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During a recent STS webinar on “Early Career Surgeons, COVID-19, and the Future,” panelists described some of the things that the pandemic has helped them better appreciate.   “One of the things that has really struck me is how much the patients themselves mean to me. It reminds me of why I went through all of this training and why the hard days are worth it. It’s all about the patients.” Elizabeth A. David, MD, MAS “Specific to the COVID crisis, there really was an ‘all hands on deck’ sense of solidarity both within and outside of the hospital. I think that is something that we desperately need to remember and keep hold of moving forward. Being reminded of our common humanity, I hope that mindset becomes the new normal.” Melanie A. Edwards, MD “We can take comfort in knowing that this pandemic will end. It may take until the end of the year, but it will end. So embrace the challenges, appreciate every day that you are healthy, and keep focusing on your mission and your patients.” Gabriel Loor, MD “I have learned that the things that are with you day in and day out are your family, your colleagues, and your patients. Really value those things in times of crisis and in times of calm.” HelenMari L. Merritt-Genore, DO

STS News, Summer 2020 — The COVID-19 pandemic has proven to be a powerful trigger that not only has changed just about everything in daily life, but also has accelerated adoption of new methods of education and information sharing. As temperature taking, elbow bumps, and face coverings, as well as constant hand washing and hand sanitizing become the proverbial “new normal,” the Society is managing the immediate impact and recognizing the importance of keeping an eye on longer-term changes. While there is much uncertainty about what the future holds, STS will be vigilant in its efforts to develop and share timely information, expanded resources, expert guidance, and superior educational opportunities. The Society’s top priority remains supporting the needs of its members and helping to ensure that those within the cardiothoracic surgery community stay connected, learn from one another, and lean on each other as the world tackles this historic public health crisis. Here are some of the ways that STS is continuing to support its members and offer valuable products and services during this challenging time: Education The Society canceled all remaining planned in-person meetings for 2020, but both the 17th Annual Perioperative and Critical Care Conference (September 24–26) and Advances in Quality & Outcomes: A Data Managers Meeting (September 29–October 2) will be held in virtual format. See page 11 for additional information about these upcoming courses.  At press time, STS was considering its options for the 57th Annual Meeting, scheduled for January 30–February 2, 2021, in Austin, Texas. The latest information can be found at sts.org/annualmeeting. Webinars The Society presented the free live webinar series, “Cardiothoracic Surgery in the COVID Crisis,” which focused on important topics related to the coronavirus. Featuring STS members and other expert participants, including public health, industry, and infectious disease specialists, the webinars provided information on lessons learned, best practices, and key considerations to help navigate cardiothoracic surgery during the COVID-19 pandemic and ramp up for the future. These webinars cumulatively attracted more than 8,000 viewers to the live broadcasts. An archive is available online at sts.org/webinars and on the STS YouTube channel. Also now under way is the “STS Summer Series,” a collection of biweekly, hour-long webinars featuring presentations and discussions on a variety of key topics—some are related to the COVID-19 crisis, while others are geared toward clinical or career development topics in cardiothoracic surgery. The webinars are broadcast live via Zoom and Facebook on Thursdays at 6:00 p.m. ET/3:00 p.m. PT. The first episode, “Early Career Surgeons, COVID-19, and the Future,” aired on June 4. Moderators Joseph A. Dearani, MD, and Mara B. Antonoff, MD, talked to colleagues from around the US and in varying practice situations about how they have been coping—both physically and emotionally. The panel shared insights on how cardiothoracic surgeons can thrive in the specialty as they begin to emerge from the COVID crisis. In addition, other episodes have explored topics such as robotic cardiac surgery and the financial impact of COVID on cardiothoracic surgery. The next webinar—scheduled for July 16—will highlight low-risk transcatheter aortic valve replacement, with the following episode delving into the challenging and controversial issue of Medicare reimbursement cuts. Webinar dates and topics may vary based on speaker availability. The series will include seven episodes, and each episode will be available on the STS website and the Society’s YouTube channel the day after the live broadcast. COVID-19 Resources Page The COVID-19 Resources page offers a plethora of helpful information and resources, including links to a real-time tracking map, guidance documents, active research projects, resource tools, a personal protective equipment (PPE) burn rate calculator, and video messages from