SATURDAY, MAY 14, 2005
Refresher Courses
Outcomes in Cardiovascular Anesthesiology- Lessons Learned from America's Best Hospitals
At the conclusion of the lecture the participant will understand how outcomes are measured in heart surgery. The methods used by the US News and World Report and other ranking systems will be reviewed.
Heparin Induced Thrombocytopenia: Epidemic or Better Diagnostics?
At the conclusion of the lecture the participant will have an understanding of the diagnostic tests available to identify heparin-induced thrombocytopenia with and without thrombosis. The different presentations of the disease and options for treatment in cardiac surgery will be reviewed.
Glucose Control in the Cardiac Surgical Patient: Relevance to Clinical Outcomes
At the conclusion of the lecture the participant will understand the scientific background that supports glycemic control in the perioperative period. The relationship between glucose and organ function will be discussed. The maintenance of tight glucose management and its specific relevance to cardiac surgery will be emphasized.
Bacterial Endocarditis: The Critical Diagnostic Role of Transesophageal Echocardiography
At the conclusion of the lecture the participant will know the important diagnostic criteria for bacterial endocarditis. The common medical and echocardiographic criteria will be reviewed. A wide variety of TEE presentations of endocarditis will be demonstrated.
Update and Review of Perioperative Beta Blockade
At the conclusion of the lecture the participant will gain insight into the benefits of the use of beta blockade therapy in the perioperative period. The participant will gain an understanding of the current literature that supports the use of beta blockade in patients at risk for perioperative morbidity.
Atrial Fibrillation after Coronary Artery Surgery: Current Theories and Treatments
At the conclusion of the lecture the participant will understand potential risk factors and predictive markers for atrial fibrillation after coronary artery surgery. Prophylactic and therapeutic interventions will be discussed.
SUNDAY, MAY 15, 2005
Current Topics and Controversies in the Perioperative Management of the Cardiovascular Patient
Overall Learning Objective: At the conclusion of this session, the participant will learn how changes in technology, new considerations for pharmacological intervention, and patient demographics impact perioperative decision making for the cardiovascular patients.
Impact of New Technology on Options for Coronary Revascularization
At the conclusion of this lecture, the participant will learn about the impact of new technology on patient selection for novel options for coronary revascularization including drug eluting stents and gene therapy.
The Surgical Approach to the High-Risk Patient Undergoing CABG Surgery
At the conclusion of this lecture, the participant will learn how changing demographics and technological innovation have impacted surgical decision-making for the high-risk CABG patient.
What is the Ideal Hematocrit for Patients with Coronary Artery Disease
At the conclusion of this session, the participant will learn about the impact of variable hematocrit on perioperative morbidity and mortality in patients with coronary artery disease.
Is there a Role for Perioperative Statins?
At the conclusion of this session, the participant will learn about the lipid and non-lipid mediating effects of statins, and their impact on perioperative clinical outcomes in cardiovascular surgical populations.
Session A: Current Clinical Trials With Impact on our Specialty
Overall Learning Objective: At the conclusion of this session, and emphasizing data from recent clinical trials, the participant will understand: 1) the potential impact of new pharmacologic and surgical therapies on the future practice of cardiovascular medicine, 2) potential new options for improving anesthetic care in patients with cardiovascular disease.
Complement Inhibition
At the conclusion of this lecture the participant will understand the impact of anticomplement therapy on inflammation mediated organ injury after cardiac surgery.
On vs. Off-Pump Cardiac Surgery: An Overview of End-organ Outcomes
At the conclusion of this session the participant will understand recent data relating to the potential risks and benefits of off pump as compared to conventional coronary artery surgery.
Session B: Vascular I: Monitoring the Cardiovascular Patient
Overall Learning Objective: At the conclusion of this session, the participant will have an understanding of the appropriate indications for pulmonary artery catheter (PAC) and TEE monitoring in the high-risk vascular surgical patient. The potential benefits of TEE and PAC monitoring in the vascular patient population will be discussed, as well as the risks associated with each type of monitoring.
PAC: Who, How, Why, and Why Not
At the conclusion of the session, the participant will be able to determine which vascular surgical patients would most likely derive benefits from invasive PAC monitoring. The risks associated with PAC monitoring, and the impact of PA catheterization on mortality and major morbidity, will be discussed. Recommendations about appropriate use of PACs will be provided.
TEE in Vascular Surgery
At the conclusion of the session, the participant will have an understanding of the information that is provided by TEE monitoring in the high-risk noncardiac surgical patient. Studies examining the potential benefits and harms of TEE monitoring in vascular surgical patients will be discussed. The issue of who should be performing TEE examinations in this patient population will be discussed.
Case Discussion
A 56 year-old female is undergoing an open suprarenal AAA repair. Past medical history is significant HTN, DM, and a RCA stent 3 months ago. Preoperative EF is 30% and serum creatinine is 1.9.
Session C: How to Start Doing Research at Your Hospital
Overall Learning Objective: After this lecture, the participant should be able to 1) understand how to identify sources of funding for research from industry, specialty societies and the federal government and 2) learn how to develop and implement a clinical research team.
