Three hundred and sixty four days afterthe previous Spring meeting, the 2007

edition kicked off on a rare sunny day inCambridge.There was a significantly increasedturnout with over 170 delegates.The largeturnout of delegates were supported by 15trade stands keen to promote their wares anddemonstrate innovations.

This was the first meeting which allowedon-line application (over 50% of

delegates used this facility), supported byonline payment using “PayPal” (35 % ofdelegates); this was especially popular withIrish and European colleagues, who attendedin record numbers.An afternoon breakoutwas undertaken at the Moller centre, a fiveminute stroll in the grounds of Churchill, forthe paediatric specialists within theAssociation.

The free paper session featured eightpresentations from speakers all around

the UK. Intriguingly, this year’s papers weremostly presented by medical students, surgicalcolleagues and research nurses, withanaesthetists notable by their skill indelegating this task. Professor Cheng and DrHunter moderated the session was very well,and each paper prompted a number ofinterested questions and comments.Thewinning paper was judged using a combinationof the scientific and presentation scores.Thishonour was bestowed on the Southamptonstudy by Mo et al, examining the influence ofmannitol in CPB prime on fluid balance.Therole and importance of the free paper sessionin future ACTA meetings will no doubt be amatter for some debate in view of thereluctance by anaesthetic trainees and theirsupervisors to present their work.

Following a tea break and tour of thetrade stands, the audience had noticeably

swelled in numbers, and were entertained byProfessor Davy Cheng from London,WesternOntario (Canada). Davy gave a comprehensiveaccount of the state of research into onversus off-pump surgery, with particularlyexcellent dissection of recent trials and meta-analyses. Impressively, a number of scepticswere impressed by the results presented infavour of “Off Pump”.

Because of the late arrival of ProfessorRamamoorthy from California, due to a

United Airlines computer server failure, theACTA business meeting was moved to thepre-lunch slot.This was therefore betterattended than on a number of previousoccasions, and a healthy debate ensued on anumber of issues, including training, re-accreditation and local versus national awards.A number of delegates took the opportunityto visit the Churchill archives during thebusiness meeting, which was universallyenjoyed.The business meeting in the morning

led to significantly improved attendance, butdid mean that this session was not relevant toa number of delegates.Therefore it is likelythat the business meeting will return to itsafternoon slot in the future.

NewsNEWSLETTER OF THE ASSOCIATION OF CARDIOTHORACIC ANAESTHETISTS

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ACTA 2007 Spring MeetingChurchill College, Cambridge. Friday 22nd June 2007

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Churchill College

Professor Davy Cheng

The 22nd Annual Meeting of the EuropeanAssociation of Anaesthesiologists

(EACTA) took place in Krakow, Poland, inmid-June 2007.The meeting was held in theAuditorium Maximum, the congress centre ofthe 600 year old Jagiellonian University. It wascapably and efficiently organised by JanuszAndres and colleagues with the assistance ofthe Ovation Group.

The conference centre was within walkingdistance of the historic and picturesque

market square, situated in the middle ofKrakow, and was convenient for most hotels.The meeting was attended by over 400delegates and presented in two lecture hallswith the now familiar format of invitedlectures, free papers and symposia. Posterswere displayed in the communication spacebetween the lecture halls.The trade exhibitionwas held in a large separate area whereexcellent catering, with a Polish bias, wasprovided during breaks.

In line with EACTA policy there were alarge number (126) of oral and poster

presentations. 75 of these were orallypresented abstracts.There were three lunch-time symposia, all on blood related topics.These were: Heparin InducedThrombocytopenia (sponsored by Organon),Blood Transfusion and Haemostasis (Bayer)and New Drugs for Major Bleeding. Inaddition there were a further 26 “InvitedLectures”, delivered by international speakers,covering most aspects of cardiothoracicanaesthesia and cardiopulmonary bypass.Highlights of these included:Anaesthesia andoutcome (Stefan De Hert), Genetic predictorsof post-operative organ failure (DebraSchwinn) and Impact of age on cardiovascularrisk (Rob Feneck). I also enjoyed thepresentations by Thomas Hachenberg(Immunological aspects of thoracicanaesthesia) and Pierre-Guy Chassot(Anaesthesia and adult congenital heartdisease).

