January 21-22

Hear About Hot Topics from Experts at Industry-Sponsored Satellite Activities

Satellite activities are programs offered by industry and held in conjunction with the STS 53rd Annual Meeting. They are not developed or sponsored by STS.

AtriCure & MediaSphere Medical, LLC
7:00 p.m. – 9:00 p.m.
Surgical LAA Closure: Why, When, and How
Americas Ballroom D, Hilton Americas-Houston,
1600 Lamar St.

7:00 p.m. – 10:00 p.m.
Latest Updates on the Ozaki Aortic Valve Neo-Cuspidization Procedure
Americas Ballroom BC, Hilton Americas-Houston,
1600 Lamar St.

7:00 p.m. – 10:00 p.m.
Treating Your Patients With Heart Valve Disease
Room 343AB, Hilton Americas-Houston, 1600 Lamar St.

Baxter Healthcare
6:00 p.m. – 9:00 p.m.
The Role of Advanced Hemostats and Sealants in Blood Management During Cardiovascular Surgery: A Clinical Perspective
Houston Methodist Institute for Technology, Innovation & Education, 6670 Bertner Ave., 5th Floor

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Learning Opportunities Available in the Exhibit Hall

Exhibiting companies and others will present talks and demonstrations in the Learning Lab Theater, located in the Exhibit Hall.

4:30 p.m. – 5:40 p.m.
STS Jeopardy Championship

12:45 p.m. – 1:15 p.m.
Medtronic: “Overcoming Challenges in VATS Lobectomy”

3:45 p.m. – 4:15 p.m.
Abbott: “Transcatheter Mitral Valve Repair”

10:15 a.m. – 10:45 a.m.
Houston Methodist: “Hybrid CV Surgery Room of the Future”

12:15 p.m. – 12:45 p.m.
Ethicon: “Practical Skills in Thoracic Surgery”

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Thank You

The Society of Thoracic Surgeons gratefully acknowledges the following companies for providing educational grants for the STS 53rd Annual Meeting.

STS Platinum Benefactors
Provided $50,000 or above

  • Abbott
  • Medtronic

STS Silver Benefactors
Provided $10,000-$24,999

  • Bard Davol
  • Ethicon
  • St. Jude Medical
  • Zimmer Biomet Thoracic

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MCS Advances Lead to ICU Management Challenges



8:00 a.m. – 12:00 p.m.

Room 351DEF

The increased use of mechanical circulatory support (MCS) has extended the lives of thousands of cardiac patients, but it has created challenges in the form of lengthy and expensive stays in cardiac intensive care units.

“These patients require a major utilization of resources—both hardware and human-ware. We thought it was time to specifically talk about how to care for them from an intensive care point of view,” said Glenn J.R. Whitman, MD, Chair of the STS Workforce on Critical Care and co-moderator of a symposium that will address overcoming the challenges. “This is not about how to put in a ventricular assist device (VAD). Rather, it will address how to think about MCS patients, so as to prevent or treat postoperative problems.”

The session is divided into three parts: managing patients on MCS, dealing with right ventricular dysfunction, and using a team approach. Each part will end with a discussion and examples of difficult cases.

The latest advances in left ventricular assist devices, interpreting the hemodynamics of patients on these devices, and tailoring the use of extracorporeal membrane oxygenation (ECMO) is the focus of the first section.

Vassyl A. Lonchyna, MD

Vassyl A. Lonchyna, MD

“Our aim is to refine our management of these patients in the intensive care unit because there are more patients with VADs being brought in,” said co-moderator Vassyl A. Lonchyna, MD, adding that the speakers will share their device knowledge. “There are nuances to the approach to these patients that highly experienced surgeons, cardiologists, and intensivists can pass on to the audience.”

Among the topics discussed will be whether drugs or fluids should be used to control hemodynamics and which auxiliary actions should be taken when patients are on ECMO, said Dr. Lonchyna, from The University of Chicago, who is studying medical school curricula in Ukraine as part of the Fulbright Scholar program.

Managing the right ventricle will be covered in three presentations that will focus on the interaction of the lungs with the right ventricle, noninvasive assessment using ultrasound and echocardiograms, and recognizing and treating right ventricle failure, said co-moderator Rakesh C. Arora, MD, PhD.

