SPSA Gears for Its Apayao Mission
Surgical Mission March 1-9 2014
Apayao, Mountain Province, up in northern Philippines will be the next site of the Society of Philippine Surgeon in America’s next surgical mission March 1-9 2014. Hosts of the undertaking are Congresswoman Eleanor Bulut-Begtang and Governor Elias Bulut, Jr. who extended the invitation to the Society’s Mission co-Chair, Dr. Manuel Cacdac sometime last year. Tentatively, there are are at least 76 volunteers from the US, Canada, UK, Germany, and the Philippines. The medical and surgical teams are represented by general surgeons, obstetricians-gynecologists, plastic surgeons, opthalmologists, anesthesiologists, urologist, neurosurgeons, dentists, internist and nephrologist. Making up the rest of the contingent are nurses and other support personnel.
Three hospital venues have been made available for the surgical procedures to be performed during the week-long mission. The group will fly in to Laoag airport and will be bused for the three-hour drive to Luna, Apayao. Some of the team members from the Philippines are planning to drive the ten-hour trek to the site.
It will be the first SPSA surgical mission to Apayao, although other groups reportedly have had similar medical mission trips to this northern part of the country.
Cacdac and Velchek receives Phil. Presidential Award
This is a historic day for the Society of Philippine Surgeons in America. Two members, both Past Presidents of the Society were given the Presidential award for Filipino individuals or organizations overseas. This biennial award is given to deserving individuals and or organizations to recognize their contribution to Phil. development and progress and promote the interest of Filipinos in the Philippines and abroad.
Dr. Manuel A. Cacdac was awarded the LINKAPIL (Lingkod sa Kapwa Pilipino), award for his humanitarian endeavors with bringing surgical missions to different parts of the Philippines once or twice a year and for founding the Hydrocephalus Foundation of the Philippines. President Benigno Aquino recognizes the significance of his professional contribution that has resulted in an increase awareness of hydrocephalus and thereby improving the lives of afflicted Filipino babies, giving them a chance to be normal human beings. Dr. Cacdac was also a BPinoy awardee in 2010, The Most outstanding Indiana Filipino Physician of the Year in 2011, The Most Outstanding Alumnus for Community Service Award, USTMAAA in 2012. He was nominated for CNN Heroes and the Ramon Magsaysay Award in 2012.
Dr. Francisca Tolete-Velchek, was awarded the Pamana Ng Pilipino Award which is conferred to Filipinos overseas who, in exemplifying the talent and industry of the Filipino, have brought the country honor and recognition through excellence and distinction in the pursuit of their work or profession. She was one of eleven awardees. in this category. Dr. Velchek is a Professor of Surgery at The Downstate Medical Center and Chief of Pediatric Surgery at the Long Island College Hospital, Attending Pediatric Surgeon at the Lenox Hill Hospital, and visiting professor of surgery at the Univ. of the Phil., where she graduated from. She has many accomplishments, written books and medical articles, and many awards. In conferring this ward , the President recognizes her outstanding achievement as a doctor of medicine and academician in the field of Pediatric Surgery in the United States....SPSA BOARD MEETS, CANADA NEXT CME SITE
The Society of Philippine Surgeons in America held its annual spring board meeting aboard S.S. Isabel during a scheduled cruise along the Duororiver in Portugal. The Board decided among other things to hold the next CME meeting in Nova Scotia, Canada next July 2014 at a hotel/resort area not too far away from former SPSA president Bayani Ignacio, MD and his wife, Cora Ignacio’s residence. The couple have agreed to host the meeting. The venue was chosen over the city in Germany which was initially proposed by incoming SPSA President, Ed Navarro, MD who lives in Germany.
Aboard the ship which never sailed off the port of Porto because of the swollen Duoro River caused by continuous rain, the Society also held a CME meeting which qualified for an ACCME category 2 credits. Speakers during the symposium included Mel Simon, MD, Celia Ona, MD, FerdieOna,MD, Edward Quiros,MD, Ed Navarro,MD and Ralph Zaragoza, MD. The program was planned and moderated by SPSA’s CME chairman, Dr. Ben Zamora.
Meanwhile, the Board also discussed the coming CME annual meeting in Alaska, the next surgical mission venue in the Philippines presently being arranged by Manny Cacdac, MD, the financial status of the Society, and the next spring meeting in 2014.
