STS University

The STS 55th Annual Meeting, held in San Diego, California, in January 2019, featured hands-on courses during STS University. Didactic materials for the courses are available below.

Please note: No CME credit is associated with the viewing of web-based content. These presentations were created for The Society of Thoracic Surgeons STS University courses, and STS retains sole rights to these materials.

Course 1: Essentials of TAVR 

COURSE DIRECTORS: Isaac George, New York, NY, and George L. Zorn, Kansas City, KS
COMMERCIAL RELATIONSHIPS: G. L. Zorn: Principal Investigator, Medtronic

Proficiency in transcatheter aortic valve replacement (TAVR) requires the acquisition of multiple endovascular principles and techniques. This course will introduce attendees to balloon-expandable and self-expanding TAVR platforms, as well as the various sheaths, guidewires, and catheters relevant to TAVR. Basics of alternative TAVR access will be discussed, as will the operations of various delivery systems.

Learning Objectives
Upon completion of this activity, participants should be able to:

  • Describe the decision-making process for choosing a TAVR access point (transfemoral, direct aortic, subclavian artery, and transapical)
  • State the salient differences in the deployment of balloon-expanded vs self-expanded devices
  • Describe the various types of sheaths and guidewires used during the TAVR procedure and understand reasons for their use
  • Explain the procedural technique for valve deployment from start to finish in both native aortic stenosis and valve-in-valve TAVR

Course 2: TEVAR and Aortic Arch Debranching Procedures

COURSE DIRECTORS: Nimesh Desai, Philadelphia, PA, and Ourania A. Preventza, Houston, TX
COMMERCIAL RELATIONSHIPS: N. Desai: Research Grant, Abbott, Cook Medical, Medtronic, W. L. Gore & Assoc; O. A. Preventza: Consultant/Advisory Board, Medtronic, W. L. Gore & Assoc, Speakers Bureau/Honoraria, Cook Medical

This course will review basic catheter and wire skills for thoracic endovascular aortic repair (TEVAR).  Participants will have hands-on experience with thoracic stent grafts and intravascular ultrasound (IVUS), as well as using vascular plugs from the brachial or femoral approach. Surgical techniques for zone 0-2 aortic arch debranching procedures will be discussed.

Learning Objectives
Upon completion of this activity, participants should be able to:

  • Identify the most common catheters and wires for TEVAR
  • Describe the deployment of commercially available stent grafts
  • Explain the use of IVUS and vascular plugs for subclavian artery occlusion
  • Describe the surgical techniques used in aortic arch debranching

Course 3: Mitral Valve Repair

COURSE DIRECTORS: Pavan Atluri, Philadelphia, PA, and Evelio Rodriguez, Nashville, TN
COMMERCIAL RELATIONSHIPS: E. Rodriguez: Research Grant, Abbott, Edwards Lifesciences; Consultant/Advisory Board, Abbott, Boston Scientific, Edwards Lifesciences; Speakers Bureau/Honoraria, Abbott, Edwards Lifesciences

In this course, participants will be able to practice different mitral valve repair strategies for both anterior and posterior leaflet pathologies. These will include leaflet resection and non-resection techniques, commissural repair strategies, and different chordal approaches. In addition, different surgical therapies for secondary mitral regurgitation, including ring selection, leaflet extension techniques, and mitral valve replacement, will be reviewed. 

Learning Objectives
Upon completion of this activity, participants should be able to:

  • Describe different leaflet resection and non-resection approaches, in addition to different chordal techniques required for successful mitral valve repair
  • Identify advance repair techniques for both primary and secondary mitral regurgitation
  • Demonstrate proper mitral valve replacement techniques

Course 4: Valve-Sparing Aortic Root Replacement - Reimplantation

COURSE DIRECTORS: Michael P. Fischbein, Stanford, CA, and Bo Yang, Ann Arbor, MI

This course will provide interactive, hands-on instruction of the surgical techniques and critical steps necessary for performing a successful valve-sparing aortic root replacement (VSRR) – reimplantation technique.

Learning Objectives
Upon completion of this activity, participants should be able to:

  • Describe the anatomy of the aortic root
  • Outline the key components to maintain a competent aortic valve
  • Summarize the technical steps necessary for a successful VSRR
  • List different methods in choosing a graft size
  • Discuss aortic valve leaflet repair

Course 5: Aortic Root Enlargement Procedures and Aortic Valve Leaflet Reconstruction

COURSE DIRECTORS: S. Adil Husain, Salt Lake City, UT, and Joseph W. Turek, Durham, NC
COMMERCIAL RELATIONSHIPS: J. W. Turek: Consultant/Advisory Board, Admedus; Speakers Bureau/Honoraria, CryoLife

This course will review two specialized subareas of technical expertise required to perform complex aortic root surgery. Participants will learn the anatomic approaches and surgical techniques employed in performing aortic root enlarging procedures, as well as aortic valve leaflet reconstructive techniques and the importance of providing annular stabilization in the context of a repaired aortic valve. Surgical strategies for root enlargement will include Nicks, Manougian, and Ross Konno. Surgical techniques involving aortic valve leaflet reconstruction will include primary simple cusp plication techniques, patch augmentation technique, Gore-Tex free margin shortening technique, and orienting the repaired bicuspid aortic valve into its aortic neoroot.

