Call for abstracts

Session Outline

Aorto-esophageal fistula is a condition that necessitates a multidisciplinary approach to its treatment, requiring the treatment of hemodynamic compromise, a rapid and accurate diagnosis and assessment, and control of local and systemic infection. Depending on the condition of the patient, the stage of infection, and the extent of the aortic lesions, it is necessary to collaborate across fields and make accurate judgements in advance with regard to the need for esophagectomy, indications for revascularization, pretreatment of prosthetic grafts, indications for homograft replacement, omentum and muscle flap coverage, and other interventions. This session will include presentations on surgical strategies based on the experience of participating institutions and surgeons and provide educational information.

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The goal of this session is to share concepts and practical procedures in each field to ensure that appropriate actions are being taken when unexpected secondary injuries occur during cardiac, aortic, respiratory, or esophageal surgery. In particular, this session will include video presentations on successful surgical procedures that were performed by collaborating groups in the thoracic surgery department and provide information on surgical techniques, precautions on intraoperative and postoperative management, and surgical indications.

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Cases of patients undergoing surgery who have suffered from COVID-19 pneumonia are now being reported. As thoracic surgery deals with the lungs and surrounding organs, the need for information sharing on respiratory management is higher than in the abdominal or other surgical fields. For this session, we would like to have presentations on the experience of emergency surgery, perioperative management, and infection control in the field of thoracic surgery.

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Recently, with the aging of the patient population, increasing numbers of non-cardiac surgical procedures are performed on patients with cardiothoracic comorbidities. Respiratory and esophageal surgical procedures after implantation of drug-eluting stents have also become common. This session will include presentations on experience and evidence from these patients and on the routine management of similar patients in the field of cardiovascular surgery.

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The importance of medical ethics has been recognized for a long time. This session will include discussions on strategies to realize clinical trials as a means to advance clinical medicine and presentations on how to construct and manage databases that are essential for clinical trials.

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Minimally invasive approaches such as thoracoscopy, robotics, and mediastinoscopy have been developed in the fields of cardiovascular, respiratory, and esophageal surgery, and these indications are expanding. This session will include video presentations and discussions on the evolution of and indications for minimally invasive surgery in each field.

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Based on advances in surgical procedures in the field of thoracic surgery and the current need for safer and more precise surgical procedures, the development of new diagnostic imaging methods is important to understand complex and precise local three-dimensional structures, and to design pre-operative surgical strategies. This session will include presentations on innovative technologies and methods for educational support for young surgeons.

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In the field of surgical research, it is important to solve clinical questions that arise not only in the basic field, but also in actual clinical practice from a scientific perspective. The driving force is the "research-mindedness" of each surgeon to keep searching for the truth. For this session, we are calling on leaders in the field to give young researchers messages about the importance of cultivating research-mindedness with practical tips and ideas on how to balance clinical and research activities. We are also calling on young surgeons to provide their opinions from a wide perspective about issues that will be important in the field of thoracic surgery in the future as they endeavor to become excellent surgeons and researchers themselves, as well as issues that prevent them from achieving a good balance between clinical and research activities.

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Valvuloplasty has become the gold standard for the treatment of mitral regurgitation due to degenerative disease. For the treatment of Barlow’s mitral valve disease with a higher degree of degeneration, various procedures have been proposed including not only resection and suturing, but also valvuloplasty with artificial chordae and the Alfieri stitch. In this session, we will discuss surgical procedures recommended based on long-term treatment results.

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Coronary transfer is the most important step for arterial switch operation. This session will include video presentations for discussions on strategies based on preoperative images and intraoperative techniques, including techniques for usual coronary transfer and techniques for patients who cannot undergo coronary transfer, as well as patients who underwent repeat coronary transfer.

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Both congenital and adult aortic valve diseases require aortic annular enlargement for valve replacement in a small aortic annulus. This session will include an in-depth discussion of aortic annular enlargement of small aortic annuli to understand the procedures for both congenital disease such as the Konno and Ross procedures, as well as the procedures frequently used for adult disease, such as the Nicks and Manugian procedures, and to assist with more smooth aortic valve replacement of small valve annuli, including selection of the surgical procedure.

