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STS 2023 Day 1 — General thoracic surgeons should not miss this presentation that challenges lobectomy as the gold standard treatment for patients with smaller lung tumors. Surgical segmentectomy, as opposed to lobectomy, should be considered for patients whose lung cancer has been downstaged following neoadjuvant chemoimmunotherapy, STS 2023 presenters say. On Saturday, January 21 at 9:45 a.m. PT, Charles Logan, MD, from Northwestern University Feinberg School of Medicine in Chicago, will present “Pathologic Downstaging Following Neoadjuvant Chemoimmunotherapy for Locally Advanced Lung Cancer is Associated with Survival Comparable to Early Stage-Matched Disease.” The study is part of the STS 2023 session “Is the Hype Real? Targeted and Immunotherapy in Resectable Non-Small Cell Lung Cancer.” Recent randomized clinical trials suggest that a lung resection accomplished by segmentectomy may be the best approach for treating small tumors in early-stage, non-small cell lung cancer (NSCLC). This study takes the investigation further by suggesting that patients with stage IIIA cN2 lung cancer downstaged after neoadjuvant chemoimmunotherapy and lobectomy have similar survival to patients with small tumors who undergo segmentectomy. Those who receive segmentectomy may benefit from improved quality of life and greater ability to tolerate toxic adjuvant suppressive immunotherapies—compared to patients with small tumors who undergo lobectomy. “We hope to spark a discussion among those who care for lung cancer patients whether patients whose malignancies have been downstaged after neoadjuvant therapy should be candidates for segmentectomy. We think the available data point toward ‘yes,’ but a randomized clinical trial may be needed to answer this definitively,” Dr. Logan says. Segmentectomy potentially offers other advantages over lobectomy for these patients because a smaller resection minimizes the amount of functional lung tissue removed. Research into targeted therapies for NSCLC has also escalated, offering the possibility that more patients will be downstaged after neoadjuvant treatment and may not need to have an entire lobe removed. Dr. Logan is a postdoctoral research fellow and surgery resident at Northwestern, and senior study co-authors Samuel Kim, MD, Ankit Bharat, MD, and David Odell, MD, MMSc, are also from Northwestern.

A scientific session devoted to identifying and closing gaps in health care will take place on Saturday at STS 2023. The session, beginning at 2:45 p.m. PT on January 21, will highlight evidence-proven programs that have not only identified disparities in health screening and treatment, but have successfully improved care for patients regardless of demographics, emphasized moderator Cherie P. Erkmen, MD, director of the lung screening and thoracic surgery residency programs for the Lewis Katz School of Medicine at Temple University in Philadelphia, Pennsylvania. Dr. Erkmen said, “One of the things we struggle against in the realm of diversity, equity, and inclusion is that people are tired of just hearing, ‘There’s disparity, there’s inequity, there’s a problem.’ But then—what do we do? That’s part of the focus of this session—health equity in practice and people who have embraced it, successfully increasing their volumes and improving patient outcomes.” Assembled by Dr. Erkmen and Sara Pereira, MD, from the University of Utah Health, presentations within the Symposium include a report on gender outcomes in coronary bypass grafting, racial disparities in the inpatient management of ischemic heart disease, increasing health equity in the heart and lung transplant arenas, mitigating disparities across the lifetimes of patients who have undergone congenital cardiac surgery, and strategies to improve adherence to lung cancer screening guidelines in underserved communities, based on researchers’ experience in rural South Carolina. “Dr. Tara Karamlou has examined the entire continuum of congenital cardiac surgery, from diagnosis through adulthood, and has opened her doors to understand a very challenging population,” Dr. Erkmen explained. “Dr. Yoshiya Toyoda is a transplant surgeon at a very underserved, ‘safety net’ hospital, yet he’s the number one lung transplanter in the country for several years straight, accepting people across the whole socioeconomic spectrum.” “We have a thoracic surgeon, Dr. Ian Bostock, who’s looking at diversity in lung cancer screening—understanding where the disparities lie and lowering the barriers to screening so that they can get through the door and to the next step, which is lung cancer treatment,” Dr. Erkmen continued. “The last speaker, Dr. Martha McGilvray, has been awarded the podium for her research on racial disparities in the management of ischemic heart disease.” Stepping in as co-moderator is Clauden Louis, MD, MS, from Brigham and Women’s Hospital in Boston, Massachusetts. “I’m excited to be considered to represent such a name—the story of Vivien Thomas is incredibly important,” Dr. Louis said. “I think STS is taking a stand toward valuing our patients and valuing representation, understanding that outcomes are improved when the people taking care of you also have an understanding or a similarity, and are able to represent the population.” The session is named for Vivien T. Thomas, a Black laboratory supervisor who worked with famed physician Alfred Blalock, MD, at Vanderbilt University in the 1940s. When Johns Hopkins recruited Dr. Blalock, he refused to move unless Thomas accompanied him as a “package deal.” Thomas worked as part of Dr. Blalock's surgical team, helping develop the procedure used in the landmark 1944 "blue baby" operation. Despite his integral role in Dr. Blalock’s pioneering work, Thomas was hired and paid as a janitor and was not allowed to use the main entrance to Johns Hopkins. “He’s someone who could’ve been me,” Dr. Louis said. In addition to the Symposium, the third annual Vivien T. Thomas Lecture will take place at STS 2023. This year, the lecture is presented by Francisco G. Cigarroa, MD, and will mark the commencement of the annual meeting on Saturday morning at 8:00 a.m. “I’m excited about getting interest and participation from our thoracic surgery residents and our junior faculty,” Dr. Erkmen said. “And it's also important for people to know that there is an enduring workforce from the STS headed up by Dr. David Tom Cooke. Under his steady leadership, we've been able to accomplish many, many additions to the cardiothoracic surgery community, including workforce publications, looking at workforce disparity and health disparity, and also coordinating with other committees to make sure that diversity is always in mind as we legislate ourselves and create a program like the STS Annual Meeting.” On Monday at STS 2023, Dr. Erkmen also will present “The Cost of Being a Woman in Academic Surgery,” a session that analyzes rank and salary throughout women surgeons’ careers and demonstrates the additional hurdles they face. “We know that there is a difference in care when you are focused on the end goal—better access for everyone,” Dr. Louis said. “I’m excited to represent Dr. Vivien Thomas as a moderator for this session. And I’m excited to meet my colleagues in San Diego.” STS is still accepting registrations for the annual meeting, offering both an in-person experience and a virtual option, Plenary Livestream-Plus, which allows registrants to stream select meeting content and plenary sessions—including the Thomas Lecture—from anywhere in the world. STS 2023 is the premier forum for presenting new science, techniques, and technology in cardiothoracic surgery. Learn more at STS.org/AnnualMeeting.

