STS News, Fall 2022 — Just 10 months ago, Joanna Chikwe, MD, FRCS, from Cedars-Sinai Medical Center in Los Angeles, California, took over as Editor-in-Chief of The Annals of Thoracic Surgery, and already, the new leadership and ambitious agenda are paying off.
The Annals is being touted as the most cited and read journal in the specialty, with a record-breaking 5.102 impact factor; the editorial board has been expanded to include new senior editor positions, teams of statistical and digital editors, and additional content experts (see below); and the digital companion journal Annals Short Reports was successfully launched.
But there is much more important work to be done, including the expansion and strengthening of the digital footprint—an undertaking that is especially important to Dr. Chikwe, as reflected in some of the early changes to the journal.
Dr. Chikwe recognizes that digital content offers immediacy, versatility, and reach—key considerations as readers make new demands and the quality and accessibility of technologies improve. “Digital platforms have taken us from reading print newspapers and magazines with yesterday’s news to real-time multimedia content on our phones and computers. The best academic journals are leveraging that,” she said.
Right now, more content is being published than in recent years, and physicians are consuming it very differently. Recent research from an industry publication found that only 34% of physicians preferred to receive information about clinical trials through traditional sources such as print media, compared to 40% who chose a combination of print and digital. In addition, 26% of physicians indicated that in “the future” they would not have time for print at all.
But reaching busy audiences with scientific news is about more than just putting existing print content online in a digital format. Readers are looking for formats that are easier to digest, as well as more visual and more engaging. So, it’s important to build in as many mechanisms of engagement as possible to give them multiple ways to access the information and cut through the noise.
Understanding this, Dr. Chikwe and the expanded editorial board are carefully considering how The Annals should adapt content for the evolving and growing online world.
The digital future of The Annals is full of promise, according to Dr. Chikwe. Plans include not only providing subscribers with the opportunity to receive weekly content tailored to their specific interests, but also changing how it fosters exchanges with the audience.
With the addition of several digital editors to the Annals editorial board, readers can expect to see new content types that help them access and engage with the latest research. This modern multimedia—including educational videos, visual abstracts, infographics, and tweetorials—will highlight various original articles and editorials from the journal, be shared online, and posted daily on social media.
“We are working to develop content our readers want—content that encompasses high-impact science, expert reviews, consensus documents, and quality videos, and in the way they want it,” Dr. Chikwe said. “Timely, relevant content is key to real engagement, particularly if we can offer readers and authors ways to immediately comment on and share our digital content.”
However, the printed journal will not be forgotten, according to Dr. Chikwe. The Annals team plans on improving the print experience of the journal as well, perhaps moving from large issues featuring more than 100 articles to a more appealing format—slimmer and more frequent, with an even higher-quality graphical design.
The most important goal, though, is ensuring The Annals stays the first choice for research and education that informs cardiothoracic surgery, Dr. Chikwe explained. “We will work to guarantee you have a great journal that features an impressive breadth and depth of high-quality research, innovation, and education. You will want to read it every day, and it may even change your practice and your thinking.”
Stay informed about the latest Annals news at annalsthoracicsurgery.org.
New Editorial Board Appointees
NEW SENIOR EDITORS
NEW ASSOCIATE EDITORS
NEW EDITORIAL BOARD REVIEWERS
Adult Cardiac
Pedro Catarino, MD
Los Angeles, CA
Tirone E. David, MD
Toronto, ON, Canada
G. Chad Hughes, MD
Durham, NC
Vinod Thourani, MD
Atlanta, GA
Adult Cardiac
Isaac George, MD
New York, NY
John Ikonomidis, MD
Chapel Hill, NC
Marjan Jahangiri, MD
London, United Kingdom
Niv Ad, MD
Silver Spring, MD
Bahaaldin Alsoufi, MD
Louisville, KY
Vinay Badhwar, MD
Morgantown, WV
Faisal G. Bakaeen, MD
Cleveland, OH
Yaron D. Barac, MD, PhD
Petah Tikva, Israel
Michael Chu, MD, FRCSC
London, ON, Canada
J. Michael DiMaio, MD
Plano, TX
Dominic Emerson, MD
Los Angeles, CA
James S. Gammie, MD
Baltimore, MD
Tracy R. Geoffrion, MD, MPH
Milwaukee, WI
A. Marc Gillinov, MD
Cleveland, OH
Kendra J. Grubb, MD, MHA
Atlanta, GA
Makoto Hibino, MD
Cleveland, OH
Syed T. Hussain, MD
New York, NY
Masashi Kawabori, MD
Boston, MA
Katie S. Nason, MD, MPH
Springfield, MA
Olugbenga T. Okusanya, MD
Philadelphia, PA
Puja Parikh, MD
Stony Brook, NY
Valerie W. Rusch, MD
New York, NY
Ashish S. Shah, MD
Nashville, TN
Fawwaz R. Shaw, MD
Atlanta, GA
Betty C. Tong, MD, MHS
Durham, NC
Kerem M. Vural, MD
Ankara, Turkey
Congenital Heart
Danielle Gottlieb-Sen, MD
Baltimore, MD
Jeffrey P. Jacobs, MD
Gainesville, FL
David M. Overman, MD
Minneapolis, MN
Global Health
Jacques Kpodonu, MD
Boston, MA
General Thoracic
Farhood Farjah, MD
Seattle, WA
Brian Mitzman, MD
Salt Lake City, UT
Biostatistics
Natalia N. Egorova, PhD
New York, NY
Stephen Fremes, MD
Toronto, ON, Canada
Andrew B. Goldstone, MD, PhD
New York, NY
Gary Grunkemeier, PhD
Portland, OR
Alexander Iribarne, MD
Lebanon, NH
Paul Kurlansky, MD
New York, NY
Asishana A. Osho, MD
Boston, MA
David Ouyang, MD
Los Angeles, CA
Biostatistics
Michael E. Bowdish, MD
Los Angeles, CA
Mario F.L. Gaudino, MD
New York, NY
CME
Gabriel Loor, MD
Houston, TX
Perioperative
Daniel Engelman, MD
Springfield, MA
Digital Media and Digital Scholarship
Alexander A. Brescia, MD, MSc
Ann Arbor, MI
Sarah A. Chen, MD, CMI
Davis, CA
Aleksander Dokollari, MD
Toronto, ON, Canada
Joshua C. Grimm, MD
Philadelphia, PA
Jessica G.Y. Luc, MD
Vancouver, BC, Canada
Amy N. Roach, MD
Los Angeles, CA
Dominique Vervoort, MD, MPH
Toronto, ON, Canada
Moritz Wyler von Ballmoos, MD
Houston, TX
Muhammad H. Zubair, MD
Los Angeles, CA
Science
Elaine Tseng, MD
San Francisco, CA
John H. Calhoon, MD
STS News, Fall 2022 — As we emerge from the pandemic, it is fascinating to see how much has changed.
