REFRESHER COURSES
Saturday, April 26, 2003

History of the SCA, 25 Years Young
Robert Marino, MD / George E. Burgess, III, MD

At the conclusion of this lecture the audience will be familiar with: 1) the founding principles of our society and how it has expanded on its evolution and growth over the years. The audience will be enlightened on key moments in the last quarter of a century in the field of CV anesthesia and the role the SCA played in them.

Historical Review of Cardiac Surgery
Andrew Wechsler, MD

To review watershed advances in the field of cardiac surgery during the last 50 years. Since the introduction of cardiopulmonary bypass to present the current and likely future role of cardiac surgery in management of cardiac disease.

Genomics in CV Disease
Debra Schwinn, MD

At the conclusion of this lecture the audience will be familiar with: 1) the concept of "functional genomics" and its application to human disease; 2) the potential benefits and limitations of gene association studies; and 3) current knowledge regarding the influence of genotype on atherosclerotic disease and incidence of adverse, cardiovascular outcomes.

Perioperative Arrhythmia Management
Jeffrey R. Balser, MD, PhD

Review physiologic basis for implementing specific types of perioperative arrhythmia management. Discuss evidence supporting effective pharmacologic response to superventricular tachyarrhythmia, and ventricular tachyarrhythmia during cardiac surgery.

Myocardial Protection from Beta Blockers to Volatile Agents
David C. Warltier, MD, PhD

To review the evidence supporting myocardial protection from various agents administered during anesthesia. To discuss the mechanism of pharmacologic preconditioning and its role (real or potential) in clinical cardiac anesthesia.

Inflammatory Response, Consequences and Modulation in Cardiac Surgery
Jerrold H. Levy, MD

To review the physiology and pathophysiology of the systemic inflammatory response during cardiac surgery (with or without CPB). To discuss the triggers and inhibitors of this cascade and provide evidence of outcomes when it is modified.

Sunday, April 27, 2003

Is Less More?: Critical Review of Advances & Outcomes in OPCAB

At the conclusion the participants will have a thorough understanding of the state of the art in the management of the OPCAB patient from both a surgical and anesthetic perspective. Based upon the most current outcome data comparing the OPCAB to traditional CABG, the participant will be able to determine which technique is most suitable for their patient population.

Surgical Advances: Refinement of Technique and Technology
Andrew Wechsler, MD

Goals of this lecture will include familiarizing the audience with the surgical challenges, contraindications, and evolving technological advances in the OPCAB technique. A current review of the surgical outcomes will also be presented.

Anesthetic Advances: Physiology and Management of the Displaced Heart
Davy Cheng, MD

At the conclusion of this session, the participant will have an understanding of the evaluation, therapeutic options and decision analysis involved in the management of patients undergoing OPCAB. Special emphasis will be placed on the precise physiological effects of myocardial displacement and the differential diagnosis and treatment of hemodynamic instability.

The Blood and Other End Organs
Jerrold H. Levy, MD

Goals of this lecture will include familiarizing the audience about the inflammatory state of patients undergoing OPCAB and how this contrasts with the inflammatory cascade associated with cardiopulmonary bypass. The postulated effect of different intensities of inflammation on coagulation and other end organs will be explored.

Where the Money Is—Or Could Be: Neurologic Outcomes in OPCAB v CABG
Mark Newman, MD

The goal of this lecture is to review the most current literature on neurological outcomes and to propose mechanisms of neurological injury in myocardial revascularization with and without the use of cardiopulmonary bypass.

Aortic Valve Disease: Evaluation, Therapeutic Options & Decision Analysis

At the conclusion of this session, the participant will have an understanding of the evaluation, therapeutic options and decision analysis involved in the management of patients with aortic valve disease. Relevant topics including the utility of perioperative echocardiography, the timing for surgical intervention and intraoperative surgical decision-making will be reviewed.

Echocardiographer's Perspective
Randolph Martin, MD

At the conclusion of this lecture the participant will have an understanding of the pathophysiology of aortic valve disease, the utility of echocardiography in the evaluation of aortic valve disease, and the timing for surgical intervention.

Surgeon's Perspective
David Adams, MD

At the conclusion of this lecture, the participant will have an understanding of the considerations for intraoperative surgical decision-making in patients with aortic valve disease. Relevant topics including the utility of intraoperative echocardiography, the management of co-existing coronary artery disease and asymptomatic aortic stenosis, mitral regurgitation in the presence of aortic stenosis, and the choice of aortic valve replacement versus repair will be discussed.

Pediatrics

The participants in this session will be familiar with current management of pediatric lung transplantation anesthesia and surgery. Additionally, participants will have a better understanding of new developments in cardiac MRI and its utility with respect to cardiac catheterization and anesthetic dilemmas in management of these cases.