Dr. Dearani, STS President. Also available are additional articles, videos, and PowerPoint presentations on topics such as extracorporeal membrane oxygenation, PPE, ventilator management, telehealth, and many others. Stay informed by visiting sts.org/covidresources. This visual abstract supported a guidance document detailing protective measures to reduce the risk of infection. Guidance Documents Throughout the past few months of the COVID-19 pandemic, seven STS-supported guidance documents have been published in The Annals of Thoracic Surgery. Members of a special STS COVID Task Force, as well as other surgeon leaders and leading organizations, collaborated on the articles, which cover all major disciplines within the specialty—adult cardiac, general thoracic, and congenital. These documents detail “granular guidance” and recommendations for ramping up cardiac surgery, safely reintroducing cardiovascular services, implementing aggressive infection mitigation strategies, stratifying adult cardiac patients, triaging congenital heart disease patients, and facilitating difficult decisions when caring for patients with thoracic malignancies. Links to all of the documents can be found at sts.org/covidresources. Resource Tools With informed resource allocation decisions more important than ever, the Society developed two interactive, online tools to help triage adult cardiac surgery cases: STS Resource Utilization Tool for Cardiac Surgery and the COVID-19 Resource Prediction Instrument. The Resource Utilization Tool is powered by more than 440,000 de-identified patient records from the most recent 2-year period in the Adult Cardiac Surgery Database (ACSD). It displays national averages of outcome metrics such as time in the operating room, time on the ventilator after surgery, hospital lengths of stay, and expected number of blood product units likely to be needed. Access the tool at sts.org/resourcetool. The Prediction Instrument, based on 10 years of data from the ACSD, is designed to be used in conjunction with the Resource Utilization Tool. This instrument, available at sts.org/covidinstrument, provides a rapid estimate of ventilator hours, ICU time, transfusions, and risk of acute reoperation. Both resources are free to use and open to everyone. Blog Articles A number of STS members have written blog articles, sharing their experiences and perspectives from the fight on the front lines of the coronavirus crisis. The columns covered a broad range of topics, including staying grounded during COVID-19, how leaders make decisions during times of crisis, embracing the changes in health care, and how different regions, the US and Hong Kong, in particular, are dealing with the pandemic. A full list of the articles is available at sts.org/covidresources. Throughout the upcoming weeks and months, the Society will continue to serve the surgical community by disseminating information, as well as facilitating opportunities and education.

STS News, Summer 2020 — The Congenital Heart Surgery Database recently joined its adult cardiac and general thoracic registry counterparts in formally transitioning to the new online, real-time, interactive STS National Database platform. “This extremely important achievement is the culmination of several years of work and will enhance how our participants interact with their data for the benefit of our patients,” said Felix G. Fernandez, MD, MSc, chair of the STS Workforce on National Databases. For some practices, the next generation Database not only is transforming how surgeons work with their data managers, but it also is changing the speed at which quality improvement is implemented. Recent Changes Several new Database enhancements were rolled out on July 1, including direct data entry for the Adult Cardiac Surgery Database (ACSD) and General Thoracic Surgery Database and a software upgrade (version 4.20) for the ACSD. This upgrade was long-awaited because it provides approximately 30% fewer data entry fields, significantly reducing the data entry burden without sacrificing the granularity or robustness of the data. Fields that were not necessary for quality measurement or those not often completed were among the data elements that were removed. Because the COVID pandemic forced many hospitals to reassign data managers to clinical duties on a temporary basis, the Society has delayed data harvests and postponed the next round of public reporting results until early 2021. In addition, COVID variables were added as data fields, allowing sites to note which patients were COVID positive so that outcomes from these patients could be analyzed separately. ​ The transformed Database represents a sea change for the thousands of users worldwide. As a result, the Society is doing everything possible to keep data managers, vendors, and participants informed about the new platform’s myriad features. Since early January, more than 50 webinars have been conducted highlighting the new functionality and key elements, gathering user experiences, and answering questions. These webinars are available on the STS YouTube channel, as well as the Society’s website at sts.org/databasewebinars. Future Innovations In a year that has already seen a monumental transformation of the STS National Database and a global