Clinical Decision-Making

Cardiothoracic professionals from around the world gathered at the 61st Annual Meeting of The Society of Thoracic Surgeons (STS) in Los Angeles, held January 24-26, 2025.

As the premier global event for cardiothoracic surgeons, the meeting drew more than 2,000 attendees and featured more than 80 educational sessions. Participants experienced groundbreaking discoveries, hands-on demonstrations of advanced techniques, and cutting-edge technological innovations from industry leaders. 

Pre-conference Sessions Enhanced the Educational Experience

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STS offered three concurrent half-day programs on Thursday, Jan. 23. In the Lung Cancer: Clinical Trials Meet Clinical Practice session on early-stage and locally advanced non-small cell lung cancer, attendees received a comprehensive overview of recent diagnostic breakthroughs and key clinical trials through interactive discussions, debates, and case-based tumor board sessions. During the Aortic Universe: From Birth to Adulthood program, participants gained invaluable insights into diagnosing, treating, and managing aortic conditions across all age groups through detailed surgical videos and case-based presentations. The third session, The STS APP Conference — Redesigning the Future Together, focused on innovative approaches to elevate the role of advanced practice providers in cardiothoracic surgery. It highlighted strategies for enhancing clinical management, fostering professional success, and cultivating leadership within the field.

Adult Cardiac Surgery Sessions

Among the Adult Cardiac Surgery Sessions presented was a late-breaking study that revealed mechanical aortic valve replacements provide significant long-term survival benefits for patients aged 60 and younger, compared to bioprosthetic valves. The J. Maxwell Chamberlain Memorial Paper recently explored the comparative outcomes of ViV-TAVR versus redo-SAVR for patients with degenerated surgical bioprosthetic valves, highlighting the growing preference for ViV-TAVR due to its reduced surgical risk. Other sessions examined the risk of reoperation for both procedures, focusing on contributing factors such as mitral or tricuspid valve disease, advancements in cardiac surgery, new approaches to heart failure treatment, and innovations in structural heart interventions.

General Thoracic Surgery Sessions

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The General Thoracic sessions showcased groundbreaking advancements in the treatment of lung and esophageal cancers, emphasizing developments shaping the future of thoracic cancer care. The Clark Paper compared the survival outcomes of patients with non-small cell lung cancer who underwent lobectomy versus sublobar resection, focusing on the applicability of previous findings to a broader patient population. The J. Maxwell Chamberlain Memorial Paper examined the effectiveness of current lung cancer screening criteria and explored potential changes to improve them. Other areas explored included the extent of resection and quality metrics in lung cancer care, multimodal treatment of pleural mesothelioma after the MARS2 trial, and the future of lung cancer screening.

Congenital Heart Surgery Sessions

Presentations highlighted cutting-edge research and innovative approaches in the field of congenital heart surgery. The James S. Tweddell Memorial Paper focused on the relationship between hospital volume and patient outcomes for Norwood procedures. Another session explored the impact of specific factors on patient mortality in congenital heart surgery, demonstrating how large databases help identify potential predictors beyond traditional risk factors. Additional discussions included navigating congenital heart disease in premature newborns, challenges in clinical studies, and an analysis of long-term outcomes following the Ross Procedure.

Perioperative and Critical Care Sessions

The J. Maxwell Chamberlain Paper examined the impact of socioeconomic factors on the development of cardiac allograft vasculopathy (CAV) after heart transplantation, particularly in patients from disadvantaged backgrounds who face higher risks and poorer outcomes. Sessions also included a presentation on a newly developed risk model for predicting 90-day mortality after durable left ventricular assist device (dLVAD) implantation, based on real-world data to aid in patient selection and care improvement. Additional topics included structuring novel teams to improve cardiac emergency outcomes, controversies in anticoagulation and HIT after cardiac surgery, the changing landscape of heart and lung transplantation, and optimizing patient safety to enhance recovery after cardiac surgery.

Honoring Exceptional Women CT Surgeons

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More than 240 attendees gathered for the third annual Nina Starr Braunwald Extraordinary Women in Cardiothoracic Surgery Awards breakfast to celebrate women cardiothoracic surgeons who have exhibited outstanding clinical expertise and made significant contributions to the field. This year’s recipients were Jessica Donington, MD, UChicago Medicine; Stephanie Fuller, MD, Children’s Hospital of Philadelphia; and Aya Saito, MD, Yokohama City University.

Trailblazing Women Inspire at STS 2025

At STS 2025, attendees were captivated by three influential women showcasing excellence in their respective professions.

STS President Jennifer C. Romano, MD, MS, made history as the first woman surgeon to deliver the Presidential Address. In her speech, she reflected on her career journey, shared personal anecdotes, and recognized significant milestones in her professional life.

The inaugural Nina Starr Braunwald Lecture was delivered by Jennifer Doudna, PhD, a Nobel Prize-winning biochemist who co-discovered CRISPR-Cas9, a groundbreaking advancement in genetics and molecular biology. She shared her journey from scientific discovery to global impact, highlighting how innovation can shape the future of medicine.

