January 25 2020

Welcome to New Orleans

On behalf of the STS leadership, thank you for joining us in the Big Easy at the 2020 STS Annual Meeting! New Orleans is a vibrant city with a rich history—and I know you’ll enjoy not only the educational offerings, but also the cultural experiences that await you.

Robert S.D. Higgins, MD, MSHA

Robert S.D. Higgins, MD, MSHA

New this year, the meeting begins with a full day of sessions on Saturday, starting with STS University and ending with the always-thrilling Shark Tank presentations during Tech-Con. We also have added a new keynote lecture on Sunday, will demonstrate our next generation STS National Database throughout the meeting, and have many engaging scientific and educational discussions both inside and outside of the session rooms. I hope you take advantage of as many of these activities as possible, as well as spend time with our exhibitors and network with colleagues, before the conclusion of the meeting on Tuesday afternoon. 

Keynote Lecturers
I’m extremely proud of our lineup of inspiring keynote speakers—especially on Sunday, with the introduction of a new lecture honoring Vivien Thomas, the surgical technician who helped pioneer the anastomosis of the subclavian artery to the pulmonary artery. His contributions went unrecognized for many years, but now we can pay tribute to him in a national forum. The inaugural Vivien Thomas Lecture will be given by Dr. Clyde Yancy, vice dean for diversity and inclusion and chief of the Division of Cardiology at Northwestern University’s Feinberg School of Medicine in Chicago, as well as a past president of the American Heart Association.

On Monday, Dr. Domenico Pagano will deliver the Thomas B. Ferguson Lecture on the soundness of data that support the practice of evidence-based medicine. And on Tuesday, our C. Walton Lillehei Lecturer, Dr. Bartley Griffith, will speak about the journey toward a wearable pump lung.

I hope you will attend each of these keynotes, as well as my Presidential Address on Monday morning at 11:15, “On Life, Leadership, and the Pursuit of Happiness.”

Database Updates
The meeting also is a great opportunity for you to learn more about our next generation STS National Database. In the coming weeks, participants will have access to their data on state-of-the-art, interactive dashboards that are available 24/7 on a highly secure platform. And we’ll continue to roll out new features throughout the year. These features will help you save time and resources, while accelerating quality improvement and point-of-care decision-making. STS staff will be available in the Exhibit Hall to answer your questions, and you can hear more during the plenary session on Monday morning.

I’m thrilled that the new Database is ready after working on this project for more than 2 years. I’m also thrilled with the many exciting sessions on the program that will help you stay informed about the most pressing issues facing the specialty. Recent discussions surrounding the ISCHEMIA trial have led to a fierce debate about how to best treat patients with severe but stable angina. We’ll explore what cardiothoracic surgeons need to know in the Adult Cardiac: Ischemic session on Monday afternoon. I’m also looking forward to illuminating sessions on transcatheter aortic valve replacement in low-risk patients, machine learning in the prediction of cardiothoracic surgery outcomes, and lymphatic intervention after congenital heart surgery.

We’ll extend the conversations about some of these hot topics in one of the Exhibit Hall theaters. On Tuesday, you can take part in discussions on “Recent Clinical Trials and Their Impact on You” and “Training the Thoracic Surgeon.” 

You won’t want to miss these discussions or sessions that we’ve developed in conjunction with other organizations from around the world, including “Controversies in Thoracic Organ Failure” with ISHLT, “Surgery for Advanced Stage Cancer—When Is Out of Bounds Not Out of Bounds?” with CATS, and “Bicuspid Aortic Valve Repair with Aortic Root Aneurysm—Techniques and Outcomes” with EACTS.

I would like to thank Dr. David Cooke, chair of the STS Workforce on Annual Meeting, as well as the entire Program Committee and the STS staff, for putting together a meeting that I hope will educate us, motivate us, and remind us that it’s all about the patient. 

Thank you again for being here. I look forward to spending time with you in the coming days. 

Robert S.D. Higgins, MD, MSHA
STS President

Is It Too Soon to Consider TAVR for Younger, Low-Risk Patients?

A Sunday session will explore whether transcatheter aortic valve replacement (TAVR) is an appropriate treatment option for all low-risk patients, especially younger ones. One factor clouding the issue: long-term durability remains an open question.

