Future Challenges and Solutions in Cardiothoracic Surgery

Issue 20 April News 2019

In this issue Future challenges and solutions 2 Multimedia Manual of Cardio-Thoracic in cardiothoracic surgery Surgery

4 The Adult An interview with EACTS President Ruggero De Paulis Cardiac p-to-the-minute training and continuing Database education in cardiothoracic surgery forms the 5 The Czech backbone of the profession’s rapidly evolving National Register future. This was the message of EACTS UPresident Ruggero De Paulis during a recent interview of Cardiac Surgery with EACTS News. “Our profession – and cardiac surgery in particular 6 Women in – is facing several challenges,” he began, noting that cardiothoracic exciting opportunities are borne in rising to meet surgery technological advancements. However, the emergence of new technologies 8 EACTS Training risks increasing both the global developmental gap Management along international socio-economic borders, and the System generational gap. “The learning curve is particularly important for the older generation of surgeons, who 9/10 will find it more difficult to adapt, and in turn may not EACTS residents effectively pass these teachings on to the younger represent in generation,” he said. Europe “In our everyday practice, we have seen a shift from 11 MEBCTS: the standard classic operation of old to a new era of challenge your minimally invasive surgery – including smaller incisions knowledge and procedures aided by robotics.” In the field of vascular and cardiac surgery, he added, 11 The EACTS endovascular procedures are increasingly popular, Residents and this is mirrored by the growth of transcatheter Committee techniques in cardiology. Today’s cardiac surgeon must wants YOU! therefore become well practised in both classic and interventional techniques. 12 An introduction Professor De Paulis went on: “The cardiac “We are dealing with cases to aortic surgery surgeon has to face up to learning these far more complicated than endovascular skills, both to ensure they are 13 MITACS 2019 equipped with a cutting-edge skillset in vascular in the past. This makes our heads to surgery, and to enable them to enter into the Frankfurt world of transcatheter valve technologies. The future challenging, but also 14 Cardiac surgeon is probably best placed to know the very interesting.” surgery: the anatomy of the cardiac valves, so again, obtaining Ruggero De Paulis Fundamentals these endovascular skills will make for a better surgeon overall.” 15 The Thoracic He added: “We are dealing with cases far more Academy complicated than in the past. This makes our future vascular surgery audience,” he said. “But the same programme challenging, but also very interesting.” transcatheter skills can also be useful to approach To step up to the challenges of modern-day practice, aortic valve replacements (and this will soon include 16 AVRS: June the EACTS/ESVS Endovascular Skills Course has been mitral valve replacements) which, at the moment, are 20–21, 2019 in specifically designed to help cardiac surgeons become mostly being done by cardiologists and to some extent Brussels acquainted with new technologies and techniques. cardiac surgeons.” Featuring a comprehensive review – and simulator To that end, endovascular skills must also be 18 The 33rd Annual training – in various aspects of the endovascular enshrined in residency courses, he added. “What Meeting treatment of aortic pathologies, it is a key step in the Association can do is set an example and offer 19 Nurses & helping young colleagues acquire endovascular skills, opportunities. But the true change has to be made Allied Health stressed Professor De Paulis. within each country. EACTS’ role is to help our Professionals Day “We are organising this mostly with transcatheter colleagues in different countries to lobby for these endovascular aortic repair in mind, i.e. for our Continued on page 2

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Association Future challenges and solutions in cardiothoracic surgery

An interview with EACTS At this year’s Annual Meeting in Lisbon, point of view, to understand if results have a number of sessions will delve into the been properly interpreted, and determine President Ruggero De Paulis results of the latest clinical trials, with whether the conclusions are in line with Continued from page 1 emphasis placed on how to interpret the data.” things to take place.” their impact. Supported by the recently This year’s Annual Meeting continues to Professor De Paulis also spoke of established EACTS Analytical Support develop its three-day format with less overlap the opportunities in an increasingly Unit, the sessions will have particular between sessions and domains, and more interconnected world, with social media focus on boosting the knowledge of space given to the Techno-College. “We offering a means of rapidly sharing emerging statistical approaches in the cardiothoracic are trying to make it easier for people who knowledge. “The surgical community has community. “We need to better understand want to attend several sessions,” explained probably been too slow in adopting social how to properly interpret results, especially Professor De Paulis. media,” he said. “We can, for example, when new trials are published,” said “People have great interest in the cutting- share videos showcasing new techniques, or Professor De Paulis. edge technologies presented at the Techno- peculiar aspects of individual cases, or the College, but at the same time they are just results of research. as eager to attend the ‘regular’ sessions “This will change the way we communicate “What the Association we offer. This year, I think we can offer the – in fact, it is already happening. But it is not delegates the chance to attend every session the case for all generations; it comes more can do is set an they would like.” naturally to younger people. Furthermore, example and offer Professor De Paulis concluded by noting I believe it is something that could be that this year marks 500 years since the organised in a better way.” opportunities. But death of Leonardo da Vinci and, as a fitting More generally, he asserted, the the true change has tribute to his “genius of the past”, this year’s proliferation of data presents a pressing Annual Meeting will draw inspiration from need to find better ways of making sense of to be made within the polymath’s art and invention. “We are available clinical evidence. “With changes each country.” organising a plenary session devoted to in technology and different approaches, it some historical presentations on da Vinci, is becoming more difficult to make the right Ruggero De Paulis including everything he has done relating to choices,” he said. “We need to interpret the heart and, in particular, the aortic and results better and make evidence-based mitral valves. choices for our patients. Even though more “This is something that is becoming more “In addition, we hope to organise an information is emerging every day, at the and more important. In these sessions, we exhibition on da Vinci with some of his same time it is becoming less organised.” will discuss the latest trials from a statistical paintings and anatomical drawings.”

