2018 STS Meeting Bulletin

Data Indicate Improved Outcomes Using LVADs

The use of left ventricular assist devices (LVADs) is increasing, not only as a bridge to transplant but also as destination therapy. This has generated a growing clinical and academic interest in mechanical circulatory support and the treatment of patients with these devices.

STS/ISHLT Joint Symposium: LVAD Therapy in 2018—Worldwide Perspectives

Tuesday, January 30
1:00 p.m. – 3:00 p.m.
Room 304

In a new session organized by STS and the International Society for Heart & Lung Transplantation, speakers will address these issues for a global audience, including cardiac surgeons, cardiologists, VAD coordinators, and other providers involved in the care of patients with LVADs.

“The goal of the Symposium is to introduce a broad range of practitioners to the most recent clinical trial data and emerging areas of investigation in the field of mechanical circulatory support,” said moderator Gabriel Sayer, MD, of The University of Chicago Medicine.

One topic of particular interest is the optimal approach to LVAD implantation. The progressive miniaturization of these devices has made minimally invasive implantation an attractive option, but challenges exist, and data comparing outcomes with those of conventional implantation are few. Still, the available data indicate improved outcomes with minimally invasive implantation compared with conventional surgery, and many experts believe that minimally invasive implantation should become the preferred approach, unless otherwise indicated.

Another important area of focus is biventricular failure, which is a particular challenge, as little progress has been made in its treatment. In addition, the outcomes associated with biventricular support have been inferior to those associated with left-sided support strategies. New durable biventricular support options are emerging, however, and speakers will describe these options. 

An additional goal of the Symposium is to contrast the American and European experiences with LVAD therapy. Dr. Sayer noted that a highlight will be a presentation by Finn Gustafsson, MD, PhD, of Rigshospitalet in Copenhagen, Denmark, who will discuss the European experience with the HeartMate 3 LVAD. HeartMate 3, which received CE Mark approval in Europe in 2015, has been evaluated in several studies, including the HeartMate 3 CE Mark clinical trial, which demonstrated a 92% survival rate at 6 months. Dr. Gustafsson will discuss the implications of these findings and also will present data from the ELEVATE registry, which was developed to evaluate HeartMate 3 in the post-market approval setting.

 

Put Knowledge into Practice at STS University

Cap off your Annual Meeting experience by attending STS University on Wednesday morning. These hands-on courses allow attendees to gain experience with a wide variety of cardiothoracic surgical procedures. Expert instructors will work closely with small groups, providing the opportunity for ample questions and individual instruction.

Get hands-on instruction from experts in several cardiothoracic surgical procedures.

Each STS U course will be offered
from 7:00 a.m. to 9:00 a.m. and again from 9:30 a.m. to 11:30 a.m., and you must purchase separate tickets in addition to your Annual Meeting registration. Visit Registration in the Atrium Lobby to see which courses still have availability.

Please note that STS University features only hands-on learning, and attendees are strongly encouraged to review the didactic lectures in advance. View course materials at the STS University viewing station located in the Floridian Ballroom Foyer, online at sts.org/stsuniversity, or through the STS Meetings app.

Course 1: Essentials of TAVR

Course 2: TEVAR and Aortic Arch Debranching Procedures

Course 3: Mitral Valve Repair

Course 4: Valve-Sparing Aortic Root Replacement

Course 5: Aortic Root Enlargement Procedures and Aortic Valve Leaflet Reconstruction

Course 6: VATS Lobectomy

Course 7: Advanced Open Esophageal and Tracheal Procedures

Course 8: Chest Wall Resection, Reconstruction, and Pectus Surgery

NEW! Course 9: Minimally Invasive Aortic and Mitral Valve Surgery

 

Presenters Meet the Media in STS Press Conferences

The Society will host three press conferences on Tuesday highlighting some of the exciting research being presented at the STS 54th Annual Meeting. The press conferences will take place at 10:00 a.m. in Room 208.