“TAVR has become an established form of therapy for the treatment of aortic valve disease in a very short time,” said Edward P. Chen, MD, from Emory University in Atlanta. “Where it will ultimately fall in the spectrum of treatment options for structural heart disease is still unclear. The low-risk population approval suddenly expands the treatment options we have for these patients, but the long-term outcome data are yet to be determined.”

Dr. Chen will co-moderate the TAVR session with Ourania Preventza, MD, MBA, from Baylor College of Medicine in Houston.

Edward P. Chen, MD

Edward P. Chen, MD

The US Food and Drug Administration’s 2019 approval of TAVR for patients at low surgical risk could transform the treatment of aortic valve disease, but only if research supports long-term durability.

Evolving Impact: TAVR in Low-Risk Patients—Results of the Evolut Low Risk and PARTNER 3 Trials

Sunday
12:45 p.m. – 2:45 p.m.
Room 208

“Expanding TAVR to low-risk populations will potentially change the way we replace aortic valves for approximately 70% of patients, perhaps more,” said Dr. Preventza.

While the mean age of patients in the low-risk trials was approximately 70 years, cardiac surgeons see a growing number of younger patients in their 50s and 60s—and a 50-year-old TAVR recipient who is otherwise in good health can expect to live another 20 to 30 years. Since only 1-year outcomes data currently are available for this low-risk population, it is impossible to know how well the valves will perform after 10 to 20 years or if they’ll even last. “For lower-risk patients, we would like to see longer-term data,” Dr. Preventza noted.

Ourania Preventza, MD, MBA

Ourania Preventza, MD, MBA

Another important issue expected to be discussed in the session is the original approval of TAVR in higher-risk populations. With evidence that some results from the early PARTNER trials were not included in the original publication, the overall message of TAVR versus surgery could potentially change, according to Dr. Chen.  

“We should consider what is best for each patient individually in order to optimally determine the ultimate role of TAVR in the overall treatment paradigm of aortic valve disease,” he said. “This session is our opportunity to explore all of those issues together.” 

Debate Will Explore How to Treat IV Drug Users with Recurrent Endocarditis

Robert M. Sade, MD

Robert M. Sade, MD

When a post-surgical reinfection in an endocarditis patient occurs as a result of drug use, does the drug user deserve a second valve replacement? Or is this a waste of surgical resources?

These are two questions that experts will address during the Ethics Debate on Sunday afternoon.

“What is best for recidivist addicts: requiring them to take responsibility for their own health and not reoperating if they continue using IV drugs or exposing them to a series of major reoperations that will not prevent their inevitable death by endocarditis?,” asked debate moderator Robert M. Sade, MD. He is director of the Institute of Human Values in Health Care at the Medical University of South Carolina in Charleston and chairs the Cardiothoracic Ethics Forum, a joint STS and American Association for Thoracic Surgery group that is responsible for ethics education in the specialty. 

The debate will center around a young woman who was treated with an opioid painkiller after a major operation and then, in a typical addictive pattern, becomes dependent on opioids and heroin. As a result, she develops infective endocarditis. A surgeon replaces her infected aortic valve and refers her to a drug rehabilitation center. After refusing rehab, the patient is readmitted within a few months with recurrent endocarditis. The surgeon faces the dilemma of whether to reoperate, given that the patient declined treatment for her drug addiction.

Ethics Debate: Should Opioid Addicts Have a Second Valve Replacement for Endocarditis?

Sunday
12:45 p.m. – 1:45 p.m.
Room 211

The pro position might argue that surgeons have a responsibility to do the best for their patients; nothing is more important than continuing to live, even when their patients are suffering from the second disease of drug addiction, Dr. Sade said. 

The con position likely will be that surgeons have no obligation to use precious—and costly—surgical resources on patients who do not shoulder personal responsibility and make an effort to manage their drug addiction, he said.

“Surgeons are ethically committed to doing what is best for their patients, but also arguably have responsibilities for stewardship of surgical resources,” said Dr. Sade.

Infection of cardiac valves has been a growing problem due to the opioid crisis, and the burden on cardiothoracic surgery services has become quite heavy, Dr. Sade said. Reinfection is not uncommon, but occurs mostly in patients who revert to using drugs. 

“Though this debate will not produce definitive answers to difficult questions, it will provide the analytical tools needed for thinking about how to approach them,” he added. 

