members who have failed to pay their dues by March 31st of each year, and notice of such delinquency shall be mailed to each such mem-ber at the address recorded in the records of the Association. If the delinquency is not made good within three (3) months of the mailing of such notice, or excused for adequate cause by the Council, the mem-bership of each delinquent member shall be subject to termination pursuant to Section 1(g) below.


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f. Nonattendance. The membership of any member who fails to attend three (3) consecutive meetings of the Association, unless such nonat-tendance is excused by the Council for adequate cause, shall be subject to termination pursuant to Section 1(g) below.

g. Termination Procedure. Any member whose membership has become subject to termination for delinquency or nonattendance shall be given written notice of such prospective termination not less than forty (40) days before the effective date of the termination. Any member who is subject to termination may apply for reconsideration by fi ling a written request with the Council, addressed to the Secretary, within thirty (30) days following the mailing of notice of such termination, which request shall state the reasons why such membership should not be terminated. If such a request is received within the requisite period, termination will be delayed until after the next Council meeting. If the Council fi nds the reasons given in the request to be adequate, mem-bership shall not be terminated, conditioned upon payment of any arrears, where applicable. If the Council fi nds the reasons given in the request not to be adequate, the termination shall become effective on the sixth day after the Council meeting.

h. Disability. A member who becomes disabled may petition the Council for senior membership status and the Council may grant such request for a period of time until the member can return to practice.

i. Resignation. A member may resign from the Association at any time by tendering a resignation in writing and paying in full any dues or obligations owing the Association at the time.

Section 2. Senior Members.Senior membership shall be obtained by written request and Council approval for members retired from active practice at age 60 or shall be automatic at age 70 provided that continuing active membership without respect to age shall be granted on written request. Senior members shall have the same duties, rights and privileges as active members except that they shall be exempt from dues and meeting attendance requirements and shall not hold offi ce, except the offi ce of the Historian. Their numbers shall not be limited.


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Section 3. Honorary Members.Honorary membership shall be granted to persons deemed suitable by reason of special contributions in the fi eld of thoracic and cardiovascular surgery or professional accomplishments. Such persons need not be certifi ed thoracic surgeons. Persons deemed suitable as Honorary members may become such when proposed by two members, endorsed by the Membership Committee and the Council, and approved by a majority of the members present at the next meeting. Honorary members shall be exempt from dues and meeting attendance requirements and shall have no rights to vote or hold offi ce except as provided below. The Editor of THE JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY shall be an honorary member of the Association and ex-offi cio mem-ber of the Council without vote.

Section 4. Candidate Members.Candidate membership is available to:

• Residents who are matched or enrolled in either a cardiothoracic surgery edu-cation program accredited by the Residency Review Committee for Thoracic Surgery under the authority of the Accreditation Council for Graduate Medical Education or a program approved for cardiothoracic surgery education by the Royal College of Surgeons of Canada—or their equivalency—from the Associa-tion’s geographic limits as defi ned by the Constitution of the Association;

• Individuals who have completed their education in one of the above pro-grams but do not yet meet all of the criteria for Active membership per Article IV, Section 3, of the Constitution; and

• Individuals who trained outside the Association’s geographic limits who are now residing within the Association’s boundaries but do not yet have three years in practice.

Candidate members shall have no rights to vote or hold offi ce. Candidate mem-bership shall end when the Candidate becomes eligible for Active membership, at which time s/he is invited to apply for Active membership.

Section 5. Conduct & Discipline.

a. Conduct. A member of the Association shall conduct his relationship with patients, fellow physicians, and the public at large in a manner consistent with the Principles of Medical Ethics of the Society of Tho-racic Surgeons, and with the purposes of this Association.


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b. Discipline. Upon the recommendation of the Ethics Committee, the Council may take disciplinary action against a member for conduct inconsistent with the provisions of this Section or with the purposes of the Association. Any question concerning the conduct or discipline of a member shall be directed to the Chairman of the Ethics Committee. In the event that the Ethics Committee determines that disciplinary action should be considered in a particular case, the Committee shall submit to the Council a written recommendation of the disciplinary action which the Committee proposes be taken. Such determination by the Ethics Committee shall be made only after the member has been given not less than thirty (30) days written notice of the date, time and place of the Committee’s meeting, and of the nature of the complaint regarding the conduct of the member or charges against the member which are considered by the Committee, and informing the member that he may appear in person and/or by a representative and may sub-mit whatever information he deems proper to refute the charges under consideration.

In the event that the Ethics Committee recommends to the Council that disciplinary action be taken against a member, such member shall be given thirty (30) days written notice of the time and place of the Council meeting at which such recommendation is to be considered, and of his right to appear in person or by representative to submit whatever information he deems appropriate to refute the recommen-dation of the Committee. Disciplinary action may consist of censure, probation, suspension, or expulsion from membership, as deemed appropriate by a majority of the Council following hearing and con-sideration as set forth above. No such disciplinary action shall become effective less than fi ve (5) days after the scheduled date of the Council meeting at which the member had the opportunity to refute the Com-mittee’s recommendation.

ARTICLE III. OFFICERSSection 1. Nomination and Election.Candidates for election as Vice President, Secretary, Treasurer and Councilor-at-Large shall be placed in nomination by the Nominating Committee. Nomina-tions for any of these offi ces may also be made from the fl oor. An affi rmative vote by the majority of the members present at an Annual Meeting shall be required for election to offi ce. The Vice President, Secretary and Treasurer shall be elected


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annually, and will hold offi ce from the termination of the meeting at which elected until the termination of the next regular meeting when their successor will be elected. The Vice President shall become the President upon completion of his term as Vice President.

Section 2. Duties of the President.The President shall be the chief executive offi cer of the Association and shall have general supervision over the business of the Association, subject to the con-trol of the Council. He shall preside at all meetings and generally shall perform all duties incident to the offi ce of President, together with such other duties as may from time to time be delegated to him by the Council.

Section 3. Duties of the Vice President.The Vice President shall perform the duties of the President in the absence or inability to act of the President, and such other duties as set forth in these By-Laws or as may from time to time be delegated to him by the Council.

Section 4. Duties of the Secretary.The Secretary shall certify and maintain the records of the Association, including a copy of the Constitution and By-Laws, together with any amendment thereto, and a record of the names, classifi cations, and addresses of the members. The Secretary shall keep minutes of the meetings of the Association, shall fi le all non-fi nancial reports required by law and shall send all notices required by law, by these By-Laws, or by direction of the Council, and shall perform such other duties as may be assigned by the Council.

Section 5. Duties of the Treasurer.The Treasurer shall receive and have charge of all funds of the Association, sub-ject to the direction of the Council. He shall perform the usual duties incident to the offi ce of the Treasurer, including the collection of dues, the payment of the Association’s bills and obligations as approved by the Council, and the preparation, submission to the Council and presentation to the members of an annual fi nancial report, including any that may be required by statute, together with such additional duties as may from time to time be assigned to him by the Council. The fi nancial affairs and the fi nancial statements of the Association shall be audited by an Audit Committee of members, or by an outside auditor as determined from year to year by the Council.


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Section 6. Duties of the Editor.The Editor of THE JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY shall be the Editor of the Association and shall be an ex-offi cio mem-ber without vote of the Program Committee and the Council. The Editor shall be appointed annually by the Council. The Editor shall serve as advisor to the Association on standards for editing and review for publication of manuscripts and proceedings of the Association.

Section 7. Duties of the Historian.The Historian shall be the Parliamentarian and Historian of the Association and shall act as its public relations and press representative, and perform such other duties as may from time to time be delegated to him by the Council. The Historian shall be appointed annually by the Council.

Section 8. Duties of the Representative to the American College of Surgeons Board of Governors.The representative to the Board of Governors of the American College of Sur-geons shall represent the membership of the Association to the American Col-lege of Surgeons’ Board of Governors in accordance with the duties of a specialty society Governor. Such Governor shall be appointed by the American College of Surgeons from nominees submitted by the Council of the Association and shall serve on the Council as an ex-offi cio member without vote.

Section 9. Compensation of Offi cers.No Offi cer of the Association shall receive any compensation for his services, but may be reimbursed for expenses when authorized by the Council.

ARTICLE IV. COUNCILSection 1. Composition of the Council.The Council shall be composed of the President, Vice President, Secretary, Trea-surer, Immediate Past President, (3) Councilors-at-Large, up to (2) Councilors/Founders and ex-offi cio, without vote, the Historian, Editor, and Representative to the Board of Governors of the American College of Surgeons.

Section 2. Councilors-at-Large.One Councilor-at-Large may be elected at each Annual Business Meeting by majority vote and serve three years.


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Section 3. Duties of the Council.The Council shall exercise all corporate powers, excepting as otherwise provided in the By-Laws. The Council shall appoint the Historian and the Editor, and may in its discretion appoint an Assistant Secretary or Assistant Treasurer.

Section 4. Liability of Councilors. A Councilor shall have no liability based upon any alleged failure to discharge his obligations as a Councilor, except for any self-dealing transaction prohibited by law.

Section 5. Compensation of the Council.No Councilor shall receive any compensation for serving as a Councilor of the Association, but may be reimbursed for expenses when authorized by the Council.