Session A: Impact of Echocardiography of Perioperative Decision Making: Case Discussions by the Experts
Overall Learning Objective: At the conclusion of this session, the participant will learn about the impact of perioperative echocardiography on perioperative decision making in a series of commonly encountered, yet controversial clinical scenarios.
Aortic Prosthetic Valve Size: How Small is too Small?
At the conclusion of this session, the participant will learn how to determine the appropriate size and function of aortic valve prostheses using echocardiography.
Post MV Repair Mitral Stenosis - How to Evaluate, What is Too Much?
At the conclusion of this session, the participant will learn how to evaluate mitral stenosis severity using echocardiography, and determine its clinical relevance following mitral valve surgery.
Aortic Dissection - What is the Preferred Diagnostic Test?
At the conclusion of this session, the participant will learn about the relative value of echocardiography in diagnosing aortic dissection.
Dilated Ascending Aorta - How Big is too Big? When does it Need to be Fixed?
At the conclusion of this session, the participant will learn how echocardiography can be used to evaluate aortic dilatation and its utility in perioperative decision making.
Epiatoric Echocardiography: When should we do it? Never? Always?
At the conclusion of this session, the participant will learn about the utility of epiaortic chocardiography and its indications as a complimentary diagnostic technique for the perioperative echocardiographer.
Session B: Hemostatic Challenges in Cardiac Surgery
Overall Learning Objective: After this set of lectures, the participant should be able to describe current hemostatic issues in cardiac surgery patients, and prepare evidence-based approaches for their management.
Update on Antifibrinolytic Therapy: Evidence-based Applications, Benefits, and Potential Risks
After this lecture, the participant should be able to: 1) understand recent data supporting the role of antifibrinolytic drugs in cardiothoracic surgery; 2) describe settings where the data regarding antifibrinolytic therapy are suggestive but inconclusive; 3) discuss known risks and foreseeable benefits of antifibrinolytic therapy in various settings; and 4) outline the pharmacologic profiles of commonly used antifibrinolytic drugs.
Risk Factors for Thrombosis in Cardiac Surgical Patients
After this lecture, the participant should be able to: 1) describe the pertinent pathophysiologic changes induced by cardiopulmonary bypass, and how these changes impact hemostasis; 2) outline the known clinical risk factors for postoperative thrombotic complications in differing vascular beds, identifying areas of overlap; 3) contrast the hemostatic impact of cardiac surgery with and without cardiopulmonary bypass; and 4) describe clinical approaches to minimizing thrombotic complications.
Evolving Antiplatelet Therapy Following Cardiac Surgery
After this lecture, the participant should be able to: 1) describe the pharmacology of commonly used antiplatelet agents; 2) describe the settings in which preoperative antiplatelet therapy is likely to be encountered; 3) outline cogent, evidence-based approaches to management of subjects receiving preoperative antiplatelet agents; 4) discuss the therapeutic rationale for providing antiplatelet therapy in the postoperative period; and 5) discuss the currently recognized outcome advantages of antiplatelet therapy following cardiac surgery.
Case Discussion
After this discussion, the participant should be able to: 1) identify which data are essential to critical decision-making regarding hemostasis management in high-risk patients; 2) outline key economic, social, and ethical issues surrounding transfusion decisions; and 3) rationally extrapolate important management guidelines from evidence-based settings into new and uncertain settings.
Session A: Mitral Regurgitation
Overall Learning Objective: At the conclusion of this session, the participant will better understand the incidence and mechanism of mitral regurgitation. The participant will gain an appreciation of the surgical options currently available and how TEE is integrated into the decision making process.
Classification of MR
At the conclusion of this lecture, the participant will better understand the classification systems utilized to evaluate the mitral valve regurgitation.
Ischemic MR
At the conclusion of this lecture, the participant will better understand what surgical options exist for the surgeon to treat ischemic MR based on the underlying mechanisms. The decision of when to intervene based on outcome studies will be emphasized.
Case Presentations with Panel Discussion
At the conclusion of this lecture, the participant will be able to incorporate TEE findings into the surgical decision making process for MR.
Session B: Minimally Invasive Cardiac Surgery: Update on OPCAB
Overall Learning Objective: At the conclusion of this session, the participant will understand the indications for interventional procedures and the possible risks and benefits versus surgery. Minimally invasive surgery will also be reviewed.
Stent vs Surgery
At the end of this session the participant will have a thorough understanding of the differences in outcome for PCI vs surgical intervention.
OPCAB: Is it Better?
At the conclusion of this lecture, the participants will have a thorough understanding of the most current outcome data comparing the OPCAB to traditional CABG and will be able to better determine the technique most suitable for their patient population.
The Evolution of Minimally Invasive Valve Surgery
We will explore the development of minimally invasive valve surgery. Particular emphasis will be place on the basic techniques and their outcomes. Recent improvements in techniques and improved results will be discussed. Future directions in minimally invasive valve surgery will also be addressed including the use of Robotics.
MONDAY, MAY 16, 2005
Monograph Session: Innovations in the Management of Adult Cardiac Disease
Overall Learning Objective: The 2005 Monograph Session will introduce cutting-edge innovations in care of adult cardiac disease. The session will largely focus on changing knowledge and technology affecting cardiac practice outside of the operating room, primarily in interventional cardiology and electrophysiology. Innovations in cardiac surgical practice will also be presented and the session will conclude with observations on the potential effects of these innovations on manpower, resource utilization and the expanding and changing role of the cardiovascular anesthesiologist.
