News & Media

STS News, Spring 2021 — Since its establishment approximately 15 years ago through government funding, the Cardiothoracic Surgical Trials Network (CTSN) has been involved in important research that addresses evidence gaps and answers meaningful questions in cardiothoracic surgery. With the onset of the pandemic and the related public health emergency in early 2020, its scope of work dramatically changed after CTSN received two calls. Instead of focusing on research topics such as mitral regurgitation, atrial fibrillation, and coronary artery disease, CTSN pivoted toward critically ill COVID-19 patients. This would be the first time that the Network would become involved in studying areas related to infectious disease. The first request was from an industry partner that was exploring the possibility of using stem cells for patients with acute respiratory distress syndrome (ARDS) as a result of COVID-19. At the time, the pandemic left large numbers of people suffering with ARDS and requiring ventilation in intensive care units, with dismal outcomes. The company invited CTSN researchers to help evaluate its allogeneic mesenchymal stem cell product via a randomized, controlled trial. It was thought that this therapy could have immunomodulatory properties capable of counteracting the cytokine storm associated with the inflammatory conditions related to COVID-19. While there was some initial resistance from CTSN leadership about becoming involved in this trial, Peter K. Smith, MD, from Duke University in Durham, North Carolina, and Michael J. Mack, MD, an STS Past President from Baylor Scott & White Health in Plano, Texas, decided that the trial was in line with CTSN’s mandate to rigorously evaluate novel therapies for public health imperatives; thus, they led the charge. Both Drs. Smith and Mack are principal investigators for their respective institutions, which are Core Clinical Centers in CTSN. “The two of us said, ‘we’ll do this.’ So we designed and executed a trial for stem cell infusion in COVID-19 patients who were on ventilators,” explained Dr. Smith. “We created teams that were headed by surgeons but also included pulmonologists, critical care experts, hospitalists, and infectious disease specialists.” Michael J. Mack, MD, is a principal investigator for Baylor Scott & White Research Institute, which is Core Clinical Center in the Cardiothoracic Surgical Trials Network. The trial—designed in 2 weeks and sponsored by industry and the National Heart, Lung, and Blood Institute (NHLBI)—ran from April to September 2020. Results have not yet been published. “It has been an immensely gratifying experience to be able to mobilize resources so quickly and address the scourge that has overtaken the world,” said Annetine C. Gelijns, PhD, a leader in the CTSN Data and Clinical Coordinating Center and also co-director of the International Center for Health Outcomes and Innovation Research at Mount Sinai in New York, New York. “We have been humbled by the generosity of all investigators and coordinators of the Network, who have come together in their selfless efforts to care for patients and advance science.” Operation Warp Speed Not long after that first call, Operation Warp Speed came along. This program was initiated by the US government to facilitate and accelerate the testing, supply, development, and distribution of safe and effective COVID-19 vaccines, therapeutics, and diagnostics. Several Operation Warp Speed trials—all backed by the National Institutes of Health (NIH), National Institute of Allergy and Infectious Diseases (NIAID), and NHLBI—were planned to study a number of topics, including the safety and effectiveness of different therapies such as monoclonal antibodies for the treatment of COVID-19 in patients who had been hospitalized. Operation Warp Speed also coordinated with existing efforts such as the NIH Accelerating COVID-19 Therapeutic Interventions and Vaccines (ACTIV) public-private partnership. “The NIH asked us to step up as good citizens and become involved in the Operation Warp Speed COVID research trials, even though that wasn't part of our core mission,” said Dr. Mack. “Not only did we step up, but we did so in an extremely short period of time. That bespoke the value of having a ready-made infrastructure of sites that was experienced with conducting research.” According to CTSN Program Director Marissa A. Miller, who also is chief of the Advanced Technologies and Surgery Branch at NHLBI, the shift to these critical COVID-19 trials was transformative and elevated the Network “beyond a recognized trial platform within NHLBI to a national resource supporting the collective mission of the ACTIV enterprise.” CTSN was involved in three Operation Warp Speed trials and, notably, of the five networks that participated in these studies, CTSN consistently was the highest enroller of patients, providing at least half of the total number of participants in each trial (50%, 59%, and 67%). In recognition of its substantial involvement, CTSN received a congratulatory letter from NIH Director Francis S. Collins, MD, PhD. “The performance of the network has been spectacular and has been