Ami Vitale, an award-winning photojournalist and filmmaker, gave the Vivien Thomas Lecture.  During her talk, she shared impactful stories that highlighted healthcare, income, and housing disparities. Vitale stressed the importance of social responsibility and initiated meaningful discussions about caring for both people and the planet.

Hands-On Skill Building for Surgeons at All Levels

STS 2025 offered practical courses on various surgical procedures, providing an engaging and immersive learning experience for residents, early-career surgeons, and any surgeons seeking to enhance their skills. The topics included aortic annular enlargement, TEVAR techniques for aneurysms and dissections, mitral valve repair, complex central airway reconstruction, and the Ross procedure.

The Return of The Hub

For the second consecutive year, The Hub served as the focal point for early career surgeons, medical students, residents, and fellowship trainees. The Hub’s lounge area offered a variety of engaging sessions, including the White Coat Investor Talk, Mock Oral Interviews, Job Interview Preparation, Early Career Surgeon Roundtable Discussions, a Trainee Symposium with a luncheon, and more.

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Attendees also enjoyed creative activities in The Hub, such as the collaborative mural project “Splashes of Hope,” where participants contributed their creativity to artwork that will be donated to a local children's hospital. For those eager to capture memorable moments, the Selfie Station offered a fun and interactive backdrop perfect for sharing on social media. Additionally, a scavenger hunt inspired attendees to engage in challenges via the Annual Meeting app, with opportunities to win prizes.

Cutting-Edge Tools, Technologies, and Interactive Podcast Sessions

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The STS Annual Meeting exhibit hall featured more than 115 exhibitors showcasing the latest tools and technologies for surgical practice, along with live, hands-on product demonstrations. Industry symposia offered insights into emerging techniques and interventions. Two exhibit hall theaters provided attendees with the opportunity to experience live Thinking Thoracic and Same Surgeon, Different Light podcast shows, interactive industry presentations, and the CT Surgery Resident Showdown.

Annual Meeting Online Offers Continued Learning Experience

STS 2025 registrants receive complimentary access to Annual Meeting Online, where they can revisit presentations and recordings of missed sessions and earn additional CME credit. Annual Meeting Online is available for purchase at a significant discount for STS Members who did not attend, and access is free to all Resident/Fellow and Medical Student Members. Visit STS.org/AMonline to purchase.

In today’s 11:30 a.m. session, "Robotic Cardiac Surgery: The Future Is Now," Dr. Tedy Sawma will discuss how mitral regurgitation, increasingly common in aging populations, presents unique challenges for older patients considering surgical treatment options. While mitral valve repair remains an effective solution, the invasiveness of traditional open-heart surgery often discourages both patients and healthcare providers.

In the Outcomes of Robotic Mitral Valve Repair in Patients Older Than 65 Years presentation, study investigators will highlight findings on robotic mitral valve repair in older patients, comparing outcomes with those from traditional median sternotomy. The study evaluates both short-term and long-term outcomes to determine whether robotic surgery offers advantages in recovery, quality of life, long-term survival, and the need for future interventions.

Researchers analyzed data from a cardiovascular surgery database, tracking patients who underwent their first isolated mitral valve repair between 2010 and 2024. They compared the outcomes of robotic procedures with those of traditional median sternotomy surgeries, adjusting for factors like age, gender, and comorbidities.

Primary outcomes included long-term all-cause mortality and the need for reinterventions, while secondary outcomes focused on hospital recovery metrics such as blood transfusions, atrial fibrillation rates, and ICU stay durations.

The findings to be discussed include how robotic mitral valve repair offered short-term advantages over traditional surgery, such as reduced ICU and hospital stays, fewer blood transfusions, and lower rates of postoperative atrial fibrillation. However, no significant differences were observed in long-term survival or the need for future interventions. Both groups maintained excellent physical activity levels and quality of life over the years. These results suggest that robotic mitral valve repair is a viable option for older patients, providing enhanced short-term recovery without compromising long-term outcomes.

A new study sheds light on the challenges of pediatric mitral valve replacement (MVR) and evaluates the potential of the balloon-expandable Melody valve as an alternative to traditional mechanical prostheses. The findings offer important insights for treating young children with small mitral annuli, a population for whom MVR carries significant risks of morbidity and mortality.

A team of researchers, led by Morgan Moroi, MD, New York-Presbyterian/Columbia University Medical Center, conducted a retrospective review of 36 children under 2 years of age who underwent MVR at a single center between 2005 and 2023. Using propensity score matching to minimize baseline differences, the study compared outcomes between 12 patients receiving the Melody valve and 12 patients treated with mechanical prostheses.

The primary outcome was a composite measure of death, transplant, or surgical reintervention on the mitral valve prosthesis. Median follow-up was 1.6 years.