New Devices in Interventional Cardiology
Cardiac surgery has been profoundly impacted by changes in interventional cardiology. Over the last decade these practice innovations have primarily been in the treatment of coronary artery disease. Coronary interventions continue to evolve, but rapid strides in device development and treatment are now being made in treatment of valvular and in congential heart disease. This lecture will identify some of changes that will change cardiac surgical and anesthetic practice.
Innovations in Electrophysiologic Procedures
Electrophysiologic assessment has led to increasing complex understanding of the relationship between cardiac conduction and mechanical activity. Innovations include resynchronization therapy, and ablation procedures for atrial fibrillation and various tachyarrhythmias. Many of these mapping and ablation techniques are long, complicated and require anesthetic assistance. An understanding of these procedures is essential for the anesthesiologist involved in the care of these patients.
Innovations in Cardiac Surgery
Cardiac surgery continues to change. Coronary surgery has become progressively less invasive with the development of off-pump and minimally invasive procedures. Additionally surgical treatment of valvular disease continues to evolve with rapid expansion of repair procedures, initially for mitral and now for aortic valves. Additionally, it is expected that approval and development of left ventricular assist devices will change the treatment of heart failure. This session will highlight some of the cardiac surgical practice changes of interest to cardiac anesthesiologists.
Implications for Intraoperative Practice, Manpower and the Role of the Cardiac Anesthesiologist
Traditional intraoperative cardiac surgical practice has contracted and will continue to do because of advances in interventional and medical treatment of cardiac disease. At the same time, practice demands for anesthetic care outside the operating room has markedly expanded. Particularly in interventional cardiology, many procedures are in evolution. The cardiac anesthesiologists will be actively involved in the care of these patients and it is important for our specialty to participate in the development of patient care protocols. We also need to understand how changes in adult cardiovascular care might affect manpower, resource allocation and the organization of our practice over the next ten years. The goal of this presentation will is to provide an understanding of these types of changes and place them in a historical context of practice change.
Session A: Vascular II: Organ Protection in Vascular Surgery
Overall Learning Objective: At the conclusion of this session, the participant will be able to identify strategies to decrease the risk of neurological, myocardial, and renal dysfunction in high risk patients undergoing vascular surgery.
What's New in Spinal Cord Protection in Descending Thoracic Aortic Surgery?
At the conclusion of this lecture the learner will understand: 1) the causes of paralysis in thoracoabdominal aortic surgery; 2) the effectiveness of clinical therapies in reducing paralysis risk; and 3) the relationship between experimental models and effective clinical therapies
Perioperative Myocardial Protection Strategies in Vascular Surgery
At the conclusion of this lecture, the participant will be able to describe the potential beneficial effects of anesthetic preconditioning, glycemic control and statin therapy to decrease cardiovascular risk in patients undergoing vascular surgery.
Renal Protection in Vascular Surgery
At the conclusion of this lecture, the participant will be able to identify and assess the effectiveness of various pharmacological and nonpharmacological modalities for renal protection in patients undergoing vascular surgery.
New Therapeutic Targets in Cardiovascular Medicine
At the conclusion of this lecture, the participant will become familiar with new therapeutic targets and pharmacological agents in cardiovascular medicine, such as calcium sensitizers, thiazolidinediones, and Na+-H+ exchange inhibitors.
Session B: Anesthesia & Analgesia: Evidence Based Practice: Show Me the Data!
Overall Learning Objective: Application of an evidence-based approach to review and critique the published data that establish or refute the efficacy of interventions to reduce perioperative cardiovascular, neurologic and renal risks.
Session C: Clinical Dilemmas in the Cardiothoracic OR
Overall Learning Objective: At the conclusion of the session, the participant will have a sense of the risks and benefits of different therapies used to treat clinical problems. Often there are many "correct treatments" for a given problem, and these will be discussed. The clinical problems discussed will include heparin induced thrombocytopenia, antifibrinolytic therapy, ischemic mitral regurgitation, and airway trauma.
Heparin Induced Thrombocytopenia (A patient presents for urgent CABG. Platelet count was 250K yesterday and it is 110K today.)
At the conclusion of the session, the participant will understand the mechanisms of HIT and how to diagnose and treat it. Options for diagnosis and treatment will be reviewed.
Airway trauma (A patient presents for lung surgery. Upon placement of the endobronchial tube, the trachea is ruptured.)
At the conclusion of the session, the participant will learn how to manage acute airway rupture. The management of the airway and emergency devices for oxygenation and ventilation will be discussed.
Ischemic MR (A patient for CABG presents with 2+ MR.)
At the conclusion of the session, the participant will learn the mechanisms of ischemic MR and will know the literature that argues for or against repair of the mitral valve.
Aprotinin Use and Re-exposure (A reoperative patient presents for ventricular assist device placement. You want to use aprotinin but suspect the patient may undergo cardiac transplantation in the next few months.)
At the conclusion of the session, the participant will learn the risk/benefit analysis for synthetic antifibrinolytic agents versus aprotinin. Aprotinin re-exposure and the risk of anaphylaxis will be reviewed.
