Adult Cardiac

At the 2024 European Association for Cardio-Thoracic Surgery (EACTS) meeting in Lisbon, Portugal, leaders in cardiac surgery and interventional cardiology came together, signaling a newfound harmony over coronary revascularization practices for complex heart conditions. This session marked a significant change from the intense disagreements that followed the EXCEL trial controversy five years ago, which raised concerns about data interpretation in revascularization treatments for left main disease.

In a joint session between EACTS and the European Society of Cardiology (ESC), Dr. Alaide Chieffo (Vita Salute San Raffaele University, Milan) and Dr. Patrick Myers (Lausanne University Hospitals, Switzerland) presented a united front on revascularization strategy, referencing the ESC’s recent guidelines for managing chronic coronary syndromes (CCS) with a patient-centered approach. The guidelines, collaboratively crafted by cardiologists and surgeons, reflect a shared understanding of both PCI and CABG as valuable options for coronary artery disease based on individual patient conditions.

“We've gone full circle,” Dr. Myers told TCTMD. “The latest guidelines have a left main chapter that EACTS endorses because we all feel that this represents the evidence best. It's very positive to see that we've gone from surgeons unilaterally looking at the data and saying, ‘Wait a minute, this is not reasonable. We don't agree with this,’ to saying, ‘Okay, let's work on this together.’” His comments underscore the shift from discord to collaboration in developing best practices for patients with multivessel coronary artery disease, left main disease, and heart failure.

EACTS President Dr. Volkmar Falk (German Heart Center Berlin) echoed this sentiment, emphasizing that the endorsed guidelines demonstrate alignment with cardiologists and aim to serve patient needs effectively. He urged further collaboration by encouraging attendance at cardiology-focused conferences, saying, “Go to ESC, go to EuroPCR, be present at these meetings, and engage in the discussion there. It’s one thing to discuss this here at EACTS… We have to also join our cardiology friends and go to their meetings.”

In her presentation, Dr. Chieffo underscored that a “patient-centered” approach should guide heart team discussions for complex cases and highlighted that care recommendations depend on various factors—including hospital capabilities. She explained that CCS guidelines offer a Class I recommendation for CABG in low-surgical-risk patients and for PCI in low-anatomic-complexity cases, stressing that patient-centered care takes into account individualized patient needs rather than simply following patient preferences.

With the introduction of these guidelines, both EACTS and ESC reaffirm their commitment to improving outcomes through collaboration and shared expertise across disciplines, reflecting a renewed spirit of partnership in cardiovascular care.

More than 100 cardiothoracic surgeons, fellows, residents, and advanced practice providers participated in the 2024 STS Mastering Valve Surgery Workshop in Chicago on Sept 20-21. The two-day event included lectures, case-based presentations, and breakout sessions focused on mastering modern-day valve surgery, including open and transcatheter procedures for aortic, mitral, and tricuspid valves.

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"This workshop stands out for its unique blend of theoretical instruction and practical hands-on training, covering both surgical and transcatheter techniques for all valve types," said co-course director Tsuyoshi Kaneko, MD, of Washington University in St. Louis. "The active participation and insightful questions from both domestic and international attendees highlighted the course's relevance and impact."

Attendees honed their skills through small-group, hands-on experiences in wet lab settings to learn the latest in advanced valve techniques (aortic root enlargement, Ross Procedure, minimally invasive valve surgery), transcatheter therapies, and atrial fibrillation.

"I'm pleased that the valve surgery courses encompassed both traditional surgical techniques and emerging transcatheter procedures," said co-course director Katherine Harrington, MD, of Baylor Scott & White Health in Dallas. “To remain at the forefront of the latest technologies in the field, we must continually update our knowledge and ensure our outcomes are exceptional, fostering collaboration with structural heart experts."

Here's what a few attendees said about the Valve Surgery Workshop:

• "I enjoyed the panel discussions at the end of each session and found the small-group wet labs extremely helpful.” — Alex Wang, physician assistant, Johns Hopkins Health System
• "The best sessions were aortic root enlargement by Dr. Yang, mitral valve surgery by Dr. Badhwar, and TAVR explant by Dr. Kaneko."
• "Overall, it was a valuable experience to interact with experts and directly view the pig heart. The catheter-based procedure simulators were also helpful for learning."
• "Great courses and discussion topics, exemplary faculty, and I enjoyed the hands-on sessions."
• "Moving forward, I will adopt the aortic root enlargement technique as explained by Dr. Yang, the mitral valve replacement technique of Dr. Badhwar, and the Ross Procedure technique detailed by Dr. El-Hamamsy. I also intend to incorporate the maze and atrial clip procedures more frequently into my practice."

Check out our event photo gallery. 
 

On June 7-8, 2024, in Miami, more than 120 cardiothoracic surgeons and heart team members from around the world gathered for the third annual STS Coronary Conference. With a focus on the technical aspects of coronary surgery, attendees experienced case-based panel discussions, abstract sessions, practical tips and tricks, and interactive “How I Do It” video presentations featuring surgical techniques.