Lung Transplantation
Sharma Anshuman, MD

At the conclusion of this lecture the participant will be able to: 1) understand the pathophysiology of lung transplantation; 2) be familiar with the anesthetic management of lung transplantation; and 3) recognize perioperative issues pertinent to the anesthetic and surgical management.

Cardiac MRI: Do we need Catheterizations?
Kirsten Odegard, MD

At the conclusion of this lecture the participant will be able to: 1) understand the utility of cardiac MRI as an alternative to catheterization; 2) recognize the anesthetic dilemmas and management of cardiac MRI in congenital heart disease; and 3) be familiar with future advances in cardiac MRI.

Sympatholysis: The Role of B-blockade and Spinal Anesthesia in Preventing Cardiac Death

At the conclusion of this session the participant will gain insight to: 1) the mechanisms by which altered sympathetic responses lead to cardiac injury in the perioperative patient and 2) emerging clinical strategies using pharmacological and regional anesthesia based therapies for myocardial protection.

Beyond Fight or Flight:  Emerging Roles of the Sympathetic Nervous System
Dan Berkowitz, MD

At the conclusion of this lecture the participant will understand the clinical implications of novel concepts of the functioning and modulation of the sympathetic nervous system.

Use of B-Blockade to Prevent Cardiac Death: New Perspectives in the Patient with Impaired Ventricular Function
Stephen Gottlieb, MD

At the conclusion of this lecture the participant will be able to discuss the rationale and outcome data of new clinical treatment strategies using B-Blockade in cardiology practice.

Controversies in Perioperative B-Blockade
Martin London, MD

At the conclusion of the lecture the participant will understand the evidence supporting perioperative B-Blockade, the revised clinical practice guidelines of the American College of Cardiology, and concerns regarding B-blocker use in anesthetic practice.

Spinal and Epidural Anesthesia/Analgesia for Cardiac Surgery
Eric Jacobsohn, MD

At the conclusion of this lecture the participant will better understand the benefits offered by regional anesthesia on cardiac morbidity and mortality in patients undergoing cardiac surgery.

Cardiovascular Risk Assessment from Provocative Testing to Genomics

At the conclusion of this session the audience will be able to describe novel mechanisms by which individual patient variability in perioperative outcome might occur.

Novel Perioperative Targets to Improve Patient Outcome
Elliott Bennett-Guerrero, MD

At the conclusion of this lecture the audience will be acquainted with new clinical interventions that might improve patient outcome after cardiac surgery.

Genetic Markers of Inflammation
C. David Collard, MD

At the conclusion of this lecture the audience will be familiar with: 1) the concept of "functional genomics" and its application to human disease; 2) putative genes and gene products predictive of adverse cardiovascular events; and 3) current knowledge regarding the influence of allotypic variation on perioperative inflammation and incidence of adverse, perioperative outcomes.

Coagulation Variants in Cardiac Surgery
Brian Donahue, MD, PhD

At the conclusion of this lecture the audience will be able to describe how bleeding after cardiac surgery might be influenced by genetic predisposition.

Predicting the Future: Does Surgical Stress Unmask Future Neurocognitive Dysfunction?-
Charles W. Hogue, Jr., MD

At the conclusion of this lecture the participant will be familiar with patient related risks for neurocognitive dysfunction after cardiac surgery including genetic variants predisposing to this common complication.

Session C: Research

At the conclusion of this session, the attendee will: 1) better understand the current state of cardiovascular anesthesia research and opportunities for grant funding; 2) know more about recent advances in cardiovascular anesthesia research funded by the Society of Cardiovascular Anesthesiologists.

Ethics: When Should We Say No?
Panelists: Paul Barash, MD / Carl Hug, Jr., MD, PhD / Edward Lowenstein, MD

This panel consists of three senior and very experienced anesthesiologists who will present a case that poses an ethical challenge. The fundamental issue to be addressed is the role of the anesthesiologist in determining surgical futility and our right to say "No" to our surgical and medical colleagues.

Monday, April 28, 2003

Monograph Session: Progress in Thoracic Anesthesia

The aim of this monograph session is to update Cardiovascular/Thoracic anesthesiologists on the recent progress in anesthetic management for Thoracic surgery and to define the future challenges which will need to be met in this area.

Advances in Lung Isolation for Chest Surgery
Jerome Klafta, MD

At the conclusion of this session, participants will be able to: 1) describe clinical implications of recent design modifications of double lumen tubes and bronchial blockers; and 2) discuss the appropriate selection of lung separation techniques for patients undergoing various types of thoracic surgery.

Management of One-lung Anesthesia
Katherine Grichnik, MD

At the conclusion of this session, the participant will: 1) understand current concepts of ventilation and perfusion in the lateral position; 2) will have an updated understanding of hypoxic pulmonary vasoconstriction; 3) will understand intraoperative hypoxemia including who is at risk, when and how to treat this condition; and 4) will become familiar with the role of different types of ventilation during one lung anesthesia

Anesthesia for New Thoracic Endoscopic Procedures
Erin Sullivan, MD

An increasingly large portion of major thoracic surgery can now be performed with minimally invasive surgical techniques. This session will discuss the anesthetic implications of these procedures and introduce the spectrum of chest surgery which can now be done with these techniques.