The group were bussed to the places in Portugal and Spain which the cruise was supposed to have traveled and meandered through but for the strong river currents and the locks which were closed because of the rains. Six couples took and extended land tour in Spain after the river cruise ended.
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 SPSA Officer Passes Away
Hector Soto, MD FACS, a member of the SPSA Board of Governors, passed away last week. He was 72 years old and has practiced Orthopedic surgery for more than 48 years in Portsmouth, Ohio.
Dr. Soto was a 1964 graduate of University of Santo Tomas Faculty of Medicine and Surgery. He did his postgraduate training at Elizabeth General Hospital and his residency in Stamford Hospital in Connecticut and Worcester City Hospital in Massachussetts. He was board certified in Orthopedic surgery.
Dr. Soto was very active fellow of the Society of Philippine Surgeons in America. The
Society will surely miss him in the many activities he had involved himself in the Society. He is survived by his wife, Lourdes.
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SPSA Hosts Confab on its 40th Anniversary
The Society of Philippine Surgeons in America celebrated its 40th anniversary by hosting a symposium on medical and surgical missions to the Philippines, September 30 at the Chicago Marriott Hotel. The event was held during the American College of Surgeons’ annual Congress in Chicago September 29-October 4 2012.
The meeting was organized by Hernan Reyes, MD FACS, the Society’s founder and was arranged by Dr. Manny Cacdac, SPSA’s convention chairman. Past presidents of the Society which included Danny Fabito, MD FACS, Pacifico Dorado, MD FACS, Mel Simon, MD FACS, Bayani Ignacio, MD FACS and Johnny Montero, MD FACS, and Frances Velchek, MD FACS were invited to speak on surgical missions to the Philippines and the recent impact of the Philippine Regulatory Commission’s directives on foreign medical and surgical missions to the country.
 Dr. Reyes and CME chair Dr. Zamora moderated the panel.
The meeting was attended by invited dignitaries from the Philippines which included Dr. Enrique Ona, Secretary of Health, Dr. Rey Melchor Santos, past PCS and PMA president, current Philippine College of Surgeons’president Dr. Maximino Simbulan, former ACS Governor, Philippine chapter Dr. Ben Gaddi. Dr. Enrique Ona, MD FACS and a transplant surgeon was honored with Honorary Fellowship Award, by the American College of Surgeons, the first Filipino surgeon bestowed this prestigious honor. A guest of honor at this symposium, he gave a talk on the state of health care in the Philippines and what his department has done and plans for the future of health care in the Philippines. He also assured that he would look into the recent PRC directives and work on making foreign surgical and medical missions in the country continue. Dr. Rey Santos discussed the problems associated with the foreign surgical and medical missions in the Philippines as it relates to the local physicians and surgeons.
The symposium was preceded by the SPSA Board of Governors meeting during which the upcoming Ormoc City surgical mission on January 20-26 2013, the Portugal/Spain spring cruise and the Annual CME meeting, among other agenda were discussed.
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Cacdac USTMAA Awardee
Manuel Cacdac, MD, a neurosurgeon from Terre Haute, Indiana was recently awarded the Most Outstanding Alumnus for Community Service during the last USTMAAA Annual Meeting at Caesar’s Palace in Las Vegas, Nevada, August 18-21, 2012.
Dr. Cacdac, a past president of SPSA and presently a co-chair of the Society’s surgical mission, is also the founder of the Hydrocephalus Foundation of the Philippines. Dr. Cacdac has been involved in surgical missions to the underserved areas and continues to work on hydrocephalic babies in the Philippines .
He has been a recipent of numerous awards for his charitable work including Indiana’s Physician of the Year and the prestigious BPinoy Award given in the Philippines to Filipinos who have distinguished themselves in their chosen profession.
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 Michigan Surgeon SPSA's 37th President
Leo M. Madarang, MD, a Michign surgeon was installed as SPSA's 37th President during the Society's Annual CME Meeting Seminar in Surgery, July 11-15 2012 in Orlando, Florida.