Learning Objectives
Upon completion of this activity, participants should be able to:

  • Identify the anatomy and appropriate surgical landmarks in the left ventricular outflow tract and aortic valve apparatus 
  • Describe the incision sites and overall surgical techniques for a variety of root enlargement strategies 
  • Discuss surgical pitfalls associated with each strategy and mechanisms by which to delineate options based upon patient and anatomic substrate
  • Describe how to set up and expose the aortic root for primary valve repair and identify the risk factors for repair failure based on the anatomy of the aortic valve
  • Recall the different aortic annular stabilization techniques and recognize the impact of each technique on valve repair – subcommissural annuloplasty, external aortic ring, and root reimplantation
  • Identify different bicuspid aortic valve types and explain the implications for valve repair and the choice of annular stabilization
  • Demonstrate how to implant a type I bicuspid aortic valve in the context of its neoroot and explain what the different bicuspid subtypes mean for orienting the repaired valve when performing a root reimplantation

Course 6: VATS Lobectomy

COURSE DIRECTORS: DuyKhanh P. Ceppa, Indianapolis, IN, and Jeremiah Martin, Portsmouth, OH

This course will review the indications, patient selection, technical steps, and recent advances for performance of lobectomy using video-assisted thoracoscopic surgery (VATS). Participants will be able to perform a VATS left upper lobectomy on porcine heart-lung blocks.

Learning Objectives
Upon completion of this activity, participants should be able to:

  • Describe the indications and steps to perform VATS
  • Discuss potential pitfalls and strategies for intraoperative troubleshooting to successfully achieve minimally invasive lobectomy
  • Identify instruments and other technologies available to perform minimally invasive lobectomy

Course 7: Advanced Open Esophageal and Tracheal Procedures

COURSE DIRECTORS: Christopher R. Morse, Boston, MA, and Jonathan Nesbitt, Nashville, TN

This course will provide hands-on training for several esophageal anastomosis techniques, as well as airway anastomosis and repair. These advanced operative techniques are not frequently utilized in most general thoracic surgery practices, but competence in these techniques is important. Participants will be introduced to several techniques for airway and esophageal reconstruction with emphasis in the different technical aspects (“pearls”) of the anastomosis from content experts.

Learning Objectives
Upon completion of this activity, participants should be able to:

  • Perform different types of esophageal anastomoses, including hand-sewn and hybrid hand-sewn/stapled
  • Recognize the technical pitfalls associated with various complex airway resection and anastomoses
  • Identify the key steps of tracheobronchoplasty

Course 8: Complex Chest Wall Issues for the Thoracic Surgeon: Reconstruction After Tumor Resection, Pectus Deformities, and Rib Fractures

COURSE DIRECTORS: Staci Beamer, Phoenix, AZ, and Dawn E. Jaroszewski, Phoenix, AZ
COMMERCIAL RELATIONSHIPS: D. E. Jaroszewski: Ownership Interest, Zimmer Biomet; Consultant/Advisory Board, Zimmer Biomet

In this hands-on course, participants will learn the various techniques for reconstruction of large chest wall defects after resection. Other highlights of the course include stabilization of rib and sternal fractures using the most current reconstruction systems and minimally invasive repair of adult pectus excavatum defects. At the end of this course, participants should be able to independently design and perform reconstruction of the chest wall for various indications.

Learning Objectives
Upon completion of this activity, participants should be able to:

  • Perform rigid and semi-rigid reconstruction of chest wall defects after resection, including the ribs and sternum
  • Demonstrate how to stabilize single and multiple rib fractures using rib fixation devices
  • Use sternal fixation devices to stabilize the sternum
  • Perform minimally invasive repair of adult pectus excavatum defects

Course 9: Minimally Invasive Aortic and Mitral Valve Surgery

COURSE DIRECTORS: Tom C. Nguyen, Houston, TX, Juan P. Umaña, Bogotá, Colombia
COMMERCIAL RELATIONSHIPS: Tom Nguyen: Speakers Bureau/Honoraria, Abbott, Edwards Lifesciences, LivaNova

Cardiothoracic surgeons face an increased demand to adopt minimally invasive valve techniques. Unfortunately, acquiring this skillset can be difficult in real-world practice. The objective of this course is to provide hands-on experience with the newest techniques in minimally invasive aortic and mitral valve surgeries. Participants will work in alternating pairs at each station to learn critical exposure and cannulation techniques for minimally invasive aortic (right anterior thoracotomy and hemisternotomy) and mitral (lateral thoracotomy) valve surgeries. Participants will then have an opportunity to perform aortic and mitral valve repair/replacement using simulators under both direct vision and via thoracoscopic guidance. For aortic valve replacements, participants will gain exposure to sutureless and rapid-deployment technologies. At the conclusion of the course, a handout will be distributed with a list of key instruments for minimally invasive valve surgery and suggested steps for building a minimally invasive valve program.

