Adult Cardiac

The Society of Thoracic Surgeons (STS) has just released an updated STS Risk Calculator Mobile App, expanding access to data-driven surgical risk estimates at the point of care. The updated app adds the Ascending Aorta & Aortic Root Surgery Risk Calculator and brings the SAVR After TAVR Risk Calculator, previously available on the STS website, to the mobile app for the first time.

The new tools build on STS's growing portfolio of procedure-specific risk calculators, which use data from the STS National Database to support clinical decision-making and physician-patient conversations about surgical risk. Available for iOS and Android devices, the STS Risk Calculator Mobile App provides surgeons and multidisciplinary care teams with real-time risk estimates at the bedside or on the go.

The Ascending Aorta & Aortic Root Surgery Risk Calculator was developed using data from more than 67,000 adult ascending aorta and aortic root procedures submitted to the STS Adult Cardiac Surgery Database (ACSD) between July 2017 and December 2024. It provides individualized operative risk estimates for four procedural groups: Bentall procedures, ascending aorta replacement plus aortic valve replacement (Wheat Procedures), valve-sparing root replacement, and isolated ascending aorta surgery.

The SAVR After TAVR Risk Calculator provides procedure-specific risk estimates for patients undergoing surgical aortic valve replacement (SAVR) after a previous transcatheter aortic valve replacement (TAVR). The enhanced risk model incorporates a broader range of surgical scenarios, including patients undergoing concomitant procedures such as aortic surgery, coronary artery bypass grafting, or other valve procedures, as well as emergency and salvage operations. Developed using contemporary data from the ACSD, the calculator helps address the distinct risks associated with surgery following TAVR. STS has identified SAVR after prior TAVR as an increasingly important clinical scenario as TAVR use expands, particularly among younger and lower-risk patients.

The updated mobile app provides access to STS risk calculators using the same statistical models available through the Society's online tools. The app is designed to provide convenient, real-time estimates and facilitate physician-patient decision-making using data from the STS National Database.

The addition of these calculators further strengthens STS's commitment to providing clinicians with evidence-based resources that reflect contemporary cardiothoracic surgical practice and support informed decision-making.

Presented Sept. 17–19 in Chicago, the 2026 STS CABG Academy—hosted by the Society of Thoracic Surgeons—delivered an immersive educational experience for cardiothoracic surgeons and team members focused on skills development, practical learning, and collaboration in coronary revascularization.

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Formerly known as the STS Coronary Conference, the program moved beyond traditional lectures to emphasize dynamic, conversation-driven sessions. Expert faculty explored critical topics through operative videos, cinematic surgical footage, live technical analysis, and troubleshooting discussions, creating an interactive environment that encouraged audience participation and shared learning.

The three-day conference featured hands-on workshops, abstract presentations, and sessions covering advanced grafting strategies, minimally invasive and robotic coronary surgery, conduit selection, hybrid revascularization, and the surgical management of concomitant atrial fibrillation and high-risk patients.

One of the highlights of the event was the Anastomosis Challenge, a three-phase competition testing participants’ knowledge, technical skills, and ability to interpret transit-time flow measurements. The challenge culminated with the CABG Academy Finalists Showdown and an awards ceremony recognizing top performances in the competition and poster presentations.

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Experiences like these are central to the STS CABG Academy. Throughout the meeting, attendees gained practical skills, learned directly from experienced surgeons, and built connections with colleagues and faculty that can extend beyond the conference.

Through hands-on learning, close interaction with expert faculty, and innovative educational formats, the program provided participants with practical tools and techniques to enhance coronary surgery practice.

The Society of Thoracic Surgeons co-presented the 2026 Heart Valve Disease Forum (HVDF) with the Korean Society for Thoracic and Cardiovascular Surgery on Sept. 10-11 in Seoul, South Korea, bringing together experts from around the world to explore the latest advances in aortic valve and root surgery.

Centered on the theme "Restoring Harmony in Aortic Valve & Root Surgery," the forum offered insights into the anatomy, physiology, causes, diagnosis, treatment, and future directions of valvular heart disease.

The meeting attracted 333 participants from 15 countries and featured lectures, case-based discussions, wet labs, and abstract presentations. Key topics included minimally invasive and robotic heart valve surgery, valve-sparing root replacement, aortic root enlargement, and the surgical management of failed transcatheter aortic valve replacement.

“Exceptional presentations, live surgery, and truly engaging discussion translated innovation into impact for patients across Asia and beyond,” said STS President Vinay Badhwar, MD.