Finally, on the last morning of the meetingthere was the traditional workshop on

trans-oesophageal echocardiography (TOE)now titled “The famous EACTA TOEWorkshop”.This was lead by John Kneeshaw(UK), Fabio Guarracino (Italy) and PatrickWouters (Belgium). In a parallel session therewas a “hands on” thoracic anaesthesiaworkshop.This was lead by Edmond Cohen(USA) and Giorgo Della Rocca (Italy) withPeter Slinger (Canada) and John Gothard(UK), and others, in attendance.These werefollowed, in the afternoon, by the EAE/EACTAaccreditation examination.

Aside from the scientific sessions of themeeting there were some excellent and

well organised, sightseeing opportunities.These included visits to the Wiecliczka saltmines and, for those of a strong constitution,a visit to Auschwitz-Birkenau, one site ofWorld War II genocide. In Krakow itself there

were interesting trips to the old town,WawelCastle and the Jagiellonian University, plus anorganised walking tour on the Krakow JewsTrail.

Krakow itself offered many opportunitiesto meet old and new friends and sample

good food and excellent beer.The formaldinner was held in the beautiful gardens of theMuseum of Archaeology, situated at the footof the ramparts of Wawel castle.TraditionalPolish food was provided by the well-knownWierzynek restaurant (established 1364).Thisfood was perhaps a little heavy for a hotsummer’s evening but, once the UK table hadsecured adequate supplies of wine, it didn’tseem to matter much!

All in all this was a very good meeting ina part of Europe that most of us had

not previously visited.The main EACTAmeeting next year, in Antalya,Turkey, will makean interesting contrast.

John GothardAugust, 2007

EACTA Meeting Krakow, Poland, June 2007

Folk entertainment at the Opening Ceremony.

Wawel Castle.

Jagiellonian University’s Auditorium MaximumCongress Centre.

Market Square, Krakow.

Buring the lunch interval, further visits tothe trade stalls were interspersed with

the poster presentations.The winning poster,judged by Drs Manning and Gibson, examinedthe effect of a nurse-led protocol onglycaemic control; this was presented by SRajagopalan et al from the Heart hospital inLondon.

Mr Samer Nashef, a local cardiothoracicsurgeon, disturbed the post-prandial

slumber in the adult session, with a lively andentertaining presentation about performancescoring.This was entitled “Does thecardiothoracic anaesthetist make adifference?”, to which the resounding answerwas of course YES! Scoring of resultscompared with national and internationalmean scores is now the norm incardiothoracic surgery, and the anaestheticcommunity were interested to hear how thismay apply to them in the future

The president of the Royal College, DrJudith Hulf, was warmly welcomed next,

and she talked about the future ofcardiothoracic anaesthetic training, along withsome well-timed information about MMC andtraining numbers with regard to consultantjobs.Approximately 400 to 600 colleagueswere awarded final specialist certification lastyear but only 200 jobs were advertised.Thiscertainly provided for an interesting butdepressing conversation amongst the audiencebefore and during the tea break.

The next session was a TOE debate,during which the 4 protagonists fought

tooth and nail about “Every patient havingcardiac surgery should have intra-operativeTOE”.The panel and the audience expressedstrong opinions and a lively discussion ensued,but the majority disagreed with the motion,both before and after the debate, much to thedisgust of the team proposing the motion!

Following a mad dash around the M25after her delayed trans-Atlantic flight

eventually landed, Professor Ramamoorthyarrived in time to present the final talk, aboutnear infra-red spectroscopy. Her trip fromStanford University in California was kindlysponsored by Tyco Healthcare.As the majorityof the audience had little experience with thismonitor, the detailed presentation wasinteresting and well received. Only time willtell whether this technology will becomeroutine in cardiac operating theatres, andresearch is continuing into its use andapplicability.

The paediatric breakout session was heldin the lecture theatre for the Moller

Centre, which proved an excellent venue for apleasant and informative afternoon.Andy Wolfreviewed anaesthesia and stress in neonatesundergoing cardiac surgery; whilst he diddiscuss the various techniques and theirproblems he made it clear that his view wasthat anaesthetic techniques in these childrenshould be tailored to allow the speedyprogress of the child through the PICU and

back to clinic. Angus McEwen reviewed hisexperiences in setting up the anaesthesiaservice in the magnetic resonance room andgave a lead on appropriate equipment andsome novel ideas on how best to regulateventilation in that environment. Jon Smithlooked at the current choice of devices forventricular assist in children and reviewed thecurrent results in his own centre.Theafternoon concluded with discussions aroundthe formation of a loose affiliation of thepaediatric cardiac anaesthetic group thatmight provide a focus for the organization ofsessions like this and allow discussions oftraining and other issues.Anyone interested inthis is encouraged to contact Jon onjon.smith@nuth.nhs.uk.

