Download Learning Objectives - Society of Cardiovascular Anesthesiologists

34th Annual Meeting &Workshops
Society of Cardiovascular Anesthesiologists
April 28 – May 2, 2012
Westin Boston Waterfront
LEARNING OBJECTIVES
SATURDAY APRIL 28, 2012
WORKSHOPS • 8:00 - 11:00 am
Workshop 1: TEE Intermediate - Moderator: Mark A. Taylor, MD
MITRAL VALVE: Mitral valve case studies - Mark A. Taylor, MD
At the conclusion of the lecture, the participants will be able to discuss the echocardiographic evaluation
of mitral valve disease and the impact on surgical decision-making.
AORTIC VALVE: Aortic valve case studies - Daryl Oakes, MD
At the conclusion of the lecture, the participants will be able to discuss the echocardiographic evaluation
of aortic valve disease and associated systemic manifestations and their impact on surgical decisionmaking.
LEFT VENTRICLE: Left ventricle case studies - Ankur Gosalia, MD
At the conclusion of the lecture, the participants will be able to discuss different qualitative and
quantitative measurements of LV function and their applicability in the operating room.
RIGHT VENTRICLE: Right ventricle case studies - Susan M. Martinelli, MD
At the conclusion of the lecture, the participants will be able to discuss echocardiographic evaluation of
RV anatomy and function.
AORTA: Diseases of the aorta case studies - Mark T. Nelson, MD
At the conclusion of the lecture, the participants will be able to discuss the echocardiographic evaluation
of the thoracic aorta and associated pathologic disease states.
RESCUE TEE: Case studies involving rescue TEE - K. Annette Mizuguchi, MD
At the conclusion of the lecture, the participants will be able to discuss the role of emergent TEE for
non-cardiac surgery and applications to aid in cardiopulmonary resuscitation.
Workshop 2: Echo Simulation - Moderator: Annemarie Thompson, MD
Introduction to Simulator – Julian Bick, MD
At the conclusion of this introduction, the participant will be able to:
1. Describe basic functions of the echo simulator
2. Outline capabilities of the simulator
3. Delineate limitations of the echo simulator
Cardiac Surface Anatomy – Sasha Schillcutt, MD
At the conclusion of this lecture, the participant will:
1. Describe anatomical surface landmarks on the heart
2. Understand the spatial relationships between structural components of the heart
3. Outline relevant coronary anatomy
Internal Structural Anatomy – J. Mauricio Del Rio, M.D.
At the conclusion of this lecture, the participant will:
1. Delineate internal structural details of the human heart
2. Understand the spatial relationships between internal cardiac chambers
3. Outline components of cardiac valves
Terminology – Annemarie Thompson, MD
At the conclusion of this lecture, the participant will:
1. Define the terminology used to describe TEE and TTE transducer manipulations
2. Define the terminology used to describe TEE and TTE tomographic viewpoints
3. Define the terminology used to describe the various ultrasound imaging modalities
TEE Anatomical Correlation – Julian Bick, MD
At the conclusion of this lecture, the participant will:
1. Define the anatomic acoustic windows used in TEE imaging
2. Understand the advantages of the TEE imaging
3. Describe the limitations of TEE imaging
Hands on scanning stations (rotate around)
1 - TEE - Valve Interrogation - J. Mauricio Del Rio, M.D.
2 - TEE - Ventricle Interrogation - Annemarie Thompson, MD
3 - TTE - Parasternal Views - Julian S. Bick, MD
4 - TTE - Apical/Subxiphoid Views - Sasha Shillcutt, MD
At the conclusion of this hands scanning station, the participant will:
1. Demonstrate and transition between TEE imaging windows
2. Demonstrate and transition between the common TTE Parasternal views
3. Demonstrate the transition between the common TTE Apical/Subxiphoid views
Workshops • 1:00 - 4:00 pm
Workshop 3: Advanced TEE I - Moderator: Feroze Mahmood, MD
Unanticipated Aortic Stenosis during CABG Surgery - Douglas Shook, MD
At the conclusion of this educational activity, the participants should be able to:
1. Understand the pros and cons of different methods of aortic valve area calculation
2. Appreciate the incidence and effect on outcome of unanticipated aortic stenosis during coronary artery bypass graft surgery
3. Advantages and disadvantages of an expectant approach versus an aggressive approach
Unanticipated Tricuspid Regurgitation during Mitral Valve Surgery - Gregg S. Hartman, MD
At the conclusion of this educational activity, the participants should be able to:
1. Incidence of tricuspid regurgitation during mitral valve surgery
2. Assessment of tricuspid valve with transesophageal echocardiography
3. Assessment of tricuspid regurgitation and the pros and cons of repairing the tricuspid valve versus an expectant approach
Mild to Moderate Mitral Regurgitation during CABG Surgery - Albert T. Cheung, MD
At the conclusion of this educational activity, the participants should be able to:
1. Understand the echocardiographic techniques to objectively quantify severity of mitral regurgitation
2. Understand the importance of indices of left ventricular remodeling in decision-making for mitral valve repair
3. Appreciate the impact of ischemic mitral regurgitation on survival after coronary artery bypass
graft surgery
Unanticipated Congenital Abnormalities during Cardiac Surgery - Thomas M. Burch, MD
At the conclusion of this educational activity, the participants should be able to:
1. Appreciate the incidence of congenital abnormalities in asymptomatic adult population
2. Understand the commonest congenital abnormalities in adults and their echocardiographic appreciation and recognition
3. Understand the likely impact of such unanticipated findings on intraoperative decision-making
during routine cardiac surgery
Surgical Perspective on Unanticipated Echocardiographic Findings - Kamal Khabbaz, MD
At the conclusion of this educational activity, the participants should be able to:
1. Appreciate the surgical perspective on unanticipated echocardiographic findings
2. Appreciate the impact of TEE on surgical decision-making during cardiac surgery
3. Understand the importance of intraoperative TEE as a vital monitor to impact surgical decisionmaking.
Workshop 4: EPS - Moderator: Aman Mahajan, MD, PhD
My patient has an implantable cardiac device- what do I need to do? Guidelines for perioperative management- Marc Rozner, PhD, MD
At the conclusion of the lecture, the participant will be able to discuss the management of Pacemaker/ICDs in the perioperative period, including:
1. Guidelines for management of pacemakers and AICDs
2. Preoperative evaluation, effect of EMI, role of magnets and programming in patients with intracardiac rhythm management devices.
Pacemaker function and programming - Ryan Crowley, MD
At the conclusion of the lecture, the participant will be able to discuss the functioning of pacemakers,
including (1) basic programming features of implantable pacemakers and (2) optimizing pacemaker timings, intervals, blanking & refractory periods, thresholds.
Pacemaker Failures- What’s real, what’s not! - Scott Streckenbach
At the conclusion of the lecture, the participant will be able to discuss true and pseudo pacemaker/ICD
failures in the perioperative/ ICU settings:
1. True failures of device, leads and/or programming
2. Pseudo-failures from errors in programming or interpretation
3. Pacemaker algorithm/ programs that interfere with perioperative care
Case-based Simulation Program - Annemarie Thomson, MD and Jonathan Leff MD
Case scenarios will be discussed with the participants utilizing device simulation programs.
Hands-on sessions: Multiple stations - Aman Mahajan, MD, PhD; Marc Rozner, PhD, MD; Ryan Crowley,
MD; Jonathan Leff, MD; Scott Streckenbach, MD, Annemarie Thomson, MD; Dilip Thakar, MD, Jason
Chua, MD
At the conclusion of the hands-on session, the participant will be able to:
1. Identify interrogation and programming pacemakers/ICDs
2. Discuss the use of magnet in the perioperative period
3. Discuss the use of temporary pacing devices and programmers
4. Identify pacemaker/ICD type, lead configuration, malfunction using radiographs
Learning objectives for implantable devices station
1. Name steps to initiate interrogation of a pacemaker or AICD.
2. Identify atrial and ventricular signals on the different channels using the programmer. Illustrate
atrial and ventricular sensed or paced beats/signals on the programmer.
3. Identify type of device following interrogation; identify key features such as current pacing
mode, battery life, pacing and ICD history, thresholds, etc.
