Member News

FAIRFAX, VIRGINIA (March 11, 2024) - As use of prosthetic heart valves and implanted cardiac devices has increased, so too has the incidence of cardiovascular infection. While accurate diagnosis of this condition is critical for guiding treatment decisions that can prevent death and significant morbidity, current assessment strategies have proven insufficient. Recommendations released by 11 professional medical societies, including the Society of Thoracic Surgeons, detail a standardized approach for using PET/CT and SPECT/CT imaging to improve the evaluation and subsequent outcomes of patients with cardiovascular infection. The expert consensus statement – “18F-FDG PET/CT and Radiolabeled Leukocyte SPECT/CT Imaging for the Evaluation of Cardiovascular Infection in the Multimodality Context” – is published online in the Journal of Nuclear Cardiology, Clinical Infectious Disease, Heart Rhythm Journal, and JACC: Cardiovascular Imaging.

“The stakes are high with cardiovascular infection because the incidence is increasing and there is associated high morbidity and mortality,” says Jamieson M. Bourque, MD, MHS, FASNC, chair of the statement’s multisociety writing committee. “Other guidelines have recognized that FDG PET/CT and SPECT/CT imaging have high diagnostic accuracy with cardiovascular infection and can provide important information on the infection site, severity, cause, and whether the infection has spread outside the heart. This document does what others have not – it provides evidence-based consensus on specific clinical scenarios where FDG PET/CT and SPECT/CT add value for patient care in the context of robust multimodality imaging approaches available.”

Reflecting its multidisciplinary authorship, the statement emphasizes the complementary nature of advanced imaging modalities. It outlines the indications for echocardiography, cardiac computed tomography angiography, radiolabeled leukocyte SPECT/CT and 18F-FDG PET/CT in cardiovascular infection evaluation. The authors then provide a consensus-derived clinical indication rating of "appropriate," "may be appropriate," or "rarely appropriate" for use of 18F-FDG PET/CT and SPECT/CT in 73 clinical scenarios encompassing suspected native and prosthetic valve infective endocarditis, suspected cardiovascular implantable electronic device (CIED) infections, suspected prosthetic material infection, and suspected ventricular assist device (VAD) infection.

The expert consensus recommendations statement also includes:

• Diagnostic algorithmic flowcharts for suspected native or prosthetic valve infective endocarditis or prosthetic material/VAD infection and for suspected CIED infection;
• Teaching images from cases where 18F-FDG PET/CT and SPECT/CT studies were used in  prosthetic valve endocarditis, CIED pocket and lead infection, VAD infection and prosthetic material infection; and
• Teaching case examples where 18F-FDG PET/CT and SPECT/CT were used to assess prosthetic valve endocarditis, suspected lead CIED infection, suspected VAD infection and suspected prosthetic material infection.

“18F-FDG PET/CT and Radiolabeled Leukocyte SPECT/CT Imaging for the Evaluation of Cardiovascular Infection in the Multimodality Context” is the first document in the new American Society of Nuclear Cardiology Imaging Indications (ASNC I2) Series. Eleven partnering organizations participated in writing these recommendations and endorsed the document: The American Society of Nuclear Cardiology (ASNC), the American Association for Thoracic Surgery (AATS), the American College of Cardiology (ACC), the American Heart Association (AHA), the American Society of Echocardiography (ASE), the European Association of Nuclear Medicine (EANM), the Heart Rhythm Society (HRS), the Infectious Diseases Society of America (IDSA), the Society of Cardiovascular Computed Tomography (SCCT), the Society of Nuclear Medicine and Molecular Imaging (SNMMI) and the Society of Thoracic Surgeons (STS). The writing committee included representatives from each of the partnering organizations.

Read the consensus statement. 

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ABOUT ASNC

The American Society of Nuclear Cardiology and its 5,200 members have been improving cardiovascular outcomes through image-guided patient management for more than 30 years. As the leading society dedicated solely to the field of nuclear cardiology, ASNC establishes standards for excellence in cardiovascular imaging through the development of clinical guidelines, professional medical education, advocacy and research development. ASNC provides peer-reviewed original articles through its official publication, The Journal of Nuclear Cardiology. For more information, visit http://www.asnc.org.