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Bicuspid aortic valve repair involves the problem of reoperation due to late stenosis. This session will include an in-depth discussion of the details of the surgical procedures, including the repair techniques needed to preserve the bicuspid valve and whether tricuspidization is an available treatment option for a highly asymmetric bicuspid aortic valve.

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To find the best way for MICS-AVR, this session will include a discussion of the appropriate selection of right anterior thoracotomy or right lateral thoracotomy, the selection of open or thoracoscopic (camera angle) thoracotomy, valve selection (sutureless valve or rapid deployment valve), and the ligation method (use of COR-KNOT, etc.).

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Atrial switch dates back to the days when cardiopulmonary bypass was not available, and remains an important surgical technique for various pathologies involving double switch or complex venous return. Atrial switch involves three-dimensional construction, which requires much ingenuity. At this session, experts will present their know-how on the surgical procedures for the respective pathologies.

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The ART study demonstrated that there are no differences in the treatment outcomes even when a single internal mammary artery was used for bypass grafting. This session will include a discussion on whether arterial grafts should still be used to improve the long-term patency of three-vessel coronary artery bypass grafting, the method for using arterial grafts, and the roles of vein grafts.

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This session will include a discussion of the medium-to-long-term treatment results of aortic arch replacement using the FET technique for acute type A aortic dissection, chronic type B aortic dissection, and aortic aneurysm, respectively, to identify the usefulness and problems of the procedure (we are only soliciting presentations on individual diseases and will not accept presentations including more than one disease).

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For the treatment of AS in high-risk patients with HD, TAVR has been approved at some institutions in Japan and treatment options are increasing, including minimally invasive SAVR using rapid deployment/sutureless valves; and the treatment is approaching a turning point. This session will include a discussion on the optimal treatment to achieve favorable early and late treatment results in AS patients with HD.

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Cardiac surgeons sometimes experience cases requiring perioperative mechanical circulatory support because of preoperative low cardiac function and cardiogenic shock. This session will include a discussion of how to use IABP, PCPS, Impella, extracorporeal VAD, and other procedures, and how to restore cardiac function and approach the use of long-term implantable VADs.

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It is widely recognized that closure and amputation of the left atrial appendage have a preventive effect on cardiogenic cerebral infarction, but it is unclear in which patients with concurrent atrial fibrillation a Maze operation should be performed in addition to left atrial appendage closure. We call on experienced surgeons to discuss the patients in whom sinus rhythm should be restored.

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The aim of this session is to compare various aortic root replacement procedures (excluding cases of infection and dissection) in terms of the rate of avoiding reoperation and the mid- to long-term results, including anticoagulant-related complications, and to re-evaluate the role and indications of each procedure in Japan.

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In this session, experts in regenerative medicine will lecture on the current status and future of basic research through clinical application in this field in reference to various cardiovascular diseases to foster interest in regenerative medicine among young surgeons.

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While mitral valvuloplasty has recently been at the center of discussion, prosthetic MVR is required for various cases and attempts at ViV replacement have recently started, showing a trend of increasing percentage of bioprosthetic MVR. This session will include a discussion of the details of MVR procedures (valve preservation, prosthetic valve suturing, etc.) and complications, focusing on the indication criteria for current standard procedures and bioprosthetic valves, to reconsider recent cases of MVR.

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Transcatheter pulmonary valve implantation (TPVI), which was approved in 2021, is supposed to be used in clinical practice for the treatment of late pulmonary valve insufficiency and stenosis after surgery for Fallot’s tetralogy. In this session, cardiologists, pediatric cardiologists, and cardiovascular surgeons will discuss the current situation and future prospects of TPVI in Japan from their respective standpoints.

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Aortopulmonary shunt is a procedure established as palliative surgery to maintain the pulmonary blood flow, and requires many surgical considerations, including the timing and approach of surgery, selection of prosthetic graft diameter, and actions for pulmonary coarctation. This session will include presentations on detailed knowhow of the aortopulmonary shunt procedure at the representative institutions and a beneficial discussion for young surgeons who are expected to perform the shunt procedure.

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In this session, we will focus on the troubleshooting protocol for critical events during cardiopulmonary bypass for MICS/robotic surgery at each institution. Based on presentations by cardiac surgeons and clinical engineers, we will discuss the actions to be taken for elevated arterial flow pressure, decreased venous return, poor myocardial protection, and other troubles in detail with JaSECT members.