Finally, 120 of the delegates attended thedinner/dance at King’s College.This was

the first time ACTA had been able to useKing’s, and the setting for drinks on the riverCam and dinner in the Great Hall wasstunning. Some guests even travelled just forthe dinner, from as far afield as NorthernIreland. Dancing to a local band was madedifficult because of noise restrictions (due tothe stained glass windows). However, themusicians and the dancers refused to bedeterred, and the party broke up aroundmidnight.

My thanks must go to Melanie Yea, who(as always) did much of the work

before and after the meeting, as well asrunning the day itself; Paul Yea also deservesmy thanks for his tireless liaison with thetrade and ferrying of speakers and guests. Iwould also like to thank the ACTAcommittee, especially Jon Mackay, for theirinvaluable advice. Finally I would like to thankthe guest speakers, and look forward toCardiff in November.

Andrew KleinPapworth Hospital, Cambridge

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Mr Samer Nashef, Consultant Cardiothoracic SurgeonPapworth Hospital.

Judith Hulf, President of the College of Anaesthetists

Drinks at King’s College – anywhere but on the lawn

HiSince the last edition we, the ACTA TOE

committee, have had two good meetings.The

first was part of the Spring ACTA meeting

where a debate was held on the motion

“Should every patient having cardiac surgery

have an echo”. Supporting the motion were

Justiaan Swanevelder and I and against, were

Sean Bennett and John Kneeshaw who are

both strong echo personnel.

After a show of hands as to who supported

the motion or not, it was obvious we were

fighting an uphill battle with the majority of

the audience being echo uninitiated. However,

undaunted, Justiaan entertained us and tried

to persuade us to “be eagles, not ostriches”

and put a strong argument forward supported

by me following Sean, then John bringing up

the rear guard. Despite our efforts John and

Sean retained their lead, minus a few votes,

and won the debate. Still it was a good format

and a lively interactive discussion followed.

On Friday 28th September, we had the

second annual TOE meeting for

advanced accreditation on the “Ischaemic

Mitral Enigma” in Manchester, which I

organised in conjunction with Niall O’ Keeffe.

Over 110 delegates attended and there was

an exciting faculty.The first session started

with Dr Simon Ray, the president elect of the

British Society of Echocardiography (BSE), on

assessment of the ischaemic mitral.Then Dr

Pierre-Vladimir Ennezat from Lille, spoke -

with a very nice French accent - on dynamic

assessment of the mitral valve. Interestingly

the development of mitral regurgitation on

exercise only occurs in approximately 10% of

ischaemic patients.

Session 2 was with Dr Steven Bolling from

the USA and Dr Michael Borger, from

Canada. Both surgeons, they discussed the

various treatment options and what and when

to do something.The following session was by

Dr Michael Mack, another surgeon from Texas

who has an interest in innovative

developments and talked on the use of

minimally invasive devices for mitral valve

repair by the cardiologists. Dr Anita Macnab

followed with her talk on 3D echo and

assessment, coinciding with the launch of the

“real time” 3D echo probe by Phillips.

The graveyard session of an intense day

was by Niall O’ Keeffe and me. Niall

spoke on assessment of the Alfieri repair,

pitfalls and successes and I talked on

postoperative assessment of the mitral valve

repair and some of the problems encountered

with suggestions on management.We have

had very good feedback and I’m pleased to

announce the follow-up meeting for advanced

TOE will be in London preceding the London

ACTA meeting on June 5th. Dr Nick Fletcher

is organising the programme and it looks very

promising.

The next echo event is the joint

BSE/ACTA perioperative TOE exam that

will have been held in Edinburgh by the time

this edition has been published, just prior to

the BSE annual conference.Also on the

calendar is the World Congress where

Justiaan Swanevelder and Dr Henry Skinner

are organising the satellite cardiothoracic

session and 2 days of TOE workshops, which

are repeated during the week.

In March, Dr Niall O’Keeffe is running a

TOE workshop during the STCS meeting

to be held in Edinburgh.This will be the start

of joint meetings and collaboration with

cardiac surgeons.

In all it has been a successful year for us

echo enthusiasts.

Donna Greenhalgh

Echo News

TOE debaters from left to right - John Kneeshaw, Sean Bennett, Donna Greenhalgh and Justiaan Swanevelder.