recognized as the gold standard for performance across all the NIH-sponsored networks,” said Dr. Smith. “We've shown that we can make a major contribution to a national effort that's much larger than just cardiothoracic surgery.” Results from one of the trials—on the monoclonal antibody therapy bamlanivimab—were published in The New England Journal of Medicine in December 2020. “We've shown that we can make a major contribution to a national effort that's much larger than just cardiothoracic surgery.” Peter K. Smith, MD Origin of CTSN The idea to form CTSN originally was conceived in 2004 after NHLBI challenged a working group of cardiac surgeons to assess the state of cardiac surgery research, identify critical gaps in current knowledge, and determine areas of opportunity. Based on the group’s primary recommendation to form a cardiovascular surgery clinical network, NHLBI, in collaboration with the National Institute of Neurologic Disorders and Stroke and the Canadian Institutes for Health Research, created CTSN in 2007, with the mission to design, conduct, and analyze multiple, collaborative clinical trials that evaluate surgical interventions and related management approaches for the treatment of cardiovascular disease in adult patients. During that time, Timothy J. Gardner, MD, from ChristianaCare Center for Heart & Vascular Health in Philadelphia, Pennsylvania, was a medical officer in the NHLBI Division of Cardiovascular Diseases and helped drive the program through NIH. Dr. Gardner was the first surgical chair of the CTSN steering committee, which is now led by A. Marc Gillinov, MD, from the Cleveland Clinic in Ohio. Importantly, CTSN trials reflect the multidisciplinary partnership of many leading cardiothoracic surgeons, cardiologists, and neurologists; the infrastructure increases the efficiency of clinical research by providing a “clinical laboratory” in which multiple clinical questions can be asked without having to create a new infrastructure for each one. “The most exciting part of the growth of the Cardiothoracic Surgical Trials Network and the ensuing work was helping a disparate group of investigators and site teams come together as a cohesive whole and answer the most important questions in cardiac surgical practice,” said Miller. “In this process, which was slow and challenging, the Network became a powerful clinical trial platform.” Since its inception, CTSN has grown to 95 sites (60 in the US and 35 in Europe and South America) and been involved in approximately 20 trials—which is significant, considering the length of each trial from start to finish averages 3 to 7 years. With the enrollment of more than 2,000 patients in randomized trials and more than 14,000 patients in observational studies, CTSN is among the top performers of NHLBI- and NIH-sponsored networks. “We want to be bigger, better, faster, stronger.” Michael J. Mack, MD Pre-Pandemic Work  While COVID-19 has consumed much of CTSN’s time this past year, the group also has been working on other impactful research. Some of the more prominent topics in the CTSN portfolio include rate control versus rhythm control for postoperative atrial fibrillation, surgical treatment of ischemic mitral regurgitation, surgical ablation of atrial fibrillation during mitral valve surgery, the management of postoperative atrial fibrillation after coronary artery bypass grafting, and neuroprotection in patients undergoing aortic valve replacement. Many of these trials have resulted not only in peer-reviewed articles in high-profile publications, but also in changes to clinical practice recommendations. For example, trial results focusing on surgical treatment of ischemic mitral regurgitation altered clinical guidelines in the US, Canada, and Europe and, as a result, transformed clinical practice, explained Dr. Gelijns.      Future Plans for CTSN Described by Dr. Mack as an “inclusive, not exclusive” network, CTSN always is looking to expand and welcome additional sites (US and international) that serve underrepresented patient populations and young investigators who have special interests in diversity, inclusion, and health care disparities. It’s important to note that a major secondary purpose of CTSN is to develop qualified clinical investigators from the specialty who are able to design, develop, and execute clinical trials. “In the early years, there were only a handful of investigators who were cardiothoracic surgeons and able to design and conduct clinical trials,” said Dr. Smith. “This was a major deficit and was specifically addressed with CTSN funding. The Network since has served as a training ground for principal investigators, so now there is an abundance of seasoned senior investigators and a large pipeline of formally trained young surgeon scientists.” In addition to expanding the network, Dr. Mack would like to see CTSN enroll more patients, more quickly, in larger trials with longer-term follow up, which ultimately will bode well for cardiothoracic surgery. “We want to be bigger, better, faster, stronger,” he said. For more information about CTSN or to learn how to become involved, visit ctsurgerynet.org. Read the STS press release.   