“In the OR with” encounters, live exhibitor symposia, and extraordinary social events await attendees at the STS Annual Meeting in San Diego. “Attendance figures look as good as ever, but what is most energizing is the program,” said STS President John H. Calhoon, MD. “It is designed to give attendees some time … to not just talk about work/life balance, but to actually live it a bit.” STS 2023 registrants are highly encouraged to add ticketed “extras” to their registration, including the Presidents Reception and the Extraordinary Women in Cardiothoracic Surgery Awards Breakfast. The morning of Saturday, January 21 kicks off with the breakfast event, which will honor women surgeons who have achieved excellence in clinical practice and demonstrate integrity, leadership, creativity, and expertise in carrying out day-to-day duties and supporting the specialty. On Saturday evening, the Presidents Reception will be held at Coasterra, a bayfront restaurant and cocktail venue featuring a floating reception hall and a skyline lounge. Guests will make memories reuniting with—and meeting new—friends and colleagues. The event will celebrate not only the term of current STS President John H. Calhoon, MD, but also the legacies of Past Presidents Sean C. Grondin, MD, and Joseph A. Dearani, MD, who oversaw the Society’s governance with innovation and grace during the peak of the COVID-19 pandemic. “We have lost several admired colleagues in recent times, including Dr. Tweddell, Dr. Pagano, and Dr. Grondin,” said S. Adil Husain, MD, chair of the STS Workforce on Annual Meeting. “We will value our ability to celebrate their contributions to our subspecialty as well as to acknowledge the loss of other cherished members within our Society.” Space is limited for the reception and the breakfast, and attendees must add them to their carts during registration or to an existing registration. STS 2023 also heralds the return of live product demonstrations, with 150 exhibitors showcasing the latest tools and technologies for surgical practice. Industry symposia—both offsite and at the convention center this year—afford rare opportunities to practice new techniques, and product theaters let attendees experience devices and software hands-on. Between the conclusion of afternoon sessions and the Presidents Reception on Saturday, attendees can browse an exhibit hall opening reception and view presentations of scientific posters alongside their colleagues. Two half-hour coffee breaks on Sunday, January 22 give attendees more designated time to explore the exhibits and socialize at their leisure. “In the OR with …” experiences return with an added dimension of virtual reality, during which attendees can don headsets and virtually stand side-by-side with a master surgeon as they perform real-life operations including complex aortic arch reconstruction, uniport segmentectomy and left lower lobectomy, the Ross procedure, and minimally invasive mitral valve repair. Watch a teaser video.  There’s still time to register, add ticketed events, and start planning your San Diego experience at sts.org/annualmeeting.

Investigators will discuss the real—yet easily identified—risk that living in a food desert may have on patients recovering from esophagectomy on Day 1 of STS 2023. Mortality risks for patients with colon and breast cancers who live in food deserts have been reported in recent years as part of a large administrative database review. On Saturday, January 21 at 1:25 p.m. PT, surgeons from six high-volume medical centers will present the first multi-institutional research that identifies patients who undergo tri-modality therapy for esophageal cancer have increased risk of readmission following surgery. Joseph Phillips, MD, from Dartmouth Hitchcock Medical Center in Lebanon, New Hampshire, will present the study exploring the association between food deserts and patient re-hospitalizations after esophagectomy.  In this retrospective research, surgeons reviewed records from a diverse US patient population that underwent neoadjuvant chemoradiation followed by esophagectomy. Of 425 patients included, 73 lived in a food desert, which are areas where access to nutritious foods is inadequate. The study found that patients from food deserts were twice as likely to be readmitted to the hospital for any reason within 30 days post-surgery. The study also found that these patients had significantly lower median household incomes, although this was not a factor when patients were stratified by readmission status. No differences were found in length of stay, complications, or 30-day mortality between patients who lived or did not live in food deserts. “Living in a food desert is an easily identifiable risk factor that should alert surgeons that pre- and post-surgical interventions may be needed to improve outcomes,” Dr. Phillips says. Food deserts, as defined by the United States Department of Agriculture (USDA), are low-income census tracts where a substantial number of residents have low access to grocery stores. The USDA identifies about 6,500 tracts in urban and rural areas as food deserts, where 13.5 million people don’t have a supermarket nearby. Aside from scarcity of nutritious food, residing in a food desert is also often an indicator of low incomes and inadequate healthcare access. The study authors also postulate that patients receiving tri-modality therapy for esophageal cancer may benefit from early referral to resources such as social workers and dieticians for intervention prior to and during treatment. Furthermore, these patients may benefit from more directed post-discharge care to avoid unnecessary readmissions to the hospital.

