STS Preview

Annual Meeting News and Notes

What’s New

  • Tech-Con will offer insight on new devices and procedures that are not yet approved by the FDA.
  • A Weekend Pass is available so that attendees can sample the wide variety of weekend courses.
  • Tuesday’s Early Riser Sessions no longer require a separate fee.
  • STS 52nd Annual Meeting Online is included with meeting registration.
  • Two new educational sessions will be held on Sunday—a “how to” session featuring intraoperative videos and a session about the resuscitation of patients who arrest after cardiac surgery.
  • Breaktime learning opportunities in the Exhibit Hall include an international Jeopardy! championship and tutorials from The Annals of Thoracic Surgery staff.

Register for the STS/CTSNet Career Fair

Take advantage of the opportunity to meet face-to-face with top employers at the STS 52nd Annual Meeting. At the STS/CTSNet Career Fair, recruiters will be available to talk with you about career opportunities.

Maximize your exposure by posting your CV to the candidate database prior to the meeting. Participating employers will be able to view your CV in advance of the event and may schedule an appointment with you for an in-person interview to take place during the meeting. You can find more information about how to register at the 2016 STS/CTSNet Career Fair website.

The Career Fair will be open during all Exhibit Hall hours.

International Attendees: Request a Letter of Invitation

If you need a personalized letter of invitation, please visit STS Annual Meeting website and complete the Visa Invitation Letter Request Form. Once you have completed the request form, STS will e-mail a personalized letter of invitation to you within 1 business week. Please note: STS cannot promise that you or your colleagues will receive a visa, nor can it change the decision of any governmental agency should your application be denied.

Apply Today to Become an STS Member

STS membership comes with a wide range of benefits, including complimentary subscriptions to The Annals of Thoracic Surgery, the quarterly newsletter STS News, and more. Additionally, STS members receive reduced registration for the STS Annual Meeting and many other educational events throughout the year, and surgeon members qualify for discounted participation fees in the STS National Database.

Anyone with an interest in cardiothoracic surgery can become a member. Visit the STS website and fill out the application that best fits your role. If you are a member and know someone who has not yet joined, encourage them to apply! By promoting membership in STS, you’ll help your colleagues, the Society, and the specialty.

Expand Your Knowledge in the Exhibit Hall

The STS Annual Meeting Exhibit Hall is the place to learn about the latest medical devices and therapies. It is here where you can compare products and services, as well as meet with representatives from more than 100 companies and organizations.

Sunday, January 24
4:30 p.m.-6:30 p.m.
Opening Reception

Monday, January 25
9:00 a.m.-4:30 p.m.

Tuesday, January 26
9:00 a.m.-3:30 p.m.

Attend the STS Social Event

Join your colleagues for an evening of mariachi music, delicious food, and ice-cold margaritas at Corona Ranch on Monday, January 25, from 7:00 p.m. to 10:30 p.m. You can compete against fellow attendees in “cowboy games” and get a front-row seat for an exciting rodeo that will incorporate bronco and bull riding, high-speed horse maneuvers, and trick roping. Don’t miss this opportunity to relax and have fun in an Old Mexico environment. Purchase a ticket when you register for the Annual Meeting.

Hear Inspiring Guest Lectures

Ferguson Lecture to Feature Former NASA Astronaut

Scott Parazynski, MD

Scott Parazynski’s career has taken him from the emergency room, to the summit of Mount Everest, and even to outer space. In January, he will share the lessons he’s learned with Annual Meeting attendees as the 2016 Thomas B. Ferguson lecturer. His talk is titled The Requisite Innovator’s Mindset: Open-Mindedness and the Relentless Hunt for Problems in Need of Fixing.

Dr. Parazynski was 22 months into an emergency medicine residency in Denver when he was selected for the NASA astronaut corps. He flew a total of five space shuttle missions and conducted seven spacewalks, logging more than 1,381 hours (over 8 weeks) in space. He’s also summited Mount Everest and invented a number of medical devices and other technologies for life in extreme environments.

“Scott is a Professor of Practice and University Explorer at Arizona State University, and I think you’ll find his outlook on life and his idea of leadership and creativity very interesting,” said STS President Mark S. Allen, MD. “He has quite a vision for how space will be developed over the next several years, which should make for a fascinating talk.”

The Ferguson Lecture will take place at 9:00 a.m. on Tuesday, January 26, 2016, at the Phoenix Convention Center.

