The document provides information about a thoracic center in Enschede, Netherlands. It was founded in 2004 and now performs 1200 cardiac and thoracic surgeries per year. It has dedicated operating rooms and intensive care units for thoracic procedures. It employs 5 cardiac surgeons, 19 cardiologists, and 3 technical physicians. The center also has a cardio-research center. The document then presents a case study of a 60-year old male architect who is experiencing shortness of breath after previously undergoing heart valve surgery 7 years prior. He is considered high risk for repeat open heart surgery. The document discusses treatment options for this patient including a new biological heart valve, transcatheter valve implantation, or leaving the deteriorated valve in place

1. Frank R. Halfwerk, MD MSc
Technical Physician

2. Disclosure of speaker’s interests
(Potential) conflicts of interest Yes, see below
Potentially relevent company
relationships
EMCM (internship, consortium)
HCM Medical (consortium, consultant)
Research Funding
Fee or other payment
Shareholder
Other relationship
European Regional
Development Fund
No
No
No

3.  Founded in Enschede in 2004
 Increasing surgical volume to 1200 patients / year
 Dedicated Thorax OR / Thorax IC / Hybrid OR
 5 cardio-thoracic surgeons
 19 cardiologists
 3 technical physicians
 Cardio-Research Centre

4. 2016

8.  60 year old man
 Architect
 Presents at General Practioner
 Pain in chest when cycling
 Shortness of breath

9. † 2023
Istanbul Kanal 2023
† 2029
JFK 2029

10.  7 years post valve surgery again shortness of breath
 Valve deteriorated

11.  High risk
 7 years older
 Previous heart surgery (33% risk †)
 Treatment options:
 New biological heart valve
 Transcatheter Valve Implantation
 Minimally Invasive
 Bleeding
 Stroke / CVA
 Kidney Failure
 Rhythm disorders

13.  Surgical removal?
 Complications:
 Lung infections
 Nerve injury
 Ischaemic anastomosis
 Dehiscence
 Peri-operative morbidity 40%
 > 4 cm resections avoided
 No treatment options

14. Tissue-engineered trachea?
Macchiarini et. al, Lancet 2008

16. Blood vessels off the shelf
Long lasting heart valves
Functional trachea implants

17. MINIMALLY INVASIVE SURGERY TISSUE RECONSTRUCTION
PROSTHETIC DEVICESIMAGING AND MODELING
PROF J GRANDJEAN

18. Alles zelf doen is optellen,
samenwerken is vermenigvuldigen
(To work alone is adding up,
while collaboration is multiplication)
Health Outlook 2014, STZ