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46  Monday 29 October 2012  EACTS Daily News

Dawn Southey  Lead Nurse 

Practitioner, Cardiothoracic Surgery, 

New Cross Hospital, Wolverhampton, 

UK

Heyman Luckraz  Consultant 

Cardiothoracic Surgeon, Heart & 

Lung Centre, New Cross Hospital, 

Wolverhampton, UK

Thecreationofwardnursepractitioner(NP)postsattheHeart&LungCen-tre,Wolverhampton,UK

wasseenasapracticalwayofen-suringthatafullservicewasof-feredtopatients.Pressuresonclinicalresourcesandtheconse-quencesofthereductioninjun-iordoctors’hourshadalreadystim-ulatedstaffinthehospitaltolookfornewwaystoimprovetheuseofresourcesandtoservetheinterestsofthepatientandaidnursesde-velopskillsandknowledgetobe-

comeskilledprofessionalstoworkatanadvancedlevel.

Asateamoffournurseprac-titioners,ourrolecoversfromadmittingpatientsthroughtoadvancedrolesconsistingofin-dependentlyprescribing,andad-vancedwoundmanagement.Wealsoplayalargeroleinthecareandstabilisationofacutelyillpa-tients,liaisecloselywiththean-aestheticteamandinitiateemer-gencytreatmentsuchasCALS.Asateamwedeveloppolicies,pro-tocolsandundertakeauditstohighlightimprovementsinprac-tice.Thecontributionofthenursepractitionerrolewasemphasisedfollowingarecentauditoftheirpractice.

Thiscurrentstudyassessedtheimpactthattheintroductionofthenursepractitionerrolehadonpatient’scare,morespecificallyonCardiacIntensiveCareUnit(CICU)

readmissionfromtheward,itsas-sociatedmortalityandlengthofstay.From1stJanuary2005to31stOctober2011,8,591oper-ationswereundertakenattheHeartandLungCentre,Wolver-hampton(2,823werethoracicsurgicaland5,768cardiacsurgi-calprocedures).Overall,192pa-tientsneededtobereadmittedbacktotheCICUforfurtherman-agement.

Patientsweregroupedaccord-ingtotwoeras:(a)priortocom-mencementoftheNursePracti-tionersinOct2007(preNP)and(b)thosewhowereadmittedaf-terthatdate(postNP).136car-diacsurgerypatientswereread-mittedtoCICU.PreNPtherewere63patientsreadmittedwithamortalityof3.4%diedwhilepostNP73patientsreadmittedresult-ingina2.1%mortality.Readmis-sionratesoverallwerelower

followingtheNPintroductionwithoutanysignificantchangeintheEuroscore.

56thoracicsurgerypatientswerereadmittedtoCICU.PreNPtherewere26patientsreadmit-tedtoICUwitha3.7%mortal-

itywhilepostNPtherewere30patientsreadmittedresultingin2.4%mortality.Readmissionratesoverallwerelowerfollowingroleintroduction.

Thisstudyshowedthatthein-troductionofthewardNurse

Practitionersimprovedpatients’outcomewithpossiblyearlieridentificationofdeterioratingpa-tientsandearlierCICUinput.Thisinreturnreducedpatientmortal-ityandreducedpatientsoveralllengthofstay.

Dawn Southey and Heyman Luckraz

The impact of the cardiothoracic ward nurse practitioner

Arno Nierich  Isala Clinics, Zwolle, The Netherlands

Cardiacprocedures,suchasinsurgeryandin-terventionalcardiology,requestdiagnostictoolsinordertoimproveoutcome.Trans-esophagealechocardiography(TEE)isal-

readyapowerfuldiagnosticmodalityusedtoassesscardiacanatomyandfunction.IntraoperativeTEEhasbecomeoneofthecornerstoneimagingmodalitiesduringcardiacsurgeryandinvasivecardiovascularpro-ceduresreflectingthedailyincreasingcomplexityofsurgicaltechniquesandpatientpathology.