A must-see session for pediatric surgeons will showcase the first study that analyzes multiple factors impacting survival of young patients with ventricular assist devices (VADs) over the last decade.  “Variables Affecting Survival in Pediatric Patients Supported with VADs: A Special Pediatric Interagency Registry for Mechanical Circulatory Support (Pedimacs) Report,” will be presented at 11:30 a.m. PT on Sunday, January 22, 2023, during the STS Annual Meeting. The presentation is part of the STS “Current Controversies in Congenital Transplantation and Mechanical Circulatory Support” session. Awais Ashfaq, MD, from Johns Hopkins All Children’s Hospital in St. Petersburg, Florida, will report on findings. Although 10 leading children’s hospitals conducted the study, the analysis includes all 47 hospitals in the Pedimacs database of children and adolescents under age 19.  The group reviewed Pedimacs data back to the registry’s inception in 2012 through the end of December 2021, covering 1,109 patients, and identified that illness at time of VAD implantation, diagnosis, support strategy, and VAD device type all affected mortality. This study is the first step to create evidence-based guidance on VAD device choices and other decisions in care management. For instance, one finding indicates that infants and older pediatric patients with paracorporeal continuous device support, congenital heart disease, biventricular support, and Intermacs profile 1 (cardiogenic shock) had worse overall survival after six months. "For anyone in our field, and especially for those who have an interest in pediatric mechanical support, Pedimacs is invaluable,” Dr. Ashfaq says. “There is so much to learn from the data available in the database.” Pedimacs became part of The STS National Database™ in 2018 and is a joint effort among the National Heart, Lung, and Blood Institute, the Food and Drug Administration, the Centers for Medicare & Medicaid Services, and others. The North American clinic registry includes patients who receive an FDA-approved mechanical circulatory support device to treat advanced heart failure. Due to its exponential growth in terms of participation and stature, the STS National Database has become the gold standard for clinical outcomes registries among health care administrators, government officials, and payers. Dr. Ashfaq adds that the group will be taking their results and expanding them into a web-based tool to help physicians decide if patients will benefit from VADs and which device to choose.  

With too few donor hearts available for transplantation, surgeons will present a novel solution to heart allocation on Day 2 of STS 2023, with an aim at serving the growing population of eligible patients in their 70s. On Sunday, January 22, at 3:30 p.m. PT, “The Use of Donor Hearts 50 Years or Older to Septuagenarians in Heart Transplant: The Potential of Expanding the Donor Pool in Older Patients and Increasing the Availability of Younger Hearts” will uncover a potential new group of heart donors who have been previously overlooked. The presentation, part of the session “Expanding the Donor Pool in Heart Transplantation: Current Strategies and Future Perspectives,” will be thought-provoking for surgeons who want to open the door for organ donation to older recipients. Suguru Ohira, MD, PhD, from Westchester Medical Center Heart & Vascular Institute in Valhalla, New York, will present this study to consider donor patients in their 50s for an emerging segment of heart recipients ages 70-79.  Several key factors, including advances in cardiac transplantation and the 2018 modified guidelines from the Organ Procurement and Transplantation Network (OPTN), make more and more patients in their 70s eligible for cardiac transplantation. This study is the first to present a feasible solution to serve these patients without compromising the entire pool of heart recipients. In the United Network for Organ Sharing system, 1,036 heart transplants occurred between January 2011 to December 2021 in patients 70 years or older. Of these, 861 patients received hearts from donors under age 50 and 175 patients received hearts from donors ages 50 and older. Survival was comparable between both recipient groups: One-year and five-year survival rates for patients who received hearts from donors over age 50 were 89.4% and 76.6%, respectively. One- and five-year survival rates for patients who received hearts from donors ages 50 or under were 86.2% and 71.1%, respectively. “Although these hearts from advanced age donors might not be the best hearts for younger recipients who are in their 30s or early 40s, they could be a reasonable option for candidates in their 70s,” Dr. Ohira says. “Yet these hearts are often not recovered, just because of ‘donor age,’ even though their functions and structures are normal.”  Dr. Ohira says this study, conducted with six colleagues from Westchester Medical Center and New York Medical College, was undertaken following excellent outcomes at their institution with transplants for septuagenarians using hearts from donors in their 40s and 50s. STS 2023 is being held in person, and there is still time to register at sts.org/annualmeeting.  