Acclaimed Science Journalist to Give Lillehei Lecture

Gary Taubes

The 2016 C. Walton Lillehei lecturer will be Gary Taubes, an award-winning science journalist who has shaken up the status quo and challenged conventional wisdom regarding diet, weight gain, and heart disease with his New York Times-bestselling books Good Calories, Bad Calories and Why We Get Fat.

Taubes’ hypothesis is that the “low fat equals good health” dogma is not supported by scientific research and that high-carbohydrate diets contribute to cardiovascular disease and obesity.

“He has excellent ideas about how we should study this, and it will definitely open up your mind about what you’re eating, as well as help us communicate that to our patients,” Dr. Allen said.

Don’t miss the C. Walton Lillehei Lecture, Why We Get Fat, at 11:00 a.m. on Tuesday, January 26, 2016, at the Phoenix Convention Center.

For more information on this speaker, please visit the Penguin Random House Speakers Bureau.

New Protocol Increases Postoperative Survival Rates After Cardiac Arrest

Jill Ley, RN, MS

Jill Ley, RN, MS set out to increase survival for cardiac surgery patients who experience a cardiac arrest while in an ICU. By implementing a new protocol, she helped reduce mortality rates from cardiac arrest by nearly half at California Pacific Medical Center in San Francisco.

Ley had witnessed how Advanced Cardiac Life Support (ACLS)—while the gold standard for emergency responders—has significant shortcomings after cardiac surgery, including a greater risk of mortality and morbidity. To combat this issue, she learned about Cardiac Surgery Unit-Advanced Life Support (CSU-ALS), a European protocol that provides an evidence-based approach for the management of cardiac arrest after cardiac surgery.

Joel Dunning, PhD, FRCS

“Jill came over and saw our course on CSU-ALS. After she implemented the protocol, mortality rates from arrest fell from 65% to 35% at her institution,” said Joel Dunning, PhD, FRCS, Consultant Cardiothoracic Surgeon at James Cook University Hospital in Middlesbrough, United Kingdom, who developed CSU-ALS with his colleagues. Their protocol was adopted by the European Resuscitation Council in 2010 after several years of in-depth review.

Learn About CSU-ALS

Dr. Dunning will be the moderator and Ley will be among several speakers at a new hands-on session, Resuscitation of Patients Who Arrest After Cardiac Surgery, which will be held from 1:15 p.m. to 4:30 p.m. on Sunday, January 24. Attendees will learn how this method of resuscitating postoperative cardiac surgery patients can rapidly reverse the causes of arrest.

Faculty members, including cardiothoracic surgeons, an anesthesiologist, and a physician’s assistant, will cover how to perform an emergency resternotomy using a team-based approach, internal massage, emergency pacing, standardized equipment, and medication strategies, which are targeted to achieve optimal survival in this population. Attendees will have the opportunity to participate in simulated arrest scenarios using resternotomy manikins. The session will conclude with information on how to implement the resuscitation protocols and how to become an instructor.

“I originally went to the United Kingdom to learn about the protocol and bring it back to my own center. It became clear that this was a much bigger initiative. I realized what a tremendous opportunity we have to save lives in the United States,” said Ley, Clinical Nurse Specialist in Surgical Services at California Pacific Medical Center.

Protocol Goes Beyond ACLS

ACLS has a number of limitations when responding to patients who experience postoperative cardiac arrest after a major cardiac operation.

“For two of the three most common causes of arrest—tamponade and hypovolemia—the use of external cardiac massage as done with ACLS is ineffective. For both of these causes, the only treatment is to reopen the chest so you can fix the problem in about 5 minutes. Otherwise, the patient is going to have irreversible brain damage,” said Dr. Dunning, adding that ACLS also doesn’t address individuals with temporary pacing wires, endotracheal tubes, ventricular assist devices, and infusions.

Also, what may appear to be pulseless electrical activity may rather be a function of the patient’s pacemaker responding to an underlying ventricular fibrillation, which is not addressed in ACLS, but is in CSU-ALS. The protocol also includes information on how to gown and glove quickly, as well as how to mobilize and work as a team.

The protocol calls for a person trained in CSU-ALS, who could be a physician’s assistant or a nurse practitioner, to be available 24 hours a day.

“The first steps of reopening the chest are straightforward, and, if practiced on a manikin simulation, can be performed safely,” Dr. Dunning said. “In the United Kingdom, at least three nurses have opened a chest with successful outcomes.”

The Cardiac Surgery Unit-Advanced Life Support course gives participants the opportunity to train on a manikin as a group.

Manikins like the one session attendees will practice on have been sent to about 50 institutions throughout the United States.