The two-day event covered a wide range of topics, including conduit selection and harvest, graft configuration, off- and on-pump CABG, and a stepwise approach to minimally invasive coronary surgery, from MIDCAB to advanced multivessel revascularization.

"Coronary surgery is a sub-specialty within cardiac surgery, so it’s important for future surgeons to be skilled in off-pump surgery, minimally invasive surgery, and traditional on-pump cross clamp surgical techniques,” said Chase Brown, MD, assistant professor of surgery at the University of Pennsylvania, and a course presenter.  “Attendees were able to learn from experts leading the way in the field.”

"The most exciting things I learned about were the technical aspects of coronary sequential grafting," said cardiac surgery resident Dr. Kevin An from the University of Toronto. “It’s an area I’m interested in implementing into my practice.” 

Here's what a few other attendees said about the Coronary Conference:

• "I enjoyed the panel discussions at the end of each session – I learned as much from them as I did from each of the presentations."
• "So many great presentations. I think the 'How to Prevent AKI After CABG' presentation by Dr. Daniel Engleman may have been my favorite."
• "After attending the sessions, we will add certain changes in the steps for endoscopic harvesting of the saphenous vein, as well as measures to reduce and prevent sternal wound complications."
• "In the future, I would like to see more perioperative content and learn how to implant an Impella 5.5."
• "I really enjoyed the conference.  It was worth coming to the US from Brazil to take the course."
• "As a result of attending the conference, I would tend to perform MAG-TAG more often to more patients, use the skeletonization technique to decrease sternal wound infections, and practice the Y-T graft."

View all conference abstracts. 

Check out our event photo gallery.

The STS Workshop on Robotic Cardiac Surgery held May 9-10 in Peachtree Corners, Ga., offered 80 surgeons from across the country two days of hands-on team training for mitral valve repair, coronary bypass, and other surgery procedures in a cardiac robotics simulation environment.

Here are the top five benefits that surgeon attendees received from the experience:

1. Innovation: Attendees trained in robotic mitral valve procedures and robotic coronary revascularization using the latest techniques and technology. Multiple operating bays fitted with surgical robots allowed participants to sit at the console to control the robots.  

2. Training: The program offered a variety of educational activities for surgeons, including real-world simulations, case videos, faculty discussions, emphasized patient selection, perioperative management and postoperative care, and operative techniques.

3. Collaboration: The workshop was designed for both beginner robotic surgical teams who are looking for fundamental information and guidance on how to build a program, as well as advanced robotic surgical teams already practicing cardiac surgery robotics and are looking to continually improve the efficiency and effectiveness of their program.  

4. Access to luminary experts in the field: The workshop was led by world-renowned robotic heart surgeons. The surgeons who served as faculty not only mastered the use of robotics in cardiac surgery, but they also helped define it. 

5. Networking: Robotic Cardiac Surgery Workshop attendees connected with surgeons from across the country who are on the cutting edge of robotic cardiac surgery. 

Feedback on the conference was overwhelmingly positive. Here are a few highlights:

• "The best presentation was the one on preoperative criteria and assessment for robotic mitral valve patients." 
• "The session content was helpful for those thinking about starting a robotic mitral valve program." 
• "The presentations given by early-stage faculty on difficult cases where they had to convert to open were very helpful." 
• "Dr. Joanna Chikwe's session on complications of mitral valve repairs was wonderful.  I loved this presentation."
• "The most valuable sessions were those that offered peer-to-peer interaction with the experienced surgeons, including the hands-on lab."
• "I think the courses being part lecture and part hands-on gave the background and data to support what we are doing in the lab.  Even more hands-on time would be great, as well."
   

STS is pleased to announce the release of the Adult Cardiac Surgery Database Executive Dashboard Report, now available on the Database platform. The Executive Dashboard includes the following components:

• The participant’s star ratings for the last six star-rating periods, allowing you to easily track your site’s risk-adjusted performance longitudinally.
• Resource utilization metrics for isolated coronary artery bypass grafting (CABG) procedures, which provide participants near real-time data vs. STS benchmark data from the previous analysis period, including: 
  • ICU times
  • Postoperative total ventilation hours
  • Postoperative length of stay
  • Total blood project usage (intraoperative/postoperative)
• Participant’s performance on meeting inclusion eligibility criteria. Utilizing green, yellow, and red statuses and convenient drill-down functionality, participants can easily identify cases of concern and save valuable time. And case counts are available to allow users to verify if their site meets case count requirements for analysis. Updates to this report are ongoing to provide real-time data. Refer to the Notifications tab on the IQVIA Platform for updates. 

Additional procedure types for resource utilization metrics were released on April 13, 2024. More utilization metrics are being considered. If you have a suggestion, contact Carole Krohn at ckrohn@sts.org.
 
If you have questions regarding the Database, contact the STS Database Help Desk.