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Interest and core training in congenital heart surgery (CHS) has not been characterized among current cardiothoracic surgical trainees. This study aimed to evaluate perceptions, interest, exposure, and experience among current trainees. A 22 question survey was distributed to all cardiothoracic surgical trainees in ACGME-accredited thoracic surgery residencies. Questions included demographics, exposure to CHS during, perceptions of, participation in and quality assessment of CHS training. There were 106 responses (20.1% response rate) of which 31 (29.0%) were female and 87 (81.3%) were cardiothoracic track. While 69 (64.5%) reported having an interest in CHS at some point during training, only 24 (22.4%) were actively pursuing CHS. All but 7 (6.5%) residents reported having easy access to congenital mentorship, with 35 (32.7%) actively participating in CHS research. Three months was the median duration of congenital rotations. Residents reported less operative participation on CHS compared to adult cardiac surgery. Several residents noted the need for earlier exposure and increased technical/operative experience as areas in need of improvement. The most cited primary influences to pursue CHS included: mentorship, breadth of pathology, and technical nature of the specialty. Lack of consistent job availability and length of additional training were reported as negative influences. Cardiothoracic residents report adequate exposure to obtain case requirements and knowledge for board examinations in CHS but highly variable operative involvement. Mentorship and early exposure remain important for those interested in CHS, while additional training time and limited job availability remain hurdles to CHS.

Background The upper mini sternotomy Bentall (mini-Bentall) procedure may result in less trauma and earlier recovery compared with the full sternotomy Bentall procedure (full Bentall). This study compares immediate and 1- and 3-year survival rates after mini- and full Bentall procedures. Methods Between February 2009 and July 2019, 48 patients underwent a mini-Bentall and 49 underwent a full Bentall. Patients who required concomitant procedures, reoperations, or hypothermic circulatory arrest were excluded from our analysis. The mean patient age was 60.7 years in the mini-Bentall group and 59.0 years in the full Bentall group. Results There were no in-hospital mortalities. The median cardiopulmonary bypass time (mini-Bentall: 165 minutes [interquartile range (IQR), 155.5-183 minutes]; full Bentall: 164 minutes [IQR, 150-187 minutes]; P = .619) and aortic cross-clamp times (139 minutes [IQR, 128.5-153 minutes] vs 137 minutes [IQR, 125-156 minutes]; P = .948) were not significantly different between the 2 groups. The mini-Bentall group had a significantly shorter median ventilation time compared with the full Bentall group (5.5 hours [IQR, 3-14 hours] vs 17 hours [IQR, 11-23 hours]; P

Introduction: Distinct cardioplegic solutions are used in cardiac surgery for myocardial protection. Custodiol-HTK (CUS) solution consists of histidine, tryptophan, ketoglutarate and mannitol to reduce cellular edema. Del Nido (DN) is a nonglucose-based solution containing low calcium and high lidocaine concentrations, preventing intracellular Ca2+ accumulation during ischemia. Hypothesis: Using a coronary-perfused rabbit experimental model, this study compares the effects of CUS and DN on transmural electrocardiogram (ECG) and tension parameters. Methods: Twelve left ventricular (LV) wedge preparations from 12 rabbit hearts were arterially perfused with Tyrode's solution and stimulated at a cycle length of 1000 ms. Simultaneous recording of transmural ECG and tension were obtained. After exposure to normal Tyrode, the LV wedge preparation was perfused with 20 cc of CUS (n=6) or 20 cc of DN (n=6) leading to complete arrest maintained for 30 minutes. ECG and tension recordings were obtained under baseline conditions and at 5, 15, and 30 minutes after reperfusion with normal Tyrode. Differences in change from baseline ECG and tension parameters after CUS or DN were compared using a mean differences regression model. Results: Reperfusion effects of CUS and DN on ECG and tension are shown in Table 1 . After reperfusion, DN group had a significantly greater increase in QRS duration, significantly more QT shortening and more ST segment change compared to CUS group. At 5- and 15-minutes post-reperfusion, the CUS group had significantly higher tension recovery. Negative T wave were observed in 1 of 6 wedges of the CUS group and 5/6 (83.3%) wedges of the DN group. Conduction block was observed in 0/6 wedges in the CUS group and 5/6 (83.3%) wedges in the DN group. Conclusions: In a LV coronary-perfused rabbit wedge preparation, Custodiol-HTK cardioplegia led to less ischemic changes in ECG and faster tension recovery following reperfusion compared to del Nido cardioplegia.

Background: The introduction of integrated thoracic surgery residency programs has led to increased recruitment efforts of medical students to pursue a career in cardiac surgery. With little representation of cardiac surgery in medical school curriculum, we assessed a cardiac surgery mini-elective's efficacy in improving perceived knowledge among medical students. Methods: Preclinical medical students were offered the opportunity to participate in a cardiac surgery mini-elective, which consisted of five 2-hour sessions. These sessions consisted of didactic and simulation components and covered topics including cardiopulmonary bypass (CPB) and extracorporeal membrane oxygenation (ECMO), aortic disease, aortic valve replacement (AVR), transplant and left ventricular assist devices (LVAD), and coronary artery bypass grafting (CABG). Students completed pre- and post-session surveys describing their perceived knowledge in these topics. Results: Overall, 22 students completed at least one session of the mini-elective. Fourteen (73.7%) of the students were male. Fifteen (68.2%) students completed at least three out of five sessions. The post-session survey responses showed significantly higher perceived knowledge compared with pre-session responses for all survey prompts of all five sessions. The CPB/ECMO and aortic disease sessions showed the greatest increase in post-session familiarity and perceived knowledge after the session (P < 0.001) compared with the CABG, AVR, and transplant/LVAD sessions (P < 0.05). Conclusions: Beyond developing interest in cardiac surgery, these data indicate that a well-planned didactic and surgical simulation program may build confidence in students' knowledge of various cardiac surgical topics. Further studies will need to address how this increase in perceived ability lasts over time and impacts career selection.

