ACC.22 Wrap Up: An ACPC Perspective

It was fitting that ACC.22 be held in our nation's capital. After two unprecedented years of a global pandemic and ACC.21 Virtual, the first "hybrid" meeting was attended in person by a good number of Adult Congenital and Pediatric Cardiology (ACPC) members. It was wonderful to finally see friendly faces in real life and not through a screen.

Community Day
The ACPC pre-meeting Community Day kicked off with an inspiring keynote by Dr. David Skorton,1 President and CEO of the Association of American Medical Colleges, who discussed today's crisis in leadership, the imperative for leaders to make good decisions during uncertain times, and the opportunities for leadership in our own sphere as cardiovascular clinicians. Lively discussions during break-out sessions touched on clinician well-being, as well as career guidance for fellows-in-training (FIT), and those in the early and middle stages of their careers. Kudos to Drs. Arwa Saidi and Anitha John for putting together this relevant agenda!

Scientific Sessions
This year's sessions ranged a wide spectrum of topics. A moderated poster event2 discussed the association of worse outcomes in congenital heart disease (CHD) in those with lower socio-economic status, comparisons in mid-term outcomes of infants with tetralogy of Fallot who underwent full repair versus shunt palliation as the initial strategy, long-term outcomes of L-transposition of the great arteries (L-TGA), the nuances of achieving biventricular conversion after initial single ventricle palliation in left ventricle (LV) hypoplasia, and many more.

The complementary roles of echocardiography and cross-sectional imaging3 were highlighted in various conditions such as coronary abnormalities, LV hypoplasia to assess candidacy for biventricular repair, heterotaxy, atrioventricular (AV) valve regurgitation and coarctation.

The CHD global health session4 discussed the bi-directional and reciprocal benefit between international programs and United States institutions, including a debate as to whether low- and middle-income countries should limit performing complex interventions.

There were spirited discussions regarding the natural and unnatural history of L-TGA from fetal life to adulthood, whether anti-coagulation was indicated in Eisenmenger syndrome and whether heart transplant alone or a combined heart-liver transplant is indicated in Fontan associated liver disease with hepatocellular carcinoma, and how to feed the neonate with complex CHD. Not to band or to band, and when to band, how old is too old; to anti-coagulate or not to anti-coagulate, with what and when; who to transplant, when to transplant, and whether to perform a combined heart and liver transplant; when to feed, how to feed and with what, were the questions. The jury is still out.

The Future is Close
In the Innovation session,5 the utility of direct-to-consumer wearables for remote patient monitoring in children, artificial intelligence edge computing, the future of cloud-based platforms, interoperability with electronic health records, patient-technology matching, and data aggregators were discussed. Surgically implantable expandable vascular grafts are here, but subsequent transcatheter expansion still awaits Food and Drug Administration approval. Mitigating the ill effects of extreme prematurity in fetal lambs using "artificial wombs" is now reality, though studies of its utility in fetuses with CHD who are in impaired maternal-fetal environments (i.e., placental dysfunction) are still many years away.

Highlighted Original Research
Elegant studies on diverse topics were the focal points of this session.6 Magnetic resonance imaging (MRI) volumetric flow was used to assess whether the 16-20 mm rigid Gore-Tex Fontan conduits implanted in children are adequate and efficient when they achieve adult size (Hint – they are not!). 

Many other topics, including AV valve regurgitation in single ventricle Fontan patients, healthcare utilization in CHD, the effects of socio-economic status on cardiac surgical outcomes, and the contemporary incidence of brain injury in cardiac surgical patients were discussed by experts. The posters were likewise plentiful and well-done.

These are just a few highlights of this year's sessions. Kudos to all the presenters and to Drs. Meryl Cohen and Huie Lin for this innovative lineup!

YEAR IN Review and The McNamara Lecture
Dr. Daphne Hsu gave an excellent summary of the year that was in CHD, emphasizing multi-disciplinary advances to move our field forward.7 There was, in fact, an increase in PubMed pediatric cardiology articles in 2020 and 2021 (and not just COVID related) – who would have known that the pandemic was beneficial to some academic careers?

Dr. Daniel Penny gave an inspiring Dan G. McNamara Memorial Keynote Address8 underscoring the importance of team building, developing programs of systems and people, where culture is supported by structure, shortening the pipeline between ideas, education and clinical applicability, promoting "innovation on the speed of trust", and psychologic safety and accountability. These are essential if we are to operate in the complex, chaotic, unpredictable world today.