Sean C. Grondin, MD, MPH, FRCSC STS News, Spring 2021 — A hearty congratulations to the Annual Meeting Program Task Force and the STS staff for delivering an exceptional 2021 annual meeting. As well, I want to give a special thank you to Dr. Dearani for his tremendous leadership over the past year. Becoming STS President is an incredible honor and a major highlight of my professional career. Being the first Canadian general thoracic surgeon to assume the role is a further privilege for which I am grateful. I am very much looking forward to working with STS surgeon leaders, our membership, and the highly capable team of hardworking and supportive STS staff as we represent and advocate for our members and patients around the world. As your STS President for the coming year, I am committed to undertaking new endeavors as well as continuing to advance several important initiatives that have been championed by my predecessors. Below I have highlighted just a few of the many important activities that I hope to focus on over the next year as we all continue to manage the challenges arising from the pandemic. Completing the Successful STS National Database Transition In our pursuit to transition the 8 million records in the STS National Database to a first-of-its-kind, interactive, real-time, cloud-based system for all participants, STS Database leaders and staff have made tremendous progress while navigating the many challenges that come with an endeavor of this size and complexity. I want to acknowledge and apologize for any frustration some may have experienced as we have worked through transition issues. Rest assured, the STS team continues to work diligently with our IQVIA partners to ensure that our Database remains the gold standard of clinical registries. For those who want a glimpse of the new innovative functionality of the Database, see page 7 and follow the link to a short video that describes the recently released Adult Cardiac Surgery Database Longitudinal Outcomes Dashboard. Maintaining Strong Advocacy Efforts STS has benefitted from strong representation in Washington, DC, working to promote and support advocacy efforts on behalf of cardiothoracic patients and surgeons. Our Workforce on Health Policy, Reform, and Advocacy and our Washington staff remain very active in lobbying elected officials to ensure awareness of key issues affecting our specialty (see page 18). In the recent past, these efforts have contributed to Medicare coverage of low-dose CT screening for lung cancer, reversing damaging ECMO reimbursement cuts, and protecting children and adults from the harmful effects of tobacco, including limits on vaping flavors and raising the smoking age. 2020 also saw the first increase in Medicare-funded graduate medical education residency positions in 25 years, and the Society’s support of research funding continues to pay off, especially in relation to projects under the Agency for Healthcare Research and Quality, the National Institutes of Health, and the Centers for Disease Control and Prevention. Additionally, during this past year, STS helped form the Surgical Care Coalition to lobby against significant proposed cuts to surgeon Medicare reimbursement. Fortunately, in December 2020, this group’s efforts were successful in reversing, at least temporarily, those proposed cuts. With your support, we will work to ensure continued advocacy in this area, as well as other areas that impact cardiothoracic surgeons and our patients. Implementing Strategic Plan Initiatives In June 2020, the STS Board approved a new strategic plan that set our organization on the right track to advance the cardiothoracic specialty for all members, no matter their geography, discipline, or practice setting. Although some of our actions related to the strategic planning had to be put on hold temporarily due to the pandemic, STS leadership and management have reestablished the implementation process with a focus on key areas identified in the plan such as member engagement, virtual education, diversity, and advocacy. Stay tuned for further communications updating you on STS initiatives that are focused on improving the lives of patients with cardiothoracic diseases. Building on Existing Educational Offerings and Opportunities Because of previous STS investment in educational infrastructure, the Society was able to quickly expand its online educational offerings during the pandemic, providing