health pandemic, behind-the-scenes work on other Database enhancements continues to move forward. “Our next steps are to incorporate additional valuable tools to view risk-adjusted outcomes,” said Dr. Fernandez. “We also will be looking to add other sophisticated measures of performance such as cumulative sum (CUSUM) analyses and variable life adjusted display (VLAD) curves.” Vinay Badhwar, MD, meets with Melissa Sagosky, RN, about new features for the Adult Cardiac Surgery Database, which include direct data entry and approximately 30% fewer data entry fields. CUSUM charts can be valuable tools in problem solving because they reveal when a change has occurred, offering the opportunity to confirm or eliminate potential causes; VLAD curves are used to measure health care quality and patient outcomes. “The planned new interactive dashboards will provide a ‘window’ through which participants can view the rich legacy of the STS National Database,” explained Vinay Badhwar, MD, chair of the STS Council on Quality, Research, and Patient Safety. “At an institutional level, we can compare our real-time data to STS benchmarks. We also can use the dashboards to change time intervals and detect subtle changes in different subtypes of comorbidity or mortality with various operations. In addition, we can extract and present the data in a dynamic way during quality meetings to really have our teams get a good grasp of the information and implement change if change is required.” For Dr. Badhwar, the Database transformation was the first step in what he says will be a “lasting shift” in how cardiothoracic surgeons manage patients. “Having access to our data in real time and being able to implement quality change more rapidly, one would hope that all institutions will use this resource as a primary tool in quality assessment. Perhaps the availability of this valuable information will prompt increased regularity of institutional quality meetings. We hope that this will be a tide that lifts all boats for our specialty,” he said. > For more information about the STS National Database, contact STSDB@sts.org.

STS News, Summer 2020 — The COVID-19 global pandemic has pushed many medical specialties to the limits—health care professionals working around the clock taking care of the sickest of patients, putting their lives on the line like never before, and struggling to handle growing patient loads and death rates, often with limited resources. Cardiothoracic surgery has been no exception. In many ways, cardiothoracic surgeons—who are comfortable in high-pressure, intensely demanding situations—were made for times like these. “I think this is a good place for cardiothoracic surgeons to be,” said Brendon M. Stiles, MD, from NewYork-Presbyterian/Weill Cornell Medical Center in New York. “We certainly do not want to be sitting at our desks in our offices while others do the work.” Vinod H. Thourani, MD, from Piedmont Heart Institute in Atlanta, Georgia, echoed that sentiment. “We were born for this type of intense work since we have extensive training in critical care, cardiac surgery, and cardiopulmonary physiology,” he said. Cardiothoracic surgeons are uniquely equipped to handle the arduous work involved with fighting a global health emergency. John S. Ikonomidis, MD, PhD, from the University of North Carolina at Chapel Hill, explained that heart and lung surgeons—with their formidable personalities and strong opinions—are comfortable in the role of “captain of the ship.” “Over years of training, we have developed the stamina and focus that enables us to get through long and stressful days and still be able to come back for more,” he said. Few career paths offer the same personal and professional satisfaction as that of a cardiothoracic surgeon. This is where “medicine best embodies the interface between humanity and science,” Dr. Ikonomidis said, making cardiothoracic surgery “one of the most rewarding specialties to choose.” An increasing number of cardiothoracic surgeons agree, according to the 2019 STS Practice Survey. This workforce survey—carried out approximately every 5 years since the early 1970s—helps establish a current, detailed profile of the specialty. The results showed that 83.1% of surgeons are either satisfied, very satisfied, or extremely satisfied with their current career, compared with 72.8% in 2014. In addition, half of practicing surgeons would recommend that their children or grandchildren pursue a career in cardiothoracic surgery, while only 47.5% and 37.1% reported feeling that way in 2014 and 2009, respectively. Some surgeons are even postponing retirement because they have a “high level of career satisfaction.” “When a surgeon heals a patient through a carefully thought-out and expertly performed procedure followed by compassionate and comprehensive postoperative care, a deeply satisfied feeling ensues, which never dulls with time or age,” said Dr. Ikonomidis. ​ Even so, these are trying times for the specialty. The training to become a cardiothoracic surgeon has been criticized for being too rigorous and lengthy, the educational debt tremendous, and the workloads and work hours too excessive and stressful. The survey showed that 68.9% of surgeons had 7, 8, or 9 years of training (21.8%, 25.0%, and 22.1%, respectively), while 29.2% reported having 10 years of post-MD training prior to entering practice. At the same time, the educational debt accumulated by these surgeons is staggering, with 17.8% having $150,000 or more at the time they began active surgical practice.  