Impact of Surgical Factors on Event-Free Survival in the Randomized, Placebo-Controlled, Phase 3 KEYNOTE-671 Trial of Perioperative Pembrolizumab For Early Stage Non-Small-Cell Lung Cancer
In a talk given by presenting author Jonathan David Spicer, MD, PhD, of McGill University, he discussed new findings from the KEYNOTE-671 research study, focused on resectable early stage non-small-cell lung cancer (NSCLC), which have unveiled a significant breakthrough in the treatment landscape.
The study, titled "Impact of Surgical-Related Data on Event-Free Survival in KEYNOTE-671," demonstrated that neoadjuvant therapy with pembrolizumab plus chemotherapy did not delay surgery. "Results showed that neoadjuvant pembrolizumab plus chemotherapy with adjuvant pembrolizumab provided meaningful improvement in EFS," said Dr. Spicer. "This was shown when compared with neoadjuvant chemotherapy alone for resectable early stage NSCLC – regardless of clinical nodal status, baseline disease stage, or type of surgery."
Longitudinal Follow-up of Elderly Patients After Esophageal Cancer Resection in the Society of Thoracic Surgeons General Thoracic Surgery Database
In this study, Justin Blasberg, MD, of Yale School of Medicine, used the STS General Thoracic Surgery Database linked to the Centers for Medicare and Medicaid Services data to define characteristics associated with long-term survival following esophagectomy for cancer. The analysis included 4,798 patients from 207 STS sites who underwent esophagectomy between 2012-2019. "The researchers found that Medicare patients undergoing esophagectomy for cancer exhibit identifiable predictors for long-term survival and readmission," noted Dr. Blasberg. "The absence of pathologic T and N downstaging increases the risk for long-term mortality and readmission."
These findings suggest opportunities to enhance clinical practice and improve outcomes for Medicare patients undergoing esophagectomy for cancer.
On day one of STS 2024, meeting goers attended numerous sessions that explored the growing debate between SAVR and TAVR as treatment options,
Dr. Michael Bowdish presents a late-breaking session on cardiac surgery after TAVR trends and outcomes.
"Improved Longitudinal Outcomes with Surgical Aortic Valve Replacement with Atrial Fibrillation Management over Transcatheter Aortic Valve Replacement Alone," part of the larger "Bring SAVR Back" session given by J Hunter Mehaffey, MD, unveiled Class I guideline recommendations that support atrial fibrillation (AF) treatment during surgical aortic valve replacement (SAVR). And how recently, many low to intermediate risk patients with AF and aortic stenosis (AS) are managed by transcatheter aortic valve replacement (TAVR). And finally, they evaluated real-world longitudinal outcomes of TAVR vs SAVR with or without AF treatment.
"We concluded that in Medicare beneficiaries with AF who required aortic valve replacement, SAVR with concomitant treatment of AF was associated with improved longitudinal survival and freedom from stroke compared to TAVR," noted Dr. Mehaffey. "Consideration should be given for SAVR with AF treatment as a first-line approach for patients with AF requiring aortic valve replacement."
In his discussion of "Robotic Aortic Valve Replacement versus Transcatheter Aortic Valve Replacement: A Propensity Matched Analysis," Vikrant Jagadeesan, MD, presented findings on contemporary data that supports equipoise between surgical aortic valve replacement and transcatheter aortic valve replacement (TAVR) for the management of symptomatic severe aortic stenosis (AS). He further explained that controversy exists around the optimal management of patients in low to intermediate risk categories, and how the study compared outcomes of surgical robotic aortic valve replacement (RAVR) to TAVR.
"Compared to TAVR, RAVR was associated with lower stroke and PPM rates, less PVL, and improved 1 year survival," said Dr. Jagadeesan. "And RAVR may provide a safe and effective minimally invasive first-line alternative for low to intermediate risk patients presenting with symptomatic AS."
