2018 Annual Meeting Preview

Education with an Edge

Brett C. Sheridan, MD (left) and STS Secretary Joseph F. Sabik III, MD (right) help plan the adult cardiac educational sessions.

Sessions feature innovative research, cutting-edge videos, and lively debates

If you want to stay at the forefront of what’s new in cardiothoracic surgery, mark your calendar now for the STS 54th Annual Meeting to be held Saturday, January 27, through Wednesday, January 31, in Fort Lauderdale, Florida.

“The meeting will be an unparalleled educational experience,” said STS President Richard L. Prager, MD. “This is an opportunity to meet colleagues and friends from around the world, hear new ideas and concepts, and learn from each other.”

This meeting promises to be more edgy. “For example, instead of having several sessions consisting only of scientific abstracts, we encouraged our program committee to incorporate not only the very best abstracts—of which there were many—but also lively debates and surgical videos,” said Himanshu Patel, MD, Chair of the Workforce on Annual Meeting.

Hot Topics in Each Subspecialty

All cardiothoracic surgery team members will find educational programming relevant to their everyday practices. Three “How To” video sessions will be held on Sunday—one for each subspecialty. These dynamic sessions will feature video presentations on common cardiothoracic surgical procedures, with speakers offering unique insights. Other sessions on Sunday include the Practice Management Summit, the STS/AATS Critical Care Symposium, and the Adult Congenital Heart Disease Symposium.

On Monday and Tuesday, sessions for adult cardiac surgery will cover arrhythmia/atrial fibrillation, ischemic disease, mitral and tricuspid valves, and more.

“Cardiothoracic surgery is moving at a rapid clip. Some of our operations are moving from large, open procedures to small, minimally invasive, transcatheter, and other less invasive procedures to improve the health of our patients,” said STS Secretary Joseph F. Sabik III, MD. “It’s a very exciting time to be in heart surgery, and we’ll explore all of these topics at the meeting.”

The general thoracic surgery sessions will feature presentations on robotic surgery, esophageal disease, lung cancer, and more. Monday’s “Lung Cancer I” session will tackle the current opioid epidemic in the United States. It also will present an abstract on factors associated with new persistent opioid use after lung resection and an invited talk on the thoracic surgeon’s role in addressing the issue.

“For the first time, we’ll have a session on Tuesday dedicated to health services research and database analyses,” said David Tom Cooke, MD, a member of the Workforce on Annual Meeting. “We’ll also have sessions highlighting innovative clinical general thoracic surgery research, including lung cancer, esophageal cancer, and lung transplantation.”

Congenital heart surgeons can expect a mix of scientific abstracts, invited talks, debates, and videos covering disease processes in both children and adults.

“We’re going to have sessions on management of Ebstein anomaly from the newborn to the adult, complex two-ventricle repairs in patients with heterotaxy syndrome, and systemic atrioventricular valve repair in children with congenital heart disease,” said James S. Tweddell, MD, a member of the Workforce on Annual Meeting.

Improving Diversity

A new session on Monday will tackle diversity and inclusion in cardiothoracic surgery. Speakers will discuss how a diverse cardiothoracic surgery workforce can improve patient outcomes by increasing cultural competency and mitigating unconscious provider bias.

“The session will enable you to best interact with your communities and provide care for your patients in a culturally competent manner,” said Dr. Cooke, who also chairs the Special Ad Hoc Task Force on Diversity and Inclusion.

Other new offerings include a collaborative session with the International Society for Heart & Lung Transplantation, STS University courses on peroral endoscopic myotomy and minimally invasive aortic and mitral valve surgery, and a session explaining how physician documentation drives reimbursement.

View the Advance Program and register for the meeting at sts.org/annualmeeting.

The Society of Thoracic Surgeons is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

STS 54th Annual Meeting: The Society of Thoracic Surgeons designates this live activity for a maximum of 26.75 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

The Society of Thoracic Surgeons has been approved by the American Board of Cardiovascular Perfusion to award 31.7 Category I CEUs for this activity.

Register Today

Register and reserve  your housing for the  STS 54th Annual Meeting at sts.org/annualmeeting. You must register by Thursday, January 4, 2018, to receive special Annual Meeting rates for your housing.