The Future of Lung Transplantation
Shaf Keshavjee, MD

The major stimulus for progress in Thoracic Anesthesia in the past decade has come from the need to provide safe anesthesia for lung transplantation. This session will introduce the audience to the current and future frontiers of lung transplantation including techniques of improving donor lungs, non heart-beating donors and living-related transplants.

New Drugs in Cardiovascular Medicine: Are they Relevant to your Practice?

At the conclusion of this session the audience will have learned the pharmacology and clinical role of new drugs which may improve clinical outcomes.

Natriuretic Peptide in Congestive Heart Failure
Allen Anderson, MD

At the conclusion of this lecture the audience will: 1) understand the physiologic role of natriuretic peptides (NP) and the new uses of NP assays in the diagnosis and management of heart failure; and 2) understand the new therapeutic role of NP in therapy for acute heart failure, as well as learn novel potential uses of nesiritide post-cardiac surgery, and pre & post heart transplantation.

The Role of Vasopressin in Vasodilation Shock
Donald Landry, MD

At the conclusion of this lecture the audience will: 1) understand that vasopressin deficiency is a hallmark of vasodilatory shock; and 2) understand that vasopressin replacement restores blood pressure in vasodilatory shock by inhibiting vasodilatory mechanisms.

The Role of Sodium Proton Exchange Inhibitors
Nanette Schwann, MD

At the conclusion of this lecture the audience will: 1) understand the potential of sodium/proton exchanger inhibitors to decrease myocardial ischemia and improve outcome in patients undergoing CABG.

Use of Dexemetomidine in the Post-Open Heart Patient
James Ramsay, MD

At the conclusion of this lecture the audience will: 1) learn the history and pharmacology of alpha 2 agonists in the perioperative setting; and 2) learn the characteristics of sedation produced by intravenous alpha 2 agonists and the associated hemodynamic effects.

Jointly Presented by the ASCCA and SCA The CNS as a Target Organ

At the conclusion of this session, the participant will have gained vast understanding of several perioperative neurologic conditions that present in the intensive care unit to include critical illness neuropathy/myopathy (Stefan Mayer), delirium in the ICU (Wes Ely), and novel approaches to management of postoperative stroke (John Murkin). Each speaker will provide novel concepts in his respective topic to be followed by a fruitful discussion involving the audience.

Anesthesia & Analgesia Literature Review: A Critical Look
Speakers: Charles Hogue, MD / Lee Fleisher, MD / Bruce Spiess, MD

The objective of this session will be to critically evaluate selected, recent peer-reviewed publications and identify important strengths and weaknesses that influence the validity and potential impact of the literature on the practice of cardiovascular anesthesiology. A panel of recognized experts will explore issues of study design, methodology, data analysis and interpretation.

Incorporating Task Force Guidelines Into Practice

The objectives of this session are to discuss new guidelines and recommendations relevant to the perioperative care of patients with cardiovascular disease.

TEE Training Guidelines
Michael Cahalan, MD

At the conclusion of this lecture the participant will have an understanding of the guidelines from the American Society of Echocardiography/Society of Cardiovascular Anesthesia for training in perioperative echocardiography.

Preoperative Assessment of the Cardiac Patient Undergoing Non-Cardiac Surgery
Lee Fleisher, MD

The purpose of this lecture is to familiarize the participants with updated recommendations from the American Heart Association/American College of Cardiology/Society of Cardiovascular Anesthesia Task Force for the preoperative assessment of patients undergoing non-cardiac surgery.

Atrial Fibrillation Guidelines
Charles Hogue, MD

Participants of this lecture will be familiar with new guidelines from the American College of Chest Physicians for the management of atrial fibrillation after cardiac surgery.

Tuesday, April 29, 2003

The Cardiovascular Anesthesiologist's Role in the Cath Lab and Beyond New Developments in the Percutaneous Management of Peripheral Vascular Disease and Ischemic Heart Disease
- Patrick Whitlow, MD

Mechanical and Metabolic Mechanisms of Heart Failure: Basis for Therapeutic Intervention

As the population ages and the incidence of heart failure rises, anesthesiologists must acquire skills for intraoperative management of patients with symptomatic heart failure. This session will review the metabolic and structural mechanisms of heart failure with an emphasis on practical applications to perioperative care. In addition, biventricular pacing, an exciting and effective therapy for congestive heart failure will be reviewed as it relates to the anesthesiologist's practice.

Metabolic Mechanisms of Heart Failure
Allen Anderson, MD

At the conclusion of this lecture, the audience will: 1) be able to define the metabolic components contributing to acute and chronic heart failure; 2) understand the concepts of perioperative interventions to reduce the incidence and severity of the metabolic causes of heart failure; and 3) be aware of new therapies in treating patients with chronic congestive heart failure.