Section 6. Council Meetings.

a. Regular and Special Meetings. The Council shall hold regular meet-ings just before the beginning of the Annual Meeting of members, and shall hold such additional meetings as shall be called from time to time by the President or by any two voting members of the Council.

b. Notice. Meetings of the Council shall be held upon four days’ notice by fi rst class mail or 48 hours’ notice delivered personally by telephone or telegraph. Notice of regular meetings need not be given if the time and place of such meeting has been set previously by the Council. Notice of a meeting need not be given to any Councilor who signs a waiver of notice or a written consent to holding the meeting or an approval of the minutes thereof, whether before or after the meeting, who attends the meeting without protesting, prior thereto or at its commencement, the lack of such notice to such Councilor. All such waivers, consents and approvals shall be fi led with the corporate records or made a part of the minutes of the meetings.

c. Quorum. The presence of fi ve (5) voting members of the Council shall constitute a quorum for a Council meeting.

d. Telephone Conference. Council members may participate in a meet-ing through the use of a conference telephone or similar communica-tions equipment, so long as all members participating in such meeting can hear one another. Participation in a meeting pursuant to this section constitutes presence in person at such meeting.


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e. Manner of Acting. Every act or decision done or made by a majority of the Councilors present at a meeting duly held at which a quorum is present is an act of the Council. A meeting at which a quorum is ini-tially present may continue to transact business, not withstanding the withdrawal of Councilors, if any action taken is approved by at least a majority of the required quorum for such meeting.

f. Adjournment. A majority of the Councilors present, whether or not a quorum is present, may adjourn any meeting to another time and place. If the meeting is adjourned for more than 24 hours, notice of such adjournment shall be given prior to the time of the adjourned meeting to the Councilors who were not present at the time of the adjournment.

ARTICLE V. EXECUTIVE DIRECTORThe Council may appoint an Executive Director, who shall be responsible for the operational management of the affairs of the Association, under the executive direction of the Offi cers in their respective areas of responsibility. The Executive Director shall be bonded in an amount suffi cient to safeguard the fi nancial assets of the Association.

ARTICLE VI. COMMITTEES Section 1. Standing Committees.The Standing Committees of the Association shall be:

a. Membership. The Membership Committee shall consist of a Chairman and fi ve members, each to serve for a term of three years provided that the terms are initially arranged such that two members retire each year. The Committee shall formulate and recommend to the Council, rules governing the qualifi cations and procedure with respect to elections of new members and, when appropriate, a recommendation as to the numerical limitations upon each type of membership. The Committee shall consider all applications for membership and report their recom-mendations to the Council for review and for presentation to the meet-ings of the members.


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b. Program. The Program Committee shall consist of a Chairman and fi ve members, each to serve for a term of three years, provided that the terms are initially arranged so that two members retire each year. The President, Secretary, and Editor shall also serve as members ex-offi cio without vote. It shall be the responsibility of the Program Commit-tee to make all arrangements necessary to provide scientifi c sessions of high quality. The Program Committee shall submit a budget of expenses for the program, and the names of persons to be invited as guest speakers, to the Council for approval before making any fi nal commitments regarding the expenses and guest speakers. The Program Committee shall have the additional responsibility of the initial edito-rial review of all manuscripts presented at the regular meeting before they are submitted to the Editor.

c. Local Arrangements. The Local Arrangements Committee shall con-sist of a Chairman and as many members as are deemed appropriate by the Council. The Committee shall serve for a term of one year. The responsibility of the Committee shall be to make the general arrange-ments for the Annual Meeting and to submit a report and budget for such arrangements to the Council at least thirty days before such Annual Meeting.

d. Nominating. The Nominating Committee shall consist of the fi ve most recent surviving Past Presidents of the Association. The most senior Past President shall serve as Chairman. The Committee shall prepare a slate of nominees to fi ll any vacancies among the Offi cers and Council which exist or will occur at the time of the Annual Meeting. The Com-mittee shall submit its proposed slate to the Council before presenta-tion to the members at the Annual Meeting.

e. Ethics. The Ethics Committee shall consist of the three most recent surviving Past Presidents of the Association. The most recent Past Presi-dent shall serve as Chairman. The Committee shall consider questions of conduct of members and make recommendations to the Council pursuant to Article II, Section 4 of these By-Laws.


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f. Industry Relations. The Industry Relations Committee shall consist of a Chair and up to six members, each to serve a term of three years and so arranged such that no more than half of the Committee’s members retire each year. The Industry Relations Committee shall be respon-sible for preparing new ideas for consideration by Council that would expand and enhance relations with industry along with the resources required to develop such concepts, thereby sustaining the Association’s validity with industry.

Section 2. Appointment.Appointment to vacant chairmanships or memberships of each Standing Com-mittee, except the Nominating and Ethics Committees, shall be made by the Vice President for the year during which he will be President. The Vice President shall make known to the Nominating Committee and the Council for review and approval his selection of members for the Committee appointments. Vacan-cies on Committees occurring between regular meetings shall be fi lled by the President.

Section 3. Special Committees.The Council from time to time may create such Special Committees and appoint the Chairman and members thereof as it deems appropriate for carrying out the purposes and activities of the Association.

ARTICLE VII. MEETINGS OF MEMBERSSection 1. Special Meetings.Special meetings of the members may be called by the President or by 5 percent or more of the members. Any special business meeting of the members called by the President to act on an amendment to the By-Laws shall be approved by the Council.

Section 2. Notice of Meetings.Notice of each Annual or Special Meeting shall be given appropriately as deter-mined by the President or by the Council to members of record at the close of business on the business day preceding the day on which notice is given, pro-vided that such notice of the Annual Meeting or Special Meeting of the members shall be given to each member by the Secretary in writing at least thirty (30) and not more than ninety (90) days prior to the date thereof.


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Section 3. Quorum.No fewer than fi fty (50) member shall constitute a quorum for the transaction of the business of the Association at any meeting. However, if fewer than one-third (1/3) of the members are present at the meeting, the only matters which may be voted upon are those matters as to which proper notice was given.

Section 4. Proposals to the Members.Proposals concerning the operation or policies of the Association may be brought before meetings of the members upon majority vote of the Council or written request of a majority of the voting members delivered to the Secretary not less than thirty (30) days prior to such meeting. A decision reached at the meeting regarding such a proposal shall be a two-thirds (2/3) vote of the mem-bers, assuming a quorum, shall be binding on the Council and the Association.

Section 5. Proxies.Attendance or voting at a meeting of members by proxy is prohibited and shall be invalid and of no effect.

Section 6. Reports and Papers.All reports and papers read before the Association at the Annual Meeting shall be deposited with the Secretary at the time of their presentation.

ARTICLE VIII. GENERALSection 1. Operation of the Association.The Association shall operate as set forth in its Articles of Incorporation, Con-stitution and By-Laws, and its funds, both income and principal, shall be used solely for the purposes therein set forth, no part of the same being available for the benefi t of any member or other person, fi rm or society.

Section 2. Annual Financial Report.The Treasurer’s fi nancial report referred to in Article III, Section 5, shall be considered the Annual Financial Report of the Association and the Council shall have no duty to cause any other fi nancial report to be prepared. The fi nancial report shall be distributed in writing to the members at the Annual Meeting or mailed to the members as the Council determines.

Section 3. Fiscal Year.The fi scal year of the Association shall be from January 1 through December 31 of the next calendar year.


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Section 4. Parliamentary Procedure.The meetings of the members and Council, excepting as otherwise provided in the By-Laws shall be conducted pursuant to Sturgis Standard Code of Parliamen-tary Procedure, as set forth in the then current edition of said work.

Section 5. Reserve and Endowment Funds.The Council may establish a reserve fund and from time to time direct that funds of the Association not required for current operations be transferred to such fund to provide long term fi nancial stability to the Association and to be a means for accumulating funds for future projects. The reserve fund shall be deposited in an insured account or accounts in a savings bank and/or savings and loan association or invested in whole or in part in investments which legally may be made by trustees under the laws of the State of California. The Council may create a Reserve Fund Committee to make recommendations concern-ing the investment and deposit of the fund. The Council may in its discretion withdraw and use in the current operations of the Association the income of the fund, but withdrawals of principal shall be made only with the approval of the proposed withdrawal and use of the funds by a majority of the Council mem-bers present at a meeting.

Section 6. Samson Endowment Fund.The Council shall establish a Paul C. Samson Endowment Fund to perpetuate the educational activities of the Association and to underwrite in whole or in part the Paul C. Samson Resident Prize Award.

ARTICLE IX. ASSESSMENTSIf in the judgment of the Council special needs of the Association so require, it may propose an assessment of a specifi ed amount to be charged to each member. Notice of such proposal shall be mailed to the members at least thirty (30) days in advance of the meeting at which the vote is to be taken, and shall be effective if approved by two-thirds (2/3) of the members present at such meeting.

ARTICLE X. GUESTSSection 1. Guests of the Members.Each member may invite one guest and accompanying person to meetings of the Association. Members shall notify the Secretary in advance of the names of their guests. The Council shall determine the charge to be made for guests and the expenses relating to the guests’ attendance shall be the responsibility of the member who has issued the invitation.


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Section 2. Guests of the Program Committee.The Program Committee may invite guests to participate in the scientifi c pro-grams. Such guests shall be expected to bear the expenses related to their par-ticipation and attendance at meetings except as provided in Article X, Section 3.

Section 3. Guest of the Council.The Council may invite guests to attend the meetings of the Association without charge when deemed appropriate and in the interest of carrying out the pur-poses of the Association.

Section 4. Participation of Guests.Guests shall be expected to withdraw when the business of the Association is to be conducted, as an announcement by the President.