The long and irregular hours often worked by cardiothoracic surgeons may impact wellbeing. When asked about the number of hours worked per week, most surgeons reported working between 51 and 80 hours per week (69.5%) with the largest group working 61 to 70 hours per week (29.0%). Another matter of contention within the specialty is the potential workforce shortage, which is believed to be a result of factors such as aging surgeons, surgeon retirement, and a diminished cardiothoracic surgical trainee pool. The current survey showed an increase in the average age of practicing surgeons by 2 years compared with the 2014 survey (56 years vs. 54 years, respectively). This suggests that a retirement surge is imminent, as is an expected decline in the workforce—from 4,000 surgeons in 2010 to less than 2,900 by 2035, as calculated by another study. At the same time, with the general population also aging, the anticipated case load will increase from approximately 530,000 cases in 2010 to more than 850,000 cases in 2035, resulting in a 121% increase in case load per surgeon. The good news is that even though jobs are sometimes difficult to find, the current survey showed that 59.2% of practices are looking to hire a new surgeon within the next 2 years, up from 52.3% in 2014. Also important to note and related to the aging workforce is the growing concern over surgeon performance, especially considering that cardiothoracic surgery is one of the most technically, cognitively, and physically demanding fields. “Cardiothoracic surgery—as a ‘frontline’ surgical specialty—is at great risk for burnout and depression.” John S. Ikonomidis, MD, PhD The survey revealed that 85.3% of cardiothoracic surgeons worked in institutions that did not conduct cognitive and psychomotor performance testing for surgeons who are 65 years or older. This issue, especially with more institutions expected to offer testing programs in the coming years, could potentially contribute to the diminishing cardiothoracic surgery workforce. Other challenges within the specialty include the rapid introduction of novel technologies and techniques, as well as the pressure to incorporate minimally invasive treatment strategies into practice. The survey showed that while many surgeons have continued to expand their skill sets, approximately half (48.7%) have not learned a new surgical skill in the past year.  In addition, 59.6% of all surgeons reported using a less invasive approach while performing “20% or less” of cardiac surgery cases. For general thoracic surgery, 28.5% of surgeons said they use a less invasive approach “81% or more” of the time. “It is important that all physicians embrace new technologies and make them a part of their practice,” said Dr. Ikonomidis. “Adopting new surgical techniques and medical treatment methods prevents physicians from becoming obsolete.” Cardiothoracic surgeons are at great risk for developing burnout symptoms. Perhaps one of the biggest issues, though, is the risk of depression and burnout within the specialty. More than 55% of surgeons reported symptoms of burnout and/or depression related to their jobs over the past year, which is 10% to 20% higher than that observed in other specialties. “Cardiothoracic surgery—as a ‘frontline’ surgical specialty—is at great risk for burnout and depression,” said Dr. Ikonomidis. “Surgeons must be honest with themselves regarding symptoms and take steps to prevent burnout and depression.” This survey did not track specific elements contributing to these symptoms, but Dr. Ikonomidis explained that the “time-consuming, often counter-intuitive, and frustrating” implementation of electronic medical records, as well as increased scrutiny on surgeon productivity and outcomes, are among the factors that likely have impacted the personal wellbeing and emotional health of cardiothoracic surgeons. The delicate dance of balancing the demands of both professional and personal lives also may influence the risk of depression and burnout. The survey revealed that “work-life balance” is the most common reason for advising against a career in cardiothoracic surgery, with 65.2% of surgeons citing this as “very important.” “Cardiothoracic surgery is not an ‘elective’ specialty. Patients are sick and need operations now, so a surgeon is not able to choose a convenient time to deliver care,” said Dr. Ikonomidis. “Being a surgeon is a highly stressful occupation and sometimes it is difficult to check your stress at the door when you go home after a hard day’s work.” Despite numerous external pressures, the practice of cardiothoracic surgery remains strong, according to Dr. Ikonomidis. “It is a vibrant and multidimensional specialty that continues to be practiced at a very high level by an outstanding group of caring, hardworking, and highly intelligent individuals.” Note: The most recent STS Practice Survey was conducted online from September 16 to November 1, 2019, with results published online in The Annals of Thoracic Surgery on May 14, 2020.