Last month, Congress passed legislation that helps mitigate a nearly 9% cut to Medicare reimbursement for cardiothoracic surgery. Instead, cardiothoracic surgeons will experience a 2.08% decrease in reimbursement—which went into effect Jan. 1, 2023.  While the Society’s goal was to eliminate 100% of the pending cuts, its efforts as part of the Surgical Care Coalition (SCC) succeeded in substantially reducing the impact on surgeons in the interim. Throughout the course of 2022, the Society and its SCC partners engaged with legislators to stop the planned cuts.  “STS members who participated in advocacy efforts this year are to be commended for their contributions toward fixing a broken system,” said STS President John H. Calhoon, MD. “Our work will continue in 2023 or until Congress takes action on developing a long-term solution for Medicare payment.”  “These cuts are not sustainable going forward,” added Joseph Cleveland Jr., MD, chair of the STS Council on Health Policy and Relationships. “A long-term solution to Medicare reform is the most important thing in all of this in order to give cardiothoracic surgeons a degree of financial certainty to operate their practices. We need to be here so that we can take care of all patients with heart disease and cancer when they need us most.”  In addition to the Society’s individual efforts, STS’ legislative advocacy is greatly bolstered by its proactive role in the Surgical Care Coalition, a national coalition of 14 medical associations and societies that collectively represent 150,000 surgeons and anesthesiologists. Targeting Congressional leadership, the Surgical Care Coalition unifies the voice of the surgical profession on policy issues related to patient access and care quality. In addition to the Medicare cuts that just happened, Dr. Cleveland urges surgeons to think about some of the most profound long-term consequences that loom if drastic Medicare cuts continue; aging Baby Boomers may not be able to find cardiothoracic care if surgeons are forced to limit patients covered by Medicare. Further, he notes that tomorrow’s promising surgeons may choose not to enter the profession because of lengthy training, high educational debt, and unpredictable reimbursement—and patients will ultimately suffer. The US shortage of cardiothoracic surgeons is expected to reach severe levels by 2035, according to estimates derived from the STS Adult Cardiac Surgery Database and the American Cancer Society.    Although any surgeon who serves Medicare-covered patients will be impacted by these latest cuts, Dr. Cleveland adds that surgeons in rural or under-served areas and independent surgeons may be affected most. He urges STS members to take the following actions: 1. Make your views known to your federal and local lawmakers. Tell them that you want to take care of Medicare patients in their districts, but cuts might jeopardize this. Find contact information for members of Congress at congress.gov/contact-us. 2. Contribute to the STS Political Action Committee, which helps get surgeon advocates in front of legislators who can support surgeons. Donations can be made at pac.sts.org. 3. Participate in volunteer health policy work with STS that fits your preferences and time. Explore proactive opportunities at sts.org/advocacy or email advocacy@sts.org. “If we continue on the current path, we face an unsustainable crisis in providing care to our patients with heart and lung disease,” Dr. Cleveland said.

The cardiothoracic surgery community is uniquely devoted to the advancement of its specialty, and it shows in its support of The Thoracic Surgery Foundation (TSF), says Lee Wiensch, CAE, CFRE, who recently assumed the role of TSF executive director.  Wiensch described how, coming from a background of charitable foundations overseen by a parent association, she has seen rifts between the leadership, staff, and workflow of the charitable arm and those of the governing body—and that she has in fact in some cases been hired to heal those rifts. Not so with STS and TSF.  “The most refreshing and surprising thing about STS and the Foundation is that they really are one cohesive organization, and they are both very clearly working for the same purpose,” Wiensch said. “We happen to be the charitable arm who can accept donations and give away grant money, but the mission of the Foundation is very seamlessly woven into the fabric of STS.” STS covers all TSF administrative costs, which is another unusual aspect of its governance, Wiensch explained. “Administrative overhead is necessary to run a foundation, and many association foundations don’t have the luxury of a sponsoring parent organization. But STS supports TSF, which means that every dollar our donors give is spent on doing good. We are using donors’ gifts in a really meaningful and impactful way.”  In the past year, donations have supported 286 cardiothoracic surgery research and fellowship grants, 63 surgical outreach awards and scholarships, 128 travel scholarships to attend educational meetings, and 304 Alley-Sheridan scholarships, fueling work including:  A mission to save the lives of young patients—and train local staff to save many more—in underserved areas of Peru, where rheumatic heart disease still takes a toll.  Development of a novel molecular preservation technique to keep donated hearts more vigorous during transport.  Exploring the role of nonclassical monocytes and lung-restricted antibodies in the development of primary graft dysfunction in lung transplant recipients, with a special focus on patients with cystic fibrosis.  Studying the impact of PARP inhibitors on esophageal squamous cell carcinoma.  Training in an immersive congenital clinical research experiences and formal mentorship from renowned pediatric cardiac surgeons, laying the foundations for a future career as a congenital surgeon-scientist.  Examining the significance of tumor-derived extracellular vesicles in the development of lymph node metastases in patients with gastroesophageal malignancies.  Investigating metabolic derangements in acute non-ischemic cardiomyopathies.  A screening program in the Pacific Island Countries Network that will close gaps in patients’ access to lung cancer detection and treatment.  Wiensch also is impressed by the truly international scope of TSF’s sponsored research, education, and outreach. “My first week, I was on a review call for the Francis Fontan fellowship,” she said. “And on that call were reviewers who were in Spain, in Austria, in Latin America, in London—and we were interviewing applicants from all over the world. It was the most wonderfully international call, and I love that the Foundation really puts its money where its mouth is and funds excellent global research and fellowship opportunities."   The TSF/Francis Fontan Fund International Traveling Fellowship, coadministered by TSF, the Fund, and the European Association for Cardio-Thoracic Surgery, supports a cardiothoracic surgeon’s travel to another institution for the purpose of learning a novel technique, adapting innovative technology, and/or fostering collaboration among surgical investigators—ultimately furthering the progress of surgical practice at the recipient’s home institution.  The generosity of TSF donors has made a profound impression on Wiensch. “It’s always fascinating to me that people give so much to a career, to a profession, and that they are willing to give back to the organizations that ensure the future of the specialty through volunteer leadership and sharing treasure. The thoracic surgery specialty has defined and enriched TSF donors’ lives,” Wiensch added, “and when they make a commitment to giving back to that specialty through TSF, they’re committing to research, education, and outreach that will benefit the way they practice, and will benefit the future of the specialty.”  STS Members can continue to support critical advancements in cardiothoracic surgery at thoracicsurgeryfoundation.org. 