ARTICLE XI. INDEMNIFICATIONThe Association shall indemnify any person, who is or was a Councilor, offi cer, employee or other agent of the Association, to the extent allowed by law, so long as such person acted in good faith, in a manner such person believed to be in the best interests of the Association and with such care, including reason-able inquiry, as an ordinary prudent person in a like position would use under similar circumstances.

ARTICLE XII. DISSOLUTIONSection 1. Voting.The Association shall not be dissolved except by the affi rmative vote of two-thirds (2/3) of the members entitled to vote.

Section 2. Conditions.In the event of dissolution of the Association in any manner and for any cause, after the payment or adequate provision being made for payment of all of its debts, and liabilities, all of the remaining funds and assets of the Association shall be transferred to a nonprofi t fund, foundation or corporation which is orga-nized and operated exclusively for educational or scientifi c purposes related to the purpose of the Association, and which has established its tax exempt status under Section 501 (c) (3) of the Internal Revenue Code and Section 23701 (d) of the Revenue and Taxation Code of California, or equivalent statutes then in effect.


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ARTICLE XIII. AMENDMENTSProposed amendments to these By-Laws shall be submitted in writing to the members at a business meeting called for that purpose immediately preceding the one at which the vote is taken. An affi rmative vote of two-thirds (2/3) of the members present is required to adopt an amendment to the By-Laws.

Revised: June 1999June 2000June 2001June 2007

June 2009

June 2010

June 2012

June 2014

June 2015


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GUIDELINES FOR EXPERT WITNESS TESTIMONYThe Western Thoracic Surgical Association joins with other specialty organiza-tions in emphasizing the obligation of objectivity when its members respond to requests to serve as expert witnesses in the judicial system. The perceived need for a guideline outlining policies and standards for expert testimony was recog-nized by the Council following a report by the Association’s Ethics Committee of a complaint against a member. Within the legal system the defi nition of an “expert” is far less stringent than what the medical profession might acknowledge. In a trial the attorneys introduce the qualifi cations of their experts and their testimony generally embodies relevant facts, the expert’s knowledge and experience, and the expert’s best judgment. Attacks on the credibility of an expert witness are termed impeachments and tactics can be employed during cross-examination to question the expert’s qualifi cations. It is this issue that the Association wishes to specifi cally address, the qualifi cations of an expert. An expert witness should have current experience and ongoing knowledge about the areas of clinical medicine in which they are testifying as well as familiarity with practices during the time and place of the episode being considered as well as the circumstances surrounding the occurrence. The expert witness should be an impartial practicing physician. He or she must not become an advocate or a partisan in a legal proceeding. Truthfulness is essential and misrepresentation or exaggeration of facts or opinions in an attempt to establish an absolute right or wrong may be harmful both to the individual parties involved and to the profession as a whole. The experts’s views must not narrowly refl ect applicable standards to the exclusion of the other acceptable choices. The ultimate test for accuracy and impartiality is a willingness to prepare testimony that could be presented unchanged for use by either the plaintiff or the defendant. The solicitation of physicians to serve as expert witnesses by plaintiff’s attorneys who offer large fees may result in highly biased and inaccurate testimony. The expert witness should possess excellent special knowledge but be cognizant of the limitations of his competence in his own special fi eld, and recognize the possibility of multiple accepted avenues of therapy. The expert witness gives testimony that educates the court and the jury rather than obfuscates and distorts for personal gain.


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*Senior Member

IMPORTANT NOTICE: The previous member listing is proprietary information of the Western Thoracic Surgical Association (“WTSA”) and may not be distributed or duplicated, in whole or in part, for any pur-pose without the prior written consent of the WTSA. Use of the information for telemarketing or any other solicitation of any persons on this list is strictly prohibited.

NECROLOGY

John C. Bigelow, MD, Portland, OR

Lawrence H. Cohn, MD, Boston, MA

John E. Connolly, MD, Orange, CA

Charles H. Dart Jr., MD, Ventura, CA

Morris Fier, MD, Newport Beach, CA

Richard G. Fosburg, MD, Rancho Mirage, CA

George B. Hart, MD, Long Beach, CA

Adel F. Matar, MD, Lake Oswego, OR

Jack M. Matloff, MD, Los Angeles, CA

Arthur C. Miller, MD, Days Creek, OR

John R.F. Penido, MD, Pasadena, CA

Carter A. Printup Jr., MD, La Canada, CA

Hobart M. Proctor, MD, Dana Point, CA

Clifford J. Straehley, MD, Golden, CO

George J. Wittenstein, MD, Santa Barbara, CA


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Quentin R. Stiles1988–1989

John R. Benfi eld1989–1990

Richard P. Anderson1990-1991

Richard G. Fosburg1991–1992

John C. Callaghan1984–1985

Richard M. Peters1985–1986

Ivan A. May1986–1987

Lucius D. Hill1987-1988

David J. Dugan1974–1977

John E. Connolly1977–1978

Norman E. Shumway1978–1979

Harold V. Liddle1979–1980

Bertrand V. Meyer1980–1981

Paul A. Ebert1981–1982

Robert W. Jamplis1982–1983

Arthur N. Thomas1983–1984

PAST PRESIDENTS


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Steven W. Guyton2004–2005

R. Scott Mitchell2005–2006

Elliot T. Gelfand2006–2007

Douglas E. Wood2007–2008

David R. Clarke2000–2001

Donald B. Doty2001–2002

Edward D. Verrier2002–2003

Vaughn A. Starnes2003–2004

Daniel J. Ullyot1996–1997

Winfi eld J. Wells1997–1998

Kent W. Jones1998–1999

Bradley J. Harlan1999–2000

James B.D. Mark1992–1993

Marvin Pomerantz1993–1994

D. Craig Miller1994–1995

Richard G. Sanderson1995–1996


238

Robert C. Robbins2011-2012

Robbin G. Cohen2010-2011

Michael S. Mulligan2014–2015

J. Scott Millikan2009-2010

Thomas A. Burdon2013–2014

David A. Fullerton2008–2009

John C. Chen2012–2013


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THE SAMSON ENDOWMENT/SAMSON WTSA FUND

In 1984, on the tenth anniversary of its founding, the Samson Thoracic Surgical Society changed its name to the Western Thoracic Surgical Association in order to better describe its scope and to gain professional recogni-tion as the major surgical specialty organization it had become. Thereafter, the Council sought a means to perpetuate the name of Paul C. Samson, the patron and

inspiration of the society during its early years. Mindful of Paul’s legend-ary warmth and generosity to young surgeons and his lifelong dedication to both graduate and postgraduate surgical education, it was decided to link his name with the activities of the Association that pertained to these interests and in 1985 the Samson Endowment Fund was created.

The Fund is managed as an endowment and the interest accruing to the principal is used exclusively for specifi c educational purposes. One such purpose is the funding of the Samson Resident Prize Essay which each year brings to the scientifi c program the best work of residents from tho-racic surgical education programs throughout North America and from abroad.

The Samson Endowment Fund has reached its goal and has now been capped. A new, unrestricted Samson WTSA Fund has been opened, the purpose of which is to help the WTSA achieve its ongoing mission of: associating persons who desire to advance the quality and practice of thoracic and cardiovascular surgery as a specialty; encouraging research and study of thoracic and cardiovascular functions and disorders so as to increase knowledge and improve treatment; and holding scientifi c meet-ings for the presentation and discussion of topics of interest to thoracic and cardiovascular surgeons and to encourage publication to these pro-ceedings. It is suggested that each member make a contribution of $500 to the Samson Endowment and WTSA Funds. This may be viewed as a lifetime obligation to be discharged in any manner over any time period the Member chooses. Previous contributions to the now capped.

Samson Endowment Fund are totaled with any new donations to the Samson WTSA Fund when calculating whether a member has fulfi lled his/her suggested lifetime contribution of $500. Contribution is entirely voluntary and failure to contribute is not penalized or singled out in any way. A line item for optional contribution is included on the annual dues statement only as a reminder.


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DAVID J. DUGAN DISTINGUISHED SERVICE AWARD

The David J. Dugan Distinguished Service Award of the Western Thoracic Surgical Association is presented to members of the Association in recognition of distin-guished achievement and outstanding contributions to the fi eld of thoracic surgery in the areas of science or leadership over a sustained period of time. Nominations for this award are made by the Nominating Committee and are presented to the Council for consideration & approval.

1994 George E. Miller, JrPebble Beach, California

1997 Edward A. SmeloffSacramento, California

1999 Jack M. MatloffLos Angeles, California

2002 Albert StarrPortland, Oregon

2004 Leonard L. BaileyLoma Linda, California

2005 Bruce A. ReitzStanford, California

2007 W. Gerald RainerDenver, Colorado

2009 Richard P. AndersonSeattle, Washington

2010 John A. HawkinsSalt Lake City, Utah


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2013 Edward D. VerrierSeattle, Washington

2014 Harold C. Urschel, Jr.Dallas, Texas


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DONALD B. DOTY EDUCATIONAL AWARD

The Donald B. Doty Educational Award is a $10,000 educational grant with a twofold purpose: 1) to foster innovative educational initiatives in cardiothoracic surgery by WTSA members, and 2) to provide an opportunity for the dissemination of this information to other training centers and academic institutions.