Are you an MMCTS author?

René Prêtre and Roberto Lorusso referenced studies, we just need video most challenging, and every tutorial Editors-in-Chief, MMCTS demonstrations of the procedures you has valuable lessons to teach. Many undertake every day. of our most highly viewed videos are he Multimedia Manual of Cardio- demonstrations of common procedures Thoracic Surgery (MMCTS) is Surgical demonstrations, not and basic skills, so don’t feel that you the world’s only dedicated video- complex studies need to wait for a rare case or particularly based educational platform for MMCTS isn’t a journal, it’s a teaching difficult surgery before you send us cardiothoracicT (CT) surgeons. Published by programme. We publish straightforward a proposal. EACTS as a free service to the worldwide video tutorials of CT surgical procedures. community of CT surgeons, it features Each of our tutorials typically includes 5 What’s so great about publishing nearly 300 step-by-step surgery tutorials, to 10 narrated video clips with concise with MMCTS? which demonstrate procedures from the supporting text, images, and no more than Publishing with MMCTS is fast, rewarding most fundamental to the most innovative. five references. Our submission system is and good for your CV. As an EACTS member, you are already easy to access and use, and our online a supporter of MMCTS, but are you one templates make creating a tutorial a We are a boutique, not a factory of our authors too? streamlined and efficient process. Your tutorial will be edited and formatted by an experienced team who will review and Become an MMCTS author Many of our top tutorials teach optimise every video, graphic and word. Joining our MMCTS family of authors fundamental skills If you need help with illustrations, we can may be easier than you realise. We’re not MMCTS tutorials cover procedures at recommend skilled medical illustrators to looking for one-of-a-kind cases or heavily all levels, from the most basic to the assist you.

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marketing initiatives. Sharing functions on our MMCTS website and within YouTube make it easy for your tutorial to be shared through social media.

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Rewarding MMCTS is 100% educational and free. Surgeons from all over the world and at all levels of experience rely on MMCTS. Your MMCTS tutorial may be both the easiest thing you ever publish and, as a René Prêtre Roberto Lorusso true service to your fellow surgeons, the most worthwhile.

Journal articles can be ephemeral, but MMCTS tutorials are promoted by Please visit https://mmcts.org/page/431 to learn educational programmes like MMCTS EACTS and also on YouTube more about becoming an MMCTS author. are designed to endure; we polish every All our tutorial videos are hosted on YouTube, submission to ensure that you, and we, both so our authors benefit from the platform’s look our best. unrivalled reach, as well as from EACTS’

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Association Why you should join the Adult Cardiac Database

Figure 1 Petr Němec

Petr Němec Centre of Cardiovascular and Transplantation Surgery (CKTCH) Brno, Czech Republic; Chairman of the Czech Society for Cardiovascular Surgery

t the VIIIth Congress of the Czech Society for Cardiovascular Surgery, Theo de By, project manager of the EACTS Quality Improvement AProgramme (QUIP), explained the many possibilities offered by the Adult Cardiac Database (ACD). The primary aim of the ACD is to achieve quality improvement by comparing the outcomes of a specific hospital within the ACD with the anonymous outcomes of all other hospitals in Figure 2 the database. To achieve a comparison that justifies the reality of the results, a risk-adjusted analysis can be conducted by means of the ACD benchmarking tool. The tool allows the user/ participant to: • Select and compare according to age, period, urgency, logistic EuroSCORE, outcome, etc. • Use filters for single or multiple interventions of, for example, coronary artery bypass grafts (CABGs) and valves, but also on-pump/off-pump statistics • Compare hospital outcomes for institutions with the same volume of procedures • Produce timelines by means of which one can monitor outcomes over time • Use control charts in which a rolling average indicates your performance through four simple markers: Figure 3 ‘outstanding’, ‘good’, ‘caution’ or ‘action’

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Local outcomes most frequent occurrence of European data based on benchmarked appears after ‘CABG, robust local and national data, In Brno, we initiated valves and other’ surgery. the ACD offers great potential our relationship with With this in mind, we can for quality improvement the EACTS ACD in concentrate on improving and benchmarking; EACTS, 2017. We sought the the software offered by the ACD outcomes in those and its ACD task force, are assistance of ÚZIS (Institute offers direct online statistics. With combined procedures. continuously striving for of Health Information and one click, filters can be activated Figure 3 provides insight into improvement. EACTS has Statistics of the Czech and ‘PowerPoint-ready’ bar our overall performance through released a new data dictionary Republic), which maintains the charts and survival curves can be the rolling average data. This and further developed the data high-quality national register produced. The EACTS service shows the average mortality validation policy, both of which of cardiovascular interventions now includes bespoke centre over several months or years. strengthen the reliability of the with data from all units in the reports that are sent to ACD Here, outliers are clearly present, data. International trends will Czech Republic. The connection participants on a regular basis. with a frequency that marginally now begin to emerge and will between the ÚZIS Register and In an initial comparison of our influences overall results. become more transparent. the ACD, with signed permission outcomes with the ACD (Figure 1), These charts outline just After our national congress, granted from our hospital, we saw quite favourable results for some of the insights provided colleagues from three additional enabled the transfer of data by our CKTCH centre (red bars), with for individual users by the Czech cardiothoracic surgery means of a secure link to the a lower than average re-operative ACD benchmarking tool. units all reached the same ACD. Therefore, thanks to the frequency for bleeding, as well Each of these charts reveals conclusion that it is absolutely cooperation with ÚZIS, our local as a mortality rate in the lowest strengths and weaknesses of worth joining the EACTS ACD, data are now found in the ACD, quartile of the ACD statistics. In cardiothoracic surgery on a local and have now pledged to 100% error-free. addition, the benchmarking tool level, compared to the more than do so. Although we are happy with offers the possibility to go a few 125,000 procedures that are the ÚZIS Registry, the large steps further, gaining even greater now available in the ACD. To find out more about the EACTS volume of data offered by the insight into the data. ACD and how to join, please ACD offers an attractive option Figure 2 demonstrates that, National and visit: https://www.eacts.org/quip/ to benchmark outcomes on with an overall normal result for international perspectives participation/ a European level. Moreover, post-operative bleeding, the With an expansive collection