Session A: Vascular III: Dilemmas in Postoperative Care of the Cardiovascular Patient
Overall Learning Objective: At the conclusion of this session, the participant will understand monitoring of the postoperative cardiovascular patient, the need for pain management and the critical issues that can arise in postoperative care unit. Endovascular surgical techniques will be discussed.
Epidural Analgesia in Major Vascular Surgery: Advantages, Pitfalls and Postop Care
After this lecture, participants should be better able to: 1) manage placement and removal of epidural catheters in vascular surgery patients who have received or may become candidates to receive antiplatelet, anticoagulant, and/or thrombolytic drugs; 2) manage the interactions of thoracic epidural local anesthetics with other pharmacotherapy, particularly beta blockers, ACE inhibitors and ARBs; and 3) choose between lumbar and thoracic epidural catheter placement, and between infusions of opiate, local anesthetics, and other adjuvents in the intraoperative and postoperative period.
The Use of TEE for Hemodynamic Instability Post Major Vascular Surgery
After this lecture, participants will be able to: 1) appreciate typical vascular patient in tertiary referral center; 2) identify hemodynamic complications requiring TEE assessment after major vascular surgery; and 3) compare and contrast TEE vs. TTE and other alternative modalities in management of post major vascular surgery patients.
Post AAA Repair - Endovascular vs Open: Is the Playing Field that Different?
At the conclusion of this lecture, the audience will: 1) be able to recognize the complications of open AAA (emergent and elective); 2) be able to recognize the complications of endovascular AAA; 3) have a better understanding of the impact of these changes on postoperative management (qualitative and quantitative); and will understanding current and future directions in AAA surgery and how this may further impact our postoperative care strategies.
Session B: Diseases of Age: Atherosclerosis and Hypertension
Overall Learning Objective: At the conclusion of this session the attendee will have an understanding of the physiology of the aging heart and cardiovascular session and will be better able to apply this to anesthetic practice.
Atherosclerosis and the Progression of Cardiovascular Disease
At the conclusion of this lecture the participant will: 1) gain an understanding of the physiologic changes associated with an aging heart; and 2) understand the relationship between the aging cardiovascular system and the development of disease.
New Insights into Hypertension
At the conclusion of this lecture the participant will: 1) understand current thinking on the development and progression of hypertension; and 2) understand modern therapeutic targets and therapies for hypertension in the elderly.
TUESDAY, MAY 17, 2005
Emerging Paradigms for Perioperative Risk Assessment
Overall Learning Objective: After this session, the audience will understand the growing role of genetic variables in defining populations at risk, and will be better able to understand and critically evaluate current literature on postoperative inflammation, atrial fibrillation, hemostasis, and other important complications.
Functional Genomics: Impact on Clinical Practice
After this lecture, the participant should be able to: (1) describe examples of variability in the human genome, (2) outline common methods of studying the impact of genetic variability on clinical outcomes, (3) identify limitations of genetic association studies, and (4) understand the role of genetic studies in identifying at-risk subgroups.
Novel Predictors of Perioperative Inflammation
After this lecture, the participant should be able to: understand the role of genetic variation on inflammatory mediators in cardiovascular disease and its influence on adverse perioperative outcomes.
Postoperative Atrial Fibrillation: Intersection of Environmental and Genetic Risk
After this lecture, the participant should be able to: (1) describe the significance of postoperative atrial fibrillation (PoAF) as a highly relevant clinical problem, (2) identify traditional clinical risk factors for PoAF, (3) understand data supporting the role of inflammation in PoAF, and (4) understand recent genetic studies identifying genetic variables as PoAF risk factors in specific patient subgroups.
Influence of Coagulation Variability on Perioperative Outcomes
After this lecture, the participant should be able to: (1) understand the role of genetic variation in bleeding and thrombotic outcomes, (2) describe the role of rare variants upon thrombotic outcomes in ambulatory populations, (3) identify the role of common variants in thrombotic outcomes after surgery, (4) describe the role of common variants in bleeding outcomes after surgery.
Session A: Jointly Presented by the ASCCA and SCA - Postoperative Care of the Patient with Heart Failure
Overall Learning Objectives: At the conclusion of the panel, the participant will understand the diagnosis and early identification of patients at risk for postoperative right and left heart failure. The early identification of heart failure in the postoperative period will be discussed in this critical care/anesthesiology panel. Pharmacologic remedies and surgical devices used to treat heart failure will be specifically addressed.
Pharmacologic Treatment of Heart Failure
At the conclusion of this lecture the participant: 1) will have received a thorough review of the pharmacologic basis of inotropic support (cyclic AMP, PDE et al.); 2) will understand the concept of inoconstriction and inodilation and its indications; 3) will be able to evaluate the advantages and limitations of beta-adrenergic agents, PDE inhibitors and their interactions; and 4) will be able to discuss future agents and their possible role (e.g. levosimendan).
Right Heart Failure: INO vs. IPGI2
At the conclusion of this lecture the participant: 1) will have reviewed the pharmacology of inhaled nitric oxide and prostacyclin; 2) will be able to discuss the indications, benefits and limitations of inhaled vasodilators; 3) will be able to compare and contrast the efficacy, safety and cost of INO and IPGI2; and 4) will be able to evaluate alternative therapies for the postoperative management of severe pulmonary hypertension.
