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The Society’s 56th Annual Meeting in New Orleans, January 25-28, attracted more than 4,100 registrants and 142 exhibiting organizations. To view meeting photos and read the STS Meeting Bulletin newspaper, visit sts.org/annual-meeting-archive. Leaders Must Focus on the Positive to Overcome Challenges, Higgins Says Sustaining the future of cardiothoracic surgery will require effective and collaborative leadership, as well as a positive outlook, to prevail over difficulties facing the specialty. “Our profession has been and will continue to be challenged by an extraordinary number of issues,” said Robert S.D. Higgins, MD, MSHA, in his Presidential Address, “On Life, Leadership, and the Pursuit of Happiness.”  He cited several recent challenges, including concerns about public reporting, changing training paradigms, threatened reductions to Medicare reimbursement, and conflicting interpretations of scientific findings. Dr. Higgins encouraged the next generation of leaders to put these matters into perspective and “orient their view toward opportunity, not crisis.”  He added that, of the things that really matter, only a few actually can be controlled. “Focusing on those that intersect between these two apparently immovable forces is the way forward,” he said.  There will be times when people have a difference of opinion, Dr. Higgins noted, and leaders should enable new ideas and opinions to percolate up, rather than always running down from the top. “For me, this was much harder than it appeared,” he admitted. He also recommended a more flexible leadership style that takes into account the different work interests and expectations of generation Xers and millennials. “In order to chart a new course, we have to still honor the past, but create a new map for a sustainable future—and we have to do it now,” Dr. Higgins said. He concluded by encouraging the audience to have an optimistic outlook despite the difficulties. To achieve this positive mindset, Dr. Higgins recommended following eight practices outlined by Robert S. Sawin, MD, in a 2019 JAMA Surgery article, “Optimizing Joy in Surgery”: Reflect nightly on three things for which you are grateful Look for the humor in life Be intentional Be a leader Be a teacher Learn to cultivate compassion Stay involved in the community Consider accepting coaching If cardiothoracic surgeons follow this advice, Dr. Higgins said, the specialty is likely to have a better future. “I believe that we have been most successful when we have a positive outlook on the daily challenges,” he said. In addition to Dr. Higgins’s address, three other keynote lectures were delivered at the STS Annual Meeting: the Vivien T. Thomas Lecture, “The Saga of Vivien Thomas: Discrimination, Segregation, and Bias,” by Clyde W. Yancy, MD; the Thomas B. Ferguson Lecture, “M.E.G.A.: Make Evidence Great Again,” by Domenico Pagano, MD, FRCS(C-Th), FETCS; and the C. Walton Lillehei Lecture, “Bumper Car Innovation of Heart Pumps and Mechanical Lungs,” by Bartley P. Griffith, MD. >Watch videos of all four keynotes at sts.org/56AMplenaries. Award Winners Recognized for Outstanding Achievements Distinguished Service Award The STS Distinguished Service Award is bestowed upon those who have made significant and far-reaching contributions to the Society and the cardiothoracic surgery specialty. The 2020 recipients were Robert A. Wynbrandt, JD (left), and Robert L. Kormos, MD (right). Earl Bakken Scientific Achievement Award The Earl Bakken Scientific Achievement Award was presented to Sir Magdi Habib Yacoub, MD, who is estimated to have performed more heart and lung transplants than anyone else in the world—approximately 2,500. The Bakken Award honors individuals who have made outstanding scientific contributions that have enhanced the practice of cardiothoracic surgery and patients’ quality of life. President’s Award  Arman Kilic, MD, from the University of Pittsburgh Medical Center in Pennsylvania, was the recipient of the 2020 President’s Award, which recognizes an outstanding scientific abstract by a lead author who is either a resident or a surgeon 5 years or less in practice. His award-winning paper was titled “Performance of a Machine Learning Algorithm in Predicting Outcomes after Surgical Aortic Valve Replacement: An Analysis of the STS National Database.”  