Daily Bulletin, STS 2023 Preview Issue

With too few donor hearts available for transplantation, surgeons will present a novel solution to heart allocation on Day 2 of STS 2023, with an aim at serving the growing population of eligible patients in their 70s. On Sunday, January 22, at 3:30 p.m. PT, “The Use of Donor Hearts 50 Years or Older to Septuagenarians in Heart Transplant: The Potential of Expanding the Donor Pool in Older Patients and Increasing the Availability of Younger Hearts” will uncover a potential new group of heart donors who have been previously overlooked. The presentation, part of the session “Expanding the Donor Pool in Heart Transplantation: Current Strategies and Future Perspectives,” will be thought-provoking for surgeons who want to open the door for organ donation to older recipients. Suguru Ohira, MD, PhD, from Westchester Medical Center Heart & Vascular Institute in Valhalla, New York, will present this study to consider donor patients in their 50s for an emerging segment of heart recipients ages 70-79.  Several key factors, including advances in cardiac transplantation and the 2018 modified guidelines from the Organ Procurement and Transplantation Network (OPTN), make more and more patients in their 70s eligible for cardiac transplantation. This study is the first to present a feasible solution to serve these patients without compromising the entire pool of heart recipients. In the United Network for Organ Sharing system, 1,036 heart transplants occurred between January 2011 to December 2021 in patients 70 years or older. Of these, 861 patients received hearts from donors under age 50 and 175 patients received hearts from donors ages 50 and older. Survival was comparable between both recipient groups: One-year and five-year survival rates for patients who received hearts from donors over age 50 were 89.4% and 76.6%, respectively. One- and five-year survival rates for patients who received hearts from donors ages 50 or under were 86.2% and 71.1%, respectively. “Although these hearts from advanced age donors might not be the best hearts for younger recipients who are in their 30s or early 40s, they could be a reasonable option for candidates in their 70s,” Dr. Ohira says. “Yet these hearts are often not recovered, just because of ‘donor age,’ even though their functions and structures are normal.”  Dr. Ohira says this study, conducted with six colleagues from Westchester Medical Center and New York Medical College, was undertaken following excellent outcomes at their institution with transplants for septuagenarians using hearts from donors in their 40s and 50s. STS 2023 is being held in person, and there is still time to register at sts.org/annualmeeting.  

A must-see session for pediatric surgeons will showcase the first study that analyzes multiple factors impacting survival of young patients with ventricular assist devices (VADs) over the last decade.  “Variables Affecting Survival in Pediatric Patients Supported with VADs: A Special Pediatric Interagency Registry for Mechanical Circulatory Support (Pedimacs) Report,” will be presented at 11:30 a.m. PT on Sunday, January 22, 2023, during the STS Annual Meeting. The presentation is part of the STS “Current Controversies in Congenital Transplantation and Mechanical Circulatory Support” session. Awais Ashfaq, MD, from Johns Hopkins All Children’s Hospital in St. Petersburg, Florida, will report on findings. Although 10 leading children’s hospitals conducted the study, the analysis includes all 47 hospitals in the Pedimacs database of children and adolescents under age 19.  The group reviewed Pedimacs data back to the registry’s inception in 2012 through the end of December 2021, covering 1,109 patients, and identified that illness at time of VAD implantation, diagnosis, support strategy, and VAD device type all affected mortality. This study is the first step to create evidence-based guidance on VAD device choices and other decisions in care management. For instance, one finding indicates that infants and older pediatric patients with paracorporeal continuous device support, congenital heart disease, biventricular support, and Intermacs profile 1 (cardiogenic shock) had worse overall survival after six months. "For anyone in our field, and especially for those who have an interest in pediatric mechanical support, Pedimacs is invaluable,” Dr. Ashfaq says. “There is so much to learn from the data available in the database.” Pedimacs became part of The STS National Database™ in 2018 and is a joint effort among the National Heart, Lung, and Blood Institute, the Food and Drug Administration, the Centers for Medicare & Medicaid Services, and others. The North American clinic registry includes patients who receive an FDA-approved mechanical circulatory support device to treat advanced heart failure. Due to its exponential growth in terms of participation and stature, the STS National Database has become the gold standard for clinical outcomes registries among health care administrators, government officials, and payers. Dr. Ashfaq adds that the group will be taking their results and expanding them into a web-based tool to help physicians decide if patients will benefit from VADs and which device to choose.  