Mechanical Mechanisms of Heart Failure
Gerald Buckberg, MD

At the conclusion of this lecture, the audience will: 1) be able to define the structural component of LV size and shape that causes heart failure; 2) be able to show how surgical restoration changes geometry to restore function; 3) understand the septal component of right heart failure, related to operative septal stunning; 4) be able to define how surgical stunning interferes with excitation and contraction to reduce systolic and diastolic function, and how it can be offset pharmacologically, by protection, and by ventricular restoration.

Cardiac Resynchronization Therapy for Congestive Heart Failure
Angel Leon, MD

At the conclusion of this lecture, the audience will: 1) understand the concept of cardiac asynchrony and its clinical consequences; 2) have reviewed the theory behind cardiac pacing for congestive heart failure; 3) have an overview of clinical results of Biventricular Pacing Clinical Trials; 4) understand the relevance of biventricular pacing to the Cardiac Anesthesiologist; and 5) understand the indications and clinical use of biventricular pacing for left ventricular dysfunction.

Special Considerations for the Geriatric Patient having Cardiothoracic or Vascular Surgery

At the conclusion of this panel, the participant will understand the basic physiology of aging and how these changes impact anesthetic care and perioperative outcome.

Cardiopulmonary Aging and Anesthetic Implications
G. Alec Rooke, MD, PhD

At the conclusion of this lecture, the participant will have an understanding of how aging affects the cardiovascular and respiratory systems, and how these changes impact perioperative risk and anesthetic management.

Cardiac Surgery in the Very Old
David Cook, MD

At the conclusion of this lecture, the participant will have an understanding of how aging affects the type and incidence of complications from cardiac surgery, and the role of anesthetic management in the prevention of those complications.

Age and its Effects on Pulmonary Functional Status after Thoracic Surgery
Peter Slinger, MD, FRCPC

At the conclusion of this lecture, the participant will have an understanding of how aging affects the type and incidence of complications from thoracic surgery, and the role of anesthetic management in the prevention of those complications.

Alternative Surgical Techniques for Elderly Patients having Vascular Surgery
Ronald A. Kahn, MD

At the conclusion of this lecture, the participant will have an understanding of how aging affects the type and incidence of complications from vascular surgery, and the role of anesthetic management in the prevention of those complications.

Coagulation Controversies in Cardiovascular Anesthesia

At the conclusion of the panel, the participant will: 1) understand the complex interactions between coagulation, platelet function, and hemostasis; and 2) be able to discuss methods of treatment for common hemostasis abnormalities.

New and Old Monitors of Platelet Function: Which to Use in Your Practice
Thomas Slaughter, MD

At the conclusion of the session, the participant will: 1) understand the various mechanisms of platelet dysfunction; 2) learn the practical monitors available to monitor platelet function in cardiac disease; and 3) learn how to implement platelet function testing into their practice.

Genetic Predispositions to Platelet Hyperactivity: A Risk for Atherosclerosis
Nauder Faraday, MD

At the conclusion of the session, the participant will: 1) understand the pathophysiology of platelet thrombosis disorders; 2) appreciate the relationship of genetics to platelet reactivity; and 3) understand atherosclerosis as it relates to platelet activity.

Rescue Therapeutic Agents in Hemorrhage after Cardiac Surgery
Glenn P. Gravlee, MD

At the conclusion of the session, the participant will: 1) learn the common reasons for bleeding after cardiac surgery; 2) understand the common modalities used to treat excessive bleeding; and 3) learn of some new therapies used practically and experimentally to treat bleeding.

Heparin Resistance in Pre-heparinized Patients: Therapy and Outcome Implications
Jerrold H. Levy, MD

At the conclusion of the session, the participant will: 1) understand the mechanisms responsible for heparin resistance; 2) learn how to diagnose heparin resistance in cardiac surgery; and 3) learn treatment options for patients demonstrating heparin resistance.

Can We Make a Difference?: Applying Evidence-based Medicine Into Clinical Practice

At the conclusion of this plenary session the participants will a better understanding of the significant role that evidence-based medicine has in clinical anaesthesiology practice. Three important clinical areas will be discussed utilizing the information available in the medical literature to evaluate the impact therapeutic regimens have on outcome.

Neuraxial Blocks in Thoracic Surgery
Mark Chaney, MD

The rationale for and evidence opposing the use of neuraxial blockade in thoracic surgery will be presented in an interactive maner that stimulates audience discussion and participation.

Beta-Blockers for Cardioprotection in Non-cardiac Surgery
Lee Fleisher, MD

At the conclusion of this lecture the participant will have an indepth knowledge of the evidence for and against the use of betablockers for cardioprotection during the perioperative course.

Neurocognitive Protection Strategies in Cardiac Surgery
Mark Newman, MD

This lecture will focus the participant on the neurocognitive strategies published to date, their effects or lack there of on outcome and possible therapies for the future.