2005 LDS HospitalSalt Lake City

2006 James I. FannStanford, California

2007 Gordon A. CohenSeattle, Washington

2008 John D. MitchellAurora, Colorado

2009 Robbin G. CohenLos Angeles, California

2010 Michael S. MulliganSeattle, Washington

2011 Gordon A. CohenSeattle, Washington

2012 James I. FannStanford, California

2013 Winfi eld J. WellsLos Angeles, California

2014 Nahush A. MokadamSeattle, Washington

2015 Sunil P. MalhotraNew York, New York


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PAST MEETING HIGHLIGHTS

1975 The Santa Barbara Biltmore Hotel, Santa Barbara, CaliforniaPresident David J. Dugan

Oakland, CaliforniaSecretary Arthur N. Thomas

San Francisco, CaliforniaLocal Arrangements Chairman John F. Higginson

Santa Barbara, CaliforniaSamson Resident Prize Essay Award William R. Brody

Bethesda, Maryland

1976 The Banff Springs Hotel, Banff, Alberta, CanadaPresident David J. Dugan


San Francisco, CaliforniaLocal Arrangements Chairman John C. Callaghan

Edmonton, Alberta, CanadaSamson Resident Prize Essay Award Joe W. Ramsdell

San Diego, California

1977 The Broadmoor Hotel, Colorado Springs, ColoradoPresident David J. Dugan


San Francisco, CaliforniaLocal Arrangements Chairman Richard G. Sanderson

Tucson, ArizonaSamson Resident Prize Essay Award J. Nilas Young

Oakland, California

1978 Hotel Del Coronado, Coronado, CaliforniaPresident John E. Connolly

Irvine, CaliforniaSecretary Arthur N. Thomas

San Francisco, CaliforniaLocal Arrangements Chairman Richard G. Fosburg

San Diego, CaliforniaSamson Resident Prize Essay Award James M. Wilson

San Francisco, California


253


1979 Sun Valley Lodge, Sun Valley, IdahoPresident Norman E. Shumway

Stanford, CaliforniaSecretary Arthur N. Thomas

San Francisco, CaliforniaLocal Arrangements Chairman Harold V. Liddle

Salt Lake City, UtahSamson Resident Prize Essay Award Thomas H. Hoffmann

San Antonio, Texas

1980 Tamarron Lodge, Durango, ColoradoPresident Harold V. Liddle

Salt Lake City, UtahSecretary Arthur N. Thomas

San Francisco, CaliforniaLocal Arrangements Chairman W. Gerald Rainer

Denver, ColoradoSamson Resident Prize Essay Award Robert H. Breyer

Chicago, Illinois

1981 Hyatt Regency Hotel, Maui, HawaiiPresident Bertrand W. Meyer

Los Angeles, CaliforniaSecretary Lucius D. Hill

Seattle, WashingtonLocal Arrangements Chairman Quentin R. Stiles

Los Angeles, CaliforniaSamson Resident Prize Essay Award Clifford M. Kitten

San Antonio, Texas

1982 Hotel del Coronado, Coronado, CaliforniaPresident Paul A. Ebert

San Francisco, CaliforniaSecretary Lucius D. Hill

Seattle, WashingtonLocal Arrangements Chairman Richard G. Fosburg

La Jolla, CaliforniaSamson Resident Prize Essay Award Douglas A. Murphy

Atlanta, Georgia


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1983 The Broadmoor, Colorado Springs, ColoradoPresident Robert W. Jamplis

Palo Alto, CaliforniaSecretary Lucius D. Hill

Seattle, WashingtonLocal Arrangements Co-Chairmen James B.D. Mark

Stanford, California W. Gerald Rainer

Denver, ColoradoSamson Resident Prize Essay Award Michael L. Dewar

Montreal, Quebec, Canada

1984 Hyatt Regency Hotel, Maui, HawaiiPresident Arthur N. Thomas

San Francisco, CaliforniaSecretary Lucius D. Hill

Seattle, WashingtonLocal Arrangements Chairman David J. Dugan

Oakland, CaliforniaSamson Resident Prize Essay Award Keith D. Dawkins

Stanford, California

1985 Hyatt Lake Tahoe, Incline Village, NevadaPresident John C. Callaghan

Edmonton, Alberta, CanadaSecretary Lucius D. Hill

Seattle, WashingtonLocal Arrangements Chairman Edward A. Smeloff

Sacramento, CaliforniaSamson Resident Prize Essay Award George T. Christakis

Toronto, Ontario, Canada

1986 Silverado Country Club, Napa, CaliforniaPresident Richard M. Peters

San Diego, CaliforniaSecretary Richard G. Fosburg

Del Mar, CaliforniaLocal Arrangements Chairman John R. Benfi eld

Duarte, CaliforniaSamson Resident Prize Essay Award David E. Hansen



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1987 The Broadmoor, Colorado Springs, ColoradoPresident Ivan A. May

Oakland, CaliforniaSecretary Richard G. Fosburg

Del Mar, CaliforniaLocal Arrangements Chairman Leigh I.G. Iverson

Oakland, CaliforniaSamson Resident Prize Essay Award Louis A. Brunsting

Durham, North Carolina

1988 Royal Waikoloa. Waikoloa, HawaiiPresident Lucius D.Hill

Seattle, WashingtonSecretary Richard G. Fosburg

Del Mar, CaliforniaLocal Arrangements Chairman Richard P. Anderson

Seattle, WashingtonSamson Resident Prize Essay Award George E. Sarris


1989 Hyatt Regency Resort, Monterey, CaliforniaPresident Quentin R. Stiles

Los Angeles, CaliforniaSecretary Richard G. Fosburg

Del Mar, CaliforniaLocal Arrangements Co-Chairmen Richard L. Murtland

Monterey, California Winfi eld J. Wells

Los Angeles, CaliforniaSamson Resident Prize Essay Award Michael A. Breda

Los Angeles, California

1990 Hotel Del Coronado, San Diego, CaliforniaPresident John R. Benfi eld

Sacramento, CaliforniaSecretary D. Craig Miller

Stanford, CaliforniaLocal Arrangements Chairman Richard G. Fosburg

La Jolla, CaliforniaSamson Resident Prize Essay Award David Fullerton

Denver, Colorado


256


1991 Westin Hotel, Seattle, WashingtonPresident Richard P. Anderson

Seattle, WashingtonSecretary D. Craig Miller

Stanford, CaliforniaLocal Arrangements Chairman Philip C. Jolly

Seattle, WashingtonSamson Resident Prize Essay Award John S. Pirolo

St. Louis, Missouri

1992 Hyatt Regency Hotel, Kauai, HawaiiPresident Richard G. Fosburg

La Jolla, CaliforniaSecretary D. Craig Miller

Stanford, CaliforniaLocal Arrangements Co-Chairmen Edward L. Hurley

Sacramento, California Philip W. Wright

Honolulu, HawaiiSamson Resident Prize Essay Award Luis J.Castro


1993 La Costa Resort, Carlsbad, CaliforniaPresident James B.D. Mark

Stanford, CaliforniaSecretary D. Craig Miller

Stanford, CaliforniaLocal Arrangements Chairman Walter B. Cannon

Palo Alto, CaliforniaSamson Resident Prize Essay Award Paul J. Pearson

Rochester, Minnesota

1994 Resort at Squaw Creek, Olympic Valley, CaliforniaPresident Marvin Pomerantz

Denver, ColoradoSecretary Kent W. Jones

Salt Lake City, UtahLocal Arrangements Chairman Daniel L. Smith

Denver, ColoradoSamson Resident Prize Essay Award Barbara L. Robinson

Rochester, Minnesota


257


1995 The Coeur d’Alene Resort, Coeur d’Alene, IdahoPresident D. Craig Miller

Stanford, CaliforniaSecretary Kent W. Jones

Salt Lake City, UtahLocal Arrangements Chairman Ronald P. Grunwald

Spokane, WashingtonSamson Resident Prize Essay Award Michael J. Moulton

St. Louis, Missouri

1996 The Grand Wailea Resort, Wailea, Maui, HawaiiPresident Richard G. Sanderson

Tucson, ArizonaSecretary Kent W. Jones

Salt Lake City, UtahLocal Arrangements Chairman Edward A. Smeloff

Sacramento, CaliforniaSamson Resident Prize Essay Award Daniel S. Schwartz

New York, New York

1997 The Silverado Country Club & Resort, Napa, CaliforniaPresident Daniel J. Ullyot

Burlingame, CaliforniaSecretary Kent W. Jones

Salt Lake City, UtahLocal Arrangements Chairman Michael K. Wood

Hillsborough, CaliforniaSamson Resident Prize Essay Award Edward M. Boyle, Jr.