“These patients are challenging, so trying to understand the physiology and the heart-lung interactions is key,” said Dr. Arora, of the University of Manitoba in Winnipeg, Canada. “It is critical to identify important signs before you get into trouble with the failing right ventricle, and it involves the whole interdisciplinary team.”

Kevin W. Lobdell, MD

Kevin W. Lobdell, MD

That team-based approach will be highlighted in presentations about the roles of the intensivist and the surgeon, as well as using the “liberation bundle” to separate a patient from a ventilator through mobilization, and avoiding and treating delirium—all with the help of the patient’s family, said co-moderator Kevin W. Lobdell, MD.

“It is an inclusive, interactive process with the entire team—nurses, nurse practitioners, physician assistants, intensivists, and surgeons,” said Dr. Lobdell, of Sanger Heart & Vascular Institute in Charlotte, N.C. “It is so complex that no one person has all the pieces to the puzzle.”

Aaron M. Cheng, MD, of the University of Washington Medical Center in Seattle, also is a co-moderator.

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Session Delves Into Strategies for Cardiac Surgical Emergencies



2:30 p.m. – 4:30 p.m.

Room 360A

Ensuring optimal patient safety and outcomes during cardiac surgical emergencies requires a multidisciplinary team-based approach. A special Sunday session will examine strategies for team members as they respond to these emergencies, in particular acute aortic dissection, initiation of extracorporeal membrane oxygenation (ECMO), and decompensation related to transcatheter aortic valve replacement (TAVR).

“There has been a renewed interest in the contributions we all make to ensure we recognize these situations. We no longer are seeing the ‘captain of the ship’ mentality as being effective,” said co-moderator Jill Ley, RN, MS, of California Pacific Medical Center in San Francisco. “We all are thinking about teamwork, communication, and how to break down barriers, so that we’re all practicing as efficiently as we possibly can. This means assuring that the right members of the team are talking about how they can communicate effectively and bring everyone to the table as quickly as possible to manage these emergencies.”

Jill Ley, RN, MS

Jill Ley, RN, MS

Presenters will share the hallmark features that signal the need for emergent intervention, provide evidence-based approaches, and discuss strategies for communication and collaboration during management of acute surgical emergencies.

“The common theme we’ll discuss is how we position ourselves to train for the recognition and management of these acute emergencies,” Ley said.

When patients in the ICU present with acute aortic dissections, a host of medical professions are called upon to act quickly, said Walter H. Merrill, MD, of Vanderbilt University School of Medicine in Nashville. Dr. Merrill is Chair of the STS Workforce on Associate Membership, which planned the session.

Walter H. Merrill, MD

Walter H. Merrill, MD

“This is not an elective procedure. It’s urgent and somewhat dangerous,” Dr. Merrill said. “A patient might be stable when he or she presents in the emergency room but quickly could become unstable and die because of cardiac tamponade. It’s important to focus on the teamwork involved. Proper evaluation, diagnosis, and getting the patient through the operation and recovery is key.”

The same set of processes is vital for patients who experience cardiopulmonary compromise and warrant ECMO. Dr. Merrill noted that in the last 10 years, the use of ECMO has gone from being available at a few specialized centers to being performed at most hospitals.

“Putting a patient on ECMO doesn’t happen without a lot of planning. We want to look at best practices and raise everyone’s consciousness so they understand how to care for these patients,” Dr. Merrill said.

Although TAVR procedures are becoming more common, patients may develop heart failure due to acute aortic regurgitation and require intubation.

“Sometimes, a TAVR procedure must be converted to a surgical aortic valve replacement,” Dr. Merrill said. “One has to be prepared for everything. It’s not always simple and straightforward.”

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Adult, Pediatric Surgeons Can Collaborate for Improved Outcomes



8:00 a.m. – 12:00 p.m.

Room 350DEF

Advances in surgical options for aortic valve disease and failing Fontans are helping to change long-term treatment strategies for patients with congenital heart disease. Surgeons have the potential to improve outcomes for adult and pediatric heart patients by sharing lessons learned in their respective areas of expertise.

Management strategies and tips will be provided in a 4-hour symposium on Sunday. The first part of the session will focus on managing aortic valve and aortic root disease, while the second part will look at issues related to transplantation and artificial hearts.