Expectations of a return to normal just don’t seem possible. Although some things may be better, other daily experiences clearly are not. To me, one thing has become much worse: the relentless barrage of trivial and misleading information and negative news and commentary. The endless accusations of one faction’s bias or maltreatment of the other are difficult to reconcile. Without self-control, this societal noise could wear one out.
To avoid these traps, we can remind ourselves how fortunate we are to be cardiothoracic surgeons with the opportunity to make a difference each day in the lives of our patients and their families. Gratitude for my family and friends, and for the many gifts offered by this world, this country, and my community, are a great comfort to me.
Nonetheless, the seemingly ever-increasing loss of stability and predictability impacts our ability to effectively manage our lives, both at work and at home. It is all too easy as a surgeon to thrive on the illusion of stability, predictably, and control.
With time, I have come to realize the significance of this illusion. The only thing we can control is our response to the noise. Reminding myself of this has helped me be less stressed and more relaxed. Have I experienced burnout? Yes. However, taking the time to occasionally relax and recharge is the best way to manage stress and aim for a bit of balance.
Throughout my career, I have turned to senior surgeons—all of whom gave back to our specialty via volunteer work with STS and other organizations—for support and guidance. It is those surgeons and STS that have helped our specialty evolve tremendously since my days as a resident and early career surgeon. Many technologies and techniques that are common today did not exist then.
STS has been and continues to be steadfast as a leader in providing hands-on education for thoracoscopic techniques, mitral valve knowledge, TAVR, and so much more. For many of us, STS has played an important role in strengthening our skills and abilities as surgeons and leaders.
"We can remind ourselves how fortunate we are to be cardiothoracic surgeons with the opportunity to make a difference each day.
John H. Calhoon, MD
An array of STS education programs and services—including in-person meetings, webinars, on-demand content, and the STS Cardiothoracic Surgery E-Book—provide members access to the latest science and best practices. The Society also provides special opportunities for residents and early career surgeons to connect with peers and mentors, participate in hands-on training, develop leadership skills with renowned faculty, and participate in STS governance to advance the interests of the specialty.
But STS is so much more. It is a catalyst for advances in CT surgery that help surgeons provide the highest quality care and deliver the best patient outcomes. The STS National Database and accompanying research and quality initiatives help drive cardiothoracic surgery innovation and safety.
Hospitals and health systems depend on our data to strengthen their performance. Industry uses them to design and improve next generation devices and therapeutics. Data-driven research powers The Annals of Thoracic Surgery, the largest and most read journal in our specialty (congratulations to Dr. Jo Chikwe and her editorial and administrative teams!). And research is the basis for STS’s leadership in guideline development.
Most importantly, STS is the only organization engaged in public policy advocacy for cardiothoracic surgeons and the patients, institutions, and communities we serve. STS-PAC is a political action committee in Washington, DC, that exclusively represents the specialty.
Let me close by asking each of you: Are you unlocking the full value of your STS membership?
Here are five things you can do to become more engaged and give back to the profession:
Attend—in person—STS 2023, our 59th Annual Meeting in San Diego (see page 11)
Submit an abstract for a presentation at an upcoming STS meeting
Contribute an article to The Annals or Annals Short Reports
Donate to STS-PAC and develop a relationship with your member of Congress
Volunteer to serve as a mentor for a younger surgeon or join an STS Workforce or Task Force
Details about these opportunities can be found at sts.org.
More to come, John
Learn about the different facets of STS advocacy, what it can do for you, and how you can make a lasting impact on the cardiothoracic surgery specialty. Presenters share how STS advocacy intersects with everyday aspects of members' surgical practices, as well as their personal, professional, and institutional priorities from quality improvement to coding and reimbursement.