ABOUT STS

Founded in 1964, The Society of Thoracic Surgeons is a not-for-profit organization representing more than 7,700 cardiothoracic surgeons, researchers, and allied healthcare professionals worldwide who are dedicated to ensuring the best possible outcomes for surgeries of the heart, lung, and esophagus, as well as other surgical procedures within the chest. The Society’s mission is to enhance the ability of cardiothoracic surgeons to provide the highest quality patient care through education, research, and advocacy.

For the first time, The Society of Thoracic Surgeons joined the Korean Society for Thoracic and Cardiovascular Surgery (KSTCVS) in their presentation of the Heart Valve Disease Forum (HVDF), an annual conference that delivers the latest developments on the basis, cause, diagnosis, treatment, and future of valve disease.

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The forum, held September 15-16, 2023, in Dragon City, Yongsan, Seoul, was led by the President of the HVDF, Dr. Kyung Hwan Kim, and organized by co-program directors Dr. Joon Bum Kim of Asan Medical Center of Ulsan College of Medicine and Dr. S. Chris Malaisrie of Northwestern University, who commented “STS was thrilled to partner with the KSTCVS on this international event, highlighting transpacific expertise on valves.”

Dr. Kim remarked, “By co-hosting the forum with STS, we brought together the world’s top scholars in related fields for discussion and achieved the best conference experience.”

More than 300 surgeons, residents, and other medical students attending the conference heard from luminary surgeons and professors on today’s hottest topics impacting the specialty, including TAVI, innovative SAVR, and endocarditis, and trained on surgical techniques in wet labs. “The dynamic, case-based discussions and interactive wet labs with skilled faculty inspired the next generation of cardiac surgeons," said Dr. Malaisrie.

Dr. Thomas MacGillivray, president of STS, delivered several talks, including one on “Crisis Management in the Operating Room and Surgeon Leadership.”

At this year’s conference, particular emphasis was placed on connecting young surgeons responsible for the future of heart valve surgery with proven STS surgeon leaders through a mentor-mentee program. It was an exclusive opportunity for early career attendees to gain invaluable guidance on navigating their career paths and overcoming challenges from leaders.

“The heart valve symposium was a wonderful success and a historical event that stands out among the meeting’s 30-year history,” said Dr. Kim. “Our Korean colleagues agreed that collaborating with STS was the best thing in terms of excellence of lectures, one-to-one teaching in the wet lab, an exciting mentorship program, and beautiful times spent outside of the conference room.”

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Cardiothoracic surgeons provide tremendous value to the patients and institutions they serve. But understanding their value and translating it into fair compensation has always been challenging. While there are external resources that provide general guidance on surgeon compensation, there are no compensation surveys that capture the nuances of the specialty. Until now.

STS has commissioned Gallagher, a consulting firm with more than four decades of experience in physician compensation and valuation services, to conduct a first-of-its-kind compensation survey in early October to help CT surgeons practicing in the U.S. understand their value in the market specific to their specialty, practice, career stage, and geographic region. Data collected will be kept confidential and will not be shared with STS.

A compensation report, featuring only aggregated data consistent with federal guidelines to ensure data integrity and anonymity, will make it easier for CT surgeons to evaluate employment opportunities and negotiate salaries and benefits.

The compensation report—slated for release January 2024—will be available to STS surgeon members who participate in the survey at no cost, and to STS members and nonmembers who do not participate in the survey for a fee.

How To Participate in the STS Compensation Survey

Non-resident/trainee CT surgeons should have received an email with instructions on how to complete the survey from Gallagher or you can access the survey here. The survey should take about 15 minutes to complete.

Participants should have their 2022 W-2 (or equivalent income documentation), compensation plan, and associated annual compensation calculations and productivity (e.g., wRVUs, etc.) reports at hand before they begin. Participants should contact their practice administrator if they do not have access to the required documentation.

Deadline for completing the survey is October 27, 2023.

If you have questions or do not receive an email invitation but wish to participate, email jenna_lambrecht@ajg.com.

Dr. Zach Brennan’s preference for high-stakes careers led him to choose cardiothoracic surgery. He went into the specialty with eyes wide open, knowing that it was not for the faint of heart. Like most CT surgeons, Dr. Brennan is a self-proclaimed workaholic and is excited by the specialty’s rapid innovations and minimally invasive surgery new developments.