Whether they know from the start that they’ll emulate their parents’ careers—or they fight tooth-and-nail to carve a different path—there seems to be something in the genes of cardiothoracic surgeons that pulls their children toward their calling.   Hal and Sophia Roberts For Harold “Hal” G. Roberts Jr., MD, and Sophia H. Roberts, MD, Barnes Jewish Hospital and Washington University in St. Louis, Missouri, is a cornerstone, an alma mater, and a workplace.  Last year, Dr. Hal Roberts joined the Barnes Jewish Heart and Vascular Center, transitioning from a South Florida private practice. He arrived a celebrated member of the surgical team, with more than 20 years of surgeries under his belt, a patent for a 3D mitral annuloplasty ring, the first publication to describe a modification of the Cox Maze IV right atrial lesion set, and a reputation for performing the first TAVR procedure in Broward County, Florida. And another singular distinction: Sophia’s dad.  “On ‘Take Your Child to Work Day,’ cardiothoracic surgeons can pretty much blow it out of the water by bringing their kid to the OR,” Sophia reflected. “Seeing the team dynamic and the real leadership that comes with being the attending surgeon had a lasting impact on me.”  Dr. Sophia Roberts adds that although her siblings didn’t go into medicine, they also considered the experience to be special—and fundamental to understanding their dad as a person.  “I tend to be a bit quieter than baseline,” she explained, “and that initially made me concerned for my ability to lead an operative team.” But observing her father, in addition to other attending surgeons and their diverse personalities, helped to assuage that concern. “I imagine that my leadership style will channel components of my dad and my other mentors,” Sophia said. “Particularly those who lead without being the loudest person in the room.” Dr. Sophia Roberts is a third-year resident at Washington University, and she’ll soon be assuming a senior resident role. Before Dr. Hal Roberts accepted the job, he made sure that he had Sophia’s blessing, because they’d be working in the same program.    Sophia has explored many facets of surgery during her training, but her father says that, just as he did, she found that she enjoyed caring for cardiac surgical patients the most.  “As far as Sophia deciding to go into cardiothoracic surgery, I was very flattered, but I made quite sure that she realized what she was getting into,” Dr. Hal Roberts said. “Cardiac surgery can be a physically and emotionally draining field, but it does give me great satisfaction in knowing that the quality and quantity of my patients’ lives are favorably impacted by the care I render.”  The new position at Barnes Jewish has afforded the elder Dr. Roberts the opportunity to teach—a realm he entered relatively late in his career. He calls it his greatest satisfaction, saying, “I have been amazed at how much fun this really is.”  For her academic development, Sophia is working through a fellowship in cardiovascular device innovation. “Delving into engineering is new terrain for me, and I am excited to carry our new devices from concept to pre-clinical testing,” she said, adding, “It’s pretty surreal to have a single dream for so long and then realize you’re living it.”  Dr. Hal Roberts hopes that his daughter will have exposure to classic as well as novel surgical approaches. “Though there will be more and more minimally invasive techniques on the horizon, I always think there will be a role for some of the basic procedures, like coronary artery revascularization, that we have been effectively doing for years.”  David and John Cleveland “We’re both extremely pragmatic, to both benefit and fault at times,” says John Cleveland, MD, of himself and his father, David C. Cleveland, MD, MBA. The elder Dr. Cleveland is an associate professor of surgery at the Heersink School of Medicine, part of the University of Alabama at Birmingham. He’s a giant in congenital heart surgery, having served as chief of pediatric cardiac surgery for the Children’s Hospital in Buffalo, New York, the Children’s Hospital at Medical City Dallas in Texas, and St. Joseph’s Hospital and Medical Center in Phoenix, Arizona. At St. Joseph’s, he founded the Eller Congenital Heart Center and served as its executive director.  As a kid, John Cleveland was acutely aware of the demands of his father’s profession, which often pulled the elder Dr. Cleveland away from time with his wife and three children. He missed some of his kids’ big milestones, from music recitals to winning touchdowns, because he was working to save the lives of “other people’s kids.”  Even so, John was drawn to a surgical career himself—but he was determined to find a course that wouldn’t cause him to miss out on moments with his own budding family. He leaned toward reconstructive plastic surgery.   John’s internship years brought an encounter that for most would be incandescent: He helped treat a man who had been mauled by a grizzly bear. But while his fellow trainees were thrilled at the opportunity to perform a potentially once-in-a-career reconstruction, John realized that he didn’t feel the same rush.   Plastic surgery wasn’t for him, he now understood—and he was just weeks away from starting a plastic surgery residency. Luckily, he was able to slide into a surgical rotation in a different specialty.  “In the operating room, a veteran doctor threw question after question at the rookie,” recounted a feature by the American Heart Association. “Even as the queries became more complex, John—who’d never studied this area, much less trained in it—aced the quiz. The look on the veteran doctor’s face sent John a clear message.”  The area was cardiac surgery. Specifically, pediatric cardiac surgery. And John was a natural.  Since those days, Drs. John and David have developed a deeper understanding of one another—and of how they both lamented the moments they missed.  “I have been surprised by the manner in which my career has allowed me to see my father from a different perspective,” John reflected. “Now that I am a dad myself, working in the same field, I have come to better terms with the demands that this job places on you and how much it can compete with family life. It has certainly increased my empathy and understanding of how my dad had to do things growing up.”  It has also helped John approach his career decisions with a savviness for work/life balance that wasn’t as feasible for his dad.  Dr. David Cleveland was often a lone ship in his profession, having at most one surgical partner to cover for him in an emergency. Dr. John Cleveland landed a fellowship at Children’s Hospital Los Angeles (CHLA) in California, which has a large surgical staff that he described as virtually interchangeable because of their top-notch skillsets.  “I am entering my fourth year as an attending and have taken over as the program director for our congenital heart surgery training program,” Dr. John Cleveland said. “I’m looking forward to continue matching high-quality applicants that our group of surgeons can mold into excellent technicians as well as thoughtful bedside physicians who care for children with congenital heart disease.”  As his career and family have blossomed, John has happily stayed with CHLA, and it allows him the freedom to be present for moments like birthdays and softball games.  The senior Dr. Cleveland recently celebrated a milestone of his own. He has retired from clinical practice, and he’ll now have the time to not only make memories with his kids and grandkids but also to pick up a research project for which he completed pilot data before the pandemic. He and John are working collaboratively. “We are transplanting genetically modified pig hearts into infant baboons with the intention to translate this to clinical care of neonates and infants as a bridge to cardiac allotransplant,” Dr. John Cleveland said. “The current technology used to bridge this fragile patient population is fraught with complications and risk. We believe xenotransplant will prove to be safer and a more appropriately tailored option for these small children.”  The research is funded, Dr. Cleveland said, and it’s slated to kick off this month. If you know of a unique member experience that should be featured in STS News, contact stsnews@sts.org.

Latin America Cardiovascular Surgery Conference Makes a Resounding Return  The Latin America Cardiovascular Surgery Conference made a strong comeback in December after the COVID-19 pandemic shut down the in-person program for the last three years. More than 300 surgeons, trainees, and industry representatives gathered in Cartagena, Columbia, for 2 solid days of education, discussion, and networking.  The conference emphasized cultivation of up-and-coming surgeons: 75 received a scholarship to attend. Supporting their work, the crowd browsed through more than 60 poster presentations and listened attentively to presentations of new research and surgical techniques with the aim of improving surgery and related care. Nearly one-third of attendees participated in the Residents Symposium. Another 100 attendees gathered at the conference’s symposium “Women of the World in Cardiac Surgery: Bringing Balance to Our Field.” The 2022 session was a milestone—the first time that attendees from three continents convened to talk about challenges, opportunities, and barriers facing women in the surgical profession. One of the most popular features of the conference focused on training for the latest surgical techniques and devices. Edwards Lifesciences, Artivion, and Terumo Aortic sponsored hands-on wet labs on mitral and tricuspid valve repair and replacement, the Ross procedure, and a comprehensive overview of innovative approaches to aortic surgery.  Catch up with conference activity, photos, and recollections by browsing #LatAmCardiac2022.   AQO Proves a Valuable Resource for Data Managers  AQO was held in October 2022 to help data managers from surgical teams to effectively utilize the STS National Database™ as part of their work to improve clinical outcomes and patient safety. Data managers learned from surgeon leaders, data managers, and Database platform experts, and expanded their knowledge of the newest research discoveries and clinical guidance. Experts also presented four learning tracks to master each component of the Database: Adult Cardiac, Congenital, General Thoracic, and Intermacs/Pedimacs.  The Database puts unique analytical power in the hands of individual institutions. STS is dedicated to helping users master the Database to assist in each institution’s work for continued analysis of outcomes and perpetual efforts for improvement. In addition, virtual AQO access also brings users the opportunity to attend the “AQO Hot Topics” webinar for each Database registry in January 2023. Speakers from the actual meeting will return and answer questions from virtual attendees.  The Resilient Surgeon Podcast Releases New Episodes Do not miss The Resilient Surgeon podcast, now in its second season! This STS podcast has been a smash hit with audiences who appreciated the insights they could apply to their lives inside and outside the OR.  “The choice of guests featured this season parallels a paradigm I developed called ‘Best Self Pie,’” said Michael A. Maddaus, MD, host of The Resilient Surgeon. “I prefer the term ‘best self’ to the word ‘wellness’ because it is an intuitive and personal reference point that we all have—if we are aware enough."  