Oneoftherecentultrasoundinnovationsisthree-dimensional(3D)tyransesophagealechocardiogra-phy(3DTEE),atechniqueinwhichsoundwavesfromamatrixarrayultrasoundprobearetranslatedtoreal-timedetailedon-line3Dimagesoftheheartandma-jorbloodvesselsofthebody.Unlike2DTEE,whichre-liesonstandardlimitedimagingplanes,3DTEEusesvolumedatasets.These3Ddatasetsaredirectoff-linetranslatedbyanalyticalsoftwareinto3Dmodelsen-ablingimprovedassessmentofvalvestructuresandquantificationofventricularfunction.Normalorpath-ologiccardiacstructurescannowbeviewedfrommul-tipleperspectives.Thisisaninvaluablevisualaidinun-derstandingbetterspecificpatientanatomy.

3DTEEenablessurgeons,cardiologistsandanesthe-siologiststomakeacompleteinvestigationandim-agingoftheheart,viewedfrommultipleperspec-tives.Thisprovidesthesurgeonorcardiologistdirect

diagnosticinformationjustbeforethefirstincisionismadeandallowsadjustmentsofthetreatmentplan

basedonpotentialnewinformation.3Dultrasoundal-lowsrealtimedynamicimagingofthecontractilityoftheheart,thestructureofthevascularstructuresandtheopeningandclosingoftheheartvalves.Theim-agesareeasilytranslatedtoanatomicalviewsdur-ingsurgery.Theseviewsareimportantbecausedur-ingsurgerytheheartismostlyastaticemptystructureduringtheperiodofextra-corporealcirculation.Eval-uationofthesurgicalresultduringtheprocedureal-lowstimelycorrectionandevaluationinordertode-terminewhethertheoperativeproblemshavebeen

solvedcompletely.Duringclosedchestcardiacprocedures,suchas

transcatheteraorticvalveimplantations(TAVI)orport-accesroboticsurgery,3DTEEenablesmoreeasilypa-tientmonitoringinthephaseofplacementofcath-etersanddevicesinthemainvesselsandtheheart.However,thereisverylimitedinformationavailablefortheuseofRT3DTEEintheperioperativesetting.Uptillnow,theindicationtouse3DTEEisasafo-cusedexaminationofspecificpathologyortherapeu-tictreatmentsratherthanperformingacomprehen-sive3Dexamination.

The3Dultrasoundpresentationwillhighlightsomeimportantspecificapplicationssuchas:nWhatis3DTEEnPeri-operativeMitralvalveevaluationnAcuteAorticdissections:complete3Dultrasound

diagnosisandperi-operativemonitoringofthebrainperfusion

nStrokepreventionstrategyincardiacsurgeryandTAVIprocedureswith3DTEEA-Viewtechnique

Insummary,3DTEEisofaddedvalueforcardiologists,surgeonsandanesthesiologistssince:n3DTEEisasurgicalequivalentofGPS,nLeadstoeffectiveperi-operativedecisionmaking,

treatmentplanningandevaluation,nProvidesimprovedcommunicationbetweenthe

specialists,because3DTEEisquiteunderstandableforallstakeholders.

3D ultrasound: preoperative and perioperative benefits

Figure 1

Figure 2

PublisherDendriteClinicalSystems

Editor in ChiefPieterKappetein

Managing EditorOwenHaskinsowen.haskins@e-dendrite.com

Design and layoutPeterWilliamswilliams_peter@me.com

Managing DirectorPeterKHWaltonpeter.walton@e-dendrite.com

Head OfficeTheHubStationRoadHenley-on-Thames,RG91AY,UnitedKingdomTel+44(0)1491411288Fax+44(0)1491411399Websitewww.e-dendrite.com

Copyright2012©:DendriteClinicalSystemsandtheEuropeanAssociationforCardio-ThoracicSurgery.Allrightsreserved.Nopartofthispublicationmaybereproduced,storedinaretrievalsystem,transmittedinanyformorbyanyothermeans,electronic,mechanical,photocopying,recordingorotherwisewithoutpriorpermissioninwritingoftheeditor.

EACTSDaily News

Highlights from Sunday

Resident’s Luncheon 2012Minimal invasive cardiothoracic surgery

26th EACTS Annual MeetingConference center, Barcelona

Monday 29th October 12:45-14:00

ModeratorsPeyman Sardari Nia, Breda, Netherlands.

