Patient Outcomes

A groundbreaking study to be presented at the 2025 Society of Thoracic Surgeons Annual Meeting sheds light on an important decision point for patients requiring aortic valve replacement. Utilizing data from the STS Adult Cardiac Surgery Database, researchers have delivered the most extensive analysis to date on the outcomes of prosthetic valve types for patients aged 60 and younger.

The study, to be presented by Dr. Michael Bowdish, Cedars-Sinai Medical Center, examines the impact of valve choice—mechanical versus bioprosthetic—on long-term survival. By linking patient-level data from the STS ACSD with the National Death Index, researchers offer fresh insights into the critical question of how age and valve type affect surgical outcomes.

With its rigorous methodology and focus on tailoring care to individual needs, the study underscores the potential of advanced surgical techniques and data analytics to improve patient outcomes. It also highlights the pivotal role of the STS National Database, which provides robust national benchmarks for cardiothoracic procedures in the US, in driving impactful research and clinical innovation.

In presenting the Adult Cardiac Clark Paper on day two of STS 2025, Increased Risk of Surgical Aortic Valve Replacement After Prior Transcatheter Versus Surgical Aortic Valve Replacement with Concomitant Valve Disease, Dr. Robert Hawkins explores the heightened mortality risk for patients undergoing reoperation after transcatheter aortic valve replacement (TAVR) compared to those who have undergone surgical aortic valve replacement (SAVR).

Using data from the STS Adult Cardiac Surgery Database, which covers the years 2011 to 2021, Dr. Hawkins and his team examine the impact of concomitant mitral and tricuspid valve diseases on reoperation outcomes, with a particular focus on TAVR explants.

As part of the “Aortic Valve Surgery: What Do Our Patients Need to Know?” session on Saturday, Jan. 25 from 4:30 – 5:45 p.m., Dr. Hawkins will discuss findings that show patients with prior TAVR are more likely to suffer from severe concomitant valve diseases, such as mitral regurgitation, compared to those who underwent SAVR. These patients demonstrated a higher mortality rate during reoperation, particularly TAVR explants with an increase in the odds of mortality. The study further finds that severe valve disease is associated with significantly higher mortality in both TAVR explant and redo-SAVR cases.

During this session, Dr. Hawkins will share findings indicating that heart teams should consider these risks when deciding between TAVR and SAVR, as well as when addressing dysfunctional TAVR valves to avoid the heightened risks of reoperation. 

On Saturday, Jan. 24, from 10:15 to 10:25 a.m., Tomaz Mesar, MD, from the University of Pittsburgh Medical Center, will present An Age-Based Analysis of Transcatheter and Surgical Outcomes in Low-Risk Patients. The study compares outcomes of transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) in low-risk patients with aortic stenosis, with a particular focus on the impact of age on treatment outcomes.

Using a combined STS and TVT database, Dr. Mesar analyzed low-risk patients who underwent either SAVR or TAVR for degenerative aortic stenosis over a 13-year period, categorizing them into three age groups: under 65, 65-74, and over 75.

As part of the “Updates in Structural Heart: Surgeons are Still in the Game” session, Dr. Mesar will present on the crucial role of age in determining the optimal approach—TAVR or SAVR—for structural heart interventions. His presentation will address how current findings suggest that TAVR may not be suitable for younger, low-risk patients due to observed higher mortality rates. 

For patients aged 65-74, the choice between TAVR and SAVR requires a personalized assessment, as neither procedure demonstrates a clear survival advantage. Finally, for patients over 75, while TAVR may offer a reduction in certain complications, SAVR appears to provide better long-term survival outcomes for this patient population.

Evaluating the performance of congenital heart surgery centers is essential for improving patient outcomes. However, traditional methods of assessing performance have their limitations. At yesterday’s STS 2025 session, Sharon-Lise Normand, PhD, a professor of health care policy at Harvard Medical School, presented Improving Risk Adjustment in the Assessment of Congenital Heart Center Surgical Quality, which explored the use of modern causal inference techniques. These techniques aimed to better account for differences in case mix across centers, enhance risk adjustment, and provide a more accurate evaluation of center performance.

Utilizing data from the STS Congenital Database over a five-year period, the study examined 115 heart surgery centers across the United States. It compared two approaches for predicting postoperative mortality rates:

1. Traditional Method: This approach employed a statistical model that included data from all types of heart surgeries, even those that differed significantly from the procedures performed at the specific center.
2. Causal Inference Method: In contrast, this method focused on identifying other centers that performed similar surgeries and compared the outcomes of patients at those centers to those at the center under study.

Key findings

Dr. Normand discussed how the study revealed that causal inference methods yielded significantly higher and more variable estimates of expected mortality compared to traditional regression models. This suggests that traditional methods may underestimate the complexity of risk adjustment and the variability in performance across different centers. Additionally, causal inference methods were more effective in aligning the distribution of risk factors between comparison and target centers, leading to more accurate estimates of expected mortality.

Implications

These findings emphasize the potential of causal inference methods to provide a more tailored approach to risk adjustment, enhancing the accuracy of performance assessments across various centers. “Further research is needed to explore the implications of these methods for quality improvement and reporting,” said Dr. Normand. “By refining risk adjustment techniques, we can more effectively identify high-performing centers, pinpoint areas for improvement, and ultimately contribute to better outcomes for patients with congenital heart disease.”
 

At the 2025 Society of Thoracic Surgeons Annual Meeting, researchers will unveil a late-breaking study exploring the long-term survival outcomes of different surgical approaches for early-stage non-small cell lung cancer (NSCLC). The analysis leveraged the robust STS General Thoracic Surgery Database (GTSD), combined with long-term follow-up data, to evaluate the effectiveness of anatomic lung resections versus alternative techniques.

