News & Media

  STS News, Fall 2021 — More than 300 registrants and faculty participated in the recent Advanced TAVR Symposium: New Perspectives for the Surgeon and Heart Team, where they joined in-depth discussions on classic and complex topics in the areas of transcatheter aortic valve replacement (TAVR). A “TAVR in Low-Risk Patients” session explored the landscape of TAVR, highlighting the case of a 65-year-old patient with tricuspid aortic stenosis. Presenters shared insights from the perspective of both a surgeon and an interventional cardiologist, and in the context of a new guideline from the American Heart Association and American College of Cardiology. During the “Valve-in-Valve TAVR” session, attendees heard the latest clinical data on valve-in-valve procedures, were guided stepwise through the procedure using the BASILICA technique, explored findings on second-valve (TAV-in-TAV) implantation, and learned approaches to balloon valve fracturing. “Controversies in Bicuspid TAVR” addressed guideline recommendations and bicuspid procedure classifications, compared TAVR and surgery for all bicuspids, and examined the merits of a randomized control study. During the “Alternative Access for Surgeons” session, presenters weighed the merits of transcarotid, percutaneous axillary, transinnominate, and transcaval TAVR and discussed which routes are preferable in different patients. Identifying TAVR explant as a new specialty for cardiac surgery, moderators and faculty assessed current data on explant procedures, demonstrated techniques for bicuspid aortic valve, self-expanding valve, and sutureless explantation. They also addressed the question, “Would TAVR explant change your point of view on TAVR in low-risk patients?” In a concluding session on optimizing TAVR, faculty covered topics such as commissural alignment to replicate surgical aortic valve replacement-like results, the necessity of cerebral embolic protection devices, the advent of TAVR for aortic insufficiency, and new techniques and devices on the horizon. Each session concluded with in-depth live discussions and Q&A, during which attendees, presenters, and panelists shared perspectives, addressed questions, and debated strategies to address professional challenges. The digital archive of the TAVR Symposium—now available for purchase—includes unlimited access to course materials until September 20, 2022. More details are available at STS.org/TAVR.

Higgins Appointed President at Brigham and Women’s Robert S.D. Higgins, MD, MSHA, has been named president of Brigham and Women’s Hospital in Boston, Massachusetts, and executive vice president at Mass General Brigham. In these new roles, which are effective in December 2021, Dr. Higgins will be responsible for faculty and academic leadership appointments and stewardship of the research programs. He previously was surgeon-in-chief at The Johns Hopkins Hospital in Baltimore, Maryland, as well as director of the Department of Surgery and senior associate dean for diversity and inclusion for The Johns Hopkins University School of Medicine. An STS member since 1997, Dr. Higgins is a Past President and currently serves on the STS Workforce on Career Development and the Nominating Committee. Sádaba Joins STS Board as International Director J. Rafael Sádaba, MD, PhD, FRCS(C-Th), is the new International Director on the STS Board of Directors. He fills the vacancy left by Domenico Pagano, MD, FRCS(C-Th), FETSC. Dr. Sádaba is the associate clinical professor at the University of Navarra in Pamplona, Spain, and head of Cardiovascular Research and Innovation at the Navarra Hospital Complex. He also serves as the Secretary General for the European Association for Cardio-Thoracic Surgery. Dr. Sádaba has been an STS member since 2011. Abbas Takes Reins of Brown Thoracic Surgery Abbas El-Sayed Abbas, MD, is the new chief of thoracic surgery at Brown Surgical Associates in Providence, Rhode Island. He also will serve as chief of thoracic surgery at all Lifespan hospitals—the health system associated with The Warren Alpert Medical School of Brown University—and chief of thoracic oncology at the Lifespan Cancer Institute. Previously, Dr. Abbas was system thoracic surgeon-in-chief and system director of the Foregut Disease Thoracic Oncology Programs at Temple University Health System in Philadelphia, Pennsylvania, and chief of thoracic surgery at Fox Chase Comprehensive Cancer Center. He has been an STS member since 2009. Shekar Leads CT Surgery at Lahey Prem S. Shekar, MD, MBA, has joined Lahey Hospital & Medical Center in Burlington, Massachusetts, as chair of cardiac and thoracic surgery. Prior to joining Lahey, he was