Poster Awards Adult Cardiac Surgery Atrial Functional versus Secondary Functional Mitral Regurgitation: Prognostic Implications on Short- and Mid-Term Outcomes (Sameer Hirji, MD) Congenital Heart Surgery Defining Contemporary Determinants of Cost following Primary Tetralogy of Fallot Repair: A Nationwide, Multi-Institutional Cost Analysis (Philip Allen) General Thoracic Surgery Important Yet Undescribed: Use of Machine Learning to Elucidate and Predict the Impact of Intraoperative Variables on Thoracic Surgery Outcomes (Biniam Kidane, MD, MSc, FRCSC) Quality Improvement  The Implementation and Effectiveness of Evidence-Based Opioid Prescribing Guidelines for Postoperative Pain Management after Open Transthoracic and Laparoscopic Hiatal Hernia Repair (Jennifer M. Burg, MD, MS) Available Soon: STS 56th Annual Meeting Online STS Annual Meeting Online provides access to more than 100 hours of recorded sessions and the ability to earn up to 126.5 CME credits. Annual Meeting attendees receive free access to Annual Meeting Online, while non-attendees can purchase the online product at sts.org/AMonline. Access is free for all Candidate and Pre-Candidate Members—even those who didn’t attend the meeting! By the Numbers 2,351 professional registrants 62 countries represented by registrants 409 speakers 168 oral scientific abstracts and videos presented 142 exhibiting companies and organizations 20.3 million social media impressions for #STS2020   Thank You STS gratefully acknowledges the following companies for providing educational grants for the 56th Annual Meeting. Platinum Benefactors Provided $50,000 or more Edwards Lifesciences Medtronic Gold Benefactors Provided $25,000-$49,999 Abbott Baxter

STS President Joseph A. Dearani, MD, delivered an important message on March 31 about how the Society is responding to the COVID-19 crisis and supporting members during this pandemic. The following is a transcript of his remarks; you can view the video at sts.org/COVID-messages-president. STS applauds surgeons, providers, and hospitals performing lifesaving surgery on patients that are COVID positive or turn COVID positive immediately after surgery. STS also recognizes that front line workers and hospital administration are struggling to manage valuable resources such as PPE and ventilators. Fortunately, decision-making is now being driven more by science, not conjecture. This message will focus on five important questions and answers about what the STS is doing for you. What is STS doing to help us get the supplies we need – PPEs, ventilators, ECMO supplies, etc.? STS has been in direct communication with high-level officials at HHS, FDA, CDC, Congress, and NIH and called for increased medical supplies, greater availability of testing, and removal of barriers interfering with the supply chain to ensure these products reach the hospitals in need and increase availability of medical supplies such as Lasix, heparin, ventilators, and ECMO equipment (see page 14). Our efforts are paying off. The Washington DC Administration responded by calling on industry to produce more ventilators, and there are signs that more supplies are reaching hospitals—not enough, but improvement in response to the medical community outreach. What help can STS provide regarding ECMO availability and use? The Society thinks it can best serve its members and the medical community at large by coordinating, rather than competing, with groups that are also developing COVID-19 related initiatives. As such, STS is working closely with ELSO to provide relevant resources for ECMO-related matters. The STS website directs people to the ELSO registry, now open and at no cost to enter ECMO data on COVID-19 patients into the registry for real-time information; directing physicians to the ELSO online map, tracking ECMO centers nationwide and their availability to accept patients. The STS website also has an ELSO ECMO guidance document created for non-COVID patients, and we recently added a video prepared by some of our members in Philadelphia that demonstrates proper PPE use when preparing patients for ECMO. What about published guidance documents? The cardiothoracic surgery community has expressed substantial interest in contributing to the literature with guidance documents. Some are already in our journals, and others will be available in coming days. They include crisis management documents in congenital and adult heart surgery and triage of operations for thoracic malignancies. Documents that have a theme of guidance that provide direction, allow flexibility, and adaptability are the most helpful at this stage while more evidence is being accumulated. “A moderated webinar series … will address the realities and challenges facing cardiothoracic surgeons in COVID hotspots.” Joseph A. Dearani, MD How is the STS National Database being leveraged during the COVID-19 crisis? STS is working hard to use the power of your STS National Database to examine specific data elements that would provide added support to providers. In addition to the current STS risk calculator, we are developing – and soon to be complete – a tool that provides