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Prolonged implantable LVAD therapy, regardless of BTT or DT, may be a global trend. In this session, surgeons working in Japan and the United States will discuss VAD for right heart failure, infection, valvular disease, and single-ventricle disease, all of which contribute to prolonged implantable LVAD therapy, and measures for social aspects (medical expenses and terminal care).

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The training situation differs between thoracic surgeons specializing in adult diseases and those specializing in congenital diseases. There has, for example, been a marked decrease in the number of surgeons applying to take the examination to become a congenital disease specialist. We have invited the President of the Japanese Society of Pediatric Cardiology and Cardiac Surgery to explain the differences in the training situation of thoracic surgeons specializing in adult and in congenital diseases, and will discuss the training of young surgeons and the centralization of institutions based on the recommendations of the Japanese Society of Pediatric Cardiology and Cardiac Surgery. We may in certain cases ask officers of the Ministry of Health, Labour and Welfare to attend the session as observers.

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JATS offers foreign training programs to promote internationalization of members and the association itself through experience at foreign institutions. This session will include discussions on how young surgeons who wish to study abroad and their supervisors should proceed in reference to the experience of Japanese heart surgeons working abroad.

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Whether surgery for complicated moderate ischemic MR is effective during CABG remains unclear. The 2020 guidelines recommend using the presence or absence of viability in the inferoposterior wall as an intervention criterion. This session will include a discussion of the criteria for mitral valve intervention when cardiopulmonary bypass is available and safe, and OPCAB may also be indicated.

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Most cases of atrial functional MR/TR can be treated with ring annuloplasty. However, ring correction alone may be insufficient for advanced-stage patients with a giant left atrium. This session will include a discussion of the appropriate procedures for such cases.

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Severe secondary TR is treated with various surgical procedures including ring annuloplasty alone, intervention involving the subvalvular tissues such as the papillary muscles, leaflet augmentation using an autologous pericardial patch, and valve replacement, although consensus is still lacking. In this session, we will discuss various topics related to this interesting theme.

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This session will include a discussion of repeat prosthetic graft replacement and TEVAR for the arch, descending, and thoracoabdominal aorta after non-total arch replacement procedures for acute type A aortic dissection, including arch reoperation following ascending aortic replacement and Hemiarch replacement and partial arch replacement selected taking TEVAR reoperation into account (in this session, we will not discuss problems concerning central aortic replacement such as aortic root replacement).

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This session will include a discussion of repeat prosthetic graft replacement after TEVAR or surgery using the frozen elephant trunk technique (excluding retreatment with TEVAR).

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Taking procedural changes and complications associated with recent advances in open heart surgery into account, we will reconsider optimal myocardial protection in this session. For this session, we are also calling for presentations on the current situation of myocardial protection (crystalloid/blood, method of administration) with recent surgical procedures including minimally invasive cardiac surgery.

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In this session, surgeons using direct-vision, endoscopic, and robotic-assisted approaches will present “points to consider at preoperative screening,” “cardiopulmonary bypass set-up,” “tricuspid valve deployment,” and “TAP technique” to explore the key points for safer and more reliable tricuspid valve surgery using MICS approaches.

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Every institution may have various techniques of aortic valvuloplasty modified or refined by gaining more surgical experience and learning from successful and failed cases. This session will include the sharing of surgical techniques and precautions at each institution, including how to perform annuloplasty, how to repair prolapse (plication or suspension), and how to treat unicuspid or quadricuspid aortic valve, mainly based on video presentations for the purpose of improving the skills of participants.

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Type III AR may be the last hurdle of mastering all techniques for aortic valvuloplasty. Although autologous pericardium must be used for valves with a short GH and large fenestration, the following questions remain to be answered: What are the results of late treatment? What are precautions for the handling of autologous pericardium? Can autologous pericardium be added to a cuspid valve and similar bicuspid valve? Can very asymmetrical bicuspid AV be tricuspidized with autologous pericardium? To answer these questions, this session will include video presentations of relevant cases and discussion of the results of late treatment in these cases.