Surgical Treatment of Heart Failure
At the conclusion of this lecture the participant: 1) will understand the indications for ventricular assist devices (bridge to recovery, bridge to transplant or destination therapy); 2) will be able to unravel the alphabet soup (LVAD, RVAD, BiVAD); 3) will understand the Columbia experience with traditional devices (Abiomed I, HeartMate I, Thoratec I), including postoperative complications; and 4) will be able to critically review the new generation of devices and the future of surgical treatment.
Session B: Management of the Adult Patient with Congenital Heart Disease: A Timeline
Overall Learning Objective: At the conclusion of this session the attendee will have obtained a thorough understanding of the complexity and heterogenicity of the adult congenital heart disease population. In addition, the attendee will have acquired knowledge of management options applicable to their clinical practice.
Defining the Adult Congenital Heart Disease Population and Their Needs
At the conclusion of this session the attendee will have obtained perspective on the demographics and care needs of the rapidly growing and increasing complex population of adult patients with repaired congenital heart lesions
TOF from Infancy to Adulthood
At the conclusion of this session the attendee will have obtained perspective on the management of TOF patients from the time of initial repair to adulthood. Specifically, the role of pulmonary valve replacement and ICD placement in adult patients will be addressed.
The Adult Fontan Patient
At the conclusion of this session the attendee will have obtained perspective on the management of Fontan patients from the time of initial repair to adulthood. Specifically, the role of Fontan revision and arrhythmia surgery in adult patients will be addressed.
The Adult with Palliated Congenital Heart Disease
At the conclusion of this session the attendee will have obtained perspective on the management of adult patients who have palliated congenital heart disease for lesions that in the current era would be repaired in childhood.
Session A: Pulmonary Hypertension: Etiologies, Therapies, and Case Studies
Overall Learning Objective: At the conclusion of this lecture, the participant will be familiar with: 1) pathophysiology of pulmonary hypertension (with special emphasis on obstructive sleep apnea); 2) transesophageal echocardiographic diagnosis and pharmacological treatment of right heart failure; 3) surgical interventions to improve right heart failure; 4) case studies and specific management strategies for complex cases of right heart failure .
Understanding Pulmonary Hypertension in 2004
At the conclusion of this lecture the participant will have received a pathophysiologic review of PAH including common and uncommon causes. The lecture will emphasize the pathophysiology of the disease. A review of OSA as a cause of PAH will receive special emphasis.
Right Heart Assist Devices: Recent Outcome Data and Management Principles
At the conclusion of this lecture the participant will have a better understanding of the surgeon's perspective of pre and intraoperative warning signs of right ventricular failure. They will also understand the surgeon's role in developing strategies for intra-operative management of right heart failure. Mechanical interventions to relieve right heart failure during cardiopulmonary bypass will also be discussed.
Perioperative Management of the PAH patient: Case Studies
At the conclusion of this session the audience will understand specific management therapies for these complex patients. Clinicians will leave with recommendations for care.
Session B: Anesthesia for Minimally Invasive Thoracic Surgery
Overall Learning Objective: At the conclusion of this session, the participant will understand the latest surgical video assisted technology, and understand the anesthetic management challenges associated with VAT surgery. He/she will become familiar with regional anesthetic techniques used with VAT surgery for surgical anesthesia and management of postoperative pain.
What's New in Minimally Invasive Thoracoscopic Surgery
At the conclusion of this lecture, the attendee will understand how video assisted thorascopic surgery (VAT) is changing, and how it is likely to be used in the near future and what technical issues surgeons are faced with when using VAT, and how anesthetic techniques can improve operative conditions.
Anesthesia Techniques for VAT
At the conclusion of this lecture, the attendee will understand the specific anesthetic techniques that are appropriate for use during video assisted thorascopic surgery, and be able to appropriately tailor an anesthetic for different VAT surgeries, incuding use of appropriate regional techniques for intra and postoperative care.
Challenging Thoracoscopic Cases
At the conclusion of this lecture, through presentation of challenging thorascopic cases, the attendee will learn how the anesthesia and surgical teams can best work together to resolve difficult clinical scenarios.
WORKSHOPS & EVENING SESSIONS
SATURDAY, MAY 14, 2005 . 1:00 pm - 4:00 pm
WORKSHOPS
Practical Echocardiography I
Overall Learning Objective: The objective of this workshop will be to provide a solid foundation in echocardiography for the basic practitioner of intraoperative TEE. At the completion of this workshop the participant will understand how to perform a comprehensive TEE examination, as well as understand the basics of Doppler, recognize normal and abnormal left and right ventricular function, identify imaging artifacts and apply Doppler for the calculation of basic hemodynamic measurements.
Comprehensive TEE Examination
The objective of this lecture is to provide information that will enable the participant to perform a comprehensive TEE examination. Specifically, the participant will understand imaging plane orientation and the acquisition of images in relationship to cardiac anatomy.
Basics of Doppler Echocardiography
The objective of this lecture is to enable the participant to understand the basics of Doppler ultrasound. The function of ultrasound transducers, physical properties of the ultrasound wave and pulsed-wave and continuous wave Doppler modes will be discussed.
