Dynamic Event Featured CVT Critical Care and ERAS Techniques, Strategies
The multifaceted nature of cardiovascular and thoracic (CVT) critical care cases was the focus of the 19th Annual Perioperative and Critical Care Conference, held September 8–10, in Denver, Colorado.
More than 150 cardiothoracic surgeons, cardiologists, anesthesiologists, nurses, perfusionists, and other medical professionals learned about new concepts, management protocols, and clinical experiences from a multidisciplinary faculty. In addition, Ronald M. Stewart, MD, from the University of Texas Health Science Center at San Antonio, delivered the special keynote address, “Team Management Through Crisis: Firearm Injury Prevention Initiative from the American College of Surgeons Committee on Trauma.”
“For our first in-person meeting in 2 years, it was great to meet with a very engaged and interested group,” said Rakesh C. Arora, MD, PhD, one of the program directors. “Participation in every session was outstanding: the level of talks, the questions being asked, the conversations in-between. We had great science and breakout sessions, and meeting old friends again was a real treat.”
Thomas Knapp, a third-year medical student from the University of Central Florida College of Medicine in Orlando, received the Best Overall Poster honor for his presentation, “Dexmedetomidine Withdrawal in Pediatric Cardiac ICU Patients: A Systematic Review and Meta-Analysis.”
Thomas Knapp, from the University of Central Florida College of Medicine in Orlando, received the Best Overall Poster honor.
He shared how much he enjoyed the hands-on sessions, especially the “ECMO 101” session. “I was really excited because it was smaller groups and very visual, which appealed to me. I appreciated the intimacy of the sessions and that the conference was niche.”
The meeting content will be available for purchase this month through the STS Learning Center. More information is available at sts.org/criticalcare.
New Award Will Honor Extraordinary Women in CT Surgery
Nominations currently are being accepted for the inaugural Extraordinary Women in Cardiothoracic Surgery Award, which is co-sponsored by STS and Women in Thoracic Surgery.
This honor will recognize outstanding women cardiothoracic surgeons who achieve excellence in clinical practice. Nominees also should exemplify one or more of the following characteristics:
Selfless leadership in cardiothoracic surgery
Mentorship/sponsorship of others in the specialty
Exceptional advocacy on behalf of cardiothoracic surgery, the patient population, or fellow surgeons/trainees
Integrity, innovation, creativity, and expertise in carrying out day-to-day professional responsibilities
The Extraordinary Women in Cardiothoracic Surgery Award will be presented live during STS 2023 in January. Nominations are being accepted through October 21.
For more information, visit sts.org/extraordinarywomen.
STS 2023 Will Reconnect the CT Community in San Diego
After 2 years of virtual-only Annual Meetings, STS is bringing the cardiothoracic surgery community back together for never-before-seen science, hands-on demonstrations, virtual OR experiences, industry showcases, and thought-provoking keynote lectures. STS 2023 will take place January 21–23, at the San Diego Convention Center.
“There isn’t an STS Annual Meeting that I don’t walk away from having learned something new, thought about something differently, or gained a unique perspective about how another surgeon or institution is tackling a problem,” said S. Adil Husain, MD, Chair of the STS Workforce on Annual Meeting. “Being together face to face creates organic conversations and opportunities to learn from one another, as well as allows us to find joy, excitement, and commonalities in terms of challenges and successes we have as cardiothoracic surgeons.”
For those who can’t travel to San Diego—or for those who want to do more with their in-person registration—a new option, Plenary Livestream-Plus, will allow registrants to livestream the President’s Address and the Thomas B. Ferguson, Vivien T. Thomas, and C. Walton Lillehei Lectures from anywhere onsite or across the globe. Plenary Livestream-Plus also gives participants access to all session recordings within 48 hours of presentation.
Early registration guarantees a place—and the best choice of hotel rooms—at the most highly anticipated cardiothoracic surgery event in the world. Registration now is under way at sts.org/annualmeeting.
World-Class Faculty Will Headline Latin America Conference
Featuring interactive panel discussions, original scientific abstracts, and hands-on courses, the 2022 STS/EACTS Latin America Cardiovascular Surgery Conference takes place December 1–3, in Cartagena, Colombia.