Coronary Artery Bypass Surgery Compared to Percutaneous Coronary Intervention in Patients Younger Than 50 Years of Age: Long-Term Outcomes
Speaker: Wael I. Awad, MD,
St. Bartholomew’s Hospital, London, United Kingdom
Discussant: Robbin G. Cohen, MD, University of Southern California, Los Angeles

Factors Associated With New Persistent Opioid Use After Lung Resection
Speaker: Alex A. Brescia, MD, University of Michigan, Ann Arbor
Discussant: David T. Cooke, MD, University of California Davis Health, Sacramento

Consequences of Refusing Surgery for Esophageal Cancer: A National Cancer Database Analysis
Speaker: Sebron W. Harrison, MD, Weill Cornell Medical College and New York-Presbyterian Brooklyn Methodist Hospital, New York, NY
Discussant: Mark S. Allen, MD, Mayo Clinic, Rochester, MN

Diversity in Cardiothoracic Surgery Workforce Benefits Patients, Professionals

An important new session offered this morning will address the role of diversity and inclusion in the cardiothoracic surgery workforce and explore why physicians who are underrepresented in medicine are important for the optimal delivery of cardiothoracic surgical care.

David T. Cooke, MD

The session was developed by the Society’s Special Ad Hoc Task Force on Diversity and Inclusion, which was created last year with a mission of fostering inclusion and diversity within STS, as well as the cardiothoracic surgery specialty.

Diversity and Inclusion in Cardiothoracic Surgery: What’s In It For Me?

Monday, January 29
11:30 a.m. – 12:30 p.m.
Floridian Ballroom B-C

“It is the vision of our President, Dr. Richard Prager, to see a workforce equipped to care for diverse populations both nationally and internationally by cultivating an open environment,” said Task Force Chair and session moderator David T. Cooke, MD.

During the session, David A. Acosta, MD, Chief Diversity and Inclusion Officer at the Association of American Medical Colleges, will share his expertise on the value proposition of diversity and inclusion.

“Studies have demonstrated that diversity provides a more robust learning environment. Students who interacted with students from racial/ethnic-diverse backgrounds demonstrated the greatest engagement in active thinking, growth in intellectual discourse, engagement and motivation, and growth in intellectual and academic skills,” he said.

A diverse physician workforce also benefits patients, Dr. Acosta added. “Studies have also demonstrated that racial/ethnic concordance and language concordance between patients and physicians have major benefits. For example, patients state that they experience better interpersonal care with racial/ethnic concordance, hence, better patient satisfaction.”

Following Dr. Acosta’s talk, Dr. Cooke will lead a panel discussion with STS First Vice President Keith S. Naunheim, MD, STS Public Director Christopher M. Draft, and others representing a variety of backgrounds and career stages.

“The panelists will offer their insights on the importance of a diverse workforce and how it benefits their patients,” Dr. Cooke said. “The goal of the session is to educate attendees about how diversity and inclusion can be valuable to their practices, service lines, training efforts, and relationships in the communities where they practice.”

Moving forward, the Task Force will help STS create programs and resources that will not only further diversify the cardiothoracic surgery workforce, but also lead to a better understanding of health care disparities among cardiothoracic surgery patients and, ultimately, better patient outcomes.

“Diversity and inclusion are important to STS. We know that the more diverse the cardiothoracic surgery workforce is, the better we can serve our communities,” Dr. Cooke said.

Share Your Thoughts on Diversity

If you haven’t done so already, please take 10 minutes to fill out the STS Diversity and Inclusion Survey at sts.org/diversitysurvey. Results will be used by the Society to develop and implement programming and other resources. Individual responses will remain anonymous, and aggregate survey results will be reported after analysis for peer review and/or general dissemination.

‘Shark Tank’ Pitches Address Unmet Needs

The growing prevalence of cardiovascular disease and advances in technology have led to exponential growth in the cardiothoracic device market. Three physician-innovators are hoping to be part of that burgeoning market and pitched their cutting-edge products and novel devices during yesterday afternoon’s STS/AATS Tech-Con Joint Session: Robotic Cardiothoracic Innovations and “Shark Tank”—Rapid-Fire Pitches of Revolutionary Technology.

James H. Mehaffey, MD describes his idea on how to improve ventricular assist devices.

Jeffrey L. Port, MD, of Weill Cornell Medical Center in New York, led off the pitch session by discussing a device designed to address the clinical challenge of identifying small nodules, especially during minimally invasive surgery. He said that his novel microshell marker offers many benefits over other tools, such as hookwires and dyes, including lack of migration or dispersion, intraoperative ultrasound visibility, long-term (30 days or more) duration, elimination of the need for a localization procedure, and bioresorbability.