Leo graduated from the University of Santo Tomas in 1971. He did his internship at St, Joseph Hospital and then his residency in General Surgery and Trauma at Hurley Medical Center. He served as Chief of Surgery at Genesee Memorial Hospital in Flint, Michigan and Wheelock Memorial Hospital in Goodrich, Michigan. He is in practice as a general surgeon and as a wound care specialist and hyperbarist at McLaren Regional Medical Center in Flint, Michigan. He is married to his wife of 40 years, Maria Teresa. They have 4 children-- Angela Joyce, a paralegal, Candice, a Director of Restaurants and Marriott, Michelle, a registered nurse, and Leo, Jr., a lawyer. The new SPSA president plays golf, collects classic comic books and enjoys traveling. The group is scheduled to have another surgical mission, tentatively set on the third or the last week of January 2013.
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Past Presidents’ Special Program
Sunday, September 30, 2012
5:00 p.m. – 10:00 p.m.
40th Anniversary Celebration
Chicago Marriott Downtown Magnificent Mile
The Society of Philippine Surgeons in America will host a Past Presidents’ Special Program on the occasion of the Society’s 40th anniversary during the American College of Surgeons’ 96th Annual Congress in Chicago. The meeting will be held on September 30, 2012 at the Chicago Marriott Downtown Magnificent Mile at 5-10 PM.
Hernan Reyes, MD FACS, the Founder of the the Society, has prepared a program that includes past presidents of the Society, together with special guests from the Philippines which include Dr. Enrique Ona, the Secretary of Health of the Philippines, Dr. Rey Melchor Santos, former Philippine College of Surgeons and Philippine Medical Association president, and Dr. Ben Gaddi, Past President and Governor, ACS Philippine Chapter.
 Dr. Michael Nussbaum SPSA’s 38th Annual CME Education Seminar in Surgery Professorial Lecturer
Michael S. Nussbaum, MD FACS, Professor and Chair of the Department of Surgery, University of Florida College of Medicine, Jacksonville will the Professorial Lecturer July 13, 2012 during the SPSA’s 38th Annual Continuing Medical Education in Seminar in Surgery in Orlando, Florida. He will be speaking on “Laparoscopic Management of Common Bile Duct Stones”. Dr. Nussbaum who is also the Surgeon-in-Chief at Shands Jacksonville Hospital and Program Director of the Surgery Residency Program at UFCM, Jacksonville has been named one of the Best Doctors in America since 2009.
He will be joined during by a number of distinguished guests and SPSA faculty during the Society’s 3- day seminar the theme of which is “Standards of Surgical Practice 2012, Diagnosis, Management and New Techniques”.
Benjamin Zamora, MD FACS, SPSA’s CME Committee Chairman says that all the speakers are known experts in their respective specialties. The educational activity has been designated by the Accreditation Council for Continuing Medical Education (ACCME) to provide 16 credits in Category One of the AMA Physicians Recognition Award. For registration and inquiries, call 843. 243.0369
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Calbayog Mission Ends on a Positive Note
SPSA’s surgical mission to Calbayog last November 28 to December 5 2011 ended on a strongly positive note despite the fewer number of missionaries compared to the two previous missions there in 2006. Working at three different venues, most of which were done at St. Camillus Hospital, the team performed 111 major surgeries, 128 minors and 665 dental procedures over five and half days.
The mission was sponsored by Congressman Mel Sarmiento and Calbayog City Mayor Aquino.
For the new members of the surgical team as well as the ‘veteran’ missionaries led by Dr. Manny Cacdac, it was a moving and overwhelming experience.
The group is scheduled to have another surgical mission, tentatively set on the third or the last week of January 2013.
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SPSA CME Re-Accredited
The Society of Philippine Surgeons in America now belongs to a select few, out of several hundreds of providers of continuing medical education in the country, having received the highest rating on its 2011 re-accreditation application. Dr. Benjamin Zamora, the Society’s CME chairman proudly announced that SPSA was given a 6-year full accreditation to expire on November 30, 2017 by the Accreditation Council on Continuing Medical Education. Dr. Zamora stated that “In our 38 years of accreditation with ACCME, we have always achieved the standard 4-year accreditation which means compliance to all required elements”
Dr. Zamora and his wife Mary Zamora, RN, the Society’s Coordinator who worked hard on the re-application process for several months, received the notification letter and the certificate from Murray Kopelow, MD, MS, the ACCME Chief Executive Officer.