The conference is an exceptional opportunity to explore the latest developments and best practices in coronary artery disease, congenital heart disease, thoracic aortic disease, atrial fibrillation, and the surgical management of heart failure. The final day of the conference will showcase industry-sponsored workshops that demonstrate mitral, tricuspid, and aortic valve repair, as well as valve sparing and the Ross procedure.
“The Latin America Cardiovascular Surgery Conference this year will be a remarkable event as surgeons from South America, Europe, and North America come together to disseminate knowledge and learn from each other,” said program committee member Vinod H. Thourani, MD. “We will discuss cases, listen to didactic lectures, and watch videos about the best practices for adult cardiac, congenital, and heart failure surgery. I encourage you to attend this don’t-miss event.”
For more information, visit sts.org/latam.
8 in 8s Provide Quick Tips for Hypoxemia, Reimbursement, Epicardial Pacing, and More
The STS 8 in 8 Series is a collection of expert-presented videos that offer clear, concise explanations of cardiothoracic surgery topics—each features just 8 slides and is approximately 8 minutes long.
The newest videos cover hypoxemia during VV ECMO, academic promotion for advanced practice providers, post-cardiotomy temporary epicardial pacing in the ICU, surgeon reimbursement, and tracheostomy techniques.
The series is available at sts.org/8in8 and on the STS YouTube channel, ThoracicSurgeons.
This 8 in 8 video identifies contributors to hypoxemia during VV-ECMO support, including cannula recirculation.
Now Is the Time to Send Data Managers to AQO
Surgeons are encouraged to register their data management teams for the 2022 Advances in Quality Outcomes (AQO): A Data Managers Meeting, October 26–28 in Providence, Rhode Island. Registrants can choose one or multiple in-person tracks—for the Adult Cardiac, Congenital, General Thoracic, and/or Intermacs/Pedimacs Databases—or choose a virtual pass to get access to digital content. STS members, including non-physician associate members, save even more. Details are available at sts.org/aqo.
Blog Curates Conversations for Aspiring Surgeons
The Aspiring CT Surgeons Blog launched to much celebration, providing a space for trainees to openly reflect on their experiences and share ideas to help each other navigate the troubles and triumphs of medical school, residency, fellowship, and beyond. New articles—which offer viewpoints from a diverse range of backgrounds and stages of training—are added regularly. The first few articles detail coping with complications, feeding the joy, and finding your own way to the operating room.
Coping with Complications in Cardiothoracic Surgery: How Do We Grow as Trainees? by Linda Schulte, MD
The Scenic Route to Cardiothoracic Surgery by Mahnoor Imran, MD
Feed the Joy by Anna Olds, MD
Visit sts.org/aspiringctsurgeons, and carry on the discussion via social media with #aspiringctsurgeons.
Webinar Challenges Teams to Prepare for Post-Surgical Arrest
In the event of a sudden cardiac arrest after surgery, everyone on the perioperative team needs to know their roles and act fast. A recent installment of the STS Webinar Series teaches teams to establish a protocol that everyone can follow. In “Arrest after Cardiac Surgery: Is Your Team Ready?,” an expert panel demonstrates how to implement Cardiac Surgery Advanced Life Support protocols and their utility in failure-to-rescue algorithms. The free webinar is available to watch now at sts.org/videos.
STS Traveled to Milan for EACTS Meeting
The Society had an important presence at the European Association for Cardio-Thoracic Surgery (EACTS) Annual Meeting in Milan, Italy, in October. STS President John H. Calhoon, MD, met with colleagues from around the world, while other surgeon leaders gave presentations during the meeting. STS staff also promoted the benefits of STS membership at a booth in the Exhibit Hall.
John H. Calhoon, MD
STS News, Fall 2022 — As we emerge from the pandemic, it is fascinating to see how much has changed.
Expectations of a return to normal just don’t seem possible. Although some things may be better, other daily experiences clearly are not. To me, one thing has become much worse: the relentless barrage of trivial and misleading information and negative news and commentary. The endless accusations of one faction’s bias or maltreatment of the other are difficult to reconcile. Without self-control, this societal noise could wear one out.
