Cardiothoracic Anesthesia Division Shines at SCA 2016


In typical Duke fashion, the Cardiothoracic Anesthesia Division headed to San Diego with an arsenal of material to present at the Society of Cardiovascular Anesthesiologists 38th Annual Meeting and Workshops (SCA) which kicked-off on April 2. This year, 12 faculty were involved in 20 presentations, workshops, lectures and panel discussions; not to mention the division’s 13 fellows who gave 22 presentations (see details below).

“I think overall, our division hits above its weight,” says Vice Chairman of Education and Director of Fellowship Education, Dr. Mark Stafford-Smith. “We have a great history of a significant presence at this meeting, demonstrating that we’re one of the best, if not the best cardiothoracic anesthesia divisions in the country.”

This year, Dr. Stafford-Smith was invited to moderate an oral research presentation which showcases the abstracts deemed to have the most significant scientific contributions. He also presented on the progress being made in terms of reducing acute kidney injury that can occur as a result of cardiac surgery. And, he hosted a town hall discussion about whether the Adult Cardiothoracic Anesthesia Fellowship needs to have a certification exam as part of its training. But among his busy schedule, he was most looking forward to the experience this meeting provides for the division’s fellows and their new fellowship director, Dr. Brandi Bottiger, who was also a presenter this year.

“The SCA is a wonderful opportunity to have our fellows be introduced to members of the community of cardiothoracic anesthesia across the country,” says Dr. Stafford-Smith. “It’s a chance to celebrate the hard work that they’ve done with their research projects and have them be presented and appreciated on a national stage.”

Accompanying Dr. Stafford-Smith to the meeting was one of last year’s winners of a SCA/IARS starter grant, Dr. Quintin Quinones. He won a two-year grant to fund the basic science in his lab that explores the differences in how the innate immune system is activated in hibernating mammals vs. non-hibernators, specifically the rat and the arctic ground squirrel.

“I enjoy the basic science of trying to understand how we might change our practices and improve how we care for patients by what we learn in the laboratory, and I’m grateful to the SCA for their support,” says Dr. Quinones. He presented two posters this year – arctic ground squirrel research and a clinical review of cardiogenic shock in influenza patients. He also took part in a panel discussion about innate immunity and why different patients in the cardiac surgical population respond differently to surgery, specifically involving inflammation and organ dysfunction. “These are all issues we are trying to get our hands on using Duke’s bench-to-bedside concept. We’re starting in the lab with hibernating mammals and then going back to humans to compare similarities and differences.”

Content at this year’s SCA meeting focused on clinical decision making in cardiovascular anesthesiology and perioperative medicine. The meeting provides many opportunities to learn about some of the cutting-edge techniques in cardiac surgery and critical care arenas, including advanced echocardiographic techniques. According to Dr. Quinones, Duke’s Cardiothoracic Anesthesia Division has been a world leader in teaching echocardiography for decades; he believes the next generation will continue to “write the textbooks” and that echo will continue to be a major focus of the division.

One of those echo leaders at Duke is the director of Duke’s Perioperative Echo Services, Dr. Alina Nicoara, who also attended this year’s SCA meeting. She was part of a panel discussing anesthesia for electrophysiology procedures, moderated a workshop on case-based transesophageal echocardiogram (TEE) and participated in “Echo Jeopardy” as one of three members of the East Coast Team.

“This meeting is re-energizing for me personally. And as a presenter, it’s very rewarding,” says Dr. Nicoara. “It’s easy to get into a daily routine in your clinical and academic work, and this conference provides the opportunity to reignite the passion I have for my career each year.” Dr. Nicoara points out that it’s an especially exciting time for her at Duke as her team is renewing their entire fleet of echo machines in the operating rooms (with improved imaging technology), recruiting new colleagues to the division, and are in the process of changing their echo reporting system. “This meeting is a chance for all of us to come together and find multiple opportunities to collaborate.”

A rapid development in the cardiothoracic field in general, according to Dr. Stafford-Smith, is the concept of implantable heart valves that occur without surgery through a transcatheter approach. He says Duke is playing a key role in the imaging of those valves with its transesophageal echo that is so excellently led by Dr. Nicoara and Dr. Madhav Swaminathan, who made medical history last year when he became the first cardiac anesthesiologist to be named as a Feigenbaum Lecturer. Dr. Swaminathan was a panelist in the presentation, “Career in CT Anesthesiology: Mission Possible” at this year’s SCA, speaking to fellows about that honor and his path of becoming a leader in this field. Dr. Stafford-Smith adds that particularly in the postoperative period, the addition to ultrasound of transthoracic echocardiography is something that is being rapidly developed in this division and looks to be a very promising front.

“The nature of cardiac surgery is that it seems to be continually reinventing itself,” says Dr. Stafford-Smith. In the last several years, Duke has seen a great transition toward circulatory assist devices and their best use in a variety of patients with failing hearts. He sees this as being a really interesting area of expansion, noting, “Our prominent role in understanding the best way to conduct organ transplantation is a major part of what we do here at Duke.”

So, what’s next for this team of cardiothoracic anesthesiologists after the SCA meeting wraps-up on  April 6? Dr. Quinones predicts that basic and translational science will be the next big push from this division and will become one of the many things Duke Anesthesiology is known for. Dr. Stafford-Smith believes the division will continue to spread its wings and collaborate in both the operating room and intensive care unit. He concludes, “All of these roles are compatible and we are stronger together than individually. That’s been our strength here at Duke all along.”

