Clinical Decision-Making

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.

Cardiothoracic professionals from around the world gathered at the 62nd Annual Meeting of The Society of Thoracic Surgeons (STS) in New Orleans, held January 29 – February 1, 2026.

This year’s theme, “Teaching for Tomorrow Together,” guided the meeting’s focus on emerging data and clinical debates, along with an enhanced, multisensory learning experience designed to engage surgeons at every stage of their careers.

Adult Cardiac Surgery Sessions

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Presentations featured the J. Maxwell Chamberlain Memorial Paper, which offered a randomized comparison of coronary artery bypass grafting guided by CT-derived fractional flow reserve versus traditional angiography, providing insights into how advanced imaging may improve surgical decision-making. The Clark Paper examined the management of moderate aortic stenosis in patients undergoing bypass surgery. Additional sessions explored strategies for managing new-onset atrial fibrillation after cardiac surgery, the growing challenge of transcatheter aortic valve explantation, and the benefits of mitral valve repair over replacement in patients over age 65. Presentations also highlighted one-year results from endovascular repair of aortic arch lesions using a thoracic branched endoprosthesis, offering new data on its role relative to open surgery, and evaluated whether prophylactic left atrial appendage occlusion reduces stroke risk in older patients without atrial fibrillation.

General Thoracic Surgery Sessions

The General Thoracic sessions addressed critical issues in the management of patients with esophageal and lung cancers, highlighting evolving strategies to improve surgical outcomes and cancer care. The Clark Paper evaluated nodal upstaging rates and morbidity associated with the ACS Commission on Cancer Operative Standard 5.8, comparing it with other commonly used lymph node sampling guidelines using data from the STS General Thoracic Surgery Database. The J. Maxwell Chamberlain Memorial Paper explored the relationship between nodal assessment, pathological upstaging, and survival in patients with clinically node-negative non-small cell lung cancer undergoing resection, offering insights into the prognostic value of thorough lymph node evaluation. Other sessions examined the extent of nodal resection, upstaging rates, and outcomes associated with evaluating more than a single N1 lymph node, evidence-based guidelines for defining and performing sublobar resection, and strategies for determining the most effective interventions for screen-detected lung nodules.

Congenital Heart Surgery Sessions

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Presentations in the congenital heart surgery sessions included innovative strategies and evolving technologies aimed at improving outcomes in congenital heart care. The James S. Tweddell Memorial Paper featured an institutional machine learning model used to predict postoperative morbidity and mortality in adult congenital heart disease patients undergoing cardiac reoperations, demonstrating the potential of artificial intelligence in managing complex, high-risk populations. Another session introduced a novel technique for heart procurement in donation after circulatory death, addressing ethical considerations while helping expand the donor pool. The Clark Paper also examined the impact of preoperative tracheostomy on outcomes following congenital cardiac surgery, using data from the STS Congenital Heart Surgery Database to inform perioperative risk assessment.

Perioperative & Critical Care Sessions

Highlights included The J. Maxwell Chamberlain Perioperative Paper, which analyzed the effect of expedited discharge on 30-day readmission rates following lung resection, offering a national comparison between robotic-assisted and video-assisted thoracoscopic approaches. Sessions also featured discussions on real-time clinical decision-making in the management of vasoplegia and explored minimally invasive cardiac surgery within the context of enhanced recovery protocols. Additional topics included strategies for managing severe postoperative anemia in patients who decline blood transfusions, evolving techniques for routine versus selective distal perfusion in VA ECMO, the use of multimodal virtual reality combined with olfactory stimuli to reduce perioperative pain and anxiety in thoracic surgery patients, and best practices for first-line treatment of cardiac arrest following surgery.

Celebrating Outstanding Women CT Surgeons

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More than 240 attendees gathered for the fourth annual Nina Starr Braunwald Extraordinary Women in Cardiothoracic Surgery Awards breakfast to honor women cardiothoracic surgeons who have exhibited exceptional clinical expertise and made significant contributions to the specialty. This year’s recipients were Emily Farkas, MD, Indiana University School of Medicine and the Richard L. Roudebush VA Medical Center in Indianapolis; Carolyn Jones, MD, University of Rochester Medical Center; and Rosemary Kelly, MD, University of Minnesota Medical School and MHealth Fairview.

Reflections on Leadership and the Future of Surgery

STS President Joseph F. Sabik III, MD, delivered the presidential address, highlighting his career, personal milestones, and the evolving future of cardiothoracic surgery and the Society. Through stories and insights, Dr. Sabik shared the experiences that shaped his leadership and vision.

Main Stage Voices Inspired and Challenged at STS 2026

At STS 2026, attendees heard from dynamic speakers who offered insight on leadership, teamwork, and performance under pressure.

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The Vivien T. Thomas Lecture was given by bestselling author Shola Richards. In his talk, “The Courage To Go Together™: Three Questions to Change How You Work, Live, and Lead,” he introduced a framework for building psychological safety and seamless coordination—capabilities essential for cardiothoracic surgical teams striving for optimal patient outcomes.

Two-time World Series Champion Terry Francona delivered a plenary address on leadership in adversity. In “From the Dugout to the OR: The Art of Building a Winning Team,” he shared lessons on building trust, navigating challenges, and staying focused on a common goal.

Globally recognized Peloton instructor Ben Alldis also took the stage, presenting his plenary talk, “Auditing Your Well-Being.” He offered practical strategies for maintaining peak performance, prioritizing well-being, and sustaining motivation in high-demand environments.