STS/AATS Tech-Con 2018  and the STS 54th Annual Meeting  require separate registration. Tech-Con registration provides access only to the educational sessions on Saturday, January 27. Annual Meeting registration provides access only to the educational sessions from Sunday, January 28, to Tuesday, January 30. You also will receive complimentary access to Annual Meeting Online with your Annual Meeting registration.

Tickets for the President’s Reception at the Fort Lauderdale Marriott Harbor Beach Resort & Spa on Sunday evening, January 28, and STS University courses on Wednesday, January 31, require separate purchases with Annual Meeting registration.

If you have questions about registration, contact the Society’s official registration partner, Experient, at (800) 424-5249 (toll free), 00-1-847-996-5829 (for international callers), or sts@experient-inc.com.

Understanding Bias Helps Improve Patient Safety


Tuesday, January 30
1:00 p.m. – 5:30 p.m.
Rooms 301-302

Medical errors may have roots in cognitive biases

In this era of evidence-based medicine, evidence can sometimes be ignored during diagnosis and treatment, leading to adverse events. The 2018 Patient Safety Symposium will explore how cognitive biases and “rules of thumb” can affect clinical decisions.

“The purpose of the symposium is to explore, understand, and talk about these biases,” said moderator Michael S. Kent, MD. “We will give specific examples to help explain these biases and how we make decisions when it comes to individual patients.”

Symposium topics include how heuristics affect everyday decisions, why evidence is sometimes ignored, how root cause analysis could be used to reduce biases, and how surgeons can learn from errors.

Physicians often must make decisions when the evidence does not appear to fit a specific case or if no guidelines have been developed, said Dr. Kent, a member of the STS Workforce on Patient Safety.

“Even though there is a lot of evidence for helping us make clinical decisions, it is our job as physicians to make individual decisions based on individual patients,” he said. “With that context, there are a lot of biases that come into play when we make decisions.”

One speaker will be a psychiatrist with an expertise in understanding biases. He will explain heuristics, which are rules of thumb used in everyday life.

“We allow these biases to become part of our subconscious, and they make a great impact on how we make decisions,” Dr. Kent said. “The psychiatrist will explain how they are present even if we don’t know about them and how they affect our decision making.”

A cardiothoracic surgeon will explore why surgeons override guidelines, such as those for blood transfusion rates. There is great variability among institutions and even among surgeons in the same institution about transfusion rates, Dr. Kent said.

Biases are at the root of this variability, and one option to reduce their impact is root cause analysis.

“This is a technique where providers look at a surgical error in retrospect and try to understand why it happened,” Dr. Kent said. “The goal is to prevent future errors. Root cause analysis has been useful in helping providers identify biases that might impact their decisions.”

In addition, a cognitive psychologist, whose focus has been the integration of concepts from psychology, computer science, and the social sciences, will address how experts in medicine and other high-pressure environments make decisions and deal with complexity.

The symposium will conclude with a panel discussion and a question-and-answer session.

Relax and Recharge in Fort Lauderdale

Scenic beaches and waterways make Fort Lauderdale a prime vacation destination, but the city offers much more. Before and after the STS Annual Meeting, attendees can take advantage of a diverse selection of lively shopping and entertainment districts, cultural activities, and fine dining.

Standout Cuisine

It should be no surprise that Fort Lauderdale features a wealth of delicious seafood, given its waterfront location. After the meeting wraps up for the day, head to one of the area’s many outstanding restaurants.

The 15th Street Fisheries is located directly inside the Lauderdale Marina, offering you a prime view. There’s a more formal dining room upstairs and a casual dockside restaurant downstairs. Both menus feature a variety of fresh seafood, which you can enjoy while watching yachts, fishing vessels, and other boats cruising down the Intracoastal Waterway.

Market 17 is a farm-to-table restaurant featuring housemade charcuterie and a constantly changing rotation of dishes. A unique option is the restaurant’s “dining in the dark” experience. This multicourse meal is served in a pitch-black private room, with the idea being it will heighten your other senses by experiencing the food without the help of your sight. The chef creates new dishes separate from the main menu, and reservations are required as only two seatings are offered each night.

Other great dining options include Greek Islands Taverna (authentic Greek), Sea Watch on the Ocean (fresh-caught seafood dining set on a bluff 50 yards from the ocean), and Shooters Waterfront (laid-back experience with a view).

Nearby Sights

If you plan to arrive before the meeting or stay after, Fort Lauderdale has plenty to do for every interest.