Dr. Brennan received the STS Looking to the Future Scholarship, which he said boosted his skills, knowledge, and resolve. Today, he is training in Cedars-Sinai Medical Center’s Integrated Cardiothoracic Surgery Residency program. He unequivocally adds that the mentorship of Tyler Wallen, DO, a general surgeon specializing in cardiac surgery at Geisinger; Jeffrey Jacobs, MD,  pediatric cardiac surgeon and professor of surgery and pediatrics at the University of Florida; and Anthony Perez-Tamayo, MD, cardiothoracic surgeon at Loyola University Medical Center,  sold him on cardiothoracic surgery. “I was hooked from Day 1!” he says. “Now, being able to walk a medical student through a procedure early on in residency, teaching some of the same basic things mentors have taught me, was a really surreal moment—a full circle experience that was really special.” 

He is no stranger to extreme challenges. Dr. Brennan spent 14 years working in military and government service as a federal agent in intelligence and law enforcement. He worked on local and global issues: improvised explosive devices in Afghanistan, curbed proliferation of missile chips throughout the world, and mastered Arabic. 

Surgery represented the change he was looking for that still fulfilled his drive to respond tactically and strategically to difficult situations. He was awestruck when he first observed aortic surgery with circulatory arrest, a congenital heart transplant, and went on heart procurements. “I think that learning and growing as a surgeon while also facing the complexities of treating CT patients have been challenging, but very welcomed ones.” Outside the OR, the connection to patients hit home and stuck during Dr. Brennan's first residency rotation: a post-operative patient in the cardiac ICU whom he had treated asked him to sign a special heart-shaped pillow. 

Dr. Brennan hopes to build on his interaction thus far with STS, participating in committees in his capacity as a resident and moving on to leadership roles.

With a multitude of interests, sailing, scuba diving, reading, playing guitar, and board games with friends are on top of his favorites list. He prizes traveling and does it with his dog, Korah, whom he has taken to every coast and border of the U.S. 

Catch up with Dr. Brennan on X (formerly Twitter) at @zachjbrennan and watch his recent TEDx Talk.

This summer, I hope everyone found find time to escape the record-breaking heat while spending quality time with family and friends. Recently, while driving to the beach with my family and thinking about what to write for this column, I was surfing the satellite radio channels and was inspired by the title of the 1986 Janet Jackson song, “What Have You Done for Me Lately?” My mission for my day at the beach was clear: Update STS members on the Society’s exciting accomplishments, ongoing projects, and future plans that will directly benefit each one.

Strengthening the STS National Database

In the last President’s Column, I talked about the power of the STS Database and its impact on the specialty. Combined, the four registries of the STS National Database ─ adult cardiac surgery, general thoracic surgery, congenital heart surgery, and STS-Intermacs ─ have accurate, patient-level data on nearly 10 million cardiothoracic surgery operations. STS data along with research trials have been used to develop numerous clinical practice guidelines. Risk calculators are available to help assess the suitability for surgery in patients. Over the last three decades, risk-adjusted data has improved the safety of care, and 30-day outcomes of countless patients.

We now have the ability and opportunity to link our vast data with the National Death Index and with Medicare claims data to demonstrate long-term efficacy, comparative effectiveness, and value-based care compared with other interventional treatments. Over the next six months, we will publish sentinel papers with long-term outcomes on hundreds of thousands of patients demonstrating the efficacy of surgery on specific topics of adult cardiac surgery, general thoracic surgery, congenital heart surgery, and mechanical circulatory support devices. The first sentinel manuscript, which includes more than one million coronary artery bypass grafting patients from our database, demonstrates the long-term survival benefit of multi-arterial grafting and has been submitted to a high-impact journal.

That said, the STS Database is not perfect. Our users have helped to identify gaps and shortcomings as the Database has evolved from its original purpose to provide individual surgeons with tools to benchmark their program’s quality assessment and performance improvement.

Members have asked if the purpose of the database has changed to one of research for the benefit of some academic surgeons rather than serving as a patient care and quality assurance tool for all surgeons. Some members have noted that data collection has become too labor intensive because of the many data elements. Others have complained about the added expense due to abstractors, data coordinators, and third-party vendors needed to manage the data. There continue to be questions about the risk modeling and the relevance of the reported index cases given the rapidly evolving surgical practices related to the increase in transcatheter, endovascular, and endoscopic procedures, and novel drug therapies. 