“The need is not in the 20% of large units; it is in the 80% of small units, where patients are going to mixed critical care units instead of specialized cardiac intensive care units,” he said.

Knowing that cardiac arrests typically happen within the first few hours after cardiac surgery, when patients are still in the ICU, Ley said she is grateful for this protocol.

“Why would we call on a protocol designed for people on the street when we have completely different patients, environments, and resources when these cardiac events occur,” she said. “People who have cardiac surgery are vulnerable to these events, but with this protocol, we can respond with the most evidence-based approach that is going to give us good outcomes.”

View an image illustrating a proposed protocol for Cardiac Surgery Unit-Advanced Life Support for the management of patients who arrest after cardiac surgery.

Glean Tips to Simplify Cardiac Surgery Procedures

Gorav Ailawadi, MD

While unusual cases are interesting, most cardiothoracic surgeons will never see those operations. A new how-to session at the STS 52nd Annual Meeting will focus specifically on common operations to help surgeons improve their techniques, become more efficient, and optimize outcomes.

“This session is about providing a broad overview of the more challenging things we could see in the relatively common operations we face every day,” said moderator Gorav Ailawadi, MD, Chief of the Section of Adult Cardiac Surgery and Associate Professor of Surgery at the University of Virginia in Charlottesville. “Surgeons may think, ‘I’d like to do this operation, but it’s been a while, and I just don’t feel that comfortable doing it.’ This session will help them overcome that.”

During the session, How To: Technical Tricks and Pitfalls to Simplify Cardiac Surgery Procedures, expert faculty will share their tried-and-true tips during 21 presentations focused on four common adult cardiac areas: coronary artery bypass grafting (CABG) surgery, mitral valve surgery, aortic valve surgery, and aortic surgery. The session will be from 1:15 p.m. to 4:30 p.m. on Sunday, January 24.

“Our specialty is heavily based on technical skills, and every surgeon has some tricks they use to make their operations easier. The reality is we all do these operations, and we might do them differently. If attendees can learn one or two tricks from each talk, then that will lead to better outcomes. That’s a win in my mind,” Dr. Ailawadi said.

Presenters will only have one data slide each, and they will share their best tips while highlighting pitfalls to avoid via high-quality videos in their 8-minute presentations. 

Among the three CABG presentations is one on minimally invasive CABG. Although not a new procedure, Dr. Ailawadi said minimally invasive CABG has not been adopted by many surgeons. Other CABG talks will cover skeletonized internal mammary artery harvest and total arterial CABG, as surgeons have been criticized for not performing enough arterial bypass beyond just the left internal mammary artery.

The mitral valve section of the session will offer guidance in several areas, including anterior and bileaflet prolapse repair, as well as exposure tips in challenging patients.

“The goal of the mitral sessions is to encourage more widespread adoption of mitral surgery and make it easier to do difficult repairs, as well as total chordal preservation replacement,” Dr. Ailawadi said.

The aortic valve surgery presentations will give attendees tips to follow when performing newer procedures, including sutureless aortic valve replacement, which he said is expected to receive approval from the US Food and Drug Administration in the winter or spring.

“It’s possible that by the time of the STS Annual Meeting, at least one of the sutureless valves might be approved,” Dr. Ailawadi said. “The idea here is to give everyone exposure to how do this so that when it becomes approved, they’ll at least understand what this is all about.”

The afternoon will wrap up with a focus on aortic surgery, including repair of type A dissections.

“These typically are not done in elective settings, and you need to know how to fix them safely,” Dr. Ailawadi said. “I think most surgeons feel comfortable with this repair, but there are always tricks to be gained from experts.”

Other aortic surgery speakers will tackle more complex valve-sparing root replacement and Bentall with stented bioprosthetic valve.

“These operations are done a little more selectively, but we certainly want all surgeons to have exposure to them and feel comfortable doing them on their own,” Dr. Ailawadi said.

STS University Offers More Hands-On Learning than Ever Before

Attendees will have the opportunity to practice a variety of cardiothoracic surgical procedures.

The popular STS University will expand in 2016 to include 14 hands-on courses. Attendees will be able to gain experience with a wide variety of cardiothoracic surgical procedures and familiarize themselves with the latest technology in the field. STS U courses will be offered on Wednesday, January 27, from 7:00 a.m. to 9:00 a.m. and again from 9:30 a.m. to 11:30 a.m. Pick two when you register for the Annual Meeting.

STS University features only hands-on learning, and didactic lectures are provided in advance. View the materials for the courses of your choice at STS University.