The Riverwalk Fort Lauderdale spans the north and south banks of the New River, which is located right downtown. Meander along the waterfront while you visit shops, restaurants, museums, and other attractions.

In the area’s historic district, the Stranahan House is the oldest surviving structure in Broward County, built in 1901 as a trading post and converted into a residence in 1906. In the arts and science district farther west, the Broward Center for the Performing Arts features concerts, dance performances, comedy, and more.

Day Trips

If you have the opportunity to extend your visit, there are several things to do within a day’s drive.

The Florida Everglades is a tropical wetlands spanning 1.5 million acres. A 30-minute drive from the convention center will take you to Everglades Holiday Park, a working park and rescue operation that offers airboat rides, a gator show, and one-on-one encounters with a variety of animals such as tortoises, snakes, and a baby alligator.

If you want to trade Fort Lauderdale’s vintage vibe for the exotic atmosphere of Miami, head less than an hour south and hit the city’s Design District, which features luxury shops, restaurants, art galleries and museums, and home design showrooms. South Beach is well-known for its glamorous nightlife, as well as its art deco architecture.

For additional information on dining, attractions, and much more, visit sunny.org.

Looking at Tomorrow’s Technologies

Hear about new technology that will change your practice at Tech-Con 2018.

Tech-Con pulls back the curtain on innovative products

Learn about cutting-edge technologies and new developments in cardiothoracic surgery at STS/AATS Tech-Con 2018. Held Saturday, January 27, the day before the opening of the 54th Annual Meeting, Tech-Con will offer separate tracks for adult cardiac and general thoracic surgery.

Tech-Con also will feature a Shark Tank session, in which entrepreneurs will pitch their innovative cardiothoracic surgery products to the audience and a panel of experts in medical device development. Representatives of several companies developing robotic technology also have been invited to present.

“I think not attending Tech-Con leaves you a bit antiquated,” said Tech-Con Task Force Co-Chair James D. Luketich, MD. “So many new techniques and technologies will be coming out at Tech-Con. You may not be doing these procedures today, but they’re what we’re going to be doing tomorrow.”

Tech-Con registration is separate from Annual Meeting registration. Register today at sts.org/annualmeeting. Continuing medical education credit will not be offered for Tech-Con programming.

Symposium Highlights Techniques to Manage Heart Infections


Monday, January 29
1:30 p.m. – 3:30 p.m.
Room 304

Juan P. Umaña, MD

Infectious heart disease, especially as a result of the current opioid epidemic, is on the rise among young adults. At the International Symposium, surgeons from around the world will explain their approaches to dealing with these infections, the central challenges they face, and the ethical disease management dilemmas related to infectious heart disease in young adults.

“Many surgeons in developing countries don’t have the resources they need to treat these patients,” said session moderator Juan P. Umaña, MD, of Fundacion Cardoinfantil-Institute of Cardiology in Bogota, Colombia. “Imaging techniques are not readily available, so discussing a simple algorithm in how to approach these patients will be a major focus.”

Taweesak Chotivatanapong, MD will explain approaches he uses in the treatment of infected mitral valves in patients with rheumatic heart disease. Dr. Chotivatanapong is from the Central Chest Institute of Thailand.

The symposium’s focus will then shift to the bicuspid aortic valve in a presentation by Joseph E. Bavaria, MD, of the University of Pennsylvania in Philadelphia.

“One of the issues in developing countries is the fact that aortic and mitral valves  don’t get repaired as often as they should,”  Dr. Umaña said. “Dr. Bavaria will talk about how to repair and secure the infected bicuspid aortic valve. He will review the long-term prognosis of the repaired valve in young adults.”

Michele De Bonis, MD will examine the timing of surgery for endocarditis to avoid neurological complications. He is a surgeon at Vita-Salute San Raffaele University in Milan, Italy.

“With less access to medical and dental care, patients tend to have more infections of native valves or previously implanted prostheses,” Dr. Umaña said. “This will focus on two big issues—the fact that valves need to be repaired more often and how to approach and repair those infected valves.”

Enrico Ferrari, MD, of Cardiocentro Ticino in Lugano, Switzerland, will explain transcatheter interventions for previous repairs that are failing.

“This talk will bring into the mix technologies that are being applied in developed countries and try to rationalize  their use for the international community,”  Dr. Umaña said.