Jennifer S. Nelson, MD

Jennifer S. Nelson, MD

“The spirit of this session is to share ideas, collaborate, and focus on areas in cardiac surgery where pediatric cardiac surgeons and adult cardiac surgeons overlap,” said Jennifer S. Nelson, MD, symposium co-moderator and a congenital heart surgeon from Norfolk, Va. “We think that collaboration and sharing of ideas make us all better. This session asks you to step outside your comfort zone to see how it is done on the other side.”

Two presentations in the first part of the symposium will try to put in perspective two options for replacing aortic valves—transcatheter aortic valve replacement (TAVR) and a Ross procedure.

Vinod H. Thourani, MD, of Emory University in Atlanta, will discuss staging for TAVR. As aortic valve replacement has become more common in older patients, surgeons have begun to think about how that affects the treatment of young adults.

“The younger aortic valve population may require TAVR in the future, so this talk is designed to shed some light on staging, which is setting up that valve for the next valve procedure if it is going to be percutaneous,” Dr. Nelson said.

Another option is a Ross procedure. Richard G. Ohye, MD, of the University of Michigan C.S. Mott Children’s Hospital in Ann Arbor, will present data from his institution and discuss his indications for performing the procedure.

“When do the benefits of a Ross procedure in an older child become outweighed by the risks?” Dr. Nelson asked. “At what age is a mechanical valve or other prosthetic valve a better choice? We now have more long-term outcomes data on the durability of the Ross procedure.”

The session also will address when to determine if a valve-sparing procedure is not an option and long-term outcomes for repair of bicuspid aortic valves.

During the second half of the session, two presentations will focus on the long-term impact of living with single-ventricle physiology.

Steven J. Kindel, MD, from Children’s Hospital of Wisconsin in Milwaukee, will examine the timing of transplantation for a patient with a failing Fontan, as well as the role of temporary mechanical support as a bridge to transplantation. Kristine J. Guleserian, MD, of Miami Children’s Hospital, will discuss the challenges of transplantation in adult congenital patients who have been operated on several times.

“In the multiple redo situation, these can be very difficult cases. There often is a lot of reconstruction to be done,” Dr. Nelson said. “Dr. Guleserian will present video and photos to describe techniques and strategies not only for how you implant and reconstruct during the transplant, but also how you should harvest organs to make these reconstructions successful.”

Two personal case studies dealing with failing Fontans will be covered in another presentation by Carl L. Backer, MD, of Northwestern University School of Medicine in Chicago.

Two other surgeons will present tips for success on the cutting edge of mechanical support. Francisco A. Arabia, MD, MBA, of Cedars-Sinai Medical Center in Los Angeles, and J. William Gaynor, MD, of Children’s Hospital of Philadelphia, will discuss total artificial heart implantation and the use of artificial heart devices in patients with small body surface areas.

Dr. Nelson’s co-moderators are Joshua L. Hermsen, MD, of the University of Washington in Seattle, Robert B. Jaquiss, MD, of Duke University Medical Center in Durham, N.C., and Frank G. Scholl, MD, of Joe DiMaggio Children’s Hospital in Hollywood, Fla.

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Session to Show Cutting-Edge Congenital Procedures



1:00 p.m. – 4:30 p.m.

Room 350DEF

Learning cutting-edge approaches to treat congenital cardiac conditions can be a challenge. Increasingly, surgeons are using a variety of educational modes, including videos, interactive discussions of clinical scenarios, and lectures, to smooth out the learning curve.

“We have feedback from prior STS symposia on the educational approaches surgeons like the most and are using that to present innovative techniques that have had a bit of road testing,” said Jonathan M. Chen, MD, co-moderator of a Sunday afternoon session that will feature those approaches in 12 presentations.

The program contains three basic formats: complex case discussion, invited lecture, and short technique video. A variety of topics will be covered, including pulmonary vein stenosis, dilated cardiomyopathy, damaged heart valves, complex airway disease, and trisomy 13/18.

Fellows and junior faculty from different centers will present the complex cases with at least three therapeutic options. The surgeon who performed the operation will then defend the chosen therapy and present the result.

“Experts will give their opinions about why they would choose one option or another,” said Dr. Chen, of the University of Washington in Seattle. “It should have lively interaction because the cases chosen are intentionally controversial.”

Following each discussion will be a lecture. First up will be “Should We Offer Operations to Patients With Trisomy 13 or 18?” by Aarti Bhat, MBBS, of Seattle Children’s Hospital.