The Society of Philippine Surgeons in America conducts a yearly annual surgical symposium and continuing medical education in July and during its spring Board meeting.
Click here to view [ Accreditation Council Continuing Medical Education ]
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 Former SPSA President Out With New Book
Philip Chua, MD FACS FPCS long-awaited book came out of publication recently. “Let’s Stop Killing Our Children” is a collection of the author’s articles and commentaries on our environment and social issues which were published in numerous websites and newspapers here in the United States and abroad. The book, according to the author is meant to encourage “the fundamental value of starting a healthy lifestyle and prevention of diseases from crib, or even before the conception of the child”. The articles are “aimed to educate, challenge, and inspire the public on health issues and offer preemptive strategies in dealing with diseases in general”.
Dr. Chua, a cardiac surgeon, is a former president of the Society of Philippine Surgeons in America, editor emeritus of the Philippine Surgeon and presently the Chairman of the Filipino United Network USA. He writes a weekly column on health related issues for four newspapers in the United States. The foreword to the book was written by Dr. Denton Cooley with whom the author trained under during his cardiac fellowship at Texas Heart Institute.
Dr. Chua who is married to his wife Farida, a pediatrician, and has five children who are all physicians, has promised to donate royalties from books purchased by and through the Society of Philippine Surgeons in America in the Philippines towards the charitable activities of the Society. The book can be purchased through Xlibris, the publisher of the book or through the internet, Amazon.com and Barnes and Noble.
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 SPSA Fellow UST Quadricentennial Awardee
Zorayda Lee-LIacer, MD from Maryland member of the SPSA Faculty and SPSA Board of Governors was recently honored with the Thomasian Leadership Award during the University of Santo Tomas Quadricentennial Celebration last December 2010 in recognition of her humanitarian services to her patients, her colleagues and to organized medicine.
An anesthesiologist and critical care specialist, she is considered a trailblazer for championing antidiscrimination against women and foreign medical graduates as chairman of the Anti-Discrimination Committee of the Maryland State Medical Society. She lobbied many times during the legislative sessions of the Maryland Legislature in support of physician issues. For her advocacy of patient and physician issues, she was recognized and presented with citation awards by the Governor, Senate President and the Speaker of the House of the State of Maryland.
She was the first female president of the Georges County Medical Society and for eight years, a member of the Maryland Board of Physician Quality Assurance and was for twenty-five years, a member of the state’s Medical Society’s House of Delegates. Formerly, she was also an assistant professor in the Department of Anesthesia at Georgetown University Medical Center. Since 1988, Dr. Lee-LIacer has been joining the surgical mission to Sorsogon.
She has also been with the SPSA surgical mission for the last five years. Dr. Zorayda is married to Dr. Reynaldo Lee-LIacer, a surgeon from Maryland and a former president of the Society of Philippine Surgeons n America. Currently, she is Medical Director of a 22-bed critical care unit at Laurel Regional Hospital in Laurel, Maryland.
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Church Donates to SPSA Surgical Mission
The First Presbyterian Church of Borger recently donated $5303.60 to
Philippine Surgeon Charities for the SPSA's surgical mission to the Philippines. Pictured above is Dr. Ed Quiros receiving
the donation from Mr. Jerry Pool and Ms. Julia Kasch, both representing the Church.
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Cacdac Indiana PMA Physician of the Year
The Philippine Medical Association of Indiana awarded the Indiana PMA Physician of the Year to Manuel Cacdac, a neurosurgeon during the PMA Inaugural Ball September 17, 2011. Dr. Cacdac, a past president of SPSA, its current Convention Chairman and co-chair of SPSA’s surgical missions, has been a recipient of numerous local and national awards for his humanitarian activities. He is the founder and chairman of the Hydrocephalus Foundation of the Philippines which undertakes surgical treatment hydrocephalic indigent babies and children through ventriculo-peritoneal shunt program.
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Rep. Mel Sarmiento, in the middle, at Tacloban
Airport with Dr. Cacdac. Alice Barcelona,
RN and Rep. Torres staff last January.