Mathias Siepe, Freiburg, Germany.

ProgramTable 1: Minimal invasive mitral valve surgery

Fredrich Mohr, LeipzigThom De Kroon, Nieuwegein

Table 2:  Minimal invasive aortic valve surgeryMattia Glauber, Massa

Marjan Jahangiri, London

Table 3: Minimal invasive maze proceduresWim-Jan Van Boven, Amsterdam

Jos Maessen, Maastricht

Table 4: Minimal invasive thoracic proceduresWilliam Walker, Edinburgh

Paul Van Schil, Antwerp

Table 5: Minimal invasive aortic surgeryMartin Czerny, Bern

Ernst Weingang, Mainsz

Table 6: Minimal invasive revascularization proceduresJean-Luc Jansens, BrusselsAnthony De Souza, London

Table 7: Hybrid congenital proceduresDavid Anderson, London

Christian Schreiber, Munich

The Luncheon is sponsored by an unrestricted educational grant from AtriCure.Registration for the luncheon is only possible on site in the conference center

EACTSDaily News

48  Monday 29 October 2012  EACTS Daily News

Floor plan

27 A&EMedicalCorporation

39 AATS

115 AbbottVascularInternationalBVBA

17 Andocor

28–29AsanusMedizintechnikGmbH

45 AtriCureInc

114 BBraunSurgicalS.A.

13–14BaxterHealthcareSA

82 BerlinHeartGmbH

16 BioCerEntwicklungs-GmbH

12 BiometMicrofixation

92–93BioVentrixInc

129 BoltonMedical

80 BracePlus/SlimstonesBV

70 CardiaInnovationAB

125 CardiaMedBV

10 CardioMedicalGmbH

53 CareFusion

90 CASMED

4–8 CircuLiteGmbH

59–61CookMedical

31 CorMatrixCardiovascularInc

122 CoroneoInc

24 CorrexInc

79 CryolifeEuropaLtd

37 CTSNET

117 Delacroix-Chevalier

98–99DendriteClinicalSystems

123 DePuySynthes

35 EACTS

104 EdwardsLifesciences

107–109 EstechInc

120 Ethicon–Johnson&Johnson

112 Euromacs

78 EurosetsSRL

118 FehlingInstrumentsGmbH&CoKG

34 GeisterMedizintechnikGmbH

119 GeneseeBioMedicalInc

69 Geomed®Medizin-TechnikGmbH&Co.KG

23 GunzeLimited

68 HamamatsuPhotonics

72 HeartandHealthFoundation

26 HeartHugger/GeneralCardiacTechnology

32 HeartWareInc

11 Integra

100–101 IntuitiveSurgicalSarl

38 ISMICS

81 JarvikHeartInc

63–64JenaValveTechnologyGmbH

121 JOTECGmbH

43–47KarlStorzGmbH&CoKG

94–95KLSMartinGroup

51 LabcorLaboratoriosLtda

66 LepuMedicalTechnology(Beijing)CoLtd

110–111 LSISolutions

102 ManiInc

86 MaquetCardiopulmonaryAG

15 MasterSurgerySystemsAS

74 MDDMedicalDeviceDevelopmentGmbH

3 MedaforInc

65 MedexResearchLtd

116 MedistimASA

40 MedosMedizintechnikAG

105 MedtronicInternationalTradingSÁRL

88–89MiCardiaCorporation

9 MicromedCVInc

67 NeoChordInc

131 NeomendInc

42 On-XLifeTechnologiesINC™

30 OxfordUniversityPress

134 PCR

124 PetersSurgical

62 PraesidiaSrl

128 QualiteamSRL

25 RedaxSRL

18 RumexInternationalCo

71 SanofiBiosurgery

33 ScanlanInternationalInc

87 SiemensAG

91 SmartcanulaLLC

85 Sorin

106 StJudeMedical

96 StarchMedicalInc

36 STS

73 SunshineHeart

41 SymetisSA

126–127 SynCardiaSystemsInc

77 TerumoEuropeCardiovascularSystems(TECVS)

103 TheSocietyforHeartValveDisease

113 ThoratecCorporation

55 TianjinPlasticsResearchInstitute

132 TransMedicsInc

19 TransonicSystemsEurope

130 ValveXchange

20–21WexlerSurgicalInc

1–2 WisepressOnlineBookshop

97 WLGore&AssociatesGmbH

42414034333231

45

23

21

19

119117

118

122120

121

125123

124

18

17

16

15

14

13

12

11

10

9

128

131

127

130

126

129

2037

39

36

38

113104

105

106

85

86

87

114

115

116

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1