2016 Society of Cardiovascular
Anesthesiologists Annual Meeting

Saturday Sunday Monday Tuesday Wednesday
April 2nd April 3rd April 4th April 5th April 6th
Aronson 6:45am-8am
PBLD 21 – Negotiating Payments for Anesthesia Services and Bundling & Capitation
Del Rio 10:30am-12pm
Red Cell Transfusion Controversies Moderator
Workshop: 3D TEE – Siemans System
Lecture: The Perioperative Surgical Home
Ghadimi 8am-11am
Workshop 2 – Coagulation & Transfusion: POC Testing
Levy 11am-12:30pm
Lecture: Alternatives to Heparin
Mathew 10:30am-12pm
Lecture: Post-Op Prophylaxis
Nicoara 1pm-4pm
Workshop 4 – Case-based TEE Moderator
Lecture: Anesthesia in the EP Lab
Echo Jeopardy
Podgoreanu 1:30pm-3pm
Lecture: A Little Bad May Be Good: Hormesis and Adaptive Responses in Health and Disease
Quinones 11am-12:30pm
Lecture: Inflammation – Why do some people mount more of a response than others?
Stafford-Smith 4pm-6pm
Oral Research Presentations Moderator
PBLD 8: Lung Transplantation
Lecture: Town Hall Debate – SCA Sponsored Subspeciality Certification in CT and Vascular Anesthesiology

Lecture: Renoprotective Pharmacological Agents are Useful in Cardiac Surgery-Con
Swaminathan 8am-11am
Workshop 1 – Advanced TEE: Mitral Valve
BOD TEE Pro/Con Moderator
A Career in CT Anesthesiology: Mission Possible (Fellows) – Panelist
Thompson 1pm-3:30pm
Lecture: Mechanical Assist
Panelist: Super Echo
Welsby 6:45am-8am
PBLD 7 Perioperative Coagulopathy and Transvusion
Lecture: Reversing NOACs
Lecture: Heparin Induced Thrombocytopenia
Friday, April 1
Poster Presentation
1:15 – 2:00 pm
Berndt, B.  Open sleeve resection for endobronchial carcinoid in a Jehovah’s Witness patient [AS5]

Dunkman, W.J.  Elective veno-venous extracorporeal membrane oxygenation for resection of endotracheal tumor [TAS27]

Junious, S.  Quality improvement in perioperative pain management:  A retrospective review of current practice [TAS43]

Saturday, April 2
Fellow and Resident Complex Case
11:00 am – 12:00 pm
Al-Rawas, N. Left circumflex artery injury during left atrial appendage ligation with codominant coronary circulation [F19]
5:00 – 6:00 pm Low, Y.  Right ventricular failure due to RCA ostial thrombus after aortic valve replacement [F175]

Hashmi, N.  Resection of a large vertebral artery aneurysm with cardiopulmonary bypass and deep hypothermic circulatory arrest:  Considerations and challenges [F215]

Sunday, April 3
Fellow and Resident Complex Case
7:00 – 8:00 am
Junious, S. Persistent mitral regurgitation and systolic anterior motion after edge-to-edge repair and mitral valve annuloplasty
Poster Presentation
12:30 – 1:30 pm 
Kretzer, A. Incidence of acute kidney injury following heart transplantation [SCA 20]

Low, Y.  Heart-specific release of immune mediators during surgical ischemia-reperfusion and their association with postoperative adverse outcomes [SCA22]

Hansberry, S. Influenza, extra-corporeal membrane oxygenation, and mechanical circulatory support:  A single center, two year case series [SCA43]

Berndt, B. Mast cell activation and acute kidney injury following coronary artery bypass grafting requiring cardiopulmonary bypass [SCA16]

Al-Rawas, N. Ultrasound imaging of thoracic duct in patients with different levels of left ventricular ejection fraction [SCA36]

Amhaz, H. Do D-dimer levels predict mortality in patients with mechanical circulatory support in the cardiothoracic ICU? [SCA58]

Duce, L. Outcomes in blood refusal patients undergoing cardiac surgery and receiving erythropoietin compared to patients who did not:  A case-matched study [SCA62]

Dunkman, W.J. Fibrinogen targets and transfusion after cardiopulmonary bypass [SCA63]

Witt, S.  Postoperative anticoagulation and impact of left ventricular assist device thrombosis within 1 year:  A single-center, retrospective, observational study [SCA75]

Monday, April 4
Poster Presentation
12:30 – 1:30 pm
Richburg, T. Post-operative atrial fibrillation:  Predictive value of global longitudinal strain obtained by intraoperative TEE [SCA103]

Dunkman, W.J. Impact of cost conscious intraoperative vasodilator strategy [SCA110]

Tuesday, April 5
Poster Presentation
12:30 – 1:30 pm
Hauck, J.  The intra-operative renal resistive index and early mortality following cardiac surgery [SCA152]

Low, Y.  Aminocaproic acid is associated with higher incidence of early postoperative cognitive dysfunction after cardiac surgery than tranexamic acid [SCA167]

Nailer, P.  Interrelationship of preoperative anemia, postoperative anemia, acute kidney injury and mortality after coronary artery bypass grafting surgery [SCA172]

Chris KeithCardiothoracic Anesthesia Division Shines at SCA 2016