eastern ardiothoracic urgical ociety · st. jude medical transonic systems inc. wl gore &...

EASTERN CARDIOTHORACIC SURGICAL SOCIETY

53rd Annual Meeting

Four Seasons Resort Palm Beach, Florida

2015 LEADERSHIP

Board of Directors

President Benny Weksler, MBA, MD, FACS

Vice President Robert J. Moraca, MD

Treasurer Michael J. Walker, MD, FACS

Secretary Abbas E. Abbas, MD, MS, FACS

Program Committee

Faiz Y. Bhora, MD, FACS, MD, Chair Eric J. Lehr, MD, PhD, FRCSC, Cardiac Chief

Sharon Ben-Or, MD, Thoracic Chief

Membership Committee

Doraid Jarrar, MD, Chair Nimesh D. Desai, MD, PhD

Anthony A. Holden, MD

Council

Joseph E. Bavaria, MD

Geoffrey M. Graeber, MD

Michael F. Szwerc, MD

Glenn J.R. Whitman, MD

FACULTY

Abbas E. Abbas, MD, MS, FACS Chief, Division of Thoracic Surgery Director of Thoracic and Foregut Surgery Associate Professor of Surgery Temple University School of Medicine Philadelphia, Pennsylvania

Carlos J. Anciano, MD Associate Professor Thoracic & Foregut Surgery Department of Cardiovascular Sciences Brody School of Medicine East Carolina University Greenville, South Carolina

Curtis A. Anderson, MD REX UNC Health Care Raleigh, North Carolina

William R. Auger, MD Professor of Clinical Medicine University of California, San Diego La Jolla, California

Sharon Ben-Or, MD Assistant Professor of Surgery University of South Carolina at Greenville Greenville, South Carolina

Faiz Y. Bhora, MD, FACS Chief of Thoracic Surgery Mount Sinai Roosevelt and Mount Sinai St. Luke’s Hospitals Associate Professor of Surgery Icahn School of Medicine at Mount Sinai New York, New York

William D. Bolton, MD Associate Professor of Surgery University of South Carolina at Greenville Greenville, South Carolina

Joanna Chikwe, MD Professor of Cardiovascular Surgery Icahn School of Medicine at Mount Sinai New York, New York

Todd L. Demmy, MD Professor and Chief, Sections of Thoracic Oncology and Thoracic Surgery, Department of Surgery Robert Wood Johnson Medical School Associate Chief Surgical Officer Rutgers Cancer Institute of New Jersey New Brunswick, New Jersey

Nimesh D. Desai, MD, PhD, FRCSC, FAHA Co-Director, Aortic and Vascular Center of Excellence Director, Thoracic Aortic Surgery Research Program Assistant Professor, Division of Cardiovascular Surgery Hospital of the University of Pennsylvania Senior Fellow, Leonard Davis Institute of Health Economics University of Pennsylvania Philadelphia, Pennsylvania

Mark R. Dylewski, MD Chief of Thoracic Surgery Medical Director of Thoracic Robotic Surgery Baptist Health of South Florida South Miami, Florida

John A. Elefteriades, MD William W.L. Glenn Professor of Surgery Director, Aortic Institute at Yale-New Haven Yale University School of Medicine New Haven, Connecticut

Richard H. Feins, MD Professor of Surgery University of North Carolina at Chapel Hill Chapel Hill, North Carolina

Victor A. Ferraris, MD, PhD Tyler Gill Professor of Surgery University of Kentucky Lexington, Kentucky

Sebastien Gilbert, MD, FRCSC Head, Division of Thoracic Surgery The Ottawa Hospital Ottawa, Ontario Canada

Scott M. Goldman, MD Director, Structural Heart Disease Program Lankenau Heart Institute Wynnewood, Pennsylvania

Julian Guitron, MD Assistant Professor, Thoracic Surgery University of Cincinnati Medical Center Cincinnati, Ohio Benjamin E. Haithcock, MD, FACS, FCCP Assistant Professor, Thoracic Surgery University of North Carolina at Chapel Hill School of Medicine Chapel Hill, North Carolina

FACULTY

W. Clark Hargrove, III, MD Penn Presbyterian Medical Center Philadelphia, Pennsylvania

Wayne L. Hofstetter, MD Professor MD Anderson Cancer Center Houston, Texas

Elizabeth A. Johns, Esq. Delaware County Memorial, Taylor and Springfield Hospitals Springfield, Pennsylvania

Sunjay Kaushal, MD, PhD Associate Professor of Surgery University of Maryland Medical Center Baltimore, Maryland

Shaf Keshavjee, MD, MSc, FRCSC, FACS Surgeon in Chief, University Health Network James Wallace McCutcheon Chair in Surgery Director, Toronto Lung Transplant Program Professor, Division of Thoracic Surgery University of Toronto Toronto, Ontario Canada

Andy C. Kiser, MD, FACS, FACC, FCCP Byah Thomason-Sandford Doxey Distinguished Professor of Surgery Chief, Division of Cardiothoracic Surgery University of North Carolina School of Medicine Chapel Hill, North Carolina

Zachary N. Kon, MD Assistant Professor University of Maryland School of Medicine Baltimore, Maryland

Mark J. Krasna, MD Corporate Medical Director for Oncology Meridian Cancer Care Jersey Shore University Medical Center Neptune, New Jersey

Michael Lanuti, MD Associate Professor of Surgery Harvard Medical School Director of Thoracic Oncology Division of Thoracic Surgery Massachusetts General Hospital Boston, Massachusetts

John F. Lazar, MD Director of Minimally Invasive Thoracic and Foregut Surgery PinnacleHealth Cardiovascular Institute Harrisburg, Pennsylvania

Richard S. Lazzaro, MD Chief Division of Thoracic Surgery North Shore – LIJ Health System Lenox Hill Hospital New York, New York

Eric J. Lehr, MD, PhD, FRCSC Director of Cardiac Surgery Research and Education Co-Director of Minimally Invasive and Robotic Cardiac Surgery Swedish Heart & Vascular Institute Seattle, Washington

Bradley G. Leshnower, MD, FACS Assistant Professor of Surgery Emory University School of Medicine Atlanta, Georgia

M. Blair Marshall, MD Professor of Surgery Chief, Division of Thoracic Surgery Department of Surgery MedStar Georgetown University Hospital Washington, DC

Daniel L. Miller, MD Chief, General Thoracic Surgery WellStar Health System/Mayo Clinic Care Network Clinical Professor of Surgery, Medical College of Georgia/Georgia Regents University Program Director, General Surgery Residency Program WellStar Kennestone Regional Medical Center Marietta, Georgia

Robert J. Moraca, MD Director of Thoracic Aortic and Arrhythmia Surgery Allegheny General Hospital Pittsburgh, Pennsylvania

Rohinton J. Morris, MD Chief, Division of Cardiothoracic Surgery Abington/Jefferson Health Systems Abington, Pennsylvania

FACULTY

Douglas K. Pleskow, MD, AGAF, FASGE Associate Clinical Professor of Medicine Harvard Medical School Co-Director of Endoscopy Beth Israel Deaconess Medical Center Boston, Massachusetts

Konstadinos A. Plestis, MD, FACS System Chief, Cardiothoracic & Vascular Surgery Lankenau Heart Institute Main Line Health Wynnewood, Pennsylvania

Richard L. Prager, MD Professor of Adult Cardiac Surgery Section Head of Adult Cardiac Surgery Co-Director of Frankel Cardiovascular Center University of Michigan Health System Ann Arbor, Michigan

Ramachandra C. Reddy, MD Assistant Chief for Pulmonary Embolism Surgery Mount Sinai Medical Center New York, New York

Evelio Rodriguez, MD, FACC Chief of Cardiac Surgery Saint Thomas Health Medical Director, Saint Thomas Research Institute Saint Thomas West Hospital Nashville, Tennessee

Sanjay A. Samy, MD Associate Professor, Commonwealth Medical College, Department of Cardiothoracic Surgery Guthrie Clinic Sayre, Pennsylvania

Behzad Soleimani, MD, MRCP, FRCS(C-Th) Surgical Director of Transplantation and Mechanical Circulatory Support Assistant Professor of Surgery Penn State Hershey Medical Center and College of Medicine Heart and Vascular Institute Hershey, Pennsylvania

Joshua R. Sonett, MD Professor of Surgery, Chief, General Thoracic Surgery New York Presbyterian Hospital Columbia University Medical Center New York, New York

William E. Stansfield, MD, CM, FACS Assistant Professor of Surgery University of Toronto Toronto, Ontario Canada

Allan S. Stewart, MD Director, Center for Aortic Disease Co-Director, Valve Reference Center Mount Sinai Hospital New York, New York

Bradley S. Taylor, MD, MPH Associate Professor of Surgery Director of Coronary Revascularization University of Maryland Medical Center Baltimore, Maryland

Michael J. Walker, MD, FACS Chief, Thoracic Surgery Medical Director, Cancer Program Main Line Health System Bryn Mawr, Pennsylvania Clinical Associate Professor Sydney Kimmel Medical College Philadelphia, Pennsylvania

Fred Weber, MD, JD Ocean City, New Jersey

Benny Weksler, MBA, MD, FACS Eastridge-Cole Professor of Thoracic Oncology Chief, Division of Thoracic Surgery University of Tennessee Health Science Center Methodist University Hospital Memphis, Tennessee

Andrea S. Wolf, MD, MPH Mount Sinai Medical Center Assistant Professor, Department of Thoracic Surgery The Icahn School of Medicine at Mount Sinai New York, New York

David Zeltsman, MD, FACS Associate Professor of Surgery Chief, Division of Thoracic Surgery Director of Minimally Invasive Thoracic Surgery Long Island Jewish Medical Center New Hyde Park, New York

We Gratefully Acknowledge and Extend a Special Thank You to Our Convention

Exhibitors and Supporters

Exhibitors

Admedus Astute Medical, Inc.

AtriCure, Inc. Boston Scientific Endoscopy

Cook Medical Inc. CSA Medical, Inc.

Davol, Inc., A BARD Company Edwards Lifesciences Corp. Ethicon Endo-Surgery, Inc.

HeartWare, Inc. KLS Martin Ltd. LSI Solutions Maquet, Inc.

Medtronic, Inc. Merit Medical Endotek

Myriad Genetics On-X Life Technologies, Inc.

Sorin Group Spiration, Inc.

St. Jude Medical Transonic Systems Inc.

WL Gore & Associates, Inc. Zimmer Biomet

Supporters

Medtronic, Inc.

PROGRAM DESCRIPTION

This three-day program is the 53rd in a series of annual programs offering a realistic view of current clinical topics in cardiovascular and thoracic surgery, customary and prevailing, controversial and/or investigational, including basic and clinical research. A faculty of leaders are invited to share their knowledge and experience of complex cases of new technology relevant to surgeons practicing this specialty. The format consists of faculty and resident didactic oral presentations with moderated discussion periods, poster presentations and surgical videos focusing on basic research, quality assurance, ischemic heart disease, valvular heart disease, congestive heart failure and treatment, treatment of thoracic aneurysms, lung cancer, esophageal cancer, and thoracic trauma. Physicians will have an enhanced understanding of the latest techniques and current research specifically related to adult cardiovascular surgery and general thoracic surgery. Physicians will be able to utilize the results presented to select appropriate surgical procedures for their own patients and integrate state-of-the-art knowledge into their practice.

TARGET AUDIENCE

The 53rd Annual Meeting of the Eastern Cardiothoracic Surgical Society is designed for cardiothoracic surgeons, including physicians, residents, physician assistants, fellows and other cardiology health care providers.

ACTIVITY GOAL

This activity is designed to address the following ABMS / IOM competencies: Patient Care, Medical Knowledge, Practice-based learning, and System-based practice.

LEARNING OBJECTIVES

At the conclusion of the 53rd Annual Meeting, the participants will be able to:

� Access the effectiveness of existing and evolving treatment options. � Identify key factors in selecting appropriate treatment for patients. � Discuss the technical challenges in the use of new technologies and techniques. � Demonstrate improved competency in cardiothoracic techniques. � Identify the relevant challenges facing the field of cardiothoracic surgery and the possible solutions to those

challenges.

DISCLOSURE

Ciné-Med adheres to accreditation requirements regarding industry support of continuing medical education. Disclosure of the planning committee and faculty’s commercial relationships will be made known at the activity. Speakers are required to openly disclose any limitations of data and/or discussion of any off-label, experimental, or investigational uses of drugs or devices in their presentations.

All Ciné-Med employees in control of content have indicated that they have no relevant financial relationships to disclose.