meaningful and targeted information to audiences globally. These offerings included webinars and podcasts, as well as virtual meetings. To continue making progress and leading in the area of cardiothoracic surgery education, the Society has launched its new Learning Center through which users can access interactive CME-accredited educational programs and material 24/7. As well, the Society recently completed the online Pearson’s textbook (part of the STS Cardiothoracic Surgery E-Book), which serves as a great resource for trainees and staff alike. In 2021, STS leadership will be reviewing and refining the Society’s educational programs and resources, and we will continue to actively develop educational offerings with partner societies/associations, especially as they relate to the pandemic. Advancing DEI Efforts Although STS has made significant steps in advancing diversity, equity, and inclusion (DEI) efforts, we continue to explore additional opportunities for improvement, including examining our membership and leadership data and selection processes. We will explore making changes that help our leadership team better reflect the world we live in and the members we represent.   “I am proud to see STS expand its leadership in physician wellness by creating a new Task Force on Wellness led by Dr. Mike Maddaus.” Sean C. Grondin, MD, MPH, FRCSC Advancing Leadership Development and Physician Wellness Programs I am excited to build on previous leadership development efforts by Dr. Bob Higgins and the Workforce on Career Development, as he and I co-chair the new STS Leadership Series Task Force. In 2021, I look forward to working with engaged task force members to develop our leadership webinar series culminating in a capstone event at the 2022 Annual Meeting in Miami Beach (see page 10). I am proud to see STS expand its leadership in physician wellness by creating a new Task Force on Wellness led by Dr. Mike Maddaus. This task force is charged with developing resources that will support STS members especially as we face increased personal and professional stresses that have been exacerbated by the pandemic (see page 11). I thank you for your trust in me and I look forward with excitement and enthusiasm to the year ahead as your 57th STS President. If at any time you have questions, concerns, or just want to provide feedback on an issue, please reach out to me (sgrondin@sts.org).

STS News, Spring 2021 — New STS officers and directors were elected or reelected during the virtual Annual Membership (Business) Meeting on Sunday, January 31. The meeting was held in conjunction with STS 2021, the Society’s 57th Annual Meeting. Leading the Board and the Society for 2021-2022 is Sean C. Grondin, MD, MPH, FRCSC, from Calgary, Canada, who was elected STS President. John H. Calhoon, MD, from San Antonio, Texas, was elected First Vice President, and Thomas E. MacGillivray, MD, from Houston, Texas, was elected Second Vice President and reelected for a final year as STS Treasurer.   The following also were elected or reelected: Secretary Joseph F. Sabik III, MD Cleveland, Ohio Secretary-Elect Wilson Y. Szeto, MD Philadelphia, Pennsylvania Treasurer-Elect Vinod H. Thourani, MD Atlanta, Georgia Resident Director Kimberly A. Holst, MD Rochester, Minnesota Directors-at-Large Thomas G. Gleason, MD Pittsburgh, Pennsylvania Kevin D. Accola, MD Orlando, Florida James S. Tweddell, MD Cincinnati, Ohio Learn more about the Society's governance structure at sts.org/governance.

Conte Appointed System Chair John V. Conte, MD, is the new system chair of cardiothoracic surgery at Geisinger Health System and vice chair of the Geisinger Heart Institute in Danville, Pennsylvania. Before accepting this role, Dr. Conte served as chief of the Division of Cardiac Surgery at Penn State Health and the associate director of the Penn State Heart and Vascular Institute in Hershey, Pennsylvania. He has been an STS member since 1999. Cooke Promoted at UC Davis     David Tom Cooke, MD, recently was appointed chief of the newly assembled Division of General Thoracic Surgery at the University of California Davis Health in Sacramento. In addition to this new role, Dr. Cooke will continue to serve as vice chair for faculty development and wellness and director of the general thoracic surgery robotics program. An STS member since 2010, Dr. Cooke leads the STS Workforce on Diversity and Inclusion. Cox Receives Jacobson Innovation