Role of the Institute of Health Information and Statistics of the Czech Republic (ÚZIS) and the Czech National Register of Cardiac Surgery (NKCHR)

Svetlana Drábková register also contains necessary data for ÚZIS (Institute of Health Information and identification of the healthcare provider in Statistics of the Czech Republic), Czech which cardiac surgery was performed. Republic Range of data provided by health Our purpose establishments to the NKCHR he ÚZIS maintains a National Since the end of 2003, NKCHR has Register of Cardiovascular Surgery operated as a web application with a and Interventions (NKCHR). In 2017, central database. The commissioned it was decided that our institute NKCHR workplace inputs data to the wouldT cooperate with the EACTS to ensure register via a secure https protocol. Access 100% compatibility between local, national to the register and assignment of user and European data. roles is authorised by the administrator of In the Czech Republic, a national the register. register of cardiovascular surgery had been maintained since 1997. In 2002, The additional value of the NKCHR was established in order international cooperation to satisfy the needs of all participating ÚZIS supports the cooperation with the cardiac surgery facilities wishing to obtain Czech Society for Cardiovascular Surgery information on the numbers of heart and EACTS; we believe in seizing the surgery operations performed in individual opportunity to unlock data that are useful centres across the country and to facilitate for cardiothoracic surgeons to improve their more precise evaluation and quality outcomes. For ÚZIS, and most likely for analysis of the procedures, including data necessary for identification of the other national databases, our assistance mortality, length of hospitalisation and patient, data connected with the status enables the units to evaluate results on a stratification of the risk factors. of the patient in relation to the disease, local, national and European level, based on The register includes processed personal plus all perioperative information. The data of consistent quality.

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Association Women in cardiothoracic surgery

Marlies Keijzers Opening the door of opportunity Maastricht University Medical Center, the During last year’s EACTS Annual Meeting Netherlands in Milan, a great discussion took place on the role of women in cardiothoracic surgery ardiothoracic surgery has been by Drs Miia Lehtinen, Meghan Helder historically dominated by male and Shanda Blackmon1. These female physicians. During the early cardiothoracic surgeons addressed a years after EACTS was founded number of important issues and gave many Cin 1986, only a few female physicians tips, including the necessity of mentorship. were EACTS members. Fortunately, Most successful cardiothoracic surgeons during the past decade, the number of have had cardiothoracic mentors. Having female cardiothoracic surgeons is rising! a mentor early on in your career can help For example, in 2008, only 49 female in guiding through important steps on the cardiothoracic surgeons were listed as career ladder, and often opens ‘doors EACTS members. These numbers increased of opportunity’. This, of course, doesn’t rapidly to 353 female members in 2018. only account for female physicians. From At present, around 10% of EACTS a resident’s perspective, I advise other members are female physicians, and the residents to actively search for a mentor. field is also getting more popular among Look for a mentor that can help to answer young physicians. Out of the 376 EACTS questions on your personal development as 1. To watch a video of the discussion that took Resident Members, 100 (27%) are women. well, such as how to achieve good workplace, please visit: https://vimeo.com/296155298 One can only imagine how these figures life balance, and how to be successful as a or visit the EACTS Media Library (http:// will grow 10 years from now! surgeon and also have children. medialibrary.eacts.cyim.com/)