STS 2023 Abstract Deadline Is Approaching Fast
The STS 59th Annual Meeting—to be held January 21–23 in San Diego, California—is the premier forum for sharing research findings, quality initiatives, and cutting-edge techniques with the global cardiothoracic surgery community.
Abstract submission closes July 22; there’s still time to submit materials for oral presentations, scientific posters, and surgical videos in:
⊲ Congenital heart surgery
⊲ General thoracic surgery
⊲ Basic science research
⊲ Quality improvement
⊲ Cardiothoracic surgical education
⊲ Physician/provider wellness
⊲ Perioperative management and critical care
For authors involved in Phase I, II, or III clinical trials for which no preliminary data will be available by the July deadline, the Society will consider promissory abstracts (data must be available by December 16).
In addition, the Society is accepting compelling session proposals that showcase emerging, innovative, and/or critical issues facing the specialty. The deadline for promissory abstracts and session proposals also is July 22.
More information is available at sts.org/annualmeeting.
Annals Impact Factor Reaches Record High
The Society’s peer-reviewed journal, The Annals of Thoracic Surgery, has earned its highest impact factor to date—and the first one over five.
The impact factor, an important metric indicating a journal’s influence, measures the frequency with which the average article has been cited in a particular year. For 2021, the impact factor was 5.102, as reported by Clarivate Analytics in its Journal Citation Reports.
Notably, The Annals was the most cited journal in cardiothoracic surgery, with more than 45,000 total citations in 2021.
Article topics that received the most citations last year include: the Intermacs and STS National Database annual reports; representation of women in STS authorship and leadership positions; adult cardiac infection mitigation strategies; tiered patient triage for adult cardiac and thoracic surgery; sexual harassment in cardiothoracic surgery; and social media’s influence in cardiothoracic surgical literature dissemination.
A subscription to The Annals is a benefit of STS membership. To read the journal online, visit annalsthoracicsurgery.org.
Leadership Institute Graduates Emerge with Crisis Management, Branding Skills
In April, a select group of STS members gathered in Chicago for the capstone event of the 2021-2022 STS Leadership Institute.
This program is designed to arm early- and mid-career cardiothoracic surgeons with the skills to lead teams in complex and everchanging health care environments.
During the event, participants had plenty of face-to-face time with a world-class faculty—surgeons with exceptional experience in leadership and mentorship roles.
Presenters explored the impact of organizational culture and how to influence change, identified tools for effective communication within a diverse working environment, examined strategies for achieving personal goals inside and outside the workplace, defined wellness, and pinpointed skill sets for obtaining work/life balance.
In the months leading up to the event, Leadership Institute participants completed three virtual training courses that formed the core curriculum: “Leading During Crisis,” “Building Your Practice and Your Brand,” and “Promoting Your Brand.”
The STS Leadership Institute is an educational opportunity with a limited number of seats, and it’s available only to STS Members. The 2022-2023 program is underway, and the next application round will be for the 2023-2024 track.
Learn more at sts.org/leadershipinstitute.
Anita R. Krueger, MD, connected with fellow faculty members Robert S.D. Higgins, MD, MSHA, and Mara B. Antonoff, MD, at the Leadership Institute capstone event.
Latest Webinars Offer Hours of Self-Paced Learning
The STS Webinar Series is designed to give participants access to training, techniques, and expert perspectives on a variety of topics in cardiothoracic surgery, allowing them to learn on their own time. The latest installments include:
“Dos and Don’ts of the Mobile ECMO Team,” in which a multidisciplinary panel shares their expertise in establishing and maintaining an effective mobile ECMO unit.
“Coronary Revascularization Guideline: Why STS and AATS Did Not Endorse,” paneled by senior leaders from STS and the American Association for Thoracic Surgery. The panelists discuss the concerns that informed the decision not to endorse the 2021 Guideline for Coronary Artery Revascularization published in December.
“Bronchoscopy: Electromagnetic, Robots, & Ablation,” featuring an international panel of surgeons who share their experiences with electromagnetic and robotic approaches to bronchoscopy, as well as ablation of lung cancers.
“Understanding and Implementing the New CoC Lung Cancer Standards,” in which an expert panel discusses the new Quality of Care Measures updated by the American College of Surgeons Commission on Cancer (CoC).
“Management of Type B Aortic Dissection: Takeaways from the STS/AATS Guideline,” presented by guideline coauthors, who discuss the key takeaways from this comprehensive, up-to-date summary of the state of the evidence.
“Robotic Mitral Valve Repair Essentials,” with world-renowned robotic cardiac surgeons, explores the essential components of successful robotic mitral valve repair and implications for the future of cardiac surgery.
These videos and more are available at sts.org/webinars.
Surgical Teams Encouraged to Send Data Managers to AQO
By attending the 2022 Advances in Quality Outcomes (AQO): A Data Managers Meeting, data managers will learn the newest research discoveries, clinical guidance, and master techniques for harnessing the STS National Database.
AQO, October 26–28 in Providence, Rhode Island, will offer tracks for all four components of the Database: Adult Cardiac, Congenital, General Thoracic, and Intermacs/Pedimacs.
Surgeon leaders, data managers, and Database platform experts will share valuable findings and approaches to clinical data analysis. Attendees also can submit abstracts for presentation, highlighting the research and performance of participating sites.