4. Identify programmed pacing rates briefly explaining the LRL, URL etc.
5. Demonstrate changing the pacing mode from DDD or VVI etc to an asynchronous (AOO/DOO)
mode. Demonstrate how to change the rate.
6. Identify how the rate adaptive feature is displayed and programmed on the programmer. Learn
how to turn off the rate adaptive feature.
7. Interrogate underlying rhythm (or the presence/absence of one) using specific programmers
8. Demonstrate magnet response behavior of the different pacemakers and ICDs. Review magnet
pacing rates under different battery life conditions.
9. Identify the settings for an AICD. Demonstrate how to deactivate the AICD using specific programmers.
10. Identify other advanced features- special algorithms that should be deactivated before surgery.
Workshop 5: Mechanical Circulatory Support - Moderators: Daryl Oakes, MD; Douglas Shook,
MD
Cardiopulmonary Bypass Simulation - Bruce Searles, BS, CCP
At the conclusion of this educational activity, the participant should:
1. Understand initiation, maintenance, and weaning from cardiopulmonary bypass through simulation
2. Be able to troubleshoot standard problems during cardiopulmonary bypass
Perfusion Myth Busters: Challenging the status quo - Daniel Fitzgerald, CCP, LP
At the conclusion of this educational activity, the participant should:
1. Recite the latest data guiding anticoagulation practices
2. Understand what is more important: flow rate or blood pressure
3. List techniques for blood conservation during cardiopulmonary bypass.
4. Answer the question: Why go cold?
Perfusion Assessment During Cardiopulmonary Bypass - Glenn P. Gravlee, MD
At the conclusion of this educational activity, the participant should:
1. Understand the fundamentals of flow and pressure physiology
2. Understand the controversy regarding management of hemodynamic parameters during cardiopulmonary bypass
3. Be able to list common markers for adequate systemic perfusion
4. Understand the value and limitations of monitoring regional perfusion (eg. CNS)
Ventricular Assist Devices: Where are we now? - Gregory Couper, MD
At the conclusion of this educational activity, the participant should be able to discuss the surgical decision-making for ventricular assist devices including currently used devices, the reasons for choosing a
particular device, and various cannulation strategies.
Cases: Now what can go wrong? Group Discussion and Review – Daryl Oakes, MD; Douglas Shook, MD,
Panel
At the conclusion of this educational activity, the participant should be able to idenify and address problems that arise during CPB or with ventricular assist devices through an interactive case discussion with
the panel and the audience.
8:00 - 10:00 am REFRESHER COURSE LECTURES - Moderators: Colleen G. Koch, MD, MBA, FACC;
Kathryn E. Glas, MD, MBA, FASE
Out of your mind? Epidemic of Postoperative Delirium - Michael H. Wall, MD
At the conclusion of this lecture, the participants will be able to become aware of the prevalence, risk
factors and management strategies for patients who experience postoperative delirium.
Knowledge Translation: Practicing perioperative evidence-based decision making - Davy C.H. Cheng, MD
At the conclusion of this lecture, the participants will be able to better understand the role of evidencebased medicine as applied to decision making in clinical practice.
Are adults with CHD just grown up children with CHD? - James A. DiNardo, MD
At the conclusion of the lecture, the participants will be able to discuss:
1. Similarities and differences between adult and pediatric patients undergoing congenital surgery.
2. The epidemiology of adults with congenital heart disease will be reviewed.
Descending Aortic Surgery, Open or Closed Evidence Basis and Operative Management - Brian J. Gelfand,
MD
At the conclusion of the lecture, the participants will be able to discuss the:
1. Indications for percutaneous aortic stenting.
2. Indications for open descending aortic replacement.
3. Outcomes differences for the two procedures- short and long-term.
4. Key differences and similarities in anesthetic management- spinal drain, regional v GA, IV access,
etc.
The Inflammatory Response to CPB (Why am I so dilated?) - Robert N. Sladen, MD
At the conclusion of this lecture, the participants will be able to recognize and apply management
strategies for a common etiology for the development of post operative vasoplegia.
10:30 am -12:00 pm Bleeding Hearts - Moderator: Gregory A. Nuttall, MD
Uncontrolled Bleeding after Cardiac Surgery: Risk factors and management strategies - Davy C.H. Cheng,
MD
At the conclusion of the lecture, the participants will be able to discuss the:
1. Incidence and outcomes of massive bleeding post cardiac surgery
2. Predisposed risk factors of massive bleeding in cardiac surgery patients
3. Management strategies for bleeding patients post cardiac surgery.
Nature or Nuture: Genetics and perioperative bleeding - Simon C. Body, MD
At the conclusion of the lecture, the participants will be able to discuss the:
1. Genetic variants may impact coagulation function during and after surgery.
2. The relative impact of surgical and other non-genetic factors upon bleeding during and after
surgery.
3. The likely small role genetic testing will play in prediction or management of surgical bleeding.
Novel Anticoagulants and the Cardiac Patient - C. David Mazer, MD
At the conclusion of the lecture, the participants will be able to discuss the:
1. New antiplatelet and anti-thrombotic agents which may be prescribed for cardiac patients
2. Optimal timing for discontinuation and restarting these drugs perioperatively
3. Prevention, reversal and treatment strategies for management of postoperative bleeding in
patients exposed to these agents
1:00 - 1:30 pm Late Breaking DECS Trial - Moderator: Andrew Shaw, MB, FRCA, FCCM
Presenter - Diederik van Djik, MD
At the conclusion of the lecture, the participants will be able to:
1. Review the place of corticosteroid therapy in cardiac surgery.
2. Discuss the results of the dexamethasone in cardiac surgery trial.
3. Understand the therapeutic options available for ameliorating the inflammatory response to
cardiopulmonary bypass.
1:30 - 3:30 pm Colloid vs. Crystalloid Debate: War or Truce? - Moderators: Andra I. Duncan, MD;
Chad E. Wagner, MD
Razing Research Fraud – Where do we stand? - Steven Shafer, MD
At the conclusion of the lecture, the participants will be able to discuss the:
1. Methods to detect and prevent research fraud
2. Ethics in Research
What is our goal in ‘goal-directed’ therapy? - Michael H. Wall, MD
At the conclusion of the lecture, the participants will be able to identify and discuss:
1. Interpreting perioperative measures to guide volume management
2. Whether tissue perfusion is our goal and how we know when we get there
3. What is wrong with “too much fluid”
Crystalloid or Colloid: Does it really make a difference? - Andrew D. Shaw, MB, FRCA, FCCM
At the conclusion of the lecture, the participants will be able to determine/discuss:
1. Whether colloids are more effective volume expanders than crystalloids in the critically ill
2. Whether the synthetic colloids as safe as albumin
3. Relevant clinical outcome and cost data to warrant use of crystalloid vs. colloid as fluid of choice
for perioperative cardiac surgery resuscitation .
4. Relevant clinical outcome and cost data to warrant use of albumin and pentastarches as fluid of
choice for perioperative cardiac surgery resuscitation.
What do we still know about Voluven? - Scott Beattie, MD, PhD
At the conclusion of the lecture, the participants will be able to determine the:
1. Whether voluven are really better than the “older” hetastarches
2. How the deletion of Boldt’s work impacts our knowledge about the benefits of colloid solutions
Pick Your Poison: A closer look at tissue effects of crystalloids and colloids - Anthony M. Roche, MB ChB
At the conclusion of the lecture, the participants will be able to discuss the:
1. Effects of volume solutions on the microcirculation
2. Importance of tissue oxygen delivery
1:00 - 6:00 pm Fellow and Junior Clinical Faculty Program - Moderators: Nanhi Mitter, MD; Annemarie
Thompson, MD
At the conclusion of the fellow session, each fellow will:
1. Be able to outline the benefit of becoming and staying involved in the SCA throughout their career.
2. Be able to understand the steps necessary for developing and presenting effective and professional presentations.
3. Be able to identify the steps necessary for research, publication and application for
grants/extramural funding.
4. Have had the opportunity to interact with fellows and faculty members from other institutions.
Inter-institutional discourse is encouraged to discuss complex cases, clinical management, scientific projects and professional opportunities.