Steven F. Bolling, MD, of the University of Michigan in Ann Arbor, William E. Cohn, MD, Vice President for Johnson & Johnson Medical Device Companies, and Arjun (J.J.) Desai, MD, Vice President, Innovation, Johnson & Johnson, served as the “sharks” to evaluate the pitches and offer advice.

Drs. Bolling and Cohn commended Dr. Port and his team for the device but noted that the presentation fell short of a pitch; because of this, they opted not to invest. Dr. Desai agreed but said he would be “in as an advisor.”

In the second pitch, James H. Mehaffey, MD, of the University of Virginia in Charlottesville, discussed the important role of ventricular assist devices (VADs), while noting that suction events due to low-flow states and malposition of the inflow cannula result in significant morbidity. In addition, leftward shift results in distorted right ventricular geometry, leading to late right ventricular dysfunction as a sequela of adverse remodeling. Dr. Mehaffey said that his device, VADStent, addresses these issues by aligning the inflow cannula with the mitral valve and maintaining the left ventricular cavity.

Dr. Cohn noted that VADStent addressed an unmet need and said he would be interested in investing, but Drs. Desai and Bolling said that they preferred to “watch and wait.” Dr. Bolling applauded the strong intellectual property position, a valuable asset for a start-up company.

In the third pitch, Bryan M. Burt, MD, of Baylor College of Medicine in Houston, described a problem for all surgeons who perform minimally invasive procedures: debris deposits on the videoscope lens, which impair visualization of the operative field. Cleaning requires manual removal and cleaning of the scope, which prolongs operative time, frustrates the surgeon, and compromises patient safety. Dr. Burt noted that other proposed solutions have been insufficient and described his device, a trocar with wash and dry functions. He said that the scope can be cleaned within the trocar itself in one forward and backward movement, in under 2 seconds.

Dr. Burt acknowledged that Dr. Cohn was involved in the design of the prototype of the invention, noting that Dr. Cohn agreed to be a judge before knowing that the trocar would be pitched. “I am emotionally in,” said Dr. Cohn. Dr. Bolling agreed that a dirty scope is irritating and that he, too, was in. Dr. Desai, however, said, “Nobody spends money to save money,” and he urged Dr. Burt to identify his true customer and capture the value of the device to that customer base.

The judges’ perspectives on the three pitches demonstrated the challenges of launching new devices, even when they address an unmet need.

Earlier in the day, the role of robotics in cardiothoracic surgery was debated for both cardiac and general thoracic procedures.

T. Sloane Guy, MD, of Weill Cornell Medicine in New York, and David H. Adams, MD, of Mount Sinai Hospital in New York, presented the pros and cons, respectively, of robotic mitral valve repair. Dr. Guy said that a new value equation factors in a positive patient experience and low cost in addition to quality and safety, whereas Dr. Adams pointed to the positive outcomes with sternotomy using his approach of a shorter incision, direct access, and a modified retractor.

In debating the role of robotics in general thoracic surgery, Mark S. Allen, MD, of the Mayo Clinic in Rochester, MN, focused on the cost, operating room space, and learning curve associated with robotics, and Robert J. Cerfolio, MD, MBA, of NYU Langone Medical Center in New York, countered that surgeons should consider value rather than cost, adding that robotics offers the best educational tool and extends surgeons’ careers.

Chamberlain Papers Represent the Best in New Research

Enhanced recovery after surgery, regionalization of congenital heart surgery centers, and surgical atrial fibrillation ablation are the focus of this year’s prestigious J. Maxwell Chamberlain Memorial Papers.

Robert M. Van Haren, MD

The Chamberlain Papers are considered by the Workforce on Annual Meeting Program Task Force to be among the best scientific abstracts submitted for the meeting.

ERAS Pathway Decreases Perioperative Morbidity Following Thoracotomy for Primary Lung Cancer

J. Maxwell Chamberlain Memorial Papers

Monday, January 29
7:15 a.m. – 8:15 a.m.
Grand Ballroom

Enhanced recovery after surgery (ERAS) programs are safe, feasible, and effective for reducing postoperative morbidity in patients undergoing a thoracotomy for primary lung cancer. Thoracic surgeons should move forward with confidence in implementing ERAS, according to Robert M. Van Haren, MD, of MD Anderson Cancer Center in Houston, who will present the Chamberlain Paper for General Thoracic Surgery.