The first piece of the “pie”—individual habits and activities such as sleep, diet, exercise, gratitude, and connection with others—were covered in the podcast’s first season. Season 2, which began airing in August, covers the additional pieces—self-awareness, purpose, and connection at work and home. Listeners say they can truly relate to the biweekly episodes because they’ve lived the same experiences. More recent episodes included:  Rich Diviney, retired US Navy Seal officer Commander Diviney also authored The Attributes, 25 Hidden Drivers of Optimal Performance. Drawing from his 20-plus years of experience in the Navy, Diviney came to understand that even individuals at the highest levels of physical and mental capabilities can sometimes fail to perform in specific situations. He determined that an individual’s ability to succeed is determined by attributes, not skills. Attributes such as patience, resilience, situational awareness, and adaptability inform behaviors, and each person has a unique combination of attributes that dictates how they behave, react, and perform. Diviney shares how his time with the Navy Seals helped him develop his strongest attributes and how others can come to understand their own. Through careful examination of these attributes, people can build better relationships and teams and ultimately unlock their potential. Brian Little, PhD Dr. Little is a world-renowned psychologist and an expert on personalities. He  has written three bestselling books on personality and has a TED Talk called “Who Are You, Really?” that has been viewed more than 20 million times. He was voted a favorite professor at Harvard University from 2002-2004 and is current professor at the University of Cambridge. In the podcast, he discusses the importance of self-awareness and how understanding our own personality traits can help us make better, more meaningful connections with those around us at work and at home. Learn about the Big Five Personality Traits—openness, conscientiousness, extraversion, agreeableness, and neuroticism—and the profound impact they can have on how our lives unfold and flourish. Drs. Maddaus and Little share examples of these different personality traits and provide insights into how we can harness the unique qualities which truly allow us to be our best selves.   Christine Porath, PhD Professor Porath is an associate professor at Georgetown University McDonough School of Business. She has dedicated her career to understanding the business and personal impacts of how people treat one another in the workplace and how the influence of leaders plays a huge role in happiness and engagement at work. The need for human connection is part of our genes; Porath’s work identifies today’s modern technologies and self-sufficient mindset as disconnecting factors that lead to increased anxiety, depression, and other mental health challenges.  She is a frequent contributor to the Harvard Business Review and has authored articles in the New York Times, Wall Street Journal, and Washington Post. The Resilient Surgeon is part of STS’ Surgical Hot Topics ongoing podcasts. Subscribe via your favorite podcast app, or find episodes at sts.org/podcast. Social media postings about The Resilient Surgeon series will include the hashtag #BeYourBestSelf. Save the Date for the 2023 Coding Workshop Health Information Management professionals with proficient coding skills are a must for any practice. Their work analyzing clinical statements and assigning standard codes according to the widely used classification system has signficant impact on maximizing reimbursement. Industry and government data collection used for research, resource allocation, and other purposes also relies heavily on information generated by coding professionals.  Learn the latest coding changes for 2023 by attending or sending your coders to the 2023 STS Coding Workshop: Best Practices for Cardiothoracic Surgery. Taking place virtually February 10 – 11, this 2-day workshop will address new and revised codes affecting cardiothoracic surgical practices. The event will feature live sessions at conveniently scheduled times as well as recorded sessions that registrants can watch at their convenience. Learn more at sts.org/codingworkshop.  Boot Camp Training Gives Surgeons High-Intensity Simulation Sixty first-year residents took a major step forward in cultivating their surgical skills at STS Boot Camp this past fall. Supervised by 70 surgical leaders from throughout the country, residents were introduced to simulation learning that replicated the OR environment for cardiac and general thoracic procedures. Participants rotated through six immersive, hands-on sessions for cardiopulmonary bypass, vessel anastomosis, open lobectomy/hilar dissection, diagnostic and therapeutic endoscopies, robotic lobectomy/hilar dissection, wire skills, and transcatheter aortic valve replacement. Residents received personalized one-on-one attention to point them on the path to proficiency through the lengthy training ahead. The educational event, previously hosted by the Thoracic Surgery Directors Association, was made possible through generous  industry donations.  Applications Due February 1 for 2023 STS Leadership Institute As the 2022-2023 class of the STS Leadership Institute concludes its curriculum in late January, a new cohort will soon be chosen for 2023-2024.  Applications opened in December for the curriculum, which starts with the first virtual session on March 23. The STS Leadership Institute develops skills for cardiothoracic surgeons that have become vital as healthcare delivery grows more complex and rapidly transforms. Physicians who have the necessary leadership skills are essential for medical teams to adapt and work together effectively in order to provide the best patient care.          The STS Leadership Institute is targeted for early career (0-7 years in practice) and mid-career (8-15 years in practice) surgeons who are STS members. It includes five events: three virtual sessions and two in-person meetings. The capstone event will take place in San Antonio, Texas, in conjunction with STS 2024. Selected applicants are required to participate in all five events of the series.  