TEE Evaluation of the Left Ventricle
The objective of this lecture is to demonstrate how to perform a complete TEE examination of the left ventricle. Additionally, at the completion of the lecture the participant will be able to recognize normal from abnormal left ventricular function as well as identify regional wall abnormalities.
TEE Evaluation of the Right Ventricle
The objective of this lecture is to enable the participant to perform a complete TEE examination of the right ventricle as well as identify normal from abnormal right ventricular function. TEE case examples demonstrating normal and abnormal right ventricular will also be demonstrated.
Imaging Artifacts
The objective of this lecture is to enable the participant to recognize and understand ultrasound imaging artifacts from true anatomic findings. TEE cases will demonstrate examples of imaging artifacts commonly produced by ultrasound.
Hemodynamic Assessment
The objective of the lecture will be to provide an understanding for the use of TEE in the calculation of basic hemodynamic measurements commonly used in the assessment of cardiac and vascular surgical patients. Case examples will identify the utility of TEE for assessing hemodynamics in the perioperative period.
Advanced TEE Clinical Cases: A Comprehensive Review
Learning Objective: At the conclusion of this audience interactive workshop, the participant will gain an appreciation of the significant impact that TEE can have on perioperative decision-making through specific clinical scenarios. The collection of clinical scenarios will be chosen in order to obtain a broad overview of difficult decision areas within clinical practice. Cases involving valvular abnormalities, systolic and diastolic dysfunction, congenital unknowns, ICU problems will be shown.
Left and Right Ventricular Function
The participant will gain an appreciation of the significant impact TEE can have on evaluating LV and RV function.
Diastolic Function
The participant will gain an appreciation of the significant impact TEE can have on evaluating diastolic function.
Mitral Valve
The participant will gain an appreciation of the significant impact TEE can have on evaluating the mitral valve.
Aorta/Aortic Valve
The participant will gain an appreciation of the significant impact TEE can have on evaluating the aorta and aortic valve.
ICU Dilemmas
The participant will gain an appreciation of the significant impact TEE can have on evaluating unstable ICU patients.
Prosthetic Valves
The participant will gain an appreciation of the significant impact TEE can have on evaluating with prosthetic valves.
Congenital Heart
The participant will gain an appreciation of the significant impact TEE can have on evaluating patients with congenital heart disease.
Grab Bag
The participant will gain an systematic approach to evaluating patients with unknown conditions with TEE.
SATURDAY, MAY 14, 2005 . 4:15 pm - 7:15 pm
WORKSHOPS
Making the Call: Echocardiographic Diagnosis and Decision Making in Perioperative Care Workshop
Overall Learning Objective: This session is designed for intermediate to advanced (NBE eligible) echocardiographers. The objective of this interactive program is to discuss common diagnostic dilemmas facing the perioperative echocardiographer. Echocardiography for aortic surgeries, hemodynamic emergencies, interventional procedures, and for diagnosis of cardiac and vascular masses is emphasized. The program concludes with an interactive session where the participant and expert panel are challenged by a series of echocardiographic diagnostic and management challenges.
Vascular Surgery: Aneurysms, Dissection, and Aortic surgeries including endovascular approaches
At the end of this lecture, the participant will better understand the use of TEE to both diagnose and manage endovascular surgeries.
Rescue TEE: Hemodynamic Emergencies and ICU Challenges
At the end of this lecture, the participant will better understand how TEE is used in the ICU setting to solve hemodynamic dilemmas.
Interventional Procedures: Catheters, Cannulas, and the Cath Lab
At the end of this lecture, the participant will appreciate the utility of TEE to assist interventional and catheter based cardiovascular procedures.
Lumps and Bumps
At the end of this lecture, the participant will recongize uncommon cardiac and intravascular anomalies which are encountered during otherwise routine TEE examinations.
Interactive Case Presentations
Through a case discussion format, at the end of this lecture, the participant will be versed in the broad range of TEE challenges presented during non-cardiac surgeries.
Practical Echocardiography II
Overall Learning Objectives: This workshop is designed to be a didactic overview of selected major topics in perioperative echocardiography, primarily designed to improve the foundation of knowledge for intermediate echocardiographers. At the conclusion of this workshop, the participant will have been refreshed and educated about essential echocardiographic topics such as evaluation of anatomic variants, the mitral valve and the aortic valve, including new knowledge about epiaortic and epicardial ultrasound, 3-D ultrasound and diastolic dysfunction
Anatomical Variants and Masses
At the conclusion of this lecture, the participant will learn the common anatomic variants and masses and will be able to distinguish normal variants from abnormal pathology
Overview of Mitral Valve Pathology (Regurgitant and Stenotic)
At the conclusion of this lecture, the participant will will understand basic mitral valve anatomy and will have learned how to evaluate the mitral valve for stenosis and regurgitation using 2D-echocardiography and doppler echocardiography.
Overview of Aortic Valve Pathology (Regurgitant and Stenotic)
At the conclusion of this lecture, the participant will understand basic aortic valve anatomy and will know how to evaluate the aortic valve for stenosis and regurgitation using 2D-echocardiography and doppler echocardiography.