Dr. Van Haren and colleagues compared outcomes for all patients undergoing pulmonary resection for primary lung cancer at MD Anderson between 2006 and 2016. Patients were evaluated at the pre-ERAS stage, during a transitional period with elements of ERAS, and after full implementation of an ERAS pathway.

ERAS components included limited pre-anesthetic fasting, preemptive analgesia, intraoperative regional analgesia with liposomal bupivacaine intercostal blocks, drain minimization, postoperative opioid-sparing multimodal analgesia, early ambulation, and oral intake.

The pathway’s benefits included reducing complications, such as atrial fibrillation and pneumonia, and opioid-sparing drug treatment. Opioid-sparing benefits are particularly valuable at a time of a global opioid epidemic, Dr. Van Haren said.

“ERAS hasn’t been looked at in thoracic surgery until now,” he said. “Our goal with ERAS is to give patients better pain control and shorten their stay. We’re seeing a reduction in hospital stays from 5 days to 4, with no increase in readmissions. It’s clear from our analysis that ERAS is effective, but it needs buy-in and collaboration from the entire team—from the thoracic surgeons and anesthesiologists to nursing and pharmacy.”

Patients Will Travel Long Distances for Better Care

Regionalization of care has been hypothesized to be an ideal model for the delivery of congenital heart surgery (CHS); however, it has not been investigated in the United States. The Chamberlain Paper for Congenital Heart Surgery details the current network of hospitals at which patients undergo CHS as the basis for designing a regionalized system.

Tara B. Karamlou, MD, of Phoenix Children’s Hospital, was among a team of researchers who examined congenital heart surgery referral patterns throughout the United States. Some states, such as California, Florida, New York, and Texas, had many CHS centers, while other states had none. California, for example, had 25 centers, many of which were located in close proximity to one another.

“We have to be good stewards of our patients’ care,” Dr. Karamlou said. “It’s important for centers to collaborate and discuss partnerships with other centers. Our data would suggest that providers and stakeholders should look critically at models in their states and, if possible, collaborate with local or regional centers of excellence.”

In addition to describing the distribution of CHS centers in the United States and demonstrating national referral patterns, the researchers sought to characterize the demographic currently traveling for CHS and the incurred travel burden. The results showed that patients often travel long distances to high-volume centers perceived as high quality, regardless of patient age or case complexity. Patients without insurance traveled the least for care.

“One of the major unanticipated findings of this initial study was that many patients are already traveling a fair distance to perceived centers of excellence for surgery. Our study shows that 84% of patients already bypass the nearest center, which suggests that regionalization of care already exists to a certain extent,” Dr. Karamlou said.

While higher case complexity was primarily concentrated in larger volume hospitals, very low-volume hospitals still performed important numbers of complex cases. Researchers accounted for case complexity using the RACHS-1 system and hospital volume.

According to Dr. Karamlou, if more hospitals were consolidated, such that only those centers with an annual case volume greater than 150 surgeries, travel distance would increase by a median of about 100 miles.

Significant Long-Term Survival Benefits Are Associated With SAFA

Surgical atrial fibrillation ablation (SAFA) was previously proven to be highly effective in reducing atrial fibrillation. Now, it appears to have a more lasting influence, affecting long-term survival.

Alexander Iribarne, MD, of Dartmouth-Hitchcock Medical Center in Lebanon, NH, and colleagues performed an extended look at SAFA, which can be performed without additional risk of operative mortality or major morbidity and is recommended at the time of concomitant mitral operations, as well as aortic valve and coronary bypass surgery, to restore sinus rhythm.

“The effectiveness of this technique in achieving freedom from atrial fibrillation is well documented in the literature,” said Dr. Iribarne, who will present the Chamberlain Paper for Adult Cardiac Surgery. “Unfortunately, it remains an underutilized procedure. Our paper shows a significant long-term survival benefit associated with SAFA.”

This new, multicenter analysis is consistent with a recent STS Clinical Practice Guideline recommending SAFA for concomitant mitral operations, as well as isolated aortic valve replacement (AVR), isolated coronary artery bypass grafting (CABG) surgery, and AVR plus CABG.

The study, conducted between 2008 and 2015, analyzed more than 2,000 patients undergoing CABG, valve, and CABG/valve operations with preoperative atrial fibrillation across seven hospitals. There was a significant improvement in unadjusted survival among patients undergoing concomitant SAFA, and at 5 years, patients undergoing SAFA had a 26% improvement in adjusted survival, compared to those who had no ablation. While SAFA patients had longer bypass times, they had a shorter overall length of admission.

