This document proposes the development of an advanced endovascular cardiac surgery program at a US institution. Such a program would train surgeons in minimally invasive techniques like TAVR and endovascular repair of aortic aneurysms using skills in imaging, endovascular devices, and hybrid operating rooms. It would include fellowships to disseminate these skills and research partnerships to develop new image-guided therapies. The goal is to equip future cardiac surgeons with the ability to use cutting-edge endovascular approaches and address the growing demand for minimally invasive cardiac procedures.

1. Endovascular Cardiac Surgery : A New
Subspecialty of Cardiac Surgery :Developing The
Next Generation of Cardiac Surgery Therapies.
Jacques Kpodonu, MD
ABS,ABTS,ABVM.

2. 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.

3. The Times Are Fast Changing: Are We
Prepared?

4. Endovascular Cardiac Surgery: A New
Subspecialty of Cardiac Surgery
Open
Procedures
Minimally
Invasive
Techniques
Percutaneous
Approaches
Patient-Optimized Care

5. 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.

6. 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.

7. 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.)

8. 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.

9. Cook Medical
Ascending aorta
endograft
1.Endo-Aortic Program: Ascending Aorta Endograft.
• Type A dissection
• Pseudo-aneurysm
ascending aorta

10. 1.Endo-Aortic Program: Arch-Aorta Endograft.
Arch aneurysm
Branched arch endograft
Post repair arch
Courtesy cook Australia

11. 1.Endo-Aortic Program: Thoraco-abdominal
Endograft.
Hybrid TAAA graft

12. 1.Endo-Aortic Program: Abdominal Aorta
Endograft.
Pre repair of aneurysm
using 3D Fusion Technology Post repair of aneurysm

13. 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.

14. 2.Trans-catheter Valve Program:
3D Dyna CT performed in
a hybrid OR to accurately
size and deploy trans-
catheter valves
surgeon procedural details

15. 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.

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

17. 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

18. 5. Real-time MRI Cardiac Surgery Program.
• MRI guided cardiac
surgery procedures is
possible for TAVR
procedures,Structural
heart procedures and
stem cells injection

19. 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

20. 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.

21. 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.

22. Pre-Exclusion Post-Exclusion
Wireless Pressure Sensor for Remote Aneurysm
Surveillance.

23. 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 .

24. 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.

25. Thank –you