Diastolic Dysfunction Made Easy
At the conclusion of this session, the participant will have learned about how diastolic dysfunction impacts care of the cardiac patient and will understand how to use echocardiography to evaluate diastolic dysfunction.
Using Epicardiac and Epiaortic Ultrasound
At the conclusion of this session, the participant will have learned about the use of epicardiac ultrasound scanning to evaluate cardiac function and anatomy when TEE is contraindicated. In addition, the participant will know how to use epiaortic scanning to evaluate the proximal aorta for pathology.
3-Dimensional Echo - The New Frontier
At the conclusion of this session, the participant will understand the clinical benefits of 3D echocardiography and how to utilize this modality in his/her practice.
SUNDAY, May 15, 2005 . 5:30 - 7:30 pm
EVENING SESSIONS
Pediatric CPB and ECMO Management
Overall Learning Objectives: At the conclusion of this workshop the attendee will have obtained an understanding of the management options and challenges associated with CPB and ECMO in pediatric cardiac surgical patients. In addition, the attendee will have acquired knowledge applicable to their clinical practice.
Anti-fibrinolytics/Aprotinin Update
At the conclusion of this session the attendee will have gained insight into the available evidence regarding efficacy of antifibrinolytic drugs in pediatric congenital heart surgery and will be familiar with the known risks benefits of antifibrinolytic therapy in this population.
Case Study (Neonatal ASO)
At the conclusion of this session the attendee will be familiar with the CPB management issues and strategies associated with the neonatal ASO procedure.
Case Study (Stage 1 for HLHS)
At the conclusion of this session the attendee will be familiar with the CPB management issues and strategies associated with the neonatal Stage 1 procedure.
Case Study (post surgery ECMO support patient)
At the conclusion of this session the attendee will be familiar with the management issues and strategies associated with use of ECMO for post-cardiotomy circulatory failure in the pediatric patient.
Thoracic Anesthesia: A Hands-On Approach to Lung Isolation and Regional Anesthesia
Overall Learning Objective: The participant will understand both theoretical and technical aspects of lung isolation and regional anesthesia. Participants will be able to practice placement of double lumen tubes, bronchial blockers, univent tubes as well as placement of thoracic epidurals and paravertebral blocks.
Stations 1, 2 - Placement of Double Lumen Tubes with Bronchoscopic Confirmation
Station 3 - Bronchial Blockers
Station 4 - Univent Tubes
Station 5 - Thoracic Regional Anesthesia (epidurals, paravertebrals)
WEDNESDAY, MAY 18, 2005 . 8:00 am - 12:00 noon
WORKSHOPS
Practical Echocardiography III: Advanced Cases in Echo
Overall Learning Objective: At the conclusion of the workshop the participant will have an understanding of how to utilize TEE to diagnose and quantitate cardiac disease. Application of TEE to measuring pressure gradients, shunt flow, valvular disease, systemic diseases, and diastolic dysfunction will be reviewed.
TEE Assessment of Infective Endocarditis
At the end of this lecture the participant will be able to describe the diagnostic criteria for IE and will know the echocardiographic manifestations of IE.
PISA - What is it? Is it good for anything?
At the end of this lecture the participant will be able to describe how PISA can be used to measure flow volumes, will understand how to use PISA to quantify the severity of mitral regurgitation and will be able to use PISA to quantify the severity of mitral stenosis.
Tissue Doppler - Is it the best way to evaluate LV function?
At the end of this lecture the participant will know how tissue Doppler is different from color flow Doppler and will be able to use tissue Doppler to measure strain in the myocardium.
TEE Findings in Systemic Diseases
At the end of this lecture the participant will be able to explain the role of echocardiography in diagnosing systemic diseases and will be able to describe the echo manifestations of amyloidosis, carcinoid, and sarcoidosis.
TEE Evaluation of the Interatrial Septum: Aneurysm, Holes and PFOs
At the end of this lecture the participant will be able to perform a complete TEE exam of the IAS and will be able to describe how to use TEE to diagnose PFO.
Hemodynamic Calculation Cases: Practice Applying the Principles
At the end of this lecture the participant will be able to use Doppler flow velocity measurements to measure intracardiac pressures and will be able to describe how to use TEE to measure cardiac output.
Perioperative TEE: A Comprehensive, Interactive Review
Overall Learning Objectives: This workshop will provide the participant with a comprehensive interactive review of perioperative echocardiography. This review is intended for those with a working knowledge of perioperative echocardiography. Topics are chosen to represent a broad overview of TEE important to the practicing clinician and for those preparing for certification in perioperative echocardiography. At the conclusion of the session the participant will have a broad review of common TEE principles and applications. The learner will have an opportunity to assess knowledge with specific interactive questions and case presentations.
Physics and Hemodynamic Calculations
At the conclusion of this lecture the learner will be able to use Doppler flow velocity measurements to measure intracardiac pressures and will be able to describe how to use TEE to measure cardiac output.
Assessment of LV and RV Systolic Function
At the conclusion of this lecture the learner will have gained an understanding of normal RV and LV function, regional wall motion abnormalities, coronary artery blood supply.
Assessment of Diastolic Function
Diastolic dysfunction will be reviewed and its importance in clinical anesthesiology will be emphasized. At the end of the lecture, the participant will have an understanding of pulse wave doppler techniques in the evaluation of diastolic dysfunction.