“Cardiothoracic surgery departments can benefit greatly from the insights presented at AQO,” said Felix G. Fernandez, MD, MSc, Chair of the STS Workforce on National Databases. “I encourage every data manager who works with the STS National Database—or who wants to see how it can help transform quality improvement methods at their site—to join us at the meeting, so that we can keep building upon the Database and optimize the care we provide to our patients.”
To learn about AQO abstract submission and registration, visit sts.org/AQO.
Industry Spotlight Videos Illuminate Unmet Needs, Optimal Screening for Lung Cancer
The latest videos in Industry Spotlight, a collection from industry partners that highlights cutting-edge techniques, medical devices, and other industry news and education, cover clinically important findings and developments in lung cancer diagnosis and treatment.
“Addressing Unmet Needs for Patients with Resectable NSCLC and the Benefits of an MDT Approach” and “The Importance of Early Detection of Lung Cancer: Best Practices to Optimize Screening Programs,” sponsored by AstraZeneca, are ready to watch now at sts.org/industryspotlight.
Once posted, Industry Spotlight videos are available for a limited time. New videos will be added periodically.
Upcoming STS Course Offers In-Person Critical Care Training
Now is the time to join colleagues for face-to-face fellowship, the newest scientific breakthroughs, and the opportunity to learn state-of-the-art techniques in critical care.
The 19th Annual Perioperative and Critical Care Conference will take place September 8–10 in Denver, Colorado. This event—which attracts attendees and faculty from around the world—is designed to enhance knowledge and expertise in cardiovascular and thoracic critical care as well as in enhanced recovery after surgery.
Abstracts are being accepted through July 13 and registration is open at sts.org/criticalcare.
Coronary Conference Marked First-of-Its-Kind Experience in Ottawa
Attendees from 18 countries converged in June for the 2022 STS Coronary Conference, which delivered state-of-the-art training in coronary artery surgery, late-breaking science abstracts, and a world-renowned faculty.
The 2-day conference, held in Ottawa, Ontario, Canada, was a unique experience, featuring didactic presentations, “How I Do It” video sessions on surgical techniques, practical tips and tricks, in-depth abstracts sessions, and case-based panel discussions.
Topics focused on the current state of revascularization, conduit selection and harvest, graft configuration, off- and on-pump coronary artery bypass grafting (CABG), endarterectomy, low ejection fraction, minimally invasive CABG, myocardial revascularization, CABG and fractional flow reserve, and post-operative medical therapy.
Sessions were highly interactive, with audience participation and questions encouraged throughout the conference.
“We are pleased to report that the conference—the first of its kind—was a resounding success," said course director Marc Ruel, MD, MPH, who serves as STS Canadian Director. "It is germane that cardiac surgeons specialize deeply in advanced coronary surgery, as the field experiences a resurgence, represents about half of what adult cardiac surgeons do, and has been greatly promoted through a widespread emphasis on heart team discussions. More than ever, we need to regularly meet as a strong and innovative community."
Those who registered for the Coronary Conference will receive free access to its recorded content. For those who couldn’t attend, the content will be available for purchase in the STS Learning Center at learningcenter.sts.org.
STS Leadership Positions: Are You Interested?
All members are invited to participate in the Society’s self-nomination process for standing committee and workforce appointments.
In order to represent the full gender and ethnic diversity of the membership, STS encourages submissions from all practice types, career levels, disciplines, geographic areas, and other demographics.
Submissions will be accepted in August; information on how to self-nominate is available at sts.org/selfnomination.
A full list of the Society’s leadership and governance structure can be found at sts.org/leadership.
Scholarships Support Attendance at STS Annual Meeting
Aspiring cardiothoracic surgeons—and general surgery residents looking for a glimpse at a career in cardiothoracic surgery—have the opportunity to experience the STS Annual Meeting and see what a future in the specialty has to offer.
The STS Looking to the Future Scholarship (LTTF) is intended for medical students and general surgery residents.
Benefits of the 2023 LTTF scholarship include:
⊲ Complimentary registration for STS 2023—the Society’s 59th Annual Meeting—being held January 21–23 in San Diego, California
⊲ A 3-night stay at an STS-designated hotel
⊲ Participation in exclusive events
⊲ Reimbursement of up to $500 in related travel expenses
The following are eligible to apply:
⊲ Medical students training at an institution in the United States or Canada
⊲ Clinical PGY1, PGY2, or PGY3 general surgery residents training at an institution in the United States or Canada
⊲ General surgery residents on dedicated research time who have not started their PGY4 clinical year training at an institution in the United States or Canada
Application details will be available later this summer at sts.org/lttf.
Previous scholarship recipients are not eligible; however, previous applicants are encouraged to re-apply.
STS News, Summer 2022 — Grassroots advocacy is action that grows organically from the heart of a constituency—its members. And, one of the most powerful types of this grassroots work is patient advocacy.
Meet two STS members who have taken patient advocacy to the next level.
The 2019 STS Key Contact of the Year, Rob Headrick, MD, MBA, from CHI Memorial Chest and Lung Cancer Center in Chattanooga, Tennessee, traveled to the White House in late spring to advise the Administration on the mobile lung cancer screening program that he started. The program, known as “Breathe Easy,” features a built-from-scratch bus with a portable computed tomography scanner and brings opportunities for early detection of lung cancer directly into the community. Learn more about the program and Dr. Headrick’s grassroots efforts in the Q&A below.