Why Do US and Canadian Surgeons View Cancer Treatment Differently?

Linda W. Martin, MD, MPH

Linda W. Martin, MD, MPH

Surgeons around the world differ in their perspectives about when, where, and how to treat advanced stage cancer of the lungs, esophagus, trachea, and mediastinum. Whether one plays it safe or pushes the envelope can depend upon the surgeon’s professional preference, but also may be influenced by what is standard practice geographically.

A session on Sunday morning—developed in collaboration with the Canadian Association of Thoracic Surgeons—will examine how cardiothoracic surgeons from both sides of the US and Canadian border approach the treatment of advanced stage cancer. 

“This will be an opportunity to talk about challenging cases where the answers are not clear and may be ‘out of bounds’ of any guidelines,” said Linda W. Martin, MD, MPH, from the University of Virginia Health System in Charlottesville. 

One differentiating factor between Canada and the US is regionalization. In the late 20th century, most Canadian provinces adopted a new approach to health care that consolidated complex care.  

“Canadian surgeons are willing to refer patients to centers of expertise. They don’t feel this is a negative for them. And Canadian patients are willing to travel a significant distance to get expert care at a high-volume center,” said Gail E. Darling, MD, from Toronto General Hospital and University Health Network, who will moderate the session with Dr. Martin. 

STS/CATS: Surgery for Advanced Stage Cancer—When Is Out of Bounds Not Out of Bounds?

Sunday
10:00 a.m. – 12:00 p.m.
Room 215

In contrast, the US health care system is less regionalized. This appeals to American patients who generally prefer treatment close to home with shorter wait times. Most thoracic oncology surgeons see a wide variety of cases, from routine to complex. 

In both countries, evolving market pressures will continue to influence surgical paradigms. For example, the availability of systemic therapy can affect patient eligibility for surgery. 

“We are seeing occasional responses to systemic therapy that border on miraculous, with stage IV patients having durable responses with only residual cancer in the lung,” Dr. Martin said. “Part of our discussion will be centered on when—or if—we should consider operating in these situations.”

During Sunday’s 2-hour session, the presenters will go beyond the published literature to explain how surgeons in two different health care systems are thinking about these emerging scenarios: 

  • When to consider surgery for oligometastatic lung cancer
  • Which T4 lesions are appropriate for resection
  • The strengths and limitations of resection, ablation, or radiation for pulmonary metastases
  • How and when to implement salvage esophagectomy

Following each mini-lecture, the moderators will take a deep dive into the topic through a related case study and tumor-board style debate. Attendees also will have the opportunity to voice their opinions.

No matter which side of the border surgeons practice, and no matter which end of the surgical spectrum they represent, this session will offer new perspectives for advanced cancer care. “As surgeons, we should always be aware of what is possible,” said Dr. Darling. 

Video-Based Sessions Enrich the Learning Experience

Cardiothoracic surgeons often learn best by observing real surgeries and seeing how others navigate common and complex procedures. With that in mind, Sunday’s “MyTube” sessions will offer videos focusing on all three disciplines.

“The ability to produce excellent surgical outcomes often is not only the product of traditional educational paradigms, but also more contemporary learning platforms such as visiting mentorships or the sharing of surgical videos and expertise,” said S. Adil Husain, MD, from the University of Utah in Salt Lake City, who will co-moderate the congenital heart surgery session.

Adult Cardiac Surgery
State-of-the-art techniques for coronary artery bypass grafting (CABG) surgery, aortic valve surgery, transcatheter approaches, and complex valve repair will be on display during the adult cardiac video session.

MyTube: Adult Cardiac Video and Expert Panel Session

Sunday
7:45 a.m. – 9:45 a.m.
Room 217

Co-moderator and creator of the how-to video session, Gorav Ailawadi, MD, MBA, from the University of Virginia in Charlottesville, said many surgeons don’t perform intraoperative coronary graft assessments following common CABG procedures. 

“I think hearing from some thought experts on the topic could elevate outcomes with CABG by better assessing the patency of bypasses,” he said. “We’ll focus on the surgical techniques with the goal of facilitating rapid transmission of knowledge, while offering technical tips and describing pitfalls to avoid.”