In a late breaking session titled, "Cardiac Surgery after Transcatheter Aortic Valve Replacement: Trends and Outcomes," Michael Bowdish, MD, illustrated how his research team set out to document trends and outcomes in cardiac surgery following transcatheter aortic valve replacement (TAVR), a topic gaining importance as reports of subsequent cardiac operations and early TAVR explantations increase. Using the Society of Thoracic Surgeons Adult Cardiac Surgery Database, the study covers adult patients who underwent cardiac surgery after an initial TAVR from January 2012 to March 2023.
"The study findings underscore the escalating need for both aortic and non-aortic valve cardiac surgeries following TAVR," explained Dr. Bowdish. "They note a substantial increase in the frequency of these surgeries, emphasizing the importance of understanding outcomes." He observed elevated risk in these cases, as indicated by mortality and stroke rates, which calls for careful consideration, particularly given the expanding use of TAVR across a broader range of age and risk profiles. Finally, the study suggests the need for ongoing assessment and longitudinal evidence to inform decision-making in the evolving landscape of TAVR applications.
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.
The 2024 Lung Transplant Symposium: Surgical and Medical Insights for Transplant Assessment and Management, presented at the STS 2024 pre-conference convening on Friday, January 26. Approximately 100 surgeons, pulmonologists, anesthesiologists, and other transplant team members learned about best-practice approaches for surgical and medical care of lung transplant patients – from assessment as candidates though post-surgical care as recipients.
Nearly 100 surgeons, pulmonologists, anesthesiologists, and other transplant team members attended the 2024 Lung Transplant Symposium.
After a welcome and introduction by STS President Dr. Tom MacGillivray, Dr. Shaf Keshavjee of the Toronto Lung Transplant Program at the University Health Network, gave a brief overview of lung transplantation firsts and milestones before moving into present-day breakthroughs and areas of concern.
"Current noteworthy topics we’re addressing in lung transplantation include primary graft dysfunction, donor management, and organ repair centers, refining the transplant ecosystem, as well as understanding the challenges of retrieval and transport of organs," said Dr. Keshavjeee.
Five 90-minute sessions covered the following subject areas: recipient selection, donor selection, intraoperative management, postoperative management, and challenging situations led by expert panels who answered questions from attendees.
Among the wide range of presentations, the Symposium featured included, "ECMO as Bridge to Transplant;" "Organ Procurement Techniques -- DBD, DCD, or NRP;" "Perioperative and Intraoperative Anesthesia Management;" and "Diagnosis, Monitoring and Therapeutic Challenges," which each cited current research and case study results.
This presentation on day one of STS 2024 will report on a comprehensive approach that focuses on maximizing survival and optimizing the utilization of donor hearts in patients with hypoplastic left heart syndrome (HLHS) and HLHS-related malformations with functionally univentricular ductal-dependent systemic circulation.
Dr. Mark Bleiweis will report on study findings of a comprehensive approach to treating neonates with HLHS and HLHS-related
“A Comprehensive Approach to the Management of Patients with HLHS and HLHS-Related Malformation” will begin at 9:45 a.m. CT in room Stars at Night 1. The presentation is part of the STS “Cardiac Center in Evolution: Management of Single Ventricle” session.
Dr. Mark Bleiweis, from the University of Florida, will report on findings describing outcomes that resulted from using this approach in 100 consecutive neonates. During the talk, Dr. Bleiweis will detail how these neonates with HLHS and HLHS-related malformations, during an eight-year period, were stratified into three different pathways based on their risk factors, and mortality rates that resulted for these neonates.
“This study is based on the principle that some patients with HLHS or HLHS-related malformations are at very high-risk for Norwood (Stage 1) palliation or hybrid palliation secondary to important cardiac risk factors,” said Dr. Bleiweis.
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.
A new and exciting space, The Hub will be the center of activity for programs, sessions, networking, and mentoring specifically for cardiothoracic surgery trainees and early surgeons. Use the following schedule to plan to connect with your colleagues and refresh during the meeting:
The Hub will make its first appearance at STS 2024
Saturday, January 27
Juice Shots Available
9 - 9:45 a.m.
Early Career Insights with Dr. Leah Backhus, sponsored by AstraZeneca
9:10 - 9:40 a.m.
