Celebrating Decades of Innovation in Perioperative Echocardiography

Abstract

G. Burkhard Mackensen MD, PhD, FASEView Large Image Figure ViewerDownload Hi-res image Download (PPT) The perioperative care of patients has always been a driver of innovation in echocardiography. In the 1950s, Dr. Edler, while caring for surgical patients with mitral stenosis, had the early vision of using ultrasound to diagnose concomitant mitral regurgitation. While basic perioperative imaging was feasible with epicardial M-mode scanning, it was not until the development of transesophageal echocardiography (TEE) that perioperative ultrasound became a routine imaging tool during cardiac surgery. The ability to provide real-time, perioperative/periprocedural high-resolution three-dimensional (3D) imaging enabled entirely new noninvasive therapies in the care of our patients. This June in Portland, the American Society of Echocardiography (ASE) will host its 30th Annual Scientific Sessions and celebrate decades of innovation. The ASE Council on Perioperative Echocardiography has designed a truly exciting perioperative track for this historic meeting. In an effort to shine the limelight on important topics that traditionally have received less attention, we elected to have an entire session devoted to echocardiography in adult patients with congenital heart disease with a focus on the perioperative and periprocedural environments. We will divide this session into imaging of unrepaired and repaired defects, as well as echocardiographic guidance for repairing defects. This multidisciplinary panel will include representation from cardiac surgery, cardiac anesthesiology, and cardiology. With the increasing prevalence of mechanical circulatory support in the care of cardiovascular patients, we felt it was important to again dedicate a session to echocardiographic imaging of the myriad of devices and approaches. This session will review the utility of echocardiography in extracorporeal membrane oxygenation (ECMO) as well as both durable and temporary ventricular assist devices. Due to popular demand, we will also include a talk on cardiac imaging during organ transplantation. In this session, we will feature a truly multidisciplinary panel and start with a case of functional mitral regurgitation. A cardiac anesthesiologist will dive into the mechanism of functional mitral regurgitation and discuss some challenges and approaches to evaluating the severity of regurgitation in and out of the operating room. A cardiac surgeon will review data on when to repair versus replace valves with functional mitral regurgitation. A cardiologist will review the results and implications from the recent COAPT trial. Finally, we will return to the case and learn what actually happened. To celebrate the 30th Anniversary of ASE’s Annual Scientific Sessions, we decided to learn about innovation in perioperative imaging of the mitral valve. We will hear from an individual whose contributions as an engineer really enabled echocardiography as we know it today. Of course, not all innovative ideas in echocardiography have withstood the test of time. We will revisit some past approaches to imaging of the mitral valve that we no longer use, while also learning what has made some innovations truly successful. We will also learn about multimodality imaging and what it can add to diagnostic ability over echocardiography alone. Finally, we will look toward the future and the potential of new technologies including virtual reality and 3D printing. For over a decade we have heard about transcatheter aortic valve replacement (TAVR) in high-risk patients. TAVR is now being applied to intermediate-risk patients, and the results of large trials in low-risk patients are going to be published this spring. The TAVR technology is also being used in valve-in-valve (ViV) procedures to treat patients with degenerated bioprosthesis. Our panel of experts will be presented with a case. A cardiologist will discuss the challenges that can arise when applying the guidelines in the preprocedural evaluation of aortic stenosis. The audience will then hear about key aspects of imaging during TAVR and TAVR ViV, as well as the VIVID registry. Recognizing the supreme importance of the left ventricular outflow tract (LVOT) in a variety of surgical- and transcatheter-based interventions, we will be dedicating an entire session to this cardiac structure. In this session, we will review the basics of predicting and avoiding LVOT obstruction in mitral valve surgery. We will also hear from an expert on transmitral valve replacement who will discuss the challenges in predicting and assessing the neo-LVOT in the context of transcatheter mitral valve replacements. Of course, no session on LVOT would be complete without talking about hypertrophic obstructive cardiomyopathy (HOCM). We will learn about considerations in choosing between surgical myectomy and alcohol septal ablation in HOCM. There will also be a discussion on the impact of anesthesia on LVOT gradients in HOCM and how stress testing can be used in the perioperative setting for surgical guidance. As an experienced echocardiographer, you may think that you know everything there is to know about Doppler, but wait until you have heard Dr. Natesa Pandian talk about its power and utility. He is a captivating speaker, and it will be a tremendous privilege to hear him speak on this subject. ASE’s Annual Scientific Sessions is about what is new. These two novel learning labs will provide a “hands-on” opportunity for attendees to explore virtual reality and 3D printing as it pertains to echocardiography and beyond. For details about the Scientific Sessions, see the Advanced Program at https://www.asescientificsessions.org/wp-content/uploads/2019/02/ASE_AdvanceProgram2019-final-web-002.pdf-2-11-19.pdf It has been a unique privilege to collaborate with colleagues from different disciplines in creating this year’s perioperative track for ASE’s 30th Annual Scientific Sessions. Marielle Scherrer-Crosbie, MD, PhD, FASE, and Lanqi Hua, BS, ACS, RDCS, FASE, have provided outstanding leadership for those of us on the program committee. Help us create a buzz by tweeting about the perioperative program at #ASE2019 and #SeeYouInPortland!G. Burkhard Mackensen, MD, PhD, FASE, is the Chief of the Division of Cardiothoracic Anesthesiology at UW Medicine and a UW Medicine Research & Education Endowed Professor in Anesthesiology. He is a current member of the ASE board of directors and serves as the chair of the Perioperative Track Scientific Sessions, ASE 2019 in Portland.Frederick C. Cobey, MD, MPH, FASE, is the Chief of the Division of Cardiac Anesthesiology and Assistant Professor of Anesthesiology at Tufts University School of Medicine and serves as the Co-Chair of the Perioperative Track Scientific Sessions, ASE 2019 in Portland.