News & Media

Latin America Surgery Symposia Will Feature World-Class Insights In November and December, two virtual collaborative events from STS and international partner organizations will showcase the latest advances in thoracic and cardiovascular surgery, featuring faculty from across the globe. Hosted by STS, the European Association for Cardio-Thoracic Surgery (EACTS), and the European Society of Thoracic Surgeons (ESTS), the Latin America Thoracic Surgery Symposium on November 19 will offer new data and insights on managing patients with COVID, starting a lung cancer screening program, segmentectomy, and treating patients with chest wall trauma. Find details at sts.org/LatAmThoracic. The STS/EACTS Latin America Cardiovascular Surgery Symposium on December 3 will present the latest developments and best treatment practices for coronary artery disease, valvular heart disease, thoracic aortic disease, atrial fibrillation, and the surgical management of heart failure. Learn more at sts.org/LatAmCardiac. Dr. Stulak shows a different configuration for left ventricular venting in the Deep Dive video, “Post-Cardiotomy ECMO Support.” Deep Dive Series Launches with More Critical Care Essentials Complementing the popular 8 in 8 video series, the STS Deep Dive Series provides experts with a little more time to take in-depth looks at important cardiothoracic topics. The series launched with four videos highlighting must-know techniques in critical care. Initiation of VV ECMO for COVID Patients The coronavirus pandemic has led to a resurgence in use of veno-venous (VV) ECMO, which has become a salvage treatment when other therapies have failed. In this deep dive, presented by J.W. Awori Hayanga, MD, MPH, MHL, from West Virginia University Medicine, and HelenMari Merritt-Genore, DO, from Methodist Health System in Omaha, Nebraska, viewers will hear about emerging criteria, indications, and strategies for VV ECMO use for patients with COVID. Post-Cardiotomy ECMO Support Presenter John M. Stulak, MD, from the Mayo Clinic in Rochester, Minnesota, leads viewers in exploring post-cardiotomy ECMO support for patients who have undergone a conventional cardiac operation and are unable to wean from cardiopulmonary bypass. Topics include cannulation configurations for VV and veno-arterial ECMO, left ventricular venting, troubleshooting failure to wean, and flow optimization. In Part 2 (Thoracoabdominal Surgery) of the “Perioperative Care of the Aortic Surgical Patient” Deep Dive video, Dr. Chatterjee shares that “literally every organ system in the body is vulnerable during thoracoabdominal aneurysm repair.” Perioperative Care of the Aortic Surgical Patient: Parts 1 and 2 In a series of two videos, Rita K. Milewski, MD, PhD, MSEd, from Yale School of Medicine in New Haven, Connecticut, along with Subhasis Chatterjee, MD, and Jonathan C. Hong, MD, both from Baylor College of Medicine in Houston, Texas, highlight the perioperative management of aortic surgery, identifying fundamentals and pitfalls. Part 1 focuses on aortic dissection, as well as proximal aortic and arch surgery with hemodynamic considerations and optimal neurologic outcomes. Part 2 focuses on managing the unique challenges of aortic aneurysm surgery and reducing the risk of spinal cord ischemia in the postoperative period. The collection is free and available at sts.org/deepdive, as well as on the STS YouTube channel. Application Submissions Begin Soon for Miami Beach Leadership Capstone The STS Leadership Series is a unique learning experience designed to help early to mid-career cardiothoracic surgeons build and hone their leadership skills. The 2021 series of webinars will culminate in a capstone in-person event on Friday, January 28, prior to STS 2022 in Miami Beach, Florida—and attendance at the event is limited. STS will consider applications from surgeons within their first 8 years of practice who have watched the three webinars, including “Leading During Crisis,” “Building Your Practice and Your Brand,” and “Promoting Your Brand.” There’s still time to watch these webinars and be part of the exclusive event. Information about the application process will be announced soon. Visit sts.org/leadershipseries to take advantage of this career-building opportunity. Critical Care Conference Showcases Cutting Edge of ERAS, ECMO During the 18th Annual Perioperative and Critical Care Conference, more than 350 registrants and faculty came together for a 2-day virtual experience featuring techniques and technological advancements in cardiothoracic perioperative and critical care medicine. The conference included live presentations, e-posters, abstract sessions, on-demand videos, a virtual technical exhibition, and social and wellness events for attendees to connect and unwind with colleagues. Day 1 highlighted enhanced recovery after surgery (ERAS), beginning with “What’s New” sessions covering cardiac and thoracic topics, complemented with panel discussions on issues, including “Making the Case for ERAS to Administrators” and “Can ERAS Equalize Outcomes Between Open and VATS?”. The day continued with discussions on opioid avoidance in ERAS, postoperative atrial fibrillation, managing the right ventricle after left ventricular assistive device placement, and complications after thoracic surgery. Linda W. Martin, MD, MPH, from the University of Virginia in Charlottesville, presented the session “Why Are We Avoiding Opioids in the First Place?” During day 2, attendees explored the latest in extracorporeal membrane oxygenation (ECMO), with panelists and presenters addressing ethical controversies and conundrums in ECMO, goal-directed perfusion, and advanced life support after cardiac surgery. Sessions also addressed experiences with COVID “long-haulers,” and attendees had the privilege of hearing testimonials from two COVID survivors, who shared their stories of treatment, recovery, and living life after their illnesses. During the conference, Errol L. Bush, MD, from Johns Hopkins Medicine in Baltimore, Maryland, discussed dual lumen cannulation as the “go-to strategy” for COVID ECMO. If you missed the conference, the meeting content will be available for purchase this month through the STS Learning Center.   