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Human and technical exchanges with other Asian countries are thriving, and these countries have been reporting excellent results to the rest of the world. Compared with Japan, cardiac surgery has a shorter history in these countries. Therefore, institutions are centralized, and many procedures are performed at specific facilities. At this session, we will look at the results of these high-volume centers and reconsider the ideal way to treat congenital diseases in Japan in the future.

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The results of the EXCEL and NOBLE trials demonstrated that CABG of main trunk lesions is effective for secondary prevention of myocardial infarction. However, survival improvement with CABG may be smaller than with drug therapy or PCI until 15 to 20 years have passed. In this session, we will discuss the application of CABG and PCI as well as the early- and long-term results (myocardial infarction and mortality) at each institution.

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With coronary artery bypass graft surgery, proper use of the bilateral internal mammary artery is an important theme. The focus of this session will be the right internal thoracic artery (RITA), with a three-way debate on the three “in-flow” options of “in-situ = subclavian artery,” “ascending aorta = AC bypass,” and “in-situ ITA = composite graft,” by experts in the respective fields as designated speakers. By organizing the advantages and disadvantages of each option based on rich experience and major articles in the literature, the theory of selecting the optimal in-flow and target for each patient will be introduced and it is expected to obtain a deeper understanding of the proper use of bilateral ITA.

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What is the appropriate way to apply bilateral internal thoracic artery (BITA) to coronary artery bypass graft surgery? At this session, we hope to specifically discuss the cases to which BITA and SITA apply.

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The merits and demerits of MVR and MVP, which are both surgical treatments for severe ischemic IMR, have not been established. A randomized controlled study conducted in 2016 showed no significant differences in the 2-year results, but the recurrence rate was significantly higher with MVP. However, MVP included only MAP, and it is also considered that long-term results may be improved by leaflet patch augmentation or additional subvalvular procedures. At this session, we will discuss the indications and surgical procedures of MVR and MVP from the respective viewpoints.

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Conservative treatment of functional mitral regurgitation associated with low left ventricular function is known to have poor results, and attempts have been made to improve the prognosis with various surgical procedures including mitral valve surgery. Since transcatheter mitral valve repair (MitraClip) and LVAD as permanent destination therapy (DT) have been added to the national health insurance list, treatment options have expanded, and the indications and outcomes are being discussed. The discussion by experts in each field at this session will deepen our understanding of the treatment of functional mitral regurgitation associated with low left ventricular function.

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This session will include discussions on the pros and cons of using the frozen elephant trunk procedure for type A acute aortic dissection.

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This session will include a discussion on whether to perform total arch replacement once enlargement has been confirmed or to perform early TEVAR for distal arch saccular aortic aneurysm in a patient with a low risk for surgery involving extracorporeal circulation, mainly based on presented cases.

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What is the best treatment for AS? In this session, three patients in whom it was difficult to select the kind of AS treatment will be presented, and the speakers, who are experienced in AS treatment, will discuss their respective treatment strategies by way of a debate.

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At this session, speakers will present extracorporeal circulation methods, surgical and valvuloplasty techniques, device development, and education and training pertaining to robot-assisted and minimally invasive endoscopic mitral valve repair procedures from their respective viewpoints and discuss the advantages, precautions, and future prospects of each procedure.

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Better myocardial protection is required in patients with severe cardiac dysfunction. This session will include a thorough debate on whether blood cardioplegia or crystalloid cardioplegia is more suitable for patients with severe cardiac dysfunction, based on institutional experience and theoretical background.

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A standard cardioplegia method has not been established for complex heart diseases in children, especially neonates and infants. This session will include discussions on the characteristics, advantages, and disadvantages of the current highly regarded Del Nido blood cardioplegia and the conventional crystalloid cardioplegia methods.

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As a solution to the significant donor shortage and prolonged transplant waiting time, heart transplantation from a donor after cardiac death (DCD) needs to be considered in Japan. At this session, speakers who have led heart transplantations in Japan will; give separate presentations on the pros and cons and discuss the issues and measures involved to introduce heart transplantation from DCD.