Cardiac Anesthesiology: Mission possible? - Panel: Linda Shore-Lesserson, MD; John Coleman, MD;
Mark Stafford-Smith, MD; David A. Zvara, MD; Colleen G. Koch, MD, MBA, FACC
At the conclusion of the panel, participants will be able to:
1. Identify the various paths to a successful career in cardiac anesthesiology.
2. Understand the process of moving from fellowship towards a career into private practice cardiac anesthesiology.
3. Describe mechanisms for finding work/life balance in academic anesthesiology.
4. Understand the role of mentorship in a successful career in cardiac anesthesiology.
Complex Case Discussion with Panel - Kathryn E. Glas, MD, MBA, FASE; Mark Stafford-Smith, MD
At the conclusion of the panel and case presentations, participants will be able to:
1. Identify unique manifestations of hemodynamic alterations during cardiac surgery.
2. Understand how to manage complex case presentations in cardiac surgery.
3. Increase their knowledge of complex case management through in-depth understanding of
physiologic basis of disease and literature review.
PBLDs – (1) LVAD: Insertion and Management; (2) Blood Management During Cardiac Surgery
At the conclusion of the PBLDs, participants will be able to:
1. Understand the unique considerations regarding LVAD insertion and management.
2. Describe blood utilization techniques, including conservation, during cardiac surgery.
3. Share and identify a variety of techniques used nationally to manage both VADs and Blood Utilization.
SUNDAY, APRIL 29, 2012
6:45 - 8:00 am Problem Based Learning Discussions 1 - 7
PBLD 1 Hybrid OR - Christopher A. Troianos, MD; Joyce J. Shin, MD
After this educational activity, participants should be able to:
1. Describe the multidisciplinary approach for the design and utilization of hybrid operating rooms
2. Recognize the anesthetic implications of working in a hybrid operating room
3. Identify potential critical events and complications unique to the hybrid operating room.
PBLD 2 Cardiac Tumors - Nanhi Mitter, MD; Rosanne Sheinberg, MD
After this educational activity participants should be able to:
1. Describe common cardiac tumors, their etiology, clinical presentation, and natural course.
2. Understand the intraoperative TEE imaging, potential pitfalls in recognizing cardiac tumors, and
review intraoperative management and postoperative complications.
PBLD 3 Coagulation - Ian Welsby, MD; Prakash A. Patel, MD
After this educational activity participants should be able to:
1. Identify risk factors for perioperative coagulopathy and increased transfusion requirements in
cardiac surgery.
2. Understand the mechanisms that lead to perioperative coagulopathy and describe interventions
for decreasing coagulopathy and transfusion in cardiac surgery.
3. Be familiar with current guidelines for transfusion and perioperative management of pro- and
anticoagulants.
PBLD 4 Spinal Cord Protection - Albert T. Cheung, MD; Heidi Bas, MD
At the conclusion of this educational activity, the participant should be able to identify:
1. Patients at risk for spinal cord ischemia after open or endovascular thoracic and thoracoabdominal aortic aneurysm (TAAA) repair.
2. What techniques can be employed to decrease the risk of spinal cord ischemia for thoracic and
thoracoabdominal aortic repair.
3. What techniques can be used to detect spinal cord ischemia in patients under general anesthesia.
4. The potential complications of lumbar cerebrospinal fluid drainage and how to avoid them
PBLD 5 Cooling After Cardiac Arrest - Mark A. Taylor, MD; Jason D. Kennedy, MD
At the completion of this activity the participants should be able to:
1. Give the indications for therapeutic hypothermia after cardiac arrest
2. Know the different methods currently utilized to induce therapeutic hypothermia
3. Describe the duration of hypothermia and some of the treatment implications
PBLD 6 LVAD GI Bleeding - Katja R. Turner, MD; Julie L. Huffmyer, MD
After this educational activity, participants should be able to:
1. Describe the indications for left ventricular assist device (LVAD) therapy
2. Compare and contrast the different types of LVAD, including continuous and pulsatile flow devices
3. Identify the challenges associated with nonpulsatile flow LVAD therapy
4. Discuss the anesthetic implications for patients with nonpulsatile LVADs who require elective as
well as urgent noncardiac surgery and procedures
PBLD 7 Lung Transplantation - Andrew J. Roscoe, MBChB; Vera Dossow-Hanford, MD
At the conclusion of this PBLD session, the participant should be able to:
1. Understand the principles of anesthetic induction in a patient with pulmonary hypertension.
2. Develop intraoperative one-lung ventilation strategies.
3. Discuss the role of intraoperative transesophageal echocardiography (TEE) in lung transplantation.
4. Recognize the role of postoperative protective lung ventilation strategies
8:00 - 9:00 am Earl Wynands Lecture - Moderators: Colleen G. Koch, MD, MBA, FACC; Peter D. Slinger,
MD
Tissue Engineering in the 21st Century: From the bench to the bedside - Charles A. Vacanti, MD
9:00 - 10:30 am The Mitral Valve: Anatomy, Imaging and Beyond - Moderator: Douglas Shook, MD
Complex Repairs: Resect or respect - Vinay Badhwar, MD
At the conclusion of this educational activity, the participants should be able to:
1. Explain the surgical approach to defining mechanism of mitral valve dysfunction
2. Describe surgical decision-making in complex surgical repair of the mitral valve
3. Identify different surgical techniques used to repair the mitral valve
Imaging to Decision-Making: 2D/3D TEE of the mitral valve - Stanton K. Shernan, MD
At the conclusion of this educational activity, the participants should be able to:
1. Explain how 2D and 3D echocardiography compliment each other in determining mechanism of
mitral regurgitation
2. Interpret echocardiographic images to determine mechanism of mitral dysfunction in complex
mitral repairs
3. Summarize echocardiographic information to assist with complex surgical repair of the mitral
valve
Let’s Make a Case Out of It: Interactive demonstration with a porcine heart model - Douglas Shook, MD
At the conclusion of this educational activity, the participants should be able to integrate the anatomy of
the mitral valve, echocardiographic imaging, and surgical decision-making in a case-based format.
11:00 am - 12:30 pm Minimally Invasive Surgery (EACTA) - Moderators: Manfred D. Seeberger, MD;
Albert C. Perrino, MD
Overall Learning Objectives
At the conclusion of the panel, the participant will be able to:
1. Distinguish advantages and limitations, indications and contraindications for percutaneous aortic valve replacement and for the MitraClip procedure
2. Describe the techniques of these two minimally invasive procedures
3. Describe the role of the anesthesiologist in these procedures
4. Identify potential problems and complications of these minimally invasive techniques, and describe treatment options
5. Review the literature related to percutaneous aortic valve replacement and to the MitraClip
procedure
Percutaneous Aortic Valve Replacement (Transcatheter aortic valve implantation – TAVI): Options and
Outcomes – Andrew Klein, MD
At the conclusion of this lecture, the participant will be able to;
1. Understand indications and suitability for TAVI, and how they differ from surgical AVR, including
critical appraisal of the literature
2. Discuss the value of multi-disciplinary team assessment and preparation for TAVI
3. Decide on best approach for TAVI: transfemoral, transapical, transaortic or subclavian
4. Assess whether general anaesthesia is required or sedation may be adequate
5. Plan suitable postoperative care after TAVI based on appraisal of risks and procedural success
Misadventures and Complications of Transcatheter Procedures: Tips and tricks of the trade –
Joerg Ender, MD
At the conclusion of this lecture, the participant will be able to:
1. Understand the main key steps in transcatheter valve implantations
2. Identify the potential risks associated with each step
3. Estimate the specific value of transesophageal echocardiography in these procedures
4. Implement a protocol for anesthetic management for these procedures
5. Develop and implement strategies for handling misadventures and complications of transcatheter procedures
The Mitral Clip: What to expect and what to do when things go wrong - Fabio Guarracino, MD
At the conclusion of this lecture, the participants will be able to:
1. Describe the several steps of the MitraClip procedure
2. Choose the appropriate echo views to guide the procedure
3. Evaluate the result of the procedure
4. Understand how to design a strategy when things go wrong and describe the possible options.
11:00 am - 12:30 pm Relax, It’s Only Diastology - Moderator: Thomas M. Burch, MD
At the conclusion of this educational activity, the learner will understand:
1. The basic and advanced echocardiographic techniques for assessing diastolic function, including
the utility, advantages, and limitations of each technique with a discussion of the most recent
guidelines
2. Recent outcome data showing perioperative evaluation of diastolic function to be an important
prognostic indicator
3. A practical guideline for how the busy perioperative echocardiographer can rapidly assess diastolic function and discuss what potential therapies exist or may soon exist
Let’s Get It Started: Basic diastology - Gregg S. Hartman, MD
At the conclusion of this educational activity, the learner will understand basic echocardiographic techniques for assessing diastolic function, including the utility, advantages, and limitations of each technique with a discussion of the most recent guidelines.