Former STS President Douglas E. Wood, MD, from the University of Washington in Seattle, has taken his patient advocacy to a global level, demonstrating that early detection of lung cancer can have a significant impact in reducing overall cancer mortality.
Dr. Wood chaired the Lung Cancer Screening Panel of the National Comprehensive Cancer Network (NCCN) when it was created in 2009. The panel was in the process of creating the first lung cancer screening guidelines when the National Lung Screening Trial (NLST) was published in 2010 (the trial was launched in 2002, and the initial findings were released in November 2010).
The NLST demonstrated that a lung cancer screening program could reduce lung cancer mortality by 20%. As Dr. Wood explained, until that point, lung cancer screening hadn’t been accepted as a screening modality and the NLST results “changed the conversation.” However, there was still considerable work to do to get patients access to low-dose CT (LDCT) lung cancer screening.
In December 2013, the United States Preventive Services Task Force (USPSTF) granted a B rating for lung cancer screening in adults aged 55 to 80 years who had a 30 pack-year smoking history and were currently smoking or had quit within the past 15 years. The B rating required that private insurance companies cover LDCT scans, but did not extend to Medicare beneficiaries.
A Medicare advisory panel advised against screening for Medicare beneficiaries, withholding early detection from those at highest risk for lung cancer. Dr. Wood helped lead a coalition of health professionals to work with Medicare administrators on the safe implementation of screening. In February 2015, Medicare issued a National Coverage Decision providing lung cancer screening as a covered benefit for Medicare beneficiaries.
The USPSTF updated its LDCT lung cancer screening recommendations in March 2021 to include adults aged 50 to 80 years who have a 20 pack-year smoking history, and Medicare followed a year later. Unfortunately, they both maintain an upper age limit and the requirement that eligible patients must currently smoke or have quit within the past 15 years.
Dr. Wood more recently worked with the President’s Cancer Panel on a report issued in early 2022 that highlighted lung cancer as one of the top four cancers of focus. He also is the vice chair of the National Lung Cancer Roundtable from the American Cancer Society, a consortium of public, private, and voluntary organizations that work together to fight lung cancer by engaging in research and projects that no one organization can take on alone.
In addition, Dr. Wood participates in the Lung Cancer Collaboration—a partnership between the World Economic Forum and the Lung Ambition Alliance. This coalition of patient organizations, scientific and medical societies, and industry—which shares the urgent ambition to double 5-year survival in lung cancer by 2030—developed a report that examined lung cancer as global public health issue. The report was presented to the World Health Assembly in May 2022.
More information, including important lung cancer references and documents, is available below.
References and Documents from Dr. Doug Wood
A report from the President’s Cancer Panel—Closing Gaps in Cancer Screening: Connecting People, Communities, and Systems to Improve Equity and Access
A report from the President’s Cancer Panel—Lung Cancer Companion Brief Lung Cancer Companion Brief
About the American Cancer Society National Lung Cancer Roundtable
World Economic Forum: Urgent, Coordinated Global Action on Lung Cancer
Q&A with Dr. Rob Headrick
How did you get invited to the White House?
We lobbied Washington, DC, and the Tennessee state government for funding to expand the mobile lunger cancer screening concept, but the pandemic put those efforts on hold. In 2021, we announced a partnership with the GO2 Foundation for Lung Cancer, AstraZeneca, Merck & Co., Inc., Bristol Myers Squibb, and a nonprofit foundation to expand the program.
This collaboration caught the attention of the Biden Administration and the Cancer Moonshot initiative, and we received an invitation to the White House to help highlight important public-private partnerships that are critical to achieving the Cancer Moonshot goal of decreasing overall cancer mortality by 50% over the next 25 years. It was the highlight of my career to have our many years of work recognized by the White House and used as an example for the type of partnership they are looking for.
What did you learn about the Administration’s work to advance lung cancer screening?
It was clear to all involved that the quickest way to make progress toward the goal of reducing cancer mortality by 50% is through screening. Lung screening is the biggest first step that will start improving overall cancer mortality rates—which is why the White House was highlighting our mobile program and its effort to reach at-risk rural and underserved populations. The Moonshot leadership recognizes the importance of supporting continued improvements in screening policy.
What is the latest on the mobile lung cancer screening bus initiative?
The next mobile lung cancer screening bus is currently in the build stage and will hopefully be on the road by January 2023. In order to provide further value to these high-risk patients, the bus will include continued advancements in screening technology such as artificial intelligence (AI), calcium scoring, and possibly bone density assessment. Reliability, remote connectivity, and throughput also will remain priorities in the design.
What innovations are there in the lung cancer screening space that STS members and patients should know?
Low dose lung screening is much more than just finding lung cancer early. This population also is at high risk for ischemic cardiac mortality. We already use non-gated calcium scores with each lung screening to help protocolize patient risk and make sure appropriate medications are being prescribed. Smoking cessation also is encouraged. There is an opportunity to reduce the cardiac mortality in this population by 30%—similar to the lung screening benefit.
In addition, so much data from these scans are not being used. For example, AI will play a role in our future by helping the radiologists read these scans and make better use of the data on the scans to improve the overall health of this population. We will become more efficient at predicting future risk for disease and focusing efforts to help mitigate that risk—all while staying within the low dose parameters and with a short single breath CT scan.
How can STS members get involved in supporting the mobile lung cancer screening initiative?