To avoid these traps, we can remind ourselves how fortunate we are to be cardiothoracic surgeons with the opportunity to make a difference each day in the lives of our patients and their families. Gratitude for my family and friends, and for the many gifts offered by this world, this country, and my community, are a great comfort to me.
Nonetheless, the seemingly ever-increasing loss of stability and predictability impacts our ability to effectively manage our lives, both at work and at home. It is all too easy as a surgeon to thrive on the illusion of stability, predictably, and control.
With time, I have come to realize the significance of this illusion. The only thing we can control is our response to the noise. Reminding myself of this has helped me be less stressed and more relaxed. Have I experienced burnout? Yes. However, taking the time to occasionally relax and recharge is the best way to manage stress and aim for a bit of balance.
Throughout my career, I have turned to senior surgeons—all of whom gave back to our specialty via volunteer work with STS and other organizations—for support and guidance. It is those surgeons and STS that have helped our specialty evolve tremendously since my days as a resident and early career surgeon. Many technologies and techniques that are common today did not exist then.
STS has been and continues to be steadfast as a leader in providing hands-on education for thoracoscopic techniques, mitral valve knowledge, TAVR, and so much more. For many of us, STS has played an important role in strengthening our skills and abilities as surgeons and leaders.
"We can remind ourselves how fortunate we are to be cardiothoracic surgeons with the opportunity to make a difference each day.
John H. Calhoon, MD
An array of STS education programs and services—including in-person meetings, webinars, on-demand content, and the STS Cardiothoracic Surgery E-Book—provide members access to the latest science and best practices. The Society also provides special opportunities for residents and early career surgeons to connect with peers and mentors, participate in hands-on training, develop leadership skills with renowned faculty, and participate in STS governance to advance the interests of the specialty.
But STS is so much more. It is a catalyst for advances in CT surgery that help surgeons provide the highest quality care and deliver the best patient outcomes. The STS National Database and accompanying research and quality initiatives help drive cardiothoracic surgery innovation and safety.
Hospitals and health systems depend on our data to strengthen their performance. Industry uses them to design and improve next generation devices and therapeutics. Data-driven research powers The Annals of Thoracic Surgery, the largest and most read journal in our specialty (congratulations to Dr. Jo Chikwe and her editorial and administrative teams!). And research is the basis for STS’s leadership in guideline development.
Most importantly, STS is the only organization engaged in public policy advocacy for cardiothoracic surgeons and the patients, institutions, and communities we serve. STS-PAC is a political action committee in Washington, DC, that exclusively represents the specialty.
Let me close by asking each of you: Are you unlocking the full value of your STS membership?
Here are five things you can do to become more engaged and give back to the profession:
Attend—in person—STS 2023, our 59th Annual Meeting in San Diego (see page 11)
Submit an abstract for a presentation at an upcoming STS meeting
Contribute an article to The Annals or Annals Short Reports
Donate to STS-PAC and develop a relationship with your member of Congress
Volunteer to serve as a mentor for a younger surgeon or join an STS Workforce or Task Force
Details about these opportunities can be found at sts.org.
More to come, John
STS News, Fall 2022 — The highly anticipated new season of The Resilient Surgeon is underway, featuring game changers in the high-performance and wellness space, including a professor of leadership at Harvard Business School, a performance coach, and a psychiatrist. This provocative STS podcast series aims to help surgeons be their best selves inside and outside of the operating room.
“The choice of guests featured this season parallels a paradigm I developed called ‘Best Self Pie,’” said Michael A. Maddaus, MD, host of The Resilient Surgeon. “I prefer the term ‘best self’ to the word wellness because it is an intuitive and personal reference point that we all have, if we are aware enough."
The first piece of the “pie”—individual habits and activities such as sleep, diet, exercise, gratitude, and connection with others—were covered in the first season of the podcast; whereas the additional pieces—self-awareness, purpose, and connection at work and home—will be tackled in Season 2 of The Resilient Surgeon, which began airing in late August.