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Lung transplants requires bronchial and pulmonary arteriovenous anastomoses surgical techniques, while not commonly used in surgery for lung cancer, they can be applicable in surgery for advanced lung cancer cases. To attract the interest of thoracic surgeons who are not routinely involved in lung transplants, in this session we will focus on the technical aspects of lung transplant surgery. This session will included video presentations on: bronchial anastomosis techniques to avoid ischemia of the bronchial mucosa, pericardial patch plasty for pulmonary artery revascularization, revascularization of the pulmonary trunk to the main pulmonary artery, handling of the left atrium and pulmonary vein in the pericardium, and other techniques, as well as tips and precautions concerning these techniques.

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A prospective randomized study, JCOG0802/WJOG4607L showed that the postoperative survival rate was significantly higher with segmentectomy than lobectomy of small lung adenocarcinoma with GGO located in the periphery. However, the interpretation of this result is not simple. This session will include presentations and discussions on how to apply evidence originating from Japan to future surgical treatment.

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For this session, we are calling for presentations on specific research results as well as future prospects in the field.

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It is often difficult to determine treatment strategies for the narrowing of the airway due to thoracic deformity, thoracic surgery, benign tumors, and other causes. This session will include presentations and discussions on surgical treatments for each condition.

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Thoracoscopic surgery, which is minimally invasive, has become common in the field of thoracic surgery and is performed at many institutions. Indications for thoracoscopic surgery are inevitably expanding, including intrathoracic total adhesions and advanced cancer. Thoracic surgeons sometimes experience cases requiring careful consideration of the treatment strategy, cases of unexpected conditions that could not be foreseen from preoperative images, and difficult or challenging cases with procedural troubles such as lymph node leakage or enlargement, infiltration into the surrounding organs, and bleeding. This session will include presentations on such cases that can be discussed in a conference format.

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This session will include presentations on techniques for complete resection of primary lung cancer in technically difficult cases such as re-operation or post-CRT surgery.

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In recent years, RATS and uniportal VATS have spread rapidly as approaches of minimally invasive surgery for lung cancer. Although such surgical procedures were originally indicated for early-stage cases with normal lobulation, the indications have been expanded to include advanced cases with incomplete lobulation or lymph node metastasis and cases requiring complex procedures such as bronchoplasty. Very complicated cases, however, may be associated with more problems.
In this session, we will share information on the current extent of indications and the accumulated tips and pitfalls using video material to help expand the indications and ensure safety.

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It is well known that the 5-year survival rate of lung transplantation in Japan is over 70%, which is better than the world average of 50% to 60%. However, there have been few studies examining the reasons for this. It is important to elucidate these reasons for the advancement of lung transplantation, but we cannot deny the possibility of a unique bias in Japan. We hope that this panel discussion will serve as an opportunity to consider the current status of lung transplantation from various perspectives and to communicate our findings to the world.

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Various energy devices are used in the field of thoracic surgery, including ultrasonic coagulation cutting devices, vascular sealing devices, and special electrosurgical knives. Biological sealants are also frequently used. This session will include video presentations on the usage and techniques of energy devices and biological sealants used in clinical practice at each institution and also report on their performance and problems.

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Although surgical resection may be selected for the treatment of recurrent thymoma, consensus is lacking about when and how it should be performed. In this session, we will discuss the positioning of surgery as part of multidisciplinary treatment including chemotherapy and radiotherapy, the timing of repeat resection, limitations of surgery, indications for extrapleural pneumonectomy, and other related matters.

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Lung cancer in the presence of COPD causes more postoperative complications and thus requires careful decision making about the appropriateness of performing the surgery. For this session, we are calling for presentations on various techniques used during the perioperative period and on surgical procedures that are applied to prevent postoperative complications at each institution.

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In recent years, increasing numbers of patients are diagnosed with very small lung cancer lesions due to the widespread use of CT screening and other reasons. Thoracoscopic surgery now requires various techniques to resect such “untouchable” and “invisible” tumors. For this session, we are asking experienced surgeons to make presentations on special methods for resecting small lesions in the lungs. In this session, we expect that surgeons will show the advantages and disadvantages of these techniques and provide procedural tips as we discuss the potential for future advances.

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In 2017, the UICC developed a TNM staging system for thymic tumors. The original TNM staging system was primarily intended to classify solid tumors; therefore, can it actually be useful for thymoma, which hardly ever involves lymph node or distant hematogenous metastasis? What is the situation with thymic carcinoma? In this session, we will discuss the significance of two classification systems, Masaoka and TNM, which are currently often reported concurrently.