A scientific session devoted to identifying and closing gaps in health care will take place on Saturday at STS 2023. The session, beginning at 2:45 p.m. PT on January 21, will highlight evidence-proven programs that have not only identified disparities in health screening and treatment, but have successfully improved care for patients regardless of demographics, emphasized moderator Cherie P. Erkmen, MD, director of the lung screening and thoracic surgery residency programs for the Lewis Katz School of Medicine at Temple University in Philadelphia, Pennsylvania. Dr. Erkmen said, “One of the things we struggle against in the realm of diversity, equity, and inclusion is that people are tired of just hearing, ‘There’s disparity, there’s inequity, there’s a problem.’ But then—what do we do? That’s part of the focus of this session—health equity in practice and people who have embraced it, successfully increasing their volumes and improving patient outcomes.” Assembled by Dr. Erkmen and Sara Pereira, MD, from the University of Utah Health, presentations within the Symposium include a report on gender outcomes in coronary bypass grafting, racial disparities in the inpatient management of ischemic heart disease, increasing health equity in the heart and lung transplant arenas, mitigating disparities across the lifetimes of patients who have undergone congenital cardiac surgery, and strategies to improve adherence to lung cancer screening guidelines in underserved communities, based on researchers’ experience in rural South Carolina. “Dr. Tara Karamlou has examined the entire continuum of congenital cardiac surgery, from diagnosis through adulthood, and has opened her doors to understand a very challenging population,” Dr. Erkmen explained. “Dr. Yoshiya Toyoda is a transplant surgeon at a very underserved, ‘safety net’ hospital, yet he’s the number one lung transplanter in the country for several years straight, accepting people across the whole socioeconomic spectrum.” “We have a thoracic surgeon, Dr. Ian Bostock, who’s looking at diversity in lung cancer screening—understanding where the disparities lie and lowering the barriers to screening so that they can get through the door and to the next step, which is lung cancer treatment,” Dr. Erkmen continued. “The last speaker, Dr. Martha McGilvray, has been awarded the podium for her research on racial disparities in the management of ischemic heart disease.” Stepping in as co-moderator is Clauden Louis, MD, MS, from Brigham and Women’s Hospital in Boston, Massachusetts. “I’m excited to be considered to represent such a name—the story of Vivien Thomas is incredibly important,” Dr. Louis said. “I think STS is taking a stand toward valuing our patients and valuing representation, understanding that outcomes are improved when the people taking care of you also have an understanding or a similarity, and are able to represent the population.” The session is named for Vivien T. Thomas, a Black laboratory supervisor who worked with famed physician Alfred Blalock, MD, at Vanderbilt University in the 1940s. When Johns Hopkins recruited Dr. Blalock, he refused to move unless Thomas accompanied him as a “package deal.” Thomas worked as part of Dr. Blalock's surgical team, helping develop the procedure used in the landmark 1944 "blue baby" operation. Despite his integral role in Dr. Blalock’s pioneering work, Thomas was hired and paid as a janitor and was not allowed to use the main entrance to Johns Hopkins. “He’s someone who could’ve been me,” Dr. Louis said. In addition to the Symposium, the third annual Vivien T. Thomas Lecture will take place at STS 2023. This year, the lecture is presented by Francisco G. Cigarroa, MD, and will mark the commencement of the annual meeting on Saturday morning at 8:00 a.m. “I’m excited about getting interest and participation from our thoracic surgery residents and our junior faculty,” Dr. Erkmen said. “And it's also important for people to know that there is an enduring workforce from the STS headed up by Dr. David Tom Cooke. Under his steady leadership, we've been able to accomplish many, many additions to the cardiothoracic surgery community, including workforce publications, looking at workforce disparity and health disparity, and also coordinating with other committees to make sure that diversity is always in mind as we legislate ourselves and create a program like the STS Annual Meeting.” On Monday at STS 2023, Dr. Erkmen also will present “The Cost of Being a Woman in Academic Surgery,” a session that analyzes rank and salary throughout women surgeons’ careers and demonstrates the additional hurdles they face. “We know that there is a difference in care when you are focused on the end goal—better access for everyone,” Dr. Louis said. “I’m excited to represent Dr. Vivien Thomas as a moderator for this session. And I’m excited to meet my colleagues in San Diego.” STS is still accepting registrations for the annual meeting, offering both an in-person experience and a virtual option, Plenary Livestream-Plus, which allows registrants to stream select meeting content and plenary sessions—including the Thomas Lecture—from anywhere in the world. STS 2023 is the premier forum for presenting new science, techniques, and technology in cardiothoracic surgery. Learn more at STS.org/AnnualMeeting.