“These infants have a high mortality simply from their native disease, so there is a clinical conundrum as to whether one should even operate on these children,” Dr. Chen said. “It is a big ethical problem we all face, but most of our clinical protocols are based on historical anecdotal impressions, which may or may not be true in the current era. Dr. Bhat will address both the ethical aspects and the hard data on survival.”

Iki Adachi, MD will present “Pulmonary Artery Banding for Dilated Cardiomyopathy: North American Experience.” Dr. Adachi, of Baylor College of Medicine in Houston, is a leader in the use of a pulmonary artery band to manage the condition.

“This simple operation has turned out to work quite successfully in selected cases. Interestingly, Dr. Adachi’s first presentation of these data was at the congenital symposium 2 years ago as a complex case discussion. Fast forward 2 years, and it is an innovative procedure with preliminary data worldwide from which we can all learn,” Dr. Chen said.

Shigeyuki Ozaki, MD will discuss “Aortic Reconstruction With Autologous Pericardial ‘Neo-Cusps,’” a procedure he has demonstrated at major children’s hospitals. Dr. Ozaki is from Toho University Ohashi Hospital in Tokyo.

“With the Ozaki technique, a surgeon can replace the aortic valve with a valve created out of the patient’s pericardium,” Dr. Chen said. “It works quite well, and Dr. Ozaki has incredible data out to 8 years with remarkable rates of success.”

By measuring the size of a patient’s natural valve opening with templates created by Dr. Ozaki, surgeons can determine the size of the replacement valve.

Christopher A. Caldarone, MD, of the University of Toronto, will explain the science behind “What’s New in the Management of Pulmonary Vein Stenosis.” He helped lead the development of a commonly used stenosis procedure.

“More recently, the focus has been on the basic science behind the disease process, so his talk will be a mix of science and clinical applications,” Dr. Chen said.

Sitaram M. Emani, MD will present a video demonstrating how to implant a Melody valve in infants.

Sitaram M. Emani, MD will present a video demonstrating how to implant a Melody valve in infants.

The first of four video presentations will be “Novel Use of Expandable Valves.” Sitaram M. Emani, MD, of Boston Children’s Hospital, will demonstrate Melody valve implantation in infants.

“It is a very technical video that focuses on the implant, specifically where to put the suture that anchors the device in the left ventricle. I look forward to this because it’s a chance to ask the technique questions I always want to ask,” Dr. Chen said.

Scott M. Bradley, MD, of the Medical University of South Carolina in Charleston, will present “Repair of Atrioventricular Valves in Single Ventricle Patients.”

“These are children with one dominant valve that is often very distorted and abnormal, and it is a real challenge to repair them. The degree of success with such a repair can be the difference between successful single ventricle palliation and transplantation,” Dr. Chen said.

Christopher E. Mascio, MD, of the Children’s Hospital of Philadelphia, will show “Advanced HeartWare Techniques.” “He will have tips and tricks on how you implant a ventricular assist device that was not made to be put into a child,” Dr. Chen said.

Michael E. Mitchell, MD, of the Children’s Hospital of Wisconsin in Milwaukee, will present “Aortopexy in Complex Airway Disease.” “For people who are not used to seeing these techniques, it is going to be really interesting and helpful,” Dr. Chen said.

Dr. Chen’s co-moderators are Dr. Mascio and Glen S. Van Arsdell, MD, of the University of Toronto.

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STS Staff Welcomes You to Houston

Rob Wynbrandt

Rob Wynbrandt

On behalf of the Society’s staff, I join STS President Joe Bavaria in welcoming you to The Society of Thoracic Surgeons 53rd Annual Meeting and Exhibition in Houston, Texas. As in the past, the Annual Meeting will provide you with a wide range of educational, networking, and social offerings.

Because there is so much to experience between Saturday and Wednesday, this STS Meeting Bulletin will help you keep track of what’s happening and provide up-to-date information about new sessions, meeting room locations, exhibitor descriptions, and much more.

Watch for the Monday and Tuesday/Wednesday editions of the Bulletin; the newspapers will be placed in bins throughout the George R. Brown Convention Center during the Annual Meeting. Check the front page left-hand column in each issue for a quick summary and update of the day’s activities.