The episodes will be released biweekly with a lineup that includes:
Brad Stulberg: author of The Practice of Groundedness discusses being successful without crushing the soul (self-awareness and habits)
Marcus Buckingham: world expert on engagement at work and the author of Love + Work provides a master class on finding purpose by embracing our "wyrd" (self-awareness and purpose)
Amy C. Edmondson, PhD: professor of leadership at Harvard Business School and author of seven books discusses psychological safety and its crucial role in performance, creativity, and wellbeing (all four)
Paul M. Conti, MD: psychiatrist who specializes in mental illness and the impact of life stressors breaks down the epidemic of trauma and how it impacts lives in ways that people may not even realize (self-awareness)
Christine Porath, PhD: professor at Georgetown University and author of Mastering Community offers insights on the critical role of being valued and respected in the workplace (connection)
Additional guests will include Rich Diviney, Brian R. Little, PhD, and Steve Magness.
Subscribe to Surgical Hot Topics via your favorite podcast app, or find the episodes at sts.org/podcast. Social media postings about the series will include the hashtag #BeYourBestSelf.
What is psychological safety? According to Dr. Edmondson, it is a belief that one will not be punished or humiliated for speaking up with ideas, questions, concerns, or mistakes, and that the team is safe for inter-personal risk-taking.
STS News, Summer 2022 — Four open heart surgeries and a kidney transplant represent stark milestones for STS member Marcus Balters, MD, whose career as a surgeon has been interspersed with stints as a patient, brushes with mortality, new perspectives on teaching, and solidified faith.
Dr. Balters directs the general surgery residency program and serves as vice chair of surgical education at Creighton University in Omaha, Nebraska. His experiences as a young patient—he underwent a coarctation repair at age 6 and a repeat repair at age 16—made a career in cardiothoracic surgery a natural choice.
“My mother would probably tell you I was talking about being a cardiac surgeon from a very young age, probably 7 or 8,” he said. “I remember thinking my pediatric cardiologist was very cool, and even when I moved on to an adult cardiology group, I was imagining him as my surgeon. I have a memory of him standing over me in scrubs as I was going to sleep.”
Dr. Balters studied medicine at the University of Nebraska Medical Center. In 1999, while a fourth-year resident, he experienced a descending aortic graft rupture.
“This rupture presented as an aortobronchial fistula, and it was very emergent,” he recalls. “I started that morning with massive hemoptysis; I was exsanguinating.”
Image
During his final year of residency, Dr. Balters underwent emergency repair for an aortic rupture.
Dr. Balters credits the world-renowned Lars Svensson, MD, PhD, now at the Cleveland Clinic in Ohio, for saving his life at the Lahey Clinic that day—the first of two such occasions, he’d later discover. Notably, that operation also revealed an ascending aortic aneurysm that warranted a close watch.
“I made it back to residency in about 8 weeks after a very near miss with death,” Dr. Balters said.
He went on to a cardiothoracic surgery fellowship at the State University of New York in Syracuse (SUNY-Syracuse), and from there to a private practice group back in his home state of Nebraska. The group joined Omaha’s Creighton University in late 2005.
A few months later, his aneurysm had grown to the point of needing repair.
“I called Dr. Svensson, and he graciously and adeptly saved my life again in April 2006 at the Cleveland Clinic,” recalled Dr. Balters. “By the grace of God, once again I made it back to work in 8 weeks, and I resumed a very busy clinical practice.”
Being very busy, he now reflects, kept him on a sort of “autopilot,” turning his focus to work, which served as a distraction from what he now recognizes as a form of post-traumatic stress.
“During residency, colleagues would at times take me aside and ask, ‘Are you sure you want to go into this? This is what your life is going to be like.’ And looking back, I realize that I probably spent 10 or 15 years after that third operation wondering, ‘Am I going to die today?’ Every time I would cough, every time I would have a pain, it would remind me of those dramatic events,” he said.
Throughout those years, however, Dr. Balters had a support system that presented him with avenues he’d never considered and with the revelation that it’s okay to lean on colleagues and loved ones, to accept the grace of a higher power, and to employ a little creative assistance.
