Cardiac surgery
Techno-Academy
Surgical treatment for aortic root infection：recent insights including requirement of homograft replacement
session outline
For critical conditions with severe infective endocarditis with root abscess or graft infection after aortic root replacement, the usefulness of root replacement with aortic valve homograft was once addressed. However, due to shortness of homograft and difficulty of its use in Japan, it has been carried out at limited institutions. At the other centers, alternative surgical procedures including AVR with patch closure of annular abscess, standardized Bentall operation, xenograft replacement, and Ross procedure have been carried out. In this session, we would discuss the recent insights including the long-term outcome of homograft root replacement and the validity of other procedures.
How to make MICS a standard procedure.
session outline
Tips and pifalls are discussed by expert suyrgeons who have done more than hundreds MICS procedures as a routine approach for mitral valve surgery. This fantastic session provides you cutting edge "Art and Science" of MICS.
Devising surgical techniques in Cone procedure
session outline
Recent first choice of tricuspid valvuloplasty for Ebstein's disease is Cone procedure, but surgical techniques have not always been standardized in this disease due to rich anatomical variations. Technical tips and details will be shared and discussed.
Surgical repair of Truncus Arterisus
session outline
We would like to discuss the different points when it is performed in the neonatal period or it is preceded by bilateral PA band. We would also discuss surgical techniques for truncal valve repair, anomalous coronary artery origin, and combined IAA.
Symposium
Aoritc valve selection and its long term result for young patients under 60 years old
session outline
In the TAVI era, valve selection of AVR is about to change significantly. The AHA / ACC Guideline 2020 also recommends class I for selecting TAVI valves for people aged 65 and over, regardless of risk stratification. In the future, it is expected that young people will be required to select a valve as a comprehensive treatment strategy throughout the patient's life span in consideration of future TAVI and valve in valve. Therefore, in this symposium, I would like you to discuss the future direction of young AVR by showing the valve selection of young (under 60 years old) AVR and its long-term results, which are the basic data of the comprehensive strategy. Mechanical valve, biological valve, Ross procedure, Homograft or TAVI valve?
Mitral valve repair in redo surgery; indication and limitation.
session outline
Mitral valve repair has been recommended as the surgical treatment of infective endocarditis (IE) when technically feasible. However, the repair rate remained low because of the requirement of complex reparative techniques and concerns for its long term durability. We will discuss IE repair, focusing on its technical aspects including the use of autologous pericardium and artificial chordae, management of annular abscess and its long term results .
The new era of long-term VADs for destination therapy
session outline
Destination therapy (DT) using implantable VADs for patients with severe heart failure has recently been put into perspective in Japan. The optimal implantation technique and management of the VAD is crucial for a complication-free patient’s life for a long-term period. The important issues to be discussed will include device selections, concomitant valve procedures, management of right heart failure, care for drive-line infection, prevention of bleeding/thromboembolic complications, and their future visions in the DT patients.
Surgical strategy for congenital aortic valve diseases on children, adolescents and young adults
session outline
Anatomical aortic valves that require surgical intervention in the childhood and AYA generation are accompanied by both narrow annulus and leaflet abnormalities associated with congenital dysplasia and/or hypoplasia.
In most cases, they cannot be inserted by the usual valve replacement procedure, even using the smallest mechanical valves on the market.
In recent years, several procedures have been recommended and performed at each institute, including valve repair (including cusp replacement procedures like the Ozaki’s one), Ross operation (including the Ross-Konno), and artificial valve replacement using annulus enlargement procedures including Konno’s one.
In this symposium, we would like to get recent information in this area and hope to have reasonable consensus and future direction, for the patients.
Video Symposium
Mitral valve repair for infective endocarditis.
session outline
Mitral valve repair has been recommended as the surgical treatment of infective endocarditis (IE) when technically feasible. However, the repair rate remained low because of the requirement of complex reparative techniques and concerns for its long term durability. We will discuss IE repair, focusing on its technical aspects including the use of autologous pericardium and artificial chordae, management of annular abscess and its long term results .
Panel discussion
Surgical management of hypertrohpic obstructive cardiomyopathy
session outline
Surgical management of hypertrophic obstructive cardiomyopahty (HOCM) is challenging, because its location and thickness are varied between patients and mitral valve regurgitation due to systolic anterior motion also complicates treatment. Please discuss how to manage HOCM surgically.
Aortic root surgery in adult congenital heart disease
session outline
Surgical treatment for congenital heart disease has improved long-term results. However, the long-term complications of aortic valve in tetralogy of Fallot or pulmonary valve in transposition of great arteries have become a problem in recent years. Also, the long-term prognosis of pulmonary valve as systemic chamber outflow tract has not been investigated to date. Under these circumstances, we would like to discuss the surgical indication and results for the aortic root in congenital heart disease.