chief of the Division of Cardiac Surgery and surgical director of Brigham and Women's Hospital Heart & Vascular Center in Boston, Massachusetts, as well as associate professor of surgery at Harvard Medical School. Dr. Shekar has been an STS member since 2008. Killinger Named Chief Medical Officer in Houston William A. Killinger, MD, now serves as the chief medical officer for HCA Houston Healthcare Clear Lake and HCA Houston Healthcare Mainland in Texas. Most recently, he was chief medical officer in the HCA Healthcare West Florida Division at the Medical Center of Trinity in Florida. Dr. Killinger has been an STS member since 2006. Sai Sudhakar Is New Chief at UConn C.B. Sai Sudhakar, MD, has been appointed chief of cardiothoracic surgery at UConn Health in Farmington, Connecticut. Most recently, he was a cardiothoracic surgeon at Largo Medical Center, which is part of the HCA Healthcare West Florida Division. Dr. Sai Sudhakar has been an STS member since 2006.

STS News, Fall 2021 — This fall, the STS/American College of Cardiology (ACC) Transcatheter Valve Therapy (TVT) Registry will begin a much-anticipated public reporting program, where participating hospitals can demonstrate their ongoing commitment to quality measurement in the public eye.  “The same public reporting efforts that have powered the STS National Database will now be available for the TVT Registry, with the aim toward improving patient care,” said Vinod H. Thourani, MD, from Marcus Heart Valve Center at Piedmont Heart Institute in Atlanta, Georgia, who serves as vice chair of the Registry’s steering committee. A collaboration between STS and ACC, the TVT Registry monitors patient safety and real-world outcomes related to transcatheter valve replacement and repair procedures. It collects and aggregates clinical data that give participants the evidence they need to understand their institution’s performance and consequently improve quality of care—as well as demonstrate success. The new reporting platform will employ a “site win-difference” method to represent risk-standardized composite outcomes, both fatal and non-fatal, associated with transcatheter aortic valve replacement (TAVR) performed at each site. The site win-difference model, used in clinical trials that have a composite of primary endpoints, provides different weights for adverse events surrounding valve procedures, including in-hospital or 30-day mortality, stroke, major bleeding, acute kidney injury, and paravalvular aortic regurgitation. Weights are based on the clinical importance and timing of the outcomes. This new method supplies the foundation of site reports, characterized publicly by a 3-star rating system that represents “better than expected,” “as expected,” or “worse than expected” outcomes. In simple terms, star ratings are a visual representation of the probability that an average patient is better off going to a participant’s hospital versus an average hospital, minus the probability that an average patient is better off going to an average hospital versus the participant’s hospital. “Public data submission is voluntary for participating sites, and because sites need 3 years of data in order to publicly report outcomes, it will take about 3 years before patient outcomes are fully represented,” explained Dr. Thourani. “Our goal is for transparency for TAVR care in the US.” Endpoint variables were selected and ranked based on their adjusted association with 1-year mortality and the patient’s quality of life, self-reported via the Kansas City Cardiomyopathy Questionnaire (KCCQ). The TAVR 30-day morbidity/mortality composite, for example, includes 46 variables, including KCCQ scores and gait speed on a 5-meter walk. The TAVR 30-day morbidity/mortality composite is a hierarchical, multicategory risk model that estimates risk standardized results, including the calculation of 1–3 stars for public reporting. The initial consent period for TVT Registry participants to join the public reporting program closed in April 2021, and new consent periods will open on a yearly basis. Sites must have submitted a case to the TVT Registry prior to the first date in the reporting period, said David M. Shahian, MD, from the Division of Cardiac Surgery at Massachusetts General Hospital in Boston, who serves as co-chair of the TVT Public Reporting Committee and chair of the STS Work Force on Quality Measurement. “You have to be a registry participant for 3 years,” Dr. Shahian said. “Your site must have performed 60 or more TAVRs within the 36-month reporting timeframe, and you have to have 90% or greater data completeness on the baseline—KCCQ and 5-meter walk—and then a status of ‘green’ or ‘yellow’ on data quality reports.” Thresholds for KCCQ and 5-meter walk test were relaxed for the second and third quarter of 2020 related to the impact of COVID at sites. The reporting metrics include the date of a site’s first TAVR procedure, the cumulative volume at program inception, the average annual volume for the reporting period, and the site’s composite score and composite rating. Participating in the Public Reporting initiative will give institutions advanced decision-making capabilities, driven by quarterly reports that show practice patterns, demographics, and procedure outcomes that compare their performance with that of the national experience. The interface will provide an executive summary dashboard that enables not only “big picture” review and assessments at a glance but also the ability to drill down and analyze outcomes on the patient level. As with the STS National Database, participants will receive ongoing support from clinically experienced staff, and they’ll be able to participate in training activities and discussions via regularly scheduled webinars and other educational offerings. The Public Reporting pages are expected to begin displaying results for current participants this fall, and public-facing pages will be available on the STS Public Reporting page. To learn more about the STS/ACC TVT Registry, visit sts.org/tvtregistry.

STS News, Fall 2021 — Top-quality research, groundbreaking procedures, expert discussion, networking, and wellness activities are abundant in the program for the Society’s 58th Annual Meeting, Saturday through Monday, January 29–31, in Miami Beach, Florida. The theme of STS 2022 is “Together Again,” and it will include both an in-person meeting and a virtual option for attendees to tune in from anywhere in the world. With 47 parallel sessions, 14 “Ask the Experts” sessions, four hands-on courses, four 360° “In the OR with…” sessions, eight Deep Dive presentations, featured lectures, more than 220 electronic posters, and more, STS 2022 is a don’t-miss event for cardiothoracic surgical professionals of every discipline and at every career level. “The program planning team has hit the ball out of the park with STS 2022 offerings,” said STS President Sean C. Grondin, MD, MPH, FRCSC. “The adult cardiac, general thoracic, congenital, and critical care presentations are top-shelf. This will be a tremendous meeting.” Adult Cardiac Offerings Highlight Trials and Techniques Trending in the adult cardiac program are observations from major trials and registries, and a session devoted to them will deliver key points for attendees, said Tom C. Nguyen, MD, a member of the Annual Meeting Program Task Force. “We decided to break the usual cadence a bit by having four abstracts within each session, mixed in with preludes and discussions,” said Dr. Nguyen. “A ‘what’s the latest’ session will include topics of interest to all cardiac surgeons, and during our ‘controversies’ session we’re going to start off with a discussion about what we know and what we don’t know about our most common operation, coronary artery bypass grafting.” A “2025 forecast” will explore what’s in store for adult cardiac surgery in the next few years. “We’ll also have a video session featuring top-scoring productions,” Dr. Nguyen continued. Deserving of attention is a presentation addressing why cardiac surgeons should be involved with acute pulmonary emboli, as well as an aortic session that focuses on both the ascending and descending aorta. “This one will be accompanied by a talk called ‘A Brief Walk in Time: A History of Aortic Surgery,’” he added. Cancer Breakthroughs, Quality, Robots Shine in General Thoracic Surgery “Our abstract session on novel technology in non-small cell lung cancer looks at new techniques that aren’t part of current care,” said Jessica S. Donington, MD, MSCR, a member of the Program Task Force. These applications include artificial intelligence applications for predicting malignancy and nodal metastasis during resection, virtual reality planning of segmentectomy, transbronchial microwave ablation of lung nodules in a hybrid operating room, and CT radiomics and serum histoplasmosis testing for improving diagnosis. In the arena of bronchoscopy, the “EM, Robots, Ablation” session will explore robotic and electromagnetic navigation, ablation, and other advances in therapy. “We also have a very good group of esophageal cancer papers, looking at everything from new neoadjuvant therapies to robotic esophagectomy,” Dr. Donington said. Additional lung cancer sessions will address clinical care, quality issues, and access to care and disparities within the health system—a prevailing