Teresa M Kieser, Jean J Prieur Albright, how hard might it be for the rest Foothills Medical Centre, Calgary, Canada of womankind? There is a fine line between speaking with lthough women represent roughly determination and using argumentative, half of the world’s population, accusatory tones. The truth of the matter it has taken a long time for is that the line is even finer for women than opportunities to emerge for women it is for men. Strong words are anticipated Ain many heretofore male-dominated fields. from men, but resented from women. Yet, as With this comes a major responsibility to Associate Justice Ginsburg also said: “You be an example to women, but also to the can disagree without being disagreeable.” men in the field; that is, not to correct their The most important attribute a woman way of thinking but to make men realise by can cultivate is self-conviction. In October women’s actions, words and thoughts that 2018, Canadian physicist Donna Strickland having women work shoulder-to-shoulder was the third woman ever to win the Nobel alongside them is a welcome thing. Prize in Physics. When asked her advice for Women who are pioneers in male- but it must be realised that these people Canada’s next generation of scientists, she dominated careers live in glass houses and may have been burned by less-than-stellar said: “If somebody else says something that are constantly watched by both women examples of women in their field. you don’t believe in, just think they’re wrong and men in and out of the field. We are Feminine attributes are suited to caring and you’re right and keep going. Because all products of our prejudices and our for the sick, as women are also blessed with that’s pretty much the way I always think.” upbringing, and nobody embraces change the role of bringing forth and nurturing new It was only after receipt of the Nobel Prize easily. Ruth Bader Ginsburg was successful life. Being the ‘gentler’ sex, women too often that she was made a full Professor. This is a in changing the male-dominated Supreme suffer in silence, yet not speaking out against classic example of the inequity that exists for Court of the United States by her philosophy: injustices can lead to misinterpretation. women, but it is only by taking a higher road “If you want to influence people, you want Having the courage to speak up has that women will succeed. them to accept your suggestions, you been counterintuitive to the upbringing of Having worked with men for more than don’t say, ‘You don’t know how to use the most women. thirty years, one thing is striking: men seldom English language,’ or ‘How could you make By not speaking up, women frequently complain – they mostly get on with their that argument?’ It will be welcomed much give men the upper hand, so it is imperative work. Linda Mickleborough was the first more if you have a gentle touch than if you to do so if male dominance is to cede to female cardiac surgeon in Canada, and her are aggressive.” equality between women and men. Change advice for women wanting to be a cardiac She firmly believed that: “It is not women’s is happening and cannot be thwarted. surgeon was: “Don’t complain, nobody likes liberation; it is women’s and men’s liberation.” Madeleine Albright, former United States a whiner.” We must always be conscious of Women in cardiothoracic surgery today Secretary of State said: “It took me quite others who are following us. are still in the minority. They must champion a long time to develop a voice, and now Change can and is happening, but with the cause not by criticism, but by leading that I have it, I am not going to be silent.” small, sometimes imperceptible steps, and by example. There will always be naysayers, If it was hard for someone like Madeleine Continued on page 8

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Association Women in cardiothoracic surgery

Continued from page 6 interchangeable with men while still descending spiral. this is how progress must be. Men are remaining different. Because of the minority The burden for successful women beginning to realise that working with women status of women at present, a good example in male-dominated careers weighs as collaboratively is better, and women are of a woman in a male-dominated field heavily on women as it does on men. The starting to believe in themselves. causes an ascending spiral of positivity, initiating resides with women, and positive Women must come to be seen as whereas a non-ideal example may cause a engagement is crucial.

Elena Sandoval cardiothoracic surgery. Hospital Clínic de Barcelona, Spain In my own personal experience, I would say that for most of the time at work there ina Starr Braunwald was one of is no disparity between us as cardiothoracic the first female cardiothoracic surgeons, regardless of gender. However, if surgeons. Born in 1928 in Brooklyn, we were to take a more critical look at our New York, USA, she completed interactions, we can identify those moments Nher degree at New York University (NYU) where we fall short of our ideal of equality. School of Medicine, followed by general Unfortunately, a double standard does surgery training at NYU’s Bellevue Hospital. exist. For example, men who are assertive She was a true pioneer, going on to lead the are seen as confident, while women who first implantation of a prosthetic heart valve are assertive are seen as overbearing. In (which she also designed) in 1960. addition, our personal appearance also Despite her success, Dr Braunwald serves as a double-edged sword; some use struggled to secure new opportunities as her it to their advantage to advance, despite Dr Elena Sandoval (left) with article career progressed, wrestling with the balance perhaps not being the most skilled clinician co-contributor Dr Maria Ascaso of family and professional life. Pressures and and, on the other hand, it sometimes attracts choices such as these are inevitably faced unwanted advances that are inappropriate amount of time invested, the acuity of the by women in cardiothoracic surgery, but in a professional setting. Furthermore, patients, the demands on your personal there are other factors at play that must be there are still the occasional chauvinists out life. However, there are several reasons why considered even in this modern age. there who view us with the subtle bigotry of many — including myself — have chosen to In recent years, sexual harassment in lowered expectations. become cardiothoracic surgeons. I believe the workplace has taken centre stage in This is not meant to be a warning against that by continuing to try to achieve a culture our collective mindset. There is perhaps no pursuing a career in cardiothoracic surgery. of equality and professionalism, we can better time to reflect on our own field and There are a great many other factors that enhance the appeal of our specialty to the examine our attitudes toward women in deter people from pursuing the field: the Nina Braunwalds of the future. The EACTS Training Management System (EACTS-TMS) András Durkó employ, appropriate tools for evaluations. Importantly, the Erasmus Medical Center, this purpose. system is fully confidential, and Rotterdam, the Netherlands To fulfil these needs, the local head of training will EACTS created the Training decide which functions of the or cardiothoracic Management System (TMS), TMS (procedure registering/ surgeons in training, the a standardised, online tool evaluation) they prefer to use. operating room remains for tracking and evaluating Like the training programmes the main area to develop residents’ progress, available found in other fields (e.g. Fand practice their surgical skills. free-of-charge for all aviation), portfolio systems are In addition, a modern surgeon EACTS members. invaluable tools in facilitating is not only expected to be The TMS can be easily tailored optimal training. Since its launch proficient in performing surgical to the needs of any training in 2018, the TMS is now in use procedures, but should also be programme: it facilitates easy in 12 countries, and we hope to an evidence-based clinician, registration of procedures (the grow it even further in the future. a professional care taker, an whole range of cardiac, vascular outstanding teacher and a good and thoracic procedures and Interested in joining, or have any team player. systematic and structured procedural parts are covered), questions? Contact portfolio@ In an era where pathologies are monitoring of the development and also has several feedback eacts.co.uk to arrange a virtual tour of the TMS, and please visit getting more complex, training of these skills are more important functions including a built-in the EACTS website: https://www. programmes are becoming than ever. However, many OSATS (Objective Structured eacts.org/educational-events/ shorter and patient safety is European training programmes Assessment of Technical Skills) training-management-system/ for subjected to closer scrutiny, do not have, nor systematically platform, and forms for periodical more information.