  • 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 Enlarging Procedures
  • Course 6: ICU/ECHO
  • Course 7: VATS Lobectomy
  • Course 8: Advanced Open Esophageal and Tracheal Procedures
  • Course 9: Chest Wall Resection and Adult Pectus Surgery
  • Course 10: Atrial Fibrillation (Maze Procedure)
  • Course 11: Aortic Valve Leaflet Reconstruction
  • Course 12: Advanced Aerodigestive Endoscopy
  • Course 13: Adult Congenital Pulmonary Valve Replacement
  • Course 14: TSDA Cardiac Surgery Simulation Curriculum*

*This course runs once from 7:00 a.m. to 10:30 a.m.

Symposium Delves Into Ethics of Device Testing in Developing Countries

A. Pieter Kappetein, MD, PhD

Before new devices are released on the US market, they oftentimes undergo testing in developing countries. Because the devices are too costly to purchase and maintain, these countries cannot ultimately afford to use them.

A panel of experts will tackle the device-testing process during the International Symposium: The Ethics and Practicality of Using New Technologies to Treat Cardiothoracic Diseases in Different Parts of the World, which will be from 3:30 p.m. to 5:30 p.m. on Monday, January 25.

“Medical ethics committees are less stringent in developing countries, so it’s easy to go there, test devices, come back, and report that you had good results,” said A. Pieter Kappetein, MD, PhD, who will moderate this ticketed symposium, which will be followed by a reception.

During a panel discussion, Dr. Kappetein and international faculty from various specialties, including cardiothoracic surgery and medical ethics, will debate the ethics of testing devices in countries where the technology likely will not be dispersed.

“Some may argue that these countries, which otherwise don’t have access to such medical treatment, at least now have some treatment,” said Dr. Kappetein, who is a Professor of Cardiothoracic Surgery at Erasmus Medical Center in Rotterdam, The Netherlands. “It’s an ethical debate, especially when unsuccessful results are not reported.

“You have to move the field forward, but when is the time right, when do you have enough evidence that you can do this, and which patient population should participate?”

The panel will respond to these questions with regard to new technologies for mitral valve disease, including transcatheter mitral valve repair and replacement devices. Symposium speakers also will talk about other evolving treatment approaches for mitral valve disease, endocarditis, and rheumatic heart disease in relation to their viability for use in treating cardiothoracic diseases in underdeveloped parts of the world.

During an examination of the modern era of endocarditis treatments, presenters will share emerging trends in infective endocarditis and different treatment approaches in Japan and South Korea.

Dr. Kappetein, an STS International Director and Secretary General of the European Association for Cardio-Thoracic Surgery, said one speaker will discuss a trial out of Korea, which compared operating early on patients and use of conventional treatment on patients who had infective endocarditis.

“Whether you should operate early or not is always a question. If you wait a little while and give patients antibiotics, your repair may last longer,” Dr. Kappetein said. “On the other hand, if you wait too long, the patient may deteriorate and be more difficult to repair.”

One presentation, Rheumatic Heart Disease: Between a Rock and a Heart Place, is a play on words for the hard calcium found in the mitral ring of patients with rheumatic valve disease, but this serious discussion will highlight the challenges of repairing and replacing the mitral valve. Although rare in the United States, rheumatic heart disease is prevalent in sub-Saharan Africa, Asia, and other developing countries.

“We can exchange information and learn from others in developing countries. In Asia, where much of the population has rheumatic heart disease, they have developed treatment techniques,” Dr. Kappetein said. “We always like to cover a technique in cardiothoracic surgery that is of interest to many people all over the world.”

Quality and Value Are Crucial for CT ICUs

Kevin W. Lobdell, MD

To say that Kevin W. Lobdell, MD has a patient-centered approach is an understatement. As Director of Quality for the Sanger Heart & Vascular Institute at Carolinas HealthCare System in Charlotte, N.C., he and his team rely on quality measures to make comprehensive performance management improvements in cardiothoracic critical care.

“Let’s agree that much has been organized around health care workers, as opposed to our patients. It never occurred to me that care wouldn’t be patient-centered. I kind of coined the term PCTR—patient-centered transformational redesign—in our work here. We’re looking to do things that will transform the quality and value of medicine, and inherent in all of that is a redesign,” said Dr. Lobdell, who is a co-moderator of the STS/AATS Critical Care Symposium: Quality and Value in the CT ICU, which will be held from 7:50 a.m. to 12:00 p.m. on Sunday, January 24.