Workshops
Saturday, April 26, 2003

Echo Imaging and Anatomic Correlates

At the conclusion of this workshop the participant will have a good knowledge of normal anatomy and the practical aspects of completing a basic TEE exam. The participant will also gain some understanding of how common congenital variants arise from embryological changes and how to recognize these variants in clinical practice. In addition the participant will also learn how to recognize common artifacts and machine problems seen in routine TEE practice. This workshop is designed for the beginner to intermediate echocardiographer.

Normal Exam and Anatomy
Jack Shanewise, MD

At the conclusion of this lecture the participant will: 1) acquire the knowledge to perform a basic TEE examination; 2) learn the standard imaging views as determined by the SCA/ASE Guidelines; and 3) have an understanding of the cardiac anatomy seen in the standard imaging views.

Embryology and Variants
Katherine Grichnik, MD

At the conclusion of this lecture the participant will: 1) understand how aberrations of embryological development can lead to normal anatomic variants; 2) learn the common anatomic variants; and 3) learn to distinguish normal variants from abnormal pathology.

Common Congenital Defects
Patricia Murphy, MD

The goal of this lecture is to provide the participant with a thorough review of the common congenital defects encountered in clinical practice. In addition to images depicting these defects, the lecture will also focus on the practical aspects of obtaining the relevant TEE views to demonstrate these abnormalities.

Artifacts and Common Machine Problems
Andre Stephane Lambert, MD

The goal of this lecture is to provide the participant with a demonstration of the common artifacts seen in routine TEE practice, how these artifacts are created and how to distinguish reality from artifact in clinical practice. The lecture will also discuss the common machine problems seen in clinical TEE practice and how to troubleshoot these common problems.

Incorporating New Echo Technologies into Practice

Upon completing this workshop, participants will have been exposed to a variety of new echocardiography devices and understand their usefulness and applications. Specifically, participants will: 1) recognize the value of transthoracic echocardiography in the perioperative period; 2) be able to obtain basic transthoracic images using portable, hand-held echocardiography devices; 3) be familiar with substernal epicardial echocardiography imaging via the SEE IT mediastinal drain; 4) understand the application of Tissue Doppler Imaging in transesophageal echo; 5) appreciate the usefulness as well as the limitations in using TDI to assess systolic and diastolic myocardial function; 6) learn how to obtain and interpret epiaortic images during cardiac surgery and use this tool to direct cross clamp placement; 7) gain knowledge of myocardial contrast echocardiography and understand its usefulness in evaluating myocardial perfusion; 8) be exposed to intraoperative echocardiographic imaging of coronary arteries and graft anastomosis via epicardial echocardiography.

Anesthesia for Vascular and Thoracic Aortic Surgery

At the conclusion of this workshop the audience will have a better understanding of 1) anesthetic considerations in major vascular surgery, including endovascular surgery, and the possible role of anesthesia in relation to outcome; and 2) strategies for protection of major end-organs during major vascular surgery spinal cord, myocardium, kidneys, intestines.

Anesthesia for Endovascular Repair of AAA and DTAA
David Moskowitz, MD

At the conclusion of this lecture the participant will understand: 1) current technology, indications, and patient selection for endovascular surgery; and 2) anesthetic considerations (monitoring, anesthetic technique, access), complications and outcome of endovascular surgery for thoracic and abdominal aortic aneurysms

Protection of Abdominal Organs during Vascular Surgery
Christopher O'Connor, MD

At the conclusion of this lecture, the participants will: 1) learn the pathophysiology of renal injury that sometimes occurs during aortic surgery; and 2) some therapeutic interventions that potentially decrease the rate of this complication. Some discussion will address the pathophysiology and therapy of ischemia-reperfusion injury in general, and in the gut in particular.

Regional v General Anesthesia for Myocardial and Graft Protection in Peripheral Vascular Surgery
K.W. Tim Park, MD

At the conclusion of this lecture the participant will understand: 1) the purported mechanisms of the benefits of regional anesthesia over general anesthesia for myocardial and graft protection; and 2) the clinical data on GA vs. RA for myocardial and graft protection.

Perioperative Management of Diabetes in Major Vascular Surgery
Pieter van der Starre, MD, PhD

At the conclusion of this lecture the participant will understand: 1) the major complications in diabetics undergoing vascular surgery; and 2) anesthetic strategies including the benefits of "tight" perioperative control of serum glucose.

Controversies Regarding CSF Drainage for Spinal Cord Protection during DTA Surgery
Ramiro Arellano, MD

At the conclusion of this lecture the participant will understand: 1) the purported mechanisms of the benefits of CSF drainage; and 2) the literature on the actual benefits of CSF drainage.