NON ENDORSEMENT STATEMENT

Ciné-Med verifies that sound education principles have been demonstrated in the development of this educational offering as evidenced by the review of its objectives, teaching plan, faculty, and activity evaluation process. Cine-Med does not endorse or support the actual opinions or material content as presented by the speaker(s) and/or sponsoring organization.

ACCREDITATION

This activity has been planned and implemented by Ciné-Med and the Eastern Cardiothoracic Surgical Society™. Ciné-Med is accredited by the American Nurses Credentialing Center (ANCC), the Accreditation Council for Pharmacy Education (ACPE), and the Accreditation Council for Continuing Medical Education (ACCME), to provide continuing medical education for the health care team. Ciné-Med designates this live activity for a maximum of 13.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

EASTERN CARDIOTHORACIC SURGICAL SOCIETY 53RD ANNUAL MEETING

SCHEDULE OF EVENTS

WEDNESDAY, OCTOBER 14, 2015

4:00 p.m. - 6:00 - p.m. Check-In and Registration

6:00 p.m. - 7:30 - p.m. Welcome Reception

THURSDAY, OCTOBER 15, 2015

6:30 a.m. – 1:00 p.m. Registration

7:00 a.m. - 7:45 a.m. Executive Session

7:30 a.m. - 8:30 a.m. Breakfast Buffet

8:00 a.m. - 8:15 a.m. Opening Remarks Benny Weksler, MBA, MD, FACS President, Eastern Cardiothoracic Surgical Society University of Tennessee Health Science Center, Memphis TN

8:15 a.m. - 9:25 a.m. Expert Session I

Moderators: Bradley G. Leshnower, MD, FACS Emory University School of Medicine, Atlanta, GA

Benjamin E. Haithcock, MD, FACS, FCCP University of North Carolina at Chapel Hill, Chapel Hill, NC

8:15 a.m. - 9:00 a.m. Pulmonary Embolectomy

William R. Auger, MD University of California San Diego, La Jolla, CA

Ramachandra C. Reddy, MD Mount Sinai Medical Center, New York, NY

9:00 a.m. - 9:20 a.m. Stop the Bleeding: Avoiding Additional Risk with Electronic Documentation Elizabeth A. Johns, Esq. Delaware County Memorial, Taylor and Springfield Hospitals, Springfield, PA

9:30 a.m. – 10:30 a.m. Expert Session II

Moderators:

Curtis A. Anderson, MD REX UNC Health Care, Raleigh, NC

Andy C. Kiser, MD, FACS, FACC FCCP University of North Carolina School of Medicine, Chapel Hill, NC

Sharon Ben-Or, MD University of South Carolina at Greenville Greenville, SC

Mark J. Krasna, MD Jersey Shore University Medical Center Neptune, NJ

Cardiovascular Thoracic

9:30 a.m. - 9:50 a.m. Resection vs. Preservation in Degenerative Mitral Valve Disease W. Clark Hargrove, III, MD Penn Presbyterian Medical Center, Philadelphia, PA

Pancoast Tumor: Historic Roots and Evolutionary Progress Joshua R. Sonett, MD New York Presbyterian Hospital/ Columbia University Medical Center, New York, NY

9:50 a.m. - 10:10 a.m. TAVR in Moderate Risk Patients Nimesh D. Desai, MD, PhD Penn Heart & Vascular Center Philadelphia, PA

Pulmonary Sleeve Resections: Tips and Pitfalls Benjamin E. Haithcock, MD, FACS, FCCP University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC

10:10 a.m. – 10:30 a.m. Current State of Durable Mechanical Circulatory Support Behzad Soleimani, MD, MRCP, FRCS Penn State Hershey Heart and Vascular Institute, Hershey, PA

Handport in the Management of Giant Paraesophageal Hernia M. Blair Marshall, MD MedStar Georgetown University Hospital Washington, DC

10:15 a.m. - 11:15 a.m. Refreshments

11:00 a.m. -1:00 p.m. Scientific Session

Moderators: Julian Guitron, MD University of Cincinnati Medical Center, Cincinnati, OH

Rohinton J. Morris, MD Abington/Jefferson Health Systems, Abington, PA

SA1 – Surgical Treatment of Diffuse Complex Pulmonary Arteriovenous Malformations (PAVM) in Pediatric Patients Stephanie Fuller1, Reed E. Pyeritz2, Raezelle Zinman1, Brian Hanna1, Jonathon J. Rome1, Scott O. Trerotola2 1The Children's Hospital of Philadelphia, Philadelphia, PA, USA, 2The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA

SA2 – Alternate Approaches to Femoral Transcatheter Aortic Valve Replacement (TAVR) in High-risk Patients with Limited Peripheral Access or Challenging Aorta Mark A. Groh, William B. Abernethy, Joshua P. Leitner, Gerard L. Champsaur Mission Hospital, Asheville, NC, USA

SA3 – Lymph Node Sampling Rates and Wedge Resection for Primary NSCLC: an Analysis of the SEER Database (2004-2012) Cameron T. Stock, Jr., Karl Uy, Maggie Powers, Geoffrey Graeber UMass Memorial Medical Center, Worcester, MA, USA

SA4 – Total Arch Replacement Using the Trifurcation Graft, Antegrade Cerebral Perfusion in the Era of Endovascular Surgery Ioannis Paralikas1, Oleg Orlov1, Jessica Grippaldi2, Grace E. Kim2, Louis E. Samuels1, Konstadinos Plestis1 1Lankenau Heart Institute, Wynnewood, PA, USA, 2Villanova University, Villanova, PA, USA

SA5 –The Use of Liposomal Bupivacaine in Thoracic Surgery Joseph D. Whitlark, Spencer M. Jackson Thoracic & Vascular Associates of Kinston, Kinston, NC, USA

SA6 – Preventing Knot Failure in Mitral Valve Chordal Replacement Using ePTFE Jacob R. Miller, Corey R. Deeken, Shuddhadeb Ray, Matthew C. Henn, Timothy S. Lancaster, Richard B. Schuessler, Ralph J. Damiano, Spencer J. Melby Washington University in St. Louis, St. Louis, MO, USA

SA7 – Post Surgical Lung Hernia: Is Your Incision At Risk? Allison J. Tompeck, John F. Lazar, MD, Troy A. Moritz, DO, Raymond F. Kostin, MD PinnacleHealth, Harrisburg, PA, USA

SA8 – Prophylactic Application of Hemostatic Agents in Left Ventricular Assist Device Does Not Reduce Chest Tube Output nor Transfusion Requirements Mahim A. Malik1, Arman Kilic2, William Rothstein1, Peter H. Lee1, Bryan A. Whitson1, Robert S. Higgins1, Ahmet Kilic1 1The Ohio State University, Columbus, OH, USA, 2Johns Hopkins University, Baltimore, MD, USA

5:00 p.m. - 6:00 p.m. Movie Night

Moderators: Eric J. Lehr, MD, PhD, FRCSC Swedish Heart and Vascular Institute, Seattle, WA

Michael J. Walker, MD, FACS Main Line Health System, Bryn Mawr, PA

Endovascular Stent Grafting For Leaking Ascending Aortic Pseudoaneurysms Muhammad Aftab, Jay J. Idrees, Eric E. Roselli, Cleveland Clinic Foundation, Cleveland, OH

Hybrid Biport Video Assisted Thoracic Surgical (VATS) Approach for Right Upper Lobectomy Mark Crye, Mathew VanDeusen, Lana Schumacher, Rodney Landreneau, Allegheny Health Network, Pittsburgh, PA

Robotic Transmyocardial Revascularization Sharon Ben-Or, Barry Davis, William Bolton, University of South Carolina at Greenville, Greenville, SC

Laparoscopic Recurrent Giant Paraesophageal Hernia Repair in the "Unfriendly" Abdomen Carlos Anciano, Matthew Kohan, Mark Iannettoni, Ramesh Daggubati, East Carolina University, Greenville, NC

Aortic Valved Conduit in the Mitral Position for Treatment of Mitral Endocarditis Requiring Reconstruction of the Intravalvular Fibrous Body Daniel Watson, Nirvana Siraswat, Angela Peters, Riverside Methodist Hospital, Columbus, OH

Thoracoscopic Left Upper Lobectomy with Suture Closure of Bronchus Jeremiah T. Martin, Angela L. Mahan, Nathan L. Kister, University of Kentucky, Lexington, KY

6:00 p.m. - 7:30 p.m. Case Bowl

Moderators: Sharon Ben-Or, MD University of South Carolina at Greenville Greenville, SC

Fred Weber, MD, JD Ocean City, NJ

FRIDAY, OCTOBER 16, 2015

7:00 a.m. - 3:00 p.m. Registration



Moderators: Zachary N. Kon, MD University of Maryland School of Medicine, Baltimore, MD

Benny Weksler, MBA, MD, FACS University of Tennessee Health Science Center, Memphis, TN

8:00 a.m. - 8:20 a.m. Simulation Based Adverse Event Training in Cardiothoracic Surgery Richard H. Feins, MD, University of North Carolina at Chapel Hill, Chapel Hill, NC

8:20 a.m. - 8:40 a.m. ICD-10 Billing and Coding: What Do You Need to Know? Sanjay A. Samy, MD, Guthrie Clinic, Sayre, PA

9:00 a.m. - 10:45 a.m. Expert Session II

Moderators:

Scott M. Goldman, MD Lankenau Heart Institute Wynnewood, PA

William E. Stansfield, MD, CM, FACS University of Toronto, Toronto, Ontario, Canada

Sebastien Gilbert, MD, FRCSC The Ottawa Hospital, Ottawa, Ontario, Canada

David Zeltsman, MD, FACS Long Island Jewish Medical Center, New Hyde Park, NY


9:00 a.m. - 9:45 a.m. Restrictive vs. Liberal Transfusion Strategy in Cardiac Surgery

Victor A. Ferraris, MD, PhD University of Kentucky College of Medicine Lexington, KY Richard L. Prager, MD University of Michigan Health System Ann Arbor, MI

VATS or RATS for Lung Cancer: Who Really Cares

Abbas E. Abbas, MD, MS, FACS Temple University School of Medicine Philadelphia, PA

Todd L. Demmy, MD Rutgers Cancer Institute of New Jersey, New Brunswick, NJ

9:45 a.m. - 10:05 a.m. Valve Replacement in Middle Age - Mechanical or Bioprosthesis Joanna Chikwe, MD Mount Sinai Hospital, New York, NY

Freeze, Fry or Cut – Endoscopic Management of Barrett’s Esophagus Douglas K. Pleskow, MD, AGAF, FASGE Beth Israel Deaconess Medical Center Boston, MA

10:05 a.m. - 10:25 a.m. Novel Stentless Valve Conduits for Aortic Root Replacement Allan S. Stewart, MD Mount Sinai Hospital, New York, NY

Microvascular Augmented Long-Segment Jejunal Interposition: An Option for the Reversal of an Esophageal Diversion Wayne L. Hofstetter, MD MD Anderson Cancer Center Houston, TX

10:25 a.m. - 10:45 a.m. Practical Tips and Complex Aortic Operations and Reoperations John A. Elefteriades, MD Yale University School of Medicine New Haven, CT

Management of Anastomotic Leaks After Esophagectomy Benny Weksler, MBA, MD, FACS University of Tennessee Health Science Center, Memphis TN


11:00 a.m. - 12:45 p.m. Scientific Session

Moderators: Carlos J. Anciano, MD

East Carolina University, Greenville, SC

Robert J. Moraca, MD Allegheny General Hospital, Pittsburgh, PA

SA9 – Effect of Repeat Sternotomy on Cardiac Surgery Outcomes Anthony Lemaire, George Batsides, Aziz Ghaly, Takashi Nishimura, Leonard Y. Lee Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA

SA10 – Geographic Variability in Video Assisted Thoracic Surgery Adoption: A MedPAR Medicare Analysis of Lobectomy for Primary Lung Cancer Justin D. Blasberg, James D. Maloney, Ryan A. Macke University of Wisconsin Hospital and Clinics, Madison, WI, USA

SA11 – Is the Underlying Etiology of Cardiogenic Shock Associated with Myocardial Recovery in Patients on Veno-Arterial Extracorporeal Membrane Oxygenation? Joshua K. Wong, Amber L. Melvin, Peter A. Knight University of Rochester Medical Center, Rochester, NY, USA

SA12 – Video-Assisted Thoracoscopic Decortication for the Management of Late Stage Pleural Empyema, Is It Easible? Rawan K. Sultan, Waseem Hajjar, Waad Alwgait, Hanoof Alkhalaf King Saud University, Riyadh, Saudi Arabia

SA13 – Characteristics Influencing Outcomes in Patients Who Undergo Extracorporeal Membrane Oxygenation After Cardiopulmonary Resuscitation Amber Melvin, Peter Knight, Joshua Wong University of Rochester, Rochester, NY, USA