Investigators will discuss the real—yet easily identified—risk that living in a food desert may have on patients recovering from esophagectomy on Day 1 of STS 2023. Mortality risks for patients with colon and breast cancers who live in food deserts have been reported in recent years as part of a large administrative database review. On Saturday, January 21 at 1:25 p.m. PT, surgeons from six high-volume medical centers will present the first multi-institutional research that identifies patients who undergo tri-modality therapy for esophageal cancer have increased risk of readmission following surgery. Joseph Phillips, MD, from Dartmouth Hitchcock Medical Center in Lebanon, New Hampshire, will present the study exploring the association between food deserts and patient re-hospitalizations after esophagectomy.  In this retrospective research, surgeons reviewed records from a diverse US patient population that underwent neoadjuvant chemoradiation followed by esophagectomy. Of 425 patients included, 73 lived in a food desert, which are areas where access to nutritious foods is inadequate. The study found that patients from food deserts were twice as likely to be readmitted to the hospital for any reason within 30 days post-surgery. The study also found that these patients had significantly lower median household incomes, although this was not a factor when patients were stratified by readmission status. No differences were found in length of stay, complications, or 30-day mortality between patients who lived or did not live in food deserts. “Living in a food desert is an easily identifiable risk factor that should alert surgeons that pre- and post-surgical interventions may be needed to improve outcomes,” Dr. Phillips says. Food deserts, as defined by the United States Department of Agriculture (USDA), are low-income census tracts where a substantial number of residents have low access to grocery stores. The USDA identifies about 6,500 tracts in urban and rural areas as food deserts, where 13.5 million people don’t have a supermarket nearby. Aside from scarcity of nutritious food, residing in a food desert is also often an indicator of low incomes and inadequate healthcare access. The study authors also postulate that patients receiving tri-modality therapy for esophageal cancer may benefit from early referral to resources such as social workers and dieticians for intervention prior to and during treatment. Furthermore, these patients may benefit from more directed post-discharge care to avoid unnecessary readmissions to the hospital.

“In the OR with” encounters, live exhibitor symposia, and extraordinary social events await attendees at the STS Annual Meeting in San Diego. “Attendance figures look as good as ever, but what is most energizing is the program,” said STS President John H. Calhoon, MD. “It is designed to give attendees some time … to not just talk about work/life balance, but to actually live it a bit.” STS 2023 registrants are highly encouraged to add ticketed “extras” to their registration, including the Presidents Reception and the Extraordinary Women in Cardiothoracic Surgery Awards Breakfast. The morning of Saturday, January 21 kicks off with the breakfast event, which will honor women surgeons who have achieved excellence in clinical practice and demonstrate integrity, leadership, creativity, and expertise in carrying out day-to-day duties and supporting the specialty. On Saturday evening, the Presidents Reception will be held at Coasterra, a bayfront restaurant and cocktail venue featuring a floating reception hall and a skyline lounge. Guests will make memories reuniting with—and meeting new—friends and colleagues. The event will celebrate not only the term of current STS President John H. Calhoon, MD, but also the legacies of Past Presidents Sean C. Grondin, MD, and Joseph A. Dearani, MD, who oversaw the Society’s governance with innovation and grace during the peak of the COVID-19 pandemic. “We have lost several admired colleagues in recent times, including Dr. Tweddell, Dr. Pagano, and Dr. Grondin,” said S. Adil Husain, MD, chair of the STS Workforce on Annual Meeting. “We will value our ability to celebrate their contributions to our subspecialty as well as to acknowledge the loss of other cherished members within our Society.” Space is limited for the reception and the breakfast, and attendees must add them to their carts during registration or to an existing registration. STS 2023 also heralds the return of live product demonstrations, with 150 exhibitors showcasing the latest tools and technologies for surgical practice. Industry symposia—both offsite and at the convention center this year—afford rare opportunities to practice new techniques, and product theaters let attendees experience devices and software hands-on. Between the conclusion of afternoon sessions and the Presidents Reception on Saturday, attendees can browse an exhibit hall opening reception and view presentations of scientific posters alongside their colleagues. Two half-hour coffee breaks on Sunday, January 22 give attendees more designated time to explore the exhibits and socialize at their leisure. “In the OR with …” experiences return with an added dimension of virtual reality, during which attendees can don headsets and virtually stand side-by-side with a master surgeon as they perform real-life operations including complex aortic arch reconstruction, uniport segmentectomy and left lower lobectomy, the Ross procedure, and minimally invasive mitral valve repair. Watch a teaser video.  There’s still time to register, add ticketed events, and start planning your San Diego experience at sts.org/annualmeeting.