The Lung Ambition Alliance—with our help—currently is organizing an international mobile lung screening meeting that will feature all current mobile programs in the US (3) and United Kingdom (1). This meeting will allow those who are interested in developing such a program to learn from the existing programs and ask questions. We are hoping to have the meeting by the fall of 2022. It will likely be held in conjunction with one of the international lung meetings and will include a virtual option for those who cannot attend in person.
Mobile lung screening isn’t for everyone, but for many, it is a great way to find lung cancer at an early stage and educate patients in areas where geographic or economic barriers prevent patient engagement. We are always willing to talk with STS members about the business model, discuss how we set up our program, and organize site visits to see the bus.
STS News, Summer 2022 — Four open heart surgeries and a kidney transplant represent stark milestones for STS member Marcus Balters, MD, whose career as a surgeon has been interspersed with stints as a patient, brushes with mortality, new perspectives on teaching, and solidified faith.
Dr. Balters directs the general surgery residency program and serves as vice chair of surgical education at Creighton University in Omaha, Nebraska. His experiences as a young patient—he underwent a coarctation repair at age 6 and a repeat repair at age 16—made a career in cardiothoracic surgery a natural choice.
“My mother would probably tell you I was talking about being a cardiac surgeon from a very young age, probably 7 or 8,” he said. “I remember thinking my pediatric cardiologist was very cool, and even when I moved on to an adult cardiology group, I was imagining him as my surgeon. I have a memory of him standing over me in scrubs as I was going to sleep.”
Dr. Balters studied medicine at the University of Nebraska Medical Center. In 1999, while a fourth-year resident, he experienced a descending aortic graft rupture.
“This rupture presented as an aortobronchial fistula, and it was very emergent,” he recalls. “I started that morning with massive hemoptysis; I was exsanguinating.”
Dr. Balters credits the world-renowned Lars Svensson, MD, PhD, now at the Cleveland Clinic in Ohio, for saving his life at the Lahey Clinic that day—the first of two such occasions, he’d later discover. Notably, that operation also revealed an ascending aortic aneurysm that warranted a close watch.
“I made it back to residency in about 8 weeks after a very near miss with death,” Dr. Balters said.
He went on to a cardiothoracic surgery fellowship at the State University of New York in Syracuse (SUNY-Syracuse), and from there to a private practice group back in his home state of Nebraska. The group joined Omaha’s Creighton University in late 2005.
A few months later, his aneurysm had grown to the point of needing repair.
“I called Dr. Svensson, and he graciously and adeptly saved my life again in April 2006 at the Cleveland Clinic,” recalled Dr. Balters. “By the grace of God, once again I made it back to work in 8 weeks, and I resumed a very busy clinical practice.”
Being very busy, he now reflects, kept him on a sort of “autopilot,” turning his focus to work, which served as a distraction from what he now recognizes as a form of post-traumatic stress.
“During residency, colleagues would at times take me aside and ask, ‘Are you sure you want to go into this? This is what your life is going to be like.’ And looking back, I realize that I probably spent 10 or 15 years after that third operation wondering, ‘Am I going to die today?’ Every time I would cough, every time I would have a pain, it would remind me of those dramatic events,” he said.
Throughout those years, however, Dr. Balters had a support system that presented him with avenues he’d never considered and with the revelation that it’s okay to lean on colleagues and loved ones, to accept the grace of a higher power, and to employ a little creative assistance.
Another opportunity to broaden Dr. Balters’s viewpoint occurred in early 2006, when he approached the department head to inform him of his plans to undergo the aneurysm repair. “When I had to have that fourth surgery, I went to my chairman and broke down in tears,” he recalled. “He assured me that no matter what happened, even if I could never operate again, there would be a place for me.”
The chair, R. Armour Forse, MD, PhD, suggested that Dr. Balters consider a teaching position, and that recommendation altered the course of Dr. Balters’s professional life.
Meanwhile, Dr. Balters’s wife, Sarah Beth—whom he has known since they were 14 and with whom he celebrated 25 years of marriage this year—was a steady source of spiritual support. “She is the person that lifts me,” he said.
Early in his fellowship, Dr. Balters recalls, he was watching a surgeon deftly perform a procedure, and while observing he had a moment of anxiety about the tremor in his own hands.
“I was thinking to myself, ‘I’m not sure I’m going to be able to do this.’ And right at that moment, without any prompting, my attending said to me, ‘You know, Marcus, I’m resting my hand on the sternum while I do this.’”
Dr. Balters had been so focused on the narrow view through the magnification lenses that he’d never appreciated that his attending surgeon was using a technique to alleviate his own tremor.
Dr. Balters began honing his clinical practice from a mixed bag of cardiac, thoracic, and vascular operations to focus mostly on lung surgery and hemodialysis access at Creighton University Medical Center, now part of CommonSpirit Health, and the Veterans Affairs Nebraska-Western Iowa Health Care System.
The dean of the School of Medicine at Creighton University, Robert W. “Bo” Dunlay, MD, recommended that Dr. Balters turn his talents toward teaching both medical students and general surgery residents.
In the intervening years, Dr. Balters’s kidneys began to fail.
Ultimately diagnosed with idiopathic glomerular nephropathy, he “continued to work the surgeon’s life, though I had stopped doing cardiac surgery back in 2006 when I had the arch repair.” Eventually he required a transplant, and in 2010 he received a kidney from his brother.