Participants will work in tracks specific to their career standing and will have ample time to interact with the program’s faculty of prestigious leaders. Course Directors for the 2023-2024 program are Mara B. Antonoff, MD, David T. Cooke, MD, Dawn S. Hui, MD, Anita R. Krueger, MD,  Tom C. Nguyen, MD, and Ram Kumar Subramanyan, MD, PhD. Now in its fourth year, the STS Leadership Institute teaches key physician leadership skills that can influence career progression. Applications are due online by Wednesday, February 1 and can be submitted at sts.org/leadershipinstitute-apply. Step Up and Mentor Early Career Surgeons The STS Board of Directors urges everyone in an STS leadership role to volunteer with STS’ Mentorship Program. Trusted advisors are needed and vital to raise the next generation of surgeons.   Seasoned surgeons are quick to credit those who mentored them along the way, and STS seeks to build these same relationships for up-and-coming surgeons who will no doubt face the rigors of the profession. The program matches trainees and younger surgeons with mid- or later-career surgeons who share their clinical or research interests and/or have been through similar experiences or challenges. The Mentorship Program launched in 2021 and has received numerous requests from early career surgeons for guidance, advice, and collaboration to reach their career goals.   A few weeks after applications are submitted, STS matches mentees with mentors and facilitates initial contact by email. After that, the mentor and mentee will drive their own experience and how they communicate.   Sign up through the easy-to-use mentorship portal, sts.org/sts-mentorship-program. For more information about the program, contact mentorship@sts.org. Promising Physicians Awarded Looking to the Future Scholarships STS congratulates the following medical students and general surgery residents who will receive Looking to the Future (LTTF) Scholarships in 2023. LTTF Medical Student Scholars Nishant Agrawal University of Pittsburgh School of Medicine Adham Ahmed CUNY School of Medicine - New York, NY Alan Amedi Emory School of Medicine Mohammad Arammash University of California San Francisco Philip Broughton University of South Carolina Lin Chen Case Western Reserve University  Juliana Cobb University of Louisville School of Medicine Abeer Dagra University of Florida Tobias Fauser University of Arizona COM - Tucson Yan Gernhofer University of the Incarnate World School of Osteopathic Medicine, San Antonio Carter Glenn University of Cincinnati College of Medicine Adam Kiridly Donald and Barbara Zucker School of  Medicine at Hofstra/Northwell Ryan Kramer Duke University School of Medicine Anson Lee University of Hawaii John A. Burns  School of Medicine Hanna Mandl David Geffen School of Medicine at UCLA Araiye Medlock University of California, Davis Pournika Muniyandi University of Missouri - Kansas City  School of Medicine Ayesha Ng David Geffen School of Medicine at UCLA Xuan-Mai Nguyen Carle Illinois College of Medicine John Nonu University of Utah School of Medicine George Olverson University of Rochester School of  Medicine and Dentistry Jay Patel California University of Science and Medicine Adegbemisola Perkins University of Tennessee Health  Science Center Ryan Rebernick University of Michigan Natalia Roa-Vidal University of Puerto Rico Medical Science Campus Natalie Schudrowitz University of Wisconsin School of Medicine and Public Health Shwetabh Tarun University of Pittsburgh School of Medicine Allie Thompson University of Michigan Lamario Williams  University of Alabama at Birmingham LTTF Resident Scholars Farshad Amirkhosravi, MD Houston Methodist Hospital Adam Awe, MD  University of North Carolina - Chapel Hill Louisa Bai, MD Washington University in St. Louis Kian Banks, MD UCSF - East Bay Sean Burgwardt, DO  Saint Mary's Hospital - Connecticut Ifeanyi Chinedozi, MD University of Maryland Michael Eisenberg, MD University of Texas Health Science Center at Houston Katherine Foley, MD, MPH LSU New Orleans Kathleen Fuentes, MD Lahey Hospital and Medical Center Hiba Ghandour, MD Duke University Hospital Gianmarino Gianfrate, DO Mercy Health at St. Elizabeth Hospital - Ohio Douglas Gouchoe, MD Wright-Patterson Medical Center Elaine Griffeth, MD Mayo Clinic - Rochester William Head, MD The Ohio State University Ryan Holcomb, DO, MPH Penn State Milton S. Hershey Medical Center Lauren Johnson, MD University of Arkansas for Medical Sciences Jessica Katsiroubas, MD New York Presbyterian Brooklyn Methodist Alixandra Killian, MD, MPH University of Alabama at Birmingham Eleanor Kitchell, MD University of Arizona - Phoenix Nicole Lin, MD, MPH Westchester Medical Center - New York Medical College Brandon Peine, MD East Carolina University Terrance Peng, MD, MPH UCLA Medical Center Ryan Randle, MD Oregon Health & Science University Marisa Sewell, MD  Oregon Health & Science University Klaudiusz Stoklosa, MD Northern Ontario School of Medicine Nikia Toomey, MD University of Tennessee Health Science Center - Memphis Kaity Tung, MD  SUNY - Buffalo Kevin Wang, MD,  University of Arizona - Tucson Noah Weingarten, MD Cleveland Clinic Foundation - University of Pennsylvania Research Bobby Zhang, MD  Madigan Army Medical Center - 88th Surgical Operations Squadron They were selected based on their clinical and research achievements and their dedication to advance in the field. Although STS received applications from many worthy candidates, priority was given to applicants who have not attended a national cardiothoracic surgery meeting or received another CT surgery meet­ing scholarship.  Future surgeons need to be nurtured, mentored, and inspired to undergo the lengthy training that is required to enter the field. LTTF Scholar­ship winners will receive unique mentorship to develop their knowledge and surgical skills and encourage them to pursue careers as cardiotho­racic surgeons. Learn more at sts.org/lttf.