SAN ANTONIO (January 28, 2024) — A study of pediatric heart surgery centers across the United States has demonstrated that, when it comes to successful surgery, it’s not just the size of the program that matters in determining quality outcomes.
SAN ANTONIO (January 28, 2024) — Despite national guidelines recommending surgical aortic valve replacement (SAVR) for patients under age 65 with severe aortic stenosis, many hospitals are still opting for a nonsurgical approach in patients under 60—possibly with poorer survival rates.
During this session, investigators unveiled findings from the largest multicenter study of post-arterial switch operations (ASO) that resulted in increased survival rates for adolescents and adult patients – as well as an increase in the potential for these patients to require cardiac reoperations to address arterial switch related complications that arise later in life.
At day two's presentation on “Burden of Reoperative Cardiac Surgery among Adolescents and Adults Who Have Undergone Prior Arterial Switch Operation: Society of Thoracic Surgeons Database Analysis,” Bret Mettler, MD, from Johns Hopkins University, examined a multi-year assessment of the prevalence and types of cardiac surgical interventions in patients who previously underwent ASO using data from the STS National Database.
“Anatomical repair of transposition of the great arteries (TGA) and related anomalies by arterial switch operation (ASO) achieves a normal anatomic and physiologic cardiac configuration,” said Dr. Mettler. “And as survival rates have increased, so have the potential for these patients to require cardiac reoperations to address resulting ASO-related complications.”
As most reoperations involved multiple procedures, the presentation examined how a hierarchical stratification of procedure categories was established, with each eligible surgical hospitalization assigned to the single highest applicable hierarchical category.
Dr. Mettler's presentation also examined implications for surgical counseling, post-operative clinical surveillance, and therapeutic management. An analysis of the role of procedural prevalence, timing, categories, trends, and the growing number of reoperations was discussed.
An engaging presentation on day two of STS 2024 focused on how socioeconomic disadvantage is associated with inferior patient survival following heart transplantation, while closely examining how future efforts and national policy changes are needed to improve longitudinal follow-up care and address systemic barriers to necessary healthcare.
Sara Sakowitz, MS, MPH, examines how socioeconomic disadvantage is associated with inferior patient survival following heart transplantation at STS 2024.
“Hospital Volume Does Not Mitigate the Effect of Community Socioeconomic Deprivation on Outcomes of Heart Transplantation” was given as part of the J. Maxwell Chamberlain Memorial Papers Perioperative and Critical Care Surgery session.
Sara Sakowitz, MS, MPH, from UCLA David Geffen School of Medicine, reported on the independent association between neighborhood area deprivation and survival following heart transplantation, showing that patients who live in socioeconomically deprived communities demonstrate inferior long-term outcomes.
“These disparities were not mitigated by receiving care at high-volume heart transplantation centers and have persisted over the last two decades,” said Ms. Sakowitz. “Our study findings underscore the need to improve access to and engagement with longitudinal follow-up care, remove barriers to medication and appointment non-adherence, and directly address the underlying and systemic root causes of community-level inequities in transplant outcomes.“
This talk demonstrated the need for a team-based, collaborative approach to solve the issue. Clinicians and hospitals should consider implementing certain programs for their own communities – including expanded patient navigator services, social support groups, and clinical pharmacy services.
“Over the past year, the STS has reaffirmed our mission to improve the lives of patients with cardiothoracic disease. We have revised our strategic plan and identified three top priorities: champion the value and impact of the specialty; advance the health, well-being, and inclusion of all cardiothoracic surgeons; and enhance the STS member value and educational experience.
It’s been an extraordinary year. We have been champions of the specialty and champions of each other. Thank you for the honor of being your president.”
STS President Dr. Tom MacGillivray
The Hub made its debut at STS 2024. In the Exhibit Hall, meeting participants attended the "Early Career Journey Roundtable: Trade Secrets for a Successful Career Journey," creating peer-to-peer connections while networking.