Moving Beyond PW Doppler: Advanced diastology function - Feroze Mahmood, MD
At the conclusion of this educational activity, the learner will understand:
1. Advanced echocardiographic techniques for assessing diastolic function, including the utlity, advantages, and limitations of each technique with a discussion of the most recent guidelines.
2. Recent outcome data showing Perioperative evaluation of diastolic function to be an important
prognostic indicator.
3. A practical guideline for how the busy perioperative echocardiographer can rapidly assess diastolic function and discuss what potential therapies exist or may soon exist.
Diastolic Dysfunction: What’s next? – Robina Matyal, MD
At the conclusion of this educational activity, the learner will understand new advances and methods of
assessing diastolic function and how these might influence potential future management of these
challenging patients.
11:00 am - 12:30 pm Use of POC - Are We There Yet? - Moderators: Gregory A. Nuttall, MD; Ferenc
Puskas, MD, PhD
At the conclusion of this session, the participants will be able to:
1. Review the efficacy of point of care coagulation testing in different surgical situations.
2. Know expected turn around times for release of emergency blood products and understand evidence for proactive replacement of clotting factors
3. Examine data regarding the predictive capacity for bleeding and the assessments comparing
plasma based screening coagulation tests versus viscoelastic tests
4. Understand the mechanism of viscoelastic coagulation testing, and learn how Rapid TEG, Platelet Mapping and ROTEM compares to classic Thromboelastography
Should we access hemostasis at all? - Gregory A. Nuttall, MD
At the conclusion of this presentation, the participants will be able to:
1. Review the efficacy of point of care coagulation testing in different surgical situations.
2. Understand the recent literature on transfusion strategies in trauma with massive bleeding.
3. Discuss when different transfusion strategies should be used in the bleeding patient.
Coagulation Testing: A blood banker’s perspective – Lawrence T. Goodnough, MD
At the conclusion of this presentation, the participants will be able to:
1. Understand pathophysiology of coagulopathy in patients with massive hemorrhage
2. Know expected turn-around times for release of emergency blood products
3. Understand evidence for proactive replacement of clotting factors
4. Know recommendations for massive transfusion protocols
Standard Coagulation Tests or Viscoelastic Point-of-Care Monitoring in Patients in Need of Massive
Transfusion - Bruce D. Spiess, MD
At the conclusion of this presentation, the participants will be able to:
1. Understand how routine coagulation tests are run using plasma.
2. Learn of the importance of platelet centered coagulation (the contemporary models) and how
those views relate to "best" whole blood coagulation testing.
3. Examine data regarding the predictive capacity for bleeding and the assessments comparing
plasma based screening coagulation tests versus viscoelastic tests.
4. Learn of future ideas on how present day and future viscoelastic tests could/should be applied
to the situation of massive transfusion.
Super TEG: Beyond the ordinary - Rapid TEG, ROTEM, Platelet Mapping - Nathaen S. Weitzel, MD
At the conclusion of this presentation, the participants will be able to:
1. Understand mechanism of Rapid TEG, Platelet Mapping and ROTEM as compared to classic
Thromboelastography
2. Understand applications of Platelet mapping in the clinical setting
3. Describe clinical application and evidence for using Rapid TEG
4. Discuss how these modified POC tests fit into current transfusion models
2:00 - 3:30 pm Risk and Prevention of Atrial Fibrillation (AF) - Moderator: Aman Mahajan, MD, PhD
At the conclusion of this educational activity, the participants will be able to:
1. Understand the new advancements in the field of interventional electrophysiology for treatment of AF
2. Discuss the new surgical techniques and challenges in AF ablation
3. Understand the risks and management strategies for post-operative AF (POAF)
Rapidly Evolving Field of Atrial Fibrillation Ablations: Interventional EP techniques and implications Kevin Monahan, MD
At the conclusion of this educational activity, the participants will be able to:
1. Evaluate the benefits of currently interventional EP approaches for treating AF
2. Define the role of EP procedural and monitoring techniques in ablation procedures
Getting out of the MAZE: Surgical approaches for atrial fibrillation ablation – Gus Vlahakes, MD
At the conclusion of this educational activity, the participants will be able to:
1. Assess the benefits of surgical ablation in treating A
2. Evaluate the procedural implications of new surgical techniques for AF
The Persistent Problem of Post-operative AF: New approaches - Joseph P. Mathew, MD
At the conclusion of this educational activity, the participants will be able to:
1. Recognize the underlying risk factors for post-operative AF
2. Identify the use of new techniques and therapies in prevention of post-operative AF
2:00 - 3:30 pm The Great Carotid Surgery Debate: Carotid Stenosis-Stents, Pills and Suture Moderator: E. Andrew Ochroch, MD
At the conclusion of this educational activity, the participants will be able to:
1. Determine the risks and benefits of a CEA versus a carotid stent and the anesthetic and periprocedural implications.
2. Discuss current best practices to maximize the benefit of the preoperative period prior to carotid surgery.
3. Understand the current status of medical management of atherosclerotic disease and its perioperative implication.
Debate: I want my carotid stent awake - Benjamin Jackson, MD
At the conclusion of this educational activity, the participants will be able to:
1. Understand the current state of the art for preoperative preparation for carotid stent patients
2. Understand how surgeons may choose suitability for carotid stent placement versus open carotid endarterectomy
3. Discuss the many randomized controlled studies of CEA versus stent and understand the implications of the data
Debate: I want my CEA asleep - Leo Kevin, MD
At the conclusion of this educational activity, the participants will be able to:
1. Understand the current risks and benefits of regional versus general anesthesia for CEA
2. Review the strategies for CNS monitoring under general anesthesia
3. Discuss perioperative strategies for optimizing outcome
Debate: I just want medical management - Joanne Guay, MD
At the conclusion of this educational activity, the participants will be able to:
1. Discuss the changes in preoperative medical management over the last 10 years
2. Review the recent trials of CEA and stenting and see how outcomes for control groups have
changed in the last 10 years
3. Discuss guidelines for carotid intervention in symptomatic and asymptomatic patients
It’s Not the Anesthesia, It’s the Monitoring - John E. Ellis, MD
At the conclusion of this educational activity, the participants will be able to:
1. Discuss the current risks of CEA and stenting with a focus of CNS outcomes
2. Understand the source of CNS risk
3. Review preoperative, intraoperative and postoperative care paradigms that minimize risk and
optimize outcome
2:00 - 3:30 pm Systemic Inflammation and Perioperative Steroid Use
Moderator: Roman Sniecinski, MD
At the conclusion of this educational activity, the participants will be able to:
1. Understand the pathogenesis of SIRS during CPB
2. Discuss the pros and cons of steroid use
3. Decide what patients may benefit from steroid prophylaxis
Pathogenesis of CPB-induced SIRS – Jerrold H. Levy, MD
At the conclusion of this educational activity, the participants will be able to:
4. Define SIRS
5. Identify inflammatory mediators involved in SIRS
6. Describe how SIRS develops in cardiac surgical patients
Prophylactic Steroids Should be Used in CPB Patients - John G.T. Augoustides, MD
At the conclusion of this educational activity, the participants will be able to:
1. Describe how steroids prevent or attenuate SIRS
2. Discuss the evidence for routine use of steroids in cardiac surgery
Prophylactic Steroids Should NOT be Used in CPB Patients - Mark A. Chaney, MD
At the conclusion of this educational activity, the participants will be able to:
1. Identify the side effects of prophylactic steroids use
2. Discuss the evidence for NOT routinely using steroids in cardiac surgery
Panel – Jerrold H. Levy, MD; John G.T. Augoustides, MD; Mark A. Chaney, MD; Diederik van Djik, MD
At the conclusion of this educational activity, the participants will be able to discuss the results of the
DECS trial.