Big Tent and other Events
The power and pitfalls of Social Media were discussed in the Heart2Heart Stage.9 The Women in Cardiology Section (#ACCWIC) put together several practical sessions touching on mentorship, fostering respect, civility and inclusion and being a parent while trying to be a cardiologist, among others.

Popular this year was an ACPC FIT Mix and Mingle, a "speed-dating" of sorts where our younger colleagues got to meet, network and chat with mid-career and senior faculty. Also well attended was the ACPC section meeting and "open bar" showcasing the past year's achievements of the section work groups.

ACC's Digital Transformation, that will enable ACPC members to find the latest in Cardiology, Section news, and certified content with ABP MOC credit, was highlighted in the Engage Stage.10 ACC.org truly wants to be the voice of the ACPC community and your digital clinical home.

As we look forward to ACC.23, we hope to bring back Community Day with more member engagement and to increase involvement in submissions and presentations that focus on the many aspects and perspectives of care for all our patients. See you in the Big Easy in 2023!

P.S. Do not forget to claim your ABP MOC Part 2 credit for the sessions you attended!

References

  1. Keynote, ACPC Community Day. Presented by Dr. David Skorton at the American College of Cardiology Annual Scientific Session (ACC.22), April 1, 2022.
  2. Pediatric and Congenital Heart Disease: Basic and Translational Science 1. Presented at the American College of Cardiology Annual Scientific Session (ACC.22), April 2, 2022.
  3. Multimodality Imaging and Team Decision-Making in Congenital Heart Disease. Presented at the American College of Cardiology Annual Scientific Session (ACC.22), April 2, 2022.
  4. Around the World for Pediatric and Congenital Heart Disease Care: What We Can Learn From Each Other – A 'Global Health Spoken Here' Session. Presented at the American College of Cardiology Annual Scientific Session (ACC.22), April 2, 2022.
  5. Innovations in Treatment of Congenital Heart Disease. Presented at the American College of Cardiology Annual Scientific Session (ACC.22), April 3, 2022.
  6. Highlighted Original Research: Pediatric and Congenital Heart Disease and the Year in Review. Presented at the American College of Cardiology Annual Scientific Session (ACC.22), April 4, 2022.
  7. Pediatric and Congenital Heart Disease Year in Review. Presented by Dr. Daphne Hsu at the American College of Cardiology Annual Scientific Session (ACC.22), April 4, 2022 .
  8. Dan G. McNamara Keynote: Team Building and Innovation into the 21st Century. Presented by Dr. Daniel Penny at the American College of Cardiology Annual Scientific Session (ACC.22), April 4, 2022.
  9. Social Media For Cardiologists: Why, When, How & Where? Presented at the American College of Cardiology Annual Scientific Session (ACC.22), April 2, 2022 .
  10. Digital Transformation: How the Evolving Digital Strategy Affects You. Presented at the American College of Cardiology Annual Scientific Session (ACC.22), April 4, 2022.

Clinical Topics: Cardiac Surgery, Cardiovascular Care Team, Congenital Heart Disease and Pediatric Cardiology, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Cardiac Surgery and CHD and Pediatrics, Cardiac Surgery and Heart Failure, Congenital Heart Disease, CHD and Pediatrics and Imaging, CHD and Pediatrics and Interventions, CHD and Pediatrics and Quality Improvement, Heart Transplant, Interventions and Imaging, Interventions and Structural Heart Disease, Echocardiography/Ultrasound, Magnetic Resonance Imaging

Keywords: Infant, Newborn, Carcinoma, Hepatocellular, Transposition of Great Vessels, Tetralogy of Fallot, Liver Transplantation, Artificial Intelligence, Cloud Computing, Cross-Sectional Studies, Developing Countries, Economic Status, Eisenmenger Complex, Electronic Health Records, Global Health, Heart Ventricles, Leadership, Leadership, Mentors, Pandemics, Social Media, United States Food and Drug Administration, Liver Neoplasms, Placenta, Heart Transplantation, Treatment Outcome, Magnetic Resonance Imaging, Patient Acceptance of Health Care, Wearable Electronic Devices, Monitoring, Physiologic, Monitoring, Physiologic, Echocardiography, Social Responsibility, Technology, Arteries, COVID-19


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