theme in this year’s abstracts, said Dr. Donington. The J. Maxwell Chamberlain Memorial Paper in the general thoracic category will use a statewide collaborative to identify racial differences in lung cancer surgery. “The authors found pretty significant differences in terms of staging and workup and the care delivered,” she said. A joint session, “Regional Quality Collaboratives,” will explore metrics and perspectives from faculty at the University of Michigan in Ann Arbor, as well as from the Northern New England Cardiovascular Disease Study Group and the Canadian Association of Thoracic Surgeons. Congenital Sessions Employ Hard Data, Expert Demonstrations Abstract sessions in the congenital realm will delve into an abundance of neonatal topics, from tackling surgical challenges to exploring the pathway to surgical innovation, said S. Adil Husain, MD, Vice Chair of the Program Task Force. The “It’s Not in the Books … So How Do They Do It?” session will demonstrate an array of techniques, including cone repair for Ebstein anomaly and prophylactic commissural resuspension during unroofing procedures for anomalous coronary arteries. “We also have really nice basic science abstracts, and we’re sprinkling them in with two invited talks—one that looks at stem cell use within the single-ventricle population and one that demonstrates how to establish a basic science lab and use it as a transition into creating novel techniques within the OR,” Dr. Husain said. “A session on the aortic valve and the left ventricular outflow tract covers anatomic regions of congenital heart surgery that continue to have quite a bit of controversy.” Another session will examine advancements in pediatric heart failure and transplantation, addressing issues such as the impact of persistent renal dysfunction and high-panel reactive antibody, transplantation in pediatric patients with heterotaxy syndrome, and re-intervention for superior vena cava obstruction, culminating in an invited talk on implantation and outcomes for systemic ventricular assist devices. “There's been a lot of push within the congenital population to look at the concept of program regionalization and how data and outcomes may be employed as tools to define metrics and approaches,” said Dr. Husain. Accordingly, a data-centric session—featuring the congenital Clark paper—includes presentations that explore risk stratification for adults and mortality predictive models utilizing the STS National Database.   “Our abstract session on novel technology in non-small cell lung cancer looks at a lot of new techniques that aren’t part of current care.” Jessica S. Donington, MD, MSCR Transplantation, MCS Share Spotlight with Critical Care To help ensure that attendees have a rich experience with the latest devices—and that they can attend high-priority concurrent sessions without missing others of interest—STS 2022 will include cardiothoracic transplantation assist devices within the “critical care” category. Ahmet Kilic, MD, from the Program Task Force, oversaw programming for the mechanical circulatory support (MCS), critical care, and transplant arenas. “Two sessions are dedicated to critical care devices, including for MCS, lung transplant, and heart transplant,” Dr. Kilic explained. “One focuses on identifying issues while you’re on circuit. We’re going to talk about topics like left ventricular dilatation pulmonary edema, the use of veno-arterial ECMO for pulmonary embolism, recalcitrant hypoxia, and harlequin syndrome. We expect a lively discussion on the key problems surgeons are having.” The next session will be “Same Toys, New Indications,” and it explores novel applications such as axillary access with a balloon pump and flow pumps to get patients safely to transplantation. “In addition, we’ll be talking about a total artificial heart, as well as the unmet needs with current left ventricular assist devices that are already out there,” said Dr. Kilic. For lung transplantation, experts will examine the euthermia approach with ex vivo donors. Still more must-attend sessions will address the impact of COVID positivity in recipients and donors, a data-driven analysis on how weekends, holidays, and thoracic conferences impact the acceptance of heart transplant offers, as well as transplant controversies in the ICU and extended-criteria donors for heart/lung transplantation in the modern era. The STS 58th Annual Meeting will bring the cardiothoracic surgery specialty together again in Miami Beach, Florida. Quality, Wellness Sessions Help Surgeons Be Their Best Selves Elizabeth A. David, MD, MAS, a member of the Program Task Force, identified a great variety of topics in the