Award  James L. Cox, MD, was honored this past February with the 2020 Jacobson Innovation Award from the American College of Surgeons. This international award recognizes living surgeons who have developed new surgical approaches or techniques. Dr. Cox is best known for the Cox-Maze procedure, which implements a series of incisions that form scar tissue blocking the erratic electrical impulses of atrial fibrillation and has been the “gold standard” for treating the condition since its development in 1987. He has been an STS member since 1985. Forbess Heads UMD Children's Heart Program Joseph M. Forbess, MD, MBA, has been named surgical director of the Children’s Heart Program at the University of Maryland (UMD) Children’s Hospital and appointed professor of surgery in the Division of Cardiac Surgery at the UMD School of Medicine in Baltimore. Previously, he was executive co-director of the Ann & Robert H. Lurie Children’s Heart Center in Chicago and professor of surgery at Northwestern University’s Feinberg School of Medicine.  Dr. Forbess has been an STS member since 2003. Kon Directs Transplant Programs at Northwell Zachary N. Kon, MD, now serves as surgical director of both the advanced heart failure and cardiac transplantation program and the advanced lung failure and lung transplantation program for Northwell Health in Manhasset, New York. Most recently, he served as surgical director of the lung transplantation program and the pulmonary hypertension and pulmonary thromboendarterectomy program at NYU Langone Health in New York City. Dr. Kon has been an STS member since 2010. Mullett Chairs Commission on Cancer Timothy W. Mullett, MD, MBA, from UK HealthCare in Lexington, Kentucky, has been installed by the American College of Surgeons as chair of its Commission on Cancer (CoC). The CoC is one of the largest cancer organizations in the world, with more than 1,500 CoC-accredited cancer programs in the US and Puerto Rico. The CoC also supports the National Cancer Database, which tracks national trends and demographics of cancer incidence. Dr. Mullett is medical director of the Markey Cancer Center Research Network and professor of surgery at the University of Kentucky. He has been an STS member since 2001. Weyant Leads Team at Inova Michael J. Weyant, MD, is the new chief of thoracic surgery for Inova Health System in Falls Church, Virginia, and holds the newly created position of Moran Family Endowed Chair in Thoracic Oncology. He also serves as co-director of the Thoracic Oncology Program at the Inova Schar Cancer Institute in Fairfax, Virginia. Prior to this position, Dr. Weyant was a professor of surgery and an associate professor of cardiothoracic surgery at the University of Colorado School of Medicine in Aurora, and a thoracic surgeon at National Jewish Health in Denver, Colorado. He has been an STS member since 2007 and chairs the STS Membership Committee. Stiles Is New Chief at Montefiore Brendon M. Stiles, MD, has joined Montefiore Health System and the Albert Einstein College of Medicine in Bronx, New York, as chief of thoracic surgery and surgical oncology. He also serves as associate director of surgical oncology for the Albert Einstein Cancer Center. Dr. Stiles moved to Montefiore from NewYork-Presbyterian Hospital and Weill Cornell Medical Center in New York City. An STS member since 2010, he serves on the STS Workforce on Media Relations and Communications. Gammie Joins Johns Hopkins James S. Gammie, MD, has moved to Johns Hopkins Medicine in Baltimore, Maryland, as co-director of The Johns Hopkins Heart and Vascular Service Line. He also has been appointed the James T. Dresher Sr. Professor of Surgery at The Johns Hopkins University School of Medicine. Dr. Gammie previously served as chief of the Division of Cardiac Surgery at the University of Maryland in Baltimore. He has been an STS member since 2003. Mandal Heads Cardiovascular Services in Michigan  Kaushik Mandal, MD, MPH, MS, is the new chief of cardiovascular services at the Detroit Medical Center (DMC) Sinai-Grace Hospital in Michigan and clinical professor of surgery at Wayne State University School of Medicine in Detroit. Before joining DMC, he was director of robotic cardiac surgery and surgical research at Penn State Health Milton S. Hershey Medical Center and associate professor of surgery at Penn State College of Medicine in State College, Pennsylvania. Dr. Mandal has been an STS member since 2015.