The Hub Sharpens Skills and Builds Connections

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For the third consecutive year, The Hub served as a central gathering space for early-career surgeons, medical students, residents, and fellowship trainees. The lounge area hosted a wide range of engaging sessions, including the White Coat Investor Talk, Mock Oral Interviews, Job Interview Preparation, and a luncheon celebrating the 20th Anniversary of the Looking to the Future Scholarship Program, among others. Attendees also took part in creative activities within The Hub, such as the collaborative mural project “Splashes of Hope.” Through this initiative, participants contributed their creativity to a piece of artwork that will be donated to a local children’s hospital.

Immersive Surgical Training

STS 2026 featured practical, hands-on courses covering a range of surgical procedures throughout the Annual Meeting, providing an engaging, immersive learning experience for residents, early-career surgeons, and others looking to sharpen their skills. Topics included aortic annular enlargement, TEVAR techniques for aneurysms and dissections, mitral valve repair, complex central airway reconstruction, and the Ross procedure.

Cutting-Edge Science and Live Podcast Conversations

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The STS Annual Meeting exhibit hall featured more than 130 exhibitors showcasing the latest tools and technologies for surgical practice, along with live, hands-on product demonstrations. Industry symposia provided valuable insights into emerging techniques, innovations, and interventions shaping the future of cardiothoracic surgery. The exhibit hall theaters provided attendees with the opportunity to experience live podcast recordings of Thinking Thoracic, The Resilient Surgeon, and Same Surgeon, Different Light, interactive industry presentations, and the CT Surgery Resident Showdown.

On Sunday, Feb. 1 at 10:45 a.m., during the “Advancing Lung Cancer Screening Implementation in Real World Settings” session, Dr. Elliot Servais of Lahey Hospital and Medical Center will present The Society of Thoracic Surgeons Expert Consensus on Surgical Quality Standards for Lung Cancer Screening Detected Nodules. As chair of the STS Task Force responsible for the consensus document, Dr. Servais will walk attendees through comprehensive, multidisciplinary recommendations designed to standardize perioperative care for CT lung cancer screening programs nationwide.

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Lung cancer screening with low-dose CT has proven effective in reducing disease-specific mortality, but wide variation in how programs manage screen-detected nodules persists. To address this, the STS convened a multidisciplinary panel to review the evidence and establish clear benchmarks for diagnostic evaluation, complication rates, and timeliness of intervention. Through a structured literature review and modified Delphi process, the panel produced 23 consensus statements focused on improving safety, consistency, and coordination in screening pathways.

Key recommendations include permitting surgery without a preoperative tissue diagnosis in select patients—preferably using minimally invasive, parenchymal-sparing techniques—and rejecting pneumonectomy without a diagnosis.

In his presentation, Dr. Servais will also highlight why certain targets, such as achieving a benign resection rate below 10%, may challenge some programs. “Meeting this benchmark requires consistent multidisciplinary review, judicious use of preoperative biopsy, and a willingness to follow equivocal lesions closely—approaches that can reduce unnecessary surgery and improve patient outcomes,” says Dr. Servais.

By integrating diverse clinical perspectives, programs can better determine when invasive intervention is warranted versus when surveillance is safest, improving decision-making and minimizing avoidable procedures.

“Thoracic surgeons must remain central to lung cancer screening programs, and adherence to strong perioperative quality standards—rooted in multidisciplinary evaluation, operative safety, and timely intervention—is critical to ensuring that lung cancer screening continues to save lives with minimal harm to patients,” adds Dr. Servais.

On Saturday, Jan. 31 at 2:45 p.m., during the “Adult Congenital Heart Disease” session, Jennifer Nelson, MD, of Nemours Children’s Hospital will present Indications and Timing of Pulmonary Valve Replacement in Repaired Tetralogy of Fallot. Her talk will highlight a new, comprehensive body of work designed to bring greater clarity and consistency to decision-making around pulmonary valve replacement (PVR) for one of the largest populations of patients living with repaired congenital heart disease.

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PVR is a common and critical intervention for patients with repaired tetralogy of Fallot (TOF) and clinically significant pulmonary regurgitation; however, indications and timing have varied widely across practice settings. To reduce this variability, The Society of Thoracic Surgeons (STS), in collaboration with the World Society of Pediatric and Congenital Heart Surgery (WSPCHS) and the European Congenital Heart Surgeons Association (ECHSA), developed a three-part series of complementary clinical practice documents: Clinical Practice Guidelines, a pediatric-focused Expert Consensus Document, and an Expert Opinion paper on the role of exercise testing.

Developed through a rigorous literature review, adherence to PRISMA methodology, and a modified Delphi consensus process, these documents synthesize available evidence and expert judgment to establish practical, consensus-based recommendations.

Key considerations include symptoms, MRI-based ventricular assessment, arrhythmia risk, and procedural factors, emphasizing individualized, data-driven decisions over single thresholds. “Routine, standardized measurement during long-term follow-up is essential,” says Dr. Nelson, who also highlights the role of multidisciplinary review and exercise testing in revealing unrecognized functional limitations.

The new guidance incorporates emerging MRI-based evidence linking ventricular changes to mortality and supports earlier consideration of pulmonary valve replacement in select asymptomatic adults. It also emphasizes that arrhythmia risk persists after intervention, reinforcing the need for continued surveillance.

Together, this three-part series provides an updated framework to guide clinicians caring for children and adults with repaired TOF, balancing evolving evidence with real-world clinical complexity. “These recommendations matter because they should change practice,” Dr. Nelson adds. “They help clinicians better identify the right patient and the right time for pulmonary valve replacement, with the goal of improving long-term outcomes while minimizing unnecessary risk.”