Key Findings

Both groups had similar baseline characteristics, with a median age of 5.2 months and median weight of 6.5 kg at the time of surgery. The study revealed several important differences and similarities in outcomes:

• Hospital Stay: Melody valve patients had shorter hospital stays (median: 20.5 days) compared to mechanical valve patients (median: 59.0 days), though the difference was not statistically significant (P=0.11).
• Mitral Valve Gradients: The Melody valve group had significantly lower mitral valve gradients at discharge (5.5 mmHg vs. 8.7 mmHg, P=0.046).
• Permanent Pacemakers: No patients in the Melody group required a permanent pacemaker, while 41.7% of the mechanical group did (P=0.04).
• Reintervention Rates: Both groups experienced early surgical reinterventions at similar rates (33.3% vs. 25%, P=1.00).
• Survival Outcomes: At 1 and 3 years, transplant-free survival was comparable between the groups, with no significant difference (P=0.92).
   

Implications 

The findings suggest that the Melody valve offers several advantages over mechanical prostheses in young children with small mitral annuli, including lower rates of permanent pacemaker insertion and no need for lifelong anticoagulation. While early reintervention rates were high across both groups, the Melody valve demonstrated equivalent survival outcomes and may provide a safer and more effective option for this vulnerable patient population. However, the study authors emphasize the need for further research with larger cohorts and longer follow-up to confirm these promising results.
 

A groundbreaking study to be presented at the 2025 Society of Thoracic Surgeons Annual Meeting sheds light on an important decision point for patients requiring aortic valve replacement. Utilizing data from the STS Adult Cardiac Surgery Database, researchers have delivered the most extensive analysis to date on the outcomes of prosthetic valve types for patients aged 60 and younger.

The study, to be presented by Dr. Michael Bowdish, Cedars-Sinai Medical Center, examines the impact of valve choice—mechanical versus bioprosthetic—on long-term survival. By linking patient-level data from the STS ACSD with the National Death Index, researchers offer fresh insights into the critical question of how age and valve type affect surgical outcomes.

With its rigorous methodology and focus on tailoring care to individual needs, the study underscores the potential of advanced surgical techniques and data analytics to improve patient outcomes. It also highlights the pivotal role of the STS National Database, which provides robust national benchmarks for cardiothoracic procedures in the US, in driving impactful research and clinical innovation.

In presenting the Adult Cardiac Clark Paper on day two of STS 2025, Increased Risk of Surgical Aortic Valve Replacement After Prior Transcatheter Versus Surgical Aortic Valve Replacement with Concomitant Valve Disease, Dr. Robert Hawkins explores the heightened mortality risk for patients undergoing reoperation after transcatheter aortic valve replacement (TAVR) compared to those who have undergone surgical aortic valve replacement (SAVR).

Using data from the STS Adult Cardiac Surgery Database, which covers the years 2011 to 2021, Dr. Hawkins and his team examine the impact of concomitant mitral and tricuspid valve diseases on reoperation outcomes, with a particular focus on TAVR explants.

As part of the “Aortic Valve Surgery: What Do Our Patients Need to Know?” session on Saturday, Jan. 25 from 4:30 – 5:45 p.m., Dr. Hawkins will discuss findings that show patients with prior TAVR are more likely to suffer from severe concomitant valve diseases, such as mitral regurgitation, compared to those who underwent SAVR. These patients demonstrated a higher mortality rate during reoperation, particularly TAVR explants with an increase in the odds of mortality. The study further finds that severe valve disease is associated with significantly higher mortality in both TAVR explant and redo-SAVR cases.

During this session, Dr. Hawkins will share findings indicating that heart teams should consider these risks when deciding between TAVR and SAVR, as well as when addressing dysfunctional TAVR valves to avoid the heightened risks of reoperation. 

On Saturday, Jan. 24, from 10:15 to 10:25 a.m., Tomaz Mesar, MD, from the University of Pittsburgh Medical Center, will present An Age-Based Analysis of Transcatheter and Surgical Outcomes in Low-Risk Patients. The study compares outcomes of transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) in low-risk patients with aortic stenosis, with a particular focus on the impact of age on treatment outcomes.

Using a combined STS and TVT database, Dr. Mesar analyzed low-risk patients who underwent either SAVR or TAVR for degenerative aortic stenosis over a 13-year period, categorizing them into three age groups: under 65, 65-74, and over 75.

As part of the “Updates in Structural Heart: Surgeons are Still in the Game” session, Dr. Mesar will present on the crucial role of age in determining the optimal approach—TAVR or SAVR—for structural heart interventions. His presentation will address how current findings suggest that TAVR may not be suitable for younger, low-risk patients due to observed higher mortality rates. 

For patients aged 65-74, the choice between TAVR and SAVR requires a personalized assessment, as neither procedure demonstrates a clear survival advantage. Finally, for patients over 75, while TAVR may offer a reduction in certain complications, SAVR appears to provide better long-term survival outcomes for this patient population.