The session will focus on the role of postoperative quality and value improvement initiatives in reducing morbidity and mortality, as well as leveraging expertise with telehealth solutions, hospital-acquired infections (HAIs), mechanical ventilation, and advanced life support.

“We broke the session down by phases of care and things that we could do to assess and mitigate risk. Then we went by body systems, so we looked at it from different directions,” said Dr. Lobdell, Clinical Professor of Surgery at the University of North Carolina-Chapel Hill. “We even looked at registration data and feedback to make sure that our offering not only was current and respectful of what’s been done in the past, but also one that would allow us to improve on how we present these topics.”

A member of both the STS Workforce on Critical Care and Workforce on Patient Safety, he will begin the program by describing the principles and potential impact—both positive and negative—of quality and value. This will flow into a discussion on the use of the tele-ICU to transform critical care. Formal ICU telemedicine programs now support 11% of non-federal hospitalized critically ill adult patients, according to a November 2014 article in Critical Care Medicine.

“We’ll emphasize how tele-ICUs improve the quality of care and have a financial impact,” Dr. Lobdell said.

In addition to a presentation on the effect of HAIs on quality and value, attendees will learn about the Hospital Microbiome, which aims to collect microbial samples from surfaces, air, staff, and patients at The University of Chicago’s new Center for Care and Discovery.

“This cutting-edge work will provide a comprehensive view of the hospital environment, its practices, and how that system either fosters or prevents infections,” Dr. Lobdell said.

After an overview of cardiac surgery unit-advanced life support (CSU-ALS), speakers will describe the role of physician assistants and implementation in a CT ICU. In use in Europe, CSU-ALS is a set of protocols for patients suffering cardiac arrest and all common serious complications in an ICU or on a cardiac surgery unit. (See related article.)

The session will conclude with four presentations about prolonged ventilation.

“We track five major complications: stroke, reoperation, prolonged ventilation, deep sternal infection, and acute renal failure,” Dr. Lobdell said. “We thought that given the impact of prolonged ventilation on the quality and the value of our efforts, it was worth spending a section of this session on this topic.”

Speakers will share expertise on the ventilator bundle, prevention of prolonged ventilation, timing of tracheostomy, and extracorporeal membrane oxygenation.

Dr. Lobdell encouraged those who have roles in the evolving multidisciplinary cardiothoracic critical care team to attend the Critical Care Symposium, noting that they will leave with important information on quality and value.

Tech-Con Amps Up the Wow Factor

Tech-Con 2016 will feature an increased emphasis on new technology in the pipeline.

When STS/AATS Tech-Con was introduced in 2002, its goal was to provide a platform for presenting innovative techniques, concepts, and devices for cardiothoracic surgery. In short, Tech-Con was conceived with the wow factor in mind. Fourteen years later, the Tech-Con Task Force has come up with new ways to provide the wow factor.

Beginning in 2016, Tech Con will focus on new devices and procedures that have yet to be approved by the US Food and Drug Administration, but could be available (with FDA approval) within 1-3 years from the time of presentation.

“We thought that this time frame allows industry to introduce near-ready products so that surgeons can begin to prepare,” said Tech-Con Task Force Co-Chair Shanda H. Blackmon, MD, MPH. “The advantage of this approach is that it will not overlap with what we are seeing at the main STS Annual Meeting.”

Despite the expanding focus on not-yet-released technology, Tech-Con will still feature information that attendees immediately can put into action.

“We still want the audience to go home with something they can use tomorrow in their next case,” said Tech-Con Task Force Co-Chair Gorav Ailawadi, MD. “A part of the program will certainly still focus on techniques or devices that are available now, but are not yet adopted by all cardiothoracic surgeons.”

Proposals for presentation topics were accepted this past summer. For the first time, anyone involved in the field of cardiothoracic surgery—including surgeons, allied health care professionals, engineers, and industry representatives—could submit a proposal.

“One of the most exciting parts of Tech-Con will be the ‘Shark Tank’ session. Inventors will give a brief elevator pitch about their technology, and a panel of experts will critique the ideas,” Dr. Ailawadi said.

The presentations will cover the newest robotic, haptic, and stapling technology, plus minimally invasive access procedures.

“Specifically in the general thoracic sessions, we’ll feature new ways to treat lung cancer, potentially using percutaneous access to ablate tumors in a way that’s never been done before,” said Dr. Blackmon.

STS/AATS Tech-Con will be held January 23-24, 2016, in conjunction with the STS 52nd Annual Meeting in Phoenix, Arizona. You can register today at the STS Annual Meeting website. Continuing medical education credit will not be offered for Tech-Con programming.

Top