areas of education, wellness, and quality. During a wellness session, an expert in physician resilience will address issues that surgeons may bring home to their families. “Then we have invited panelists who represent a diverse array of surgical families, such as dual-physician and dual-surgeon families, single parents, those who had children at different phases of their careers, and those with children who needed congenital cardiac surgery,” Dr. David said. A session on global health and cardiothoracic surgery will feature a diverse international panel, Dr. David continued, and it will address topics such as how to craft a career in global cardiothoracic surgery, how gender disparities limit capacity building, different models of providing care, complementing a career using databases, and the status of global health disparities. For surgeons looking to enhance their publishing prowess, a panel of statisticians and editorial board members will lead an “Annals Academy” session aiming to demystify artificial intelligence and machine learning. “They’ll explain how to use these methodologies—and appropriately write them up,” said Dr. David. “There are fewer issues with manuscripts submitted using these methods, so this should be a very helpful session.” A session on cultural competence in surgical leadership will explore strategies to build leadership and inclusive cultures in health care systems. Another will be geared toward the concept of “psychological safety”—a person’s level of willingness to speak up in a group setting. Abstracts in quality initiatives are a high-scoring mix of adult cardiac and thoracic topics, with several related to emergency departments, Dr. David said. “And there’s a session on the Negotiation Toolkit, with topics such as rules of engagement, understanding the landscape in which you are negotiating, showing your value and what you need to bring to the table, and the nuts and bolts of negotiation lessons from the business world.” In a moderated expert discussion, attendees will be presented with sample scenarios of burnout-inducing issues in surgeons, said Dr. David. “I’ll give you an example: ‘I’m feeling growing resentment toward patients who choose not to get vaccinated. I feel they imperil the lives of other patients, health care workers, and their families. I fear that my compassion is beginning to wane, and I weigh the sheer magnitude of resources that have been consumed.’” 360° and Deep Dive Sessions Return for More Unforgettable Experiences Two popular programs launched at the STS 2021 Annual Meeting again will be available in Miami Beach. “In the OR with…” sessions will feature 360° videos, offering attendees panoramic and up-close views of challenging cardiothoracic procedures from beginning to end. Highly acclaimed surgeons will walk participants through each case and provide live feedback that’s nearly like standing beside the team in the operating room. The four operations on the agenda this year are uniport lobectomy, complex aortic arch reconstruction, Ross procedure, and minimally invasive complex mitral valve repair. In addition, during eight “Deep Dive” courses, experts will walk attendees through the considerations, challenges, and real-time decision making involved in an interdisciplinary variety of procedures and scenarios. Hands-On Courses Provide Access to World-Class Faculty STS 2022 provides the unique opportunity to learn from and practice with some of the most celebrated minds in cardiothoracic surgery. Trainees and veteran surgeons alike will benefit from real-world wet lab sessions on valve sparing root replacement, mitral valve repair, laryngeal tracheal resection, and creation of both a bi-leaflet and a tri-leaflet polytetrafluoroethylene valved conduit. Exhibits, Learning Labs Get Hands-On with New Technology Throughout the meeting, attendees will have dedicated time to meet with industry representatives. The Exhibit Hall will be open Sunday and Monday, and newly reimagined Learning Labs will allow participants to receive more in-depth hands-on demonstrations of the latest products and technologies in a dedicated space in the hall. And as always, STS will offer a host of social events, wellness activities, and networking opportunities for attendees to unwind and socialize with colleagues. Registration Is Now Open Attendees may choose to register for either an in-person or virtual event. Registration is open now at sts.org/annualmeeting. Extra fees are required for Saturday morning sessions and the President’s Reception. COVID vaccination will be required for anyone attending the in-person meeting. STS 2022 COVID protocols are available at sts.org/AMcovid.