Seattle, Washington

1998 The Chateau Whistler Resort, Whistler, B.C., CanadaPresident Winfi eld J. Wells

Los Angeles, CaliforniaSecretary Vaughn A. Starnes

Los Angeles, CaliforniaLocal Arrangements Co-Chair W.R. Eric Jamieson

Vancouver, B.C., Canada Patricia A. Penkoske

Edmonton, Alberta, CanadaSamson Resident Prize Essay Award Vivek Rao

Toronto, Ontario, Canada


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1999 The Resort at Squaw Creek, Olympic Valley, CaliforniaPresident Kent W. Jones

Salt Lake City, UtahSecretary Vaughn A. Starnes

Los Angeles, CaliforniaLocal Arrangements Chairman J. Edward Okies

Portland, OregonSamson Resident Prize Essay Award Leonard Y. Lee

New York, New York

2000 The Orchid at Mauna Lani, The Big Island, HawaiiPresident Bradley J. Harlan

Sacramento, CaliforniaSecretary Vaughn A. Starnes

Los Angeles, CaliforniaLocal Arrangements Co-Chairs Paul B. Kelly and Linda M. Kelly

Fair Oaks, CaliforniaSamson Resident Prize Essay Award Murray H. Kown


2001 Rancho Bernardo Inn, San Diego, CaliforniaPresident David R. Clarke

Denver, ColoradoSecretary Vaughn A. Starnes

Los Angeles, CaliforniaLocal Arrangements Co-Chairs Myles S. Guber and Debbie Bishop

Denver, ColoradoSamson Resident Prize Essay Award Baiya Krishnadasan

Seattle, Washington

2002 Big Sky Resort, Big Sky, MontanaPresident Donald B. Doty

Salt Lake City, UtahSecretary R. Scott Mitchell

Stanford, CaliforniaLocal Arrangements Chairman John A. Hawkins

Salt Lake City, UtahSamson Resident Prize Essay Award Susan D. Moffatt-Bruce



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2003 La Costa Resort, Carlsbad, CaliforniaPresident Edward D. Verrier

Seattle, WashingtonSecretary R. Scott Mitchell

Stanford, CaliforniaLocal Arrangements Chairman Douglas E. Wood

Seattle, WashingtonSamson Resident Prize Essay Award Albert J. Chong

Seattle, Washington

2004 Wailea Marriott, Wailea, Maui, HawaiiPresident Vaughn A. Starnes

Los Angeles, CaliforniaSecretary R. Scott Mitchell

Stanford, CaliforniaLocal Arrangements Chairman Winfi eld J. Wells

Los Angeles, CaliforniaSamson Resident Prize Essay Award Frederick A. Tibayan


2005 Fairmont Empress Hotel, Victoria, BC, CanadaPresident Steven W. Guyton

Seattle, WashingtonSecretary John A. Hawkins

Salt Lake City, UtahLocal Arrangements Chairman W. R. Eric Jamieson

Vancouver, BC, CanadaSamson Resident Prize Essay Award Matthew G. Whitten

Salt Lake City, UtahDonald B. Doty Award LDS Hospital

Salt Lake City, Utah

2006 Sun Valley Resort, Sun Valley, IdahoPresident R. Scott Mitchell

Stanford, CaliforniaSecretary John A. Hawkins

Salt Lake City, UtahLocal Arrangements Chairman Thomas A. Burdon

Stanford, CaliforniaSamson Resident Prize Essay Award T. Brett Reece

Charlottesville, VADonald B. Doty Award James I. Fann

Stanford, CaliforniaNorman E. Shumway Award John A. Hawkins

Salt Lake City, Utah


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2007 Hyatt Regency Tamaya Resort & Spa, Santa Ana Pueblo, New MexicoPresident Elliot T. Gelfand

Edmonton, AB, CanadaSecretary John A. Hawkins

Salt Lake City, UtahLocal Arrangements Chairman Jorge A. Wernly

Albuquerque, New MexicoSamson Resident Prize Essay Award Jayan Nagendran

Edmonton, CanadaDonald B. Doty Award Gordon A. Cohen

Seattle, WashingtonNorman E. Shumway Award Michael J. Weyant

Aurora, Colorado

2008 Sheraton Keauhou Bay Resort and Spa, Kona, HawaiiPresident Douglas E. Wood

Seattle, WashingtonSecretary John A. Hawkins

Salt Lake City, UtahLocal Arrangements Chairman Michael S. Mulligan

Seattle, WashingtonSamson Resident Prize Essay Award John Keech

Seattle, WashingtonDonald B. Doty Award John D. Mitchell

Denver, ColoradoNorman E. Shumway Award Joseph S. Carey

Torrance, California

2009 The Fairmont Banff Springs, Banff, CanadaPresident David A. Fullerton

Aurora, ColoradoSecretary Thomas A. Burdon

Palo Alto, CaliforniaLocal Arrangements Chairman Michael J. Weyant

Aurora, ColoradoSamson Resident Prize Essay Award David C. Mauchley

Denver, ColoradoDonald B. Doty Award Robbin G. Cohen

Los Angeles, CaliforniaNorman E. Shumway Award Anthony D. Caffarelli



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2010 Ojai Valley Inn, Ojai, CaliforniaPresident J. Scott Millikan

Billings, MontanaSecretary Thomas A. Burdon

Palo Alto, CaliforniaLocal Arrangements Co-Chairs Dominic and Carolyn Tedesco

Ventura, CaliforniaSamson Resident Prize Essay Award Phillip D. Smith

Aurora, ColoradoDonald B. Doty Award Michael S. Mulligan

Seattle, WashingtonNorman E. Shumway Award Phillip D. Smith

Aurora, Colorado

2011 The Broadmoor, Colorado Springs, ColoradoPresident Robbin G. Cohen

Los Angeles, CaliforniaSecretary Thomas A. Burdon

Palo Alto, CaliforniaLocal Arrangements Co-Chairs David and Christine Fullerton

Aurora, ColoradoSamson Resident Prize Essay Award Jessica A. Yu

Denver, ColoradoDonald B. Doty Award Gordon A. Cohen

Seattle, WashingtonNorman E. Shumway Award Agustin E. Rubio

Seattle, Washington

2012 The Grand Wailea, Maui, HawaiiPresident Robert C. Robbins

Stanford, CaliforniaSecretary Thomas A. Burdon

Stanford, CaliforniaLocal Arrangements Co-Chairs James and Andrea Fann

Stanford, CaliforniaSamson Resident Prize Essay Award Ryan Kim

Saginaw, MichiganDonald B. Doty Award James I. Fann

Stanford, CaliforniaNorman E. Shumway Award Sarah Geisbuesch

New York, New York


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2013 The Coeur d’Alene, Coeur d’Alene, IdahoPresident John C. Chen

Honolulu, HawaiiSecretary Patricia A. Thistlethwaite

La Jolla, CaliforniaLocal Arrangements Chair Yong Shin

Clackamas, OregonSamson Resident Prize Essay Award Janet Edwards

Calgary, AlbertaDonald B. Doty Award Winfi eld J. Wells

Los Angeles, CaliforniaNorman E. Shumway Award Ahmad Y. Sheikh


2014 The St. Regis Monarch Beach, Dana Point, CaliforniaPresident Thomas A. Burdon

Stanford, CaliforniaSecretary Patricia A. Thistlethwaite

La Jolla, CaliforniaLocal Arrangements Co-Chairs Anthony and Jennifer Caffarelli

Newport Beach, CaliforniaSamson Resident Prize Essay Award Jatin Anand

Houston, TXDonald B. Doty Award Nahush A. Mokadam

Seattle, WashingtonNorman E. Shumway Award Stephanie G. Worrell

Los Angeles, California

2015 The Fairmont Chateau Whistler, Whistler, British ColumbiaPresident Michael S. Mulligan

Seattle, WashingtonSecretary Sean C. Grondin

Calgary, AlbertaLocal Arrangements Co-Chairs Leah M. and Jeffrey Backhus

Stanford, CaliforniaSamson Resident Prize Essay Award Ann C. Gaffey

Philadelphia, PennsylvaniaDonald B. Doty Award Sunil P. Malhotra

New York, New YorkNorman E. Shumway Award (tie) Billanna Hwang

Seattle, Washington Justin M. Schaffer



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POSTGRADUATE COURSES AND SPEAKERS

1979 Management of the (Re-Do) Coronary Artery PatientEdward B. Stinson, MD, Stanford, CA

The Infected Artifi cial Heart ValveEdward J. Hurley, MD, Sacramento, CA

Changing Concepts in the Interpretation of Ventricular Filling PressuresGregory A. Misbach, MD, San Francisco, CA

Are Randomized Trials Possible for Devices or Surgical ProceduresLawrence I. Bonchek, MD, Milwaukee, Wl

1980 Preoperative Assessment of the Patient with Marginal Pulmonary FunctionRichard M. Peters, MD, San Diego, CA

Airway ManagementG. Hugh Lawrence, MD, Portland, OR

Postoperative Care of the Patient With Marginal Pulmonary FunctionAlan Hilgenberg, MD, Denver, CO

1981 Historical PerspectiveJohn C. Callaghan, MD, Edmonton, Alberta, Canada

Dysoxia of CellsEugene Robin, MD, Palo Alto, CA

Crystalloid Solution for Myocardial ProtectionR. Leighton Fisk, MD, Phoenix, AZ

Blood Cardioplegia for Myocardial ProtectionGerald D. Buckberg, MD, Los Angeles, CA

Before and After – Myocardial PreservationShahbudin Rahimtoola, MD, Los Angeles, CA

1982 Current Diagnostics and Drug Therapy For Thoracic InfectionsArnold Weinberg, MD, Boston, MA

Surgical Therapy of Pleural Space InfectionsG. Hugh Lawrence, MD, Portland, OR

Post-Operative Mediastinal Wound InfectionsE.A. Rittenhouse, MD, Seattle, WA

Current Therapy of Esophageal PerforationsArthur N. Thomas, MD, San Francisco, CA


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1983 The Thymus: Master Gland of the Immune SystemRobert A. Good, MD, PhD, New York, NY

The Mediastinao Imaging TechniquesJames B.D. Mark, MD, Stanford, CA

Surgical Approaches to the MediastinumPhilip C. Jolly, MD, Seattle, WA

Surgical Oncology of Mediastinal TumorsJohn R. Benfi eld, MD, Los Angeles, CA

1984 The Surgical Management of Aortic DissectionPaul A. Ebert, MD, San Francisco, CA

Routine Use of the Internal Mammary Artery Conduit for Coronary Bypass: Late Clinical and Angiographic Follow-Up StudiesU. Scott Page, MD, Portland, OR