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Residents EACTS Residents at the German Society of Thoracic and Cardiovascular Surgery, Wiesbaden, February 2019 Alicja Zientara on behalf of the EACTS Residents Committee

n an effort to reach out to all European trainees, and inspire the next generation of cardiothoracic surgeons Ito engage in international collaboration and discussion about training systems, the EACTS Residents Committee has been busy visiting national society meetings throughout Europe. The first visit was in February at the German Congress of Thoracic and Cardiovascular Surgery which, in cooperation with the Society for Pediatric Cardiology, took place for the first time in Wiesbaden, Hessen. The junior organisation of the German Society, Junges Forum (Left to right). Can Gollmann-Tepeköylü (Innsbruck Medical University, Austria) Miia Lehtinen (University of (JF), organised a programme for Helsinki, Finland and Kymenlaakso Central Hospital, Kotka, Finland), Sven Helms (Herz- und Diabeteszentrum young surgeons and students, NRW, Bad Oeynhausen, Germany) and Alicja Zientara (Department of Cardiac Surgery, Triemli Hospital, starting with several training Zurich, Switzerland). opportunities on the first day, and followed by the official by trainees from Switzerland focused workshops, a newly The resident workshops and meeting of the JF and a critical and Russia, pointing out designed concept entitled the numerous awards supporting session about training systems several educational difficulties ‘Auf den Punkt gebracht’ young scientists and inventors in Europe. The JF belongs to that currently exist in their (‘Put in a nutshell’) – which created a perfect platform for one of the largest young national countries, including a paucity of was comparable to the Rapid career-orientated meetings and communities, with a registered training programmes. Fire sessions at the EACTS training improvement. Once membership base of over 200 One of the JF’s successes Annual Meeting – reached a again, the German congress young surgeons and students. in recent years has been the wide audience. Three-minute demonstrated that it is the ideal As Chair of the EACTS reduction of required operations presentations were followed by stage on which young surgeons Residents Committee and a to a consistent number of 100 an open-question round involving and students can stand to build trainee herself, Miia Lehtinen cases for the cardiosurgical the moderators, speakers and their formative experience in the from Finland was invited to specialty. Previously this ranged the audience. scientific community, presenting provide an overview about the from 100 to 200, depending on As is traditional since the and discussing their abstracts training system in her country, the German state in question. founding of the JF in 2012 in for the first time in front of a big as well as the international Three days of resident Freiburg, the social party took audience. For our Residents, cooperation that EACTS sessions and active participation place on Monday night in the this visit was a truly inspirational residents are engaged in across in the training village were Classical building Kurhaus and eye-opening way to learn Europe. Further impressive and featured. Apart from the Kollonaden, which continued about the training culture of our controversial talks were given traditional wetlabs and career- until the morning light. colleagues in Germany.

EBCTS Apply now for the Level 1 (MEBCTS) examination. Application deadline is 31 May 2019. Applications are also being accepted for the Level 2 (FEBCTS) examination to be held in December 2019. All regulations and requirements for both levels of examination can be found at www.ebcts.org

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Residents EACTS Residents Committee in Portugal: The Portuguese Cardiac Surgery Residents Club Rui J. Cerqueira President, CICC; the opportunity to discuss relevant topics very happy to have a representative from Member, EACTS Residents Committee with senior surgeons outside the formal the Association in attendance. András environment of the hospital. Durkó, of the EACTS Residents Committee, he Portuguese Cardiac Surgery Hands-on sessions were well received, was present to promote the activities of Residents Club (CICC) organised with young surgeons given the opportunity EACTS, with a special focus on the Training the ‘Informal Weekend 3’ with the to perform implantation of left ventricular Management System. support of the Portuguese Society assist devices in the wetlab, as well as echo- We look forward to having more ofT Cardiothoracic and Vascular Surgery guided percutaneous vascular access in a collaborations like this one, and we (SPCCTV). It was the third edition of this simulation course. Meanwhile, the winner of welcome all European residents and EACTS residents-focused meeting and was a great the clinical cases competition was awarded members to visit our website and join us for success. More than 40 attendees, almost with a complimentary pass for an EACTS future events. all of whom were Portuguese residents, Academy course. were gathered together in Penela, Portugal, The current CICC directive board is Head to the CICC (Clube Internos Cirurgia to attend various scientific sessions and working to bring Portuguese residents Cardíaca) website for more information: http:// career development roundtables, with closer to EACTS and, this year, we were www.clubeinternoscirurgiacardiaca.com

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Residents Challenging your knowledge with the MEBCTS exam Interviewee: Christoffer Stark educational programme for residents with Department of Cardiac Surgery, Heart and weekly meetings at our hospital which aims Lung Center, Helsinki University Hospital, to prepare residents for the MEBCTS Level Finland One examination.