Learning Objectives
Upon completion of this activity, participants should be able to:

  • Explain exposure (right anterior thoracotomy, hemisternotomy, and lateral thoracotomy), cannulation, and cardioprotection techniques for minimally invasive valve surgery
  • Identify key operative steps for successful minimally invasive aortic and mitral valve surgeries, including sutureless and rapid deployment technologies
  • Describe the indications and contraindications for minimally invasive valve surgery

Course 10: Peroral Endoscopic Myotomy (POEM) Skills

COURSE DIRECTORS: Ralph W. Aye, Seattle, WA, and Inderpal S. Sarkaria, Pittsburgh, PA
COMMERCIAL RELATIONSHIPS: I. S. Sarkaria: Speakers Bureau/Honoraria, Intuitive Surgical

This is a practical, hands-on course for learning peroral endoscopic myotomy (POEM) using an explant model. Participants will learn how to plan landmarks for the procedure, access the submucosal space and create a long submucosal tunnel extending through the gastroesophageal junction, perform myotomy, and close the mucosotomy. The standard tools and electrothermy instruments for performing the procedure will be explored in detail.

Learning Objectives 
Upon completion of this activity, participants should be able to:

  • Determine the proper landmarks for beginning and completing the procedure
  • Create a submucosal tunnel
  • Perform an endoscopic myotomy within the tunnel
  • Close the mucosotomy

NEW! Course 11: Robotic Lobectomy

COURSE DIRECTORS: Edward Y. Chan, Houston, TX, Lana Y. Schumacher, Pittsburgh, PA, and Kazuhiro Yasufuku, Toronto, Canada
COMMERCIAL RELATIONSHIPS: E. Y. Chan: Speakers Bureau/Honoraria, Boston Scientific, Medtronic; L. Y. Schumacher: Speakers Bureau/Honoraria, Intuitive Surgical; K. Yasufuku: Research Grant, Olympus; Consultant/Advisory Board, Intuitive Surgical

This course will provide cardiothoracic surgeons of all experience levels with a detailed overview of the critical elements needed to successfully perform a lobectomy using a da Vinci Xi robot. Participants will gain hands-on experience with the technical skills, robotic instrumentation, port placement, anatomic exposure, and surgical techniques of a robotic lobectomy.

Learning Objectives 
Upon completion of this activity, participants should be able to:

  • Explain the different components of the robotic surgical platform
  • Describe the fundamental skills on the robotic console
  • State the basic technical skills necessary to perform robotic thoracic surgery
  • Outline the critical steps for performing a robotic lobectomy

NEW! Course 12: VATS Sleeve Lobectomy

COURSE DIRECTORS: Thomas A. D’Amico, Durham, NC, and Todd L. Demmy, Buffalo, NY
COMMERCIAL RELATIONSHIPS: T. A. D’Amico, Consultant/Advisory Board, Scanlan; T. Demmy, Consultant/Advisory Board, Medtronic

This course will review the indications, patient selection, instrumentation, and technical steps for the performance of bronchial and arterial sleeve lobectomy using video-assisted thoracoscopic surgery (VATS).

Learning Objectives 
Upon completion of this activity, participants should be able to:

  • Identify indications and contraindications for bronchial and arterial left upper lobe (LUL) sleeve lobectomy
  • Identify key operative steps in obtaining exposure for LUL sleeve lobectomy
  • Successfully complete thoracoscopic suture closures/anastomosis of secondary airway (either bronchoplasty or sleeve resection) and arterial sleeve in a tissue simulator
  • Discuss tools and supplies that enhance VATS bronchial and arterial reconstruction

NEW! Course 13: Percutaneous Transseptal Access, Transcatheter Mitral Valve Repair, and Mitral Valve-in-Valve Replacement

COURSE DIRECTORS: Tsuyoshi Kaneko, Boston, MA, and Gilbert H. Tang, New York, NY
COMMERCIAL RELATIONSHIPS: T. Kaneko: Speakers Bureau/Honoraria, Abbott, Edwards Lifesciences; G. H. Tang: Speakers Bureau/Honoraria, Abbott, Edwards Lifesciences

Transcatheter and surgical mitral valve therapies are emerging as complementary options for treating mitral valve disease, and cardiothoracic surgeons are best positioned to offer their patients both options. As we’ve learned from transcatheter aortic valve replacement, the transvenous access/transseptal approach to transcatheter mitral valve repair/replacement will, in time, predominate over the transapical approach. With the emergence of more transseptal transcatheter mitral valve repair and replacement devices, surgeons must acquire this skillset quickly to stay relevant in a rapidly evolving field. This course will expose participants to this important skill and myriad emerging transcatheter mitral technologies. 

Learning Objectives

  • Upon completion of this activity, participants should be able to:
  • Recognize the imaging modalities necessary for transseptal access
  • Perform transseptal access with necessary guidance
  • Explain the importance of transseptal access for cardiothoracic surgeons

Thank You

The Society of Thoracic Surgeons gratefully acknowledges the following companies
for providing educational grants for the STS 55th Annual Meeting.

Platinum Benefactors
Provided $50,000 or more