Small Theater
STS Trainee Luncheon
11:15 a.m. - 12:30 p.m.
Large Theater
Leaders in CT surgery, including members of the STS Board of Directors, Workforces, and Task Forces, will be seated with trainees to discuss topics of interest to residents. Discussion topics include subspecialty training, dedicated research time, interventional and catheter-based skills during training, gaps in diversity, training paradigms, the current job market, and addressing non-clinical training needs. Attendance is limited to trainees (residents, fellows, medical students, LTTF scholars) and invited faculty.
Sunday, January 28 Ask the Experts: How I Succeeded as an Early Career Surgeon
7 - 8 a.m.
Large Theater
Listen to a panel discussion from your colleagues who found success early in their careers.
Moderators:
Dr. Brian Mitzman – University of Utah
Dr. Jessica Rove – University of Colorado
Panelists:
Dr. Amy Fiedler – University of California San Francisco
Dr. Stephanie Worrell – University of Arizona
Dr. Reilly Hobbs – University of Utah/Primary Children's Hospital
Dr. Derek Serna-Gallegos – University of Pittsburgh Medical Center
Dr. Olugbenga Okusanya – Thomas Jefferson University
Juice Shots Available
9:45 - 10:30 a.m.
Early Career Journey Roundtables
9:55 - 10:30 a.m.
Large Theater
Early career surgeons and trainees have the opportunity to meet in an informal setting with STS leaders, who will offer insight into topics relevant to their career stages. Early career surgeons and trainees are on a unique journey, and seasoned surgeons will provide high-value information and an opportunity to meet and network with leaders in the specialty.
(The roundtables listed below will be held concurrently.)
STS: Your Career Journey Partner
This roundtable discussion will focus on how STS is a surgeon’s partner throughout one’s career journey, including how to become a more active and involved member; tap into award and fellowship opportunities; engage in STS’s resources, avenues of support, and advocacy opportunities; and make the most of the STS Annual Meeting.
Trade Secrets for a Successful Career Journey
This roundtable discussion will focus on how surgeons can set themselves up for success early in their career journey, including how to navigate a job transition, negotiate a contract, get the most out of being a mentor or mentee, best manage one’s time, lead an OR team, and network with peers and colleagues.
TSRA Luncheon
11:30 a.m. -12:45 p.m.
Large Theater
Join fellow trainees for the TSRA Luncheon moderated by TSRA President, Dr. David Blitzer. The program will include TSRA Awards, an update on TSDA activities, and a "State of the Workforce," including the job market and policy changes impacting trainees.
Monday, January 29
STS Trainee Symposium: Professionalism Puzzles You May Encounter During Residency: How to Piece Together a Resolution
7:15 - 8:45 a.m.
Large Theater
Continental breakfast will be served
This session showcases challenging situations that occur in medical practice regarding professionalism using real and hypothetical scenarios.
Moderators:
Dr. Elizabeth Dexter – Roswell Park Comprehensive Cancer Center
Dr. Amber Duda – University of Nebraska Medical Center
Presentations:
Dr. Pauline Go — Penn State College of Medicine - Proper Use of Social Media for Surgeons
Dr. Clauden Louis – BayCare Medical Systems – Named in a Malpractice Lawsuit? Keep Calm, Consult with a Malpractice Lawyer, and Learn On
Dr. Aundrea Oliver – East Carolina Heart Institute at East Carolina University – Harassment in Residency
Dr. Sean A. Jordon – University of Tennessee Medical Center – A Co-Residents Substance Abuse is Affecting Their Work – What Now?
Dr. Melanie Edwards – Trinity Health Care – Financial Planning During Training and the Transition from Training to Practice
Presentations of Thoracic Surgery Foundation Research Award Recipients
9:30 - 10 a.m.
Large Theater
A highlight of research being conducted by cardiothoracic surgeon and trainee recipients of a TSF Research Award.
Juice Shots Available
10:30 - 11:15 a.m.
Early Career Journey Roundtable: My Approach to Wellness
10:40 - 11:15 a.m.