he Membership of the European Did you feel that the exam tested Board of Cardiothoracic Surgery relevant aspects of your specialty? (MEBCTS) Level One examination The exam consisted of both common and tests an individual’s scope of rare clinical cases, and was very challenging. knowledge,T clinical judgement and ability to I think it was a good way to test knowledge apply the principles and practice of surgery to in a standardised fashion. You really had to the standard expected at the end of national stay focused and move on quickly because training in the generality of cardiothoracic of the time limit. I was exhausted after surgery. Those who complete the exam answering the final question. can be reassured that they are ready to commence as an independent specialist. What benefit do you expect to get from After completing his exam, Christoffer taking the exam? Stark spoke to EACTS News to share his After passing the MEBCTS examination I perspectives on the process. did not have to take the Finnish national exam to qualify for my specialist degree. Was it a long process to prepare It is also personally rewarding to pass this yourself for the examination? difficult exam and realise that you actually I’ve been involved in experimental and took a long time, but I wouldn’t say it was a know something! clinical cardiothoracic surgery since medical hard process. school. For me, the past 10 years have Do you have any other comments about been a continuous learning process with Did you need to take time off from the exam? the goal of obtaining my specialist degree, clinical work to prepare for it? I am very happy with the exam and would and I think it’s more about becoming a I attended the EACTS Fundamentals in recommend it to all my junior colleagues as good clinician than just preparing yourself Cardiac Surgery courses in Windsor. They an alternative to the national cardiothoracic for a single exam. The day before the were very helpful and covered most of surgery examination. examination, I enjoyed a nice dinner in Milan the syllabus. All other preparations were and had a good night’s sleep. Preparing done alongside clinical work. We have an More information can be found at ebcts.org.

Apply for the EACTS Residents Committee! Miia Lehtinen University of Helsinki, Finland and Kymenlaakso Central Hospital, Kotka, Finland

he Residents Committee is a voice inside EACTS speaking out to cardiothoracic surgical trainees across Europe. Our aim is to bring together residents from different countries, find ways to ensure equal training opportunities and identify potential issues in cardiothoracic surgeryT training in Europe. The Committee plans sessions for residents at each Annual Meeting, and has a representative in each of the EACTS Domains. The committee meets one to two times per year in Windsor, UK and at the Annual Meeting. Right now, the EACTS Residents Committee has three open positions starting in October 2019. If you are interested in joining, please send your application including a CV and a motivation letter before 1 May 2019 via the EACTS website. All applications will be scored according to a pre-defined transparent scoring system rating the contents of the motivation letter, scientific contributions of the applicant, level of education, acquired scientific funding, previous organisational activity, and international and national awards that may have been obtained. Successful applicants will hold the position is for three years. Join us!

For more information and how to apply, head to: https://www.eacts.org/resources/residents/

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The EACTS Academy

Introduction to Aortic Surgery 14–16 March 2019, Windsor, UK imed at residents in their last year of training and surgeons wishing to broaden their expertise in major aortic valve and aortic pathologies, Athis year’s highly interactive course covered the major aspects of aortic surgery, from the aortic valve to the descending aorta. Special attention was devoted to the various options for sparing the aortic valve and on modern approaches to aortic arch surgery. In addition to the keynote presentations and live-in-a-box surgical cases, there were ample opportunities for the attendees to participate in practical training during the programme, including a wetlab on annulus enlargement and a thoracic endovascular aortic aneurysm repair (TEVAR) simulation session.

Want to take part in the next course? Head to the EACTS user area to book your place.

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The EACTS Academy Minimally Invasive Techniques in Adult Cardiac Surgery (MITACS) 27–28 June 2019, Frankfurt, Germany

ocusing on the technical aspects of minimally invasive surgery, this year’s MITACS course will provide an insight into the latest techniques and procedures. The programme will appeal to cardiothoracic surgeons, cardiologists, cardiac anaesthesiologists, perfusionists, Fresidents and fellows interested in the field of minimally invasive surgery. Over two days, the course will emphasise the success of the teamwork approach via interactive lectures, live-in-a-box video presentations and live case transmissions directly from the University of Frankfurt Hospital, Germany. Four specific subject areas will be addressed: aortic valve, the aorta, coronary surgery and atrioventricular valves (mitral and tricuspid).

Head to https://www.eacts.org/educational-events/programme/mitacs_2019/ to see this year’s programme in full.

Make sure you don’t miss out: book your place now via the EACTS user area!

Course Directors: Thomas Walther (Frankfurt, Germany), Volkmar Falk (Berlin, Germany) and Peyman Sardari Nia (Maastricht, the Netherlands)

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The EACTS Academy Fundamentals in Cardiac Surgery

he EACTS Fundamentals offered in two wetlabs, one in Cardiac Surgery courses focusing on coronary surgery – are designed to cover including harvesting of the internal all of the basic aspects mammary artery (IMA), arterial ofT cardiac surgery that a trainee grafting and sequential grafting – would expect to be familiar with. and the other covering aortic valve Three courses are held over three replacement techniques. These separate weeks – February, June sessions are always extremely and October – at the EACTS popular with participants who Headquarters in Windsor, UK, and are able to benefit from practical are designed to be aligned with the training under the supervision of syllabus of the European Board of our international faculty. Cardiothoracic Surgery (https:// The dates for the remaining www.ebcts.org/syllabus/). 2019 courses are as follows: Ideally, it is preferable that our attendees complete all three Fundamentals II: 3–7 June courses in the same year as the Covering the essentials in aortic format may change slightly from surgery, congenital cardiac surgery year to year. There are places and the surgery of heart and available for approximately 40 lung failure, including mechanical delegates on each course: they circulatory support. have proved extremely popular and do fill up quickly, so book early! Fundamentals III: The first course of the series 21–25 October (Fundamentals I) took place in Mitral and tricuspid valves, Windsor from 4–8 February this arrhythmia, endocarditis, year and was a sell-out, with 43 hypertrophic obstructive participants from 17 countries cardiomyopathy, carcinoid and in attendance. The programme aortic root. covered all aspects of coronary artery surgery, aortic valve Both of the above courses will replacement and aortic root once again offer expert, hands-on surgery. Experienced lecturers wetlab training. from all over the world presented a systematic overview of topics, using To secure your place on these advanced teaching techniques. popular courses, register now via the On the second day of the EACTS website at www.eacts.org/ course, hands-on training was educationalevents/academy/