A highlight of the forum was a live surgical case involving annular enlargement. The patient had severe symptomatic aortic stenosis and a small aortic root and underwent aortic valve replacement with a bioprosthetic valve and posterior aortic root enlargement using the Yang procedure.

The operation was performed by Seung Hyun Lee, MD, chief of cardiothoracic surgery at Severance Hospital and Yonsei University, and Bo Yang, MD, of the University of Michigan. Dr. Badhwar moderated the case from the audience, while S. Christopher Malaisirie, MD, of Northwestern Medicine, moderated it from the operating room.

Conducted in accordance with the new live surgery policy, the case received positive feedback from attendees and marked the first successful live operative demonstration performed under the policy. Most importantly, the patient experienced no reported complications.

The successful case represented an important step in advancing international surgical education while maintaining the standards and safeguards established for live operative demonstrations.

Through partnerships and programs such as the Heart Valve Disease Forum, STS continues to foster global collaboration, knowledge sharing, and innovation in cardiothoracic surgery.
 

The ongoing opioid crisis has led to a marked increase in tricuspid valve endocarditis (TVE), particularly among people who inject drugs (PWID). This trend presents cardiac surgeons with complex clinical and psychosocial challenges, as patients often face overlapping issues—including infection, addiction, and social instability. These factors complicate surgical decision-making and underscore the need for comprehensive, multidisciplinary approaches to care.

To address the lack of clear surgical guidance and the unique challenges associated with TVE in PWID, the Society of Thoracic Surgeons (STS) convened a multidisciplinary panel to develop expert consensus statements focused on clinical decision-making in this high-risk population.

“Unlike left-sided endocarditis, TVE lacks definitive data to guide surgical timing and intervention strategies,” said Joshua Goldberg, MD, of Weill Cornell Medicine, who chaired the task force that produced the document. “This consensus document represents an important step forward, organizing expert recommendations into key categories that reflect the multifaceted clinical challenges encountered in managing PWID with TVE. Each group of statements addresses specific, real-world dilemmas faced by the multidisciplinary care team.”

The eight core categories outlined in the document include:

• Vegetation size
• Influence of microbial organism on surgical decisions
• Management of persistent bacteremia and timing of antibiotics
• Prosthetic valve infection
• Decisions around valve removal, repair, or replacement
• Prosthetic type selection
• Use of emerging technologies such as transcatheter debulking
• Ethical challenges of recurrent disease in the context of substance use

A Thorough, Multidisciplinary Approach to Consensus Building

The STS writing group employed a rigorous, evidence-based methodology to develop the consensus statements, incorporating a comprehensive literature review and a modified Delphi process. The evidence review was guided by PICO Framework (Patients/Population, Intervention, Comparison/Control, Outcome)-formatted questions, ensuring a structured and focused appraisal of the data. Consensus statements were established in the first round of voting, with a minimum threshold of 75% agreement required from a multidisciplinary panel that included cardiac surgeons and infectious disease specialists

Navigating Complex Decisions in Endocarditis

“First, surgeons and treatment teams must always remember that tricuspid endocarditis in the setting of injection drug use is a symptom and sign of the disease of addiction. Effective care requires addressing both the infection and the underlying pathology of addiction,” said Dr. Goldberg. “Second, published surgical indications for tricuspid valve surgery are largely extrapolated from data derived from studies on left-sided valve disease. When combined with complex psychosocial factors, the decision to operate can be enigmatic and is best approached through thoughtful, multidisciplinary evaluation.”

A Practical Framework for Attentive, Evidence-Informed Care

Ultimately, this expert consensus provides cardiac surgeons with a practical, evidence-informed framework for managing TVE in PWID. It supports individualized decision-making while promoting standardization in key areas such as vegetation assessment and the use of emerging technologies. Most importantly, it emphasizes the need for compassionate, team-based care that integrates medical, surgical, and psychosocial perspectives. The document serves not only as a clinical tool, but also as a call to action—to treat not just the infection, but the patient as a whole.

In addition to offering clinical guidance, the consensus highlights critical knowledge gaps that demand further investigation. “Because published surgical indications are largely extrapolated from studies on left-sided valve disease, the true indications and optimal timing for intervention remain unclear—particularly in the absence of uncontrolled sepsis or right heart failure,” Dr. Goldberg noted. “We also lack a clear understanding of the efficacy and utility of transcatheter therapies, which have seen a dramatic rise in use in recent years.”

Read the Annals article.