CT Surgery Update Winter 2018: Advancements in Cardiothoracic Surgery

In this issue, we celebrate the accomplishments of our dedicated faculty and provide updates on upcoming events, clinical trials, and research initiatives. From the Division  of Lung Transplant/Lung Failure, we share the innovative work of Chief Jonathan D’Cunha, MD, PhD, FACS, as he works to decrease instances of organ rejection in transplant patients. We explore the determination of Victor Morell, MD, chief of the Pediatric Cardiothoracic Surgery Division and co-director of the UPMC Heart and Vascular Institute, to find better solutions for children requiring RVOT reconstruction. We are also pleased to share our progressive work with near-infrared fluorescence imaging and expertise with the POEM operation for achalasia. Additionally, this issue discusses TAVR for aortic stenosis and expanding the donor pool for heart transplant.

Educational objectives:

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

• Recognize the potential benefits of using hepatitis C virus (HCV)-positive donors in heart transplantation.
• Discuss and implement treatment innovations that allow the possibility of using organs from HCV-positive donors in HCV-negative recipients.
• Recognize patient populations who would likely benefit from transcatheter aortic valve replacement (TAVR).
• Recognize patient characteristics that should be taken into consideration when determining the best approach for aortic valve replacement.
• Articulate the potential benefits of PTFE conduits for right ventricular outflow tract reconstruction in patients with congenital heart defects.
• Recognize that the use of valved PTFE conduits in right ventricular outflow tract reconstruction has led to satisfactory outcomes that are comparable with outcomes after right ventricular outflow tract reconstruction using homograft conduits.
• Articulate the potential benefits and limitations of near-infrared fluorescence imaging (NIFI) in thoracic surgery.
• Explain how lung adenocarcinoma might be specifically detected with NIFI intraoperatively.  
• Identify patients who would likely benefit from peroral endoscopic myotomy surgery.  
• Describe the basic steps of peroral endoscopic myotomy surgery for achalasia.

Reading Resources:

1. Levitsky J, Formica RN, Bloom RD, Charlton M, Curry M, Friedewald J, Friedman J, Goldberg D, Hall S, Ison M, Kaiser T, Klassen D, Klintmalm G, Kobashigawa J, Liapakis A, O'Conner K, Reese P, Stewart D, Terrault N, Theodoropoulos N, Trotter J, Verna E, Volk M. The American Society of Transplantation Consensus Conference on the Use of Hepatitis C Viremic Donors in Solid Organ Transplantation. Am J Transplant. 2017 May 29. [Epub ahead of print].
2. Kling CE, Perkins JD, Landis CS, Limaye AP, Sibulesky L. Utilization of Organs From Donors According to Hepatitis C Antibody and Nucleic Acid Testing Status:  Time for Change. Am J Transplant. 2017 Jun 8. [Epub ahead of print].
3. Woolley AE, Baden LR. Increasing access to thoracic organs from donors infected with hepatitis C: A previous challenge-now an opportunity. J Heart Lung Transplant. 2017 May 29. [Epub ahead of print]
4. Goldberg DS, Abt PL, Blumberg EA, Van Deerlin VM, Levine M, Reddy KR, Bloom RD, Nazarian SM, Sawinski D, Porrett P, Naji A, Hasz R, Suplee L, Trofe-Clark J, Sicilia A, McCauley M, Farooqi M, Gentile C, Smith J, Reese PP. Trial of Transplantation of HCV-Infected Kidneys into Uninfected Recipients. N Engl J Med. 2017 Jun 15;376(24):2394-2395.
5. Ahmed KT, Almashhrawi AA, Ibdah JA, Tahan V. Is the 25-year hepatitis C marathon coming to an end to declare victory? World J Hepatol. 2017 Jul 28;9(21):921-929.
6. Reardon MJ, Van Mieghem NM, Popma JJ, Kleiman NS, Søndergaard L, Mumtaz M, Adams DH, Deeb GM, Maini B, Gada H, Chetcuti S, Gleason T, Heiser J, Lange R, Merhi W, Oh JK, Olsen PS, Piazza N, Williams M, Windecker S, Yakubov SJ, Grube E, Makkar R, Lee JS, Conte J, Vang E, Nguyen H, Chang Y, Mugglin AS, Serruys PW, Kappetein AP; SURTAVI Investigators. Surgical or Transcatheter Aortic-Valve Replacement in Intermediate-Risk Patients. N Engl J Med. 2017 Apr 6;376(14):1321-1331.
7. Gleason TG, Schindler JT, Adams DH, Reardon MJ, Kleiman NS, Caplan LR, Conte JV, Deeb GM, Hughes GC Jr, Chenoweth S, Popma JJ. The risk and extent of neurologic events are equivalent for high-risk patients treated with transcatheter or surgical aortic valve replacement. J Thorac Cardiovasc Surg. 2016 Jul;152(1):85-96.
8. Mack MJ, Leon MB, Smith CR, Miller DC, Moses JW, Tuzcu EM, Webb JG, Douglas PS, Anderson WN, Blackstone EH, Kodali SK, Makkar RR, Fontana GP, Kapadia S, Bavaria J, Hahn RT, Thourani VH, Babaliaros V, Pichard A, Herrmann HC, Brown DL, Williams M, Akin J, Davidson MJ, Svensson LG; PARTNER 1 trial investigators. 5-year outcomes of transcatheter aortic valve replacement or surgical aortic valve replacement for high surgical risk patients with aortic stenosis (PARTNER 1): a randomised controlled trial. Lancet. 2015 Jun 20;385(9986):2477-84.
9. Adams DH, Popma JJ, Reardon MJ, Yakubov SJ, Coselli JS, Deeb GM, Gleason TG, Buchbinder M, Hermiller J Jr, Kleiman NS, Chetcuti S, Heiser J, Merhi W, Zorn G, Tadros P, Robinson N, Petrossian G, Hughes GC, Harrison JK, Conte J, Maini B, Mumtaz M, Chenoweth S, Oh JK; U.S. CoreValve Clinical Investigators. Transcatheter aortic-valve replacement with a self-expanding prosthesis. N Engl J Med. 2014 May 8;370(19):1790-8
10. Kodali SK, Williams MR, Smith CR, Svensson LG, Webb JG, Makkar RR, Fontana GP, Dewey TM, Thourani VH, Pichard AD, Fischbein M, Szeto WY, Lim S, Greason KL, Teirstein PS, Malaisrie SC, Douglas PS, Hahn RT, Whisenant B, Zajarias A, Wang D, Akin JJ, Anderson WN, Leon MB; PARTNER Trial Investigators. Two-year outcomes after transcatheter or surgical aortic-valve replacement. N Engl J Med. 2012 May 3; 366(18):1686-95.
11. Yoshida M, Wearden PD, Dur O, Pekkan K, Morell VO. Right ventricular outflow tract reconstruction with bicuspid valved polytetrafluoroethylene conduit. Ann Thorac Surg. 2011 Apr;91(4):1235-9.
12. Yamashita E, Yamagishi M, Miyazaki T, Maeda Y, Yamamoto Y, Kato N, Asada S,  Hongu H, Yaku H. Smaller-Sized Expanded Polytetrafluoroethylene Conduits With a Fan-Shaped Valve and Bulging Sinuses for Right Ventricular Outflow Tract Reconstruction. Ann Thorac Surg. 2016 Oct;102(4):1336-44.
