News & Media

John H. Calhoon, MD STS News, Fall 2022 — As we emerge from the pandemic, it is fascinating to see how much has changed. Expectations of a return to normal just don’t seem possible. Although some things may be better, other daily experiences clearly are not. To me, one thing has become much worse: the relentless barrage of trivial and misleading information and negative news and commentary. The endless accusations of one faction’s bias or maltreatment of the other are difficult to reconcile. Without self-control, this societal noise could wear one out. To avoid these traps, we can remind ourselves how fortunate we are to be cardiothoracic surgeons with the opportunity to make a difference each day in the lives of our patients and their families. Gratitude for my family and friends, and for the many gifts offered by this world, this country, and my community, are a great comfort to me. Nonetheless, the seemingly ever-increasing loss of stability and predictability impacts our ability to effectively manage our lives, both at work and at home. It is all too easy as a surgeon to thrive on the illusion of stability, predictably, and control. With time, I have come to realize the significance of this illusion. The only thing we can control is our response to the noise. Reminding myself of this has helped me be less stressed and more relaxed. Have I experienced burnout? Yes. However, taking the time to occasionally relax and recharge is the best way to manage stress and aim for a bit of balance. Throughout my career, I have turned to senior surgeons—all of whom gave back to our specialty via volunteer work with STS and other organizations—for support and guidance. It is those surgeons and STS that have helped our specialty evolve tremendously since my days as a resident and early career surgeon. Many technologies and techniques that are common today did not exist then. STS has been and continues to be steadfast as a leader in providing hands-on education for thoracoscopic techniques, mitral valve knowledge, TAVR, and so much more. For many of us, STS has played an important role in strengthening our skills and abilities as surgeons and leaders. "We can remind ourselves how fortunate we are to be cardiothoracic surgeons with the opportunity to make a difference each day. John H. Calhoon, MD An array of STS education programs and services—including in-person meetings, webinars, on-demand content, and the STS Cardiothoracic Surgery E-Book—provide members access to the latest science and best practices. The Society also provides special opportunities for residents and early career surgeons to connect with peers and mentors, participate in hands-on training, develop leadership skills with renowned faculty, and participate in STS governance to advance the interests of the specialty. But STS is so much more. It is a catalyst for advances in CT surgery that help surgeons provide the highest quality care and deliver the best patient outcomes. The STS National Database and accompanying research and quality initiatives help drive cardiothoracic surgery innovation and safety. Hospitals and health systems depend on our data to strengthen their performance. Industry uses them to design and improve next generation devices and therapeutics. Data-driven research powers The Annals of Thoracic Surgery, the largest and most read journal in our specialty (congratulations to Dr. Jo Chikwe and her editorial and administrative teams!). And research is the basis for STS’s leadership in guideline development. Most importantly, STS is the only organization engaged in public policy advocacy for cardiothoracic surgeons and the patients, institutions, and communities we serve. STS-PAC is a political action committee in Washington, DC, that exclusively represents the specialty. Let me close by asking each of you: Are you unlocking the full value of your STS membership? Here are five things you can do to become more engaged and give back to the profession: Attend—in person—STS 2023, our 59th Annual Meeting in San Diego (see page 11) Submit an abstract for a presentation at an upcoming STS meeting Contribute an article to The Annals or Annals Short Reports Donate to STS-PAC and develop a relationship with your member of Congress Volunteer to serve as a mentor for a younger surgeon or join an STS Workforce or Task Force Details about these opportunities can be found at sts.org. More to come, John

STS News, Fall 2022 — The highly anticipated new season of The Resilient Surgeon is underway, featuring game changers in the high-performance and wellness space, including a professor of leadership at Harvard Business School, a performance coach, and a psychiatrist. This provocative STS podcast series aims to help surgeons be their best selves inside and outside of the operating room. “The choice of guests featured this season parallels a paradigm I developed called ‘Best Self Pie,’” said Michael A. Maddaus, MD, host of The Resilient Surgeon. “I prefer the term ‘best self’ to the word wellness because it is an intuitive and personal reference point that we all have, if we are aware enough." The first piece of the “pie”—individual habits and activities such as sleep, diet, exercise, gratitude, and connection with others—were covered in the first season of the podcast; whereas the additional pieces—self-awareness, purpose, and connection at work and home—will be tackled in Season 2 of The Resilient Surgeon, which began airing in late August. The episodes will be released biweekly with a lineup that includes: Brad Stulberg: author of The Practice of Groundedness discusses being successful without crushing the soul (self-awareness and habits) Marcus Buckingham: world expert on engagement at work and the author of Love + Work provides a master class on finding purpose by embracing our "wyrd" (self-awareness and purpose) Amy C. Edmondson, PhD: professor of leadership at Harvard Business School and author of seven books discusses psychological safety and its crucial role in performance, creativity, and wellbeing (all four) Paul M. Conti, MD: psychiatrist who specializes in mental illness and the impact of life stressors breaks down the epidemic of trauma and how it impacts lives in ways that people may not even realize (self-awareness) Christine Porath, PhD: professor at Georgetown University and author of Mastering Community offers insights on the critical role of being valued and respected in the workplace (connection) Additional guests will include Rich Diviney, Brian R. Little, PhD, and Steve Magness. Subscribe to Surgical Hot Topics via your favorite podcast app, or find the episodes at sts.org/podcast. Social media postings about the series will include the hashtag #BeYourBestSelf.