Practical Use of TEE in Cardiac Surgery

At the conclusion of the workshop, the participant: 1) will understand the use of intraoperative transesophageal echocardiography to evaluate cardiac performance, both systolic and diastolic, and valvular lesions using 2-dimensional and Doppler echocardiographic techniques; and 2) will have enhanced skills for diagnosing and assessing myocardial performance and structures.

Evaluation of Left and Right Ventricular Systolic Function
John Augoustides, MD

The participant will gain an enhanced understanding of the utility and limitations of using intraoperative TEE for assessment of ventricular systolic function.

Evaluation of Diastolic Function
Christopher McQuitty, MD

The participant will gain understanding of the use and limitations of echocardiography for assessment of diastolic function.

Doppler Evaluation and Hemodynamic Calculation
Andrew Maslow, MD

Participants in this program will gain a better understanding of the use of Doppler echocardiography for quantitative analysis of myocardial function, including calculation of pressure gradients, volume flow, and shunt flow.

Evaluation of the Aortic Valve and Ascending Aorta
Kathryn Glas, MD

The participant will learn basic evaluation of the aortic valve and ascending aorta using 2-D and Doppler echocardiography as well as assessment of common pathophysiological conditions.

Evaluation of the Mitral and Tricuspid Valves
Kristine Hirsch, MD

Participants will learn evaluation of the mitral and tricuspid valves using 2-D and Doppler echocardiography including assessment of common pathophysiological conditions.

Use of TEE in Common Clinical Conundrums
Albert Perrino, MD

Participants will view case presentations demonstrating common clinical scenarios using echocardiography for clinical analysis and decision making. Faculty panelists will comment on the cases.

Advanced Decision making in Valvular Heart Disease

At the conclusion of the workshop, the participant will: 1) have a practical understanding of mitral regurgitation and its treatment; 2) will be able to communicate anatomic abnormalities to the surgeon; and 3) will be able to evaluate post-repair valvular competence.

Classification and Assessment of Mitral Valve Regurgitation
David Adams, MD

At the conclusion of the session, the participant will: 1) learn the classification of mitral regurgitation; 2) distinguish between ischemic mitral regurgitation and other anatomic abnormalities; 3) understand the restoration of mitral valve function; and 4) be able to discuss treatment options, both surgical and medical for mitral regurgitation.

Evaluation of the Aortic Valve and Aortic Root: Stentless Valves and Native Valve Repair
Christopher Troianos, MD

At the conclusion of the session, the participant will: 1) learn TEE evaluation techniques of the aortic valve with and without aortic root disease; and 2) be able to discuss different treatment options for the aortic valve based upon TEE findings.

Hypertrophic Obstructive Cardiomyopathy: Myectomy with and without Mitral Valve Repair
Jack Shanewise, MD

At the conclusion of the session, the participant will: 1) be able to identify TEE characteristics of asymmetric septal hypertrophy; 2) be able to evaluate septal thickness and tissue resectability before repair; and 3) be able to evaluate the interventricular septum and mitral valve after septal resection.

Prosthetic Valve Insertions: What is an Acceptable Result?

Randolph Martin, MD

At the conclusion of the session, the participant will: 1) learn the different prosthetic valves available for clinical use; 2) understand common acceptable surgical results and residual gradients; and 3) learn possible pitfalls in evaluating prosthetic valve insertions.

Case Presentations and TEE Analysis: A Variety of Complex Valvular Lesions and Surgical Results
Steven Konstadt, MD plus faculty

At the conclusion of the session, the participant will: 1) have a keen understanding of the complex TEE analysis of mitral valve abnormalities; and 2) be able to discuss the TEE findings and possible surgical options for patients with complex valvular disease.

Pediatric/Congenital Heart Disease Workshop

The workshop participants will be presented with interactive didactic lectures and discussions on a broad range of topics in pediatric cardiac anesthesia and surgery from experts in the field. A historical perspective leading to recent advances, current therapy, as well as challenging case management dilemmas will be offered.

History of Pediatric Cardiac Anesthesia
Dolly Hansen, MD

At the conclusion of this lecture the participant will be able to: 1) understand the genesis of pediatric cardiac anesthesia and surgery; 2) recognize the stages of development of pediatric cardiac anesthesia; and 3) anticipate future directions of pediatric cardiac anesthesia.

Coagulation Dilemmas
Bruce Miller, MD

At the conclusion of this lecture the participant will be able to: 1) understand the effects of cardiopulmonary bypass on blood components; 2) understand the pathophysiology of coagulation defects in children following cardiac surgery; and 3) consider alternatives in the diagnosis and treatment of coagulopathy.

Minimally Invasive Congenital Heart Surgery
Redmond Burke, MD

At the conclusion of this lecture the participant will be able to: 1) be familiar with recent advances in minimally invasive pediatric cardiac surgery; and 2) recognize alternative surgical approaches to congenital heart disease.