SA14 – Management of Prolonged Pulmonary Air Leaks with Endobronchial Valve Placement Charles Bakhos, Peter Doelken, Stevan Pupovac, Tom Fabian Albany Medical Center, Albany, NY, USA

SA15 – The Use of Axillary Cannulation in Re-Do Cardiac Surgery Utilizing Port Access Technology Tyler J. Wallen1, Prashanth Vallabhajosyula2, Lauren Solometo2, W. Clarke Hargrove, III2 1Mercy Catholic Medical Center, Darby, PA, USA, 2University of Pennsylvania Health System, Philadelphia, PA, USA

1:00 p.m. - 2:00 p.m. James A. Magovern, MD Memorial Lectureship Luncheon The Next Frontier: Ex vivo Repair of Organs for Transplantation Shaf Keshavjee, MD, MSc, FRCSC, FACS University of Toronto, Toronto, Ontario Canada

2:15 pm – 3:00 pm Membership Business Meeting

5:00 p.m. - 6:00 p.m. Scientific Poster Rounds

Moderator: Abbas E. Abbas, MD, MS, FACS Temple University School of Medicine, Philadelphia, PA

Sunjay Kaushal, MD, PhD University of Maryland Medcial Center, Baltimore, MD

6:00 p.m. - 7:30 p.m. President’s Reception

SATURDAY, OCTOBER 17, 2015

7:00 a.m. - 1:00 p.m. Registration



Moderators:

Sunjay Kaushal, MD, PhD University of Maryland Medical Center, Baltimore, MD

Sanjay A. Samy, MD Guthrie Clinic, Sayre, PA

William D. Bolton, MD Greenville Hospital System Greenville, SC

John F. Lazar MD PinnacleHealth Cardiovascular Institute, Harrisburg, PA


8:00 a.m. - 8:20 a.m. Concomitant Tricuspid Valve Disease – When to Repair Eric J. Lehr, MD, PhD, FRCSC Swedish Heart & Vascular Institute Seattle, WA

Thermal Ablation Techniques for Lung Cancer: Patient Selection and Outcomes Michael Lanuti, MD Massachusetts General Hospital Boston, MA

8:20 a.m. - 8:40 a.m. Management of the Descending Thoracic Aorta in Type A Aortic Dissection Konstadinos A. Plestis, MD, FACS Lankenau Heart Institute Wynnewood, PA

State of the Art Management of Pulmonary Air Leaks Following Lung Resection Mark R. Dylewski, MD Baptist Health of South Florida South Miami, FL

8:40 a.m. - 9:00 a.m. Multiarterial Grafting in CABG Bradley S. Taylor MD, MPH University of Maryland Medical Center Baltimore, MD

To Spare or Not to Spare the Lung in Malignant Pleural Mesothelioma: Extrapleural Pneumonectomy and Pleurectomy/Decortication Andrea S. Wolf, MD, MPH The Icahn School of Medicine at Mount Sinai, New York, NY

9:00 a.m. - 9:20 a.m. Valve-in-Valve vs. Redo Valve Replacement Evelio Rodriguez, MD, FACC Saint Thomas West Hospital Nashville, TN

3-D Printing of the Trachea: Science Fiction or a Reality Faiz Y. Bhora, MD, FACS Mount Sinai Roosevelt and Mount Sinai St. Luke’s Hospitals, New York, NY

9:20 a.m. - 9:40 a.m. Emergence of Stem Cell Trials in Congenital Heart Disease Patients Sunjay Kaushal, MD, PhD University of Maryland Medical Center Baltimore, MD

Navigational Bronchoscopy and the Art of Tattooing Sharon Ben-Or, MD University of South Carolina at Greenville Greenville, SC


10:00 a.m. - 10:45 a.m. Expert Session II

Moderators: Faiz Y, Bhora, MD, FACS Mount Sinai Roosevelt and Mount Sinai St. Luke’s Hospitals, New York, NY

Eric J. Lehr, MD, PhD, FRCSC Swedish Heart and Vascular Institute, Seattle, WA

10:00 a.m. - 10:45 a.m. Industry’s Involvement in Surgical Education

Richard S. Lazzaro, MD Lenox Hill Hospital, New York, NY

Daniel L. Miller, MD WellStar Kennestone Regional Medical Center, Marietta, GA

10:45 a.m. - 12:00 p.m. Scientific Session

Moderators: Zachary N. Kon, MD University of Maryland School of Medicine, Baltimore, MD

Andrea S. Wolf, MD, MPH The Icahn School of Medicine at Mount Sinai Medical Center, New York, NY

SA16 –Intracoronary Delivery of Cardiac Stem Cells to the Right Ventricle: Preclinical Assessment in a Swine Model Sunjay Kaushal, Brody Wehman, Osama Siddiqui, Godly Jack, Rachana Mishra, Tieluo Li, Mark Vesely University of Maryland School of Medicine, Baltimore, MD, USA

SA17 – Identifying Small Pulmonary Nodules for Minimally Invasive Resection: The Role of Electromagnetic Navigational Bronchoscopy Katy A. Marino, Jennifer Sullivan, Benny Weksler UTHSC, Memphis, TN, USA

SA18 – 15-A-42-ECTSS Which Patients are at Risk for Distal Aortic Pathology Following Conservative Repair of Acute Type A Aortic Dissection? Kellianne Kleeman, Himanshu Patel, Donald Likosky, Bo Yang, Matthew Romano, Elise Woznicki, Michael Paulsen, Kevin Schmidt, Zhyldyz Kabaeva, Michael Ranella, Theron Paugh, G. Michael Deeb University of Michigan, Ann Arbor, MI, USA

SA19 – Electromagnetic Navigational Bronchoscopy Reduces the Time Required for Localization and Resection of Lung Nodules William D. Bolton, Thomas Cochrane, Andrew Binks, James Stephenson, Allison Hale, Sharon Ben-Or University of South Carolina at Greenville, Piedmont, SC, USA

SA20 – Regional Variability of In-Patient Outcomes for Coronary Artery Bypass in the United States Ahmed Ali1, Anahita Dua1, Dustin Hang1, Sapan Desai2. 1Medical college of WI affiliated hospitals, Wauwatosa, WI, USA, 2Southern Illinois University, Carbondale, IL, USA

12:15 p.m. - 12:30 p.m. Closing Remarks Benny Weksler, MBA, MD, FACS President, Eastern Cardiothoracic Surgical Society University of Tennessee Health Science Center, Memphis TN

NOTES FROM THE EASTERN 2015

SCIENTIFIC ABSTRACT – SA1

SA1. Surgical Treatment of Diffuse Complex Pulmonary Arteriovenous Malformations (PAVM) in Pediatric Patients

Stephanie Fuller1, Reed E. Pyeritz2, Raezelle Zinman1, Brian Hanna1, Jonathon J. Rome1, Scott O. Trerotola2 1The Children's Hospital of Philadelphia, Philadelphia, PA, USA, 2The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA

Objective: Diffuse-type PAVMs respond poorly to embolotherapy. Although initial response is favorable, progressive development of bronchial to pulmonary collaterals is common and incurs late morbidity and mortality. When PAVMs are limited, surgery can be curative and prevents the long-term sequelae of collateral formation and resultant hemoptysis.

Methods: Three hypoxemic pediatric patients ages 10, 13 and 15, with diffuse-type PAVMs limited to one lung were treated by resections including wedge, lobectomy and pneumonectomy. Two patients with hereditary hemorrhagic telangiectasia (HHT) had multiple embolotherapy treatments prior to surgery. The third had resection without embolization. The outcomes of embolotherapy and surgery were analyzed retrospectively.

Results: Embolotherapy was performed 4 times in one patient and 5 times in another using conventional techniques (coils, microcoils) starting as peripherally as possible and working centrally as previously described. Initial response to embolotherapy in these patients yielded improvement in O2 sat to >90%. Failures of embolotherapy were declared for hemoptysis (n=1) and intractable hypoxemia (n=3). Lung resection via thoracotomy was successful in all patients with normal postoperative O2 saturation on room air at follow-up. Hemoptysis has not occurred post-surgery.

Conclusion: Surgery is successful in treating limited diffuse-type PAVMs. With careful patient selection, curative resection may be considered front-line therapy in this rare patient population as it avoids repeated radiation exposure and eliminates the risk of bronchial collateral formation.


SA2. Alternate Approaches to Femoral Transcatheter Aortic Valve Replacement (TAVR) in High-risk Patients with Limited Peripheral Access or Challenging Aorta

Mark A. Groh, William B. Abernethy, Joshua P. Leitner, Gerard L. Champsaur Mission Hospital, Asheville, NC, USA

Objective: As TAVR volumes increase, reducing risk for patients with access, aortic, or implantation issues is critical to improving implant results. We are increasingly seeking alternate approaches for TAVR and we are assessing in this work their potential clinical benefits.

Methods: Between 2012 and 2015, a consecutive series of 145 patients underwent a TAVR in our Institution. All data were entered prospectively in our local ACC/STS/TVT database and retrieved for analysis. The types of procedures were 8 cases of trans-apical (TA), 62 cases of trans-femoral (TF), and 75 cases of trans-aortic (TAo) approaches, including a trans-innominate artery route (TI) in 23 recent cases.

Results: Demographics and procedure data are displayed in Table 1 and Figure 1 for the two approaches (TAo vs. TF) since there were no significant differences between original TAo and recent TI cases. TAo was performed in higher risk patients, with a more severe mean STS risk score and more frequent comorbidities although ages were not different. TAo procedures were shorter than TF ones and patients received smaller contrast volumes, radiation doses, and shorter fluoroscopy times. There were 8 strokes in the whole series, 5 in TF patients and 3 after TAo, and 2 TIAs, one in each group. Pre-discharge mortality (4%) was equivalent in both groups.

Conclusions: TAo and TI approaches have led to similar short-term outcomes in a higher risk population than our TF cases. Alternate access via the innominate artery is increasingly used at our Institution as it provides reliable easy access with minimal sternal disruption.

Table 1 - Peri-operative Variables. Data Expressed as Mean±SD or Frequency and (%).

Variable TF, n= 62 TAo, n= 75 p value

Age 84.9±7.4 83.9±7.5 0.481

Pre-op. Hemodialysis 0.0% 7±0.3% 0.038

STS risk Score, % 6.5±2.4% 8.9±6.1% 0.006

Left Main Disease 1 (1.6) 18 (25) 0.010

Procedure duration, H:mn 2:16±1:04 1:50±0:47 0.006

Device success 0.85±0.36 0.95±0.33 0.063

Contrast Volume, ml 114.9±47.8 70.99±33.15 <0.001

Fluoro time, mn:sec 19:4±6:5 10:2±18:5 <0.001

Fluoro dose, PKA 1060.5±864.8 628.9±613.3 0.001

Figure 1 – Number of Cases Per Procedure Per Year


SA3. Lymph Node Sampling Rates and Wedge Resection for Primary NSCLC: an Analysis of the SEER Database (2004-2012)

Cameron T. Stock, Jr., Karl Uy, Maggie Powers, Geoffrey Graeber UMass Memorial Medical Center, Worcester, MA, USA

Objective: Low rates of lymph node (LN) sampling in patients undergoing non-anatomic sub-lobar resections for NSCLC compared with lobectomty have been reported. LN status plays a role in determining which patients receive adjuvant therapy following resection. Given the interest in LN sampling for staging and adjuvant treatment, the SEER database from 2004-2012 was analyzed to determine if the rates of LN sampling have changed over time.

Methods: The SEER database was queried from 2004-2012. All patients who underwent wedge resections for NSLC during this time were included. Overall, 5135 patients were included in the analysis. Patients were excluded if the number of lymph nodes sampled was reported as unknown at the time of surgery.

Results: Overall, 47.7% had no lymph nodes sampled (-nodal sampling). When analyzed over time, from 2004-2007 50.1% of patients -nodal sampling, 2008-2010 48.3% of patients -nodal sampling, from 2011-2012 43.1% of patients -nodal sampling. When matched for T stage (T1a) from 2010-2012 the overall survival was 92.4% in patients + nodal sampling vs. 87% in patients -nodal sampling. The cancer specific survival was 96.2% +nodal sampling vs. 92.6% -nodal sampling. 6% of patients with T1a lung cancer had positive nodes when pathologically staged.

Conclusions: The percentage of patients who fail to have LN sampling performed when undergoing wedge resection has decreased over time. However, as of 2012 over 40% of patients did not have LN sampled. In patients with T1a lesions, LN sampling correlates with increased survival possibly due to improved staging.