Valvular Heart Disease I
At the conclusion of this lecture the learner will be understand the fundamentals of TEE evaluation of the aortic valve including both stenosis and regurgitation.
Valvular Heart Disease II
At the conclusion of this lecture the learner will have gained an understanding of mitral valve disease including both stenotic and regurgitant lesions.
Pitfalls, Artifacts, and Other Wrong Turns
The participant will be exposed to several examples of TEE artifacts and other sonographic pitfalls that may compromise the examination. At the end of the session, the participant will be able to avoid common TEE errors.
This Heart isn't Right: Adult Congenital Heart Disease
At the conclusion of this lecture the learner will better understand common adult congenital heart lesions. TEE examples of both repaired and unrepaired lesions will be studied.
Stat Rule In and Rule Outs: Aortic Dissection, Tamponade, and Cardiac Arrest
The participant will be guided through common clinical emergencies in which TEE may help in the diagnosis and guide therapy. The common findings in these disease states will be reviewed as well as clinical examples from case studies.
Problem-based Learning Discussions
Sunday, May 15, 2005
1. Ischemic Mitral Regurgitation from Diagnosis to Treatment
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.
2. Heparin-induced Thrombocytopenia
The participant will develop an understanding of the problem of HIT in cardiac surgery. Current strategies for diagnosis, monitoring and treatment will be explored.
3. New Methods of Mechanical Ventilation
The participants will understand reasons for "unconventional" ventilation modalities and specifically when to utilize the prone position.
4. OPCAB Surgery, Nuts and Bolts
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".
5. Thoracic Case Conference: Airway Trauma
The participants will discuss several cases of complex airway trauma and perioperative management principles. Techniques for airway trauma diagnosis and therapy will be reviewed.
6. OR Management of Pacemakers and AICDs
The participant will review current guidelines and recommendations regarding the management of pacemakers and AICDs in the perioperative setting. Specific recommendations will be reviewed for appropriate cardiology consultation.
7. TEE Hemodynamic: Problem-based Approach
The participant will have a review of clinically relevant TEE hemodynamic calculations followed by a number of practical examples. At the end of the session, the participant will be ready to perform these calculations in a clinical environment.
8. Management Guidelines for Atrial Fibrillation after CABG
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.
Monday, May 16, 2005
9. Carotid Endarterectomy: Anesthestic Management
The objectives of this session are to discuss the controversial area of which anesthestic and monitoring techniques are best for carotid endarterectomy. A pro/con of regional verses general anesthesia will be discussed.
10. Management of Antiplatelet Drug Therapy
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.
11. Neuromonitoring/Protection during CABG
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.
12. The Child with Complex Congenital Heart Disease
The participant will gain an appreciation of the anesthetic and monitoring challenges faced when presented with a child requiring noncardiac surgery who has complex congenital heart disease.
13. Right Ventricular Failure
Participants will learn the various modalities available for the detection and monitoring of right ventricular failure. They will also learn about the various treatment strategies currently used to treat right ventricular failure and how best to manage these patient.
14. Cardioprotection during OPCAB
The participant will review strategies of myocardial protection during OPCAB procedures. The principles of ischemic preconditioning and pharmacologic preconditioning will be discussed.
15. TEE Credentialing and Billing
The participant will review the requirements for Board certification in Perioperative Echocardiography. A review of the hospital credentialing procedure and a review of customary billing practices for TEE will be reviewed.
16. Clinical Application of Ischemic Preconditioning.
The participant will review the current state of knowledge regarding the clinical application of ischemic preconditioning in both heart and other end-organ surgical procedures.
Tuesday, May 17, 2005
17. Perioperative Decisions in Clinical and surgical Heart Failure
The participant will review the pathophysiology of acute and chronic heart failure. The data for perioperative heart failure treatment will be reviewed and specific recommendations for treatment will be discussed.
18. Epiaortic Scanning of the Ascending Aorta
The participant will gain an appreciation of the limitations of manual palpation and TEE evaluation of the ascending aorta for atheromatous disease. Epiaortic scanning of the ascending aorta prior to manipulation will be discussed.
19. Blood Transfusions in Cardiothoracic Surgery
The participant will review the current data regarding blood transfusion practice in cardiothoracic surgery. The benefits and complications of transfusion will be discussed. At the end of the session the participant will have a working knowledge of the risk/benefit ratio for transfusion in cardiothoracic surgical patients.
20. Wireless Technology in the CT Operating Room: Is it time?
The participant will evaluate the utility of new wireless technology in the cardiothoracic operating rooms. Cost considerations, HIPPA concerns, and research applications will be reviewed.
21. Surgery on the Descending Aorta
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.
22. Evidenced-based Outcomes in OPCAB Surgery
Participants will learn about the outcome of patients undergoing OPCAB surgery compared to conventional on-pump CABG. The data for these studies will be crtically reviewed and recommendations based on the data discussed.
23. Perioperative Renal Dysfunction
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.
24. Congenital Heart Disease Case Discussion
The participant will review perioperative management principles of common and uncommon congenital heart defects. Issues of preoperative evaluation, intraoperative anesthetic techniques, and postoperative concerns will be reviewed.
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