STS News, Spring 2021 — As part of the Society’s ongoing initiatives to facilitate quality measurement, STS has launched a powerful, first-of-its-kind tool for Adult Cardiac Surgery Database (ACSD) participants—the Longitudinal Outcomes Dashboard. With the dashboard, “surgeons and data managers will be able to track important outcome trends over select timeframes for patient subcohorts in their program in a way never before realized,” said Vinay Badhwar, MD, Chair of the STS Council on Quality, Research, and Patient Safety. The Longitudinal Dashboard allows data managers and surgeons to explore their observed, expected, and risk-adjusted rates for major morbidity and mortality outcomes. They can select the specific type of cardiac procedure, define the data aggregation timeframe—calendar year, quarter, or month—and fine-tune the data to specific demographic subcohorts and certain surgical parameters.   ACSD participants also can use the dashboard to display their site’s performance longitudinally over time—back to 2017 and up to the most current analyzed data harvest—and benchmark against their own outcomes, risk adjust based on STS risk models, and contrast with corresponding national averages. Participants can select 3-year periods corresponding to a specific data harvest or use the cumulative longitudinal dataset that is updated quarterly after each data harvest. These results are available for nine major outcome measures. “This is a transformative way to bring years of data to your fingertips,” said Dr. Badhwar. Participants can see, for example, how many patients experienced stroke or renal failure associated with an operation, how many patients required prolonged ventilation, and how many patients stayed in the hospital for more than 14 days for one procedure. Importantly, using the same time parameters and risk models, data managers and surgeons can compare outcomes or their procedure-specific performance to those in the national data, and they can see where they fall on observed versus expected rates for each outcome and overall procedure grouping as well as for specific patient subgroups. The Longitudinal Dashboard also allows insights into fluctuations in patient volume, enabling a focused perspective on factors—such as the effect of competing treatment options or decreasing numbers of cardiothoracic surgeries as the COVID-19 pandemic peaked—that affect procedures or site operations. Another noteworthy feature is the flexibility of the display, such as making graphs larger or smaller and displaying numerical values. Using these comprehensive, risk-adjusted data views, participants can pinpoint areas where certain patient or procedure factors may play a role in surgical outcomes and quality measures at their program. "Tools like this punctuate how STS is advancing quality through innovation that leverages the rich data in the STS National Database." Vinay Badhwar, MD For example, a user might see better outcomes in older versus younger patients for a set time period and can then further drill down by sex to see outcomes in older male versus older female patients. In this way, said Dr. Badhwar, data managers can identify trends, as well as areas needing improvement that could become a quality enhancement initiative. “Tools like this punctuate how STS is advancing quality through innovation that leverages the rich data in the STS National Database,” he said. Participants also can export illustrative charts and customized reports that can be used in quality improvement presentations to help explain performance to stakeholders and demonstrate where improvements have taken place. The dashboard can be adjusted to display broad trends or fine details, as desired, in real time or for preparing quality reports. Data are displayed in a matter of seconds as users modify filters, and mousing over individual points on the charts displays the corresponding numbers. “STS is committed to delivering innovative, cloud-based access to the STS National Database,” said Dr. Badhwar. “This unique tool brings it all together.” The Dashboard is available now to all ACSD participants via “Operational Reports” in the left navigation menu on the STS IQVIA platform. For training and tips on using the dashboard, a short video demonstration and a recorded webinar are available on the STS YouTube channel.