MyTube: Congenital Video and Expert Panel Session

Sunday
7:45 a.m. – 9:45 a.m.
Room 211

Experts also will explore transseptal puncture, percutaneous axillary access for catheter-based valvular and aortic interventions, the pitfalls of mitral valve repair with anterior leaflet prolapse and of tricuspid valve repair in endocarditis, and extended arch and branched arch graft repairs in acute type A dissection.

“This will be an exciting session—video-based presentations are a draw,” Dr. Ailawadi said. “It’s a more fun and effective way to learn than a PowerPoint lecture with mounds of data.”

MyTube: Pushing the Limits of Minimally Invasive Thoracic Surgery and Avoiding Pitfalls

Sunday
7:45 a.m. – 9:45 a.m.
Room 220

Congenital Heart Surgery
A series of eight videos will help surgeons learn how to avoid common obstacles during congenital heart surgery. 

According to Dr. Husain, topics that continue to spark debate and will be featured include:

  • Options for the surgical correction of valve disease in the neonatal and infant populations
  • Technical variations in reconstructing aortic arch anomalies
  • New frontiers within tracheal interventions 
S. Adil Husain, MD

S. Adil Husain, MD

“We will have an opportunity to discuss the caveats and pitfalls of these surgical techniques and their best-use cases and scenarios,” Dr. Husain added. “We hope the presentations will cultivate much discussion among the attendees.”

General Thoracic Surgery
General thoracic surgeons can expect videos on the latest techniques for minimally invasive thoracic surgery, highlighting the use of advanced methods and adjuncts to address common clinical conditions of the lungs, esophagus, and mediastinum.

Session co-moderator Nathaniel R. Evans III, MD, from Thomas Jefferson University in Philadelphia, said that a group of “young and new voices representing a diverse population of thoracic surgeons” will guide video-led discussions covering hot topics such as anastomotic techniques in esophagectomy, localization of subsolid lung nodules, and minimally invasive pectus excavatum repair. 

That last topic, Dr. Evans said, was specifically chosen because thoracic surgeons reported that if they knew more about minimally invasive pectus excavatum repair, they might pursue a specialization in it, especially if no one currently was performing these operations in their area. Another highlight will be the discussion of three different approaches to minimally invasive esophagectomy and the varying results.

Exposure to new surgical techniques and approaches is critical to the evolution of cardiothoracic surgery, and Dr. Evans said he is confident attendees will gain valuable information that may help them implement these strategies back home. 

Tech-Con Explores New Frontiers in Adult Cardiac and General Thoracic Surgery

Today’s Tech-Con program will feature innovative techniques and novel approaches to solving common clinical problems faced by adult cardiac and general thoracic surgeons. 

The adult cardiac sessions will incorporate the most advanced surgical therapy and technology for treating coronary artery disease, atrial fibrillation, and aortic dissection, said moderator Ibrahim Sultan, MD, from the University of Pittsburgh Medical Center in Pennsylvania.

Andrew C. Chang, MD

Andrew C. Chang, MD

Presentations on organ donation after cardiac death and the intraoperative use of bare stents as adjuncts for aortic remodeling in type A aortic dissection will offer important takeaways that adult cardiac surgeons won’t want to miss.

The general thoracic sessions will focus on advances in nanotechnology, mediastinal diseases, and lung cancer, with a little something about “what’s old is new” in esophageal surgery. Moderator Andrew C. Chang, MD, from Michigan Medicine in Ann Arbor, predicts that general thoracic surgeons will be especially interested in robotics, particularly the incorporation of robotic bronchoscopy.

Tech-Con

Saturday
11:00 a.m. – 6:15 p.m.
Great Hall B and Rivergate Room

“Tech-Con will provide information that is on the edge of innovation and is almost practice-ready,” he said. “These presentations and discussions are intended to be more practical and less academically oriented than what might be addressed within the typical sessions at the Annual Meeting.”

New this year are two Lunch and Learn sessions where industry representatives will share their thoughts on emerging device technology and challenges that they go through while developing medical devices. The adult cardiac session will discuss the future of transcatheter management for the mitral valve, while the general thoracic session will examine the use of a robot for airway management.

In the afternoon, Mark S. Cohen, MD, innovation chief at the University of Michigan Rogel Cancer Center in Ann Arbor, will deliver a keynote lecture, followed by the always-exciting Shark Tank presentations. Entrepreneurs will pitch their novel cardiothoracic surgery products to the audience and a panel of experts in medical device development. 

