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.”
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During his final year of residency, Dr. Balters underwent emergency repair for an aortic rupture.
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.
Dr. Balters cherishes the family he's built with his wife, Sarah Beth.
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.
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Medical students training with Dr. Balters have named him "Most Inspirational Educator."
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.
STS President Sean C. Grondin, MD, MPH, FRCSC, updates members on the STS 58th Annual Meeting and the decision to transition from an in-person meeting in Miami, Florida, to a fully virtual format.
STS 2022 Preview — Amidst rising COVID cases and the Society’s decision to convert STS 2022 to an all-virtual program, one aspect remains paramount—delivering the finest, most relevant, and most current science to the cardiothoracic surgical community.
“Although it is disappointing for all that we could not meet in person in Miami, I am appreciative of the outpouring of support we have received in favor of this very difficult decision,” said STS President Sean C. Grondin, MD, MPH, FRCSC. "I am so pleased with the high-quality virtual conference our STS staff and volunteer physician leaders have been able to put together on such short notice. We have been able to retain or reschedule the key elements, including groundbreaking science and research, thought-provoking plenaries, and industry symposia. I also am grateful for the adaptability and flexibility of our talented speakers, faculty, and technology partners.”
From the beginning of the planning process, STS leadership made clear its stance that all registrants, faculty, exhibitors, and staff attending the meeting in person should be required to be fully vaccinated against COVID-19. However, as STS began making preparations for the approaching meeting date, it learned that legislation had been enacted that prohibited businesses in Florida from requiring any patrons to show proof of vaccination as a requirement of entry. This applied to events hosted in Florida.
While the vast majority of STS 2022 registrants, and all STS staff, already were fully vaccinated or planning to be fully vaccinated in time for the meeting, the legislation created a roadblock for registrants and faculty whose institutions had instated travel restrictions to events where vaccination was not required—or for those who simply weren’t comfortable traveling to Florida in the grip of a pandemic.
“The rising COVID cases created additional issues in crafting in-person scientific sessions in a safe, reasonable environment,” said John D. Mitchell, MD, Chair of the STS Workforce on Annual Meeting. “This would not be an ideal experience for attendees, and certainly not what we had in mind for being ‘Together Again.’”
STS leadership and staff waited in the wings as the Omicron wave surged at the end of 2021, greatly exacerbating safety concerns for all attendees, and in early January the STS Board of Directors unanimously voted to pivot to a virtual meeting in recognition that the dramatic worsening of the COVID-19 pandemic made such a move necessary for the health and safety of attendees, faculty, exhibitors, and staff. Those staff stood ready to manage the logistics of presenter schedules, exhibitor showcases, attendee communications, and—most importantly—the attendee experience.
“As you can imagine, it’s challenging to take a 3-day meeting and pare it down to an experience that will be well received and effective,” Dr. Mitchell said. “We’re not simply taking the whole meeting and placing it in a virtual environment. We have to keep in mind attendees’ personal and professional schedules, and present highly engaging content that won’t contribute to ‘Zoom fatigue.’”
STS has condensed the program to 2 days, retaining the most critical scientific presentations, technology demonstrations, and discussions of current issues affecting the specialty. Plenary sessions—including Dr. Grondin’s Presidential Address, the Thomas B. Ferguson Lecture, the Vivien T. Thomas Lecture, and the C. Walton Lillehei Lecture—remain cornerstones of the event, as will highly anticipated sessions such as “It’s Not in the Books … So How Do They Do It?”, new technologies sessions, and “Same Toys, New Indications.”
Parallel sessions will form the meeting’s core, with the concurrent presentation of four tracks—adult cardiac, general thoracic, congenital, and a track combining wellness and cardiopulmonary failure topics. See “Scientific Program at STS 2022 Represents the Finest in Every Discipline” for more details on program highlights.
An additional 19 sessions will be available as on-demand content, allowing registrants to browse and learn at their own pace. Popular immersive experiences, including “In the OR with …” and “Deep Dives” sessions will become separate offerings and are expected to make an appearance later this year.
“We’re certainly disappointed that we won’t be able to see each other in person in Miami, but with the reconfiguration of STS 2022 we’ve kept in mind the best ways to have the crucial discussions we need to have in the virtual setting, and to bear witness to the science that drives us,” Dr. Mitchell said. “We’re confident that the meeting will reflect all the strengths of our specialty and of STS.”
Cardiothoracic surgeons from the US and Italy receive practice-changing funding support
CHICAGO (January 19, 2022)—Through a collaborative effort between The Society of Thoracic Surgeons (STS) and the European Association for Cardio-Thoracic Surgery (EACTS), two standout young surgeons recently each received $20,000 in fellowship grants to learn new techniques used by institutions across the world.