Large Theater
Coffee will be served
Early career surgeons and trainees have an opportunity to meet in an informal setting with STS leaders who will provide insight into topics relevant to their career stage. Early career surgeons and trainees are on a unique journey, and seasoned surgeons will provide high value information and an opportunity to meet and network with leaders in the specialty.
This roundtable discussion will focus on achieving personal and professional wellness, how to avoid burnout, advice on personal self-care, and tips for achieving financial stability.
This program is designed to help decrease the stress of the American Board of Thoracic Surgery (ABTS) exam by allowing trainees to prepare for and practice with the oral exam format. Registrants will receive access to a collection of online modules and resources that provide an overview of effective oral exam test-taking strategies, the anatomy of an oral exam, mock oral exam dos and don’ts; and an in-person session with a mock examiner (including small group of other trainees) who will present case scenarios, pose questions, and provide individualized verbal and written feedback to each participant. Limited spots are available, and priority will be given to cardiothoracic surgery residents who are registered for the Annual Meeting and scheduled to take the ABTS oral examination in June 2024.
STS Mentorship Program
STS Mentorship Program mentors and mentees are encouraged to meet up in the Networking Lounge. The STS Annual Meeting is an excellent opportunity for mentors and mentees to meet face-to-face with their program partners during breaks, meals, or any other time that works best for both parties.
Painting with a Purpose
While in The Hub, tap into your creative side and contribute to Painting with a Purpose by adding your personal touch to a mural that will be completed through meeting-goers’ collected efforts and donated to Shriners Children’s Hospital in Galveston, TX, after the meeting.
An in-depth session on day one of STS 2024 will showcase study results of the potential importance of treating preoperative anemia — often a marker of more advanced coronary disease and illness, and often associated with adverse outcomes — to reduce intraoperative RBC transfusions to help improve outcomes after CABG.
“A Mediation Analysis of Anemia and Transfusions with CABG Outcomes in the National STS Database” will be presented at 1:15 p.m. CT on Saturday, January 27, during the STS Annual Meeting. The presentation is part of the STS “How to Achieve a 0% Transfusion Rate after CABG” session.
Dr. Motahar Hosseini, from Massachusetts General Hospital, will report on findings that utilize data of more than 53,000 patients from the National STS Adult Cardiac Surgery Database who underwent CABG in 2019, comparing operative mortality and outcomes of patients who presented with preoperative anemia to those who were non-anemic at baseline.
“Preoperative anemia is associated with increased risk of operative mortality and longer ICU and hospital stays,” said Hosseini. “Interestingly, the study results showed that most of these effects were mediated through the effect of intraoperative RBC transfusions, while the higher association of preoperative anemia and higher rates of postoperative dialysis were largely due to direct effects of anemia itself, and only partially mediated by intraoperative transfusions.”
On day one of STS 2024, Dr. Moritz Wyler von Ballmoos, of Texas Health Resources, will present a session titled, “The STS 2023 Clinical Practice Guidelines for the Surgical Treatment of Atrial Fibrillation: Key Takeaways and How Do They Differ from the ACC/AHA Atrial Fibrillation Clinical Practice Guidelines?”
During his talk — one of several STS 2024 sessions to feature late-breaking studies that significantly influence advances in cardiothoracic patient care — Dr. Wyler von Ballmoos will share the latest evidence for surgical ablation (SA) and left atrial appendage occlusion (LAAO) across various clinical scenarios from the clinical practice guidelines. Emphasis is on the evolving role of surgical ablation and left atrial appendage occlusion in managing atrial fibrillation.
The recommendations highlight the importance of a multidisciplinary team, comprehensive assessment, and long-term follow-up with specific attention to diverse clinical scenarios. The Class I recommendation for LAAO and expanded use of SA signify the growing confidence in these interventions based on recent evidence.
This discussion is part of a larger session, titled "Leaving Money on the Table: Benefits of Ablation and Left Atrial Appendage Management in Atrial Fibrillation" that includes four additional presentations on the topic, as well as an expert panel discussion and question and answer sessions that follow each presentation.