13. Yamashita E, Yamagishi M, Miyazaki T, Maeda Y, Yamamoto Y, Kato N, Asada S, Hongu H, Yaku H. Smaller-Sized Expanded Polytetrafluoroethylene Conduits With a Fan-Shaped Valve and Bulging Sinuses for Right Ventricular Outflow Tract Reconstruction. Ann Thorac Surg. 2016 Oct;102(4):1336-44.
14. Miyazaki T, Yamagishi M, Maeda Y, Yamamoto Y, Taniguchi S, Sasaki Y, Yaku H. Expanded polytetrafluoroethylene conduits and patches with bulging sinuses and fan-shaped valves in right ventricular outflow tract reconstruction: multicenter  study in Japan. J Thorac Cardiovasc Surg. 2011 Nov;142(5):1122-9.
15. Predina JD, Newton AD, Keating J, Barbosa EM Jr, Okusanya O, Xia L, Dunbar A, Connolly C, Baldassari MP, Mizelle J, Delikatny EJ, Kucharczuk JC, Deshpande C, Kularatne SA, Low P, Drebin J, Singhal S. Intraoperative Molecular Imaging Combined With Positron Emission Tomography Improves Surgical Management of Peripheral Malignant Pulmonary Nodules. Ann Surg. 2017 Sep;266(3):479-488.
16. Sarkaria IS, Luketich JD. Seeing green…augmentation of lymph node assessment with near-infrared imaging in esophageal cancer resections. J Thorac Cardiovasc,Surg. 2016 Aug;152(2):555-6.
17. Sarkaria IS, Bains MS, Finley DJ, Adusumilli PS, Huang J, Rusch VW, Jones DR, Rizk NP. Intraoperative near-infrared fluorescence imaging as an adjunct to robotic-assisted minimally invasive esophagectomy. Innovations (Phila). 2014 Sep-Oct;9(5):391-3.
18. Vahrmeijer AL, Hutteman M, van der Vorst JR, van de Velde CJ, Frangioni JV. Image-guided cancer surgery using near-infrared fluorescence. Nat Rev Clin Oncol. 2013 Sep;10(9):507-18.
19. 1: Ponsky JL, Marks JM, Pauli EM. How i do it: per-oral endoscopic myotomy (POEM). J Gastrointest Surg. 2012 Jun;16(6):1251-5.
20. Inoue H, Sato H, Ikeda H, Onimaru M, Sato C, Minami H, Yokomichi H, Kobayashi Y, Grimes KL, Kudo SE. Per-Oral Endoscopic Myotomy: A Series of 500 Patients. J Am Coll Surg. 2015 Aug;221(2):256-64. 
21. Haito-Chavez Y, Inoue H, Beard KW, Draganov PV, Ujiki M, Rahden BHA, Desai PN, Pioche M, Hayee B, Haji A, Saxena P, Reavis K, Onimaru M, Balassone V, Nakamura J, Hata Y, Yang D, Pannu D, Abbas A, Perbtani YB, Patel LY, Filser J, Roman S, Rivory J, Mion F, Ponchon T, Perretta S, Wong V, Maselli R, Ngamruengphong S, Chen YI, Bukhari M, Hajiyeva G, Ismail A, Pieratti R, Kumbhari V, Galdos-Cardenas G, Repici A, Khashab MA. Comprehensive Analysis of Adverse Events Associated With Per Oral Endoscopic Myotomy in 1826 Patients: An International Multicenter Study. Am J Gastroenterol. 2017 Aug;112(8):1267-1276. 
22. Kilic A, Schuchert MJ, Pennathur A, Gilbert S, Landreneau RJ, Luketich JD. Long-term outcomes of laparoscopic Heller myotomy for achalasia. Surgery. 2009 Oct;146(4):826-31; discussion 831-3.
23. Weksler B, Cook C, Luketich JD. Endoscopic transoral stapling of Zenker's diverticula. Multimed Man Cardiothorac Surg. 2010 Jan 1;2010(517):mmcts.2007.002923.

Disclosures:

Drs. Sciortino, D’Cunha, Sarkaria, Levy, Morrell, Schaheen, and sultan  report no relationships with any entities producing health care goods and services.

Dr. Luketich has financial interests with the following any entity or entities producing health care goods or services as indicated below:

• Grant/Research Support: Accuray
• CE Speakers’ Bureau: Covidien
• Stockholder: Express Scripts, Inc., Intuitive Surgical, Inc., P&G, J&J, United Tech Group
• Other: Elsevier royalty, patient registered with University of Pittsburgh, Speaker with Covidien

Dr. McDyer has financial interests with the following any entity or entities producing health care goods or services as indicated below:

• Grant/Research Support: Agmen

Dr. Gleason has financial interests with the following any entity or entities producing health care goods or services as indicated below:

• Grant/Research Support: Medtronic
• Consultant: Ethicon, Covidien, Boston Scientific, St. Jude’s Medical, Abbott

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.

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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.

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Release Date: 11/22/2017 | Last Modified On: 11/22/2017 | Expires: 11/22/2018