SA4. Total Arch Replacement Using the Trifurcation Graft, Antegrade Cerebral Perfusion in the Era of Endovascular Surgery

Ioannis Paralikas1, Oleg Orlov1, Jessica Grippaldi2, Grace E. Kim2, Louis E. Samuels1, Konstadinos Plestis1 1Lankenau Heart Institute, Wynnewood, PA, USA, 2Villanova University, Villanova, PA, USA

Objective: To evaluate the impact of hypothermic circulatory arrest (HCA), antegrade cerebral perfusion (ACP) and the utilization of trifurcation graft (TG) in the outcomes of patients who underwent total aortic arch replacement (TAAR).

Methods: This is a retrospective analysis of prospectively collected data from 70 patients who underwent TAAR between 2005 and 2014. There were 39(53.4%) male patients (mean age 62.2±16). Thirty (41%) patients had aortic dissections (10 Acute and 20 Chronic), 29 (40%) had medial degeneration and 3 (4%) had Marfan’s syndrome. Out of thirty three (59%) patients who had previous cardio-aortic surgery, 5(6.9%) had aortic valve replacement, 17(23.3%) had ascending aortic replacement and 5(6.9%) had composite valve replacement.

Results: The mean pump time was 216±76, mean aortic cross clamp time was 128±70, mean circulatory arrest time was 21.3±18, and mean antegrade cerebral perfusion time was 58±30 minutes. The hospital mortality was 7%(5 patients). Three (4%) patients had stroke, 5(6.9%) had transient neurologic dysfunction, 6(8.22%) had new onset of renal insufficiency and 31(44.2%) had prolonged ventilatory support (≥48 hours) postoperatively. Reoperation for bleeding was required in 8(11.4%) patients.

Ten (15.4%) patients died during the follow-up (mean: 714.2±507.8 days). The survival probability at 1 year is 0.997, 3 years is 0.86 and at 5 years is 0.817.

Conclusion: The utilization of HCA, ACP and the trifurcation graft has led to excellent perioperative and midterm outcomes for patients undergoing TAAR.


SA5. The Use of Liposomal Bupivacaine in Thoracic Surgery

Joseph D. Whitlark, Spencer M. Jackson Thoracic & Vascular Associates of Kinston, Kinston, NC, USA

Objective: Liposomal Bupivacaine is a long acting local anesthetic agent which lasts between 72 to 96 hours after injection. It has been used widely in orthopedic surgery. We began using this in our thoracic surgery patients and noticed an improvement not only postoperatively but also long-term.

Methods: We retrospectively compared a group of 20 patients treated with intrathoracic intercostal nerve blocks using liposomal bupivacaine and compared this to 20 patients who had been blocked with just bupivacaine.

Results: What we found from analyzing these two groups of patients was that liposomal bupivacaine not only decreased length of stay but also decreased narcotic use postoperatively and after discharge.

Conclusions: This procedure is done intrathoracically and can be done quite quickly. A recent paper from MD Anderson Cancer Center shows no significant difference between intercostal Liposomal Bupivacaine blocks and thoracic epidurals. However, thoracic epidurals add time to the case and also had some issues such as urinary retention and hypotension postoperatively. We have found that the Liposomal Bupivacaine intercostal blocks are actually better from a pain control perspective. Not only are the cases shortened and postoperative management simplified, but we have found it better for long-term pain control.


SA6. Preventing Knot Failure in Mitral Valve Chordal Replacement Using ePTFE

Jacob R. Miller, Corey R. Deeken, Shuddhadeb Ray, Matthew C. Henn, Timothy S. Lancaster, Richard B. Schuessler, Ralph J. Damiano, Spencer J. Melby Washington University in St. Louis, St. Louis, MO, USA

Objective: Expanded polytetrafluoroethylene (ePTFE) suture is commonly used for chordal replacement in mitral valve repair, but due to material characteristics, knots can unravel. Our aim was to determine the knot security, including how many throws are necessary to prevent knot failure, with two currently available ePTFE suture types.

Methods: Knots were evaluated for the maximum load prior to knot failure based on the number of throws (6, 8,10 and 12), tension to secure each throw (10, 50 and 85% of the knot holding power) and type of ePTFE (2 suture types). Ten knots per group were analyzed. A relative physiological force of 2N was used for comparison.

Results: A total of 240 knots were evaluated. For all knots, the mean load to knot failure was 11.1±5.8N. Failure occurred due to unraveling in 141 (59%) at 7.1±4.1N and breaking in 99 (41%) at 16.7±2.0N (p<0.01). Increasing throws increased the maximum load to failure (p<0.01), with a significant increase between 8 (8.2±3.9N) and 10 throws (15.3±3.4N) (p<0.01, Figure 1) due to the reduced rate of unraveling. Six (5%) of each suture type unraveled at 2N, all occurring with less than 10 throws (Table 1).

Conclusions: ePTFE suture, used commonly for mitral valve chordal replacement, has adequate strength to prevent breakage. However, there exists a risk of knot unraveling. This study demonstrated that, at physiologic conditions, the unravelling of knots is significantly reduced by performing at least 10 throws with ePTFE suture.

Figure 1 - Maximal Load Prior to Knot Failure Based on Number of Throws, Grouped by Method of Failure

Table 1 - Rate of Failure at 2N Based on Number of Throws and Tension Used to Secure Each Throw

Tension Groups

Number of throws 1.4N 7.1N 12.1N

6 (n=20) 0.30 0.25 0

8 (n=20) 0.05 0 0

10 (n=20) 0 0 0

12 (n=20) 0 0 0


SA7. Post Surgical Lung Hernia: Is Your Incision At Risk?

Allison J. Tompeck, John F. Lazar, Troy A. Moritz, Raymond F. Kostin PinnacleHealth, Harrisburg, PA, USA

Objective: With an incidence of <0.1%, lung herniation is only described in single case reports. We present our experience, the largest single institution case series to date, of 7 patients with post-surgical lung requiring operative repair.

Methods: From 2011 to 2015, 7 male patients between the ages of 54 and 73, presented with lung herniation following open thoracotomy in 1 patient, robotic assisted coronary artery bypass in 3 patients, and minimally invasive mitral valve replacement in 3 patients. A single cardiothoracic surgeon performed all consultations and subsequent 7 procedures. Each operation included isolation of the hernia sac, obliteration of seroma cavity, and repair of chest wall with either interrupted sutures or mesh implantation.

Results: Time to presentation ranged from post-operative day 22 to 196, with an average of 121 days. Chest wall defects were repaired primarily in 5 patients, while 2 patients required mesh reinforcement. 1 patient returned to operating room on postoperative day 3 for evacuation of hematoma. No other complications were identified prior to discharge with an average stay of 4 days. Regardless of technique, no morbidity, mortality or recurrence was observed at 50 day average follow up.

Conclusions: The anatomic differences of the anterior chest wall infer an inherent weakness and incisions in this location may be at increased risk of lung herniation. In addition, activities that increase intrathoracic pressure during recovery promote herniation. Our experience suggests that symptomatic lung herniation can be successfully repaired primarily or with mesh implantation, at minimal risk.


SA8. Prophylactic Application of Hemostatic Agents in Left Ventricular Assist Device Does Not Reduce Chest Tube Output nor Transfusion Requirements

Mahim A. Malik1, Arman Kilic2, William Rothstein1, Peter H. Lee1, Bryan A. Whitson1, Robert S. Higgins1, Ahmet Kilic1. 1The Ohio State University, Columbus, OH, USA, 2Johns Hopkins University, Baltimore, MD, USA

Objectives: The objective of this study was to evaluate the impact of using topical hemostatic agents on postoperative bleeding in patients undergoing left ventricular assist device (LVAD) implantation.

Methods: Patients undergoing LVAD implantation between 2012 - 2014 at our institution were reviewed. Primary stratification was by use of hemostatic agent on the inflow suture line, and secondary stratification was by type of hemostatic agent. The primary outcome was requiring a blood transfusion in the first 48 hours postoperatively. Secondary outcomes included cumulative chest tube output in the first 48 hours postoperatively, number of red blood cell units transfused, and re-exploration for bleeding. Multivariable analyses were also conducted incorporating univariate predictors for risk adjustment.

Results: 90 LVAD implants were performed, and hemostatic agents were utilized in 56 (62.2%), including 29 (32.2%) with fibrin sealant and 27 (30.0%) with an albumin and glutaraldehyde based sealant. The groups were well matched with no between-group differences. There was no difference in blood transfusion rates in the first 48 hours (58.8% no sealant versus 51.8% sealant; p=0.52) (Table 1). Multivariable analyses adjusting for potential confounders including use of heparin postoperatively confirmed that sealant use did not reduce the odds of requiring a blood transfusion or reduce chest tube output (each p>0.05).

Conclusions: In this series of LVAD implants, the use of hemostatic agents on the inflow suture line did not reduce the occurrence of clinically significant bleeding. In the setting of rising cost of healthcare, judicious use of hemostatic agents seems most prudent.

Table 1 - Outcome Comparison Between Sealant and No Sealant Groups

Sealant group (n=34 No sealant (n=57 p-value

Chest tube output (ml per patient) 2539.9+/-1197.2 2880.1+/-1921.1 0.36

Blood transfusion at 48 hrs (n/%) 20(58.8%) 29 (51.1%) 0.52

RBC units transfused (units per patient) 1.94 +/-2.49 2.12 +/-3.44 0.80

Re-exploration for bleeding (n/%) 5 (14.7%) 7 (12.5%) 0.77


SA9. Effect of Repeat Sternotomy on Cardiac Surgery Outcomes

Anthony Lemaire, George Batsides, Aziz Ghaly, Takashi Nishimura, Leonard Y. Lee Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA

Objective: To determine the impact of repeat sternotomy after adult cardiac surgery on surgical outcomes. The primary endpoints include operative mortality and rate of reoperation for bleeding.

Methods: A retrospective review of prospectively collected data from a single institution. The patients underwent coronary artery bypass grafting (CABG), valvular surgery (VS), CABG and VS and other procedures from July 1, 2011 to December 31, 2013. Charts were evaluated for demographics, operative details and postoperative outcomes. Operative mortality was defined as death within 30-days of surgery.

Results: The average age of the patients was 67.13 ±14 and the majority of the patients were male (N=118). We identified 165 patients who underwent adult cardiac surgery. Of the patients, 54 patients had an aortic valve replacement (AVR), 34 patients had a mitral valve procedure, 14 patients had multiple valvular procedures, 24 patients had CABG, 10 patients had CABG and VS, and 29 patients had additional procedures including aortic dissection repair. The mortality rate was 6.06% for the entire group with 3% mortality for AVR, and 0% for CABG. The rate of reoperation for bleeding is 2.4% for the entire group with 1.9% for AVR, and 0% for CABG.

Conclusions: Repeat sternotomy has increased risk for patients undergoing adult cardiac surgery. The data from our study shows that the patients who underwent redo-sternotomy had low mortality and the rate of reoperation is low at 2.4% for postoperative bleeding. Although the risks are enhanced with the proper preparation patients can have successful outcomes.


SA10. Geographic Variability in Video Assisted Thoracic Surgery Adoption: A MedPAR Medicare Analysis of Lobectomy for Primary Lung Cancer

Justin D. Blasberg, James D. Maloney, Ryan A. Macke University of Wisconsin Hospital and Clinics, Madison, WI, USA

Objective: VATS lobectomy has slowly become an accepted surgical approach for lung cancer treatment. However, recent reports indicate less than half of lobectomies are performed by VATS, despite evidence supporting oncologic efficacy and decreased morbidity. We examined nationwide lobectomy trends to identify predictors of VATS adoption (Figure 1).

Methods: MedPAR Medicare hospital data (2010 to 2012) was used to identify principal procedures for lobectomy (ICD-9 codes 32.41-VATS, 32.49-open, MS-DRG codes 163,164,165) for primary lung cancer. Data was stratified by region according to Medicare Provider ID. Descriptive analytics were performed to identify geographic variation and institutional characteristics.

Results: In 2012, 15,114 lobectomies were performed in 1832 hospitals (39.6% by VATS). Low-volume hospitals performing ≤ 10 lobectomies annually (1366 hospitals,74.6%) had lower VATS adoption rates (27.3%,1206/4418 lobectomies) compared to high-volume hospitals (44.6%,4773/10969 lobectomies,p<0.001). Proportion of VATS versus open lobectomies varied by region: Northeast (53.3%,41.3-65.5%), Midwest (30.0%,0-40.7%), South (39.4%,7.7-55.5%), and West (38.5%,15.4-55.2%). Northeast hospitals with resident training programs, within large cities (>500,000 people), and in the top 10% by volume (>30 lobectomies annually) had VATS adoption rates of 73.2% (62.4-84.4%). Northeast data trended from 2010 to 2012 demonstrated increased VATS utilization in high-volume centers and stagnant adoption in low-volume centers.