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The EACTS Academy The Thoracic Academy programme he EACTS Thoracic Academy and transplantation. A hands-on drylab on interest in VATS lobectomy. The Medizin im programme covers all of the bronchoscopy placement of double lumen Grünen training facility is a medical centre basic aspects of thoracic surgery tubes and bronchial blockers also featured. of excellence located in Wendisch Rietz, important for the aspiring trainee. Course two in September will cover just outside Berlin. Attendance will be SpanningT three parts, the programme the chest wall, mesothelioma, techniques limited to 12 participants, each of whom focuses on different facets of thoracic for metastasectomy and tumours of the will receive intensive training in different surgery. The Thoracic Domain ran the first mediastinum. In addition, there will be an patient simulations in an extremely modern course in the series, Thoracic Surgery: Part opportunity for practical training over two operative environment. The training will cover I, on 4–6 April at the EACTS Headquarters in wetlabs on chest wall reconstruction, and topics including: Windsor, UK. energy and lasers in surgery. • Use of VATS staplers and In previous years, all three Thoracic The Part III programme in Porto in energy systems Surgery courses have been held at the November will cover the topics of metastatic • VATS sleeve lobectomy EACTS Headquarters, but this year the small-cell lung cancer (mSCLC), emphysema • Complications management latter two will take place in other facilities in and tumours, thoracic trauma management, • Bronchoscopy double lumen intubation Europe. Thoracic Surgery: Part II will be held as well as a wetlab on carinal and superior • Bronco-mediastinoscopy 5–7 September in Berlin, Germany, while vena cava resection. Thoracic Surgery: Part III will take place in https://www.eacts.org/educational-events/ Porto, Portugal, from 28 to 30 November. Video-Assisted Thoracoscopic programme/vats-2019/ The first course of the series offered Surgery (VATS) Skills Course, great insight and up-to-date knowledge on Berlin, Germany, 16–17 May 2019 Spaces are limited for each of the above different aspects of thoracic surgery related This specialist two-day course is aimed at courses so do not delay – register via the EACTS to lung diseases with emphasis on lung thoracic surgeons training in a thoracic and/ website: http://www.eacts.org/educationalevents/ cancer, infectious diseases, lung resection or cardiac department who have a specific academy/

(Left to right) The Thoracic Academy programme Course Directors: Eric Roessner, Michael Dusmet and Peter B. Licht

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The EACTS Academy EACTS Aortic Valve Repair Summit 2019 The world’s largest meeting on aortic valve repair Laurent de Kerchove and Gebrine El Khoury On behalf of the AVRS Organising Committee

ear Colleagues, It is with great pleasure that we invite you to the fifth Dedition of the Aortic Valve Repair Summit (AVRS) to be held 20–21 June 2019 in Brussels, Belgium. Save this date in your diary – it Laurent de Kerchove Gebrine El Khoury is your chance to participate in the world’s largest meeting on repair has established itself to expect, this generates two questions remain unsolved and aortic valve repair ever. This year, such a degree in worldwide exciting days of intellectual debated. The AVRS is the forum the Summit returns to where it daily practice that more than challenges, fruitful debates and where all of these questions will was inaugurated four years ago 45 countries have participated sharing of best practice. The be placed front and centre of the thanks to a collaborative effort in each edition of the Summit. Summit’s roster of lectures, discussion. If you want to actively between two pioneers in aortic Conscious of this fact, and debates, abstract sessions, live participate in this exciting event, valve repair, Professor Gebrine in pursuit of its educational surgeries and ‘live-on-tapes’ don’t hesitate to prepare your El Khoury and Professor Hans- mission, last year, EACTS ensures there are plenty of best abstract and video. Joachim Schäfers. accepted not only to endorse learning opportunities available, Submissions are now open on After the first two editions the Summit, but also to integrate with a rich programme that not the EACTS website, and please in Brussels, a third AVRS was aortic valve repair into its only covers surgical treatment, note that authors of abstracts held in Ottawa (led by Dr Munir well-structured educational but also assessment modalities, submitted for presentation at Boodwani), Canada, followed programme. Indeed, this is a medical management and timing the Summit are not precluded by last year’s meeting in Paris, unique opportunity for surgeons for surgery. The Summit is, from also submitting at the 33rd France, which was organised who want to initiate such a therefore, an ideal opportunity EACTS Annual Meeting in Lisbon by EACTS and led by Dr programme themselves, or for adult and congenital in October 2019. Emmanuel Lansac. develop their skills. heart teams to digest the We are very much looking It was felt that due to the Enriched by the collaboration latest developments in these forward to meeting you at the positive and widespread of committed experts and exciting fields. next Aortic Valve Repair Summit response to the initial three EACTS, the AVRS has become Despite growing in Brussels! Summits, a larger meeting a scientific meeting where standardisation and the focused on aortic valve repair all schools of thought are availability of efficient techniques https://www.eacts.org/educational- was necessary. Aortic valve represented. As one would for aortic valve repair, many events/programme/2019avrsummit/

