Minutes to Annual Meeting
UKAS Belfry 7th September 2024
11th Annual Meeting
Apologies - Alex Cale, Uday Dandekar, Sanjay Asopa, Indu Deglurkar
Attendees - 45
Welcome and Minutes of last meeting - Michael Sabetai
M Sabetai opened the meeting and welcomed attendees and gave apologies. Minutes from the last meeting had been circulated after the last meeting and no objections were received.
Membership Update Karen Booth
The charities account was presented, and the costs of the charity and main funding event of the Belfry meeting was explained. Membership is up 16% from 2021 last year to 110 members. Annual costs of the meeting have risen, and members were encouraged to pay the annual fee, discounted to £45 when paid online at
https://uk-as.org/index.php/apply
Annual fees apply annually, running from September to September as we currently cannot continue the meeting unless more than 20% pay the annual fee. Please can members ensure they only pay once and with the correct amount. £50 as a one-off payment, reduced to £45 by direct debit or standing order.
Bank account: Natwest
Sort Code: 60-40-05
Account Number: 41245091
Formal charity status for UKAS - Karen Booth
Charitable status was applied for first in March 2023 and following a rejection resubmitted in June 2023. Resubmission occurred on the 27th June 2023 and was accepted at the end of 2023.
UKAS Website update - Karen Booth
Members were taken through website updates and also encouraged to follow UK-AS on ‘X’ and ensure we have each individual aortic centre’s ‘X’ handle. It is important the UK-AS supports and promotes local units’ education sessions, promotes events and advertising and we can only do this if units reach out. Please follow us on ‘X’ and/or email us at admin@uk-as.org
Research Publications
Research published in the last 3-4 years (including aortic service specification and TAAD registry) was presented by Giovanni Mariscalco and a sample of our publications can be found on the website www.uk-as.org
Stuart Grant updated the executive’s future plans on using national registry data to inform UK-AS publications alongside updates to the national database to capture a more accurate and fuller picture of activity in the UK. A ‘UK-AS’ part time statistician has been proposed to work alongside the exec to increase published work in the coming 12-36 months from accessing registry data.
Education Update – Giovani Mariscalco and Shakil Farid
The annual SCTS and university day meeting is organised and sponsored by UK-AS. This partnership has been running very well for many years and discussion on feedback from attendees which has been lacking was discussed with an update on hopefully a successful SCTS app improvement planned for 2025. We now offer a monthly webinar series which has had over 150 attendees to date. The schedule for 2025 was presented and a call for support from UK-AS members was made. Shakil Farid updated the meeting on a proposed cadaveric course to run 2-3 times a year for NTN’s and TAD’s throughout the UK in collaboration with SCTS. A debate ensued on the practicalities of organising and running wetlab’s between members but was very much encouraged.
Aortic Dissection Charitable Trust research agenda Catherine Fowler
Catherine Fowler presented an update on the ADCT aims and objectives and updated us on funding research and ADCT has over 700 members in their research advisory group. If members are thinking of undertaking research, please view two films on current research projects (including DASHED), found at https://aorticdissectioncharitabletrust.org
and reach out to ADCT for support.
The ‘silent why’ podcasts have been impactful and candid educational additions to the charity in the last 12 months and focus on dealing with death where other educational resources have not. These are widely available on U-Tube.
The NHS toolkit is lobbied for and supported in each local region by ADCT with work ongoing.
Dr John Elefteriades is now a patron of the charity and for aortic dissection awareness month, the charity has planned webinars including a research focus on the 19th September, 19.30 UK time.
A patient video was played displaying an unmet need in follow-up and psychological support and the first aortic nursing symposium has taken place with ADCT announcing funding for aortic nurse roles in collaboration with Macmillan to start this Autumn.
This level of research could not take place with funding and anyone looking to fundraise on behalf of ADCT, please get in touch and join them for their annual charity ball on the 5th October 2024!
Aortic Dissection Awareness initiatives Gareth Owens
Gareth informed the group about the charities annual events including the upcoming awareness day on the 18th September 2024 being host by Edinburgh this year. Aortic Dissection Awareness is supporting aortic nurse specialists in many units throughout the UK and has just appointed Emma Hope. The charities big focus is on providing support to those who have experienced an aortic dissection so please pass on their details to patients and their families that you meet in your clinical practice.
Patient stories along the theme of Stronger Together was emphasised with stories of how the charity interacts with specialists around the UK to support patients who are in desperate need of advice in times of need.
‘Till death do us part!’
Aortic Dissection are asking for more of the same, more education and more support for patients in specialised MDT’s, clinics and a request was made to ensure patients can receive patient guides which are supplied for free, just contact the charity on
https://aorticdissectionawareness.org
A call was made for fairer treatment for all, with access to treatment being standardised throughout the UK given the national data on healthcare inequality seen in published research. Outcomes post-operatively needs to be better standardised and thoroughly reported. NACSA data should be supported to include outcomes from England, Wales, Scotland, Northern Ireland and Ireland combined.