The study, to be presented by Dr. Christopher Seder, Rush University Medical Center, examined data from more than 32,000 patients, provides valuable real-world insights that complement existing randomized controlled trials, offering a comprehensive perspective on how surgical decisions influence outcomes over time. With findings drawn from diverse healthcare settings, this research underscores the potential of leveraging large-scale databases to refine treatment strategies and optimize patient care.

The STS GTSD remains a leading resource for capturing detailed surgical and patient data, driving advancements in cardiothoracic surgery. This latest study adds to its legacy by highlighting the importance of integrating real-world evidence into clinical practice.

The Congenital Heart Surgery Clark Paper, Understanding Mortality Following Congenital Heart Surgery: What Do Procedure-Specific Factors (PSF) Add? will assess the contribution of PSFs beyond standard risk factors in estimating mortality in this population.

Meena Nathan, MD, a pediatric cardiac surgeon at Children’s Hospital Boston, will present this paper on Friday, Jan. 24, from 2:16 to 2:24 p.m. as part of the "The Tribulations of Trials: Challenges in CHD Clinical Studies" session. During her talk, she will discuss data from The Society of Thoracic Surgeons Congenital Heart Surgery Database, a crucial resource for enhancing the quality of congenital heart surgery. In 2013, the Database expanded to include 82 Patient Safety Factors (PSFs) for benchmark operations (BMOs), though the impact of these PSFs on mortality prediction has yet to be fully explored.

To address this knowledge gap, Dr. Nathan and her team analyzed the contribution of PSFs to mortality estimation beyond standard STS risk factors. The study included a large cohort of BMOs from 115 U.S. centers between 2017 and 2022.

Dr. Nathan will present study findings, which emphasize the complexity of mortality prediction in congenital heart surgery and highlight the need for continued research to identify the most relevant risk factors and PSFs for each procedure, with the goal of developing more accurate prediction models that enhance patient care and support informed decision-making.

In patients undergoing coronary artery bypass grafting (CABG), a novel analysis evaluating surgeon preference for multi- versus single-arterial grafting may help explain the differing results between prior retrospective analyses and randomized controlled trials regarding long-term survival.

A novel study to be presented on Friday, Jan. 24, at The Society of Thoracic Surgeons’ 61st Annual Meeting by lead author Justin Schaffer, MD, a cardiothoracic surgeon at Baylor Scott & White Health, offers fresh insights into the long-debated question of whether multi-arterial grafting (MAG) improves long-term survival compared to single-arterial grafting (SAG) in patients undergoing CABG. The analysis evaluates over one million Medicare beneficiaries and incorporates an innovative approach using surgeon preference as a tool to address unmeasured variables.

While the findings highlight nuances in interpreting retrospective and randomized trial data, they also underscore the need for future randomized studies, such as the forthcoming results of the ROMA trial, to definitively guide clinical decision-making.

The researchers emphasized that understanding the survival benefit of MAG over SAG requires randomized data, and it remains an important and open clinical question. 
 

In today’s presentation of the Clark Memorial Paper for General Thoracic Surgery, Lobectomy versus Sublobar Resection Among Lung Cancer Patients Understudied in Recent Clinical Trials, Gavitt Woodard, MD, a thoracic surgeon at Yale Medicine, will discuss the findings of a comprehensive evaluation of lung cancer surgery outcomes.

This study examined survival outcomes across groups to determine whether the trial’s results are widely applicable to a broader population, including older patients, those with reduced pulmonary function, and non-smokers.

Researchers analyzed data from the Society of Thoracic Surgeons General Thoracic Surgery Database, linking it with Medicare survival data to evaluate patient outcomes. The study included a diverse group of patients who underwent different surgical resections, including lobectomy, segmentectomy, and wedge resection.

“The study found that sublobar resection and lobectomy offer similar survival outcomes for many patients, including those over 75, with poor lung function, or who are lifelong nonsmokers,” said Dr. Woodard. "Inadequate lymph node evaluation during sublobar resection was associated with worse survival. These findings highlight the need for better nodal assessment, particularly for patients with compromised lungs or minimal lymph node spread."

On Thursday, Jan. 23, the Society of Thoracic Surgeons (STS) kicked off its pre-conference for STS 2025. The program featured three concurrent half-day symposia designed to enhance attendees' educational experience at this year's Annual Meeting.

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The symposium, Lung Cancer: Clinical Trials Meet Clinical Practice, explored the rapidly evolving landscape of early-stage and locally advanced non-small cell lung cancer. Through interactive formats, participants examined recent diagnostic breakthroughs and key clinical trials, gaining practical strategies to integrate this knowledge into their daily practice.

The STS APP Conference: Redesigning the Future Together marked the inaugural program dedicated to advanced practice providers (APPs) in cardiothoracic surgery. This event focused on innovative ways to enhance the role of APPs, strengthen clinical management, and present strategies for professional success and leadership. Expert-led sessions and collaborative discussions provided attendees with valuable insights into improving patient care, driving clinical excellence, and fostering career development.

The Aortic Universe: From Birth to Adulthood symposium provided a comprehensive overview of aortic disease across all age groups. Participants learned about diagnosing, treating, and managing the full spectrum of congenital and acquired aortic conditions. "Through videos, detailed case-based presentations, and surgical techniques, these courses helped strengthen our ability to provide the highest level of care to those affected by aortic disease," said course co-director Ibrahim Sultan, MD, a cardiothoracic surgeon at the University of Pittsburgh Medical Center.