Products to be presented include:

  • A soft robotic biventricular cardiac compression device for the treatment of acute heart failure syndrome
  • A chest drainage unit with an integrated carbon dioxide detector
  • Catheters designed to stop brain damage during cardiac arrest
  • A mixed-reality application for improving visualization in thoracic surgery

Attendees will be able to vote for their favorite products using live polling. After the Shark Tank presentations, the day will wrap up with a cocktail and networking reception in the Tech-Con exhibit area. 

You still can purchase a ticket to attend today’s Tech-Con sessions. Visit the Registration desk in the Hall B1 Lobby and add a ticket to your Annual Meeting registration. 

See what new techniques and technologies are on the horizon for cardiothoracic surgery.

11:00 a.m. – 12:30 p.m.
Adult Cardiac: Ischemic, Heart Failure, and Atrial Fibrillation
Great Hall B

General Thoracic: Chest Wall, Mediastinum, and Esophagus
Rivergate Room

12:30 p.m. – 1:30 p.m.
Adult Cardiac Lunch & Learn: The Future of Transcatheter Mitral Valve Therapies
Great Hall B

General Thoracic Lunch & Learn: Airway Management – Why Use a Robot?
Rivergate Room

1:30 p.m. – 3:00 p.m. 
Adult Cardiac: New Technologies in Aortic and Structural Heart Disease
Great Hall B

General Thoracic: Innovations in Lung Cancer Care
Rivergate Room

3:00 p.m. – 3:30 p.m.
Break—Visit Tech-Con Exhibits
Great Hall Lobby

3:30 p.m. – 5:30 p.m. 
Joint Session: Keynote Lecture and Shark Tank
Great Hall B

5:30 p.m. – 6:15 p.m. 
Reception
Great Hall Lobby

You must purchase a separate ticket to attend the events listed above.

Scrub In Today at STS U

Learn a new surgical procedure or perfect your skills with one-on-one instruction from the experts.

Learn a new surgical procedure or perfect your skills with one-on-one instruction from the experts.

If you haven’t already signed up to attend STS University this morning, there’s still time to register for these interactive, hands-on sessions. Visit the registration desk in the Hall B1 Lobby to see what courses still have openings. Sessions take place from 7:00 a.m. to 8:30 a.m. and again from 9:00 a.m. to 10:30 a.m. in Hall B1. Descriptions of each course as well as supplemental video lectures are available at sts.org/stsuniversity.

STS University Courses

Course 1: VATS Lobectomy

Course 2: Complex Chest Wall Issues for the Thoracic Surgeon: Reconstruction after Tumor Resection, Pectus Deformities, and Rib Fractures

Course 3: Robotic Lobectomy

Course 4: Aortic Root Enlargement Procedures and Aortic Valve Leaflet Reconstruction

Course 5: NEW! ECMO Cannulation

Course 6: Essentials of TAVR

Course 7: Mitral Valve Repair

Course 8: Valve-Sparing Aortic Root Replacement—Reimplantation

Course 9: Minimally Invasive Aortic and Mitral Surgery

Course 10: Transseptal Puncture for Surgeons 

See How NextGen STS National Database Will Improve Your Practice

Felix G. Fernandez, MD, MSc

Felix G. Fernandez, MD, MSc

A Sunday morning session will demonstrate the many ways that surgeons can use the STS National Database to support their practice and improve outcomes for their patients.

The next generation STS National Database is launching for the Adult Cardiac and General Thoracic Surgery Databases, while Congenital Heart Surgery Database participants will gain access in the next few weeks. The session will begin with a look at the new cloud-based dashboards that provide highly secure, interactive access to outcomes data.  

“These enhanced dashboards will help facilitate quality improvement in real time,” said Felix G. Fernandez, MD, MSc, from Emory University in Atlanta, who is one of the session moderators and chairs the STS Workforce on National Databases. “Surgeons will be able to interact with their data in a very meaningful way.”

Utilizing the STS National Database in Your Daily Practice

Sunday
7:45 a.m. – 9:45 a.m.
Room 208 

Attendees also will receive an update on how public reporting of surgical outcomes is evolving to meet the needs of patients and providers, while remaining a primary instrument of quality.