“The takeaway is that we not only have new guidelines based on the efficacy of SAFA in achieving freedom from atrial fibrillation, but we now also have additional data showing that SAFA has a real impact on how long patients live,” Dr. Iribarne said. “We hope this information will encourage more surgeons to incorporate SAFA in their practice.”

The Chamberlain Papers honor the scientific contributions of Dr. Chamberlain, a renowned cardiothoracic surgeon who chaired the steering committee tasked with creating The Society of Thoracic Surgeons.

Clark Papers Spotlight Three STS National Database Studies

The STS National Database has contributed to scores of research studies that advance quality and patient safety in cardiothoracic surgery. Three such studies—considered as the best submitted for the 2018 Annual Meeting—have been designated as this year’s Richard E. Clark Memorial Papers.

Richard E. Clark Memorial Paper: Congenital
Congenital: Pediatric Congenital I

Monday, January 29
1:30 p.m. – 1:45 p.m.
Room 305

Richard E. Clark Memorial Paper: General Thoracic
General Thoracic: Lung Cancer II

Tuesday, January 30
1:15 p.m. – 1:30 p.m.
Floridian Ballroom B-C

Richard E. Clark Memorial Paper: Adult Cardiac
General Session I

Monday, January 29
8:15 a.m. – 8:30 a.m.
Grand Ballroom

Instead of the Clark Papers being presented en mass, the adult cardiac paper will be presented during today’s general session, and the congenital and general thoracic papers will be featured during specialty-specific parallel sessions.

TAR Remains Gold Standard for Surgical Management of Aortic Arch Pathologies

A comparative analysis of two surgical approaches for management of aortic arch pathologies has yielded interesting and provocative results.

Total arch replacement (TAR) has been the gold standard for treatment of arch pathologies such as aneurysm, dissection, intramural hematoma, and penetrating aortic ulcer. But as endovascular technology continues to be adopted for management of thoracic aortic pathologies, hybrid arch procedures increasingly are being investigated. For hybrid arch procedures, arch vessels are debranched, and an endograft exclusion of the aortic arch is then performed.

In the Clark Paper for Adult Cardiac Surgery that will be presented today, researchers analyzed data from the STS Adult Cardiac Surgery Database to gain a national perspective on the effectiveness of TAR versus hybrid arch procedures.

“TAR is the traditional operation for arch pathologies involving the head vessels, while the hybrid arch approaches represent the newer alternative,” said Prashanth Vallabhajosyula, MD, MS, of the University of Pennsylvania. “Although several single–institution retrospective studies have demonstrated satisfactory—and sometimes superior—outcomes of hybrid arch procedures over TAR, a multicenter, large-scale comparison of the two procedures has never been done. In this investigation, we assessed the outcomes of TAR versus hybrid arch procedures performed at over 270 centers nationwide in the elective setting.”

Comparing results from the two procedures, researchers studied in-hospital/30-day mortality, stroke, paralysis, reoperation, and STS morbidity (a composite of renal failure, deep sternal infection, prolonged ventilation, reoperation for bleeding, and stroke). Patients undergoing hybrid arch procedures had a higher comorbid burden, as well as significantly higher rates of mortality, stroke, and paraplegia. Even after risk adjustment, hybrid arch procedures were associated with a significantly higher risk of stroke and mortality.

“This study emphasizes the importance of careful and meticulous investigation of hybrid arch procedures before adopting them into our routine surgical practice,” Dr. Vallabhajosyula said. “Maybe it is time that we come together as a cardiac surgical community and conduct a prospective, randomized, multicenter trial to understand the optimal surgical management of aortic arch pathologies. This issue is even more important today, as single- and dual-branch TEVAR grafts are already being investigated for treatment of arch pathologies.”

Higher-Stage Lung Cancer and Central Tumor Patients Not Receiving Proper Mediastinal Staging

Identifying key predictors of invasive mediastinal staging in stage 3 lung cancers may bridge the gap and reduce uncertainty in the quality of lung cancer care. Researchers reached the conclusion after assessing the volume and uniformity of mediastinal staging within the STS General Thoracic Surgery Database (GTSD) against previously reported rates.

