Endovascular Cardiac Surgery : A New Subspecialty of Cardiac Surgery :Developing The Next Generation of Cardiac Surgery Therapies.

Jacques Kpodonu, MD ABS,ABTS,ABVM.

Cardiac Hybrid and Endovascular Surgery: Why Train The Surgeon of the Future.

Vascular Surgery

• Patient demand and industry push for minimal invasive surgery.

• Device availability. • Handful of interventional

trained surgeons to make a difference in a new world where trans catheter therapies are exploding.

The Times Are Fast Changing: Are We Prepared?

Endovascular Cardiac Surgery: A New Subspecialty of Cardiac Surgery

Open Procedures

Minimally Invasive Techniques

Percutaneous Approaches

Patient-Optimized Care

Hybrid Cardiac Surgeon.• Highly trained specialist

(hybrid surgeon) • Hybrid OR suite • Required knowledge in

interpretation of advanced imaging.

• Perform image guided surgical procedures.

• Familiar with access • Familiar with devices and

technology. • Able to deal with

complications. • Ability to develop a

surveillance program for patients.

Proposal: Develop An Advanced Endovascular Cardiac Surgery Program .A US Institution First.

!• Endovascular Cardiac Surgery is an emergent specialty

which would be an additional component of a world famous cardiac surgery program

• Future Surgeons would require the skill set to use hybrid operating rooms and to provide transcatheter /hybrid technologies for managing aortic and structural heart patients .

• An endovascular cardiac surgery program would satisfy all those needs and also provide a 1 year sub fellowship training to residents ,fellows and staff physicians interested in acquiring interventional skill set.

Components of An Advanced Endovascular Cardiac Surgery Program : A US Institution First.

• 1.Endo aortic program: • 2.Trans catheter aortic valve program. (TAVR) • 3.Endovascular robotic program. • 4.Advanced imaging surgical program. • 5. MRI guided cardiac surgery program. • 6.Advanced Cardiac Tele-robotic program. (Collaboration

with In touch Health). • 7.Develop 1 year endovascular cardiac surgery fellowship

curriculum in collaboration with ABTS.( Sponsorship Cook Medical for endo-aortic program available on request).

• Advanced image guided cardiac surgery research program. (Research agreement with Siemens medical already in place.)

1.Endo aortic Program• Ascending aortic endograft technology. Ascending

aortic aneurysms. • Branched arch graft technology. Arch aneurysms. • Thoracic Endovascular grafts. Thoracic aortic

aneurysms. • Branched thoraco-abdominal endografts. Thoraco-

abdominal aneurysms • Fenestrated endografts . Para-renal aneurysms • Bifurcated endografts .Abdominal aortic aneurysms. • Partnership with Cook Medical and Medtronic for

development of next generation endovascular Bental grafts for ascending and aortic root pathology.

Cook Medical Ascending aorta endograft

1.Endo-Aortic Program: Ascending Aorta Endograft.

• Type A dissection • Pseudo-aneurysm

ascending aorta

1.Endo-Aortic Program: Arch-Aorta Endograft.

Arch aneurysm Branched arch endograft

Post repair arch

Courtesy cook Australia

1.Endo-Aortic Program: Thoraco-abdominal Endograft.

Hybrid TAAA graft

1.Endo-Aortic Program: Abdominal Aorta Endograft.

Pre repair of aneurysm using 3D Fusion Technology Post repair of aneurysm

2.Trans-catheter Valve Program:• US Heart Valve Market to

Reach $1.5 Billion by 2016 • Growth Almost Entirely Due to

Introduction of Transcatheter Aortic Valve Replacement Devices, According to Millennium Research Group

• TAVR may account for 50% of aortic valve replacements

• Endovascular Cardiac Surgery Fellowship program to train future surgeons as primary implanters both for transfemoral and transapical as numerous aortic valve concepts are being developed.

2.Trans-catheter Valve Program:

3D Dyna CT performed in a hybrid OR to accurately size and deploy trans-catheter valves

surgeon procedural details

3.Endovascular Robotic Program:• Endovascular Robotic

program would be built to complement the advanced endo-aortic program for branched and fenestrated endografts for repair of thoraco-abdominal and arch aortic aneurysms.

4.Advanced Surgical Imaging Program. Train Surgeons to Preplan Endo-aortic Cases on a 3D CT Workstation.

4.Advanced Surgical Imaging Program. Train Surgeons into multimodality imaging required for image guided cardiac surgery.

3D angio

3D ICE

3D TEE

IVUS

Fusion of 3D CT and 3D ultrasound

5. Real-time MRI Cardiac Surgery Program.

• MRI guided cardiac surgery procedures is possible for TAVR procedures,Structural heart procedures and stem cells injection

5. Real-time MRI Cardiac Surgery Program. Trans Apical Aortic Valve Deployment.

coronary ostia coronary ostia

aortic annulus aortic annulus

marker

stent

Courtesy Keith Horvath

6.Cardiac Surgery Telerobotic and Remote Tele presence Program.

• Cardiac surgery tele-robotic program would be developed to collaborate with fellow physicians within the US and worldwide using remote tele-presence technology.

• Technology could be used to help a physician in China preplan an endo-aortic case on a 3D workstation from Boston or to review an echo of a patient for surveillance and monitoring.

Wireless Pressure Sensor for Surveillance of Aneurysms Remotely. (The future)?

Kpodonu J, et. al Department of Cardiovascular and Endovascular Surgery - Arizona Heart Institute Annals of Thoracic Surgery 2007.

Pre-Exclusion Post-Exclusion

Wireless Pressure Sensor for Remote Aneurysm Surveillance.

7.Endovascular Cardiac Surgery Program: Fellowship.

• There is no formalized training for cardiac surgeons to acquire interventional skill set, imaging skill set within ACGME residencies.

• Cardiologists have started to develop a structural heart interventional program to train future cardiologists for the increased transcatheter therapies in structural heart.

• My unique training and board certification in cardiac surgery and endovascular medicine could provide a readily available platform for collaborating with my colleagues to develop the therapies of tomorrow and share my skill set with residents, fellows and colleagues for the therapies of tomorrow.

• A 1 year fellowship would provide training in imaging, endovascular surgical skills, proficiency in the use of a cardiovascular hybrid room and patient surveillance technology including remote tele-presence .

8.Image Guided Cardiac Surgery Research Program.

• A Unique opportunity exists for collaboration and research projects with industry to develop future image guided cardiac surgery therapies that would revolutionize the field of cardiac surgery and make the specialty of cardiac surgery very exciting for the future residents and medical students looking at a career in cardiac surgery.

Thank –you