Conclusions: There is wide variation in VATS utilization, with increased adoption rates in high-volume centers and institutions with resident training programs. Variability in VATS utilization is greatest when comparing hospital setting, region, and volume. Increased efforts to educate lower-volume surgeons in rural and non-teaching hospitals are needed if increased VATS adoption is expected.

Figure 1


SA11. Is the Underlying Etiology of Cardiogenic Shock Associated with Myocardial Recovery in Patients on Veno-Arterial Extracorporeal Membrane Oxygenation?

Joshua K. Wong, Amber L. Melvin, Peter A. Knight University of Rochester Medical Center, Rochester, NY, USA

Objectve: Myocardial recovery in patients with cardiogenic shock (CS), stabilized on Veno-Arterial (VA) Extracorporeal Membrane Oxygenation (ECMO) may be associated with the underlying etiology of CS. This study seeks to determine myocardial recovery patterns by CS etiology in patients on VA-ECMO.

Methods: This is a retrospective review of 103 adult patients supported on VA-ECMO for acute-CS from January 2010-2015. Myocardial recovery was estimated by serial left ventricular ejection fraction improvement (LVEF-I) measurements using echocardiography at a minimum of 48 hours apart. Patients with <2 LVEF measurements or a baseline LVEF >35% were excluded.

Results: Forty-two patients supported on VA-ECMO met criteria and were analyzed. Indications for support were CS secondary to ischemia, post-cardiotomy shock, malignant arrhythmia and cardiomyopathy in 15 (35.7%), 17 (40.5%), 5 (11.9%) and 5 (11.9%) patients while the mean baseline LVEF was 15.3%, 17.9%, 12.0% and 10.0% in CS-ischemia, CS-post-cardiotomy, CS-arrhythmia and CS-cardiomyopathy patients respectively (p=0.21) There was a trend towards a significant difference in mean LVEF-I between CS-ischemia (+25.6%), CS-post-cardiotomy (+15.3%), CS-arrhythmia (+4.2%) and CS-cardiomyopathy (+18.0%) patient groups (p=0.07). 18 patients (18/22, 81.8%) who had LVEF-I ≥15% successfully weaned to recovery versus 2 patients (2/20, 10.0%) with LVEF-I <15% (OR: 40.5, CI: 6.6-249.7, p<0.001). Overall survival was not different between patients by indication groups (p=0.39) (Table 1).

Conclusions: Myocardial recovery for acute CS patients stabilized on VA-ECMO may be associated with the underlying etiology of CS. Our data suggests patients with LVEF-I ≥15% have a significantly higher likelihood of weaning from VA-ECMO without the need for further mechanical support.


SA12. Video-Assisted Thoracoscopic Decortication for the Management of Late Stage Pleural Empyema, Is It Easible?

Rawan K. Alsultan, Waseem Hajjar, Waad Alwgait, Hanoof Alkhalaf King Saud University, Riyadh, Saudi Arabia

Objective: The aim was to estimate the effectiveness of thoracoscopic debridement in the advanced stages of pleural empyema.

Methods: All patients with pyogenic empyema (stage II & Stage III) in our Hospital, (admitted from January 2009 to December 2013) who did not respond to chest tube/pigtail drainage and/or antibiotic therapy were treated with VATSD and/or open thoracotomy. Prospective evaluation was carried out and the effect of this technique on perioperative outcomes was appraised to evaluate our technical learning with the passage of time and experience with VATS for late stage empyema management.

Results: Out of total 63 patients, 26 had stage II empyema and 37 had stage III empyema. VATSD was employed on all empyema patients admitted in our Hospital. VATSD was successful in all patients with stage II empyema. Twenty-five patients (67.6%) with stage III empyema completed VATSD successfully. However, only 12 cases (32.4%) required conversions to open (Thoracotomy) drainage (OD). The median hospital stay for stage III VATSD required 9.65±4.1 days. Whereas, patients who underwent open thoracotomy took longer time (21.82±16.35 days). Similarly, stage III VATSD and stage III open surgery cases showed significance difference among chest tube duration (7.84±3.33 days for VATS and 15.92±8.2 days for open thoracotomy).

Conclusions: VATSD facilitates the management of fibrinopurulent, organized pyogenic pleural empyema with less postoperative discomfort, reduced hospitalization, and have fewer postoperative complications. VATSD can be an effective, safe as first option for patients with stage II pleural empyema, and feasible in most patients with stage III pleural empyema.


SA13. Characteristics Influencing Outcomes in Patients Who Undergo Extracorporeal Membrane Oxygenation After Cardiopulmonary Resuscitation

Amber Melvin, Peter Knight, Joshua Wong University of Rochester, Rochester, NY, USA

Objective: It is well established that patients with cardiac arrest related to cardiogenic shock are at high risk for mortality. Often venoarterial extracorporeal membrane oxygenation (VA-ECMO) is used in these patients as a life-saving measure. We analyzed this population to review outcomes and determine pre-ECMO characteristics that may confer survival benefit.

Methods: This is a retrospective review of patients treated with VA-ECMO after CPR from January 2010-2015; post-cardiotomy patients were excluded. The mean age of the population was 53.0. (Table 1) The primary outcome was survival until ECMO termination, whether to ECMO wean or intervention. Pre-ECMO characteristics that were analyzed include pH, lactate, time from CPR to ECMO initiation, and pre-ECMO ejection fraction.

Results: A total of 103 VA-ECMO patients were identified, of which 47 (45.6%) had CPR prior to ECMO. Patients with pH7.25 had 70% (16/22) survival (OR 3.8095, CI 0.99-14.6, p 0.05). There were no survivors with pH<7.0 (4/39). Patients who survived had no statistically significant difference in pre-ECMO lactate levels, ejection fraction, or time from CPR to ECMO initiation from nonsurvivors. There was no statistically significant survival difference in patients who underwent CPR prior to ECMO compared to those who did not.

Conclusions: Patients with pH < 7.25 have inferior survival; furthermore patients with pH <7.0 have 0% survival although the population is small. It may be advisable to avoid ECMO in patients with pH <7.25. Interestingly the time from CPR to ECMO was not statistically significant.

Table 1 - Pre-ECMO Patient Demographics

Survival (n=22)

Non-survival (n=17) P value

Age 54.67 51.11 0.470

Sex – Male 13 (59%) 14 (82%) 0.169

Diabetes Mellitus 3 (14%) 3 (18%) 1.000

Hypertension 12 (55%) 6 (35%) 0.334

Hyperlipidemia 6 (27%) 7 (41%) 0.497

Prior CVA 0 (0%) 3 (18%) 0.074

PVD 0 (0%) 0 (0%) 1.000

History of Chronic Renal Injury 0 (0% 0 (0%) 1.000


SA14. Management of Prolonged Pulmonary Air Leaks with Endobronchial Valve Placement

Charles Bakhos, Peter Doelken, Stevan Pupovac, Tom Fabian Albany Medical Center, Albany, NY, USA

Objective: Prolonged pulmonary air leaks (PAL) are associated with increased morbidity and extended hospital stay. Our goal is to investigate if the bronchoscopic placement of one-way valves can help treat this condition.

Methods: We queried a prospectively maintained database of all patients with PAL lasting more than 7 days at a single tertiary medical center. Main outcome measures included duration of chest tube placement and hospital stay before and after valve deployment.

Results: Sixteen patients were eligible to be enrolled from 2012 until 2015. One patient refused to give consent and in 4 patients the source of air leak could not be identified with bronchoscopic balloon occlusion. Eleven patients (9 male, mean age 65 ± 15) underwent bronchoscopic valve deployment. Eight patients had postoperative PAL and 3 had a secondary spontaneous pneumothorax. The mean duration of air leak prior to valve deployment was 16 ± 12 days, and the mean number of implanted valves 1.9 (mode=2, median=2). Median duration of hospital stay before and after valve deployment was 12 and 7 days, respectively (p=0.05). Digital monitoring demonstrated a mean drop in air leak flow of 1200 ml/min after valve deployment. There were no procedural complications related to deployment or removal of the valves.

Conclusions: Bronchoscopic placement of one way valves is a safe procedure that can help manage patients with prolonged PAL and shorten the hospital stay. A prospective randomized trial with cost-efficiency analysis is necessary to better demonstrate the role of this minimally invasive modality.

Figure 1 - Digital air leak monitoring guiding the placement of a single endobronchial valve in a Patient with interstitial lung disease after a thoracoscopic wedge resection of an adenocarcinoma of the RML (right middle lobe) (a: balloon occlusion of right upper lobe bronchus; b: balloon occlusion of right lower lobe bronchus)


SA15. The Use of Axillary Cannulation in Re-Do Cardiac Surgery Utilizing Port Access Technology

Tyler J. Wallen1, Prashanth Vallabhajosyula2, Lauren Solometo2, W. Clarke Hargrove, III2 1Mercy Catholic Medical Center, Darby, PA, USA, 2University of Pennsylvania Health System, Philadelphia, PA, USA

Objective: Re-do cardiac surgery via port access technology has been described by several centers. Patients requiring re-do surgery often have significant comorbidities, including significant vascular disease which can make standard cannulation difficult. This study compares clinical outcomes of patients undergoing redo cardiac surgery via a port access approach with axillary cannulation to those with femoral cannulation.

Methods: From 2002-2015, patients undergoing redo cardiac surgery via a port access approach were divided into those receiving axillary arterial cannulation (Group 1, n=11) and those receiving femoral cannulation (Group 1, n=90).

Results: Group 1 was older (73 years in group 1, 64 in group 2, p=<0.05). Other demographics were similar (Table 1). Cardiopulmonary bypass time was similar (CBP: 133, 152 min, p=NS), however, cross clamp time was longer in group 2 (cross clamp: 44, 90 min, p=<0.05). Sternotomy conversion rate was similar in both groups (0%, 4%, p=NS). Death, stroke, aortic dissection, transfusion requirement, and wound infection rates were similar (death: 0%, 3%; stroke: 0%, 1%; aortic dissection: 9%, 3%; transfusion requirement: 55%, 47%; wound infection: 0%, 1%, p=NS in all categories). Reoperation rate for bleeding and for valvular indications was similar (bleeding reoprations: 0%, 6%; valve reoperations: 0%, 2%, p=NS) (Table 2).

Conclusions: Outcomes in patients undergoing redo cardiac surgery via a port access approach with axillary cannulation are equivocal to those who receive femoral cannulation. Axillary cannulation is a suitable option in patients with vascular disease prohibitive of standard cannulation.

Table 1 - Demographics

Preoperative Characteristics Group 1 (n=11) Group 2 (n=90) P

Age (years) 73 +/- 7 64 +/- 14 0.0484

Male 6 (55%) 56 (62%) 0.5058

NYHA >2 8 (73%) 58 (64%) 0.4874

Ejection Fraction (%) 48 +/- 14 47 +/- 14 0.8308

Table 2 - Operative Data and Clinical Outcomes

Operative Data Group 1 (n=11) Group 2 (n=90) P

MVR 5 (45%) 39 (43%) 1

MV Repair 6 (55%) 45 (50%) 1

Other 0 (0%) 6 (7%) 1

Cross Clamp Time (min) 44 +/- 45 90 +/- 49 0.0055

CPB Time (min) 133 +/- 33 152 +/- 47 0.2172

Conversion to Sternotomy 0 (0%) 4 (4%) 1

Clinical Outcomes Group 1 (n=11) Group 2 (n=90) P

Death 0 (0%) 3 (3%) 1

Stroke 0 (0%) 1 (1%) 1

Aortic Dissection 1 (9%) 3 (3%) 0.3742

Wound Infection 0 (0%) 1 (1%) 1

Transfusion Requirement 6 (55%) 42 (47%) 0.7527

Reop for Bleeding 0 (0%) 5 (6%) 1

Redo Valve Surgery 0 (0%) 2 (2%) 1


SA16. Intracoronary Delivery of Cardiac Stem Cells to the Right Ventricle: Preclinical Assessment in a Swine Model

Sunjay Kaushal, Brody Wehman, Osama Siddiqui, Godly Jack, Rachana Mishra, Tieluo Li, Mark Vesely University of Maryland School of Medicine, Baltimore, MD, USA

Objective: Cell-based therapies are currently under investigation in patients with hypoplastic left heart syndrome. However, the optimal technique for cell delivery to the right ventricle has yet to be explored in a preclinical model.