CALBAYOG SAMAR NEXT SPSA SURGICAL MISSION VENUE
SPSA’s next surgical mission will be in Calbayog, Samar. This is scheduled for November 28 – December 4 2011. This would be the Society’s third surgical mission to Calbayog. Two previous missions to the city were held in January and December 2006 under the auspices then of the late Congressman Reynaldo Uy and Mayor Mel Senen Sarmiento and Congressman Catalino Figueroa who had patients from his Catbalogan district come to Calbayog for needed surgery.
Previously, the Society also held a mission in Catbalogan, sponsored by Congressman Figueroa.
This next mission is upon the invitation of Congressman Sarmiento who now represents the first district of Samar in the 15th Congress. The congressman has sent a letter to SPSA President Dr. Gualberto requesting the Society to return to the city. Dr. Manny Cacdac, co-chair of SPSA’s surgical mission committee is coordinating the activity with the congressman’s office.
During the 2006 missions to Calbayog, close to a thousand surgical procedures were performed by the missionaries, “SPSA’s efforts changing the lives of many Samarenos”, as Congressman Sarmiento acknowledged in his letter.
Dr. Cacdac as started fund-raising activities to subsidize the Society’s missionary activities and has asked fellows of the Society and volunteers to sign up early if they are joining the post Thanksgiving, pre-Christmas trip to Samar.
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The Society of Philippine Surgeon in America’s surgical mission to Ormoc City last January 30 to February 5, 2011 ended with 836 surgical procedures performed by different specialists represented in the surgical team. The operative procedures include 212 minor surgeries, 119 majors including cleft lips and palates, 421 dental, 72 eye cases that included 52 cataracts/lens implant, and 12 ventriculo-peritoneal shunts in conjunction with the Hydrocephalus Foundation of the Philippines.
The procedures were carried out in three different hospitals: Ormoc sugar Plantation Farmers Hospital where majority of the major and minor procedures were done, Gatchalian Hospital, and the Ormoc City District Hospital.
The surgical mission was sponsored by Congresswoman Lucy Torres-Gomez of the 4th Congressional District of Leyte. The congresswoman, her husband chief-of staff Richard Gomez, her staff and all the civic organizations who undertook the sponsorship of the mission in so short a period of time, went all-out to make the mission end on a successful note.
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Dr. Antonio Alfonso delivered the Annual Professorial Lecture
Dr. Antonio Alfonso delivered the Annual Professorial Lecture at the recent 37th Annual Surgical CME Seminar of the Society of Philippine Surgeons in America. His talk was "Surgical Approaches to Thyroid Disorders-Evolution of Treatment in 30 Years".
Dr. Alfonso, a Fellow of SPSA is the Distinguished Teaching Professor and Clarence and Mary Dennis Chair, Department of Surgery, State University of New York-Downstate Medical Center. He is also the concurrent Chair, Department of Surgery, Long Island College Hospital in Brooklyn, New York.
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 Cacdac BPinoy Awardee
Indiana neurosurgeon Manuel Cacdac, MD, a former president of the Society of Philippine Surgeons in America and co-chair of the Society's. Surgical Mission and its Convention Chair was unanimously selected to receive this year's BPinoy Awards by the Selection Committee of the Bank of Philippine Islands. The award is in recognition of Dr. Cacdac's "exceptional talent and outstanding achievement in the field of medicine". The BPinoy Awards, now in its fifth year, is given to Filipinos who excel in their chosen fields of discipline at home or internationally.
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 Physicians for Peace Honors Past SPSA President
Physicians for Peace, an international non-profit organization, presented Dr. Juan Montero with its first Excellence in Service Award for his longtime support of the organization's mission, at home and abroad, as well as his humanitarian efforts in the Philippines.
The award ceremony took place at the 2010 Physician for peace Celebrate the Nations gala reception in Virginia Beach, Virginia last October 2. "It is fitting that our first Excellence in Service Award honors Dr. Montero, who has been the consummate volunteer, leader and advocate for our organization for 15 years and counting", said Brig. Gen. Ron Sconyers (USAF, Ret), president and chief executive officer of Physicians for Peace. For his numerous work, Montero who retired from general and thoracic surgery private practice in 2007, and a past president of the Society of Philippine Surgeons in America, has received numerous honors including the Philippine Presidential Award in 2000, the Association of Medical College's Humanism in Medicine Award in 2002, and the American College of Surgeons' Surgical Volun-teerism Award in 2003.
