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Ann Thorac Surg 2002;73:S353-S354
© 2002 The Society of Thoracic Surgeons
a Department of Anaesthesiology and Perioperative Medicine, University Hospital Campus, London Health Sciences Center, London, Ontario, Canada
b Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
* Address reprint requests to Dr Murkin, Department of Anaesthesiology, London Health Sciences Centre, University Campus, 339 Windermere Rd, London, ON N6A 5A5, Canada
Outcomes 2001 was once again held at the Casa Marina Resort in Key West, Florida, from May 23 through May 27, 2001. There were more than 200 registrants from research and clinical sites throughout North America, as well as from Germany, Sweden, Norway, The Netherlands, UK, France, Finland, New Zealand, and Australia. The multidisciplinary nature of this meeting is recognized as providing an expert forum in which to discuss issues related to brain protection for patients undergoing a variety of cardiac and other surgical procedures. Registrants included cardiac and vascular surgeons, anesthesiologists, perfusionists, neurologists, neuropsychologists, cardiologists, nurses, and psychometrists, as well as industry representatives. In many cases, several members of the same research team were participating. The shared learning experiences are felt to be an important factor in enhancing each center’s research efforts and collaborations.
In addition to state-of-the-art lectures and research papers from many North American, European, and AustraloAsian medical research centers, another well-attended feature of Outcomes 2001 was the opportunity to join invitational focus group luncheons and breakfast meetings. These industry-sponsored events included scientists and phase I project development specialists representing various pharmaceutical, biotechnological, physiologic monitoring, and information technology industries. Many of those registrants who participated in these informal dialogues felt them to be an important link in recruiting and developing industry-based research contracts and funding.
Given this mix of expert clinicians and scientists, as well as the high levels of attendance from the various researchers, technicians, and industry representatives, the interest level at the various lectures, discussions, and question and answer sessions was very strong. The highlight of this meeting was the Pro-Con Debate, featuring Drs Steve Oesterle and Billy Cohn, who debated the topic, "The Future of Cardiac Surgery Lies With Interventional Cardiology." Not only were both these presentations entertaining and broadly humorous, but their high quality and "leading edge" topicality provided an insightful view of the newest advances in interventional cardiology as well as in cardiac surgery. Among other topics, Dr Oesterle presented an overview of his groundbreaking work on endovascular coronary artery bypass, while Dr Cohn included speculations on the future of robotic heart surgery and other noninvasive surgical modalities. Their debate is available for viewing and comment at www.hsforum.com.
Audience participation was uniformly high throughout the meeting with audience interaction and discussion being facilitated and encouraged by the program format. The separate Poster/Discussion sessions were arranged topically and were structured to stimulate discussion from both the session Chairs and the audience. The evening poolside Poster/Discussion session was particularly successful, reflecting not only the complimentary wine and cheese refreshments but also the high quality of the data presented. The insightful nature of the various question and answer sessions, given the depth of knowledge and range of disciplines represented by the audience, was felt by most of the presentors to provide invaluable feedback and assistance both in interpreting their current work as well as in stimulating ideas for further studies.
A remarkably consistent feature of this meeting is the number of new scientific papers dealing with issues raised in discussion the previous year, as at Outcomes 2000. This demonstrated the utility of a format that creates cross-fertilization among disciplines, which, in turn, can accelerate new discoveries. At last year’s meeting, increased aortic manipulation in the absence of epiaortic scanning (EAS) was shown to be associated with increased cerebral embolization. The challenging nature of this issue was underscored, however, by follow-up data from the London Ontario group. Their paper this year reported that cannulation of nonpalpable plaque significantly increased risk of perioperative stroke, indicating that primary detection of ascending aortic arteriosclerosis is only part of the solution. Optimal surgical management given the presence of such unanticipated aortic plaque remains unclear, however. Whether conversion to beating heart surgery and employing a "no touch" aortic technique, or rather selection of an alternative arterial cannulation site, should be employed remains unclear. What is apparent is that findings on EAS cannot be disregarded without significant potential for patient compromise.
After John Hammon’s presentation of methods to improve cerebral outcomes after traditional on-pump surgery, including decreased surgical manipulation associated with use of a single cross-clamp, the Johns Hopkins group presented compelling data showing marked improvement in their patients’ outcomes when this technique was employed. The hot topic for this year was the use of new radiologic tools to assess brain injury related to cardiac surgery. Alejandro Kohn gave an outstanding overview of the latest in magnetic resonance imaging (MRI) registration techniques and shared his experience from the Hammersmith Hospital [1]. The Wake Forest University group presented animal and human data demonstrating the sensitivity of diffusion-weighted imaging in revealing new lesions that both the patient and neurologic assessment team missed in both on- and off-pump surgical patients. They also showed animal data demonstrating that numerous (1,000+) small microemboi resulted in no discernable changes in any clinical MRI evaluations. However, magnetic resonance spectroscopy did show quantifiable changes and may become a useful tool in assessing neurologic outcomes. Another way of assessing outcomes was presented by Richard Novick from London, Ontario. Using CUSUM analysis, the unedited outcome measures resulting from the commencement of a new surgical technique, beating heart surgery, were analyzed. By predetermining various adverse clinical outcomes, surgical performance characteristics can be assessed in an ongoing, cumulative fashion to either confirm optimal outcomes or act to flag the need for intervention at an early stage. The full paper outlining this potentially useful statistical technique is presented in this Supplement [2].
The negative impact of shed blood return was discussed by the London, Ontario group and the Eindhoven group. Murkin presented a new meta-analysis confirming the association of full-dose aprotinin in reducing stroke, while Peter Everts initiated a lively debate about plasma sequestration and improved patient outcomes. Identification of neuroprotective agents and methods that protect the brains of patients at risk is the goal of all researchers, and data presented here show that our patients are beginning to benefit from our collaborative efforts. Although all of the accepted abstracts were printed in the meeting syllabus, some authors chose not to have their abstract published in these Proceedings.
Lastly, we would like to acknowledge the efforts of all those individuals without whose assistance none of this would have been possible. The support of Stan Horton, PhD, and others from Bayer Pharmaceutical in providing an unrestricted educational grant to help support both the Outcomes Meeting as well as the publication of these Proceedings is gratefully acknowledged. The efforts of our own staff from both Wake Forest University School of Medicine and University Hospital Campus, London Health Sciences Center, were prodigious and largely unsung. A particular thanks to the audio-visual team from E-Media Medical Educationals for excellent quality sound and state-of-the-art projection facilities. They seamlessly coordinated various computer-based, conventional slide, and video presentations, and their efforts were favorably commented upon by many of the meeting participants. Ultimately, thanks for the overall success of this Outcomes Meeting, as well as for the high quality of the scientific papers as published in these Proceedings, must go to all those participants, registrants, lecturers, and staff who contributed so much to the success of the 2001 program. Thanks to you all. We hope to see you at Outcomes 2002, May 22 to 26, 2002. For further information, registration, and abstract submission details, visit our website at www.outcomeskeywest.com.
References
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