The Bulletin also provides a handy reference to the Exhibit Hall, which is an important component of the meeting experience. The Exhibit Hall is a great place to learn about new and improved technology and products, and it offers the perfect opportunity to see and meet with colleagues and friends. Surveys from past meetings show that the majority of attendees make a point of visiting with the exhibitors at least three times over the course of the meeting. The STS Exhibit Hall opens its doors at 4:30 p.m. on Sunday, with a reception that runs through 6:30 p.m. Snacks and refreshments will be served throughout the Exhibit Hall.

While you’re there, I hope you will stop by the STS booth (#533). Staff members will be there, eager to talk with you about—and provide updates on—all things STS. Be sure to ask about plans to upgrade and expand the STS National Database, our public reporting initiatives, exciting developments from the STS Research Center—including the new PUF Research Program—and upcoming educational programs, such as the STS ECMO Symposium and the Symposium on Robotic Mitral Valve Repair, both scheduled for this coming March.

You also will want to take a moment and talk with the STS Government Relations staff, who can bring you up to date on the Society’s many efforts on Capitol Hill. From coding and reimbursement issues to the future of health care reform legislation and regulation in the new Administration, STS continues to champion the specialty in Washington. Stop by and learn more. There’s a lot going on, perhaps more than ever this coming year—and you’ll want to understand the implications for your practice.

If you are not already an STS member, please stop by the STS booth and learn about the many membership benefits we have to offer, including a complimentary subscription to The Annals of Thoracic Surgery. Those attendees who are not cardiothoracic surgeons—i.e., other physicians, CT surgery and general surgery residents, medical students, and all allied health care professionals—should especially note that our rolling admission process for Candidate, Pre-Candidate, and Associate Membership allows for the prompt disposition of their STS membership applications, typically within a week or two, so that they can start enjoying the benefits of STS membership almost immediately. And under the Bylaws changes adopted by the membership last year in Phoenix, we are also acting more promptly on CT surgeon applications for Active and International Membership: three times per year instead of once! Even if you already are an STS member, please pick up a membership packet to take home to a colleague; you will be helping both your colleague and your Society.

All the scientific sessions at this 53rd Annual Meeting, including the symposia, early riser sessions, breakout sessions, hands-on sessions, and invited talks, create a vast array of educational opportunities—more than any one person could ever attend onsite. Fortunately, the STS 53rd Annual Meeting Online is included free with your Annual Meeting registration. This online product will allow you to catch those sessions you weren’t able to attend—and review all the sessions you did attend—in the comfort of your home or office throughout the year ahead.

In closing, please know that all of us on the staff are here to serve you. Look for the distinctive green STAFF ribbon on our name badges, and please don’t hesitate to let us know if there’s anything we can do to help.

Thank you for attending, and enjoy the meeting.

Rob Wynbrandt
STS Executive Director & General Counsel

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Changes in Practice Models Require Adjustments



8:00 a.m. – 12:00 p.m.

Room 360A

Changes in the regulation of health care and reimbursement are driving more cardiothoracic surgeons into practice models with new business strategies. Surgeons need to keep pace with changing trends as they increasingly join larger medical practices or hospitals in this new environment.

“Many cardiothoracic surgeons are no longer in independent private practices but are aligned with large health care systems. We still deal with the business aspects of delivering cardiothoracic surgery services and how to best deliver care for our patients, but the landscape has changed, and is continuing to change rapidly,” said Frank L. Fazzalari, MD, MBA, Chair of the STS Workforce on Practice Management.

Frank L. Fazzalari, MD, MBA

Frank L. Fazzalari, MD, MBA

Changing from a fee-for-service model of reimbursement to a value-based one will be examined by cardiothoracic surgeons and non-surgeons involved in health care management in a series of Sunday presentations. Dr. Fazzalari, of the University of Michigan Health System in Ann Arbor, and Paul S. Levy, MD, MBA, of Northeast Arkansas Baptist Hospital and Clinic in Jonesboro, are co-moderators.

Many of the reimbursement changes are driven by the Centers for Medicare & Medicaid Services. Eight speakers will discuss these developments, their impact on practice, and how to address them in a session divided into two parts, with panel discussions at the end of each section.

“These changes are not well defined. A lot of this is new thinking, and it is untried,” Dr. Fazzalari said of the evolving CMS regulations. “What we are trying to do in this Practice Management Summit is provide an educational program that helps practicing cardiothoracic surgeons deal with the changes.”