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5 62

66

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101

96

100

109

112

108

111

107

110

6

7

8

132

134

43

47

5351

55

35

CateringCatering CateringCatering

ENTRANCEENTRANCE

Training Village

50  Monday 29 October 2012  EACTS Daily News

Medtronic reports over 1,000implantations of the 3f Enable®

Aortic Bioprosthesis, the world’s firstcommercially available sutureless tissueheart valve. The Medtronic 3f Enable®Aortic Bioprosthesis received CE-Markin December 2009 with first implantstakingplacein2007.Medtronicformallyannounced this milestone during thisyear’s edition of the Sutureless Club,recently held in Amsterdam, TheNetherlands.

This innovative valve technology hasa self-expanding Nitinol™ frame thatallowsthe3fEnable®AorticBioprosthesistobe folded intoa smalldiameter. Thisfacilitates placement through a smallerincision,withouttheuseofconventionalsuturesforfixation.Instead,radialforcesoftheself-expandingframeholdthevalveinplaceintheannulus.Nootherpointsof fixation are required. Implantationis therefore reduced to a single-stepprocedure and without the need forballooning. If needed, the 3f Enable®AorticBioprosthesiscanbe repositionedto achieve optimal outcomes for eachpatient.

Medtronic’s 3f Enable® AorticBioprosthesis helps the surgeon simplifythe procedure with a reproducibletechniquethatmaycontributetoshortercross-clamp times and reduced traumato the patient. The 3f Enable® self-expanding Nitinol™ frame houses a

stentlesspericardialvalvewitha tubulardesign that preserves sinus form andfunction. Improved stress distributionmimicsthefunctionalcharacteristicsofanativevalve.Thevalvehasalargeorificearea with laminar flow for excellenthemodynamics.Publicationshaveshownlowandstablegradientsacrossallsizes,from19to27mm.

“Medtronicispleasedtobringour3fEnable® Aortic Bioprosthesis to cardiacsurgeonsandtheirpatients”saidShawnMonaghan,vicepresidentoftheSurgicalBased Therapies business unit. “The3f Enable® tissue heart valve providesa new and simplified way to replacediseased, damaged or malfunctioningaortic valves, and in a way that is lessinvasiveforpatients.”

Over 1,000 implantations of the Medtronic 3f Enable® Aortic Bioprosthesis

M Yuksel  Course Director, Istanbul; 

EACTS House, Windsor, UK

ChestWallInterestGroup(CWIG)isagroupbelongingtotheEACTSThoracicDo-

main.ItwasfoundedduringTheSec-ondInternationalNussProcedureWorkshopheldinIstanbulinJune2009.

Wehavesetouttoestablishachannelofcommunicationacrossdif-ferentcontinentswithaviewtoal-lowtheexchangeofknowledgeamongthoseexperiencedpracti-tionerswhoarestudying,develop-ingandinnovatingmethodstotreatchestwalldiseases.InJune2010,wegottogetheragaininIzmir,forTheThirdInternationalWorkshopontheMinimallyInvasiveRepairofPec-tusDeformitiesunderthecustodyofEACTS.TheWorkshopwasagreatsuccessandwehadthechancetodiscussthefutureprojectionsoftheCWIG.

OurnextimportantmeetinginthecalendarwasTheFourthInter-nationalChestWallInterestGroupWorkshoponChestWallDiseaseswhichwasheldinIstanbulonJune

22–23,2012,underthecustodyofEACTS,withtheparticipationof35invitedfacultyfromaroundtheworld.

Nowwewanttoreachabroaderspectrumofresidents,specialistsandacademicians,thusweareorganiz-ingaworkshopon“ChestWallDis-eases”inWindsor,UK,atEACTSHouse,28-30November2012.