Here is a photo of the speakers, Dr Steven Bolling, Dr Michael Mack, Dr Michael Borger, Dr Niall O’Keeffe,Dr Donna Greenhalgh, Dr Pierre-Vladimir Ennezat, Dr Anita Macnab and Dr Mark Patrick, who ispretending to be Dr Simon Ray but was an excellent chair.

CHAIRMAN’S ReportCardiothoracic departments around the UK are queuing

up to host ACTA meetings and around all across thecountry events organised by ACTA members are becomingmore frequent.Whilst well supported, attendance at thesemeetings is ‘price sensitive’. Excellent content for themeetings is provided by local and international speakers.Theincrease in meetings reflects a growing level of confidenceand the desire to share knowledge and experience. Nolonger are we reliant on ‘overseas speakers’ and just one ortwo famous centres.This will continue as long as memberstake the challenge in our cardiothoracic clinics and insist onbeing active players.We all have a role in setting standardsand ensuring that our patients get the very best that is onoffer. Nobody should accept second class treatment.

There is competition for traditional coronary patients andmany innovations exist that offer alternative therapies in

which we can play our part. Examples are; pre-optimisation,management of atrial fibrillation, minimally-invasive valve andcoronary artery bypass surgery. In the operating room, wecan reduce neurological damage using near-infraredspectroscopy, use low volume bypass circuits, reduce bloodtransfusion and guide surgical procedures with high qualitytransoesophageal echocardiography (live 3D has arrived) andthe list goes on! Anything that improves patient outcomereflects well and there are so many opportunities. No onetechnique will radically change outcome but lots of things canhave an influence.This is how we can improve morbidity andmortality. Keep your surgeon informed of the latestdevelopments. It is surprising how often they listen!

Later this year, NICE will be providing new guidelines onthe treatment of coronary artery disease and we may see

the tide turning on percutaneous interventions. Sir LiamDonaldson will be advising on re-certification that will comevia our college and I hope that our presence at ChurchillHouse will be a positive influence. Certainly having a base andsecretarial support has already made the lives of committeemembers easier.TOE accreditation jointly with the BSE, is now establishedand I predict that the overall proportion of accreditedcardiac anaesthetists (as opposed to cardiologists) willincrease. I know this is well received by surgical colleagues.Further advances in peri-operative echo will be influencedaccording to the group that takes the most active part.Perhaps more than anything this has been the biggest changein the past ten years and the work by many anaesthetists hasbeen a credit to our profession. My only disappointmentduring my committee period is that we have not establishednational cardiac anaesthetic audit.

The next ten years can only see more advances and ourrole in any part depends on our enthusiasm. Meanwhile

ACTA provides an excellent society to facilitate, via meetingsand other means, all future developments in cardiacanaesthesia. I now pass on my role to the capable hands of JP van Besouw.

Sean BennettACTA Chairman

3

7th Haematology Associated with Cardiac Surgery Meeting

30 November 2007 from 9.00am to 4.30pmCavendish Conference Centre,

22 Duchess Mews, London,W1G 9DT (nearest tube station Oxford Circus).

Rational Use of Point of Care Testing in Cardiac Surgery Current State of Antifibrinolytic Therapy – a US Perspective Preventing Venous Thromboembolism after Cardiac Surgery

The Quest for Bloodless AVRPatient Identification - one Patient or two?

Preoperative platelet function testing Mini bypass circuits – Do they make a difference?

This meeting is open to any health professionals working or interested in the field.Tickets £80.00 per delegate including all refreshments.

For more information contact Dr Andrea Kelleher, Consultant Anaesthetist or Dr Louise Tillyer, Consultant Haematologist at

S.Angus@rbht.nhs.uk or tel 020 7351 8401

4

As I revise this piece, the AdvisoryCommittee on Clinical Excellence

Awards (ACCEA) are about to announce theoutcome of the 2007 round of awards forEngland and Wales. Successful candidates inNorthern Ireland and Scotland are notifiedthrough a parallel process.The 2008nominations cycle and the discussionssurrounding it have however, already begunwith the online portal for national awards

opening up on October 5th.ACCEA hasconfirmed that specialist societies willcontinue to be able to support candidatesapplying for national clinical excellence awardsin the 2008 round, provided they haveregistered their society’s interest.The ACCEAnational office has asked the specialistsocieties to provide additional information tohelp them in evaluating the contribution of anindividual in a specialist area – I will postthese on the website for interested parties. \