Introduction: Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CS/HIPEC) has led to improved survival in select patients with peritoneal surface malignancies. Predicting the volume of disease and any unresectable disease is important for determining CS candidacy. Computed tomography (CT) scan is the preoperative assessment of choice, and diagnostic laparoscopy (DL) is also supported in the literature but has not been widely adopted. In this study, we report our experience comparing and evaluating the role of imaging and DL in the preoperative assessment of patients being considered for CS/HIPEC. Methods: Patients considered for CS/HIPEC at our tertiary cancer center between January 2012 and December 2017 were included. Diagnostic modality sensitivity and specificity were calculated by comparing findings on CT scan and DL to findings at the time of laparotomy and on final pathology. Specificity and sensitivity of the 2 modalities were compared using the McNemar Chi-square test. Results: Our analysis included 71 patients (60.5% male, mean age of 54.9) seen in consultation for CS/HIPEC. Primary cancer diagnosis was 57.7% colorectal cancer, 25.4% pseudomyxoma peritonei, 8.5% mesothelioma, and 8.5% adenocarcinoma of unknown primary. DL was done in 42.3% of patients (median time of 30 days between CT and DL) and an open procedure was done directly after CT in 39.4% (median interval time of 39 days). Findings of DL identified 70% as being unresectable and hence ineligible for HIPEC. The median interval time between 2 operations was 29 days (range, 16–42). When comparing diagnostic modalities to open surgery and final pathology, CT had a sensitivity and specificity of 48.2% and 76.4% and DL, 68.2% and 88.9%, respectively. DL was significantly more sensitive and specific than CT (χ2=5.54; PConclusion: Our results support the recommendation for performing DL prior to open exploration in patients considered for CS/HIPEC. In our cohort, DL was significantly more sensitive and specific than CT in predicting disease volume and distribution. While there is obviously greater risk to an invasive modality compared to non-invasive CT scan, routine performance of DL can potentially avoid laparotomy without CS/HIPEC in a large proportion of patients. These results will be used to inform the next phase of our study: a prospective clinical trial.

This study examines postoperative morbidity and mortality and long-term survival after total arch replacement (TAR) using deep to moderate hypothermic circulatory arrest (HCA), antegrade cerebral perfusion (ACP), and the Y-graft. Seventy-five patients underwent TAR with the Y graft. Deep to moderate HCA was initiated at 18-22°C. ACP was either initiated immediately (early ACP) or after the distal anastomosis was performed (late ACP). The arch vessels were then serially anastomosed to the individual limbs of the Y-graft. The median age was 66 years (range = 32-82). Etiology of aneurysmal dilatation included 20 (27%) patients with medial degenerations, 25 (33%) with chronic dissections, 14 (19%) with acute dissections, 9 (12%) with atherosclerosis and 2 (3%) with Marfan syndrome. In-hospital mortality was 5%. Neurologic complications occurred in 8 (11%) patients; 2 (3%) had strokes and 6 (8%) had transient neurologic deficits. Patients undergoing TAR with moderate hypothermia had a significantly higher incidence of new-onset renal insufficiency (3 [23%] vs [0%], P0.001) and TND (3 (23%) vs 3 (5%), P = 0.028) than the profound and deep hypothermia cohort. Excluding the 1 patient who died intraoperatively, 89% (95%CI: 79-94%) were alive at 1 year, 78% at 5 years (95%CI: 66-86%), and 73% at 10 years (95%CI: 59-82%). The combination of deep to moderate HCA, ACP, and the Y-graft is a safe and reproducible technique. Further inquiry is needed to assess if early ACP provides superior clinical outcomes.

695 Background: Most studies looking at long-term outcomes in patients undergoing cytoreductive surgery/hyperthermic intraperitoneal chemotherapy (CS/HIPEC) are based on scoring systems performed at the time of the operation. With a morbidity as high as 67%, it is crucial to carefully choose the patients who will benefit from this procedure. In this study, we evaluated preoperative factors that could impact patient outcomes. Results were used to create a predictive model for patients considered for CS/HIPEC. Methods: Patients assessed for CS/HIPEC at our tertiary cancer center between 2012 and 2017 were considered for this study. Postoperative complications, recurrence free survival (RFS) and overall survival (OS) were used as endpoints, and multivariable analysis accounting for demographics, clinical, bloodwork, radiologic and pathologic findings was performed. Results: Sixty-eight patients were considered for CS/HIPEC. Preoperative elements found to have an impact on OS were lymph node involvement (p = 0.001) and high extent of carcinomatosis (p < 0.001) on computed tomography (CT) scan. Findings that impacted RFS were lymphovascular invasion (p = 0.042), lymph node involvement (p = 0.061) and omental caking (p = 0.010) on CT. Our preoperative predictive model is presented in table. An increased rate of complications was seen in smokers (p = 0.031), obese patients (p = 0.005) and carcinomatosis diagnosed ≤ 12 months from the primary diagnosis (p = 0.069). In our experience, performing CS/HIPEC did improve OS (p = 0.036) after adjustment for age, race, smoking, and BMI. Conclusions: Preoperative findings could help physicians in their discussions with patients prior to pursue CS/HIPEC. These interesting findings will be used to inform the next step of our study: a prospective clinical trial. [Table: see text]