Cardiac TraumaF. William Blaisdell, MD, Sacramento, CA

Physiologic Principles of Coronary Blood Flow as Applied to the Cardiac Surgical PatientJulien J.E. Hoffman, MD, San Francisco, CA

1985 Cardiac Support DevicesJ. Donald Hill, MD, San Francisco, CA

Cardiac Transplantation – Present Status and Future ProspectsJack G. Copeland, III, MD, Tucson, AZ

Will the Real Cass Study Stand up?Richard P. Anderson, MD, Seattle, WA

1986 Cell Membranes – Implications on Cancer ControlJonathan Singer, MD, San Diego, CA

Pathophysiology of Left Ventricular Dysfunction in a Surgical PerspectiveKirk Peterson, MD, San Diego, CA

1987 Anti-Platelet Therapy – Practical Clinical Strategies for Bypass Graft PatientsLaurence A. Harker, MD, La Jolla, CA

Platelets, Vasospasm, and Aspirin – Thoughts on the Pathogenesis and Prevention of ArteriosclerosisLaurence A. Harker, MD, La Jolla, CA


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1988 Single Lung TransplantationF. Griffi th Pearson, MD, Toronto, Ontario, Canada

1989 Challenges of the Heights: Limits For SurvivalMichael Wiedman, MD, Boston, MA

The Western Thoracic Surgical Association Multi-lnstitutional Study of Results In Cardiac SurgeryForrest L. Junod, MD, Sacramento, CADaniel J. Ullyot, MD, San Francisco, CA

1990 Cellular and Molecular Biology of Lung Cancer:Clinical ImplicationsMartin F. McKneally, MD, Albany, NYJohn D. Minna, MD, Bethesda, MD

1991 Modern Statistical Analysis of Surgical Risks and OutcomesGary L. Grunkemeier, PhD, Portland, OREugene Blackstone, MD, Birmingham, AL

1992 Growth Factors in the Injury Response: Developing Strategies To Promote (And Prevent) Cell GrowthAndrew Baird, MD, PhD, La Jolla, CAAlain Carpentier, MD, Paris, France

1993 Doing Better, Feeling WorseDonald Kennedy, PhD, Stanford, CA

1994 Esophageal Carcinoma from Molecular Biology to EsophagectomyMark Orringer, MD, Ann Arbor, MIDavid Beer, PhD, Ann Arbor, MI

1995 Molecular Genetics of the Marfan Syndrome and Related Connective Tissue DisordersHal Dietz, MD, PhD, Baltimore, MD

Practical Update on Biostatistics for Cardiothoracic SurgeonsGary Grunkemeier, PhD, Portland, OR

1996 Regulation of Intimal Thickening and Luminal Narrowing After Vascular Reconstruction: Molecular Mechanisms and Pharmacological ControlAlexander W. Clowes, MD, Seattle, WA


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1997 What is Wrong with the Failing HeartWilliam W. Parmley, MD, San Francisco, CA

1998 The Surgical Treatment of End-Stage Heart Disease by Transplants and Mechanical Devices: Outcomes and CostsKeith Reemtsma, MD, New York, New York

1999 The Surgical Profession at the Turn of the Century: Challenges and OpportunitiesSamuel A. Wells, Jr., MD, Chicago, Illinois

2000 The Current Status of Therapy for Thoracic AneurysmsDenton A. Cooley, MD, Houston, Texas

2001 Thinking Beyond the Third DimensionMarc R. DeLeval, MD, FRCS, London, England

2002 Advances in Aortic SurgeryNicholas T. Kouchoukos, MD, FACS, St. Louis, Missouri

Advances in Congenital Heart Disease SurgeryFrank L. Hanley, MD, San Francisco, California

Advances in Cardiac Valve SurgeryRobert Karp, MD, Snowmass, Colorado

2003 Cell Transplantation to Prevent Heart FailureRichard D. Weisel, MD, Toronto, Ontario Canada

2004 Where, When and How it all StartedNorman E. Shumway, MD, Stanford California

2005 Progress Toward A Tissue Engineered Heart Valve John E. Mayer, Jr., MD, Boston, MA

2006 Stem Cell ResearchIrving Weissman, MD, Stanford, CA

2007 Frontiers in Disease Phenotyping: The Example of Organ TransplantationPhilip F. Halloran, MD, Edmonton, AB, Canada

2008 Allogeneic Stem Cell Transplantation for Malignant and Nonmalignant Hematologic DisordersRainer F. Storb, MD, Seattle, Washington


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2009 Cardiac Surgery and Translational Research—A Critical Partnership in Critical ConditionFrancis G. Spinale, MD, Charleston, South Carolina

2010 The Emerging Science of Healthcare DeliveryNicholas Wolter, MD, Billings, Montana

2011 Why Would Anyone Want to Be on Your Surgical Team?Robert C. Myrtle, Los Angeles, California

2012 Paging Dr. Moore, STATArnold Milstein, Stanford, California

2013 Medical Miracles Cost MoneyGeoffrey Sewell, Honolulu, Hawaii

How to Be Successful in the Accountable Care Organization (ACO) MovementFrancis J. Crosson, Alexandria, VirginiaJ. Scott Millikan, Billings, MontanaDominic J. Tedesco, Ventura, California

2014 From Checklists to Culture: What Spacewalking Brings to SurgeryDavid Williams, Toronto, Ontario

2015 Innovations in the Access to New Medical DevicesMichael J. Mack, MD, Plano, TX


268

TSF IS YOUR FOUNDATION

The Thoracic Surgery Foundation (TSF) was established in 1988 as a 501(c)(3) not-for-profi t charitable organization. The TSF Board of Direc-tors was composed of members of the four leading thoracic surgery societies: The American Association for Thoracic Surgery (AATS), The Society of Thoracic Surgeons (STS), the Southern Thoracic Surgical Association (STSA), and the Western Thoracic Surgical Association (WTSA). On October 1, 2014, TSF became the charitable arm of The Society of Thoracic Surgeons. The foundation represents thoracic surgery in the United States and its research and educational initia-tives support the broad spectrum of thoracic surgery. The mission of TSF is to foster the development of surgeon scientists in cardiothoracic surgery, increasing knowledge and innovation to benefi t patient care. STS underwrites all of TSF’s management expenses so that every dollar donated to the Foundation goes directly to support TSF CT Surgery Award programs.

For 28 years, TSF has supported over $13 million toward thoracic surgery research and education programs, and has supported over 275 Alley-Sheridan Scholarships.

Your donations to TSF have a direct impact on the future of cardiotho-racic surgery and the welfare of our patients. Please consider making an annual donation to TSF via the following options:

• Donate in person at the TSF Booth #T25

• Donate online at thoracicsurgeryfoundation.org/donate

• Donate by mail: TSF, 633 North St. Clair Street, 23rd Floor, Chicago, IL 60611

To receive more information about giving opportunities or TSF Awards, please contact Priscilla S. Kennedy, TSF Executive Director, at (312) 202-5868, or by e-mail at [email protected].


269

2016 BOARD OF DIRECTORSJohn H. Calhoon, MD – President

Douglas E. Wood, MD – Vice PresidentKeith S. Naunheim, MD – Secretary

Mark S. Allen, MD – TreasurerShanda H. Blackmon, MD Andrea J. Carpenter, MD David A. Fullerton, MD Robert C. Gorman, MD

Robert S.D. Higgins, MD Richard N. Pierson, III, MD

Joseph F. Sabik, III, MD

Thomas K. Waddell, MD, 2016 TSF Awards Program ChairPriscilla S. Kennedy, Executive Director


270

2016 TSF RESEARCH AND EDUCATION AWARD RECIPIENTS

TSF/National Institutes of Health Matching K Award: Provides sup-port for outstanding clinically trained professionals who are committed to a career in laboratory or fi eld-based research and have the potential to develop into independent investigators. The award total is $150,000 for a fi ve-year NIH award period.

Ankit Bharat, MDNorthwestern University“High Carbon Dioxide Impairs Lung Repair”

TSF/STS Research Award: Operational support of original research efforts by cardiothoracic surgeons who have completed their formal training, and who are seeking initial support and recognition for their research program. Awards of up to $40,000 a year for up to two years are made each year to support the work of an early-career cardiothoracic surgeon (within seven years of fi rst faculty appointment).

Matthew J. Bott, MDMemorial Sloan Kettering Cancer Center“Genomic Correlates of Histopathologic Classifi cation in Lung Adenocarcinoma”

Rajeev Dhupar, MDUniversity of Pittsburgh“Modulating Autophagy in the Neoadjuvant Treatment of Patients with Esophageal Adenocarcinoma”

Stephen H. McKellar, MDUniversity of Utah“Metabolic Flux Analysis and Right Ventricular Remodeling”


271

TSF STSA Research Award: Operational support of original research efforts by cardiothoracic surgeons who have completed their formal training and who are seeking initial support and recognition for their research program. Awards of up to $25,000 for one year will be granted to support the work of an early-career cardiothoracic surgeon (within seven years of fi rst faculty appointment at the time of application dead-line). STSA membership is not required; however, applicants must meet STSA membership eligibility requirements.

Bradley G. Leshnower, MDEmory University School of Medicine“The Search for the Optimal Cerebral Protection Strategy During Aortic Arch Replacement: A Pilot Study”

TSF Acelity Wound Care Research Award: Operational support of up to $25,000 for one year to support the research efforts by cardiothoracic surgeons who have completed their formal training, and who are seek-ing support and recognition for their research program related to wound care management.