  STS News, Spring 2021 — In the past year, COVID-19 has altered or halted virtually every aspect of society, and the practice of cardiothoracic surgery has not been immune. The abrupt cessation of surgery in mid-March 2020 had and will continue to have far-reaching implications, as the negative effects of canceled and postponed procedures emerge. A recent, comprehensive analysis of data from the STS National Database illustrates the sharp reduction of adult cardiac surgery volumes during the first wave of the pandemic and also shows the resulting consequences on surgical outcomes. This research—the first of its kind, according to study author Tom C. Nguyen, MD, from the University of California San Francisco—was presented during the Society’s Annual Meeting in January. “The study was a true herculean analysis and tour de force,” said Dr. Nguyen. “The pandemic has changed the world as we know it, causing a dramatic drop in adult cardiac surgery volume and worsening patient outcomes.” Dr. Nguyen and colleagues queried the STS Adult Cardiac Surgery Database for data from January 1, 2018, to June 30, 2020, and The Johns Hopkins COVID-19 Dashboard from February 1, 2020, to January 1, 2021. The group examined information on 717,103 adult cardiac surgery patients and more than 20 million COVID-19 patients. They found that from December 2018 to December 2019, approximately 24,000 cardiac surgeries were performed per month in the United States. However, in April 2020, the average number of cases dropped to 12,000, representing a 53% decrease nationwide in all adult cardiac surgery volume. Also that month, there were 65% fewer elective cases and 40% fewer non-elective cases in the country. In addition, the data showed that no matter the procedure—isolated coronary artery bypass grafting (CABG), isolated aortic valve replacement (AVR), isolated mitral valve replacement (MVR), CABG+AVR, CABG+MVR, isolated MV repair, and CABG+MV repair—there was a significant decline in case volume—54% overall—when compared to 2019. “Only the STS National Database has the level of granularity, COVID variables, and longitudinal follow-up to answer the questions posed in this important study,” said Dr. Nguyen. While the early stages of the pandemic clearly induced a surge of untreated patients, case volumes did not fully return to baseline after the initial COVID storm. It is unclear if these untreated patients were ever treated, according to Dr. Nguyen. In Ontario, Canada, Vivek Rao, MD, from the University of Toronto, performed a similar analysis and observed like patterns of dramatic reductions in cardiac surgical procedures. “While we all expected a flood of patients to return as we resumed normal activity in the fall of 2020, this did not occur,” he said. “In fact, right through to November 2020, we never quite achieved our prepandemic volume, which begs the question: What happened to those hundreds if not thousands of patients who didn't seek cardiac surgery during the height of the first wave of the pandemic? The sad fact is many of them simply died while avoiding hospital care for their cardiac disease.” Studies like these “highlight the fact that cardiac disease remains an important killer of men and women in North America which should not be obfuscated by the pandemic that we're currently in,” he added. The Mid-Atlantic and New England regions were among the hardest hit by COVID, experiencing decreased cardiac surgery case volume and increased operative mortality. Most Impacted Regions in the US Regionally, the Mid-Atlantic area (New York, New Jersey, and Pennsylvania) was among those hardest hit during the first surge of the COVID pandemic, experiencing a 71% decrease in overall cardiac surgery case volume, 75% fewer elective cases, and a 59% reduction in non-elective cases. Another hotspot, the New England region (Maine, Vermont, New Hampshire, Massachusetts, Connecticut, and Rhode Island), showed a 63% reduction in overall case volume. These two regions also had spikes in operative mortality: their observed-to-expected (O/E) ratio for mortality for all cardiac procedures rose from below 1.0 before the pandemic to nearly 1.2 in April 2020 (an increase of 75%). Because CABG is the most common surgery in the specialty, researchers conducted the same analysis for this procedure and found that in the Mid-Atlantic and New England regions, the O/E mortality ratio for isolated CABG surgeries jumped by 148% in that month. Meanwhile, throughout the entire country, the researchers found a 110% increase in the O/E mortality ratio for all adult cardiac procedures and 167% for isolated CABG. “We clearly demonstrated that if you have heart surgery during COVID, you have an increased risk of morbidity and mortality,” said Dr. Nguyen. “No doubt that COVID hit us hard.” Causes of this COVID Consequence As for what may be causing the additional mortality risk, Dr. Nguyen explained that it’s multifactorial, with COVID-19 infections likely playing a role. In addition, in many cases, surgeons have been limited to operating on only the most urgent coronary bypass cases and patients who tend to be sicker. Robbin G. Cohen, MD, MMM, from the Keck School of Medicine of the University of Southern California in Los Angeles, stressed that research like this should not deter patients from seeking care for chest pain or other cardiac symptoms. “If anything, it is a warning to get into the system as soon as possible,” he said. Additional Studies and Future Revelations It’s important to note that this research included data tallied only through June 2020 and does not include the fall and winter, when the second surge of COVID-19 was—in many parts of the country—even worse than in the spring. The good news is that anecdotal evidence suggests hospitals managed better the second time around due to factors such as more reliable supplies of protective equipment and established COVID-specific routines, according to Dr. Nguyen. Moving forward, the researchers plan to further drill down into the data and conduct many more “granular” analyses that will examine trends and outcomes of COVID patients vs. non-COVID patients, as well as delve more deeply into the COVID effect on specific adult cardiac procedures such as aortic dissections.