News Releases Draw Attention to Chewing Gum after Heart Surgery, ERAS Minimizing Opioid Use The Society recently distributed two news releases that featured research presented during the 18th Annual Perioperative and Critical Care Conference. Chewing Gum after Heart Surgery May Help Relieve Gut Problems Researchers: Sirivan S. Seng, MD, Hakan Orbay, MD, PhD, and Charles M. Geller, MD Main finding: Chewing gum after heart surgery may accelerate the return of gut function, helping patients feel better and potentially be discharged sooner than those who don't use this intervention. Featured in: TCTMD, HealthDay, and Cardiology Today Patient-Centered Protocols Help Eliminate Excess Opioid Use after Lung Surgery Researchers: Andres Zorrilla Vaca, MD, David C. Rice, MD, and colleagues Main finding: Lung surgery patients who utilize a comprehensive, evidence-based enhanced recovery after surgery program require fewer opioid prescriptions when discharged. Featured in: Medical Xpress For more information, visit sts.org/media.

STS News, Fall 2021 — More than 50 cardiothoracic surgeons, trainees, medical students, and other STS members participated in the Society’s Virtual Advocacy Conference this past September. STS members met with lawmakers and enlightened them about issues that can help improve care for cardiothoracic patients. Participants connected with approximately 100 legislative decision makers during the conference. They also heard from Rep. Larry Bucshon, MD (R-IN), a cardiothoracic surgeon, who provided perspective about the current Congress and his focus for the remainder of 2021. Rep. Bucshon emphasized the importance of surgeon participation in advocacy and answered questions from participants. He also explained how he helped temporarily halt Medicare reimbursement cuts for surgeons and supports tools like the STS National Database to facilitate innovation and quality improvement. During the conference, STS members met with House and Senate representatives in Congress and their staff, urging them to take action on three issues that are especially important to the specialty.   Ask #1: Stop Medicare Reimbursement Cuts Sign an important letter led by Reps. Bucshon and Ami Bera, MD (D-CA), asking Congressional leadership to stop pending payment cuts for surgeons and work on long-term reforms that would bring stability to the Medicare program. In late 2020, surgical specialties, including cardiothoracic surgery, narrowly avoided cuts to Medicare reimbursement that were set to take effect in January 2021. Congress stepped in at the last second and added new money to the Medicare pool, providing all physicians with a 3.75% increase on top of already reduced physician payments. This fix was temporary, though, and expires in January 2022. Unless Congress steps in again, cardiothoracic surgeons could see Medicare payment cuts of up to 9%. Reductions of this magnitude represent a very real threat to the financial viability of clinical practices and could limit patient access to care.   Ask #2: Support Access to Claims Data and Preserve Medicare CED Cosponsor the Meaningful Access to Federal Health Plan Claims Data Act of 2021 sponsored by Reps. Bucshon and Kim Schrier, MD (D-WA), as well as urge Reps. Fred Upton (R-MI) and Diana DeGette (D-CO) to include the following in the 21st Century Cures 2.0 legislation: Guarantee clinician-led clinical data registry access to claims data from Medicare, Medicaid, and the State Children’s Health Insurance Program Codify Medicare coverage with evidence development (CED) to ensure that patients have access to new technologies that may provide lifesaving care Claims data, when linked with clinical outcomes data in registries such as the STS National Database, allow researchers to conduct longitudinal analyses to measure quality improvement and improve patient safety. Currently, regulatory barriers prevent registries from linking claims data with clinical outcomes data. In order to perform these studies, registries need timely, cost-effective, and continuous access to these data. In addition, a key priority for the Society in 2021 has been preserving CED as a Medicare pathway. This would provide Medicare beneficiaries with earlier and more predictable access to coverage for new technologies. Ask #3: Support the Resident Physician Shortage Reduction Act Ask Senators and Representatives to support the Resident Physician Shortage Reduction Act of 2021 (S.834 / H.R.2256). By 2034, a shortage of up to 124,000 physicians is expected. This bill would help mitigate the physician shortage by creating 14,000 new Medicare-supported graduate medical education (GME) slots over 7 years. A key factor impacting the shortage of physicians is the artificial cap placed on Medicare-supported GME positions. In December 2020, Congress provided 1,000 new Medicare-supported GME positions—the first increase of its kind in nearly 25 years. While 1,000 additional positions is progress, more support is needed. The Resident Physician Shortage Reduction Act of 2021 is a step in the right direction. A share of these new positions would be targeted to hospitals with diverse needs, including those: In rural areas Serving patients from health professional shortage areas In states with new medical schools or branch campuses Already training over their caps The Resident Physician Reduction Act has been introduced in every Congress for more than a decade and regularly receives bipartisan support. Miss the STS Advocacy Conference? You still can be involved! If you could not attend the STS Advocacy Conference, you still have a chance to meet with your federal representatives. STS members are the most effective advocates for the specialty and patients; contact the STS Government Relations office at advocacy@sts.org or 202-787-1230 for help in setting up a meeting or site visit.

