Kirsten C. Odegard, MD
Program Chair

Dear Friends and Colleagues,

A warm welcome to the 2019 Congenital Cardiac Anesthesia Society (CCAS) Annual Meeting! This year’s meeting will be held Thursday, March 14th at the Marriott Marquis in Houston, Texas. Our host city of Houston provides a vibrant backdrop for our meeting. Houston, the fourth most populated city in the US, is not only home to Texas Children’s and the biggest medical center in the world, but home to the Texas Rangers and Houston Texans, to NASA and to Queen Bey herself. Houston has one of the best culinary scenes in the country with more than 10,000 restaurants. The recently opened Marriott Marquis, located downtown, is our luxurious home for the meeting, close to shopping, restaurants, theaters and live music.  After a full day of exciting cutting edge congenital cardiac anesthesia lectures, we have many options for exciting dining and entertainment.

This year we will continue the successful format of past programs, adding Round Table Discussion (RTD) to the early morning PBLDs. These small-group, interactive discussions will kick off the meeting and allow registrants a chance to gain first-hand insights from leaders in our field, with a variety of clinically relevant topics to choose from.  The PBLD’s include discussion of the Trisomy 18 patient with Eisenmenger syndrome, the patients on a VAD for emergent non-cardiac surgery and the failing Fontan patient with ventricular dysfunction going for emergency surgery. The RTD’s include discussions of new neuroprotective strategies, the diagnostic marathon: convenience versus risk, and how to deal with a “bad outcome.”

An ever-increasing public debate about the quality of healthcare has been in the news since the late 1990s, and a consequence of this has been the development of “Centers of Excellence in Healthcare” which have developed throughout the country. These specialized programs within healthcare institutions supply exceptionally high concentrations of expertise and related resources centered on particular medical areas and delivered in a comprehensive, interdisciplinary fashion. These centers provide many advantages for healthcare providers and the patients they serve. But what does this really mean for patients with Congenital Heart Disease (CHD) and our own specialty? The first session of the general meeting called “The Quest for Quality and Excellence” will hopefully shine some light on this.

We have the honor to have Mr. Doron Weber open the meeting. Dr. Weber is not only the Vice President and Program Director of the Alfred P. Sloan Foundation, but he is the father of Damon Weber and author of the book “Immortal Bird”, a beautiful family memoir about his son with Fontan physiology and his own fight against the medical establishment. This is a very well written book that all healthcare providers can learn from. This lecture will be followed by the Arthur Keats Lecture. This year’s recipient is Dr. James D. DiNardo, who will talk about “Building a Heart Centre of Excellence.”

Our next session is Innovation in Congenital Cardiac Anesthesia, where two very exciting topics are discussed.  The first lecture is an introduction to Advanced Educational Platforms where Dr. David Axelrod from Stanford will talk about the virtual heart and how virtual reality education is the future of healthcare. This is followed by a lecture from Professor James McCully from Boston Children’s Hospital who will educate us about myocardial rescue with autologous mitochondrial transplantation. This is a novel strategy which repairs and replenishes damaged mitochondria with healthy autologous mitochondria harvested from nonischemic skeletal muscles.

The last session before lunch is the popular Focus on a Lesion.  This year we will explore pulmonary vein stenosis, a very devastating lesion that is seen with increasing frequency both prior to and after cardiac repair. We will have input from the perspective of an interventional cardiologist, an anesthesiologist and a surgeon.

After lunch it is time to hear from our colleagues whose abstracts were judged among the best of those submitted.  This is a unique opportunity to become familiar with the investigations of our peers and trainees as we seek to improve care for patients with congenital heart disease.

This will be followed by our first-ever session on Cardiac Intensive Care topics. This session has been developed in anticipation of our new collaboration with the Pediatric Cardiac Intensive Care Society (PCICS). This collaboration is very exciting and will be extremely educational and beneficial for our members and the patients that we all have the privilege to care for. Dr. Peter Laussen will open the session explaining the importance and difficulties associated with the transition from the OR to the cardiac ICU after pediatric cardiac surgery.  This is followed by a discussion of unplanned cardiac re-interventions after cardiac surgery focusing on epidemiology and outcomes. The last critical care lecture will give us an overview of evolving indications for postcardiotomy ECMO and its outcome.