Follow up after aortic surgery has issues in access to rehabilitation for all. Access to services around the UK is patchy and the charity has requested we lobby together to ensure nationally rehabilitation is offered as standard to all aortic patients.
In collaboration with Gavin Murphy, the DECIDE-TAD national research programme has been funded and participation is encouraged to ensure we have a decision support tool that is successful for patients in the future, contact Gareth or Gavin directly for more information
Aortic Dissection Workstreams; update on standards from the Royal College of Radiologists – Narayan Karunanithy
Narayan talked us through the standards expected in aortic dissection care to ensure quality and equity everywhere. The South England Aortic Dissection Network supra-regional SOP have published on the standardised expectation of CT requirements to ensure patients receive a high-quality scan and a standardised reporting template is being worked on in support of removing inequality in the scans that we see around the country.
The acute aortic syndrome entities and the scope of more defined and subtle radiological changes was covered and in particular the poor prognostic signs seen in particular in an intramural haematoma which can help stratify who and when to intervene upon. This work has fed into the cardiac transformation programme for NHSE.
A discussion ensued on how best to ensure imaging is easily transferred and how to streamline referrals seen following the targeted lung screening implementation.
B R E A K
Technical Tips and Tricks session
- 'Y' Aortic Root Enlargement - Syed Sadeque
- Flow patterns in post type A chronically dissected aortas - Narayan Karunanithy
- Surgical solutions for complex proximal endocarditis - Deborah Harrington
- Endo Arch Solutions - Said Abisi
Regional Aortic Surgery Activity
SE England – Amit Modi, Graham Cooper, Michael Sabetai
Nationally the numbers of aortic dissections (HES data) operated on, have increased in the last 5 years to 700 aortic type a dissection’s operated on in England. Bart’s operates on 50-60 Type A aortic dissections a year and St Thomas’s and Kings a similar volume between the two centres with an average mortality of 12.5%. London activity carries out 28% of all aortic dissection operations each year. Multiple centres operate on less than 24 cases a year throughout the UK. A pan London (7 centres) rota should be up and running by next year.
SOP’s have been generated in most regions
The ERTAAD – Fausto Biancari
Results in Europe (>2000 cases) of type A aortic dissection repair showed an average mortality of 17% with a higher mortality reported after arch intervention. Patients with TAAD and genetic syndromes, or increased size and dissection of the abdominal aorta have higher risk of distal aortic reoperations. Cannulation strategy did not affect overall mortality or rate of stroke.
faustobiancari@yahoo.it – Transatlantic Registry of Type A Aortic Dissection
Acute Aortic Syndromes in Scotland: Trends in outcomes and impact of geography and diagnostic timing – George Gradinariu
There are 3 centres in Scotland and 35 referral centres with accident and emergency departments who can seek treatment for patients. Roughly 40 dissections are operated on yearly with 25 at Edinburgh due to transplant demands at GJNH. Data was presented for 404 patients from 2008-2022. The trend over time was for an interposition graft which has now changed to an increase in root and arch intervention (13%). Root intervention has increased to over 20% over the time period. 25% are treated by DHCA alone with an increase in Antegrade cerebral protection to 30%. Survival has improved over time with intervention on the root and ascending in combination having better long-term outcomes
The Aortic Service in the Republic of Ireland (St James’) – Saleem Jahangeer
Centres in Ireland can report through NICOR or EACTS. 4 centres serve a population of just over 5million patients. An Aortic service was established in 2022. The programme consists of a surveillance clinic and training for the operative team (perfusion/surgical/anaesthesia) alongside MDT’s. From 2020-2024 (data from James’) for non-emergency major aorta procedures has risen from <10 yearly volume to nearly 40 for this year. Most of the work is in ascending and root work. Short term outcomes are excellent with zero strokes and two re-operations for bleeding.
For acute aortic dissection work, challenges remain which are being tackled through education and study days for all staff in the aortic dissection pathway. Surgical management is heterogeneous and the threshold for turndowns is variable and no aortic rota has been implemented. 35 type A TAAD and 1 ruptured descending aneurysm have been operated on with 7 mortalities.
Future work includes an Irish Database, biobank work, education and training, patient engagement and collaboration with other units and continued work
UK NICOR data update – Stuart Grant
Overall the data demonstrates a 13% decrease in cardiac surgical activity except for a 50% increase in aortic activity since the COVID pandemic. The mean number of elective cases is 65 with 18 emergency cases with variation across the region. Both overall and emergency crude mortality rates are static.
‘Aortic surgery is now more prevalent in the UK than mitral surgery!’