​ STS News, Summer 2020 — “To be outstanding, get comfortable with feeling uncomfortable,” or so the saying goes. The COVID-19 global pandemic certainly has pushed cardiothoracic surgery out of its comfort zone. Despite feelings of uncertainty and doubt these past few months, the specialty is moving forward. Surgeons are venturing into workdays that look quite different; but that’s what growth feels like, many would say. This was an important focus of the “Global Summit on Reactivating Cardiothoracic Surgery Programs,” hosted in May by STS President Joseph A. Dearani, MD. For the first time, leaders representing the most prominent surgical organizations from around the world gathered in one (virtual) place for an open, honest dialogue about the comeback of the specialty following the COVID-19 crisis. The webinar featured Sanghoon Jheon, MD, PhD, president of the Asian Society for Cardiovascular and Thoracic Surgery, Tomislav Mihaljevic, MD, CEO and president of the Cleveland Clinic, Domenico Pagano, MD, FRCS(C-Th), FETCS, secretary general of the European Association for Cardio-Thoracic Surgery, Enrico Ruffini, MD, president of the European Society of Thoracic Surgeons, Valerie W. Rusch, MD, president of the American College of Surgeons, and Vaughn A. Starnes, MD, president of the American Association for Thoracic Surgery. “Moments like this demonstrate that we are stronger together and are able to weather the storm if we stand together and learn from one another,” said Dr. Dearani. “I am confident that we will persevere and prevail in our resolve to protect our patients, our fellow surgeons, and health care workers everywhere in the world as we recover from this crisis.” This meeting of great minds tackled various important, relevant topics while harnessing the collective knowledge of high-level leaders known to be fierce guardians of and advocates for cardiothoracic surgery. They shared vision and guidance about lessons learned from the COVID-19 pandemic, the reintroduction of elective procedures, physician wellness, and—most importantly—plans for the future of the specialty. Lessons Learned So Far In the past several months, as the virus has spread across the world at a rapid pace and exceeded 10 million cases, health care systems have struggled to carry the sudden burden. Hospitals have scrambled for ventilators that weren’t available; beds in the Intensive Care Unit overflowed; and health care workers were forced to treat patients without the proper personal protective equipment (PPE) needed to be successful and safe. Many of the surgeon leader participants in the Global Summit agreed that the lack of preparedness was a major deficiency upon emergence of the coronavirus. Italy was hit particularly hard by COVID-19, with approximately 34,000 deaths. Dr. Ruffini explained that even as the scale of the outbreak was becoming apparent, many health care systems failed to treat the pandemic as a serious threat and did not take swift enough action to protect patients and health care workers. “We were basically not prepared for this,” he said. “We underestimated the risk and the contagious spread, and I think that we made the same mistakes all over the world.” According to Dr. Starnes, this unpreparedness forced hospitals to take “draconian measures”—emptying out facilities, shutting down all elective procedures, and transforming many facilities into COVID hospitals. “I believe this was sort of an overreaction, although we didn't know it at the time,” he said. A more timely and sophisticated dissemination of accurate and critical information throughout the health care community may have been helpful and, in some cases, could have even meant the difference between life and death. “These are the kinds of strategies that we need to work together on both nationally and internationally to mitigate either a second surge in COVID or other similar pandemics in the future,” said Dr. Rusch. The Cleveland Clinic in Ohio is an international health care system with a presence in the United Arab Emirates—a country in which COVID patients appeared ahead of the US. As a result, administrators were warned earlier on about the severity of the virus and the challenges that it could potentially create in a hospital environment. With this valuable and immediate flow of daily information, the Cleveland Clinic began preparations—including securing adequate amounts of PPE and creating a sufficient surge capacity—in the beginning of January. “As a larger health care system, we had a unique opportunity to flex our resources in ways that allowed us to adequately address this pandemic. Information was essential to us successfully meeting this challenge,” said Dr. Mihaljevic. Safe Reintroduction of Cardiovascular Care The shutdown of elective surgeries and other nonessential medical care during the pandemic has left many hospitals with empty operating rooms and a serious shortage of patients. However, as restrictions begin to ease in some parts of the world, procedures unrelated to the coronavirus have slowly resumed. It’s important that the rebooting of routine cardiothoracic operations occurs in a “phased manner,” according to Dr. Dearani. These phases may be best