Personal Introduction

 Medical Background
 1970 Medical Faculty, UII, Solo
 1975 MD , Justus Liebig University, Giessen
 1982 General Surgeon, JW Goethe University, Frankfurt
 1986 Cardiac and Vascular Surgeon , Ph.D, JLU, Giessen
 1989 T.C.V-Surgeon WWU Muenster, Germany
 1997 Awarded Venia Legendi
 Associate Professor for Thoracic and Cardiovascular Surgery (T.C.V)
,WWU Muenster
 2000-2006 Visiting Professor , UI,UGM and UMY
 2007 Professor for T.C.V Surgery,
 WWU Muenster ,Germany
 2009 Academic Professor, Medical School University of Indonesia
 2012 Visiting Professor, UMY
Personal Introduction
 Institutional Affiliation
 Cardiovascular Center, International Wing KENCANA,
 Div. of Vascular and Endovascular Surgery, Dept.of
Surgery
 University Hospital/ RSCM, University of Indonesia
 Department of Thoracic and Cardiovascular Surgery,
University Hospital, Muenster-Germany (former)
 Specialty
 Adult Cardiac Surgery
 Peripheral Vascular Surgery
 General Thoracic Surgery
 Update on
Cardiovascular Surgery
Prof. Dr. med. Rasjid Soeparwata
dr. SpB, SpB(K)V, SpBTKV(K)

Division of Vascular and Endovascular, Department of Surgery FKUI/RSCM Faculty of Medicine UMY

I have no potential conflict or interest

 Contents
1 History of Cardiac Surgery
2 Coronary Heart Disease
3 Treatment of Valvular Disorder
4 Treatment of Aneurysm
5 Treatment of Heart Failure
6 Conclusion
 History
• September 9th 1896  Ludwig
Rehn successfully closed a heart
stab wound by means of a direct
suture. The first methods were
developed on the beating heart.
Johan Wolfgang
Goethe University,
Frankfurt, Germany –
established in 1890
 Cardiac Surgery Development
• 1941  1st LIMA-LAD bypass  V. Kolesov
• 1950  hypothermia  G. Bigelow, Toronto
• 1953  HLM by J. H. Gibbon
• 1960  1st AVR  D. Harken
• 1960  1st MVR  A. Starr  using HLM
• 1967  CABG  R. Favaloro
• 1995  MIC CABG
 1st HTx & LVAD
• 1967  1st HTx  Christiaan Barnard 
Louis Washkanksy, 54 y. o.  Ϯ 18 days
• 2nd  Philip Blaiberg, 59 y. o.  Ϯ 19 mo.
• 1988  1st LVAD implant  Dr. W. F.
Bernhard

Norman Edward Shumway Christiaan Barnard

Number of Deaths due to CVD
CAD is the leading cause
 1st CAD, 2nd Cancer, 3rd Stroke
Cause of Death

American Heart Association 2013

HLM Technology in Cardiac Surgery
Component of SYNTAX Scoring System
for CAD Treatment Indication

http://www.syntaxscore.com/
CABG or PCI will be determined by SYNTAX Score
• SYNTAX score is based on:
– Tree segments
classification by AHA
– Modified Leaman Score
– ACC/AHA lesions
classification system
– Classification of Bifurcation
– Total Occlusion
Classification
• ≤ 34  benefit from
PCI
• SYNTAX Score
Scoring system, weighted on
mortality (MACCE) at 1 to 5
years, for selecting
revascularization technique.
• Based on trial
– > 34  benefit
from surgery
http://www.syntaxscore.com/
 SYNTAX Trial
• n = 1800 (patients
• with 3vd or left main
coronary artery
disease)
• Major adverse cardiac
or cerebrovascular
events & repeat
revascularization in
PCI were significantly
higher.
• Conclusion:
CABG remains the
standard for patients
with three-vessel or
left main CAD.
 Off-Pump /
On-Pump Beating CABG
• Stabilizer
• Intraluminar Shunt
 Methods & Benefits of CABG
Off/On-Pump

Off-Pump / MIC On-Pump On-Pump Beating

HLM (-) (+) (+)
Cardioplegic (-) (+) (-)
SIR (-)↓↓ (+)↑↑ (+)↑↑
Indications Stable Condition Stable Condition
Comorbidities Comorbidities
Recent Treatment of Valve Disorder
• Valve Replacement  bioprosthesis and
mechanical prosthesis

• Valve repair / Ring Annuloplasty

• Transcutaneous Aortic Valve Implantation

(TAVI)
 Bioprosthesis

Carpentier-Edwards Duraflex mitral

bioprosthesis (porcine).

Edwards Sapien transcatheter aortic valve.

The Hancock M.O. II aortic bioprosthesis

(porcine).
Mechanical Valve Prosthesis
Trancatheter Aortic Valve
Implantation/MIC

JenaValve
Endovascular Treatment for AAA and Aortic Dissection
EVAR & TEVAR
Treatment of End Stage Heart Failure: BTT & DT
1st Gen. LVAD vs. 2nd Gen.
 Pulsatile vs. Continous LVAD
• n = 134 (pulsatile) + 66
(continuous)
• 2 y. follow up
• Result:
Significant reduced
Pulsatile Continuous adverse events in patients
(1st gen.) (2nd gen.) with continuous LVAD.
Volume 450 ml 63 ml
Weight 1250 g 390 g
Flow (up to) 10 L/min. 10 L/min.
Mean 100 mmHg 100 mmHg
Pressure
Treatment of End Stage Heart Failure
OHTx vs. HHTx
 Conclusion
1 • The number of cardiovascular disease is increasing worldwide
unexceptionally Indonesia.

• Recent technological advancement in cardiovascular disorder treatment

2 including EVAR, TEVAR, MICAB , on/off-pump CABG, LVAD, artificial
heart, and heart transplantation are now available.

• Unfortunately in Indonesia, several modalities are still difficult to perform,

3 because of lack of center with well educated and trained manpower
(medical/nonmedical expert) and facilities.

4 •Treating cardiovascular diseases should be done by expert team using

interdisciplinary approach in center of excellence.

• The implementation of technological transfer in cardiovascular disease

5 from abroad is possible when we have established a center of excellence
with Governmental support and Willingness.
 2009 – now
• Cardiac Ops
• CEAs
• Y-Prothese (AAA)
• Carotid-Subclavian Bypass (SSS)
• EVAR-TEVAR
• Varices
• Vasc. Abcess
• Vasc. Trauma
• Diabetic Foot

1989 – 2009
• >50.000 Cardiac Ops
• > 30.000 Vasculer Ops
• 400 Heart Transplants
• > 100 VADs
• A large number of CRTs,
Pacemakers,
Defibrillators, Thoracic
Ops