Darshan Reddy, MBChB will discuss the use of anticoagulants and how they can affect valve thrombosis. He is from Inkosi Albert Luthuli Central Hospital in Durban, South Africa.

“Thrombosis of a previously implanted prosthesis is a big issue,” Dr. Umaña said. “How to handle them pharmacologically or perhaps mechanically is something that is worth discussing.”

To wrap up the session, Joseph S. Coselli, MD, of the Texas Heart Institute in Houston, will explain the latest treatments used at his institution to manage infected aortic prostheses, particularly Dacron tubes or endoprostheses.

“This is a big issue because often you are faced with young patients who require extensive operations to remove the bulk of the disease,” Dr. Umaña said. “That may require extra-anatomic bypasses or the use of homografts that sometimes are not available in developing countries. This talk will be of tremendous value to the international community.”

STS University: Take Learning to New Levels

Cap off your Annual Meeting experience by attending STS University on Wednesday, January 31. These hands-on courses allow you to gain experience performing a variety of cardiothoracic surgical procedures. Expert instructors will work closely with small groups and will provide ample opportunity for questions and individual instruction.

STS U courses 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. To attend, you must purchase tickets separately from your Annual Meeting registration. Sign up today at sts.org/annualmeeting.

Please note that STS University features only hands-on learning. Attendees are strongly encouraged to review the didactic lectures in advance. View course materials at sts.org/stsuniversity.

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

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

Course 10:      POEM Skills NEW!


Reimbursement Changes Require Better Reporting from Surgeons


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

Scott C. Silvestry, MD

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 skill set.”

Dr. Silvestry is the moderator of a new 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 toward 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.”

Should Patients Be Left in the Care of a General Surgeon?


Monday, January 29
4:15 p.m. – 5:15 p.m.
Room 315

Robert M. Sade, MD

Ethics Debate explores  postoperative coverage

More smaller or remote health care facilities are requesting assistance from cardiothoracic surgeons at major hospitals, leading to controversy over what happens when the cardiothoracic surgeon leaves. Oftentimes, patient care is transferred to a less experienced general surgeon. During the 2018 Ethics Debate, two cardiothoracic surgeons will explore the pros and cons of this trend.

The American College of Surgeons states that the surgeon remaining at the hospital must be able to “render surgical care equivalent to that performed by the surgeon who performed the operation.”

“What does that mean?” asked STS/AATS Cardiothoracic Ethics Forum Chair Robert M. Sade, MD. “Does that mean that the surgeon who stays behind needs to be a cardiothoracic surgeon? There are people who believe strongly that is the case.”

James S. Allan, MD, of Massachusetts General Hospital, will argue that postoperative coverage by a general surgeon is an acceptable arrangement, while Alberto Ferreres, MD, PhD, of the University of Buenos Aires School of Medicine, will argue that a cardiothoracic surgeon must provide postoperative coverage.

“The best part of the debate is when we open the floor for discussion,” Dr. Sade said. “That is when sparks start to fly, and things get really interesting. We usually get a lot of comments from the audience.”

The situation of a traveling surgeon leaving a patient behind shortly after surgery is “a growing phenomenon” and an ethical quandary, he said.

“The debate is unlikely to provide a definitive answer to this question,” Dr. Sade said. “It is going to provide two different ways of thinking about it. Then, it will be up to whoever is in the audience to take that information and decide how they would handle it if it comes up.”

STS Moves to Create a More Diverse Specialty


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

David Tom Cooke, MD

Session aims to cultivate environment of inclusion in cardiothoracic surgery

Recognizing the growing diversity of cardiothoracic surgery patients and the population at large, the Society’s Special Ad Hoc Task Force on Diversity and Inclusion has designed a new session to 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.

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

During the session, David A. Acosta, MD will explain how a diverse environment can improve health care outcomes, as well as an organization’s overall effectiveness and productivity. Dr. Acosta is the Chief Diversity and Inclusion Officer at the Association of American Medical Colleges. Afterward, Dr. Cooke will lead a discussion among a panel of Society leaders, a patient advocate, a medical student, a cardiothoracic surgery resident, and academic and community-based cardiothoracic surgeons. Results from a recent survey of US-based STS members will be presented, and questions from the audience will be encouraged.

“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 develop 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 the STS. We know that the more diverse the cardiothoracic surgery workforce is, the better we can serve our communities,” Dr. Cooke said.