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Annual Meeting 33rd EACTS Annual Meeting lans are progressing well for this year’s Annual Meeting, which will take place 3–5 October in Lisbon, Portugal. PLisbon, one of the most charismatic and vibrant cities in Europe, effortlessly blends traditional heritage with striking modernism and progressive thinking. Once again we will return to the Lisbon Congress Centre, close to the river Tagus and the historical and cultural heritage site of Belem. The new three-day format of the Annual Meeting, introduced in Milan last year, was extremely popular with delegates, offering a mixture of general and special topic sessions, including the Techno-College. As such, we are delighted to repeat this format in 2019, showcasing a programme that will appeal to surgeons and allied healthcare Belem tower professionals at every level of expertise. n Heart transplantation in 2019 2019 also marks the 500th anniversary of n The developing and changing field n MMCTS video cases — challenging the death of Leonardo da Vinci, and EACTS of surgical and hybrid treatment of aortic cases will be celebrating the life and achievements atrial fibrillation n Cerebral protection in aortic arch treatment of the original Renaissance man throughout n Stroke in TAVI: Prediction, prevention n “Here we go again!” — Strategies in re-do this year’s Annual Meeting with keynote and treatment thoracic aortic surgery lectures and a special exhibition. n Physiology for the cardiac surgeon n EACTS-STS: Acute type A aortic Here is a taster of some of the sessions n Technical pearls in mitral valve repair: dissection: can we bring mortality down to planned throughout the week: artificial chordae adjustment single digits? n The team is the key n Innovations (EMB, localisation) Complementing our vibrant scientific n Help! Trainee in trouble n Oesophageal (resection + complications) programme, we will also be holding a n Visualising the heart – future aspects n Lung failure, ECMO, pulmonary hypertension large trade exhibition and a programme of n The difficult choice of prosthetic valve in n Advancements in thoracic oncology (how satellite symposia. the 21st century new oncology influences surgery) n Heart failure surgery at the cutting edge n TB and friends For more information, and to participate in all of n A further step ahead: minimally invasive n Thoracoabdominal aortic disease — these activities, please visit our website: https:// and hybrid CABG patient tailored approaches www.eacts.org/annual-meeting/.

Snapshots from Milan...

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Annual Meeting EACTS Nurses and Allied Health Professionals Day – 5 October 2019

Tara Bartley on behalf of the EACTS Allied Health Professionals Organising Committee

e are very much looking forward to this year’s EACTS Annual Meeting in Lisbon, Portugal. It is a unique opportunity for Wnurses and allied health professionals to come together to network and share how learning and innovation across European centres impacts patient care. We welcome abstracts from nurses, surgical care practitioners, physiotherapists, pharmacists, operating department practitioners, surgeon’s assistants and other allied health professionals. At last year’s Annual Meeting in Milan, the Nurses and Allied Health Professionals Day focused on the impact of enhanced recovery after surgery (ERAS) programmes on both patient experience and the flow of patients through the units. We also looked at clinical aspects such as the management of postoperative pain, wound management and mobilisation, and we focused on the Gathering at last year’s challenges faced by different roles, for Annual Meeting in Milan instance the surgical care practitioner. Moreover, the programme encompassed Professionals Day is the ideal opportunity cardiac and thoracic patient topics selected “This year, we would to present and also to learn about from the abstracts submitted. best practice. After the success of the Milan meeting, like to celebrate This year, we would like to celebrate plans are underway to deliver another excellence and team excellence and team working, with plenary stimulating Nurses and Allied Health sessions highlighting how to capitalise on Professionals Day on Saturday 5 October working, with plenary this notion, both in practice and in education. 2019 in Lisbon. To that end, we invite sessions highlighting We hope to run a wetlab, which will provide colleagues to submit abstracts of work they an opportunity for a close examination of would like to share. how to capitalise on anatomy, physiology and pathophysiology, This is an excellent opportunity to and workshops that take you through present to colleagues across Europe. Not this notion.” aspects of diagnostics. Our plenary sessions only do we enjoy celebrating achievements Tara Bartley will echo this approach to the delivery that showcase the outstanding of care. contribution that nurses and allied health professionals make to the multidisciplinary To submit your abstract, head to: https://www. team providing positive patient care, but climate, education and research are eacts.org/annual-meeting/education-meeting/ presenters can use these achievements paramount to healthcare professionals. alliedhealth/. Abstract submission closes 31 to develop their careers. In the current The EACTS Nurses and Allied Health July 2019.

News

Editor-in-Chief Editor Publishing and Copyright Peter Stevenson Rysia Burmicz Production Copyright © 2019: European Association for Cardio-Thoracic Surgery. All rights Design MediFore Limited reserved. No part of this publication may be reproduced, stored in a retrieval system, Peter Williams Tel: +44 (0) 208 771 8046 transmitted in any form or by any other means, electronic, mechanical, photocopying, [email protected] recording or otherwise without prior permission in writing from the EACTS or its associated parties. The content of EACTS News does not necessarily reflect the opinion of the EACTS, its Chairs, Scientific Advisors or Collaborators.

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