Mechanical Circulatory Support: When to Initiate
Helen Holtby, MB

At the conclusion of this lecture the participant will be able to: 1) understand the pathophysiology of heart failure; 2) recognize the indications for initiation of mechanical circulatory support; and 3) understand the differences in various types of mechanical circulatory support.

Cardiac Cath Lab Cases and Hemodynamics
Doreen Soliman, MD

At the conclusion of this lecture the participant will be able to: 1) be familiar with science of cardiac catheterization hemodynamics; 2) recognize the significance of hemodynamic analysis in congenital heart disease; and 3) interpret the results cardiac catheterization in complex congenital heart disease.

Saturday, April 26, 2003

Transplantation: What's New, What's Old, What's Controversial

At the conclusion of this session the audience will be familiar with: 1) selection criteria for heart and lung transplantation; 2) perioperative issues related to heart and lung transplantation in adult and pediatric population; 3) the role of TEE in heart and lung transplantation; and 4) outcomes of heart and lung transplantation.

Mechanical Assist Devices

At the conclusion of this session the audience will be familiar with: 1) ventricular assist device (VAD) classifications, indications and contraindications; 2) perioperative VAD management; 3) the role of transesophageal echocardiography (TEE) in VAD management; and 4) anesthetic issues related to insertion of the total artifical heart (TAH) and 5) VAD outcomes.

Wednesday, April 30, 2003

Intaoperative TEE Diagnostic Dilemmas: You Make the Call!

At the end of this workshop, the participant will appreciate the impact of TEE on intraoperative decision-making. A case discussion format with audience participation will be utilized. The individual cases are summarized in the syllabus for pre-workshop review.

TEE in Valvular Heart Disease: A Review

Upon completion of this session, participants should be able to identify and evaluate pathologic, stenotic and regurgitant valvular abnormalities and quantify the severity of the valve disease. Participants should also be able to identify mitral and aortic valvular abnormalities that are amenable to repair versus replacement and complications associated with valve repair and replacement.

Mitral Stenosis Evaluation
Luis Michelsen, MD

Upon completion of the lecture, participants should be able to identify and evaluate pathologic, stenotic abnormalities of the mitral valve and quantify the severity of the stenosis.

Mitral Regurgitation Evaluation
Mark Chaney, MD

Upon completion of the lecture, participants should be able to identify and evaluate pathologic, regurgitant abnormalities of the mitral valve and quantify the severity of the regurgitation.

Mitral Valve Repair
Robert Savage, MD

Upon completion of the lecture, participants should be able to identify abnormalities of the mitral valve that are amenable to repair, evaluate the success or inadequacy of the repair, identify complications associated with repair, and communicate findings to other physicians.

Aortic Regurgitation Evaluation
Christopher Troianos, MD

Upon completion of the lecture, participants should be able to identify and evaluate pathologic, regurgitant abnormalities of the aortic valve and quantify the severity of the regurgitation.

Aortic Stenosis Evaluation
Scott Strechenbach, MD

Upon completion of the lecture, participants should be able to identify and evaluate pathologic, stenotic abnormalities of the aortic valve and quantify the severity of the stenosis.

Tricuspid & Pulmonic Valve Disease
Jonathan Mark, MD

Upon completion of the lecture, participants should be able to identify and evaluate pathologic, stenotic and regurgitant abnormalities of the tricuspid and pulmonic valves and quantify the severity of the stenosis and regurgitation.

Prosthetic Valve Assessment
Michael Licina, MD

Upon completion of the lecture, participants should be able to identify and evaluate normal and dysfunctional prosthetic valves and recognize pitfalls in evaluation with echocardiography.

Problem-based Learning Discussions

1 Myocardial Ischemia and Infarction: Should all Cardiac Cases Receive Beta Blockers (Schwinn/Booth)

The participants will understand the risks and benefits of the potential cardioprotection effects of perioperative beta blockade. The down-regulation of beta receptors and the impact on cardiac surgical patients will also be discussed.

2 Ischemic Mitral Regurgitation from Diagnosis to Treatment (Bailey/Hirsch)

The participants will understand the therapeutic dilemma when faced with mitral regurgitation in the coronary artery bypass patient. An appreciation of when to leave the mitral valve alone or to repair/replace it will be discussed. The use of hemodynamic provocation for evaluating MR after anesthetizing the patient will be reviewed.

3 Perioperative Decisions in Clinical/Surgical Management of Heart Failure (Shernan/Cooper)

The participants will develop an appreciation for which patients might benefit from surgery for refractory heart failure. The surgical and medical treatment options will be discussed.

4 Lung Isolation: Endotracheal Tubes (Glas/Gozal)

The participants will understand the various types of endotracheal tubes/devises available to provide single lung ventilation, the potential complications and preventative/corrective measures of providing one lung ventilation, and when one-lung ventilation is desirable and/or necessary.

5 New Methods of Mechanical Ventilation (Fontes/Vender)

The participants will understand reasons for "unconventional" ventilation modalities and specifically when to utilize the prone position.