Workshop
Future of surgical aortic valve replacement in TAVI age
session outline
Rapid spread of TAVI forced to decrease number of surgical aortic valve replacement. There may be various measures for surgeons such as introduction of less invasive surgery, every effort to maximize the durability of surgical valve or strong commitment to TAVI. We will expect an audience to participate the discussion.
Will FFR change the CABG steratagy?
session outline
FFR is used to detect functional ischemia and recommended to be performed for revascularization by many guidelines in Class I. The evidence of ischemia is essential for coronary revascularization and the revascularization for non-ischemic coronary artery cloud be harmful. We would like to discuss about the impact of the induction of FFR on CABG and to know how FFR would change the strategy of CABG in the near future.
Treatment of ischemic mitral regurgitation with left ventricular dysfunction: open surgery vs. MitraClip
session outline
The ideal treatment of ischemic mitral regurgitation remains controversial. Although the use of MitraClip has become more widespread recently in Japan, a relatively restricted indication and recurrence of MR remain unsolved issues. Otherwise, surgical repair still has room for improvement. In this session, we will discuss the ideal treatment strategy for ischemic MR, especially with left ventricular dysfunction, considering the long-term results.
Video Workshop
Toward a master of aortic annuloplasty
session outline
Aortic annuloplasty has become an essential item for improving the durability of aortic valvuloplasty, but there are various approaches, and the surgeon should understand the advantages and disadvantages of each and use them flexibly for each case. In this video workshop, various annuloplasty techniques will be exhibited, and all participants aim to become masters of this area. Let’s learn the key points of the annuloplasty technique in internal ring / suture annuloplasty, external ring / suture annuloplasty, and reimplantation.
Debate
AVR for dialysis patients: mechanical valves vs. bioprostheses
session outline
The 2020 revised guideline for the treatment of valvular disease recommends mechanical valves for under the age of 60 and bioprostheses for the age of 65 and older in the aortic valve position as class IIa. However, regarding the selection of artificial valves for dialysis patients, it is known that SVD due to calcification is more common in bioprostheses and bleeding complications are more common in mechanical valves, but recent studies have shown that there are no differences in the results between the two valves, and the guideline does not recommend either valve for dialysis patients. In this session, we will debate the selection of artificial valves in the aortic valve position for dialysis patients.
Mitral valve surgery: total endoscopic vs. standard MICS
session outline
The number of MCIS is increaseing every year. There are two type of MICS: encoscopic and direcdt vision。We want to discuss about the merit and demerit of these maneuver in this session.
Atrial Fibrillation in Mitral Valve Patients: Maze procedure vs. LA appendage Occlusion
session outline
A variety of surgical procedures are performed in mitral valve patients with AF. Maze procedure is expected to bring utmost effects to the patients by restoration of sinus rhythm and resection of the LA appendage, but also prolong operation and ischemic times and may increase the incidence of permanent pacemaker implantation. Occlusion of the LA appendage alone may reduce the risk of thromboembolic stroke, but may not convert AF. We will elucidate the characteristics of these procedures and discuss the indication for the AF patients undergoing mitral valve procedures in this debate session.
Surgery for post infarction ventricular septal rupture
session outline
The outcome after surgical treatment for post-MI ventricular septal rupture (VSP) remains poor despite several surgical techniques havee been implemented. This session will discuss about the main two approaches: via right or left ventricle approach.
Debate: Onpump beating vs OPCAB
session outline
This session focuses on the role of onpump beating coronary artery bypass grafting in coronary artery bypass surgery. The indications, advantages, disadvantages, and early & late outcomes will be discussed.
How should be performed LITA harvest, direct vision or robotic?
session outline
There are several methods to harvest LITA graft in minimally invasive cardiac surgery. We would like to debate about pros and cons among direct vision harvesting using retractor versus robotic harvesting.
Redo CABG：Off vs On
session outline
Advances with percutaneous coronary interventions have led to a reduction in repeat coronary artery bypass grafting. In Japan, the percentage of redo CABG among all isolated CABG interventions is about 1-2%. The mortality rate of redo CABG patients has been higher compared to initial CABG patients.
Selections of surgical technique for redo CABG are various because of degree of adhesion, patency of previous graft, and cardiac function. Moreover, conditions of aorta and other organs may affect the approach. In this session, the surgical approach including off-pump or on-pump will be debated, and the favorable surgical strategy will be discussed to improve surgical outcomes.