information to estimate resource utilization for patients being considered for cardiac surgery (the tool is now available for use; see page 9). This tool will be available through the STS website. Finally, STS cannot precisely account for the impact of COVID on surgical outcomes. Data from these patients will still be recorded in the STS Database using an additional field regarding their COVID status (see page 11). But in fairness to all surgeons and their programs, COVID patients will be excluded from performance analyses, including public reporting. How are surgeons coping with triage of surgery? It’s not easy. This has been very difficult for me and most all of us on the front line. Cardiothoracic surgical decision-making has shifted to who gets surgery, when to do the surgery, when to transfer out of your hospital, when to accept an incoming transfer, when to offer or not offer ECMO, and the list goes on. The right decision often collides with the desired decision since it is not our nature to delay or deny treatment. On a daily basis, we are adding helpful new resources to the STS website. We also have perspectives from members inside and outside of the United States, along with tips on how to stay grounded during this pandemic. A moderated webinar series will start next week, and the first will address the realities and challenges facing cardiothoracic surgeons in the COVID hotspots in the United States. Lastly, a personal reach out to each of you from me. Isolation has been stressful. Not being in the operating room has been difficult and most of us have been troubled, frustrated, and even depressed. Clear thinking and mental toughness is difficult under these circumstances, but being decisive is essential since poor decision-making could result in the collapse of a program. I have found it very helpful to have short phone conversations with colleagues to check on their personal and professional well-being. I connect with four different surgeons each day. Learning how they are balancing their personal and professional life and how they’re maintaining emotional stability has been informing and reassuring to me. I encourage all of you to do the same. We may be socially distancing, but we are coming closer together in a new spirit of cooperation. Let’s turn this situation into an opportunity that we learn from. We are cardiothoracic surgeons. We know how to pivot, take charge, and handle uncertainty. The health care workforce is in the spotlight and the world is seeing us in action. We’re getting there. Be positive. We may not know when this pandemic will end… but we do know that we will win this battle.  A sincere thank you to each of you and your respective teams for your grit and perseverance through this difficult time. Stay informed about COVID-19 and the Society’s response by visiting sts.org/COVID-19. There, you will find an online community that allows the sharing of news, best practices, and guidance, as well as a resources page with links to relevant information from a variety of organizations and entities, including the following blog articles written by STS members: “COVID-19: The Hong Kong Perspective” by Alan D. Sihoe, MD, MA, FRCSEd “COVID-19: The US Perspective” by T. Sloane Guy, MD, MBA “How Will COVID-19 Impact My Upcoming Surgery?” by Robbin G. Cohen, MD, MMM, and Elizabeth A. David, MD, MAS “Staying Grounded During the COVID-19 Pandemic” by Erin A. Gillaspie, MD, Gabriel Loor, MD, and Mara B. Antonoff, MD Due to the evolving situation with COVID-19, the Society canceled or postponed several in-person educational meetings planned for 2020. Options for virtual meetings are being considered. Please check sts.org/meetings for the latest information.

STS Develops Resource Utilization Tool for Cardiac Surgery The COVID-19 pandemic has significantly constrained hospital resources, making informed resource allocation decisions more important than ever. To assist its members and other health care providers in triaging adult cardiac surgery cases, STS has developed an interactive resource utilization prediction tool.  