STS University

The STS 56th Annual Meeting, held in New Orleans, Louisiana, in January 2020, 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: VATS Lobectomy

COURSE DIRECTORS: DuyKhanh P. Ceppa, Indianapolis, IN, and Linda W. Martin, Charlottesville, VA

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

COURSE DIRECTORS: Staci Beamer, Phoenix, AZ, and Daniel L. Miller, Marietta, GA

In this hands-on course, participants will learn various techniques for reconstruction of large chest wall defects after resection. Other course highlights 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 3: Robotic Lobectomy

COURSE DIRECTORS: Edward Y. Chan, Houston, TX, Lana Y. Schumacher, Pittsburgh, PA, and Kazuhiro Yasufuku, Toronto, Canada
COMMERCIAL RELATIONSHIPS: E. Chan: Speakers Bureau/Honoraria, Boston Scientific, Medtronic; L. 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

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

COURSE DIRECTORS: S. Adil Husain, San Antonio, TX, and Christopher Baird, Boston, MA

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, 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 annual 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

NEW! Course 5: ECMO Cannulation

COURSE DIRECTORS: HelenMari Merritt-Genore, Omaha, NE, Erik Suarez, Houston, TX, and Joseph B. Zwischenberger, Lexington, KY

This hands-on session is intended to introduce the latest techniques and technologies in extracorporeal life support (ECLS). Simulation will allow participants to manage circuit events and safely initiate ECLS via percutaneous techniques.

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

  • Identify and troubleshoot key components of the circuit 
  • Demonstrate how to cannulate for venovenous or venoarterial access, including placement of the distal perfusion cannula 
  • Explain strategies for the prevention and management of ECLS complications and crises 
  • Recognize the circumstances for and initiate extracorporeal cardiopulmonary resuscitation

Course 6: Essentials of TAVR

COURSE DIRECTORS: Michael J. Reardon, Houston, TX, and Ibrahim Sultan, Pittsburgh, PA

This course will give participants an opportunity to practice the procedural techniques of TAVR for both balloon-expanding and self-expanding valves using the latest commercially available TAVR delivery systems. In addition, participants will be introduced to the sheaths, guidewires, and catheters that are commonly used during TAVR. Finally, participants will be introduced to imaging techniques that will help them understand how annular sizing is performed and how to choose the optimal vascular access for valve delivery. 

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

  • State the basic differences between balloon-expandable and self-expanding valves
  • Explain the cadence and techniques for transcatheter aortic valve deployment
  • Discuss the different catheters and wires used during the TAVR procedure
  • Describe the principles of annular sizing/measurement and vascular access choice using 3D computed tomography angiography
  • Outline the techniques of percutaneous vascular access and hemostasis

Course 7: Mitral Valve Repair

COURSE DIRECTORS: Pavan Atluri, Philadelphia, PA, and Serguei Melnitchouk, Boston, MA

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 8: Valve-Sparing Aortic Root Replacement – Reimplantation

COURSE DIRECTORS: Michael P. Fischbein, Stanford, CA, and Kenton J. Zehr, Baltimore, MD

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 for choosing a graft size
  • Discuss aortic valve leaflet repair 

Course 9: Minimally Invasive Aortic and Mitral Surgery

COURSE DIRECTORS: Tom C. Nguyen, Houston, TX, and Juan P. Umana, Bogota, Columbia

Cardiothoracic surgeons face an increased demand to adopt minimally invasive valve techniques; however, 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: Transseptal Puncture for Surgeons

COURSE DIRECTORS: Gorav Ailawadi, Charlottesville, VA, Richard Lee, Augusta, GA, and S. Chris Malaisrie, Chicago, IL

Catheter-based therapies have an increasing role in the management of cardiovascular disease—in particular, therapies that require percutaneous access to the left atrium. Such therapies include mitral valve repair (commercially approved edge-to-edge repair) and mitral valve replacement (commercially approved mitral valve-in-valve procedure). In addition to valvular therapies, applications exist in patients with atrial fibrillation (left atrial appendage occlusion using internal devices) and mechanical circulatory support (temporary left ventricular assist devices). Surgeons will need to become proficient in transseptal puncture in order to provide these catheter-based therapies.

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

  • Describe the step-by-step procedure to perform transseptal access via percutaneous transfemoral venous approach
  • Operate imaging modalities (fluoroscopy, echocardiography) required to perform transseptal access
  • Match the appropriate transseptal puncture technique to the catheter-based therapy

Thank You

The Society of Thoracic Surgeons gratefully acknowledges the following companies
for providing educational grants for the STS 56th Annual Meeting.

Platinum Benefactors
Provided $50,000 or more

Edwards Lifesciences