4:30 - 5:30 pm 2011 Best in Show: Best Manuscripts from Anesthesia & Analgesia
Moderators: Charles W. Hogue, MD; Jerrold H. Levy, MD; Martin J. London, MD
Heart-Type Fatty Acid Binding Protein is an Independent Predictor of Death and Ventricular Dysfunction
After Coronary Artery Bypass Graft Surgery - Jochen D. Muehlschlegel, MD
At the end of this educational activity, the participant will be able to:
1. Discuss the release mechanisms of conventional biomarkers and their relevance in diagnosing myocardial injury
2. Discuss the differences and advantages of heart-type fatty acid binding protein over conventional biomarkers.
3. Use biomarkers for risk stratification and diagnosis of myocardial injury
Hyperfibrinolysis Diagnosed by Rotational Thromboelastometry is Associated with Higher Mortality in
Patients with Severe Trauma - Oliver M. Theusinger, MD
At the end of this educational activity, the participant will be able to:
1. Understand the role of fibrinolysis and its severity, as predictors of outcome of traumatized and
non-traumatized patients.
2. Review the role of viscoelastic measurements of hemostasis to measure fibrinolysis.
3. Summarize other clinical studies evaluating fibrinolysis and therapy to improve outcomes
Review Article: High Stakes and High Risk: A focused qualitative review of hazards during cardiac surgery
Elizabeth A. Martinez, MD
At the end of this educational activity, the participant will be able to:
1. Understand the existing literature on hazards during cardiac surgery.
2. Appreciate the taxonomy of contributing factors related to such hazards.
3. Understand proposed research methods and ongoing studies (eg. FOCUS) aimed at mitigating such
hazards.
4:30 - 5:30 pm SAGA SESSION: It is Not About the Same Old Heart: Some organs are more prone to ailment
than the others - Moderator: Shamsuddin Akhtar, MD
Respiratory Dysfunction in the Elderly: The forgotten morbidity - Paul Heerdt, MD, PhD
At the end of this educational activity, the participant will be able to discuss:
1. Respiratory dysfunction with aging (changes in shunt, deadspace, respiratory mechanics, gas exchange and respiratory control with aging).
2. Perioperative respiratory outcomes after cardiac and major non-cardiac surgery.
3. Interventions that can improve respiratory outcomes (sedation protocols, incentive spirometry
etc).
Neurological Dysfunction in the Elderly: From bench to bedside - Gregory Crosby, MD
At the end of this educational activity, the participant will be able to discuss:
1. Progressive neurological function and decline with aging.
2. Discuss perioperative neurological outcomes after cardiac and major non-cardiac surgery.
3. Discuss perioperative management of elderly with new and established neurological dysfunction.
4:30 - 5:30 pm Poster Discussion I: Echocardiography, 3D, and Beyond
Moderators: Stanton K. Shernan, MD; Candice R. Montzingo, MD
At the conclusion of this educational activity, the participants should be able to understand new developments in the perioperative use of TEE.
MONDAY, APRIL 30, 2012
6:45 - 8:00 amProblem Based Learning Discussions 8 – 14
PBLD 8 Ethics of Organ Donation, Richard L. Wolman, MD; Kelly L. Grogan, MD
At the conclusion of this problem based learning discussion, the participant will have a clearer understanding
of:
1. The ethical, legal, medical, and procedural concerns with the current practice of organ donation.
2. The ethical, legal, and procedural implications of expansion of donation after cardiac death criteria
and practice, the sale of donor organs, sequential organ donation/transplantation, and the possible
involvement of anesthesiologists in these practices.
PBLD 9 Antiplatelet Drugs and Stents, Kenichi Tanaka, MD; Daniel Bolliger, MD
At the conclusion of this PBLD, the participant will be able to:
1. Understand the mechanisms of antiplatelet agents used to treat patients with cardiovascular
disease.
2. Discuss the use of platelet function assays.
3. Develop a plan for the perioperative management of patients with coronary artery stents; timing of surgical intervention, bridging therapy, and choice of anesthesia.
PBLD 10 Atrial Fibrillation, Joseph P. Mathew, MD; Sumeet Goswami, MD
At the conclusion of this educational activity, the participants will able to:
1. Identify the perioperative risk factors for postoperative atrial fibrillation
2. List the treatment options for the prevention and management of postoperative atrial fibrillation
PBLD 11 Cerebral Protection, Hilary P. Grocott, MD; Michael N. Andrawes, MD
At the conclusion of this educational activity, the participants will able to:
1. Put into perspective the spectrum of cerebral protective strategies that can be used in patients
undergoing cardiac surgery.
2. Understand how cerebral monitoring modalities may influence perioperative management of
the patient at risk for neurologic complications after cardiac surgery.
PBLD 12 ECMO Update, Manuel Fontes, MD; Kris Lukauskis, MD
After this educational activity participants should be able to:
1. Describe the indications and contraindications of ECMO (Extracorporeal Membrane Oxygenation).
2. Understand the different ECMO components.
3. Recognize ECMO configurations for various pathophysiology.
3. Describe complications of ECMO.
4. Discuss current practices for ECMO and outcomes.
PBLD 13 Ischemic MR, Jacob Raphael, MD; Matthew Klopman, MD
At the conclusion of this PBLD participants will be able to:
1. Understand the pathophysiology and natural history of ischemic mitral regurgitation
2. Understand the distinctive echocardiographic characteristics of ischemic mitral regurgitation
3. Discuss patient factors that increase morbidity/mortality in combined CABG/MV repair/replacement
4. Identify and discuss pre-op echocardiographic predictors of MR recurrence
5. Discuss the various surgical approaches to ischemic mitral regurgitation
PBLD 14 Perioperative Arrhythmia Management In Thoracic Surgery, David Amar, MD; Alessia Pedoto,
MD
After this educational activity participants should be able to identify:
1. Incidence and natural history of perioperative arrhythmias
2. Biomarkers and their use in prediction of atrial fibrillation
3. Prevention strategies
4. Treatment of perioperative arrhythmias
5. Role of anesthesiologists in stroke prevention
8:00 - 10:00 am Practice Management: From Private to Academics: Advice from the Top in Healthcare
Reform Climate - Moderators: Solomon Aronson, MD; Joseph S. Savino, MD
Health Care Reform and Washington’s Point of View – Sheila Burke
Academia and HCR: What does it mean for all 3 missions? - Lee A. Fleisher, MD
At the conclusion of this educational activity, the participants should be able to discuss:
1. The role anesthesiologists must play under the new health care reform rules, particularly with
respect to an integrated environment
2. How academic anesthesia can respond to the research opportunities created under health care
reform
Private Practice and HCR: What does it mean for anesthesia employment models in the community? – Eric
W. Mason, MD
At the conclusion of this educational activity, the participants should be able to discuss:
1. How HCR will change Private Practice
2. Joint Ventures and the impact on Private Practice
3. ACOs influence on Private Practice
4. Company Model's impact on Private Practice
5. Different Employee models
Health Care Reform: What does it mean to the hospital? - Ralph Muller
At the conclusion of this educational activity, the participants should be able to discuss:
1. Changing financial incentives
2. Hospital consolidation
3. Value and quality improvement
4. Employer movement to exchanges
5. Local variation
10:30 - 11:30 am Keynote Speaker - Moderator: Solomon Aronson, MD
Major Trends in Cardiovascular Disease Epidemiology and Treatment - Robert Califf, MD
1:30 - 3:00 pm FOCUS - Human Error - Moderator: Bruce D. Spiess, MD
A Historical Perspective on Human Error Reduction in Surgery – Lucian Leape, MD
At the conclusion of this educational activity, the participants will be able to discuss the world-wide
movement towards safe surgery, progress made and future challenges.
Cardiac Surgery Established Along the Guidelines of a Highly Efficient “Toyota” Industrial Model Michael H. Culig, MD
At the conclusion of this educational activity, the participants will be able to examine lessons learned
from a highly efficient automotive fabricating company- Toyota- and how those principles were applied
to a cardiac surgery program, thereby improving efficiency and outcome
The Value of Scenario Teamwork Training Using Simulators Today and in the Future – David J. Birnbach,
MD
At the conclusion of this educational activity, the participants will be able to examine techniques to
teach/test anesthesia care providers regarding human error through scenarios and simulation training.