Mathew Thomas, MDMayo Clinic“A Pilot Study to Evaluate the Use of Vacuum-assisted Dressings in the Management of Chronic Open Chest Wounds”

TSF Nina Starr Braunwald Research Fellowship: Support of up to $30,000 per year for up to two years for a woman resident working in a cardiac surgical clinic or laboratory research program who has not yet completed cardiothoracic surgical training.

Kimberly A. Holst, MDMayo Clinic“Optimal Cell Therapy Delivery for Pediatric Right Ventricular Failure: Umbilical Cord Blood-Derived Mononuclear Cells in Pigs”

Jennifer L. Philip, MDBoard of Regents of the University of Wisconsin“Regulation of Cardiac Fibroblast-Mediated Ventricular Remodeling by Beta-Arrestin1”


272

Carolyn E. Reed Traveling Fellowship: Support of $10,000 per fel-lowship will allow a clinically established woman thoracic surgeon to travel to another institution for the purpose of learning a new skill or technology.

Elizabeth A. David, MDUC Davis Medical Center“Mixed-Methods Experimental Design and Data Analysis at the University of Wisconsin”

Daniela Molena, MDMemorial Sloan-Kettering Cancer Center “Learn Endoscopic Assessment Tools, Ablation, Resection of Early Stage Tumors, Submucosal Dissection and Peroral Endoscopy Myotomy (POEM) Skills at Oregon Clinic”

TSF/Edwards Lifesciences Foundation Every Heartbeat Matters Award: Support of up to $37,500 for qualifi ed surgeons who con-duct charity work in underserved regions/populations. This award is designed to provide support for programs that educate, screen and/or treat underserved populations to reduce the global burden of heart valve disease, or to support other programs that advance health care and address underserved populations.

Ralph M. Bolman, III, MDUniversity of Vermont“Increasing Access to Reduce the Burdens of Rheumatic Heart Disease in Rwanda-Year II”

Emily A. Farkas, MDCardioStart International“Establishing a Not-For-Profi t Cardiac Surgical Program at Kathmandu University, Dhulikhel Hospital”

Frederick L. Grover, MDUniversity of Colorado School of Medicine“Enhancing Access to Care and Treatment of Cardiovascular Disease in Nepal”


273

V. Mohan Reddy, MDUniversity of California San Francisco“Building Capacity for Pediatric Heart Valve Disease in Southeast Asia”

Mark E. Galantowicz, MDNationwide Children’s Hospital“Education and Training of Underserved Cardiac Surgeons, Cardiologists, and Intensivists on the Surgical Management of Patients with Congenital Heart Disease (CHD); with an Emphasis on Treating Underserved CHD patients with Valvular Conditions, e.g., Assessing Valve repair, Replacement, or Catheter-Based Interventions in CHD Patients of All Ages”

TSF Surgical Outreach Mission Award: Support for qualifi ed surgeons who conduct charity work in underserved regions/populations. This award is designed to provide support for programs that educate, screen and/or treat underserved populations to reduce the global burden of heart valve disease, or to support other programs that advance health care and address underserved populations.

Robert D. Pascotto, MDHeart to Heart MissionOpen Heart Surgery Mission Trips, Dominican Republic


274

2016 TSF EDUCATION AWARD RECIPIENTS

TSF Alley-Sheridan Scholarships: TSF offers up to 10 partial scholar-ships of $2,500 toward the cost to attend the Leadership Program in Health Policy and Management at the Heller School of Public Policy and Management at Brandeis University, and the Surgeons as Educators Course, hosted by the American College of Surgeons.

Chadrick E. Denlinger, MD Medical University of South CarolinaLeadership Program at Brandeis University

Eric Devaney, MDUniversity of California, San Diego/Rady Children’s Hospital San DiegoLeadership Program at Brandeis University

Kristine J. Guleserian, MDChildren’s Medical Center/UT Southwestern Medical CenterLeadership Program at Brandeis University

Lacy E. Harville, III, MDEast Tennessee Cardiovascular Surgery GroupLeadership Program at Brandeis University

Mohammed Imam, MDBaptist Health Medical GroupLeadership Program at Brandeis University

Christopher R. Morse, MDMassachusetts General HospitalLeadership Program at Brandeis University

David D. Odell, MDNorthwestern UniversityLeadership Program at Brandeis University


