CT Surgery Fall 2017

In this issue, we celebrate the accomplishments of our growing department and provide updates on upcoming events, clinical trials, and research initiatives. We welcome Christopher Sciortino, MD, PhD, surgical director, UPMC Advanced Heart Failure Center and are excited to share his plans for the UPMC Heart Transplant Program. In addition, we share the expertise of Jose Pedro da Silva, MD, surgical director, Center for Valve Therapy, Heart Institute at Children’s Hospital of Pittsburgh of UPMC and his work in treating Ebstein’s anomaly in the pediatric patient. We are also pleased to highlight the ongoing collaboration between the Division of Lung Transplant/Lung Failure and the Division of Thoracic and Foregut Surgery to provide robotic-assisted surgery techniques to patients with gastroesophageal reflux. Lastly, we discuss the challenges associated with reoperative esophageal surgery and the work our experts are doing to meet and exceed these challenges.

Educational objectives:

Upon completion of this activity, participants should be able to:

• Recognize ways to improve identification of potential heart transplant recipients early in the course of heart failure progression.
• Discuss measures that could increase the availability of donor hearts for transplantation.
• Articulate the potential benefits and limitations of robotic thoracic surgery.
• Recognize the challenges unique to performing antireflux surgery on lung transplant recipients.
• Discriminate between the anatomy characteristic of Ebstein’s anomaly and the anatomy of other congenital heart abnormalities.
• Describe the basic steps of the cone procedure for repair of Ebstein’s anomaly.        
• Recognize the patient population with the best survival outcomes after cone repair of Ebstein’s anomaly.
• Describe the major surgical options for redo antireflux surgery.
• Execute a thorough preoperative evaluation for patients with recurrent symptoms after antireflux surgery or hiatal hernia repair. 

Reading Resources:

1. Ng K, Steinhubl SR, deFilippi C, Dey S, Stewart WF. Early Detection of Heart Failure Using Electronic Health Records: Practical Implications for Time Before Diagnosis, Data Diversity, Data Quantity, and Data Density. Circ Cardiovasc Qual Outcomes. 2016 Nov;9(6):649-658.Meystre SM, Kim Y, Gobbel GT, Matheny ME, Redd A, Bray BE, Garvin JH. Congestive heart failure information extraction framework for automated treatment performance measures assessment. J Am Med Inform Assoc. 2017 Apr 1;24(e1):e40-e46.
2. Hsich EM. Matching the Market for Heart Transplantation. Circ Heart Fail. 2016 Apr;9(4):e002679.
3. Sarkaria IS, Rizk NP, Grosser R, Goldman D, Finley DJ, Ghanie A, Sima CS, Bains MS, Adusumilli PS, Rusch VW, Jones DR. Attaining Proficiency in Robotic-Assisted Minimally Invasive Esophagectomy While Maximizing Safety During Procedure Development. Innovations (Phila). 2016 Jul-Aug;11(4):268-73.
4. Sarkaria IS, Latif MJ, Bianco VJ, Bains MS, Rusch VW, Jones DR, Rizk NP. Early operative outcomes and learning curve of robotic assisted giant paraesophageal hernia repair. Int J Med Robot. 2017 Mar;13(1). Epub 2016 Feb 29.Abbassi-Ghadi N, Kumar S, Cheung B, McDermott A, Knaggs A, Zacharakis E, Moorthy K, Carby M, Hanna GB. Anti-reflux surgery for lung transplant recipients in the presence of impedance-detected duodenogastroesophageal reflux and bronchiolitis obliterans syndrome: a study of efficacy and safety. J Heart Lung Transplant. 2013 Jun;32(6):588-95
5. Hartwig MG, Anderson DJ, Onaitis MW, Reddy S, Snyder LD, Lin SS, Davis RD. Fundoplication after lung transplantation prevents the allograft dysfunction associated with reflux. Ann Thorac Surg. 2011 Aug;92(2):462-8; discussion; 468-
6. Burton PR, Button B, Brown W, Lee M, Roberts S, Hassen S, Bailey M, Smith A, Snell G. Medium-term outcome of fundoplication after lung transplantation. Dis Esophagus. 2009;22(8):642-8.
7. da Silva JP, da Silva Lda F. Ebstein's anomaly of the tricuspid valve: the cone repair. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2012;15(1):38-45.
8. da Silva JP, Baumgratz JF, da Fonseca L, Franchi SM, Lopes LM, Tavares GM, Soares AM, Moreira LF, Barbero-Marcial M. The cone reconstruction of the tricuspid valve in Ebstein's anomaly. The operation: early and midterm results. J Thorac Cardiovasc Surg. 2007 Jan;133(1):215-23.
9. Lange R, Burri M, Eschenbach LK, Badiu CC, da Silva JP, Nagdyman N, Fratz S, Hörer J, Kühn A, Schreiber C, Vogt MO. Da Silva's cone repair for Ebstein's anomaly: effect on right ventricular size and function. Eur J Cardiothorac Surg. 2015 Aug;48(2):316-20; discussion 320-1
10. Ibrahim M, Tsang VT, Caruana M, Hughes ML, Jenkyns S, Perdreau E, Giardini A, Marek J. Cone reconstruction for Ebstein's anomaly: Patient outcomes, biventricular function, and cardiopulmonary exercise capacity. J Thorac Cardiovasc Surg. 2015 Apr;149(4):1144-50.
11. Awais O, Luketich JD, Reddy N, Bianco V, Levy RM, Schuchert MJ, et al. Roux-en-Y near esophagojejunostomy for failed antireflux operations: outcomes in more than 100 patients. Ann Thorac Surg. 2014;98(6):1905-11; discussion 11-3.
12. Awais O, Luketich JD, Schuchert MJ, Morse CR, Wilson J, Gooding WE, et al. Reoperative antireflux surgery for failed fundoplication: an analysis of outcomes in 275 patients. Ann Thorac Surg. 2011;92(3):1083-9; discussion 9-90.
13. Luketich JD, Pennathur A, Awais O, Levy RM, Keeley S, Shende M, et al. Outcomes after minimally invasive esophagectomy: review of over 1000 patients. Ann Surg. 2012;256(1):95-103
14. Pennathur A, Awais O, Luketich JD. Minimally invasive redo antireflux surgery: lessons learned. Ann Thorac Surg. 2010;89(6):S2174-9.
15. Stefanidis D, Hope WW, Kohn GP, Reardon PR, Richardson WS, Fanelli RD; SAGES Guidelines Committee.. Guidelines for surgical treatment of gastroesophageal reflux disease. Surg Endosc. 2010 Nov;24(11):2647-69
16. Kohn GP, Price RR, DeMeester SR, Zehetner J, Muensterer OJ, Awad Z, Mittal SK, Richardson WS, Stefanidis D, Fanelli RD; SAGES Guidelines Committee..Guidelines  for the management of hiatal hernia. Surg Endosc. 2013 Dec;27(12):4409-28.
17. Dallemagne B, Arenas Sanchez M, Francart D, et al. Long-term results after laparoscopic reoperation for failed antireflux procedures. Br J Surg 2011;98:1581–7.

Disclosures:

Drs. Sciortino, D’Cunha, Sarkaria, da Silva, Awais, and Levy have reported no relevant relationships with any entities producing health care goods or services

All presenters disclosure of relevant financial relationships with any entity producing, marketing, re-selling, or distributing health care goods or services, used on, or consumed by, patients is listed above.  No other planners, members of the planning committee, speakers, presenters, authors, content reviewers and/or anyone else in a position to control the content of this education activity have relevant financial relationships to disclose.

Accreditation Statement:

The University of Pittsburgh School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The University of Pittsburgh School of Medicine designates this enduring material for a maximum of .5 AMA PRA Category 1 Credits™. Each physician should only claim credit commensurate with the extent of their participation in the activity. Other health care professionals are awarded (0.05) continuing education units (CEU) which are equivalent to .5 contact hour.

For your credit transcript, please access our website 4 weeks post-completion at http://ccehs.upmc.com and follow the link to the Credit Transcript page. If you do not provide the last 5 digits of your SSN on the next page you will not be able to access a CME credit transcript. Providing your SSN is voluntary.

Release Date: 8/21/2017 | Last Modified On: 8/21/2017 | Expires: 8/21/2018