1:30 - 3:00 pm Regional Anesthesia for Cardiac Surgery - Moderator: Michael P. Eaton, MD
Regional Anesthesia for Minimally Invasive Cardiac Surgery: Pleural, paravertebral, epidural, and
parasternal blocks - James J. Lynch, MD
At the conclusion of this educational activity, the participants will be able to:
1. Understand regional anesthetic options for patients undergoing minimally invasive cardiac surgery (MICS)
2. Discuss relevant anatomy relating to these blocks and review block placement techniques
3. Understand how regional blocks can be incorporated into a MICS practice with a focus on rapid
recovery time
Watch your own heart surgery? Awake Cardiac Surgery Under High Thoracic Epidural Anesthesia – Paul
Kessler, MD
At the conclusion of this educational activity, the participants will be able to:
1. Understand potentially beneficial effects of high thoracic epidural anesthesia in patients with
coronary artery disease
2. Discuss the pro and cons of awake cardiac surgery under high thoracic epidural anesthesia, including selection of patients
3. Recognize potential limitations, complications and side effects inherent to this technique
Spinal Opiates for Cardiac Surgery: Worth the risk? - Mark A. Chaney, MD
At the conclusion of this educational activity, the participants will be able to understand the potential
clinical advantages and disadvantages of using spinal opioids in patients undergoing cardiac surgery.
1:30 - 3:00 pm Poster Discussion II: All About the CNS
Moderators: Hilary P. Grocott, MD; Bala Subramaniam, MD, MPH
At the conclusion of this educational activity, the participants should be able to understand new developments related to neurologic outcomes in cardiac surgical patients.
3:30 - 5:00 pm Super Echo Panel
Moderator: Kathryn E. Glas, MD, MBA, FASE
Panel: Gregg S. Hartman, MD; Scott T. Reeves, MD; François A. Béïque, MD
Case Presentations
At the conclusion of the panel the participant will:
1. Enhance knowledge on various echocardiographic techniques employed to solve intraoperative
echocardiographic dilemmas
2. Understand how the use of transesophageal echocardiography provided the solution to challenging clinical scenarios
3:30 - 5:00 pm Numbers on Your Mind: Cerebral monitoring during cardiac surgery
Moderators: James H. Abernathy III, MD, MPH; Hilary P. Grocott, MD
Is my patient too hot or too cold? How do I know? - David J. Cook, MD
At the conclusion of this educational activity, the participants will be able to:
1. Appreciate which methods and locations to measure temperature are ideal
2. Understand why temperature management is important to patient outcomes
3. Appreciate why different achieving temperatures at different times in the course of cardiopulmonary bypass is important
Should I be using the BIS in the heart room? - Michael S. Avidan, MD
At the conclusion of this educational activity, the participants will be able to:
1. Understand how the BIS creates a number
2. Understand what the BIS number means
3. Discuss how to incorporate the BIS into clinical decision making in the cardiac operating room
4. Appreciate the role BIS has, if any, in circulatory arrest cases
Should I be using cerebral oximetry in the heart room? - Greg D. Fischer, MD
At the conclusion of this educational activity, the participants will be able to:
1. Understand how cerebral oximetry is measured
2. Appreciate the limitations of the cerebral oximetry
3. Understand how to use physiology and pharmacology to manipulate the measured value.
4. Appreciate how adjusting physiologic parameters based upon cerebral oximetry might improve
outcomes
5. Understand the studied algorithms for incorporating cerebral oximetry into clinical practice.
3:30 - 5:00 pm The Adult With Congenital Heart Disease
Moderator: Wanda Miller-Hance, MD
Current Controversies in the Management of Congenital Heart Disease - James A. DiNardo, MD
At the conclusion of this lecture the participant will be able to:
1. Gain familiarity with the issues that are at the forefront of controversy regarding management
of congenital heart disease
2. Understand how the above issues may influence long-term outcome in these patients
Anesthetic Considerations for Adult Patients with Congenital Heart Disease - Jane Heggie, MD
At the conclusion of this lecture the participant will be able to understand:
1. The physiologic impact of congenital heart disease in the adult, including end-organ effects
2. Important considerations in the preoperative assessment of these patients
3. The major sequelae associated with congenital heart disease
4. Concerns regarding anesthetic care in these patients and challenges during noncardiac surgery
Management of Pulmonary Hypertension in the Perioperative Setting - Robert H. Friesen, MD
At the conclusion of this lecture the participant will be able to understand:
1. Most common etiologies of pulmonary hypertension
2. Perioperative risk associated with pulmonary hypertension
3. Influences of sedatives/anesthetic agents on pulmonary hypertension
4. Management strategies in patients with this condition
TUESDAY, MAY 1, 2012
6:45 - 8:00 amProblem Based Learning Discussions 15 – 21
PBLD 15 Pulmonary Thrombendarterectomy - Mary Beth Brady, MD; Erica J. Stein, MD
At the completion of this educational activity, participants should be able to:
1. Describe the pathophysiology, classification and incidence of chronic thromboembolic pulmonary hypertension (CTEPH)
2. Identify the indications for pulmonary thromboendarterectomy
3. Discuss the preoperative evaluation and hemodynamic considerations for patients with chronic thromboembolic pulmonary hypertension
4. Summarize the intraoperative anesthetic management and monitoring considerations for patients with severe supra-systemic pulmonary hypertension
PBLD 16 DHCA Management - Marc S. Kanchuger, MD; Sasha Shillcutt, MD
After this educational activity participants should be able to:
1. Understand anesthetic considerations and management strategies of patients undergoing DHCA
2. Describe neurologic monitoring modalities that can be used during DHCA
3. Describe cerebral perfusion adjunctive modalities that can be used during DHCA
4. List neuroprotective pharmacologic options that can be used during DHCA
PBLD 17 Complex Congenital Issues - James A. DiNardo, MD; Candice Montzingo, MD
At the conclusion of this PBLD the participants will be able to:
1.
2.
3.
4.
5.
Discuss the anatomical features found in D-TGA.
Discuss surgical options for repair of D-TGA, historical and current.
Discuss the prognosis after atrial level repair for TGA.
Understand the long term complications associated with atrial switch operations.
Discuss medical and surgical options for adults who have previously undergone a Mustard procedure.
6. Develop an anesthetic plan in an adult with a history of an atrial switch procedure who now presents with SA node dysfunction, severe tricuspid valve regurgitation, and right to left shunting
through a baffle leak.
PBLD 18 TEG - Linda Shore-Lesserson, MD; Michael K. Essandoh, MD
After this educational activity participants should be able to:
1. Describe the mechanisms of measurement of the thromboelastogram and related devices
2. Define the need for point of care testing in the perioperative environment to include bleeding
and thrombosis
3. Describe a rational approach to hemostasis testing and design algorithms to test the bleeding
patient or the patient preparing for surgery who takes anti-platelet medication.
PBLD 19 Minimally Invasive Surgery - Roman Sniecienski, MD; Jennifer M. McSweeney, MD
At the conclusion of this PBLD session the participant should be able to:
1. Evaluate the perioperative and long-term morbidity and mortality of minimally-invasive mitral
valve surgery via thoracotomy (mini-MVS) versus conventional open mitral valve surgery
through median sternotomy (conv-MVS)
2. Discuss some of the potential benefits of mini-MVS versus conv-MVS
3. Identify which patients may be best suited for mini-MVS versus conv-MVS
4. Discuss the airway management considerations of mini-MVS
5. Discuss the positioning considerations of mini-MVS
6. Discuss the hemodynamic monitoring considerations of mini-MVS
PBLD 20 Acute Kidney Injury - Mark Stafford-Smith, MD; Allen N. Gustin, Jr., MD
At the conclusion of the discussion, the participants will be able to:
1. Identify the multiple factors related with increased risk of postoperative acute kidney injury in
cardiovascular and thoracic surgical patients, at different levels (patient-related conditions, procedure-specific factors, and perioperative care) and to recognize how the possible interactions
between those factors affect the final patient outcome.
