Minutes to Annual Meeting

UKAS Belfry 7th September 2024

11th 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
Sort Code: 04-06-05
Account Number: 16365845

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.

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