The online STS Resource Utilization Tool for Cardiac Surgery is free to use and open to everyone. The power behind the tool is 440,000 de-identified patient records from the STS Adult Cardiac Surgery Database from 2018 and 2019. Displaying outcome metrics such as time in the operating room, time on the ventilator after surgery, ICU and hospital lengths of stay, and expected number of blood product units likely to be needed, the tool allows you to estimate the resources your hospital will need for your patients. >Access the tool at sts.org/resourcetool. For more information, contact the STS Research Center. Society Prepares New Strategic Plan The STS Board of Directors and other surgeon and staff leaders recently participated in a strategic planning retreat. The March session in Chicago was one of several that will help chart the mission, vision, and strategy for the Society for the next 3 to 5 years. STS President Joseph A. Dearani, MD, welcomed participants. During the 1.5-day meeting, the group considered how the Society can best serve members going forward. The three new STS Directors-at-Large (from left, Gregory P. Fontana, MD, Jennifer C. Romano, MD, MS, and James S. Tweddell, MD) enjoyed the STS-branded knit caps distributed at the retreat. Gain Insights into Your Performance with Individual Outcomes Report The first round of surgeon-specific outcomes reports from the STS Adult Cardiac Surgery Database (ACSD) were released in January to approximately 400 participants. The reports included individual outcomes on coronary artery bypass grafting (CABG), aortic valve replacement (AVR), AVR+CABG, isolated mitral valve repair/replacement (MVRR), and MVRR+CABG. If you are an ACSD participant and would like to receive your personalized report in the next release later this year for data from January 2017 to December 2019, complete the election form at sts.org/surgeonspecific. >If you have questions about this initiative, please contact surgeonspecific@sts.org. Roundtables Offer Perspectives on Low-Risk TAVR, Tobacco Use, ISCHEMIA Trial, and More The Society’s annual roundtable series brings experts together for lively discussions on a variety of hot topics. This year’s conversations cover issues that impact cardiothoracic surgeons, members of the health care team, and patients, including: Artificial Intelligence and Machine Learning in Cardiothoracic Surgery Which Low-Risk Patients Should Receive TAVR? The Changing Landscape of Tobacco Use What Is the Best Way to Treat Heart Disease? Strategies for Surgeons to Prevent Burnout The roundtables are available as videos on the STS YouTube channel and as episodes on the STS Surgical Hot Topics podcast. >Watch videos of the roundtables at sts.org/videos; podcast episodes are accessible at sts.org/podcast or via your favorite podcast app. Stakeholders Discuss Critical Issues for TVT Registry The STS/ACC TVT Registry Stakeholder Advisory Group (SAG) convened on February 24 for an important meeting in Fort Washington, Maryland. The SAG consists of representatives from STS, the American College of Cardiology, the Society for Cardiovascular Angiography and Interventions, industry, health systems, patient groups, US government agencies, and others. The attendees discussed current research projects based on TVT Registry data, progress on a Japanese TVT Registry, and development of a composite risk model. They also learned how health systems, industry, the Centers for Medicare & Medicaid Services, and the Food and Drug Administration are utilizing TVT Registry data. Michael J. Mack, MD, Joseph E. Bavaria, MD, Nimesh D. Desai, MD, PhD, and Tsuyoshi Kaneko, MD, were the surgeons representing STS during the meeting. Annals Readers Favor Content on CABG Recovery, Outcomes Data, Lung Cancer The most-downloaded articles on The Annals of Thoracic Surgery website in 2019 focused on a wide variety of topics, including exercise therapy after coronary artery bypass graft surgery, adult cardiac surgery data in the STS National Database, and non-small cell lung cancer. Both recent papers and older articles were popular, with one even dating back to 1966—the second year the journal was published. >A subscription to The Annals is a benefit of STS membership. Log in to read any of the below articles at annalsthoracicsurgery.org. Most-Downloaded Articles in 2019 Title Number of Downloads in 2019 Date of Publication Exercise Therapy after Coronary Artery Bypass Graft Surgery: A Randomized Comparison of a High and Low Frequency Exercise Therapy Program 9,639 May 2004 The Society of Thoracic Surgeons Adult Cardiac Surgery Database: 2018 Update on Outcomes and Quality 9,077 Jan. 2018 Standard Uptake Value Predicts Survival in Non-Small Cell Lung Cancer 8,313 Sept. 2009 The Rate of Pleural Fluid Drainage as a Criterion for the Timing of Chest Tube Removal: Theoretical and Practical Considerations 7,640 Oct. 2013 Publication of Unethical Research Studies: The Importance of Informed Consent 5,470 Feb. 2003 Localized Hodgkin’s Disease Presenting as a Sternal Tumor and Treated by Total Sternectomy 5,287 Jan. 1966 Surgical Treatment of the Dilated Ascending Aorta: When and How? 5,159 June 1999 The Use of High-Dose Hydroxocobalamin for Vasoplegic Syndrome 5,023 May 2014 Long-Term Survival in Patients Receiving a Continuous-Flow Left Ventricular Assist Device 4,926 Mar. 2018 Adjust for Multiple Comparisons? It’s Not That Simple 4,738 May 2016