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Progress in the Care of the Coronary
Artery Disease Patient
P SPSA 34 th Annual C.M.E.
Seminar in Surgery
July 16-20, 2008
The Great Wolf Lodge
Traverse City , Michigan
Progress in the Care of the Coronary Artery Disease Patient
Manuel R. Estioko, M.D.
Saint John’s Health Center
Santa Monica , CA
Coronary artery disease (CAD) remains the number one killer for both men and women in the United States. It is a progressive disease and there are clinical events that require treatment interventions either medical and or surgical. Ruptured atherosclerotic plaque often initiates platelet aggregation, thrombus generation, acute coronary occlusion and myocardial infarction (MI). Much has been accomplished in the medical treatment of the patient especially with the use of beta-blockers and statins. Better control of co-existing disease conditions like hypertension and diabetes further contribute to improved results.
In the event of admission for acute MI, cardiac catheterization and coronary angiogram is recommended to be done as soon as possible. The culprit vessel is identified; angioplasty and stenting are done to limit infarct injury. There is a trend towards multi-vessel stenting as well as repeat stenting. These are some reasons why patients are referred later for surgery and many are older and sicker. However, there are complications of stenting. Bare metal stent (BMS) has significant restenosis problem of about 25 to 40%. Drug eluting stent (DES) was introduced and decreased the incidence of restenosis by about one half but recently, there is observed acute stent thrombosis with the DES and patients have to take Clopidogrel for extended period to avoid this complication. So what is the next advance in technology?
Emergency coronary bypass is indicated in unstable patients in spite of or failed percutaneous coronary interventions (PCI). Some of these patients have tight left main coronary stenosis. The complications of PCI such as coronary dissection, occlusion, perforation and tamponade are low. Other serious conditions requiring emergency surgery are post-MI ruptured ventricular septum and ruptured papillary muscle of the mitral valve with severe regurgitation and pulmonary edema.
Coronary artery bypass graft (CABG) operation has consistently good long term results with low mortality and morbidity. CABG operation volume in most institutions in the US has decreased because of the progress in non-surgical treatments. The indications, graft conduits and present surgical techniques will be discussed in the presentation. The results of On pump and Off pump CABG will be compared. MidCab and Heartport are off the radar but Robotic surgery and minimally invasive procedures are emerging.
The high incidence cardiovascular disease in women and death from it was not well appreciated in the past. Women present their cardiac condition differently. Women’s health is the next frontier which is getting more recent attention. The treatment of CAD remains a major challenge for many years to come.
STATE OF THE ART LECTURE
P SPSA 34 th Annual C.M.E.
Seminar in Surgery
July 16-20, 2008
The Great Wolf Lodge
Traverse City , Michigan
STATE OF THE ART LECTURE
Opportunities in Blood Conservation in Major Surgery
Manuel R. Estioko, M.D.
Saint John’s Health Center
Santa Monica , CA
For so long physicians adhered to traditional transfusion practices without solid scientific evidence. An example of this is the use of arbitrary transfusion trigger and following the 10/30 hemoglobin/hematocrit rule. There were no accurate data supporting the different transfusion guidelines. Transfusion was left at the discretion of the individual physician resulting in tremendous variability in the use of blood and its components.
Over the past two decades, many studies emerged in the literature that has captured the attention of the medical community. These reports covered many aspects related to blood transfusion including: the hazards of blood-borne diseases; the deleterious effects of blood to vital organs like lung injury; immunosuppresion effect of blood transfusion and the increased risk of infection and poorer survival outcomes of transfused patients. At the same time, major, complex operations and even reoperations in cardiovascular, orthopedic and other specialties were successfully performed with less blood or no blood transfusions. Other factors became evident: the high cost of blood and its management; the dwindling volunteer blood donors and crises of blood supply. All these developments lead to the focus on blood conservation in most medical centers in the country. Blood management became important in medical practice that can no longer be ignored or considered an inconsequential issue.
Blood transfusion can be avoided in surgery in the following ways:
- Increase red cell mass before surgery.
- Minimize blood loss during surgery.
- Avoid bleeding problems.
- Accept lower levels of hemoglobin and hematocrit postoperatively.
- Optimize patient's recovery.