STS has been listening to this valuable member input, and we have made several changes to decrease the burden, lower the costs, and improve the efficiency of data reporting and return. We recently changed the data warehousing from Duke Clinical Research Institute (DCRI) to IQVIA. We moved most of the data analytics from DCRI to the STS Research Center, which will improve the efficiency and near real-time reporting, analysis, and return of program data. More than 10% of programs are using direct data entry to IQVIA, which allows these programs to bypass the need (and the cost) for third-party data vendors.

Moreover, we are modifying our data dashboard to improve its intuitive appearance and make it more user-friendly. Our goal is to encourage further engagement among surgeons and data coordinators and our STS staff are available to help train more people in direct data entry.

The STS Next Generation Risk Calculator

The STS recently launched a next-generation Operative Risk Calculator to assess the risk of adult cardiac surgery operations. This improved bedside patient care tool includes current risk model adjustment calibrated every three months to ensure up-to-date risk assessment for patients. In addition to the risk of mortality, the risk calculator also provides procedure-specific risk of individual complications associated with index operations (CABG, AVR, MVR, MV repair including one specifically for repair of primary MR, AVR-CABG, MVR-CABG, and MV repair-CABG), as well as the soon to be reported multi-valve and aortic procedures. 

The new risk calculator includes recently added risk factors, such as liver disease, concomitant tricuspid valve procedure, NYHA class, and others not previously included. In addition to providing the calculated risks of individual complications and mortality, the risk calculator also updates and records the impact of each specific risk factor responsible for the composite risk scores to facilitate patient discussions, pre-operative optimization, and medical record charting. A summary page can be easily copied into the electronic medical record. The user-friendly risk calculator is viewable on an intuitively easy-to-use single computer screen and is available on most mobile devices.

With all the new changes, one constant remains: STS’s commitment to ensure that the database exists for all CT surgeons, not just selected large academic centers. The STS database captures 98% of all cardiac surgery operations performed in the United States, allowing every program of every size to benchmark data with the outcomes of “like institutions,” as well as the entire STS cohort.

We have been collecting and analyzing data on the evolving practice of cardiac surgery and will soon be reporting outcomes of multiple-valve operations with and without coronary artery surgery, as well as proximal aortic surgery, including aortic root procedures.

2024 Strategy and Planning

The STS Board of Directors, Council Chairs, and senior staff recently completed a strategic planning process. In this post-COVID world, much has changed in our profession, our specialty, and our membership. A new strategic plan is essential to reaffirm our mission and to set the STS’s top priorities and objectives for the next five years.

As you know, the STS is committed to championing the value and impact of the specialty through quality and research initiatives, advocacy, and strategic partnership. We also are steadfast in our commitment to advance the health, well-being, and inclusion of all CT surgeons from medical school through retirement. But we can’t do it alone. We must do it together.

As part of the 2024 planning process, STS commissioned a survey to collect member feedback, ideas, and insights that will help us explore new ways to enhance membership value, advocate for the specialty and deliver quality educational experiences.

Based on your feedback, we have initiated efforts to address concerns regarding inclusion, selection of STS leaders, and surgeon compensation disparities.

We hired an external consultant to evaluate STS’s DEI policies. I created two new Presidential Task Forces: The Nominating Committee Advisory Task Force to review and improve the current process for identifying, mentoring, and nominating senior STS leaders; and The Surgeon Compensation Task Force to create an annual cardiothoracic surgeon survey to help us better understand workplace-related compensation issues and negotiation matters. The regional, subspecialty, and practice-type specific salary/benefits data will be available to better equip cardiothoracic surgeons to advocate for themselves during contracting and salary negotiations.

STS's Reach Is Extraordinary

STS is everywhere we need it to be to help advance this specialty. The Annals of Thoracic Surgery is the most widely read CT surgery journal in the world. The Thoracic Surgery Foundation, STS’s philanthropic arm, has awarded $1 million in educational, research, and outreach grants in the past year. STS Advocacy is making unprecedented progress to represent your voice in Washington, DC.