determined with the help of accurate, real-time data secured in collaboration with institutions, virologists, and epidemiologists. Dr. Pagano explained that because of the “regional behavior” of the virus, this type of “granular” assessment is needed, and the specific environments and their capabilities must be considered. Also essential to the successful relaunch of cardiothoracic surgery is the utilization of testing and triaging. Dr. Rusch described how Memorial Sloan Kettering (MSK) has progressively intensified its testing so that the status of every patient and staff member is known. This, she said, has been crucial toproviding “the most COVID-free environment.” Many hospitals around the world also have established widespread testing of their health care workers and patients. Dr. Jheon described how his hospital in South Korea sends daily text messages to every employee inquiring about symptoms or possible contact history. They are expected to reply before 10:00 a.m.; if a possible risk is determined, the staff member may be told to stay home. “Interconnection, collaboration, and integration. These are three magic words that we have to use in the future.” Enrico Ruffini, MD In addition, MSK, like other hospitals, has developed a COVID-free pathway, which has proven to be another successful strategy. This is a separate route and process for COVID-positive patients to enter the institution, receive treatment and undergo procedures, recover from anesthesia, and be discharged home. Strategies such as these are especially important as hospitals move forward and begin their recoveries, because “this infection is not about to disappear anytime soon,” said Dr. Rusch. The group also collectively agreed that the role of the heart team, with principles such as strong leadership, solidarity, and empathy, is more essential than ever. “At this time, with reduced resources and high risk of infection, we may have to face difficult decisions. It's important that no clinician makes decisions of this magnitude on his/her own. We need to collaborate and share the decision-making burden,” said Dr. Pagano. Just as mentionable as the return of cardiothoracic surgery programs is the potential mental health crisis facing health care workers. COVID-19 undoubtedly has tested the physical and emotional wellbeing of those on the front lines of this pandemic. No long-term data for the coronavirus and its psychological effects are available, but past similar crises have shown that health care workers are at great risk for depression, anxiety disorders, and post-traumatic stress disorder. “We, as surgeons on the front lines, are likely to be exposed to this kind of depression. This is very important and not something that we can underestimate,” said Dr. Ruffini. In recognizing the seriousness of these challenges, Dr. Dearani said he has been calling several colleagues every day—in the US and around the world—to check in on their physical and mental health. He said he is grateful that the cardiothoracic surgery, cardiology, and other medical specialty organizations have come closer together these past several months, and he asked that they continue to be there for each other. "This crisis has really brought forth a new appreciation for what those of us in medicine do to care for others. I think it's sort of a golden moment.” Valerie W. Rusch, MD Finding the Silver Lining In the days ahead, as cardiothoracic surgery perseveres and adjusts, one day at a time, there will be a need for steady and supportive voices everywhere and at every level. The specialty can expect more collaboration and less competition. This may include working closely with other disciplines and different associations, as well as new relationships between local and regional hospitals. “Interconnection, collaboration, and integration. These are three magic words that we have to use in the future. This will not be the last pandemic. This is just the beginning. Second waves and new viruses will appear, and it would be nice if we used this crisis to be better,” said Dr. Ruffini. Many expect this global pandemic to be an accelerator for changes and transformation in health care and its delivery. According to Dr. Starnes, the COVID crisis already has pushed forward to now what otherwise may have taken 3 to 5 years. He used the rapid rise in telemedicine as an example, explaining that half of his clinic is now by e-visit. So far, telehealth has been successfully bridging the gap between people, physicians, and health systems, enabling patients to stay at home and communicate with physicians through virtual channels, while reducing the likelihood of spread to medical staff on the front lines and the public. Perhaps the brightest of the silver linings, though, is the recuperation of a “well-deserved reputation of an honorable profession that serves a greater need,” said Dr. Mihaljevic. Dr. Rusch agreed. “In recent years, physicians have felt unappreciated and embattled. This crisis has really brought forth a new appreciation for what those of us in medicine do to care for others. I think it’s sort of a golden moment.” > Watch the Global Summit at sts.org/globalsummit or on the STS YouTube channel.