2. Apply the best available evidence in order to accurately assess patient's specific renal risk and to
devise a perioperative anesthetic intervention plan to improve patient outcome.
PBLD 21 Pulmonary Hypertension and Pulmonary Resection - Katherine P. Grichnik, MD;
Tamas Seres, MD
After this educational activity participants should be able to:
1. Recite the signs and symptoms of pulmonary hypertension
2. List the chronic medications that pulmonary hypertension patients are treated with
3. Describe the impact of pulmonary hypertension on the intraoperative and postoperative
management of patients
8:00 - 10:00 am Monograph Session: Clinical Applications of Biomarkers in Perioperative Medicine
Moderator: Mihai V. Podgoreanu, MD
Natriuretic Peptides and Cardiac Surgery: Implications for perioperative risk stratification and management Amanda Fox, MD, MPH
After this educational activity participants should be able to:
1. Describe the physiologic properties of plasma B-type natriuretic peptide (BNP).
2. Outline established diagnostic and prognostic uses for the BNP biomarker in non-surgical patients.
3. Discuss research assessing the value of perioperative BNP measurements for predicting adverse
outcomes after cardiac surgery.
Biomarkers of Perioperative Myocardial Injury: Diagnostic and prognostic significance - Mihai V.
Podgoreanu, MD
After this educational activity participants should be able to:
1. Discuss the state-of-the-art guidelines for reporting molecular epidemiology/biomarker studies
2. Discuss the short and long-term prognostic significance of perioperative elevation of validated
biomarkers of myocardial injury
3. Describe emerging biomarkers for perioperative cardiac risk
Emerging Biomarkers for Perioperative Acute Kidney Injury - Andrew D. Shaw, MB, FRCA, FCCM
After this educational activity participants should be able to:
1. Discuss novel biomarkers of renal function and damage in the context of acutely deteriorating
glomerular filtration.
2. Review recent data describing the role of endogenous protein C as a biomarker of renal dysfunction in severe inflammation.
3. Discuss the place of novel biomarkers of acute kidney injury in the context of the RIFLE criteria
for diagnosis of AKI.
Biomarkers for Evaluation of Sepsis in Perioperative, Critically Ill and Injured Patients: Development of
the Riboleukogram - J. Perren Cobb, MD
After this educational activity participants should be able to:
1. Summarize recent advances in genomics and microfluidic technologies enabling improved sepsis
diagnostics through genome-wide assessment of responses in circulating leukocytes;
2. Discuss the development and application of leukocyte-derived gene expression profiles to track
patient responses to postoperative ventilator-associated pneumonia; to introduce the new field
of immune cartography.
10:30 am - 12:00 pm Critical Care Session
Moderator: Michael H. Wall, MD
At the conclusion of this educational activity, the participants will be able to:
1. Understand economics of critical care and effects of various staffing models
2. Understand the rationale and complications of airway pressure release ventilation
3. Describe the current state of ongoing sepsis trials
4. Understand the role of tissue oxygenation in resuscitation
Can critical care pay the bills? - Laureen L. Hill, MD
At the conclusion of this educational activity, the participants will be able to:
1. Understand the changing nature of critical care in the era of resident work hour restrictions.
2. Understand the economics of nurse practitioners and physician’s assistants.
Airway Pressure Release Ventilation: What’s so new about that? - Michael C. Woo, MD
At the conclusion of this educational activity, the participants will be able to:
1. Understand the physiology behind airway pressure release ventilation. (APRV).
2. Explain the risks and potential benefits of APRV.
Cardiocerebral Resuscitation in 2012 - Michael L. Ault, MD
At the conclusion of this educational activity, the participants will be able to:
1. Understand the principles of “cardiocerebral resuscitation”.
2. Be able to apply those principles to patients.
Sepsis Trials: What have we learned? - Greg E. Kerr, MD, MBA
At the conclusion of this educational activity, the participants will be able to:
1. Understand the results of recent clinical sepsis trials.
2. Apply these results to septic patients.
Tissue Oxygen - That’s all That Matters Anyway! - Richard E. Fagley, MD
At the conclusion of this educational activity, the participants will be able to:
1. Understand the principles of monitoring tissue oxygenation.
2. Understand the role of tissue oxygenation monitors in the perioperative period.
1:30 - 3:00 pm Quality Measurements in Cardiothoracic Anesthesia
Moderator: Elizabeth A. Martinez, MD
How Can We Improve the Safety of the Care We Deliver? Insights from the Literature and the Science of
Safety - Alan F. Merry, MD
At the conclusion of this educational activity, the participants will be able to:
1. Discuss the Institute Of Medicine’s goals on patient safety
2. Describe the current landscape of quality and safety in perioperative cardiac surgical care
3. Understand limitations with measuring the impact of safety interventions
From the National Quality Forum to Consumer Reports: What have we learned about quality
measurement? - Laurent G. Glance, MD
At the conclusion of this educational activity, the participants will be able to:
1. Discuss the implications of quality measurement and risk adjustment
2. Describe the impact of the use of the STS registry in improving cardiac surgical care
3. Implement the process of developing new metrics for cardiac surgical care
Achieving IOM Goals: Improving efficiency in cardiac anesthesia programs - Michael Fitzsimons, MD
At the conclusion of this educational activity, the participants will be able to:
1. Understand the context of bundled payments
2. Describe considerations for implementing a performance improvement initiative for improving
efficiency
3. Describe one center’s experience with implementing an efficiency improvement program
1:30 - 3:00 pm Research Session: Party Balloons, Rotten Eggs and Cigarette Smoke: The novel
therapeutic potential for helium, hydrogen sulfide and carbon monoxide
Moderator: Hilary P. Grocott, MD
The Potential Role of Helium Administration for Myocardial Preconditioning – Benedikt Preckel, MD
At the conclusion of this educational activity, the participants will be able to:
1. Understand the experimental evidence for the potential for inhaled helium to provide protection from myocardial ischemia
2. Understand the potential role for helium in other crticial illness states
The Therapeutic Potential of Hydrogen Sulfide During Cardiopulmonary Bypass – Fumito Ichinose, MD
At the conclusion of this educational activity, the participants will be able to:
1. Understand the experimental rationale behind the use of hydrogen sulfide as a organ protective
agent
2. Understand the early clinical data on the use of hyodrgen sulfide administation during
cardioulmonary bypass
Carbon Monoxide: Toxic gas or organ protective agent? – Ulrich Goebel, MD
At the conclusion of this educational activity, the participants will be able to:
1. Understand the important endogenous role of carbon monoxide in health and disease
2. Understand the potential therapeutic role for carbon monoxide for organ protection in cardiopulmonary bypass
1:30 - 3:00 pm Factor Concentrates in Massive Transfusion
Moderators: Gregory A. Nuttall, MD; Saket Singh, MD
Effects of Massive Transfusion on Coagulation – Lawrence T. Goodnough, MD
At the conclusion of this educational activity, the participants will be able to:
1. Understand pathophysiology of trauma-related coagulopathies
2. Know emerging strategies for treating coagulopathies in trauma patients
3. Know current evidence for management strategies: 1:1:1 ratios of RBC: plasma: platelet protocols vs. point of care testing and transfusion algorithms
Use of FFP versus Coagulation Factor Concentrates: Is there evidence? – Lawrence T. Goodnough, MD
At the conclusion of this educational activity, the participants will be able to:
1. Understand current unmet clinical needs for reversal of warfarin-associated coagulopathy
2. Know current recommendations from international medical societies on role(s) of PCCs and
plasma therapy.
3. Know potential benefits and risks of plasma and PCC therapy.
Update on Factor VII: Heightened risk for complications? – C. David Mazer, MD
At the conclusion of this educational activity, the participants will be able to:
3:30 - 5:00 pmHeart Failure
Moderators: James H. Abernathy III, MD, MPH; Wanda Miller-Hance, MD
Medical Management of Heart Failure – Patrick T. O’Gara, MD
At the conclusion of this educational activity, the participants will be able to discuss pathophysiology of
heart failure and current approaches for medical management.
Physiology of Right Heart Failure – Jonathan Leff, MD
At the conclusion of this educational activity, the participants will be able to discuss the unique physiology of right heart failure, features that distinguish right versus left heart failure, the role of diagnostic
modalities and strategies for management.