Methods: Human c-kit+ cardiac stem cells (CSCs) were delivered to Yorkshire swine (n=12) via the proximal right coronary artery (RCA) over 4 three-minute inflation periods. To evaluate the effects of escalating cell dose on myocardial distribution, pigs were divided into three dosing groups (low: n=3; medium: n=3; high: n=3). In a fourth group (n=3), serial cardiac enzymes were measured at baseline, 6 and 24 hours post-infusion. Human CSCs were identified with immunohistochemistry.

Results: The majority of CSCs were identified in the lateral RV free wall in a dose-dependent manner (p for linear trend <0.01, Figure 1), consistent with the anatomic course of the RCA. Few CSCs were identified in medial segments of the RV, RVOT and septum. Eight (75%) pigs experienced transient ST segment changes in the precordial leads during cell delivery, which resolved spontaneously. However, at 24 hours post-infusion, cardiac enzymes were markedly increased compared to baseline.

Conclusions: Intracoronary delivery results in a limited biodistribution of CSCs to the RV. Use of the stop-reflow technique in the proximal RCA may increase risk for ischemic injury. Alternative strategies, such as intramyocardial injection or cardiopulmonary bypass-assisted coronary infusion at the time of planned surgical intervention may provide a more homogenous distribution of cells and minimize risk of myocardial infarction in patients with non-ischemic etiologies of RV dysfunction.

Figure 1 - Biodistribution of Cardiac Stem Cells to the Right Ventricle Following Intracoronary Delivery to the Right Coronary Artery


SA17. Identifying Small Pulmonary Nodules for Minimally Invasive Resection: The Role of Electromagnetic Navigational Bronchoscopy

Katy A. Marino, Jennifer Sullivan, Benny Weksler UTHSC, Memphis, TN, USA

Objective: Pulmonary Nodules smaller than 1 cm can be difficult to identify during minimally invasive resection (VATS), often requiring conversion to thoracotomy. We hypothesized that localizing nodules with electromagnetic navigational bronchoscopy (ENB) and marking them with methylene blue (MB) would allow VATS and reduce conversion to thoracotomy.

Methods: We identified all patients who underwent ENB followed by VATS from 2011 to 2014. Lung nodules smaller than 10 mm and nodules smaller than 20 mm and located more than 10 mm from the pleural surface were localized and marked with MB. Immediately after marking, all patients underwent resection.

Results: 70 patients underwent ENB marking followed by VATS. There were 41 males; median age was 57 years (range 23-82, interquartile range [IQR] 15). The majority of patients (68/70) had one nodule localized; 2/70 had two nodules localized. Median nodule size was 8 mm (4-17, IQR 5). Median distance from the pleural surface was 6 mm (1-19, IQR 6). There were no conversions to thoracotomy. Nodule marking was successful in 70 of 72 attempts (97.2%) with 2 nodules identified by palpation. The majority of patients (31/70, 44.3%) had metastases from other sites (Table 1). There were no complications related to ENB marking or wedge resections.

Conclusions: Localizing and marking small nodules using ENB is safe and effective for identification prior to VATS resection.

Table 1 -

Classification of Nodules Resected Using ENB, MB Marking, and VATS Wedge Resection

Diagnosis N/total (%)

Lung Metastases 31/70 (44.3%)

Colon cancer 12/31 (38.7%)

Breast cancer 8/31 (25.8%)

Sarcoma 7/31 (22.6%)

Lymphoma 2/31 (6.5%)

Other 2/31 (6.5%)

Lung cancer 27/70 (38.6%)

Adenocarcinoma 15/27 (55.6%)

Squamous Cell Carcinoma 7/27 (25.9%)

Carcinoid Lung Tumor 2/ 27 (7.4%)

Other 3 /27 (11.1%)

Benign Lesion 12/70 (17.1%)


SA18. Which Patients are at Risk for Distal Aortic Pathology Following Conservative Repair of Acute Type A Aortic Dissection?

Kellianne Kleeman, Himanshu Patel, Donald Likosky, Bo Yang, Matthew Romano, Elise Woznicki, Michael Paulsen, Kevin Schmidt, Zhyldyz Kabaeva, Michael Ranella, Theron Paugh, G. Michael Deeb University of Michigan, Ann Arbor, MI, USA

Objective: Conservative repair (ascending resection, arch reconstruction, and open distal anastomosis) of acute Type A aortic dissection (ATAAD) treats the primary source of mortality and offers excellent survival, but results in a risk of late death or reoperation on the distal dissected aorta. Therefore, we sought to define the cohort of patients at higher risk of late mortality or reoperation--those that may benefit from prophylactic intervention on the descending aorta (i.e. frozen elephant trunk) during the initial operation.

Methods: We reviewed 384 ATAAD patients. All underwent conservative repair. All had hemiarch replacement, except those with: primary arch tear, diameter >4.5cm, or dissection into head vessels, who underwent complete arch replacement. The primary endpoint was distal aortic pathology causing death or reoperation at 10yrs. (Table 1)

Results: Outcomes were equivalent irrespective of distal anastomosis (hemiarch vs complete arch). Early mortality (7%) correlated with tobacco use. Ten-year survival was 76%. Risk factors for all-cause mortality were increasing age and no family history of aortic dissection. Distal aortic pathology necessitated reoperation in 13% and caused 10% of late deaths. Risk factors for distal aortic pathology causing death or reoperation were African American race and connective tissue disorders.

Conclusions: Conservative repair of ATAAD yields excellent early and late survival with low rates of distal reoperation. However, newer approaches which intervene on the descending aorta (i.e. frozen elephant trunk) may add benefit in African American patients or those with known/suspected connective tissue disorders, to reduce the risk of late death or reoperation on the distal dissected aorta.

Table 1 - Risk Factors for Distal Aortic Pathology Resulting in Death or Reoperation at 10 Years

Odds Ratio CI (95%) p-value

African American race 3.44 1.56, 7.58 0.002

Connective Tissue Disorder (Genetic syndrome such as Marfan, Ehlers-Danlos, or familial)

3.26 1.03, 10.34 0.044


SA19. Electromagnetic Navigational Bronchoscopy Reduces the Time Required for Localization and Resection of Lung Nodules

William D. Bolton, Thomas Cochrane, Andrew Binks, James Stephenson, Allison Hale, Sharon Ben-Or Greenville Health System, Piedmont, SC, USA

Objective: To evaluate Electromagnetic navigational bronchoscopy (ENB) and CT-guided placement as localization techniques for minimally invasive resection of small pulmonary nodules and determine if ENB is a safer and more effective method than CT-guided localization.

Methods: We performed a retrospective review of our thoracic surgery database to identify patients who underwent minimally invasive resection for a pulmonary mass and utilized either ENB or CT-guided localization techniques between July 2011 and May 2013.

Results: 383 patients had a minimally invasive resection during our study period, 50 of whom underwent ENB or CT localization (ENB = 25; CT = 25). There was no significant difference between CT and ENB patient groups in regards to age, gender, race, pathology, nodule size, or location. Both CT and ENB were 100% successful at localizing the mass and there was no difference in the type of definitive surgical resection (wedge, segmentectomy, or lobectomy) (P=0.320). Post-operative complications occurred in 36% of all patients, but there was no significant difference in the frequency or type of complication (P = 0.552). In terms of localization time and surgical time, there was no difference between groups. However, the down time between localization and resection was significant (CT = 190mins; ENB = 24mins)(Table 1); this explains why the difference in Total time (sum of localization, down, and surgery) was significant (P < 0.001).

Conclusions: We found ENB to be as safe and effective as CT-guided wire placement, and to provide a significantly decreased down time between localization and surgical resection.

Table 1 - Localization times by procedure

Times Nav Bronch Cat Scan p-value

Localization Time 28.2 24.56 0.218

Patient Down Time 24.36 189.72 <0.001

Surgeon Wait Time 52.56 52.04 0.883

Loc Time to Surg. Start 52.56 214.28 <0.001

Operative room time 218.68 203.08 0.558


SA20. Regional Variability of In-Patient Outcomes for Coronary Artery Bypass in the United States

Ahmed Ali1, Anahita Dua1, Dustin Hang1, Sapan Desai2 1Medical college of WI affiliated hospitals, Wauwatosa, WI, USA, 2Southern Illinois University, Carbondale, IL, USA

Objective: This study aimed to determine the impact of regional variation on in-patient outcomes and cost in patients undergoing coronary artery bypass grafting (CABG) in the USA.

Methods: A retrospective analysis was completed using the 2008-2012 Nationwide Inpatient Sample (NIS) utilizing International Classification of Diseases-9 codes to select patients with coronary atherosclerosis (414.00-414.03) who underwent elective CABG (36.10-36.15). Variables included demographics, procedure type, outcome during hospital course, cost, length of stay, and location (Northeast, Midwest, South, West). Statistical analysis was with chi-square, Fisher exact test, and multivariate analysis.

Results: A total of 609,320 CABG procedures were performed over the 4 year study period in the USA the majority of which were in the Southern region (268,590) with the lowest number of CABGs being performed in western region (91,620). There were no significant regional differences in the demographics, complications, LOS or mortality. However, cost of CABG was found to be significantly elevated in the west ($55,264 +/- 34,590, p<0.001) when compared to the other 3 regions (median $38,928 +/- 28,425). The largest impact on cost was CHF (r2 = 0.93; P<0.001), followed by SSI (r2 = 0.87; P<0.001), bleeding (r2 = 0.74; P 75 (r2 = 0.71; P<0.001).

Conclusion: There is a considerable regional variation in the cost of performing CABG in the United States after adjusting for the demographics and clinical characteristics. The Western region performs the procedure for almost $20,000 more than their counterparts in Northeast.

POSTER PRESENTATIONS (Friday, October 16, 2015 – 5:00 pm – 6:00 pm – Flagler II)

P1. A Contemporary Approach to Re-Operative Aortic Valve Surgery: When is Less, More? Deane E. Smith, III, Michael S. Koekert, David W. Yaffee, Patricia Ursomanno, Ramsey Abdallah, Eugene A. Grossi, Aubrey C. Galloway, NYU Langone Medical Center, New York, NY, USA

P2. Aortic Valve Repair Oleg Orlov, Ioannis Paralikas, Carlos Padula, Alice Isidro, Konstadinos Plestis, Lankenau Heart Institute, Philadelphia, PA, USA

P3. Bentall Procedure Through the Partial Sternotomy Oleg Orlov, Ioannis Paralikas, Carlos Padula, Konstadinos Plestis, Lankenau Heart Institute, Philadelphia, PA, USA

P4. Combined Robotically Assisted Minimally Invasive Direct Coronary Artery Bypass Grafting And Transcatheter Aortic Valve Replacement Brody Wehman1, William J. Nicholson2, Jennifer A. Zumbrum2, David J. Kaczorowski2, Bradley Taylor1, Larry Shears2, 1University of Maryland School of Medicine, Baltimore, MD, USA, 2WellSpan York Hospital, York, PA, USA

P5. Combined V-V ECMO and Impella LVAD: An Alternative to V-A ECMO Louis Samuels, Eric Gnall, DO, Elena Casanova-Ghosh, CRNP, Lankenau Medical Center, Wynnewood, PA, USA

P6. Contemporary Outcomes of Open Thoracoabdominal Aneurysm Repair Using a Multidisciplinary Approach Harper Padolsky, Robert Moraca, Daniel Benckart, Bart Chess, Satish Muluk, George Magovern, Jr., Allegheny Health Network, Pittsburgh, PA, USA

P7. Examining the Learning Curve of a First Year Robotic Thoracic Surgeon in the Community Setting. John F. Lazar, Troy A. Moritz, Pinnacle Health CardioVascular Institute, Harrisburg, PA, USA

P8. Expanding the Field: Uniportal Video-Assisted Thoracic Surgery (VATS) for Esophageal Surgery David Zeltsman, Kyle Riggs, Bo Gu, Hofstra North Shore-LIJ School of Medicine - Department of Cardiothoracic Surgery, Great Neck, NY, USA

P9. Humanitarian Cardiac Surgery: A Trainee's Perspective Tyler J. Wallen, Mercy Catholic Medical Center, Darby, PA, USA

P10. Hybrid Treatment of Aortic Arch Disease Daniel Watson, Nirvana Siraswat, Riverside Methodist Hospital, Columbus, OH, USA

P11. Improving the Odds: Intercostal Metal Coils Mark the Area for Resection of Rib Lesions David Zeltsman1, Bo Gu1, Kyle Riggs1, Chris Sung2, Igor Lobko2, 1Hofstra North Shore-LIJ School of Medicine - Department of Cardiothoracic Surgery, Great Neck, NY, USA, 2Hofstra North Shore- LIJ School of Medicine, Great Neck, NY, USA