As president of the STS, I recently was invited to testify on the value of medical registries at the U.S. House of Representatives Subcommittee on Health regarding Medicare coverage pathways for innovative drugs, medical devices, and technology. Of all the witnesses testifying at this hearing, the STS was one of only two medical specialty societies invited. The impact of our database and the effectiveness of our advocacy efforts literally give the STS a seat at the table in Washington, DC.

After spending the afternoon at the beach, my family and I packed up the car and started to drive back to our hotel. It was a great day at the beach. As luck would have it, the 1974 Bachman-Turner Overdrive song “You Ain’t Seen Nothin’ Yet” came on the radio as we pulled out of the beach parking lot. In one day, two classic rock song titles have proven to be an inspiration to help me write this article. What an exciting time to be a CT surgeon and a member of the STS!

Note: Check out the print magazine mailed directly to you for more informative and inspirational news and stories. Not a member? Join today.

STS President Thomas MacGillivray, MD, recently hosted a Town Hall to get member input on how the Society can advance a more inclusive and welcoming community of cardiothoracic surgeons.

Facilitated by DEI Consultant James Pogue, PhD, the Town Hall focused on understanding member perceptions of where individuals, the specialty, and the Society are today with respect to DEI. “This work is about you, our members. We want your perspectives on the role that DEI should play in our specialty and our Society,” said Dr. MacGillivray. “This is your opportunity to speak up and have your voices heard.”

Key themes that emerged were the need for data to understand members’ general knowledge of DEI; a call to action for members to engage in real, meaningful conversations that result in tangible change; and a culture that elevates empathy, listening, kindness, and grace throughout this journey.

Dr. MacGillivray said he has listened to a wide range of opinions over the past five months, and he sees STS members at different levels of DEI understanding and engagement.

“The more we talk about things, the more we can learn. I hope all of us who are trained in science, data, and evidence take the knowledge gained from this journey and use it to help us build a better future for all,” added Dr. MacGillivray.

Leading up to the Town Hall, Dr. Pogue conducted one-on-one discussions with key stakeholders and a deep-dive DEI session with the STS Board of Directors. Next up is a member survey and focus groups. Dr. Pogue will use data and insights from this work to develop recommendations on the path forward for STS.

On June 3, 2023, in Miami Beach, Florida, cardiothoracic surgeons from around the world convened for the second annual STS Coronary Conference. Distinguished speakers and luminary surgeons painted a modern, ever-changing landscape of coronary surgery with new technologies, such as medical robotics, increasingly integrated into the specialty daily. Attendees experienced game-changing ideas, back-to-the-basics techniques, and ground-breaking science in diagnostic and therapeutic approaches to heart disease.

“The meeting brought together international leaders in the treatment of coronary artery disease and focused on the fundamentals and advanced therapies for coronary artery disease, including medical management, arterial conduits, and minimally invasive surgical revascularization,” said Joseph F. Sabik III, MD, surgeon-in-chief and vice president for surgical operations at University Hospitals Cleveland Medical Center, and a course director of the conference. “The conversations were engaging and the atmosphere was electric.”

Sessions covered a wide range of topics, including heart team patient selection and approaches; conduit selection and harvest; non-invasive and invasive preoperative workups; and postoperative medical therapy.

Here’s a look at a few key presentations:

Two Decades of Coronary Artery Bypass Grafting in Females: Has Anything Changed? ​

Elizabeth Norton, MD, Emory University School of Medicine, and a team of surgeons representing the division of cardiothoracic surgery and the division of cardiology at the institution, examined trends in females undergoing isolated coronary artery bypass grafting during the past two decades. What they found is that female CABG mortality at their institution was higher than the male cohort and the overall national average and did not improve over time.​ Females undergoing isolated CABG were increasingly diverse, experienced more preoperative comorbidities, were more likely to undergo urgent CABG, and had greater IMA utilization.

External Stenting for Saphenous Vein Grafts in Coronary Surgery

Saphenous vein grafts have high failure rates with 3% to 12% occluding before hospital discharge, 8% to 25% failing at 1 year, and only 50% to 60% remaining patent after a decade.​ As a research fellow with the department of cardiothoracic surgery at Weill Cornell Medicine, Giovanni Jr. Soletti, MD, wanted to know - can neointima formation be prevented?​

By conducting a study-level meta-analysis of randomized clinical trials and other research methods, Dr. Soletti found that VEST reduces intimal hyperplasia and thickness of SVGs after CABG. This reduction does not translate into fewer graft occlusion events or repeat revascularization compared to non-VEST SVGs at a follow-up of 1.5 years. SVGs harvested with no-touch technique or arterial conduits, when clinically adequate, may be safely used to improve long-term patency. Further long-term data and larger studies are needed.