Surgical Options for the Failing Heart – Gregory Couper, MD
At the conclusion of this educational activity, the participants will be able to discuss established and
evolving surgical options in the treatment of the patient with a failing heart.
3:30 - 5:00 pm Organ Protection During Cardiopulmonary Bypass
Moderator: Jacob Raphael, MD
Myocardial Ischemia Reperfusion Injury and Myocardial Protection from the Lab to the Bedside – David
Warltier, MD, PhD
At the conclusion of this educational activity, the participants will be able to:
1. Describe the scientific background supporting myocardial preconditioning and human clinical
data supporting this approach for cardiac protection.
2. Discuss approaches to myocardial protection during cardiopulmonary bypass.
Strategies to Prevent Acute Kidney Injury After Cardiac Surgery – Mark Stafford-Smith, MD
At the conclusion of this educational activity, the participants will be able to:
1. Discuss novel biomarkers for the diagnosis of acute kidney injury.
2. Discuss current strategies for preservation of renal function during and after CPB
Brain Protection during CPB and Postoperative Cognitive Dysfunction – Hilary P. Grocott, MD
At the conclusion of this educational activity, the participants will be able to discuss recent advances in
neurological protection during CPB and DHCA.
3:30 - 5:00 pm Poster Discussion III: Cardiac Surgery and Receptor Pharmacology
Moderators: Michael H. Wall, MD; Theodore A. Alston, MD, PhD
At the conclusion of this educational activity, the participants should be able to utilize new research related to receptor pharmacology in advancing the care of their patients.
5:00 - 6:30 pm ECHO Jeopardy
Moderators: Andrew D. Maslow, MD; Feroze Mahmood, MD; Peter J. Panzica, MD
At the conclusion of this educational activity, the participants will be able to:
1. Discuss a variety of issues surrounding cardiothoracic and vascular anesthesia involving the
evaluation, diagnosis, and management of the patient.
2. Describe normal and abnormal conditions that the anesthesiologist is faced with during their
clinical practices.
WEDNESDAY, MAY 2, 2012
6:45 - 8:00 am Problem Based Learning Discussions 22 – 24
PBLD 22 Adult Congenital, Wanda C. Miller-Hance, MD; Galina T. Dimitrova, MD
At the conclusion of this PBLD, the participant will be able to:
1. Understand the anatomic and hemodynamic abnormalities in two selected congenital cardiovascular
malformations, namely, atrial septal defect and tetralogy of Fallot.
2. Formulate plans for preoperative, intraoperative, and postoperative management for the patient
with simple and moderately complex congenital heart disease undergoing noncardiac surgery.
PBLD 23 TAVI, Wendy L. Gross, MD; Nelson Thaemert, MD
After this educational activity the participants should be able to:
1. Understand the process and specific steps involved during transfemoral and transapical
Transcatheter Aortic Valve Implantation.
2. Be aware of the high risk points and potential pitfalls which can develop during the case.
3. Understand the anesthesiologist's role and the necessity for collaboration and clear communication during the procedure.
4. Devise strategies for optimal case flow and outcome within the structures of their own institutions.
PBLD 24 Cardiomyopathy and Pulmonary Resection, Randal S. Blank, MD, PhD; Michael J. Andritsos, MD
At the conclusion of this PBLD, the participant will be able to:
1. To understand the cardiovascular effects of general anesthesia, mechanical ventilation, and one
lung ventilation in normal patients.
2. To understand the implications of general anesthesia, mechanical ventilation, and one lung ventilation on cardiovascular function in patients with severe ventricular dysfunction.
3. To understand the potential impact of pulmonary resection surgery via thoracotomy and thoracoscopy on patients with severe ventricular dysfunction.
4. To develop anesthetic management strategies to optimize perioperative outcomes in patients
with severe ventricular dysfunction undergoing pulmonary resection surgery.
WORKSHOPS • 8:00 - 11:00 am
Workshop 6: Advanced TEE II – Moderator: Feroze Mahmood, MD
Principles and Physics of 3D Echocardiography - G. Burkhard Mackensen, MD, PhD
After this educational activity the participants should be able to:
1. Understand the principles of three-dimensional echocardiography
2. Understand the basis of image formation and display
3. Appreciate the various modes of the 3D echocardiography
Current Status of Intraoperative 3D Echocardiography - Stanton K. Shernan, MD
After this educational activity the participants should be able to:
1. Appreciate the current applications of 3D echocardiography during clinical practice
2. Understand the advantages and limitations of 3D echocardiography
3. Understand the qualitative and quantitative applications for cardiac valvular analysisand assessment
Hands-on Workshop and 3D Knobology - Douglas Shook, MD; G. Burkhard Mackensen, MD, PhD; Feroze
Mahmood, MD; Stanton K. Shernan, MD
Four stations with 3D capable ultrasound systems and live models for real-time 3D image acquisition
and interpretation
This hands-on workshop consists of multiple stations with echocardiography machines and models to
demonstrate with transthoracic echo the various modes of 3D echocardiography, image acquisition and
knobology.
1. The participants will be able to practice image acquisition in an interactive fashion and learn the
techniques of image optimization and troubleshooting.
2. The participants will also be able to learn the various techniques of quantitative valvular analysis.
Workshop 7: Human Errors – Moderators: Jonathan Mark, MD; Elizabeth A. Martinez, MD
Setting the stage: What do we know about patient safety? - Elizabeth Martinez, MD
After this educational activity the participants should be able to:
1. Apply principles of patient safety
2. Discuss types of errors in cardiac surgery
Setting the stage in the OR: Briefings and Debriefings - Jonathan Mark, MD
After this educational activity the participants should be able to:
1. Describe the principles and goals of briefings and debriefings
2. Discuss the evidence for briefings and debriefings and structured communication
3. Demonstrate strategies to optimize briefings and debriefings
Medication Errors: What can we do to reduce these? - Alan Merry, MD
After this educational activity the participants should be able to:
1. Recognize the contributors to medication errors
2. Describe principles of human factors science in developing methods for reducing the risk of
medication errors
Simulation: How can we leverage simulation to improve patient safety? - Jeff Cooper, MD
After this educational activity the participants should be able to:
1. Discuss the current science of simulation
2. Describe how simulation can be used for training in nontechnical skills.
Interactive /Breakout Session:
After this educational activity the participants should be able to:
1. Work within a team to investigate a patient safety incident and design a systems-based approach to addressing the issue/case scenarios.
2. Develop a plan for solutions.
Workshop 8: Fellowship Session – TEE Review Workshop – Moderators: Nanhi Mitter, MD; Annemarie
Thompson, MD
Hemodynamics - Mary Beth Brady, MD
At the conclusion of this educational activity, the participants will be able to:
1. Apply the simplified Bernoulli equation to estimate valvular gradients and valve area
2. Compute stroke volume and cardiac output utilizing 2D and Doppler technology
3. Calculate intracardiac pressures
4. List the benefits and limitations of the above techniques
TEE and VADs - Nanhi Mitter, MD
At the conclusion of this educational activity, the participants will be able to:
1. Understand the indications for TEE during VAD insertion.
2. Describe the intraoperative TEE examination necessary during VAD implantation.
3. Describe the utilization of TEE during the management of VAD malfunction.
Physics of Ultrasound - Caroline McKillop, MD
At the conclusion of this educational activity, the participants will be able to:
1. Recognize the principles and physical properties of ultrasound.
2. Understand the different ultrasound modalities and their limitations.
3. Be able to use ultrasound principles to optimize echocardiographic imaging and avoid artifacts.
Artifacts and Pitfalls – Thomas Burch, MD
At the conclusion of this educational activity, the participants will be able to:
1. Identify multiple common artifacts and pitalls.
2. Identify the assumptions of the ultrasound system and how violations of these assumptions
result in artifact formation (mechanism of artifact formation).
Diastology - Wanda Popescu, MD
At the completion of the lecture the participant will understand concepts related to:
1. Diastolic physiology and pathophysiology
2. Echocardiographic indices employed to diagnose diastolic dysfunction
3. Clinical utility of diagnosing diastolic dysfunction in the perioperative period
Conclusion - Nanhi Mitter, MD; Annemarie Thompson, MD