Shortly after the 60th STS Annual Meeting began, a packed crowd attended the "Trends and Research from the STS Adult Cardiac Surgery Database (ACSD)" session, beginning with a presentation by Michael E. Bowdish, MD, of the Smid Heart Institute, Cedars-Sinai Medical Center. He looked back at the origins of the ACSD, which was established in 1989 to collect information on cardiac surgery procedures, track outcomes, and provide insights into opportunities for quality improvement.
Expert panel members field questions during the "Trends and Research from the STS ACSD" session.
Today – more than three decades later – the Database offers more than nine million recorded procedures making it one of the most comprehensive, robust, and sophisticated contemporary clinical databases in use.
For example, 95% of centers performing coronary artery bypass grafting (CABG) in the United States, and 97% of patients receiving CABG are included in the STS ACSD. Every year 10% of the participating sites undergo a data audit assessing data accuracy and completeness with strict thresholds to pass quality control. Continuous education of data managers is a further element to ensure data quality.
"STS ACSD is a vital source of data for outcomes research quality improvement, with overall volumes that are stable with notable trends in aortic surgery," said Dr. Bowdish.
The STS ACSD has provided the foundation for national benchmarking in adult cardiac surgery through the development of regularly updated and recalibrated risk models and performance metrics, the availability of feedback reports to database participants and individual surgeons, quality-improvement efforts, voluntary public reporting, and comparative effectiveness research.
Opening remarks were given by STS President Tom MacGillivary, MD, who introduced the C. Walton Lillehei Lecture from Mortimer J. Buckly, Chairman & CEO, Vanguard.
During the Plenary Speaker event on the main stage, Illya Yemets, MD, PhD, delivered his speech titled, "Ukraine Experience of Cardiac Care from 'Cradle to Longevity' During Russian Invasion," while poignantly reflecting on the past, with hope for the future of Ukraine, which “will not survive without help.”
Congratulations to the winners of this year's CT Surgery Resident Showdown Champions from ... the University of Iowa!
The Society of Thoracic Surgeons (STS) today announced the 2024 Extraordinary Women in Cardiothoracic Surgery Award recipients at its 60th Annual Meeting in San Antonio, Texas.
SAN ANTONIO (January 27, 2024) — The Society of Thoracic Surgeons released late-breaking research scheduled for presentation at the 2024 Annual Meeting taking place January 27 - 29 in San Antonio. The conference, healthcare’s leading scientific and educational convening specializing in cardiothoracic surgery, has a rich history of showcasing clinical trials with a strong foundation of detailed methodology and trusted data collection governed by ethical clinical principles.
During his talk, Dr. Christopher Mehta will provide insight into how comprehensive data helps inform multidisciplinary heart teams in making decisions for patients.
On Saturday, January 27 at 9:45 a.m. CT, Christopher Mehta, MD, from Northwestern Memorial Hospital in Chicago, will present “Age-Stratified Surgical Aortic Valve Replacement for Aortic Stenosis: An Analysis of the Society of Thoracic Surgeons Adult Cardiac Surgery Database (ACSD).”
The study is part of the STS 2024 session titled, “Trends and Research from the STS ACSD.” During his talk, Dr. Mehta will provide insight into how comprehensive data help inform multidisciplinary heart teams in making decisions between surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR) for patients.
Attendees will learn how the national landscape for SAVR and TAVR changed between 2011 and 2022, as experts evaluated age-specific trends and outcomes in surgical aortic valve replacement (AVR) in patients with bicuspid (BAV) or tricuspid (TAV) aortic valve by analyzing data from the STS ACSD.
Throughout the 11-year study, which followed more than 200,000 adult patients with BAV or TAV who underwent AVR for moderate and severe aortic stenosis, age-specific trends and outcomes were evaluated.
Last week, the Centers for Medicare & Medicaid Services (CMS) issued a final rule aimed at reforming the prior authorization (PA) process. The U.S. Department of Health and Human Services (HHS) estimates that these changes will result in approximately $15 billion in savings for physician practices over the next decade.