Another opportunity to broaden Dr. Balters’s viewpoint occurred in early 2006, when he approached the department head to inform him of his plans to undergo the aneurysm repair. “When I had to have that fourth surgery, I went to my chairman and broke down in tears,” he recalled. “He assured me that no matter what happened, even if I could never operate again, there would be a place for me.”
The chair, R. Armour Forse, MD, PhD, suggested that Dr. Balters consider a teaching position, and that recommendation altered the course of Dr. Balters’s professional life.
Meanwhile, Dr. Balters’s wife, Sarah Beth—whom he has known since they were 14 and with whom he celebrated 25 years of marriage this year—was a steady source of spiritual support. “She is the person that lifts me,” he said.
Dr. Balters cherishes the family he's built with his wife, Sarah Beth.
Early in his fellowship, Dr. Balters recalls, he was watching a surgeon deftly perform a procedure, and while observing he had a moment of anxiety about the tremor in his own hands.
“I was thinking to myself, ‘I’m not sure I’m going to be able to do this.’ And right at that moment, without any prompting, my attending said to me, ‘You know, Marcus, I’m resting my hand on the sternum while I do this.’”
Dr. Balters had been so focused on the narrow view through the magnification lenses that he’d never appreciated that his attending surgeon was using a technique to alleviate his own tremor.
Dr. Balters began honing his clinical practice from a mixed bag of cardiac, thoracic, and vascular operations to focus mostly on lung surgery and hemodialysis access at Creighton University Medical Center, now part of CommonSpirit Health, and the Veterans Affairs Nebraska-Western Iowa Health Care System.
The dean of the School of Medicine at Creighton University, Robert W. “Bo” Dunlay, MD, recommended that Dr. Balters turn his talents toward teaching both medical students and general surgery residents.
In the intervening years, Dr. Balters’s kidneys began to fail.
Ultimately diagnosed with idiopathic glomerular nephropathy, he “continued to work the surgeon’s life, though I had stopped doing cardiac surgery back in 2006 when I had the arch repair.” Eventually he required a transplant, and in 2010 he received a kidney from his brother.
“Again, back to work in 8 weeks, though I had multiple issues come up in the next 18 months related to the transplant,” he said. “I have stayed with Creighton—and they have stayed with me—since 2005.”
Dr. Balters has become a source of inspiration for his students and residents.
“I tell them—the students, at least—that I don’t care what kind of doctor they decide to be. There’s of course some satisfaction in ‘converting’ residents to cardiothoracic surgery, but my ultimate goal is to help them be the best doctors they can and save lives. I can only touch so many people in my lifetime as a surgeon, but if I teach people what I think is important, my effects can ripple out to lots of people across years and locations.”
He notes that the students seem to appreciate that he thinks out loud in the operating room. Dr. Balters says that while it’s easy to become silently focused on the task at hand, especially during difficult procedures, he tries to offer insights into his thought processes and decisions by talking them out among the team as he operates.
Image
Medical students training with Dr. Balters have named him "Most Inspirational Educator."
In 2018, the fourth-year medical student class named him “Most Inspirational Educator” in their yearbook, and this year he achieved the rank of full professor.
And how do his patients benefit from his experiences on—and over—the operating table?
“Once we’ve gotten through the plans for the proposed operation, I’ll say something like, ‘Well, I’ve never had lung cancer, but I’ve had four open heart surgeries and a kidney transplant. And I’m not telling you this because this conversation is about me, but because I want you to know that I’ve sat in those chairs before, and I’ve asked the questions: Why is this happening to me? Who is this person in front of me, and do they know what they’re doing?’”
Dr. Balters answers that he’s just a former kid from Nebraska, but that he’s spent years preparing to be a proficient surgeon, he’s performed hundreds of operations like these, he’s certified by the American Board of Surgery and the American Board of Thoracic Surgery, and he’ll “do everything in my powers to try and make this as uneventful of a valley as possible in what is hopefully an otherwise long and prosperous life.”
A long and prosperous life has realized itself in Dr. Balters, despite a seemingly relentless series of valleys. With his renewed perspective through the lenses of fellowship, family, and faith, he says that he feels blessed.