“By providing access to risk-adjusted outcomes, the Database allows surgeons to understand their outcomes and areas for focused improvement,” Dr. Fernandez said. “Public reporting also allows surgeons to assure patients and their caregivers that the services they provide are safe.”

Additional presentations will highlight how the Database is used for professional advocacy, including its role in establishing physician reimbursement for different procedures, as well as coverage determination by the Centers for Medicare & Medicaid Services.

Dive into the Digital Age to Boost Your Publishing Potential

Tweets, Facebook posts, YouTube videos, and other social media outlets can help you engage with colleagues about important scientific issues and broaden the impact of your findings. It’s also a useful tool to promote ideas for future exploration.

“Just like everything else in the world, science has become much more interactive,” said Jennifer C. Romano, MD, from the Congenital Heart Center at Mott Children’s Hospital in Ann Arbor, Michigan. Dr. Romano and Joanna Y. Chikwe, MD, from Cedars-Sinai Medical Center in Los Angeles, will co-moderate The Annals Academy session that will feature a crash course in using social media to increase your research impact. 

“Social media can help us go beyond just reporting the data,” Dr. Romano said. “It can help you and other leaders in the field engage in conversations about what the research findings mean and the next steps.”

Jennifer C. Romano, MD

Jennifer C. Romano, MD

With the goal of helping surgeons effectively present their clinical data to the largest possible audience, Sunday’s session also will offer accelerated coaching from leading experts on how to write and publish high-impact research. “Often, just a little extra help and thought at the planning, analysis, and writing stages can turn a study that very few people will read into a much more impactful one,” Dr. Chikwe said. “The Annals Academy is designed to give surgeons that extra bit of help.” 

The Annals Academy: The Editor’s Pick—Top Papers and Why

Sunday
10:00 a.m. – 12:00 p.m.
Room 211

Speakers also will offer insights on the journal submission process, including how to design studies, craft manuscripts, respond to reviewer comments, and write more powerful papers using national datasets. 

“A tremendous number of publications result from the STS National Database,” Dr. Romano said. “Because the Database is so massive (more than 8 million records), it’s easy to analyze a variety of things and produce statistically significant findings. The challenge is coming up with something that’s clinically significant and relevant to enhance what we can learn.” 

Experts will share their viewpoints on invited editorials and how those can help advance research, too. Details on who gets invited to write editorials and commentaries, how to take advantage of this opportunity, and best practices for writing an invited editorial will be presented.

The Annals is very different and more dynamic today than the print journal of previous years,” said Dr. Romano. “This session will help you understand how to take advantage of all The Annals has to offer.” 

Learn How to Accelerate Your Research Career

Elizabeth A. David, MD

Elizabeth A. David, MD

If at first you don’t succeed, try, try again. That advice couldn’t be any more salient for the medical research community, according to Elizabeth A. David, MD, from the University of Southern California in Los Angeles. 

Dr. David will lead a panel of experts on Sunday who will share their research failures and successes, along with lessons learned. The tips in this session are designed to help researchers at any stage of their careers and in any type of workplace, from the academic world to clinical practice. 

“I can promise you this: In order to have success, you will most likely fail first,” Dr. David said. “By sharing our failures, we might be able to speed others’ successes.”

Navigating the grant process is one key area the session will explore, including advice for leading multi-institutional research studies, securing a “K” and/or “R” grant from the National Institutes of Health, renewals, and insights from study sections. 

“No one receives a grant their first time,” Dr. David said. “Researchers who have successfully obtained grants will share what they did right and what they should have done differently.”

Failures, Successes, and Resilience in Research

Sunday
7:45 a.m. – 9:45 a.m.
Room 225

The session also will cover the importance of quantifying academic productivity toward promotion. It’s important for researchers to market their success and results in order to gain funding, but most don’t know how to characterize their research achievements, Dr. David said.

The session is sponsored by Women in Thoracic Surgery and is designed for anyone pursuing research grants, including residents. In fact, the session will feature a presentation by a resident who successfully secured research funding—which is very difficult to do, said Dr. David, adding that she hopes the experience will inspire medical students and junior residents.

“Research is how we innovate and optimize patient care and outcomes,” Dr. David said. “Research is a part of our lives, both in quality improvement and patient safety, every day.” 

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