Peripheral pulmonary stenosis: Catheterized intervention versus Surgical intervention
session outline
Treatment of peripheral pulmonary artery stenosis is controversial as to whether catheterized intervention or surgery should be selected as the first choice. From a medical and surgical standpoint, we ask specialists in the field to show their strategies and have lively discussions.
Transannular patch repair versus conduit repair for tetralogy of Fallot with severe pulmonary stenosis
Thoracic surgery
Symposium
Treatment strategies for acute and chronic empyema
session outline
A flexible approach is desired in the treatment of pulmonary empyema according to the condition of each patient, such as in acute or chronic conditions, or in the presence of fistula(s). The treatment strategy is expected to be very diverse between facilities. In the present symposium, a wide-ranging discussion of basic ideas and the various efforts made by each pulmonary empyema treatment facility will be discussed with an aim toward sharing more beneficial treatment strategies.
Surgical treatment for small-sized lung cancer, related to the results of JCOG0802 trial
session outline
Final results of JCOG0802 trial which is a phase III study comparing limited resection (segmentectomy) with lobectomy for peripheral small non-small cell lung cancer will be announced in 2021. Based on the results, this session focuses on the future optimal strategy of surgical treatments for small-sized lung cancer.
Joint operation between cardiovascular surgery and thoracic surgery
session outline
Even in lesions involving the same thoracic areas, there are not many opportunities for multidisciplinary surgical approaches between general thoracic and cardiovascular surgeons. During the present symposium, we hope to have a wide range of discussions regarding actual surgical procedures and important points based on case studies involving multidisciplinary surgeries performed by general thoracic and cardiovascular surgeons.
Debate
Surgical treatment for malignant pleural mesothelioma: extrapleural pneumonectomy vs. pleurectomy/decortication
session outline
In the surgical treatment of malignant pleural mesothelioma, indications for extrapleural pneumonectomy (EPP) and pleurectomy/pleural decortication (P/D) can be influenced by the patients’ condition, surgeons’ experience, and the treatment facility where the treatment is provided. The authors will compare two methods based on periprocedural complications, postoperative survival rates, and QOL and identify the strengths and weaknesses of each method.
Indications and methods for bronchial stump coverage
session outline
Bronchopleural fistula is a severe complication following pulmonary resection. The indications and methods/techniques of the prophylactic covering of the bronchial stump likely vary between each facility and surgeon. In the present session, the authors will present the indications and methods for covering the bronchial stump to examine beneficial strategies.
Treatment strategy for local recurrence after segmentectomy: salvage surgery vs. radiotherapy vs. drug therapy
session outline
With an increase in the number of small sized lung cancer cases in the recent years, the frequency of segmental resection is expected to rise; however, there are reports of local recurrence after segmental resection. The authors aim to discuss the appropriate indications for salvage surgeries, radiation therapies, and chemotherapies for the treatment of such local recurrences.
Treatment strategy for small-sized lung cancer: surgery vs. stereotactic radiotherapy (SBRT)
session outline
There have been no reports of randomized trials comparing surgery and SBRT in the treatment of small sized lung cancer, and hence there is no consensus. The authors will compare surgical treatment and SBRT as the standard treatment and discuss treatment results and actual indications.
Techno-Academy
Technical keypoint on surgery for giant-sized intrathoracic tumor
session outline
The surgical treatment of intrathoracic giant tumor requires a different approach than a regular tumorectomy, right from anesthesia induction to the actual resection. The authors will make a wide range of video presentations on the indications for tumorectomy as a treatment for massive tumor, its technical tips, and unexpected pitfalls.
Surgical treatment for various types of Pancoast tumor
session outline
Surgical treatment of a Pancoast tumor warrants advanced techniques and experience, ranging from the selection of thoracotomy methods, to the devising of procedures, and conservation of functions and morphology of the thoracic region. We plan to discuss and share technical knowledge using videos on the surgical techniques.
Surgery for funnel chest (pectus excavatum)
session outline
Funnel chest surgery is not yet widespread in the field of respiratory surgery; however, it is assumed that there are many potential patients who would benefit from it and hence the surgical techniques should be widely shared. We would like to organize the basic strategies and technical points of funnel chest surgery using videos.
Panel discussion
Surgical appriach for thymic epithelial tumor
session outline
The selection of surgery in the treatment of thymic epithelial tumor is based on the location of the tumor, invasion of surrounding tissues, and existence of comorbidities. Recent developments in thoracoscopic techniques and robot-assisted surgeries have further diversified surgical techniques. We aim to discuss how each facility and surgeon chooses surgeries.