Our meeting then continues with concurrent sessions offering an assortment of options.  Participants can choose to either attend a new addition to the program this year, an interactive “Pro-Con Debate" with an expert panel, or select from several workshops. The Pro-Con Debate will allow a more intimate, interactive environment in which to exchange ideas and learn from leaders in our field. The topics that will be discussed are; extubation after the arterial switch operation, early use of recombinant factor VII and prothrombin complex concentrate (PCC) and idopathic pulmonary hypertension; general anesthesia versus sedation. The goal is to keep this session informal and interactive, so you can ask questions and provide input into the topics presented.

The workshops have been tremendously well received the last couple of years, and we are excited to include two new workshops this year. One of the new workshops is the advanced educational platforms: The Virtual Heart; which takes the participants on a 'fantastic voyage' inside the heart. Users put on a VR headset and use handheld remote controls to interact with the virtual heart. They can rotate it, open it and inspect its different pieces, including various heart defects. The second new workshop is a Cardiac Morphology: hands-on workshop with Dr. Kearny from Texas children’s Hospital. Dr. Debra Kearney has for many years been actively involved in integrating cardiac pathology in the training programs for pediatric cardiology and congenital heart surgery, where she emphasizes interactive, hands-on learning. Dr. Kearney will bring cardiac specimens with specific cardiac defects to the workshop so participants can study different cardiac defects both before and after repair.

The remaining three workshops are “back by popular demand.”  Our transesophageal echocardiography (TEE) workshop will provide an overview of the use of TEE, with basic TEE views for the evaluation of pediatric and congenital heart disease using simulators as the learning tool. The second workshop is the Extracorporeal Life Support workshop: Ventricular Assist Device (VAD); options, decisions and management. This workshop will allow you to become more familiar with VAD equipment and techniques both for cardiac and non-cardiac surgery. The technology for these life-saving techniques is evolving rapidly, and it is important to remain current.  Participants will gain a better understanding of not only the devices themselves but also the indications for their use. Finally, an in-depth experience in the use and function of pacemakers will be made available once again in the pacemaker workshop.  Learners will explore and recognize the different pacing modes used during temporary pacing, and review the implications of permanent pacemakers in our surgical patients.  In addition to the information and experience gleaned from these workshops, participants can once again expect to enjoy the company of colleagues in a hands-on environment. Space will be limited to optimize the experience for everyone, so be sure to register early.

After we divide up for the Pro-Con Debate and the workshops, we will all gather together again for Professor Poster Rounds.  These poster-side sessions are another opportunity for informal interaction and discussion about a wide range of topics in our field, presented in the form of new research and discovery by our own colleagues.  There will be three groups, each led by two expert moderators. This is not only a great way to learn, but also a perfect opportunity to make new friends, expand your network, and re-connect with old friends and colleagues.  It is said that we learn best in a social environment, and our small but inclusive Society is the perfect forum for us to work together and advance our field.  In this spirit we will close out the day with a welcoming wine and cheese reception, where we can unwind and socialize in a beautiful setting.

This meeting is designed to provide a meaningful experience to providers of all levels, from new learners to experts.  We have sought to present a balanced mix of topics of scientific and clinical relevance that will enhance your knowledge base and skill set.  Anesthesiologists and other health care professionals are encouraged to attend, whether your practice is predominantly congenital heart disease or caring for children and adults with cardiac issues on a less frequent basis.

The creation of this program has been a collaborative effort.  My most profound thanks to my Co-Chairs, Jim Spaeth and Susan Nicolson, for being available and offering unconditional help throughout the process. I also want to recognize our Immediate Past Program Chair, Luis Zabala, who generously shared his wisdom and experience. Our CCAS president, Nina Guzzetta and the CCAS Board of Directors for numerous innovative ideas they contributed to the program. Finally a huge thanks to Kim Battle for her amazing inspiring organizational role and making it all happen. Thank you all!

I am confident that our meeting will leave us with new exciting knowledge and ready to improve the care of our patients.

Looking forward to seeing you in Houston.