There are many opportunities in blood conservation that include strategies before surgery, intraoperative techniques and postoperative care. Erythropoiesis stimulating agents (ESA) and iron therapy are utilized to increase red cell mass in preparation for major surgery. Sound surgical principles that have to be followed with great details will be discussed in the presentation. The main goals are to minimize blood loss and employ techniques that avoid bleeding. Meticulous hemostasis is performed in every step of the operation. Excessive intravenous fluid administration is to be avoided since it can lead to dilutional coagulopathy. The principles in blood conservation are applicable in any surgical procedure. Fewer problems are encountered in general surgical operations and non-cardiac procedures because there is no burden of large dose Heparin anticoagulation and risk of bleeding. Open heart surgery is more involved, but successful operations can be performed (including complex operations and reoperations), without the use of blood. To illustrate this, we are presenting our experience in the surgical treatment of thoracic aortic dissection and aneurysm. Usually, this group of patients have large blood loss and are always transfused. To perform these procedures without blood transfusion is indeed the ultimate surgical challenge.
The emphasis on optimum blood management is here and is gathering more attention. There are principles and strategies that are applicable in surgery to decrease blood transfusion or avoid transfusion completely. It is incumbent upon the physicians and surgeons to re-evaluate their practice to approach the state of the art. It is no longer acceptable to be using so much blood.
G. Michael Deeb, M.D.
G. Michael Deeb, M.D.
Herbert Sloan Collegiate Professor of Surgery
Director Multidisciplinary Aortic Clinic
Section of Cardiac Surgery
University of Michigan
Cardiovascular Center
Ann Arbor, Michigan
The purpose of this lecture is to discuss the surgical treatment for thoracic aortic disease. We will discuss the various sites and locations of thoracic pathology in relationship to its specific needs for repair. We will talk about the indications for intervention for each type of pathology depending on their location and the underlying etiology of the disease.
We will look at the aortic root, the ascending aorta, the aortic arch and the descending thoracic aorta separately. We will discuss the indications for operation and the various types of operations at each site. We will go into explicit detail as to the various interventional techniques which are available for each site. We will then discuss results which include both short-term and long-term data.
We first begin with the aortic root and ascending aorta and discuss the various indications for intervention. We will then divide intervention into valve sparing roots versus root conduit replacement with a valve.
We will then discuss aortic arch surgery and the evolution of aortic arch surgery as well as the techniques of hyperthermic circulatory arrest with both retrograde and antigrade cerebral perfusion. We will talk about the progression and present status of this type of surgery.
We will then end the lecture discussing descending thoracic aortic and thoracoabdominal aortic aneurysms and discuss the differences between invasive interventional and less invasive intervention with percutaneous stents.
At the end of this lecture you should have a broad idea of the various types of pathology for thoracic aortic disease as well as the particular sites and each of their specific nuances for repair. You will be familiar with the major invasive techniques as well as the new endovascular techniques.
"Asanguinous" Open-Heart Surgery
Philip S. Chua, MD, FACS, FPCS, Victor K. O' Yek , MD, FACS, FRCS, Cris J. Carlos, MD, Felix R. Gozo, MD, Cardiovascular Surgery Associates, 8684 Connecticut Street, Merrillville, Indiana 46410
"Asanguinous" open-heart surgery was initially performed by our team at our institution in January 1982 for mitral valve replacement in a Jehovah's Witness, whose religious beliefs precluded blood transfusion. Since then, we have applied this principle to all of our open-heart cases, with excellent results. Using an IBM 2991 blood cell processor and Sorensen Autologous Transfusion System, our institution has salvaged an average of 92.1 units of blood per month, from January 1982 to December of 1983, with a total of 650 units for 1982 and 1105 units for 1983. From January to August of 1984, a total of 645 units were saved, with an average of 80 units per month. This protocol involved 1121 patients with coronary bypass surgery, 32 of which had concommitant repair of LV aneurysm, and 27 with unilateral carotid endarterectomy. One hundred and sixty-eight underwent cardiac valve replacement, 109 mitral, 57 aortic, and 2 combined MVR-AYR. Eighty-six percent of our entire series did not require homologous, transfusion, other than their own, individual salvaged packed cells. "Asanguinous" open-heart surgery is not only possible and safe, but also a medically prudent technique that is cost-efficient and devoid of the usual hazards associated with homologous transfusion.
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OTHER INFORMATION
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