Close of meeting
Date for your diary - Date of the next meeting
Saturday 6th September 2025, Ryder Room
Meeting concluded with thanks to Amy Farrell for the organisation of the meeting and Terumo and Artivion for their support!
UKAS Belfry 7th September 2023
10th Annual Meeting
Apologies – Haleema Saadia, Gordon McManus, Ana Lopez-Marco, Gavin Murphy, Sunil Bhudia, Cha, Cesare, Jonathan
Attendees (online and face to face) – 30 F2F, 18 online.
Welcome and Minutes of last meeting - Manoj Kuduvalli
M Kuduvalli opened the meeting and welcomed the attendees face to face and online. A list of apologies was announced, and the minutes of the last meeting were gone through and no objections were raised.
UK-AS Accounts and Membership Fees - Karen Booth
The charities account was presented, and the costs of the charity and main funding event of the Belfry meeting was explained. Membership is up 11% from last year to 101 members. Annual costs of the meeting have risen and members were encouraged to pay the annual fee of £50 running from September to September as we currently cannot continue the meeting unless more than 20% pay the annual fee. Please can members ensure they only pay once and with the correct amount.
Bank account: TIDE (changed to Natwest, refer the 2024 Minutes for New Account)
Sort Code: 04-06-05 (as above, its changed)
Account Number: 16365845 (as above, its changed)
Formal charity status for UKAS - Karen Booth
Charitable status was applied for first in March 2023 and following a rejection resubmitted in June 2023. Resubmission occurred on the 27th June 2023 and we should have a decision by the end of the month.
UKAS Website update Karen Booth
We have made no changes to the website since the last meeting, work will start after this meeting.
Aortic Surgery Database: Next steps discussion - Aung Oo
Manoj updated the group about steps already taken and work from Ana Lopez-Marco, Aung and Manoj with regard to establishing an aortic database. As we could not ensure that data collection was mandatory without NICOR’s initial support, we were unable to secure funding through Industry to use a separate Aortic database. Since the last meeting, we have had a good proactive approach from NICOR through Nick Linker as the Lead for the cardiac services CRG. A formal meeting with NHSE and NICOR has taken place and our data set has been shared and we are hopeful that an additional dataset will be added to our current unit reporting systems (including some mandatory fields) allowing us to get a better understanding of aortic services throughout the UK. This work is slow but making progress. Geoff asked about a previous potential funding source from Harefield. This was answered by Aung as we believe a set-up fee would be £100,000-£120,000 with ongoing annual maintenance costs and now that we have better engagement from NICOR and NHSE this has changed the landscape. NHSE are aware of the funding requirements. Michael asked if units could volunteer data but we have tried this before without much success, Manoj asked Arun who runs the national vascular registry (NVR) to comment. He said that they started by entering device data which led to anatomy data being collected effectively. The NVR is a highly successful registry and a later presentation will cover its establishment and ‘lessons learnt’.
Final data from the FET registry
Ricardo Abbascione updated the meeting following on from last year’s meeting. A mid-term analysis was presented of 66 patients who had experienced a type A dissection and had a FET repair. It was noted that high volume centres had the best outcomes and overall there was a low incidence of spinal cord ischaemia. Mortality was 11% with false lumen thrombosis rate of 33% out to one year. 5 year data was presented but at a low volume (n=5). Conclusion was that their was surgical advantages in the distal arch tear with favourable and stable remodelling of the downstream aorta.
Outcomes of FET in chronic dissection - Hassan Kattach
Data from Southampton from 2017-2022 of those treated with FET for aneurysm at arch or proximal descending aorta. Radiological data and patient outcome data was analysed. 23 patients were involved in the follow up study. No mortality was seen at 30 days with a mean ITU stay of 10 days. 3 died out to follow up out to 5 years. One concomitant TEVAR was required with 3 at follow up post discharge. FLT was seen in all patients in segment A, FLD change is continuing to decrease over time.
Aortic Services in the UK – results from a national survey - Ricardo Abbascione
The rationale behind the survey was for the aortic dissection toolkit discussions. The survey ran from April to November in 2022. 19 out of 30 units responded to the survey. 23 surgeons gave answers and some units had more than one response. On average 70-80 aortic cases were performed annually. The set up of the aortic MDT was good with 70% involving a radiologist, aortic surgeon and vascular surgeon. The median number of aortic surgeons in an aortic dissection rota was 3. Access to genetics services was over 70% and most surveyed opinions felt aortic centers should offer root replacement (including VSARR), Arch replacement (including using FET), Ross procedure, Aortic valve reconstruction and that aortic surgeons should perform 30 major aortic cases/year.