“Again, back to work in 8 weeks, though I had multiple issues come up in the next 18 months related to the transplant,” he said. “I have stayed with Creighton—and they have stayed with me—since 2005.”
Dr. Balters has become a source of inspiration for his students and residents.
“I tell them—the students, at least—that I don’t care what kind of doctor they decide to be. There’s of course some satisfaction in ‘converting’ residents to cardiothoracic surgery, but my ultimate goal is to help them be the best doctors they can and save lives. I can only touch so many people in my lifetime as a surgeon, but if I teach people what I think is important, my effects can ripple out to lots of people across years and locations.”
He notes that the students seem to appreciate that he thinks out loud in the operating room. Dr. Balters says that while it’s easy to become silently focused on the task at hand, especially during difficult procedures, he tries to offer insights into his thought processes and decisions by talking them out among the team as he operates.
In 2018, the fourth-year medical student class named him “Most Inspirational Educator” in their yearbook, and this year he achieved the rank of full professor.
And how do his patients benefit from his experiences on—and over—the operating table?
“Once we’ve gotten through the plans for the proposed operation, I’ll say something like, ‘Well, I’ve never had lung cancer, but I’ve had four open heart surgeries and a kidney transplant. And I’m not telling you this because this conversation is about me, but because I want you to know that I’ve sat in those chairs before, and I’ve asked the questions: Why is this happening to me? Who is this person in front of me, and do they know what they’re doing?’”
Dr. Balters answers that he’s just a former kid from Nebraska, but that he’s spent years preparing to be a proficient surgeon, he’s performed hundreds of operations like these, he’s certified by the American Board of Surgery and the American Board of Thoracic Surgery, and he’ll “do everything in my powers to try and make this as uneventful of a valley as possible in what is hopefully an otherwise long and prosperous life.”
A long and prosperous life has realized itself in Dr. Balters, despite a seemingly relentless series of valleys. With his renewed perspective through the lenses of fellowship, family, and faith, he says that he feels blessed.
John H. Calhoon, MD
STS News, Summer 2022 — Just a couple of months ago, I was sitting in my office thinking about the importance of leadership during crisis and trying to make sense of the latest tragedy within our borders and the ongoing conflict thousands of miles away in Ukraine. So much violence and so little sense.
The Uvalde shooting hit very close to home as the school is located approximately 80 miles from where I live, work, and raise my family, and some of the victims were treated by the trauma team at The University of Texas at San Antonio.
And not as close, but just as devastating, are the war in Ukraine and its terrible consequences. Major powers have been unable to stop the fighting, and the war continues with an ongoing loss of life and mounting strife realized by the entire world.
Where do we sit in all this, and what should we be doing?
Leaders Everywhere, Every Day
We are leaders in our communities, our institutions, and our departments and teams. In these times, it is especially important to do our best to serve as wise and measured voices as we keep in mind the duties beyond those of our careers and professions. There are moments in life—like this—when people depend on our leadership to reassure those around us, build connectedness, and inspire confidence.
Building Community
Importantly, we must recognize the importance of CT surgeons and our professional associations collaborating with and supporting one another. We all have skin in the game and are working toward a common goal of advancing the specialty and providing quality care for our patients. Of course, we all are enthusiastic and excited to return to in-person meetings and resume live learning and networking.
Thankfully, once again we are experiencing the power of face-to-face interactions—deeper, more meaningful conversation, handshakes and hugs, a joyful respite from our phones and computers.
Meeting Successes
The inaugural in-person STS Coronary Conference in Ottawa, Ontario, Canada, was a great success, with nearly 150 attendees gathering from 18 countries last month to discuss the latest techniques for coronary artery bypass surgery. The sold-out, hands-on Workshop on Robotic Cardiac Surgery in Atlanta, Georgia, this spring was another highly regarded success.
Right around the corner is the Critical Care Conference in Denver, to be held Sept. 8-10. Boot Camp, scheduled for Sept. 29-Oct. 2, will provide 60 residents with an experiential foundation and hands-on practice in basic cardiothoracic operating skills. Other upcoming meetings include the LatAm meeting in Cartagena, Colombia, being held Dec. 1-3, in conjunction with our colleagues from EACTS.
The Society also recently organized a leadership retreat, attended by Drs. MacGillivray, Romano, and Szeto, key STS staff, and me. Together, we began to map out critical initiatives and discussed future opportunities, including a variety of quality education programs that will ensure STS has a clear direction and purpose for years to come.
Modernization of the Database
During the AATS meeting in May, Dr. Vinay Badhwar, on behalf of his multidisciplinary co-authors, presented an invited landmark paper on mitral valve repair that used data from the STS National Database. This paper, along with several others, showcased the value of the information from the Database.
Overall, the Database continues to get stronger, although it has not been without some hurdles as we evolve to a fully digital platform. The Society is continuing to transition data capture and data analytics to internal STS staff, eliminating the need to rely on outside vendors and giving us more authority and responsibility for accurate and timely reports. We are very resolute in this goal.
Important Advocacy Work
On the advocacy front, the cardiothoracic surgery specialty remains under attack with the possibility of additional cuts to clinical reimbursement.
As a founding member of the Surgical Care Coalition, the Society continues to work with the American College of Surgeons and other associations to find longer-term solutions to Medicare’s broken payment system, while also protecting access to necessary surgical procedures and high-quality care for all patients.