P12. Initial Three-Year Review of TAVR Program Launch at a Tertiary Academic Community Hospital Raymond L. Singer, MD1, Tara C. Stansbury, B.S.2, James K. Wu, MD1, Sanjay M. Mehta, MD1, Joseph P. Kleaveland, MD1, William G. Combs, MD1, David A. Cox, MD1, Rhonda J. Moore, PhD1

1Lehigh Valley Health Network, Allentown, PA, USA, 2Lehigh University, Allentown, PA, US

POSTER PRESENTATIONS (Friday, October 16, 2015 – 5:00 pm – 6:00 pm – Flagler II)

P13. Left VATS Resection of an Esophageal Duplication Cyst Mark Crye, Lana Schumacher, Mathew VanDeusen, Toshi Hoppo, Blair Jobe, Rodney Landreneau, Allegheny Health Network, Pittsburgh, PA, USA

P14. Outcomes of Open Repair of Mycotic Descending Thoracic and Thoracoabdominal Aortic Aneurysms Erin Mills, Christopher Lau, Mario Gaudino, Monica Munjal, Leonard Girardi, Weill Cornell Medical College, New York, NY, USA

P15. Patients with Infectious Endocarditis and Drug Dependence Have Worse Clinical Outcomes After Valvular Surgery Anthony Lemaire, Viktor Dombrovskiy, George Batsides, Aziz Ghaly, Takashi Nishimura, Lindsay Volk, Alan Spotnitz, Leonard Y. Lee, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA

P16. Peri-Operative Use of Systemic Thrombolytics in Patients Undergoing Cardiothoracic Surgical Procedures Frank Manetta1, Sean McCarney2, David Zeltsman2, L. Michael Graver2, Pey-Jen Yu2, 1Hofstra-North Shore LIJ School of Medicine, Bay Shore, NY, USA, 2Hofstra-North Shore LIJ School of Medicine, Manhasset, NY, USA

P17. Primary Intrapulmonary Thymoma: A Case Report and Literature Review of this Rare Entity Dustin J. Manchester, Ned Carp, Lankenau Medical Center, Wynnewood, PA, USA

P18. Retrospective Review of Utilization of Facilitating Technologies in Minimally Invasive Aortic Valve Replacement

Oleg Orlov1, Ioannis Paralikas1, Grace Kim2, Jessica Grippaldi2, Alice Isidro1, Scott Goldman1, Konstadinos Plestis1, 1Lankenau Heart Institute, Philadelphia, PA, USA, 2Villanova University, Villanova, PA, USA

P19. The Development of a Survivor Ovine Model for Advancing Minimally-Invasive Mitral Valve Surgery Joshua K. Wong, Amber L. Melvin, Candice Y. Lee, Devang J. Joshi, Louis DiVincenti, Jr, Peter A. Knight, University of Rochester Medical Center, Rochester, NY, USA

P20. The Diagnostic Yield of Electromagnetic Navigational Bronchoscopy: Are We Getting Everything? William K. Childers, John F. Lazar, Steve Ballinger, Troy A. Moritz, Pinnacle Health System, Harrisburg, PA, USA

P21. The Effects of Combined Mesenchymal and Cardiac Stem Cell Therapy in a Porcine Model Of Ischemic Cardiomyopathy: Early Findings A. Claire Watkins, Brody Wehman, Mark Vesley, Pablo G. Sanchez, Tielou Li, Eduardo de Faria, Zhongjun J. Wu, Bartley P. Griffith, University of Maryland, Baltimore, MD, USA

P22. The Use of a Negative Pressure Dressing for Delayed Sternal Closure and Rates of Mediastinitis. A Single Institution Experience Using the Wound VAC Mark Joseph1, Timothy Brand2, Richard Helton2, Amish Parikh2, Virginia Guerro2, William Stansfield2, Benjamin E. Haithcock2, Brett C. Sheridan2, Andy C. Kiser2, 1Carilion Clinic, Roanoke, VA, USA, 2University of North Carolina, Chapel Hill, NC, USA

P23. Total Arch Replacement Ioannis Paralikas, Oleg Orlov, Konstadinos Plestis, Lankenau Heart Institute, Philadelphia, PA, USA

CONSTITUTION OF

THE EASTERN CARDIOTHORACIC SURGICAL SOCIETY

(Founded and also known as The Pennsylvania Association for Thoracic Surgery)

FIRST, The Eastern Cardiothoracic Surgical Society, founded and also known as The Pennsylvania Association for Thoracic Surgery (Association) is organized exclusively for charitable, educational, and scientific purposes, including for such purposes, the making of distributions to organizations under Section 501(c)(3) of the Internal Revenue Code (or the corresponding section of any future Federal tax code).

SECOND, no part of the net earnings of the Association shall insure the benefit of or be distributed to its members, trustees, directors, officers, or other private persons, except that the Association shall be authorized and empowered to pay reasonable compensation for services rendered and to make payments and distributions in furtherance of Section 501(c)(3) purposes. No substantial part of the activities of the Association shall be the carrying on of propaganda, or otherwise attempting to influence legislation, and the Association shall not participate in, or intervene in (including the publishing or distribution of statements) any political campaign on behalf of, or in opposition to, any candidate for public office.

Notwithstanding any other provision of these articles, the Association shall not carry on any other activities not permitted to be carried on (a) by an organization exempt from Federal income tax under Section 501(c)(3) of the Internal Revenue Code (or corresponding section of any future Federal tax code) or (b) by an organization, contributions to which are deductible under Section 170(c)(2) of the Internal Revenue Code (or corresponding section of any future Federal tax code).

THIRD, upon the dissolution of this Association assets shall be distributed for one or more exempt purposes within the meaning of Section 501(c)(3) of the Internal Revenue Code (or corresponding section of any future Federal tax code), or shall be distributed to the Federal government, or to a state or local government, for a public purpose.

ARTICLE I. NAME

SECTION 1.

This Association shall be known as The Eastern Cardiothoracic Surgical Society, founded and also known as the Pennsylvania Association for Thoracic Surgery.

ARTICLE II. OBJECT

SECTION 1.

The object of the Association shall be to encourage and stimulate investigation and study that will increase the knowledge of intrathoracic physiology, pathology, and therapy, to correlate such knowledge and disseminate it, and to act as a common bond for physicians practicing this specialty and represent them in problems related thereto.

SECTION 2.

To attain this object, the Association shall hold at least one scientific meeting each year and shall undertake such other activities as the Council or Association as a whole may decide.

ARTICLE III. MEMBERSHIP

SECTION 1.

There shall be four classes of membership: Active, Senior, Candidate and Honorary. Senior membership requires no annual dues to be paid, but full payment for the annual meeting will be expected. Members can apply for Senior membership status once he or she has retired from clinical practice. Candidate members are defined as those physicians on a pathway towards a career in cardiothoracic surgery. Honorary membership will be given at the discretion of the membership committee. Admission to membership in the Association shall be by election. The qualifications for membership shall be determined by the Bylaws. Only Active and Senior members have the privilege of voting. Only Active and Senior members may hold elective office.

SECTION 2.

Election of Active, Senior and Honorary members shall be for life, subject to the provisions of Section 3, following.

SECTION 3.

Members in good standing may voluntarily terminate Membership at any time. The Council, acting as a Board of Censors, may recommend the expulsion of a member on the grounds of moral or professional delinquency, and submit his name, together with the grounds of complaint, to the Association as a whole at any of the regularly convened meetings, after giving the member so accused ample opportunity to appear in his own behalf. Expulsion shall be by a 2/3 vote of members present and voting at the regularly scheduled annual meeting.

ARTICLE IV. OFFICERS AND GOVERNMENT

SECTION 1.

The officers of the Association, also known as the Executive Committee, shall be the President, a Vice President, a Secretary, a Treasurer, Program committee chair, Program committee member, Membership committee chair, and Membership committee member, Immediate Past-President to serve as a Councilor, and two Councilors-at-large. These eleven officers and councilors shall be the governing body of the Association, and shall have full power to act on all matters, except as follows:

1) They may not alter annual dues, nor levy and general assessments against the membership, except that they may, in individual cases, remit annual dues or assessments.

2) They may in no ways change the Constitution or the Bylaws. 3) They may neither elect new members nor alter the status or existing members, other than to apply the

provisions of Article III, Section 3.

SECTION 2.

Officers and Councilors shall be elected at the annual meeting of the Association a year or two in advance, and shall take office upon the conclusion of the meeting the following year. The President and Vice President shall be elected for a one-year term of office and neither may be re-elected to succeed himself in the same office.

The Treasurer shall be elected for a one-year term of office and may be re-elected. The Secretary shall be elected for a one-year term of office and may be re-elected.

The outgoing President shall automatically become a Councilor for a one-year term of office.

The two Councilors-at-Large shall be selected by the nominating committee one each year, for a two-year term of office but no Councilor may be re-elected.

SECTION 3.

Vacancies occurring among the officers and committees during the year shall be filled by nomination of the President (or VP if the Presidency is vacated) with approval from the Executive Committee. This person shall finish out the term of the vacated position but WILL be eligible for re-election with the exception of the office of the Vice President or President (in keeping with Article IV, Section 2.)

ARTICLE V. COMMITTEES

SECTION 1.

At the opening session of the annual meeting, the President shall appoint a Nominating Committee of three Past-Presidents, and two senior members chosen by the current President. Senior members of the nominating committee may serve consecutive terms.

This Nominating Committee shall select a slate of officers to be voted on in the Business Meeting of the Membership at the regularly scheduled annual meeting. Members of the Nominating Committee must be present at the annual meeting to vote.

SECTION 2.

The Council is empowered to appoint a Membership Committee, a Finance Committee, and a Program Committee. All committees shall render their report at the executive session of the Association.

SECTION 3.

An Ad-Hoc Committee may be assembled by the President to address an issue that benefits the organization.

ARTICLE VI. FINANCES

SECTION 1.

The fiscal year of the Association shall run from the end of one annual meeting to the end of the next annual meeting. The books of the Association shall be kept and audited on this basis.

SECTION 2.

The membership shall contribute to the financial maintenance of the Association through the medium of annual dues and special assessments. The amount of annual dues shall be determined by the Bylaws.

SECTION 3.

To meet the current expenses of the Association, there shall be available all revenue derived from annual dues, special assessments, and any other income to the Association.

SECTION 4.

The Finance Committee will be composed of the President, Vice President, Program Chairman, Treasurer, and an Ex-Officio member appointed by the Executive Committee. The Treasurer will Chair this committee of five members. The Finance Committee shall be responsible for setting a budget for the coming year and will specifically outline a budget for the annual meeting within the annual budget. All expenditures over $1,000 that are outside of the accepted budget set forth by the Finance Committee need to be approved by a majority of the members of the Finance Committee.

SECTION 5.

The Eastern Cardiothoracic Surgical Society, founded and also known as The Pennsylvania Association for Thoracic Surgery is organized exclusively for charitable, educational, and scientific purposes, including for such purposes, the making of distributions to organizations under Section 501(c)(3) of the Internal Revenue Code (or the corresponding section of any future Federal tax code).

SECTION 6.

No part of the net earnings of the Association shall insure the benefit of or be distributed to its members, trustees, directors, officers, or other private persons, except that the Association shall be authorized and empowered to pay reasonable compensation for services rendered and to make payments and distributions in furtherance of Section 501(c)(3) purposes. No substantial part of the activities of the Association shall be the carrying on of propaganda, or otherwise attempting to influence legislation, and the Association shall not participate in, or intervene in (including the publishing or distribution of statements) any political campaign on behalf of, or in opposition to, any candidate for public office.

SECTION 7.

Notwithstanding any other provision of these articles, the Association shall not carry on any other activities not permitted to be carried on (a) by an organization exempt from Federal income tax under Section 501(c)(3) of the Internal Revenue Code (or corresponding section of any future Federal tax code) or (b) by an organization, contributions to which are deductible under Section 170(c)(2) of the Internal Revenue Code (or corresponding section of any future Federal tax code).

SECTION 8.

Upon the dissolution of this Association assets shall be distributed for one or more exempt purposes within the meaning of Section 501(c)(3) of the Internal Revenue Code (or corresponding section of any future Federal tax code), or shall be distributed to the Federal government, or to a state or local government, for a public purpose.

ARTICLE VII. MEETINGS

SECTION 1.

The Council and the provisions of the Bylaws shall determine the time, place, duration, and procedure of the annual meeting of the Association two to three years in advance.

SECTION 2.

A special meeting of the Association may be called on three months’ notice to the entire membership with a clearly stated purpose to allow members time to prepare for the meeting. The specific purposes of the meeting must be stated in the request and in the official call for the meeting.