6 Monitoring: CABG Surgery with Noninvasive Cardiac Output Monitoring (Ramsay/Botero)

The participants will become familiar with the options currently available for the non-invasively monitoring of cardiac output and the limitations/advantages of the various monitors.

7 Cardioprotection during OPCAB (Duke/Collard)

The objectives of this session are to familiarize the participants with the OPCAB techniques focusing particularly on the ability to protect the myocardium. Areas to be addressed include the role of IABP and/or inotropic support during OPCAB, the impact of inhalational anesthetics and myocardial protection and/or ischemic preconditioning and which grafts first.

8 Coagulation Monitoring: Update 2003 (Ralley/Tanaka)

The participant will understand why coagulopathy is an issue in cardiac surgery and how Point of Care devises can be utilized to help differentiate causes of bleeding.

9 Congenital Heart Disease: An Interactive Case Discussion (Daves/Miller)

A case discussion format will be utilized to discuss the initial approach to the child with CHD. What history/physical exam/studies does the anesthesiologist need? What consultations should be obtained? When should considerations be made to transfer to another facility?

10 OPCAB Surgery, Nuts and Bolts (Shanewise/Brown)

Participants will learn about the management of patients undergoing OPCAB surgery. The pitfalls and possible complications will be discussed and ways to avoid these events described. Participants will also learn how to optimize their patients during OPCAB procedures to minimize conversion to "on pump".

11 Management of the Cardiac Surgery Patient on Multiple Antiplatelet Inhibitory Drugs (Shore-Lesserson/ Slaughter)

Participants will learn about the pharmacology of and indications for the use of antiplatelet drugs in cardiology and how this might impact patient management if the patient requires emergency CABG surgery. They will also learn management strategies to try and reduce perioperative bleeding and blood loss in these patients.

12 Use of TEE in OPCAB surgery (London/Schroeder)

Participants will learn the indications for the use of TEE in OPCAB surgery, including its advantages and disadvantages. They will also learn how to optimize and utilize the information obtained during the surgery from TEE.

13 Is there a Role for Regional Anesthesia in CABG? (Chaney/Gramling-Babb)

Participants will be encouraged to participate in a debate on the pros and cons of the use of regional anesthesia techniques in patients undergoing CABG surgery. They will learn the current guidelines for the use of regional techniques in this group of patients and will be presented with a review of the current literature on this topic.

14 A-fib Prevention Strategies following CABG (Hogue/Balser)

Participants will learn about the etiology and incidence of atrial fibrillation post-CABG surgery (both on and off pump) and what strategies have been tried to reduce this incidence. They will also learn which, if any, of these strategies help reduce this incidence and if these strategies are really cost effective.

15 Spinal Cord Injury and Thoracic Aorta Surgery (Wallace/Grigore)

Participants will learn about the etiology and incidence of spinal cord injury associated with thoracic aorta surgery. Methods to try and reduce this incidence will be described and their success rates discussed.

16 Neurological Monitoring/Protection during CABG (Newman/Delphin)

Participants will learn about the various methods of neurological monitoring currently available for use in patients undergoing CABG surgery. They will also learn what strategies are available for neurological protection, how they work and to what degree they are successful.

17 Transfusion Best Practices (Spiess/Cheng)

Participants will be presented with evidence-based information on the current recommendations for transfusion practices to date. They will learn what are the indications for the use of different blood products and how these may be best determined in the operating room.

18 Perioperative Renal Protection (Sladen/Schwann)

Participants will learn the various methods suggested for protection of renal function perioperatively. They will be presented with the current data on the success of these methods and will learn how to assess and manage patients with impaired renal function during surgery.

19 ACLS: Whats New, Amiodarone, Vasopressin and Beyond (Berkowitz/Landry)

Vasopressin is becoming recognized as a critical agent in the treatment of vasodilatory shock syndrome associated with sepsis, cardiopulmonary bypass and use of ACE inhibitors. The objective of the session is to help the participant to understand the mechanisms whereby vasopressin may act in a synergistic fashion to restore catecholamine responsiveness in the vasculature in shock syndromes. In addition the role of vasopressin as a pressor in the new ACLS guidelines will be addressed.

20 Right Ventricular Failure, Recognition and Treatment (Hill/Sreeram)

Right ventricular failure is increasingly recognized as an independent predictor of morbidity and mortality in patients with myocardial infarction and certain subsets of patients undergoing cardiac surgery. In particular, patients receiving mechanical left ventricular support and heart transplantation are at higher risk for developing this complication. Early recognition and aggressive management of RV failure are essential to minimize end organ injury and improve salvage rates in these patients. Following this session, the participant will be able to: 1) discuss the pathophysiology of RV dysfunction; 2) describe etiologic factors contributing to RV failure; 3) 0utline the criteria used in the diagnosis of RV failure; and 4) explain the principles of management for RV failure, including pharmacologic and mechanical support.