The worldwide exchange of information among health professionals becomes very important in the face of rapid technological innovation. This report deals with the latest advances in cardiovascular and thoracic surgery in Asia, in the global context of cardiothoracic surgery. It also provides a brief history of the Asian Society for Cardiovascular and Thoracic Surgery (ASCVTS).1,2
2008 Annual Meeting of Asian Society for Cardiovascular and Thoracic Surgery
The 16th Annual Meeting of the ASCVTS was held on 14–16 March 2008 in Singapore under the chairmanship of Professor Chuen Neng Lee of the National University of Singapore. The venue of the main meeting was the Raffle City Convention Centre. An epoch-making event of the meeting in Singapore was the participation of the American Association for Thoracic Surgery (AATS) in the conjoint post-graduate course that was held immediately before the main meeting. The North American instructors came to Singapore to volunteer their time, energy and expertise in genuine inter-continental co-operation and assistance. In Asia, there are many surgeons from economically unprivileged regions who cannot afford to attend the North American or European meetings.
The ASCVTS is very appreciative of the global sprit of the AATS and will not forget the contribution of the faculty members. Tiron David, Past President and Historian, delivered two lectures: ‘Current status of valve-sparing operations for annuloaortic ectasia’ and ‘Selection of valves in 2007 – has the paradigm shifted?’ Richard Jonas, Past President, presented ‘Advances in cardiopulmonary bypass for neonates and infants’. Irving Kron, Secretary, discussed three topics: ‘Management of aortopathy in patients with bicuspid aortic valve disease’, ‘Update on techniques and results of surgery for TAPVC’ and ‘Surgical management of ischemic cardiomyopathy: revascularisation, mitral valve repair and ventricular remodelling’. Craig Smith, Councillor and Chair of the Education Committee, talked about ‘Changing landscape of cardiac valve replacement – percutaneous and transapical approaches’ and ‘OPCAB techniques and outcomes – comparison with revascularisation with CPB’. Harzel Schaff, Councillor, made three presentations: ‘Mitral valve repair – current techniques and indications for operations’, ‘Surgical ablation for AF – when to proceed and how to do it’ and ‘Neurocognitive deficits and coronary artery surgery – fact or fiction?’ Joseph Bavaria, Member of the Education Committee, selected the topic of ‘Role of endovascular stent grafts for thoracic aortic disease’. The superb quality of lectures, active discussions and full attendance indicated that the conjoint post-graduate course was highly successful.
The main meeting started with two plenary lectures, ‘New indications and new methods for management of hypertrophic cardiomyopathy’ by Harzell Schaff and ‘Changing strategies in the management of thoraco-abdominal aneurysm repair’ by Peter Robless. The excellent results achieved with the vascular surgical approach presented in the latter were impressive.
At the opening ceremony, welcome remarks were made by the President, Akira Furuse, and the Chairman of the Organising Committee, Chuen Neng Lee, with the Councillors of the ASCVTS and representatives of the AATS, the Society of Thoracic Surgeons (STS) and the European Association for Cardiothoracic Surgery (EACTS) on the stage. Thereafter, simultaneous presentations were given in four rooms. The topics included coronary, valve, aorta, mediastinum and novel technologies. In the session of the Young Investigator award, a total of 10 pre-selected papers were read. During the presidential dinner, the award was given to Dr M Ohno, who presented ‘ANP improves renal medullary ischaemia and renal dysfunction after hypothermic circulatory arrest’.
The second day of the main meeting began with two plenary lectures. The first, entitled ‘Entrepreneurship in cardiac surgery’, was delivered by Manny Villafana, the founder of SJM. This was a very impressive talk, especially for young individuals. The key phrases of his speech were ‘Nothing is impossible’ and ‘You have to take risks’. In the second plenary lecture, entitled ‘Randomised clinical trials for new technology: LVRS and the NETT’, Douglas Wood, Secretary of the STS, emphasised the importance of evidence-based surgery. The presentations that followed the plenary lectures in the main hall included ‘Future of adult cardiac surgery: Contribution of database’ by Noboru Motomura, ‘Understanding changes in ventricular size and function after mitral valve regurgitation: Thinking volumetrically’ by Harzell Schaff, ‘Significant experience of non-intubated awake cardiac surgeries (on and off pump)’ by Vivek Jawali, ‘New developed portable cardiopulmonary bypass system for management of cardiac shock patients in need of emergency coronary bypass surgery’ by Matthias Arlt and ‘Intermittent pressureaugmented retrograde cerebral perfusion for brain protection during aortic surgery’ by Shinichi Takamoto. The simultaneous presentations were provided in seven rooms. The topics discussed there included congenital heart disease, arrhythmia surgery, heart transplantation/heart failure therapies, developing cardiac surgery in Asia, chronic obstructive pulmonary disease (COPD), surgery of the airways, diagnosis of thoracic malignancies, thoracic infection and stem cells/tissue engineering.
On the third day, interesting discussions took place in three debate sessions: ‘Cardiac CT versus coronary angioplasty’, ‘Percutaneous aortic valves: real player in the immediate future’ and ‘The future of complex arch disease will be: hybrid/debranching versus branched endovascular’. In addition to the main meeting, which focused on patient safety in the era of modern technology, a homodynamic workshop, an endovascular aortic stenting workshop, a minimally invasive thoracic workshop and a nursing symposium were organised. The three workshops were undertaken in the Advanced Surgery Training Centre at the National University Hospital of Singapore. The 16th Annual Meeting of the ASCVTS came to a wonderful close, drawing some 800 participants from over 50 countries or regions. The illustrious faculty and scientific content were obviously the greatest draws, making the congress a great success.