Intraoperative Extubation After Isolated CABG and Post-Operative Outcomes

There is a well-known association between post-op ventilator time and morbidity in CABG surgery. Les James, MD, a resident cardiothoracic surgeon at NYU Langone Health, explored the impact of routine OR extubation on postoperative outcomes. She studied risk factors and outcomes based on a patient’s age, BMI, EF% STS risk score, STS prolonged vent score, CPB, and XC and concluded that routine OR extubation after isolated CABG is safe and that expanded use of planned OR extubation may be warranted.

All three highlighted abstract presentations were conducted by cardiothoracic fellows. STS encourages residents and fellows to submit original research to an international expert faculty for future presentations.

Review all conference abstracts.

Find the latest updates on STS member job changes, promotions, and accomplishments.

de Souza Will Advance Robotics in Tampa

Rodrigo de Souza, MD, has joined the University of South Florida’s Morsani College of Medicine as an associate professor of cardiothoracic surgery. Dr. de Souza, who previously taught at the University of California, San Francisco (UCSF), is employed to develop minimally invasive and robotic cardiac surgery at Morsani and the Heart and Vascular Institute at Tampa General Hospital. He has been an STS Member since 2022.

Dubeau Named First TSF Resident Director

Carolyn Dubeau, MD, has been appointed to serve a two-year term on the board of The Thoracic Surgery Foundation, STS’s charitable arm, as its very first resident director. Dr. Dubeau, currently in her third year of training at UT Health San Antonio, plans to pursue a path in congenital cardiac surgery. She became a Resident/Fellow Member of STS last year.

Cohen Directs Cedars-Sinai Cardiac Surgery Program

Robbin Cohen, MD, MMM, now serves as director of the Cedars-Sinai Cardiac Surgery Program at Huntington Health in Pasadena, CA, an affiliate of the Smidt Heart Institute in Los Angeles. An STS Member and volunteer since 1993, Dr. Cohen serves as chair of STS’s Workforce on Media Relations and Communications, vice-chair of the Standards and Ethics Committee, and is a member of the Workforce for Patient Safety.

Yang Is Frankel Research Professor at University of Michigan

Bo Yang, MD, PhD, has been named the inaugural Frankel Research Professor in Aortic Surgery at the University of Michigan. Dr. Yang joined the university’s Department of Cardiac Surgery in 2011 after a fellowship at Stanford University. A 2015 Thoracic Surgery Foundation Research Grant recipient and an STS member since 2010, Dr. Yang specializes in complex aortic repair.

Bhora Appointed as Hackensack Regional Chair

Faiz Y. Bhora, MD, FACS, was recently onboarded at Hackensack Meridian Health as the inaugural Regional Chair of Surgery for the New Jersey central region. Dr. Bhora previously was system chief of thoracic surgery and director of thoracic oncology at Nuvance Health and chief of thoracic and robotic surgery in the Mount Sinai Health System. He has been an STS Member since 2005.

Toker Takes Helm at West Virginia University

Alper Toker, MD, has been named professor and chief of thoracic surgery at the West Virginia University (WVU) Heart and Vascular Institute and the Department of Cardiovascular and Thoracic Surgery in the WVU School of Medicine. Dr. Toker joined WVU in 2019 and has served as interim chief of Thoracic Surgery for the last several months. An STS Member since 2021, he leads the tracheal surgery program and the thoracic surgical oncology program.

Fiedler, Scrimgeour Make History on All-Female Transplant Team

STS Members Amy Fiedler, MD, and Laura Scrimgeour, MD, were part of a historic heart transplant team at the University of California, San Francisco, in which the surgeon, anesthesiologist, surgical fellow, perfusionist, nurses, and patient were all women.

"I go to work every day because I love cardiac surgery," Dr. Fiedler told the TODAY show, who picked up their story. "To be able to be a part of something bigger that can hopefully inspire the next generation of individuals—be it boys, girls, people of color—for anyone to look at us and say, 'There's no barriers and I can do this,' that's really what makes it worth it."