275

AUTHOR INDEX

Author Program Number

Carey, Joseph S. 4

Caucutt, Jason CF21

Chan, Titus CF32, CF38

Charles, Eric J. CF13, CF16

Chawla, Munish CF22

Chen, Carol W. CF12

Chen, Jonathan M. 18, CF32

Cheng, Richard K. 9

Chin, Clifford 3

Chiu, Peter CF7

Choo, Suk Jung CF1

Chung, Cheol Hyun CF1

Chung, Jennifer J. CF12

Cleveland, John D. CF30

Consunji, Martin CF19

Conte, John V. 13

Cooper, Shannon CF23

Correa, Arlene CF15

Crawford, Fred CF11

Creighton, Sara CF33

Cuentas, Edwin P. CF15

Dagenais, Francois CF4

Dake, Michael D. CF7

Damiano, Ralph J. CF8

D'Amico, Thomas A. 5, CF17

Dardas, Todd F. 14, 9

Dasgupta, Mahua CF33

Deaver, Pamela CF31

DeCamp, Malcolm M. 11

Deeb, G. Michael 13

De León, Luis CF31


276


del Nido, Pedro J. CF29

DeMeester, Steven R. CF23

Demos, David S. CF26

Deng, Xin-Sheng CF9

Desai, Nimesh D. 16

Doty, John CF2

Drakos, Stavros G. 7

Dumont, Eric CF4

Dyck, John 15

Eckhauser, Aaron W. CF39

Edil, Barish H. 8

Emani, Sitaram M. CF29

Espinoza, Herbert M. CF3

Evans, R. Scott CF2

Feinglass, Joseph 11

Ferrara, Laura CF21

Fischbein, Michael P. CF7

Fleischmann, Dominik CF7

Fonner, Clifford E. 20

Fraser, Charles CF31

Fukunishi, Takuma CF27

Fullerton, David A. CF9

Gaffey, Ann C. CF12

Gajdos, Csaba 8

Galloway, Aubrey C. 2

Gelvin, Michael G. CF13

Ghanta, Ravi K. 20

Ghoreishi, Mehrdad 12

Gibbons, Don CF15

Gibson, William J. CF20

Giraud, George D. CF3

Gleason, Thomas G. 13

Goldstone, Andrew B. CF7


277


Green, Kyle M. CF23

Griffi th, Bartley P. 6, 12

Griffi ths, Eric R. CF39

Grossi, Eugene A. 2

Groth, Shawn S. CF14

Gu, Lin CF17

Habertheuer, Andreas 16

Hagen, Jeffrey A. CF23

Harder, Joyce 15

Harpole, David H. 5

Hartwig, Matthew G. 5, CF17

Hashimi, Samad A. 19

Hawkins, Robert B. CF13

Hazel, Kweku 8

Healy, Aaron H. 7

Heinle, Jeffery CF31

Hermsen, Joshua L. 14, CF10

Heymach, John CF15

Hibino, Narutoshi CF27

Hill, Kevin D. 10

Hofferberth, Sophie C. CF29

Hoffmann, Ray CF33

Hofstetter, Wayne CF15

Hornik, Christoph P. 10

Howington, John A. 1

Huang, Jasmine 19

Ikonomidis, John S. CF5, CF11

Ilbawi, Michel CF28

Irons, Mallory CF12

Iyengar, Amit CF36

Jack, Godly 6

Jacobs, Lisa M. 14

Jaquiss, Robert D. 10


278


Johnson, Jed CF27

Johnson, Scott CF11

Johnston, Lily CF13

Jones, Jeffrey A. CF5

Jonker, Sonnet S. CF3

Jung, Sung-Ho CF1

Kaaki, Suha 17

Kalhor, Neda CF15

Kane, Lauren C. CF31

Kaushal, Sunjay 6

Kaushik, Chandni CF22

Kern, John A. 20

Khaliel, Feras C35

Khan, Junaid 4

Khush, Kiran K. CF6

Kim, Heeyong CF19

Kim, Jae Y. CF19

Kim, Joon Bum CF1

Kim, Ki-Wan 1

Kirchen, Kevin 2

Knott-Craig, Christopher CF28

Koeckert, Michael S. 2

Kolahi, Kevin CF3

Kon, Zachary N. 12

Kostelka, Martin CF37

Krantz, Seth 1

Kratz, John CF11

Krieger, Axel CF27

Krishnamurthy, Rajesh CF31

Kron, Irving L. CF13, CF16

Kronfl i, Anthony 12

Krupnick, Alexander S. CF25

Kumar, S.R. CF30, CF34


279


Kumar, T.K. Susheel CF28

Kuo, Elbert Y. 19

Kuo, Linus CF19

Kwon, Oh Jin CF36

Laks, Hillel CF36

Lappe, Donald CF2

Lau, Christine L. 20, CF16

Laubach, Victor E. CF16

Lawton, Jennifer S. CF8

Lee, Hyun-Sung CF14

Lee, Jae Won CF1

Lee, Jason T. CF7

Lee, Jennifer CF12

Levy, Wayne C. 9

Li, Tieluo 6

Lindgren, Isa CF3

Lingala, Bharathi CF21

Lloyd, James F. CF2

Loh, Yee Jim CF29

Lorts, Angela 3

Louey, Samantha CF3

Louis, Scott G. CF20

Loulmet, Didier F. 2

Lutfi , Waseem 1

Mahr, Claudius 9

Maniar, Hersh S. CF8

Martin, Billie-Jean 15

Masri, S. Carolina 9

Maximus, Steven 4

Mayer, John E. CF29

McCarter, Martin 8

McKellar, Stephen H. 7

McKenzie, Dean CF31


280


McMullan, D Michael CF32, CF38

McMullan, David M. 18

Meguid, Robert A. 8

Mehaffey, J. Hunter CF13, CF16

Mehran, Reza CF15

Melby, Spencer J. CF8

Meng, Xianzhong CF9

Merritt, Robert E. CF18

Mery, Carlos CF31

Meyers, Bryan F. CF25

Meyerson, Shari L. 11

Meza, James M. 10

Milewski, Rita K. 16

Miller, Charles C. CF22

Miller, D. Craig CF7

Miller, Daniel L. CF24

Milliken, Jeffrey C. 4

Mishra, Rachana 6

Mitchell, John D. 8

Mitchell, Michael E. CF33

Mitchell, R. Scott CF7

Mitzman, Brian 1

Moffatt-Bruce, Susan D. CF18

Mohammadi, Siamak CF4

Mokadam, Nahush A. 14, 9, CF10

Money, Dustin CF16

Moon, Marc R. CF8

Morales, David L. 3

Moran, Cesar CF15

Morray, Brian H. 18

Mukherjee, Rupak CF5

Mulligan, Michael S. 14

Mulvihill, Michael S. 5


281


Nadeau, Elizabeth K. CF5

Nelson, Christine CF31

Nelson, Rebecca A. CF19

Nguyen, Michelle C. CF18

Obad, Adam C35

Odell, David D. 11

Oh, Daniel CF23

Omar, Ashraf 19

Opfermann, Justin CF27

Pal, Jay D. 14, 9

Parekh, Dhaval CF31

Pasrija, Chetan 12

Patel, Sanjeet CF36

Patel, Vipul 19

Perez, Michael CF28

Pfi tzinger, Duke CF20

Pike, Nancy A. CF30

Pinto, Nelangi M. CF39

Popma, Jeffrey J. 13

Pousatis, Sheelagh 12

Presson, Angela P. 7, CF39

Querijero, Michael 2

Rahatianpur, Mehrdad CF37

Raz, Dan J. CF19

Reardon, Michael J. 13

Rebeyka, Ivan M. 15

Reece, Thomas B. CF9

Reemtsen, Brian CF36

Resar, Jon R. 13

Rice, David CF15

Rich, Jeffrey B. 20

Rizwan, Raheel 3

Roberts, Colleen CF2


282


Roberts, Joan CF38

Roeser, Mark E. CF16

Roife, David CF22

Ross, David B. 15

Roth, Jack CF15

Rouse, Michael 12

Rousseau, Mathieu C. CF21

Rove, Jessica Y. CF25

Rubio, Augustin CF32

Sailer, Anna M. CF7

Samaan, Jamil CF23

Sanchez, Pablo G. 12

Sathanandam, Shyam CF28

Saudek, David CF33

Sawyer, Taylor CF38

Schaffer, Justin M. CF7

Schill, Matthew R. CF8

Schmidt, Carl R. CF18

Schnittger, Ingela CF6

Schubert, Sarah A. CF13

Schuessler, Richard B. CF8

Schwameis, Katrin CF23

Selzman, Craig H. 7

Sepesi, Boris CF15

Seslar, Stephen CF10

Shah, Rohan CF14

Shah, Shivani CF17

Sharma, Ashish K. CF16

Sharma, Sudhish 6

Shaw, Fawwaz R. 18, CF32

Shemin, Richard J. 4

Shillingford, Amanda J. CF33

Shinoka, Toshiharu CF27


283


Shively, Kent R. 9

Shrager, Joseph B. CF21, CF26

Siddiqui, Osama 6

Siki, Mary 16

Sinn, Laurie A. CF8

Smith, Jason W. 9

Smith, Michael A. 19

Speicher, Paul J. 5

Speir, Alan M. 20

Srinathan, Sadeesh 17

Starnes, Vaughn A. CF30, CF34

Stehlik, Josef 7

Steinbock, B E. 19

Stewart, Camille L. 8

Strehl, Calvin CF6

Stroud, Martha CF11

Stroud, Robert E. CF5

Sugarbaker, David J. CF14

Sugiura, Tadahisa CF27

Sun, Can-Lan CF19

Swisher, Stephen CF15

Szeto, Wilson Y. 16

Tan, Lawrence 17

Taylor, Bradley 6

Thornburg, Kent L. CF3

Tibayan, Frederick CF3

Todd, Emily M. 19

Tong, Betty C. 5

Toursavadkohi, Shahab 12

Tribble, Curtis G. CF16

Trojan, Jeff CF7

Tweddell, James S. 3

Ursomanno, Patricia A. 2


284


Vallabhosyula, Prashanth 16

Vaporciyan, Ara CF15

Veeramachaneni, Nirmal CF20

Venardos, Neil CF9

Venkataraman, Chantel M. CF12

Verrier, Edward D. 14, CF10

Vesely, Mark 6

Villa, Chet 3

Voisine, Pierre CF4

Walcott-Sapp, Sarah CF3

Wald, Joyce CF12

Wald, Ori CF14

Walia, Rajat 19

Walsh, Garrett CF15

Wang, Chi-Hsiung 1

Wang, Xiaofei CF17

Wehman, Brody 6

Weissferdt, Annikka CF15

Wells, Winfi eld J. CF30, CF34

Weyant, Michael J. 8, CF9

Wiggins, Luke M. CF34

Williams, Mathew R. 2

Wistuba, Ignacio CF15

Woo, Y. Joseph CF7

Wood, Douglas E. 14

Woods, Ronald K. CF33

Worrell, Stephanie CF23

Wu, Geena X. CF19

Yakubov, Steven J. 13

Yang, Chi-Fu CF17

Yarboro, Leora T. 20, CF13

Yerokun, Babatunde A. 5, CF17

Yeung, Kenny CF19


285


Yoon, David CF14

Yount, Kenan W. 20

Zafar, Farhan 3

Zias, Elias A. 2

Zurakowski, David CF28

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SCHEDULE OF EVENTS for Registered Professional Attendees

WEDNESDAY, JUNE 22, 20161:00 pm - 6:00 pm Registration Grand Promenade1:00 pm - 6:00 pm Speaker Ready Room Waikoloa 17:00 pm - 9:00 pm New Members / Welcome Reception Kona Pool (Weather backup

Water’s Edge Ballroom) THURSDAY, JUNE 23, 20166:00 am Samson Fun Run Start Line: Lower Lobby7:00 am – 8:00 am Breakfast Queen’s Ballroom 7:00 am – 12:00 pm Exhibits Queen’s Ballroom 7:00 am – 12:30 pm Registration Grand Promenade7:00 am – 12:30 pm Speaker Ready Room Waikoloa 1�� 9:00 am – 9:10 am New Member & Samson Prize Finalist Monarchy

Introductions9:10 am – 9:55 am Presidential Address Monarchy9:55 am – 10:20 am Coffee Break: Visit Exhibits & Posters Queen’s Ballroom 10:20 am – 10:25 am David J. Dugan Distinguished Service Award Monarchy

Presentation�� 11:45 am – 12:30 pm Controversies Debate: Monarchy �� 1:30 pm Ocean Beach Blast* Depart from Lower Lobby6:00 pm – 10:00 pm ��!�� Kamehameha Court

Theme Dinner

FRIDAY, JUNE 24, 20166:00 am – 12:00 pm Registration Grand Promenade6:00 am – 12:00 pm Speaker Ready Room Waikoloa 16:30 am – 7:50 am Breakfast Session:* Kings 1

"�#��$�%��&�%��'��*��*��7:00 am – 8:00 am Breakfast Queen’s Ballroom 7:00 am – 12:00 pm Exhibits Queen’s Ballroom 8:00 am – 8:50 am Postgraduate Course: Monarchy

+�� !��,��-�� 10:30 am – 11:00 am Coffee Break: Visit Exhibits & Posters Queen’s Ballroom �� 1:20 pm Golf Tournament* Depart from Lower Lobby2:00 pm Tennis Tournament* Tennis Club

Free Evening

SATURDAY, JUNE 25, 20166:00 am – 11:30 am Speaker Ready Room Waikoloa 16:30 am – 12:00 pm Registration Grand Promenade6:30 am – 7:30 am Breakfast Queen’s Ballroom 6:30 am – 10:30 am Exhibits Queen’s Ballroom 7:00 am – 8:45 am Concurrent Forums -�� Monarchy .��/�� Kings 1 ��'�� Kings 2�� 10:30 am – 11:10 am Coffee Break: Visit Exhibits & Posters Queen’s Ballroom 11:10 am – 12:00 pm C. Walton Lillehei Point/Counterpoint Session: Monarchy

��/��0�1��#��2��+�� 12:00 pm – 12:30 pm Annual Business Meeting 34�0#�� 5 Monarchy12:30 pm – 2:00 pm Family Luncheon Lagoon Lanai7:00 pm – 11:00 pm President’s Reception & Banquet Grand Promenade (Reception)

& Monarchy (Banquet)DRESS CODE:/��-��4��$��6-��78��2��,��6/��"��9�$��%��,��:��:��$��3��0��:-��%��56

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Abridged Program Book

Documents

Transcript of Abridged Program Book