According to Seth B. Krantz, MD, of NorthShore University Health System in Chicago, these predictors can help determine the best course of treatment for patients and potentially avoid unnecessary surgery.

“The guidelines for mediastinal staging are pretty clear. However, the problem is that people are not actually following the guidelines and doing it with consistency,” Dr. Krantz said. “We’ve found that for higher stage lung cancer and central tumors, people are doing the procedure at a much lower rate than expected, and patients aren’t getting more invasive staging.”

In the Clark Paper for General Thoracic Surgery that will be presented tomorrow, researchers retrospectively looked at lung cancer patients staged by computed tomography and positron emission tomography and treated with an anatomic resection without induction therapy. Researchers measured invasive staging procedures that occurred within 180 days of resection and evaluated variability in invasive mediastinal staging rates across the GTSD.

Given the significant variability they encountered, researchers questioned whether surgeons fail to follow the guidelines or whether those guidelines are flawed.

“This requires further insight. The guidelines are based on experts,” Dr. Krantz said. “We need to improve the quality gap or reevaluate the guidelines. Also, we need professionals to be systematic and consistent with the procedure.”

Dr. Krantz suggested that surgeons evaluate whether they have variability in their own practices, assess their own strict adherence to the guidelines for all patients, and present their data if they believe the guidelines are flawed.

“Inconsistency is not good enough for the patient. It’s critical to follow the guidelines,” he said.

Composite Quality Measure Improves Quality of Life for Congenital Heart Surgery Patients

As outcomes for children undergoing congenital heart surgery have improved over the past few decades, the limitations of operative mortality alone as a quality metric have increasingly become recognized. To address this, a team of investigators used data from the STS Congenital Heart Surgery Database (CHSD) to create the first composite quality measure in this area. A grant from the National Heart, Lung, and Blood Institute supported the project.

“A focus on early mortality alone ignores the 97% of patients who now survive to hospital discharge in the current era and the important morbidities they may experience,” said Sara K. Pasquali, MD, of C.S. Mott Children’s Hospital in Ann Arbor, MI.

The composite measure that the investigators developed comprises a mortality domain (operative mortality) and a morbidity domain, which includes major postoperative complications and length of stay. Mortality carries the greatest influence, or “weight,” on the overall composite measure, followed by major complications and length of stay.

When looking at performance related to the composite quality measure across the 100 hospitals included in the study (and accounting for the type and complexity of patients they treat), 75% were found to be performing as would be expected, 9% were performing worse than expected, and 16% better than expected.

“The composite measure enhances our understanding of quality and variation across hospitals beyond mortality alone,” Dr. Pasquali said.

In the future, the composite measure and its individual components will be available to hospitals participating in the CHSD in their feedback reports to support benchmarking and quality improvement activities.

The Clark Papers honor the contributions of Dr. Clark, who was a key leader behind the creation of the Database, serving as Chair of the STS Ad Hoc Committee to Develop a National Database for Thoracic Surgery.

Toolkit for Innovation Safely Guides CT Surgeons in New Technology

Innovation in the clinical setting can improve the patient experience. While it can be challenging to introduce new tools and techniques into a practice, efficient navigation of potential stumbling blocks is possible.

Shanda H. Blackmon, MD, MPH

Shanda H. Blackmon, MD, MPH, of the Mayo Clinic in Rochester, MN, will call upon her personal experience bringing innovation into the operating room during a session this afternoon organized by Women in Thoracic Surgery (WTS). Encouraging the adoption of new technology is among the key objectives for WTS, which offers fellowships and awards that help female cardiothoracic surgeons learn new skills.

“The process of bringing new technology and advanced procedures into general thoracic surgical practices is still uncharted territory,” said Dr. Blackmon. “It’s important that surgeons have a framework for making it happen more seamlessly.”

Women in Thoracic Surgery: How to Successfully Implement Surgical Innovations and New Technologies Into Practice

Monday, January 29
4:15 p.m. – 5:15 p.m.
Floridian Ballroom D

During the session, Dr. Blackmon will discuss an STS Expert Consensus Statement that provides a toolkit for surgeons and hospitals as they plan for the safe introduction and implementation of new technologies and advanced procedures in general thoracic surgery. Dr. Blackmon was the statement’s lead author.