Acute Aortic Dissection – NCIP dashboard - Arun Pherwani
Arun introduced himself and his national roles within the vascular society. He discussed the benefit of classifying disease rather than procedure in our data collection. He undertook the first ever UK study on aortic dissection and presented the results to the group. 15,000 patients were identified to have been admitted over a 6 year period in the UK with an aortic dissection. 22% have undergone a type A dissection repar, 4% type B undergo an emergency procedure, 74% undergo medical management for a type B dissection. The rate of dissection has steadily increased year on year and the volume of type A repairs has also increased. The overall mortality rate is 20% for operated Type A, 15% for operated Type B, 15% for medically managed Type B and out to 3 years this increased to 30%. S.lowis@nhs.net (NHSE) can be contacted if your unit would like the data for individual units to this level of detail.
Education Update - Michael Sabetai / Amit Modi
Last year we agree to expand our collaborations, education content provided by UK-AS and we discussed a European joint annual meeting, alongside educational webinars. In the last year we successfully supported the annual SCTS meeting and have agreed to a more visual engagement with SCTS. We would also like to get feedback from attendees. UK-AS executive team have written and published three articles on aortic dissection for BJC and worked with RCSEng and RCPEng on aortic webinars. If members have suggestions, please contact the UK-AS executive on karen.booth16@nhs.net. Catharine Fowler commented that education should be expanded in collaboration to include AHP groups. Geoff commented that one annual meeting should be branded as UK-AS and move around units to ensure regions can display their talents. Mark Field is in favour of this from Liverpool. Amit commented that we should use this platform to showcase local UK talent. Aung felt this should start with a monthly webinar series. This will help to start with small steps and be more economical.
Aortic Dissection Awareness initiatives - Gareth Owens
Gareth informed the group about the charities annual events including the upcoming awareness day on the 19th September 2023 being host by Papworth this year.
Aortic Dissection Charitable Trust research agenda - Catherine Fowler
Catherine Fowler presented an update on the ADCT research agenda and scope for UKAS collaboration. The NHSE AAD Toolkit is now through the design phase and is going live in regions from the 2nd October 2023.
Acute Aortic Dissection Toolkit – Regional experiences and challenges National effort / Professional societies position
Presentations by 8 regions:
National Picture – Graham Cooper
London – Aung Oo and Michael Sabetai
North East and Yorkshire – Alex Cale
West Midlands – Maciej Matuszewski
South West – Marcus Brooks
East Midlands – Niki Nicou
East of England – Arvind Singh
South East of England – Damian Balmforth
North West – Mark Field
Update on progress in each region presented. Progress variable and challenges also different in each region but it is acknowledged that there is improvement at a higher level than previously thought.
Useful regional tips
- Use MS Teams – To avoid unnecessary delays simply invite the referring physician to a teams meeting and ‘share screen’ so images can be reviewed, the call can be recorded for patient notes and the patient access’ care in a timely fashion.
- Use ‘Whats app’ – To avoid issues with lack of ‘two’ emergency teams, ensure all aortic surgeons are on a what’s app group for rota management. If the oncall center is busy, a second center can be available early.
- Data collection – Liverpool have a spreadsheet (contact mark.field@nhs.net) to ensure all dissection patients are correctly followed up.
Ross Procedure in the UK, Update - Mohamed Nassar
52 Ross Procedures versus 193 Aortic Valve Replacement (in patients less than 50 yrs) in the UK for 2022. Ross PEARS and Ross Restoration as new techniques to reduce the reintervention rate were presented. The obligation to discuss in informed consent all available options
Outcome of patients under surveillance for aortic pathologies - Hassan Kattach
A group of patients were followed up to 5 years retrospectively. Roughly half had follow up under cardiology and half had follow up at a dedicated aortic clinic and surveillance program. Non statistically significant survival was seen with more patients surviving under dedicated aortic care.
JCUH experience of AMDS - Mohamed Allam
19 patients implanted with AMDS since 2021. Successful device deployment in 100% with mortality of 21%. The stent is a safe adjunct to hemi-arch repair of type A aortic dissection.
AMDS – Indications and contra-indications, Guidelines - Aung Oo
Can be used in type A aortic dissection with no tear in the arch or proximal descending thoracic aorta. Increases circ arrest time to 60 mins. Long term surveillance data is required to assess benefit. There should be a UK-AS directed guideline and protocol to ensure that a higher than expected device related complication rate does not occur.
Close of meeting
Probable date of the next meeting : Saturday 7th September 2024
Meeting concluded with thanks to Amy Farrell for the organisation of the meeting and Terumo for their support!
Our Aim
UK Aortic Society members have considerable experience and expertise in performing complex aortic operations. Our aim is to advance the treatments and reduce the burden of aortic disease by training and advancing knowledge. We hope that this meeting has assisted all the attendees tremendously and would continue to advance in the field of aortic surgeries.