We have provided advice on the leadingjournals for cardiothoracic related

publications, a list of key abbreviations likelyto be found in a CVQ from an applicant andfinally factors considered to be evidence ofexcellence in the specialty and the provisionof service.There are continuing moves to anincreased transparency in the nominatingprocess and societies need to demonstratethat there has been lay input into theselection process. Nominating bodies mustcomply with the ACCEA regulations whichcan be found on the Department of Healthwebsite(www.advisorybodies.doh.gov.uk/accea),similar information is obtainable from theDepartments of Health in Northern Irelandand Scotland.These sites also provideguidelines regarding the application processand potential eligibility for national awards. In

2008 the entire process – including thesubmission of citations - will be on line inEngland, with slightly different arrangements inthe devolved nations.Those wishing to beconsidered need to express that interest andcomplete an application form which has to be

submitted to ACCEA by 17.00 on 18th

January 2008. It is imperative that an individualsubmits an application at Trust level to garnerlocal support: each employer has their owntimetable.

The RCoA and the AAGBI are encouraginganaesthetists to apply at both local and

national levels if they are eligible to increasethe profile of anaesthetists in the awardsprocess.With a consultant membership of 350consultants,ACTA can nominate up to tencandidates for the Bronze Award (Level 9) andfive for Silver / Gold Awards (Levels10/11) - inthe 2007 round we nominated 10 candidates(six Bronze and four Silver/Gold).Thechairman of the nominations committee isrequired to submit nominations in rankedorder.As this years chairman I will once againconvene a committee for this purpose toinclude Sean Bennett (past ACTA Chairman),three other co-opted ACTA members notapplying for awards in 2008 and a lay memberwith a knowledge of healthcare. Members areencouraged to self-nominate to ACTA if theyintend to apply for a higher national award inthe 2008 round. Demographic data from theDepartment of Health indicates thatconsultants gain a Bronze award around 10years after appointment as a consultant andhaving accrued more than five local CEApoints.These are not absolute criteria.ACTAsupport can only reflect the contribution theindividual has made to the association or tothe subspecialty of cardiothoracic anaesthesia.It is essential for potential applicants to

complete ALL of the domains on theapplication form to achieve a successfulnomination, as each domain contributes tothe final score. It is not appropriate tocomment upon an individual’s contribution tothe wider world of anaesthesia, healthcare oreducation as these will be reflected in supportfrom employers, colleges and deaneries.TheDepartment of Health emphasise theimportance of multiple inputs to define anapplicant’s eligibility. Specialist society supportis important in circumstances whereexcellence in a sub-specialty area of practiceis not fully appreciated at a Trust level.AllACTA members who wish for support inrespect of their application for a NationalClinical Excellence Award (2008 round)should send an electronic copy of their CVQNational Form A -and forms D and E ifnecessary - to mejean-pierre.vanbesouw@stgeorges.nhs.ukfor forwarding on to the ACTA ACCEA sub-committee for consideration. Following onfrom our deliberations I will reconfirm yourintention to proceed with an application for2008 and submit a citation. I would like toreceive your CVQ by end November to allowtime to write and submit citations before theclosing date.The Department of Health alsopublishes a “nominal roll” containing data onall consultants in England and Wales, definingtheir status in the ACCEA process, thisindicates an under provision of awards at alllevels to anaesthetists.The Royal College andthe Association are seeking to improve theprofile of the specialty in this process and areactively encouraging all eligible anaesthetiststo apply at both local and national levels.

J-P van BesouwSecretary ACTA.

ACCEA

ACTA Echo 20085 June

Royal Society Medicine ,LondonNew and Emerging Technologies in

Intraoperative EchoReal Time 3D TOE

New Methods of Scanning the Ascending AortaCoronaries without the Cross Clamp

Aortic DiseasePercutaneous Aortic Valve replacement

LV function – beyond the ejection fraction

For Programme details contactDr Nick Fletcher

St Georges Hospital, LondonNick.Fletcher@stgeorges.nhs.uk

Results of September 2007ACTA Committee Election

Dr J-P van Besouw, will be taking over from Sean Bennett asChairman in November after being re-elected for a secondthree year term in the September elections.

Drs Ravi Gill, Southampton and Alistair Macfie, Glasgow werethe other two successful candidates to emerge from theelection process.

A strong list of seven candidates helped stimulate an improvedturnout with 161 ballot papers being received this yearcompared to 110 in 2006.

Leeds ‘hands-on’ TOE course14 - 18 April 2008

Leeds General InfirmaryContact: Jenny Smith

Email: jennifer.smith@leedsth.nhs.uk Tel: 0113 392 6672