She also will review her own experiences with innovation in the operating room, including the introduction of her patented esophageal anastomotic device, which was designed to reduce the incidence of anastomotic leaks in esophageal cancer surgery, and a patient-reported outcome app that she uses to help evaluate and manage patients following esophageal reconstruction.

The session also will address the importance of physician training for new or existing technology. Dr. Blackmon frequently performed robotic thoracic surgeries while on staff at a Houston hospital, but when she joined the Mayo Clinic 3 years ago, she didn’t have ready access to a robot.

Now that she once again has access, Dr. Blackmon is in the process of recredentialing herself in the use of robotics for improved patient care.

“Robotics is not new to me, nor is it new to the hospital. However, I felt I needed to retrain so that I could get my skills back to the level that my patients deserve before offering this technology again,” she said.

It is an important—yet often challenging—step to ensure that surgeons are up to date with privileging and credentialing for the technologies they use.

“When you are adding new technology into the clinical setting, it’s important to be transparent with your patients in regard to physician training and certification,” Dr. Blackmon said.

She emphasized that cardiothoracic surgeons have an obligation to deliver new technology to patients in a well-prepared manner.

“Just doing the same surgery you were trained to do in residency and never improving yourself, your team, or the technology means that you are not offering your patients your best,” Dr. Blackmon said. “We must continually be retraining and evaluating new technology. We must become comfortable with the continuous acquisition of new skills.”

Collaborative Approach to Cardiac Care Benefits Complex Patients

The team approach to caring for patients with heart disease can be controversial, but it has become essential in treating today’s patients, who often have multiple comorbidities and can present unique challenges.

Vinod H. Thourani, MD

A multidisciplinary “heart team” would be best positioned to assess these patients and collectively work together to find the most effective treatment algorithm, according to Vinod H. Thourani, MD, from MedStar Heart and Vascular Institute/Washington Hospital Center in Washington, DC.

Clinical Scenarios: Cardiologists and Surgeons Working Together

Monday, January 29
1:15 p.m. – 5:15 p.m.
Floridian Ballroom B-C

“When they come together, cardiac surgeons, interventional cardiologists, and echocardiographers are able to provide a multitude of options for these patients, including traditional surgery, minimally invasive surgery, and transcatheter techniques,” Dr. Thourani said.

In this afternoon’s Clinical Scenarios: Cardiologists and Surgeons Working Together, speakers will highlight the critical need for a true, collaborative heart team approach in treating mitral stenosis and regurgitation, tricuspid regurgitation, aortic stenosis and regurgitation, and surgical management of heart failure via case presentations, invited lectures, technical videos, and panel discussions.

The discussions will offer insight into how the multidisciplinary approach can improve patient outcomes and foster communication among specialties.

Dr. Thourani hopes attendees will be inspired to consider new interventional treatments and collaborative approaches.

“We would like to open the minds of practicing surgeons and help broaden the array of treatments that they can offer their patients,” he said.

 

Reimbursement Changes Require Better Reporting from Surgeons

The Importance of Physician Documentation in Reimbursement

Monday, January 29
4:15 p.m. – 5:15 p.m.
Room 301-302

Cardiothoracic surgeons spend years learning and honing skills related to surgery, but most spend relatively little time studying the business side of medicine. That may be about to change. New reimbursement rules are forcing changes in the day-to-day activities of surgeons who must now place more emphasis on documentation, coding, and data collection.

“Daily billing needs are emerging as more important, and they will play a role in the future,” said Scott C. Silvestry, MD. “Understanding what a physician has to do in terms of documenting their visits and potentially billing for these visits is emerging as an important skillset.”

Dr. Silvestry is the moderator of a session designed to teach surgeons the nuances of documenting all aspects of their work. Presenters will explain how to note the complexity of the case, the number of patient visits, time spent on a case, and the effort required by the surgeon.

“If you are going to write it once, it should reflect the amount of work that you put in and use the appropriate words so that the coders can record the appropriate credit for your work, as well as the complexity of the illness,” said Dr. Silvestry, a member of the STS Workforce on Coding and Reimbursement. “We will address how that is done in the current environment.”

The session’s speakers will explain reimbursement requirements, the documentation needed for medical necessity, diagnosis, and services rendered.

“This session will provide the start of competency towards a more productive interaction with one’s coders, coding applications, and hospital data personnel,” Dr. Silvestry said. “Attendees will leave with a good idea of the current requirements for documentation.”

 

Top