Lui Promoted at Stanford Natalie S. Lui, MD, recently was appointed associate medical director for surgical services as part of the cancer destination service line (DSL) at Stanford Health Care in California. She will work collaboratively with cancer DSL leadership and key stakeholders throughout Stanford Medicine to ensure consistent representation of surgical oncology. Dr. Lui also is an assistant professor of cardiothoracic surgery at Stanford University. She has been an STS member since 2014. Thompson Is President at Nebraska Heart Richard B. Thompson, MD, MBA, took over as president of CHI Health Nebraska Heart in Lincoln. In addition to this new leadership role, he will serve as cardiothoracic surgeon, specializing in complex coronary revascularization, advanced surgical therapy for heart failure, and robotic lung surgery. Previously, Dr. Thompson worked at Bryan Heart in Lincoln, Nebraska. He has been an STS member since 2010. Kaneko Leads Cardiac Surgery at WashUMed Tsuyoshi Kaneko, MD, has been named the Shoenberg Professor and chief of cardiac surgery at Washington University School of Medicine and Barnes-Jewish Hospital, both in St. Louis, Missouri. He previously worked as surgical director of the Structural Heart Program at the Brigham and Women’s Hospital and associate professor in surgery at Harvard Medical School in Boston, Massachusetts. An STS member since 2014, Dr. Kaneko chairs the STS/ACC TVT Research and Publications Subcommittee and is vice chair of the STS Workforce on Technology and Innovation. Argote-Greene Begins Position in Florida Luis M. Argote-Greene, MD, is the new regional director of thoracic and esophageal surgery at the Cleveland Clinic Indian River Hospital in Vero Beach, Florida. Most recently, he was a thoracic surgeon with University Hospitals and clinical assistant professor at Case Western Reserve University, both in Cleveland, Ohio. Dr. Argote-Greene has been an STS member since 2011. Steliga Is Named Endowed Chair Matthew A. Steliga, MD, has been named the Kent Westbrook Distinguished Chair in Surgical Oncology at the University of Arkansas for Medical Sciences (UAMS)-Rockefeller Cancer Institute in Little Rock. Dr. Steliga—the division chief of thoracic surgery at the University of Arkansas and professor of surgery—led the development of the UAMS lung cancer screening and integrated tobacco cessation programs, and he is involved in the development of the UAMS mobile lung screening program. Dr. Steliga also will continue to serve as associate program director for the UAMS Surgery Residency Program. He has been an STS member since 2010. Han Honored for Exceptional Patient Care Jason J. Han, MD, received the Don Liu Humanism Hero in Surgery Award from Penn Medicine in Philadelphia, Pennsylvania. This award recognizes a member of the Penn surgical staff who exhibits compassion and sensitivity in the care of the surgical patient in a collegial, collaborative, selfless, and ethical manner. Dr. Han was selected by the chairman and vice chair of education based on peer and faculty nominations. He has been an STS member since 2018. Hoff Moves to Miami Steven J. Hoff, MD, has joined the Miami Cardiac & Vascular Institute in Florida. Previously, he served as chief of cardiothoracic surgery at Orlando Regional Medical Center and associate professor of surgery at the University of Central Florida College of Medicine in Orlando. Dr. Hoff also was part of the team at the Orlando Health Heart & Vascular Institute. He has been an STS member since 2000.