Joseph A. Dearani, MD STS News, Summer 2020 — As you read this, I hope you, your family, and colleagues are well. The COVID crisis has altered our lives, both professionally and personally. Hospitals, health care systems, private practitioners, and most of all—our patients—have been impacted. STS also has been affected. We have canceled courses, conferences, meetings, and events. Yet, I am proud to say that throughout this difficult time, STS has been front and center—vocal, visible, and increasingly virtual. Surgeon leaders, including myself and Drs. Sean Grondin and Joe Sabik, have been in regular contact with CEO Elaine Weiss and other members of the STS management team, as well as many of our talented and dedicated members. Together, we have been nimble and worked hard to develop resources and programs to help you and the specialty at this difficult time. These COVID-related resources have included webinars, guidance documents, surgeon perspective articles, and resource utilization prediction tools (see pages 2 and 12). We hosted a Global Summit that featured major leaders from our most prestigious organizations around the world. The group shared lessons learned so that we persevere and prevail in our resolve to protect our patients, our fellow surgeons, and health care workers as we recover from this crisis (see cover). More than 1,000 unique individuals participated in the live broadcast and many more have watched the archived version. The Global Summit and other moments like that demonstrated that we are stronger together and can weather the storm if we stand together and learn from one another. The Society also engaged in successful conference calls with the deputy secretary of the US Department of Health and Human Services, House Committee on Energy and Commerce, Centers for Disease Control and Prevention, Food and Drug Administration, and National Institutes of Health. These conversations focused on increasing availability of ECMO equipment, personal protective equipment, parenteral medicines (diuretics, anticoagulants), and a blood product donation initiative. Now, as the US and many other countries begin to recover from the COVID crisis, we are cognizant of how this pandemic has affected cardiothoracic surgeons—financially, physically, and emotionally. In early June, we launched a new series of webinars. This STS Summer Series began with an episode for early careerists. Dr. Mara Antonoff and I talked to colleagues about how they are coping and asked them for insights and tips on how cardiothoracic surgeons can thrive in this new world. If you did not have a chance to view this webinar, you can view it now on the STS website or on the Society’s YouTube channel. Other webinars this summer will focus on low-risk TAVR, critical care, and the financial impact of COVID. “We definitely will face some challenging conditions moving forward, but our specialty has a history of being impressive, and I know we will prevail.” Health of the Society I am pleased to report that STS remains on solid financial ground at this point in time, but we are carefully monitoring all aspects of our business and organizational activity as we know it. This is a marathon, and we are not yet close to the finish line. We will be hosting two fall meetings virtually and will do everything possible to ensure that our members have a meaningful experience and that our industry partners can continue to play a valuable role. At this time, we still plan to hold our January 2021 meeting in Austin, Texas, but will keep you apprised if the situation changes. Our Board recently held an orientation and spring meeting via Zoom. We were surprised at how effectively we were able to conduct our business and maintain meaningful exchanges throughout these meetings. As a result, we are planning an additional Board meeting via Zoom later in July. Reactivation of CT Surgery Now, as surgical programs around the country and around the world ramp back up again, we are beginning to see the effects of delayed procedures. Some patients have died because they didn’t seek help for obstructive lesions or because cancer care was delayed. We also are seeing and experiencing the financial effects that COVID has had on our hospital systems and health care workers. In addition, we are fighting a battle to stop planned Medicare reimbursement cuts from taking effect in 2021 (see page 18). We definitely will face some challenging conditions moving forward, but our specialty has a history of being impressive, and I know we will prevail. Cardiothoracic surgery is on the stage every single day. Cardiothoracic surgeons face a storm head on. Our grit, professionalism, and empathetic side have been projected to the outside world in a way that instills confidence, hope, and unity. It is a reminder to me why I went into cardiothoracic surgery in the first place. The medical profession—and specifically cardiothoracic surgeons—have performed really quite well under very untoward circumstances these past few months. I feel proud to be part of a profession in which the higher the pressure, the better the performance. I hope you feel the same way. Please feel free to reach out to me with your thoughts, concerns, and feedback at jdearani@sts.org. Be well and be safe.  

Debra A. DaRosa, PhD, a professor emerita of surgery and medical education at the Northwestern University Feinberg School of Medicine in Chicago, is the new Public Director on the STS Board of Directors. She fills the vacancy left by Roger Newton, PhD, MS. Dr. DaRosa served for many years as the vice chair of education in the Department of Surgery at Northwestern, as well as the course director for the American College of Surgeons’ Surgeons as Educators course. She was the first non-clinician elected president of the Association for Surgical Education, served on the editorial boards of Academic Medicine and the Journal of Graduate Medical Education, and has earned many awards for her commitment to medical education. A full list of the 2020-2021 Board of Directors can be found here.