ThemainsubjectsareCongenitalChestWallDeformities,ChestWallResectionandReconstruction,Tho-racicOutletSyndromeandSternalDehiscence.

TheLearningObjectivesare;Learningtheindications,techniquesandfollowupofminimallyinva-siveandopensurgeryinpectusde-formities;Learningthealternativetreatments–surgicalandnonsurg-cal-forpectusdeformities;Learn-ingchestwallresectionandrecon-structiontechniquesinchestwalldiseases;Learningthesurgicaltech-niquesinthoracicoutletsyndromeandLearningthetreatmentoptions–surgicalandnonsurgical-insternaldehiscence.

TheTargetAudienceis;ThoracicSurgeryResidents,Specialistsandthe

AcademiciansworkinginthefieldofThoracicSurgery.

WeverymuchlookforwardtowelcomingyoutoWindsor.

Toregisterforthiscoursepleasevisit:www.eacts.org/academy/specialist-courses/chest-wall-diseases.aspx

Regards,Prof.MustafaYuksel,MD

Advanced Module: Heart Failure – State of the Art and Future Perspectives 12–17 November 2012 – 2 days of wetlabs

EACTSHouse,Windsor,UKCourse Directors: G Gerosa, Padua; M Mor-shuis, Bad OeynhausenThecoursewillbeorganisedin10modules:1 Epidemiology/Pathology;2 Diagnostic/Imaging;3and4

OptimalMedicalTherapy/IC;Resynchronization;5 CardiacSurgery(Indications,Techniques,

Results);6 HeartTransplant(Indications,Techniques,Re-

sults)7 VADs/TAH(Indications,Techniques,Results);8 HTx/VADsinPaediatricPopulation;9 StemCellsRegenerativeMedicine;10WetLabs/LiveinaBox/GroupProjectsCourse Objectives:Toupdateknowledgeoftheoreticalandtechnicalissuesofsurgeryforheartfailure.

Leadership and Management Development for Cardiovascular and Thoracic Surgeons20– 23 November 2012 EACTSHouse,Windsor,UKCourse Directors – J L Pomar, Barcelona

TheLeadershipandManagementDevelopment

Courseisanintensivefive-dayprogrammeintwopartswithathreedayinitialtrainingsessionfol-lowedbyafurthertwodaysoftrainingscheduledsixmonthslater.Thecoursewillutiliseamixofpreandpostprogrammeactivitiesandeachdelegatewillbetaskedwithexploringleadershipbestprac-tiseduringthebreakbetweenthetwopartsoftheprogramme.Course Objectives:Improve,enhanceandmaximiseyourleadershipat-tributes

Thoracic Surgery Part II3rd – 7th December 2012 EACTSHouse,Windsor,UKCourse Directors – P Rajesh, BirminghamnThecourseprogrammeincludes:nTrachealSurgerynTracheobronchialinjuriesnTracheal-mainbronchusobstruction;nEsophagusCancer–Staging,preoperative;nOesophagealcancer;nThoracoscopictechnique;nMesotheliomatreatments;nMetastaticdisease;nChestwallreconstruction;nCasepresentations.

Course Objectives:Togainmoreinsightandup-to-dateknowledgeondifferentaspectsofthoracicsurgeryrelatedtotracheal,pleural,mediastinalandoesophagealdis-ease.

Chest Wall Diseases 28–30 November 2012

EACTS events

Jin XY. Implications of Stentless Valve Design and Implantation Techniques for Aortic Root Geometry [abstract]. Paper presented at: Advanced Cardac Techniques in Surgery; May 2-3, 2007; New York, NY. Cox J, Ad N, Myers K, Gharib M, Quijano RC. Tubular heart valves: A new tissue prosthesis design—Preclinical evaluation of the 3f aortic bioprosthesis. J Thoracic Surg 2005; 130:520-7. Sadowski J, et al. Sutureless aortic valve bioprosthesis ‘3F/ATS Enable’ – 4.5 years of single-centre experience. Kardiol Pol 2009; 67(8a):956-63. Martens et al. Clinical experience with the ATS 3f Enable Sutureless Bioprosthesis. Eur J Cardiothorac Surg 2011;40:749-55.