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Treatment outcomes of surgical therapy for esophageal cancer have improved through the introduction of three-field dissection, thoracoscopic surgery, and multidisciplinary therapy in Japan. Recently, new procedures such as mediastinoscopic surgery and robot-assisted surgery have been developed and are gradually spreading. Based on previous treatment results, we will discuss the future prospects of surgical therapy for esophageal cancer from various viewpoints.

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Thoracoscopic esophagectomy, mediastinoscopic esophagectomy and robot-assisted esophagectomy, have successively been included in the national health insurance list, and many endoscopic surgical procedures for esophageal malignant tumors are performed in clinical practice. With the rapid spreading of endoscopic surgery, the era of endoscopic surgery training without any experience of open procedures is coming. However, disease conditions vary among patients with esophageal cancer, and surgeons need to treat various difficult conditions such as infiltration of esophageal cancer into adjacent organs and unexpected major bleeding. This session will include a discussion of various topics on the detailed current situation and future prospects of procedural training, including the positioning of open procedure training for young surgeons who want to gain expertise in the treatment of esophageal cancer.

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Esophagectomy with esophageal reconstruction for esophageal cancer is highly invasive surgery and often causes decreased respiratory and swallowing function after surgery. Decreased eating function and nutritional disorder associated with esophageal reconstruction may continue for a long time. Recently, using health-related quality of life (HR-QOL) surveillance, which comprehensively assesses the multidimensional quality of life including physical symptoms and mental health, emotion, and social activities, has been the mainstay of the assessment of long-term surgical outcome. For this session, we are calling for presentations on the best practice of esophageal cancer surgery from the viewpoint of HR-QOL, including the indication criteria for esophageal cancer surgery, the selection of the procedures, and perioperative management.

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Various options are available for the treatment of locally advanced thoracic esophageal cancer of which the stage cannot be definitely determined since it apparently is a T4 tumor but tracheal, bronchial, or aortic infiltration cannot be ruled out, and is also called T3.5 cancer. In this session, we will explore treatment strategies for cT3b esophageal cancer, focusing on the selection of first- and second-line treatment and subsequent modalities and the rationale, surgical techniques, radiotherapy, and chemotherapy, and the use of stents and other devices as part of the multidisciplinary therapy, as well as medium-to-long-term treatment results. We are calling for presentations on treatment strategies for patients with cT3b esophageal cancer without distant metastasis.

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Thoracoscopic esophagectomy (MIE) has rapidly become widespread and is now proactively indicated for advanced cancer following neoadjuvant chemotherapy and for salvage surgery following chemoradiotherapy because visual magnification allows precise surgery. However, because of difficulty to expand the surgical field due to unclear layers caused by scarring and limited tumor mobility, safe and reliable tumor resection requires flexible measures depending on the surgical field, including tumor dissection to the edge of the preserved organ and treatment approaches based on an understanding of an overall picture of the tumor. This session will include a discussion of the techniques, tips, and precautions for dissection and surgical field expansion during MIE for advanced thoracic esophageal cancer.

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Cases of robot-assisted esophageal cancer surgery, which was added to the national health insurance list in April 2018, are increasing dramatically. On the other hand, thoracoscopic esophagectomy is performed in more than 60% of esophageal cancer surgery cases and may be an almost perfect procedure. This session will include video presentations on procedures and situations taking advantage of robot technology, such as multi-joint function, stable three-dimensional magnified visual field, and energy device, to propose its potential to outperform conventional thoracoscopic surgery.

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There are three routes for post-thoracic esophagectomy reconstruction, namely, anterior chest wall, retrosternal, and posterior mediastinal. The anterior chest wall route tends to be selected in limited cases such as high-risk patients, whereas the retrosternal and posterior mediastinal routes are selected in different ways. The treatment strategy may be determined at the institution or by the surgeon, or the routes may be applied differently in different patients. In this debate session, two experts will present their standpoints for supporting the retrosternal and posterior mediastinal routes, respectively, and discuss this old yet new topic in depth.

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This session will include explanations of the 2022 revised commentary on items related to esophageal cancer surgery.