John H. Calhoon, MD
STS News, Summer 2022 — Just a couple of months ago, I was sitting in my office thinking about the importance of leadership during crisis and trying to make sense of the latest tragedy within our borders and the ongoing conflict thousands of miles away in Ukraine. So much violence and so little sense.
The Uvalde shooting hit very close to home as the school is located approximately 80 miles from where I live, work, and raise my family, and some of the victims were treated by the trauma team at The University of Texas at San Antonio.
And not as close, but just as devastating, are the war in Ukraine and its terrible consequences. Major powers have been unable to stop the fighting, and the war continues with an ongoing loss of life and mounting strife realized by the entire world.
Where do we sit in all this, and what should we be doing?
Leaders Everywhere, Every Day
We are leaders in our communities, our institutions, and our departments and teams. In these times, it is especially important to do our best to serve as wise and measured voices as we keep in mind the duties beyond those of our careers and professions. There are moments in life—like this—when people depend on our leadership to reassure those around us, build connectedness, and inspire confidence.
Building Community
Importantly, we must recognize the importance of CT surgeons and our professional associations collaborating with and supporting one another. We all have skin in the game and are working toward a common goal of advancing the specialty and providing quality care for our patients. Of course, we all are enthusiastic and excited to return to in-person meetings and resume live learning and networking.
Thankfully, once again we are experiencing the power of face-to-face interactions—deeper, more meaningful conversation, handshakes and hugs, a joyful respite from our phones and computers.
Meeting Successes
The inaugural in-person STS Coronary Conference in Ottawa, Ontario, Canada, was a great success, with nearly 150 attendees gathering from 18 countries last month to discuss the latest techniques for coronary artery bypass surgery. The sold-out, hands-on Workshop on Robotic Cardiac Surgery in Atlanta, Georgia, this spring was another highly regarded success.
Right around the corner is the Critical Care Conference in Denver, to be held Sept. 8-10. Boot Camp, scheduled for Sept. 29-Oct. 2, will provide 60 residents with an experiential foundation and hands-on practice in basic cardiothoracic operating skills. Other upcoming meetings include the LatAm meeting in Cartagena, Colombia, being held Dec. 1-3, in conjunction with our colleagues from EACTS.
The Society also recently organized a leadership retreat, attended by Drs. MacGillivray, Romano, and Szeto, key STS staff, and me. Together, we began to map out critical initiatives and discussed future opportunities, including a variety of quality education programs that will ensure STS has a clear direction and purpose for years to come.
Modernization of the Database
During the AATS meeting in May, Dr. Vinay Badhwar, on behalf of his multidisciplinary co-authors, presented an invited landmark paper on mitral valve repair that used data from the STS National Database. This paper, along with several others, showcased the value of the information from the Database.
Overall, the Database continues to get stronger, although it has not been without some hurdles as we evolve to a fully digital platform. The Society is continuing to transition data capture and data analytics to internal STS staff, eliminating the need to rely on outside vendors and giving us more authority and responsibility for accurate and timely reports. We are very resolute in this goal.
Important Advocacy Work
On the advocacy front, the cardiothoracic surgery specialty remains under attack with the possibility of additional cuts to clinical reimbursement.
As a founding member of the Surgical Care Coalition, the Society continues to work with the American College of Surgeons and other associations to find longer-term solutions to Medicare’s broken payment system, while also protecting access to necessary surgical procedures and high-quality care for all patients.
The STS Government Relations team also remains focused on other important regulatory and legislative issues that are relevant to cardiothoracic surgeons and our patients.
There remains much to do—in the ORs, in our institutions, in our communities, for our specialty, and for each other. But I am optimistic that with the help of wise and selfless leaders like you, we have a much better chance.
Stay grounded, and do not fall prey to the quicksand around us all.
More to come, John.
Dr. Barnes takes a deep dive into the impact of sleep deprivation on leadership performance and behavior, as well as its effects on interpersonal relationships.
This in-depth conversation details the power of self-compassion and how important the practice is for our mental health and the ability to recover from failures and struggles.