The STS Government Relations team also remains focused on other important regulatory and legislative issues that are relevant to cardiothoracic surgeons and our patients.
There remains much to do—in the ORs, in our institutions, in our communities, for our specialty, and for each other. But I am optimistic that with the help of wise and selfless leaders like you, we have a much better chance.
Stay grounded, and do not fall prey to the quicksand around us all.
More to come, John.
In this May 2022 message, STS President John H. Calhoon, MD, details the STS Leadership Institute and the importance of supporting future leaders, how the Society is evolving its programs and services, the long-awaited return of live education, and the renewed focus on developing early career physicians.
Coronary Conference Early Bird Registration Ends April 14
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The 2022 STS Coronary Conference, June 4–5 in Ottawa, ON, Canada, will connect attendees with advanced educational content on the latest techniques for coronary artery bypass grafting (CABG) surgery. The agenda will feature didactic presentations, “How I Do It” video sessions, practical tips and tricks, and case-based panel discussions.
Presented by experts from around the globe, session topics will focus on the current state of revascularization, conduit selection and harvest, graft configuration, off- and on-pump CABG, endarterectomy, low ejection fraction, minimally invasive CABG, myocardial revascularization, CABG and fractional flow reserve, and postoperative medical therapy.
“This is the first STS conference entirely dedicated to advanced coronary artery surgery,” said program director Marc Ruel, MD, MPH, FRCSC, from the University of Ottawa Heart Institute in Ontario, Canada. “It comes at the right time for cardiac surgeons, as so many new advances have taken place in coronary surgery over the last few years. The STS Coronary Conference will be very interactive and provide surgeons and trainees with practical tips and tools to enhance their skills, knowledge, and the overall care of their patients with coronary artery disease.”
Early bird discounts are available until April 14. For more information, see sts.org/coronaryconf.
It’s Time to Assemble a Team for CT Surgery Masters Showdown
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Surgical residents are encouraged to find a partner and join the 2022 CT Surgery Masters Showdown, a Jeopardy-style competition of cognitive skills.
Two-person teams of residents will face off against one another in a test of knowledge in five cardiothoracic surgery categories—cardiac, congenital, thoracic, history of the specialty, and decision making. When a North American champion emerges, they’ll compete against the winning European team in a final competition at the 2023 STS Annual Meeting.
Registration opens June 1, and each individual participant will need to take an initial online qualifying exam. Visit sts.org/showdown for more information.
The most-downloaded articles on The Annals of Thoracic Surgery website in 2021 focused on a wide variety of topics, including ventricular septal defects, the aorta, unethical research studies, and mechanical heart valves.
Interestingly, one of the top articles—which highlights exercise therapy after coronary artery bypass grafting surgery—is among the most downloaded papers year after year. Others, such as the “Update to the Clinical Practice Guidelines on Patient Blood Management,” published in September 2021, demonstrate the continued importance of practice guidelines.
A subscription to The Annals is a benefit of STS membership. Log in to read any of these articles at annalsthoracicsurgery.org.
Coming Soon! Later this spring, the new open-access journal from STS—Annals of Thoracic Surgery Short Reports—will issue a call for papers, which may include short-form original research related to clinical advances, current surgical methods, controversial topics and techniques, case and image reports, and more.
The STS Surgical Hot Topics podcast generated 55,700 downloads in 2021, helped by the addition of a new series, “The Resilient Surgeon,” which features game changers in the wellness space who describe evidence-based practices and real-world strategies to help reduce burnout and achieve optimal performance. The popular “Same Surgeon, Different Light” podcast also returned in 2021 with a second season.
Of the 46 Surgical Hot Topics episodes published last year, the most downloaded were:
Beyond the Abstract: Women in Thoracic Surgery Scholarship—Impact on Career Path and Interest in Cardiothoracic Surgery (June 30, 2021)
The Resilient Surgeon: Dr. Robert Lustig (September 3, 2021)
The Resilient Surgeon: Dr. Monique Valcour (July 9, 2021)
The Resilient Surgeon: Wendy Wood (August 6, 2021)
Same Surgeon, Different Light: Dr. Ourania Preventza (March 5, 2021)
Already in 2022, STS has published several podcast episodes, including “Same Surgeon, Different Light” interviews with Susan D. Moffatt-Bruce, MD, PhD, MBA, Jacques Kpodonu, MD, Gail E. Darling, MD, Raja M. Flores, MD, Jennifer C. Romano, MD, MS, Sharon Ben-Or, MD, and Allan Pickens, MD. The final episode in Season 2 of Same Surgeon, featuring Edward P. Chen, MD, will air at the end of April.
Season 2 of The Resilient Surgeon will launch this summer.
STS Distinguished Service Award recognizes dedication to the Society and the specialty
CHICAGO (January 30, 2022) — In recognition of extraordinary efforts and steadfast service, Joseph A. Dearani, MD, and Joseph E. Bavaria, MD, each have been presented with The Society of Thoracic Surgeons 2022 Distinguished Service Award at the Society’s 58th Annual Meeting.
STS award recognizes outstanding scientific contributions to cardiothoracic surgery
CHICAGO (January 29, 2022) — Internationally recognized medical researcher, surgeon, and professor Thomas K. Waddell, MD, MSc, PhD, today was honored with the 2022 Earl Bakken Scientific Achievement Award from The Society of Thoracic Surgeons during the organization’s 58th Annual Meeting.