Indications, techniques, and outcomes of complex bronchoplasty
session outline
Since bronchoplasty avoids pneumonectomy, experiential knowledge is being accumulated. As the sharing of indications, actual techniques, and achievements regarding complex bronchoplasty (anastomosis of the right main bronchus with the lower lobe bronchus or the basal bronchus, anastomosis of the left main bronchus with the basal bronchus, and anastomosis of the left main bronchus with the upper division bronchus) is still insufficient, we will discuss the same through case studies.
Education of young thoracic surgeons: how to train competent thoracic surgeons?
session outline
With the diversification of surgical modalities in the recent years, it is necessary to examine under what environment young surgeons should experience surgeries. We would like to discuss the educational policies for young general thoracic surgeons at each facility and present the number of cases for each surgical modality to discuss the optimal education for young surgeons.
Workshop
Technical keypoints of salvage surgery
session outline
Favorable prognosis is expected with salvage surgery if the cases are appropriately selected. However, since surgeries are performed on patients who have already received treatment, more caution is necessary than that compared with normal surgeries, making the surgery highly difficult. The authors would like to discuss salvage surgery techniques following each type of pretreatment and knowledge on perioperative management.
Roles of surgical treatment in the era of multi-modality treatment for lung cancer
session outline
Due to the dramatic developments in chemotherapy and advancements in radiation therapy in recent years, the number of treatment options for lung cancer is increasing. Situations that earlier would not qualify for resection are now qualified for resection and nonsurgical treatment can now be indicated for resectable cases. The authors would like to consider the role of surgical treatment for lung cancer in the age of multimodality treatment.
Economic impact of minimally invasive (thoracoscopic and robotic) surgery
session outline
Developments in thoracoscopic techniques and robot-assisted surgeries offer new possibilities in thoracic surgeries, but their advantages in terms of cost-effectiveness are rarely discussed. We aim to compare these methods with conventional surgical methods and identify and discuss the advantages and disadvantages of modern noninvasive surgical methods from the perspective of medical economy.
Treatment strategies for refractory pneumothorax
session outline
Treatment strategies for advanced emphysema, pneumothorax in elderly patients or refractory pneumothorax, such as recurrent pneumothorax are expected to vary between facilities and surgeons. The authors aim to present the indications for conservative treatment and surgical treatment, methods of conservative treatment, creative surgical techniques, perioperative management, and treatment results.
Long-term prognosis of more than 10 years after lung cancer surgery
session outline
With an increase in the number of small sized lung cancer cases in the recent years, post-resection prognosis of lung cancer needs to be evaluated over a longer period duration. In particular, reports on long-term prognosis of over 10 years are still inadequate; hence, the authors would like the current results at each facility to be presented and shared.
Esophageal Surgery
Techno-Academy
Technical points on esophagectomy to obtain the Board Certified Esophageal Surgeon
session outline
This is the fourth examination this year since the video examination was adopted for the Board Certified Esophageal Surgeon of the Japan Esophageal Society. This system has already taken root. In this session, the expert of esophageal cancer surgery who is actually in charge of the examination will explain the points of the surgical technique required as the Board Certified Esophageal Surgeon with a surgical video. In addition, experts in other fields will explain the points regarding how to treat with serious bleeding from descending aorta and pulmonary vein/artery.
Panel discussion
Standadization of robotic esophagectomy for thoracic esohageal cancer
session outline
Robotic esophagectomy for thoracic esohageal cancer is now spreading worldwide, and several reports indicated the benefit of robotic esophagectomy in comparison with conventinal thoracoscopic approach. The panel discussion will be held to discuss the technical aspects for the standadization of robotic esophagectomy for thoracic esophageal cancer.
Workshop
Long-term health-related quality of life after esophageactomy for patients with esophageal cancer: assessment and methods for its improvement
session outline
A long-term decrease of health-related quality of life (HR-QOL) is frequently observed after esophagectomy for patients with esophageal cancer. In addition to physical problems including persistent gastrointestinal symptoms, the patients suffer from anxiety and fear of recurrence. However, HR-QOL assessment and systematic approach to improve those issues have not been enough addressed in Japan. The efforts to prevent a decrease of HR-QOL after esophagectomy should be introduced and discussed in this workshop.
Debate
Best practice for reconstruction after esophagectomy in patients after gastrectomy - Colon versus jejunum.
session outline
Esophageal reconstruction after esophagectomy in patients with a history of gastrectomy remains challenging. An interposition using the colon graft used to be standard, while recently, a reconstruction using a pedicled jejunum has been increasingly performed in Japan. However, the better reconstructive method remains controversial in terms of short-term outcomes and the long-term quality of life. In this debate, we wish the experts to present their experiences and discuss the advantages and disadvantages of each reconstructive method.