Global Activities of the ASCVTS in the Cardiothoracic Surgical Community
The parent organisation of the ASCVTS was the Asian Chapter of the International Society for Cardiovascular Surgery (ISCVS). The Asian Chapter was created in 1973 and originally consisted of Japanese, Korean, Indian and Thai surgeons. Members began participating in the biennial World Congress of the ISCVS and submitting manuscripts to its official journal.
By 1991, however, it was realised that the time had come for the Asian Chapter to hold an annual scientific meeting of its own. In order to make this a reality, the name of the Asian Chapter of the ISCVS was changed to the Asian Society for Cardiovascular Surgery.
The 1st Annual Meeting of the Society was held at the east end of Asia, in Fukuoka on 2 March 1993. The site of the Annual Meetings moved slowly westwards to Seoul, Taipei, Singapore, Jeju and Kuala Lumpur, finally reaching the west end of Asia, Istanbul, in 2004. Thereafter, it returned eastwards to Chiang Mai, Osaka, and Beijing, and this year again to Singapore.
Last year, the Society changed its name to the Asian Society for Cardiovascular and Thoracic Surgery so that it could include general thoracic surgeons. This was to tie in with the international community, as all organisations on other continents included both cardiac and thoracic surgeons in their memberships.
The mission of the ASCVTS is to offer the best quality healthcare to Asian people who are suffering from cardiovascular and thoracic diseases. The Society is a membership-based organisation. Each member has to pay annual dues that include a subscription fee to the official journal, the Asian Cardiovascular and Thoracic Annals. Currently, there are 879 members of the Society in 29 countries or regions, including Armenia, Azerbaijan, Bangladesh, Belgium, China, Germany, Greece, Hungary, India, Indonesia, Iran, Japan, Korea, Malaysia, Mongolia, Pakistan, The Philippines, Russia, Saudi Arabia, Singapore, Taiwan, Tajikistan, Thailand, Turkey, the United Arab Emirates (UAE), the UK, the US, Uzbekistan and Vietnam. Over the years, the Society has become the most important cardiothoracic surgical organisation in Asia. In the global community of our speciality, the ASCVTS has been treated as a single cardiothoracic surgical society representing Asia and has been invited to attend the Joint International Leadership Meeting of Cardiothoracic Surgical Organisations. The other members of the Joint International Leadership Meeting include the AATS, the STS, the EACTS and the European Society of Thoracic Surgeons (ESTS).
Last year the main officers of the ASCVTS were invited to attend the Annual Meeting of the EACTS in Geneva. There was an official meeting between the leaderships of the ASCVTS and the STS. According to the discussion at the meeting, the STS decided to waïve the initiation fee for members of the ASCVTS from economically unprivileged countries. Also in Geneva, we had a Joint International Leadership Meeting. The issues discussed at the meeting included: editorial services for English as an international language; updated valve reporting guidelines;3 reconstruction of the residency programme; a conjoint post-graduate course; and guidelines for live surgery.4 It should be noted that the last two issues were proposed by the ASCVTS. During the Annual Meeting in Singapore, there was a meeting between the ASCVTS and the AATS consisting of educational committee members of both organisations. It was agreed that the conjoint activity of the post-graduate course would be continued at the 17th Annual Meeting of the ASCVTS, which was scheduled for 5–8 March 2009 at Taipei International Convention Centre.
As for the future prospects of the ASCVTS, the number of patients seeking cardiovascular and thoracic treatment will certainly increase with the dramatic improvement of the economy in some parts of the region. The need for quality control, on the other hand, will become much more important. A web-based database system for adult cardiac surgery has been developed and is available to all institutes in Asia. It will play an important role in the quantitative assessment of the quality of care.
Owing to the evolution of new technology, it will be necessary to include some endovascular techniques in our speciality training. The North American training curriculum for cardiothoracic surgery is being changed to include endovascular surgery. In order to achieve this reformation, organisations of cardiothoracic surgery and vascular surgery will have to work together, because cardiothoracic and vascular surgeries have been two distinct specialities in North America. In contrast, in many centres in Asia cardiac, vascular and thoracic surgeries are performed in one unit. The ASCVTS included both cardiac and vascular surgeons from its inception, and now includes thoracic surgeons as well. This is a real advantage for the ASCVTS in terms of keeping up with the rapid development of endovascular surgery; in fact, a workshop for endovascular surgery was conducted at the 2008 Annual Meeting in Singapore.
All in all, the role of the ASCVTS will become more and more important not only in Asia but also in the global community of cardiovascular and thoracic surgery.
- Furuse A, Asian cardiovascular surgery: a new horizon, Asian Cardiovasc Thorac Ann, 2003;11:279.
- Furuse A., Hosoda Y, The History of the Asian Society for Cardiovascular Surgery, Asian Cardiovasc Thorac Ann, 2006;14(Suppl.):1–14.
- Akins CW, Miller CG, Turina MI, et al., Guidelines for reporting mortality and morbidity after cardiac valve interventions, J Thorac Cardiovasc Surg, 2008;135:732–8, Ann Thorac Surg, 2008;85:1490–95, Eur J Cardiothorac Surg, 2008;33:523–8.
- Takamoto S, Guidelines for Live Surgery [In my Opinion], CTSNet, 19 October 2007. Available at: www.ctsnet.org/sections/newsandviews/inmyopinion/articles/art icle-63.html