ARTICLE VIII. AMENDMENTS

SECTION 1.

This Constitution shall in no ways be changed except by a three-fourths vote of the members present at an annual meeting, and further provided that the proposed alteration or amendment shall have been moved and seconded at a previous annual or special meeting of the association (in keeping with Article VII, Section 2.), and that a reasonable effort has been made to circulate copies of the suggested alterations or amendments to the entire membership. The members shall have been specifically advised that such alteration or amendment will be voted upon during the business meeting of the membership at the annual meeting of the Association.

BY-LAWS OF

THE EASTERN CARDIOTHORACIC SURGICAL SOCIETY

(Founded and also known as The Pennsylvania Association for Thoracic Surgery)

ARTICLE I.

SECTION 1.

These Bylaws shall merely interpret the Constitution and specifically apply its principles. They shall set forth no principles not included in the Constitution.

ARTICLE II.

SECTION 1.

The Council may set the length of time for the presentation and discussion of scientific papers.

SECTION 2.

Members are urged to cooperate with all committees of the Association.

SECTION 3.

Attendance at annual meetings is expected.

SECTION 4.

While the scientific session of the annual meeting is held primarily for the benefit of the members of the Association, it may be thrown open to non-members who are able to submit satisfactory credentials, who register in a specific manner, and who pay such registration fee as may be determined by the Council from year to year.

ARTICLE III.

SECTION 1.

Applicants for membership in this Association must have completed a formal thoracic surgical training program recognized by The American Board of Thoracic Surgery or equivalent training if the applicant is from another country. Applicants must be formally nominated and seconded, in an approved manner, by at least two Active or Senior Members. The Membership Committee must approve the application for membership and final action can take place two times a year. The names can be presented to the Membership at the end of the six months following the annual meeting for final action, or presented to those present at a regularly convened annual meeting for final action.

SECTION 2.

There is no limit to the number of Active Members.

SECTION 3.

Active Members may become Senior Members upon specific request after retiring from clinical practice, or incapacitated by illness. Senior membership requires no annual dues to be paid, but full payment for the annual meeting will be expected.

SECTION 4.

Candidate members are defined as those physicians on a pathway towards a career in cardiothoracic surgery. They are encouraged to attend and participate in the Annual meetings. They are exempt from annual dues and voting. Candidate members will progress to Active Membership status upon completion of their training.

SECTION 5.

Honorary Membership shall be reserved for such distinguished persons as may be deemed worthy of this honor by the Council with concurrence of the Association.

SECTION 6.

The report of the Membership Committee shall be rendered at the annual executive session of the Association.

ARTICLE IV.

SECTION 1.

The President of the Association shall perform all duties customarily pertaining to the office of the President. He shall preside at meetings of the Association and Council. The President shall be elected from the Active Members of the Association.

SECTION 2.

The Vice President of the Association shall perform all duties customarily pertaining to the office of Vice President. The Vice President shall be elected from the Active Members of the Association.

SECTION 3.

The Secretary of the Association shall perform all duties customarily pertaining to the office of Secretary. The Secretary shall be elected from the Active Members of the Association.

SECTION 4.

The Treasurer of the Association shall perform all duties customarily pertaining to the office of Treasurer. The Treasurer shall be elected from the Active Members of the Association.

SECTION 5.

There will be three Councilors of the Association who shall hold office as specified in the Constitution. One will be the Immediate Past-President who will serve for one year.

The two Councilors-at-Large shall be selected by the nominating committee one each year, for a two-year term of office but no Councilor may be re-elected.

SECTION 6.

In the event of a vacancy occurring in the office of President, the Council shall advance the Vice President to the Presidency and appoint a new Vice President under the provisions of Article IV, Section 3 of the Constitution.

ARTICLE V.

SECTION 1.

The Membership Committee shall consist of two Active Members appointed in accordance with the provisions of Article V, Section 2, of the Constitution. One will serve as Chair. The Council may appoint no more than one of its own members to serve on this committee. The duty of the Membership Committee is to investigate all candidates for membership in the Association and to report their findings to the Council. Appointment to the Membership committee shall be for a period of two years, the second year as chairman.

SECTION 2.

The Program Committee shall consist of two members, chosen from the Active Membership. One will serve as chair. This shall be for a period of two years, the second year as chairman.

ARTICLE VI.

SECTION 1.

Honorary Members of the Association are exempt from all dues, but must pay to attend the annual meeting.

SECTION 2.

Annual dues for Active Members shall be set as recommended by the Council.

SECTION 3.

The Council shall recommend that any Active Members whose dues are in arrears for three years shall have his membership terminated, provided that prior notification has been forwarded to the member by the Secretary of the Association.

SECTION 4.

Senior Members are exempt from all dues, but must pay to attend the annual meeting.

SECTION 5.

Membership fees and Meeting registration will be free to all active military personnel.

ARTICLE VII.

SECTION 1.

When the Association convenes for its annual meeting, the Executive Session must be attended by all officers present at the meeting. The business meeting of all members present at the annual meeting will be scheduled thereafter or on a subsequent day.

SECTION 2.

The business meeting of the entire membership will involve:

(1.) Report of the Treasurer for the last fiscal year (2.) Action on amendments to the Constitution and Bylaws (3.) Action on recommendations emanating from the Council (4.) Unfinished business (5.) New Business (6.) Report of the Membership Committee (7.) Election of new members (8.) Report of the Nominating Committee (9.) Election of officers

ARTICLE VIII

SECTION 1.

These Bylaws shall in no ways be changed, except by a two-thirds vote of the members present at the annual meeting of a properly convened meeting of the Association, and further provided that the proposed action or amendment shall have been moved and seconded by not less than seven of the members in a properly convened annual or special meeting of the Association (in keeping with Article VIII, Section 1 of the Constitution.)

PAST MEETINGS AND PRESIDENTS

1963 - Pocono Manor, Pocono, PA Edward M. Kent, MD 1964 - Bedford Springs, Bedford, PA John H. Gibbon, Jr., MD 1965 - Buckhill Falls Inn, Buckhill Falls, PA Julian Johnson, MD 1966 - The Hotel Hershey, Hershey, PA Henry T. Bahnson, MD 1967 - Bedford Springs Hotel, Bedford Springs, PA Wilbur E. Burnett, MD 1968 - Shawnee-on-the-Delaware, PA George Willauer, MD 1969 - The Hotel Hershey, Hershey, PA John M. Snyder, MD 1970 - Seven Springs Resort, Champion, PA Thomas C. Ryan, MD 1971 - Host Farm Motel, Lancaster, PA Paul Nemir, Jr., MD 1972 - Fernwood, Bushkill, PA George J. Magovern, Sr., MD 1973 - Buckhill Falls Inn, Buckhill, PA William R. DeMuth, MD 1974 - The Hotel Hershey, Hershey, PA George P. Rosemond, MD 1975 - Seven Springs Resort, Champion, PA George J. Haupt, MD 1976 - Buckhill Falls Inn, Buckhill Falls, PA William A. Atlee, MD 1977 - Bedford Springs Hotel, Bedford Springs, PA R. Robert Tyson, MD 1978 - The Hotel Hershey, Hershey, PA John A. Waldhausen, MD 1979 – Seven Springs Resort, Chamption, PA James L. Harrison, MD 1980 - Buckhill Falls Inn, Buckhill Falls, PA John Y. Templeton, III, MD 1981 - Bellevue Stratford, Philadelphia, PA W. Winster Kunkel, Jr., MD 1982 - The Hotel Hershey, Hershey, PA Joseph C. Donnelly, Jr., MD 1983 - Inn at the Peak, Clymer, NY George J. Deangelo, MD 1984 - Skytop Lodge, Skytop, PA Horace Mac Vaugh, III, MD 1985 - Sheraton at Station Square, Pittsburgh, PA Benjamin G. Musser, MD 1986 - The Hotel Hershey, Hershey, PA Robert G. Trout, MD 1987 - Hamilton Princess Hotel, Bermuda Vincent D. Cuddy, MD 1988 - Seven Springs Resort, Champion, PA Vincent W. Lauby, MD

1989 - Toftrees Resort, State College, PA William S. Pierce, MD 1990 - Split Rock Resort, Pocono, PA Pascal Spagna, MD 1991 - Marco Island Resort, Marco Island, FL George A. Liebler, MD 1992 - Nemacolin Woodlands Resort, Farmington, PA John L. Pennock, MD 1993 - The Hotel Hershey, Hershey, PA Sang B. Park, MD 1994 - The Resort at Longboat Key, Longboat Key, FL Ronald V. Pellegrini, MD 1995 - The Four Seasons Hotel, Philadelphia, PA David B. Campbell, MD 1996 - Nemacolin Woodlands Resort, Farmington, PA Rohinton K. Balsara, MD 1997 - Le Chateau Frontenac, Quebec, Canada Jacob Kolff, MD 1998 - Penn State Conference Ctr., State College, PA Thomas Maher, MD 1999 - Skytop Lodge, Skytop, PA Manucher Fallahnejad, MD 2000 - Southampton Princess, Bermuda James A. Magovern, MD 2001 - Sheraton Station Square, Pittburgh, PA Francis Sutter, DO 2002 - Loews Miami Beach Hotel, Miami, FL Edward L. Woods, MD 2003 - Geisinger Medical Center & Pine Barn Inn, Danville, PA Craig B. Wisman, MD 2004 - Lankenau Hospital, Wynnewood, PA & Sheraton Hotel Society Hill, Philadelphia, PA Scott M. Goldman, MD 2005 - Elbow Beach Resort, Bermuda Joseph E. Bavaria, MD 2006 - Lehigh Valley Hospital & Glasbern Inn, Allentown, PA Raymond L. Singer, MD 2007 - Marriott Sea View Resort & Spa, Gallaway, NJ Rohinton J. Morris, MD 2008 - Amelia Island Plantation, Amelia Island, FL James B. McClurken, MD 2009 - Ritz-Carlton, Amelia Island, FL Ron D. Nutting, MD 2010 - Disney’s Boardwalk Inn, Lake Buena Vista, FL Sanjay Mehta, MD 2011 - Gaylord National, National Harbor, MD Fred Weber, MD, JD 2012 - Ritz-Carlton, Naples, FL Michael Szwerc, MD 2013 - Sandpearl Resort, Clearwater Beach, FL Benjamin A. Youdelman, MD 2014 – Four Season’s Resort, Palm Beach, FL Evelio Rodriguez, MD

IN MEMORIAM

* Founding Member � Honorary Member

Alberto Adam, MD Charles K. Kirby, MD*

William Atlee, MD Melvin L. Knupp, MD

Henry T. Bahnson, MD Amas S. Kyllonen, MD

Rohinton K. Balsara, MD Vincent W. Lauby, MD

Francis X. Bauer, MD William M. Lemmon, MD

Donald E. Bowes, MD George Liebler, MD

Stanley Brockman, MD C. Walton Lillehei, MD�

Richard S. Brown, MD John B. Lovette, MD

James L. Buchanan, MD George Magovern, Sr., MD*

Wilbur E. Burnett, MD* James A. Magovern, MD

Rudolph C. Camishion, MD Albert Marrangoni, MD*

Michael G. Christy, MD* John Mitchell, MD

William P. Coghlan, MD* Clarence E. Moore, MD

William J. Cushing, MD Benjamin Musser, MD

Frederick W. Dasch, MD* Paul Reis, MD

John J. DeTuerk, MD* George Rosemond, MD

Joseph C. Donnelly, Jr., MD Thomas C. Ryan, MD*

Manucher Fallahnejad, MD Charles L. Sacks, MD*

Javier Fernandez, MD Gilmore Sanes, MD*

Charles Fineberg, MD* Victor P. Satinsky, MD*

James O. Finnegan, MD William H. Sewell, MD

William B. Ford, MD* John M. Snyder, MD*

Alfred Frobese, MD* George N. J. Sommer, MD*

John H. Gibbon, Jr., MD* Paschal M. Spagna, MD

James L. Harrison, MD* Joseph Stayman, MD

Brack Hattler, Jr., MD John T. Szypulski, MD*

George J. Haupt, MD* John Templeton, III, MD*

H.R. Hawthorne, MD* William D. Todhunter, MD

Stephen L. Hudacek, MD* Louis J. Wagner, MD

Julian Johnson, MD* John A. Waldhausen, MD

Robert G. Johnson, MD* Herbert W. Wallace, MD

Eugene H. Kain, MD Donald R. Watkins, MD*

N. Peter Kamilowicz, MD George J. Willauer, MD*

Edward M. Kent, MD* Robert H. Witmer, MD*

eastern ardiothoracic urgical ociety · st. jude medical transonic systems inc. wl gore &...

Documents