At the 61st STS Annual Meeting, cutting-edge research highlighted key advancements in cardiothoracic surgery. Here’s a round-up of some of the key scientific papers presented at STS 2025.
Clark Memorial Paper for Perioperative & Critical Care: The STS National Intermacs Database Risk Model for Durable Left Ventricular Assist Device Implantation
Lead Investigator: Francis Pagani, MD
A 90-day mortality risk model for durable left ventricular assist device (LVAD) implementation was developed using data from more than 11,000 patients in the Intermacs component of the STS National Database. The risk model identified 22 centers with higher-than-expected mortality and 14 centers with better-than-expected outcomes. Overall, the Intermacs risk model demonstrated reliability in predicting mortality and offers valuable insights for candidate selection, quality improvement, and the evaluation of healthcare providers involved in LVAD implantation.
Read the full paper.
Transcatheter vs. Surgical Aortic Valve Replacement in Medicare Beneficiaries with Aortic Stenosis and Coronary Artery Disease
Co-lead Investigators: Vikrant Jagadeesan, MD, and J. Hunter Mehaffey, MD
In comparing the benefits and safety of surgical CABG+SAVR versus TAVR+PCI, this study focused on outcomes such as mortality, complications, and readmissions. TAVR+PCI was associated with lower hospital mortality, bleeding, and kidney injury but higher rates of new pacemaker and vascular complications compared to SAVR. In contrast, CABG+SAVR showed significantly lower mortality and better outcomes in terms of death, stroke, myocardial infarction, and/or valve reintervention. Subgroup analysis also found CABG+SAVR superior in single-vessel coronary patients, particularly those receiving arterial grafts.
Anastomotic Leak after Esophagectomy – Analysis of the STS General Thoracic Surgery Database
Lead Investigator: Andrea Axtell, MD
This study examined the prevalence and risk factors of anastomotic leaks after esophagectomy using data from the STS General Thoracic Surgery Database. Among more than 18,000 patients, nearly 19% developed leaks, with higher rates in those with obesity, diabetes, smoking, pulmonary hypertension, and cervical anastomosis. Leaks were linked to increased 30-day mortality, reoperation, and longer hospital stays. Multivariable analysis showed that transhiatal or 3-field esophagectomy had a higher risk of leakage compared to an open 2-field approach, while the robotic approach showed increased risk in earlier years but lost significance in recent data. These findings highlight modifiable risk factors like obesity and smoking as opportunities to improve outcomes through perioperative optimization.
Chamberlain Memorial Paper for General Thoracic Surgery: Lung Cancer Screening in the Boston Lung Cancer Study
Lead Investigator: Jeffrey Yang, MD
A panel of thoracic surgical oncologists examined the role of local consolidative therapy (LCT), including pulmonary resection, for patients with oligometastatic non-small cell lung cancer. They reviewed the literature and found strong evidence supporting surgical resection as part of LCT for stage IV lung cancer, though regional practices and institutional variations persist due to the lack of standardized guidelines. The panel identified key clinical questions, particularly regarding the extent of resection and nodal dissection, which remain unresolved. While pulmonary resection is supported, further research is needed to refine treatment approaches, with the panel offering recommendations to guide multidisciplinary teams and future studies.
Clark Memorial Paper for General Thoracic Surgery: Lobectomy vs. Sublobar Resection in the STS National Database
Lead Investigator: Gavitt Woodard, MD
This study aimed to assess whether prospective randomized trial results are applicable to a broader population, including older patients, those with reduced pulmonary function, and non-smokers. Researchers analyzed data from the STS General Thoracic Surgery Database, linked with Medicare survival data, to evaluate outcomes for patients undergoing lobectomy, segmentectomy, and wedge resection. The findings revealed that sublobar resection and lobectomy offer similar survival outcomes for many patients, including those over 75 years old, with poor lung function, or who are lifelong nonsmokers. However, inadequate lymph node evaluation during sublobar resection was linked to worse survival, emphasizing the need for better nodal assessment, especially for patients with compromised lung function or minimal lymph node spread.
Chamberlain Memorial Paper for Perioperative & Critical Care: Insurance-Based Disparities in Heart Transplant Outcomes
Lead Investigator: Sara Sakowitz, MS, MPH
Researchers investigated the impact of Medicaid insurance on the development of cardiac allograft vasculopathy (CAV) and survival outcomes in heart transplant recipients. Analyzing data from more than 37,000 patients, they found that Medicaid-insured recipients had a significantly higher risk of developing CAV over five years, especially in the post-Affordable Care Act era. While Medicaid patients at high-volume centers had similar CAV risks as non-Medicaid recipients, those treated at non-high-volume centers faced a much higher risk. Overall, Medicaid insurance was associated with poorer patient and allograft survival at five years, highlighting the need for closer monitoring and improved care for Medicaid-insured individuals, particularly in lower-volume transplant centers.
Tweddell Memorial Paper for Congenital Cardiac Surgery: Volume-Outcome Relationship of the Norwood Procedure
Lead Investigator: Reilly Hobbs, MD
This study explored the relationship between center case volume and survival and morbidity in infants undergoing the Norwood procedure. Centers were categorized into low-, medium-, and high-volume groups, with comparisons made based on preoperative risk factors, complications, and survival outcomes. The results indicate that the number of Norwood procedures performed at a center significantly impacts patient outcomes, with high-volume centers consistently achieving better results. This underscores the importance of case volume in complex congenital heart surgeries and suggests that directing high-risk patients to more experienced centers may improve outcomes. Further research is needed to identify the key factors contributing to the superior results at high-volume centers, ultimately enhancing care for single-ventricle patients.
Clark Memorial Paper for Adult Cardiac Surgery: Redo Surgical Aortic Valve Replacement vs. Valve-in-Valve TAVR for Degenerated Bioprosthetic Valves
Lead Investigator: Jake Awtry, MD
A comparison was made between the long-term outcomes of redo surgical aortic valve replacement (redo-SAVR) and valve-in-valve transcatheter aortic valve replacement (ViV-TAVR) in patients with degenerated bioprosthetic valves. After propensity score-matching more than 1,200 patients in each group, results showed that, despite higher perioperative morbidity, redo-SAVR was associated with better long-term survival and major valve event-free survival compared to ViV-TAVR. While redo-SAVR patients experienced higher rates of major adverse cardiovascular events, they had a survival advantage, particularly for those with lower or medium comorbidity risk. These findings suggest that redo-SAVR may offer better long-term outcomes, emphasizing the need for further clinical trials to guide decision-making for patients with degenerated bioprosthetic valves.
Clark Memorial Paper for Adult Cardiac Surgery: Risk of Surgical Aortic Valve Replacement After Prior TAVR
Lead Investigator: Robert Hawkins, MD
An analysis was conducted to assess the increased mortality risk for patients undergoing reoperation after transcatheter aortic valve replacement (TAVR) compared to those who had surgical aortic valve replacement (SAVR). Using 10 years of data from the STS Adult Cardiac Surgery Database, the research focused on the impact of concomitant mitral and tricuspid valve diseases on reoperation outcomes, particularly TAVR explants. The findings reveal that patients with prior TAVR are more likely to have severe concomitant valve diseases, such as mitral regurgitation, compared to those who underwent SAVR. These patients also experienced higher mortality rates during reoperation, especially TAVR explants, where the odds of mortality significantly increased. The study also highlights that severe valve disease is linked to notably higher mortality in both TAVR explant and redo-SAVR cases.