STS News, Fall 2021 — The Society’s charitable arm, the Thoracic Surgery Foundation (TSF), powers learning, innovation, and research in cardiothoracic surgery, often filling niches in underrepresented communities. For women entering a career in cardiothoracic surgery, the Nina Starr Braunwald Research Award offers a prestigious opportunity to bring original research to the table. Mallory Hunt, MD, MBE, an integrated cardiac surgery resident at the University of Pennsylvania in Philadelphia, used her award to explore complications associated with congenital heart disease before patients leave the womb. “Children who have congenital heart disease are living longer because we’re getting better at operating on them,” said Dr. Hunt. “Now we’re observing that they have neurological and neurodevelopmental sequelae later in life, meaning that they tend to lag behind their peers in areas such as educational achievement, employability, and functional status.” Dr. Hunt's lab training gave her and her team unique access to a simulated womb model. For years, the medical community speculated that these sequelae were a consequence of surgical interventions in the first few days of life, Dr. Hunt explained. But now there’s evidence that complications may begin as early as the fetal stages. By studying the effects of placental insufficiency and in utero hypoxia, Dr. Hunt’s team sought to better understand the conditions that may lead to heart defects and developmental complications. Obviously, recreating these conditions would be problematic in human fetuses. But while Dr. Hunt was studying under J. William Gaynor, MD, at Children’s Hospital of Pennsylvania in Philadelphia, she was introduced to a model akin to an artificial womb. Developed originally as a means of supporting babies who were born extremely premature, this womb model provided Dr. Hunt’s team with a tool to simulate in utero oxygen delivery in developing sheep. “We were able to deliver fetal sheep at what would roughly be sort of a second-trimester gestation equivalent to that of a human,” Dr. Hunt said. “We placed a group of sheep in this womb environment in conditions that were relatively hypoxic, as well as a group in an environment more representative of that of a normal fetus without congenital heart disease.” “Children who have congenital heart disease are living longer because we’re getting better at operating on them.” Mallory Hunt, MD, MBE Initially, the researchers focused especially on observing neurodevelopmental status in the fetuses. “Over time, though, the project really evolved and took on a life of its own, because we realized that we were able to study basically every organ system within the body,” said Dr. Hunt. “Through collaborations with researchers in different schools at the university, we now have people who are looking at all major organ systems, and I think that’ll tell us a lot—not just about average developmental habits in children who have congenital heart defects, but also how development is altered in children who are hypoxic in utero for other reasons.” Dr. Hunt and the team at CHOP explored the possibilities of translational research. Prior to this project, Dr. Hunt’s research had been mainly clinical in nature, focusing on outcomes for children who had undergone heart surgery for congenital defects. “But not necessarily anything that involved bench research or translational research,” she said. “At a certain point I was thinking about what I wanted my career to involve from the research arm, and I realized that there was this great opportunity to pursue projects that addressed the problems we saw in the clinic from a more basic science point of view. And then see those projects from inception to hopefully implementation into clinical practice.” Dr. Hunt says that the financial support of the Braunwald award was critical to bringing her project to life. “Women are underrepresented in our field, and dedicated research awards targeted at female trainees is such a great opportunity for us. It helps us establish ourselves in a way that’s unique and that highlights what we’re able to do. It really has helped propel my career over the last few years, not just in terms of funding but also in terms of the connections I’ve been able to make with people interested in my research.” TSF Surgeon Match Challenge Doubles the Impact There’s no better time to make a TSF donation and help fuel projects like Dr. Hunt’s. In July, TSF and STS launched the Surgeon Match Challenge, pledging to match surgeon donations up to $100,000. This year, Eugene Braunwald, MD, husband of the late Nina Starr Brunwald, MD, for whom the award is named, pledged $1 million to support the Braunwald Fund—if TSF can raise $500,000 in matching funds. Surgeon donations will be distributed to the fund designated by the donor, and corresponding match dollars will be directed solely toward TSF’s “area of greatest need,” a fund primarily used to award research grants. Nina Starr Braunwald was the first woman to be certified by the American Board of Thoracic Surgery, and in 1960, she led the team at the National Institutes of Health that performed the first successful artificial mitral human heart valve replacement—with a valve that she herself designed and fabricated. The TSF research award in her name provides up to $50,000 per year for up to 2 years to support original research efforts by early career women cardiac surgeons. In 2020, TSF awarded $1,056,600 in grants for 36 recipients. To support research, education, leadership, and surgical outreach programs for cardiothoracic surgery, give today at thoracicsurgeryfoundation.org/donate.