The first speaker is Aaron Robinson, CEO of Community Hospitals with Health First in Melbourne, Fla., who will examine bundled care plans in “Defining Value in the Cardiovascular Service Line.”

Michael N. Heaton, a health care business consultant from Indianapolis, will discuss contract negotiations during “Recent Trends in Economic Surveys and Their Use in Contract Negotiations.” The focus will be on employee models and professional service agreements, including compensation.

Michael G. Moront, MD, of ProMedica Toledo Hospital in Ohio, will present “Work Relative Value Unit Employment Models: A Bad Choice for Cardiothoracic Surgeons,” looking at models used in some health systems to determine the productivity of surgeons.

Chair of the STS Standards and Ethics Committee Richard I. Whyte, MD, MBA, of Beth Israel Deaconess Medical Center in Boston, will present “Ethical Issues in an Employment Model.”

In the second half of the session, health care attorney Mark Kopson, of Plunkett Cooney in Bloomfield Hills, Mich., will discuss “Experience in Dealing With Employed Physicians,” with a focus on his background in contracting and employing physicians.

Steven V. Manoukian, MD, of Nashville, will present “Partnering for Excellence in Today’s Health Care Environment: Health Corporation of America’s Cardiovascular Service Line” and review his experience working with hospital health systems.

Alan M. Speir, MD, of Cardiac, Vascular and Thoracic Surgery Associates in Falls Church, Va., will review legislative issues in “Update From the STS/AATS Workforce on Health Policy, Reform, and Advocacy.” Dr. Speir is Chair of the Workforce.

The final speaker will be Steven F. Bolling, MD, also of the University of Michigan Health System, who will present “How to Take Your Idea From a Napkin to a Company.”

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Special Session to Examine Heater-Cooler-Induced Infections



7:00 a.m. – 8:00 a.m.

Room 310ABC

Nontuberculous mycobacterium (NTM) forming in heater-cooler devices commonly used in operating rooms have been linked to deadly infections that are difficult to detect and may not manifest themselves for years following surgery.

“This is considered by both the CDC and FDA as an emerging public health concern that has generated multiple medical alerts,” said Keith B. Allen, MD, of St. Luke’s Mid American Heart Institute and the University of Missouri–Kansas City.

Dr. Allen will present an abstract on these infections associated with the use of heater-cooler devices in patients who have undergone cardiothoracic surgeries. A panel discussion featuring cardiothoracic surgeons and infectious disease experts also is part of the Sunday session.

Contamination can be seen in the dark area of a heater-cooler device tube. Photo provided by Keith Allen, MD.

Contamination can be seen in the dark area of a heater-cooler device tube. Photo provided by Keith Allen, MD.

Mycobacterium chimaera infections have been reported in at least six countries in North America and Europe. Of great concern is that the infections have a long latency period of up to 60 months, Dr. Allen said. Specific culturing techniques are required to detect NTM.

“NTM is a ubiquitous organism that can contaminate these heater-cooler devices,” he said. “Even though the devices do not come into direct contact with the patient’s blood or body fluids, they have the potential to aerosolize these bacteria into the surgical field, which then contaminate devices that are implanted into the patient or the surgical wound itself.

“What makes these infections so problematic is that they are difficult to grow. If you have somebody who presents with fevers and you are doing normal cultures, you would never culture NTM. It can take up to 8 weeks to grow, so you have to be aware of the problem and have it be part of your differential to make the appropriate diagnosis.”

Keith B. Allen, MD

Keith B. Allen, MD

Dr. Allen, lead author of the abstract, worked with other experts at the request of the FDA, which organized a Circulatory Device Panel meeting last summer to address the problem.

“This is a problem that is not going to go away,” Dr. Allen said. “Patients can be exposed to this in an open heart operation, and they might not manifest symptoms for 3 years or more.

“We are looking at the tip of the iceberg. There probably have been a lot of patients who had issues that were never diagnosed because we were not aware of it as a problem. That’s why this session is so important.”

Learn What You Can Do

In November, STS and several other societies issued a joint statement to the worldwide cardiothoracic community offering resources and other information from government entities and health care providers. To learn more about the heater-cooler situation, go to sts.org/heater-cooler.

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