STS News, Fall 2022 — With nearly as many women as men presenting with signs of ischemia in today’s health care settings, clinicians should keep in mind that coronary artery disease (CAD) goes beyond vessel obstruction, especially in female patients—and should take advantage of tools like advanced imaging to see past anatomic walls. “More and more, I think we're recognizing that, when they’re designed for the identification of primarily obstructive CAD, conventional approaches can lead to repeated testing, especially in women,” said Viviany R. Taqueti, MD, MPH, from Brigham and Women’s Hospital in Boston, Massachusetts. “And yet, often without differentiating who’s truly at risk.” Obstructive CAD is just one phenotype of ischemic heart disease, and perhaps just the tip of the iceberg when physicians take into consideration the entirety of coronary circulation, Dr. Taqueti said. A physician needs to spot other pathologies such as diffuse non-obstructive CAD and coronary microvascular dysfunction, which can certainly impact patients’ cardiovascular outcomes, she explained. As an example, Dr. Taqueti referred to a study in Denmark that presented observational data from a large registry of more than 11,000 patients who were referred for coronary angiography. The investigators found that up to a 32% of the male patients—and a startling 65% of female patients—had no significant obstructive disease to explain their symptoms. “We need a more sophisticated toolbox that looks beyond regional wall motion abnormality or even regional perfusion abnormalities to consider and quantify absolute blood flow in the heart and quantify coronary flow reserve, or CFR,” said Dr. Taqueti. Coronary microcirculation is of course too small to be directly imaged in vivo, and it needs to be evaluated indirectly by perturbing function. A variety of technologies make this possible. Coronary microvasculature, especially in female patients, represents the future of prognosis after procedures like CABG, say experts. "Conventional approaches can lead to repeated testing, especially in women. And yet, often without differentiating who’s truly at risk.” Viviany R. Taqueti, MD, MPH In the invasive realm, historically, catheter-guided wire-based testing has provided measurements of CFR and microcirculatory resistance. But noninvasive methods, including cardiac magnetic resonance, Doppler ultrasound, and—the current gold standard—positron emission tomography, are revealing just how prevalent coronary microvascular dysfunction is in patients with angina or signs of ischemia. Data from more angiography studies demonstrated that just under half of the patients had no obstructive disease. “And these were evaluated quite objectively, using fractional flow reserve normal values above 0.8,” Dr. Taqueti explained. But from that group, a large majority—76% to 89%—had some evidence of objective coronary vasomotor dysfunction on testing. “The vast majority of these had coronary microvascular dysfunction, with a minority having pure vasospasm,” said Dr. Taqueti. “This is important because we know that impaired flow reserves—that can certainly be manifestations of coronary microvascular disease—are associated with worse outcomes in terms of cardiac mortality in our patients.” More revelations come with observational data that span multiple research centers: Even in patients with no obvious obstructive lesions or inducible ischemia on stress testing, impaired CFR is independently associated with major adverse events.  In those with significant obstructive CAD, CFR also modifies the outcome of coronary revascularization procedures, especially coronary artery bypass grafting (CABG), Dr. Taqueti pointed out. With long-term cardiovascular outcomes, patients with a severely reduced CFR who underwent CABG did as well as those with a preserved CFR to begin with (adjusted p for interaction = 0.03), suggesting that impaired CFR may serve as a marker for CABG benefit akin to diabetes or SYNTAX score, said Dr. Taqueti.     When severely impaired, coronary flow reserve is even more prognostically significant in women—and may be as useful of a marker for CABG benefit as diabetes or SYNTAX score. In women, severely impaired CFR appears to be even more prognostically significant. “You can see the divergence of the hazard for men and women with a significant interaction for sex as CFR values fall substantially below 2,” Dr. Taqueti explained. “Women appear to fare even worse at the very low range of CFR despite the fact that, when you look at anatomic findings, they are much less likely to have multivessel obstructive disease. In contrast, men were much more likely to have impaired CFR in the presence of multivessel disease—perhaps explaining their impaired flow reserves.” Dr. Taqueti encouraged physicians to consider how these factors reframe their approach to understanding CAD, and to emphasize appropriate diagnostic testing to identify risk, which can help to curb repeated conventional testing in patients at low risk. These recommendations were presented as part of the STS Coronary Conference this summer, in a session devoted to noninvasive diagnostic techniques for evaluation of high-risk ischemic heart disease. The conference united faculty and attendees from 18 countries with a multidisciplinary approach. Course director Marc Ruel, MD, MPH, who serves as STS Canadian Director, touted the camaraderie displayed by participants of all backgrounds. “Surgeons have to be the top experts at understanding the very reason why they operate—or not—on a patient,” Dr. Ruel said. “It comes down to much more than ‘I can do this,’; rather, it should be ‘It is a good idea to be doing this for the patient, and I have the skills to do it.’ The Coronary Conference aimed to achieve this: Expert knowledge and skills in the huge, knowledge-intensive area of coronary surgery.” Strong surgeons need strong cardiologists, anesthesiologists, radiologists, and other experts, Dr. Ruel said. “This is why we made the Coronary Conference so multidisciplinary and team-based, with a focus both on advanced practical knowledge and on advanced technical skills.” “We need to understand microvascular disease in order to better treat ischemia in both women and men,” Dr. Taqueti added. “Coronary microvasculature represents an exciting new frontier in cardiovascular disease reduction, and the future is pointing toward a role for coronary microcirculation in macrovessel disease prognosis. That’s something we need to think about in all our practices.”