On day one of STS 2024, meeting goers attended numerous sessions that explored the growing debate between SAVR and TAVR as treatment options,
Dr. Michael Bowdish presents a late-breaking session on cardiac surgery after TAVR trends and outcomes.
"Improved Longitudinal Outcomes with Surgical Aortic Valve Replacement with Atrial Fibrillation Management over Transcatheter Aortic Valve Replacement Alone," part of the larger "Bring SAVR Back" session given by J Hunter Mehaffey, MD, unveiled Class I guideline recommendations that support atrial fibrillation (AF) treatment during surgical aortic valve replacement (SAVR). And how recently, many low to intermediate risk patients with AF and aortic stenosis (AS) are managed by transcatheter aortic valve replacement (TAVR). And finally, they evaluated real-world longitudinal outcomes of TAVR vs SAVR with or without AF treatment.
"We concluded that in Medicare beneficiaries with AF who required aortic valve replacement, SAVR with concomitant treatment of AF was associated with improved longitudinal survival and freedom from stroke compared to TAVR," noted Dr. Mehaffey. "Consideration should be given for SAVR with AF treatment as a first-line approach for patients with AF requiring aortic valve replacement."
In his discussion of "Robotic Aortic Valve Replacement versus Transcatheter Aortic Valve Replacement: A Propensity Matched Analysis," Vikrant Jagadeesan, MD, presented findings on contemporary data that supports equipoise between surgical aortic valve replacement and transcatheter aortic valve replacement (TAVR) for the management of symptomatic severe aortic stenosis (AS). He further explained that controversy exists around the optimal management of patients in low to intermediate risk categories, and how the study compared outcomes of surgical robotic aortic valve replacement (RAVR) to TAVR.
"Compared to TAVR, RAVR was associated with lower stroke and PPM rates, less PVL, and improved 1 year survival," said Dr. Jagadeesan. "And RAVR may provide a safe and effective minimally invasive first-line alternative for low to intermediate risk patients presenting with symptomatic AS."
In a late breaking session titled, "Cardiac Surgery after Transcatheter Aortic Valve Replacement: Trends and Outcomes," Michael Bowdish, MD, illustrated how his research team set out to document trends and outcomes in cardiac surgery following transcatheter aortic valve replacement (TAVR), a topic gaining importance as reports of subsequent cardiac operations and early TAVR explantations increase. Using the Society of Thoracic Surgeons Adult Cardiac Surgery Database, the study covers adult patients who underwent cardiac surgery after an initial TAVR from January 2012 to March 2023.
"The study findings underscore the escalating need for both aortic and non-aortic valve cardiac surgeries following TAVR," explained Dr. Bowdish. "They note a substantial increase in the frequency of these surgeries, emphasizing the importance of understanding outcomes." He observed elevated risk in these cases, as indicated by mortality and stroke rates, which calls for careful consideration, particularly given the expanding use of TAVR across a broader range of age and risk profiles. Finally, the study suggests the need for ongoing assessment and longitudinal evidence to inform decision-making in the evolving landscape of TAVR applications.
On Saturday, January 27 at 9:45 a.m. CT, Christopher Mehta, MD, from Northwestern Memorial Hospital in Chicago, will present “Age-Stratified Surgical Aortic Valve Replacement for Aortic Stenosis: An Analysis of the Society of Thoracic Surgeons Adult Cardiac Surgery Database (ACSD).”
During his talk, Dr. Christopher Mehta will provide insight into how comprehensive data helps inform multidisciplinary heart teams in making decisions for patients.
The study is part of the STS 2024 session titled, “Trends and Research from the STS ACSD.” During his talk, Dr. Mehta will provide insight into how comprehensive data help inform multidisciplinary heart teams in making decisions between surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR) for patients.
Attendees will learn how the national landscape for SAVR and TAVR changed between 2011 and 2022, as experts evaluated age-specific trends and outcomes in surgical aortic valve replacement (AVR) in patients with bicuspid (BAV) or tricuspid (TAV) aortic valve by analyzing data from the STS ACSD.
Throughout the 11-year study, which followed more than 200,000 adult patients with BAV or TAV who underwent AVR for moderate and severe aortic stenosis, age-specific trends and outcomes were evaluated.
Lung cancer is the deadliest cancer in the U.S. Early detection of lung cancer through low-dose computed tomography (LDCT) screening has been shown to significantly reduce lung cancer mortality in high-risk populations and is currently recommended annually by the U.S.
In observance of Lung Cancer Awareness Month, STS participated in a congressional press conference focused on the importance of lung cancer screening hosted on the U.S. Capitol grounds on Thursday, November 16. The event, hosted by Congresswoman Kathy Castor (D-FL), aimed to bring attention to the urgent need to get more people screened for lung cancer.
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Dr. Keith Mortman with Congresswoman Debbie Wasserman Schultz
STS joined other key stakeholders in the lung cancer community at this event, including LUNGevity Foundation, American Lung Association, GO2 for Lung Cancer, Moffitt Cancer Center, the Roswell Park Comprehensive Cancer Center, and Rep. Debbie Wasserman Schultz (D-FL).
STS has a long history of advocating for robust patient access to lung cancer prevention, screenings, and treatment. “Over the past decade, significant progress has been made to expand insurance coverage of lung cancer screening, yet this press conference highlighted that significant challenges remain to increasing screening rates among at-risk individuals,” said Keith Mortman, MD, who participated in the press conference and is a member of the STS Workforce on Health Policy, Reform, and Advocacy. “While innovative treatments for lung cancer are rapidly emerging, not everyone has equal access to these cutting-edge treatments. STS is relentlessly advocating with policymakers in Washington to remove barriers and increase access so our members can offer the highest quality lung cancer care possible.”
To advance this priority, STS has advocated for H.R. 4286, Increasing Access to Lung Cancer Screening Act, a bipartisan bill introduced by Reps. Brian Higgins (D-NY), Brian Fitzpatrick (R-PA), and Kathy Castor (D-FL), that would require all state Medicaid programs to cover lung cancer screenings for eligible enrollees as recommended by the U.S. Preventative Services Task Force (USPSTF). Urge your lawmakers to support this legislation today.
Overall survival rates of esophageal cancer have risen in the past 50-plus years, from 5% in 1970 to 22% in 2023. Yet, no comprehensive guidelines addressing multidisciplinary management of esophageal cancer that incorporate input from surgeons, radiation oncologists, and medical oncologists have been available, until now.
The Society of Thoracic Surgeons, American Society for Radiation Oncology, and American Society of Clinical Oncology have co-authored the first comprehensive guideline on the management of esophageal cancer. Published today in The Annals of Thoracic Surgery, the guideline addresses key clinical subject areas pertinent to the care of patients with locally advanced, resectable thoracic esophageal cancer.
The guideline delivers recommendations for the use of induction chemotherapy, optimal radiation dose, value and timing of esophagectomy, use of chemotherapy vs. chemoradiotherapy before surgery, approach and extent of lymphadenectomy, and the value of adjuvant therapy after resection.
“These comprehensive guidelines address areas critical for standardizing and improving care and outcomes for esophageal cancer patients,” says study investigator Stephanie Worrell, MD, clinical associate professor and thoracic section chief at the University of Arizona in Tucson. “The recommendations are based on a comprehensive review of innovations and advancements in the most recent literature.”
A panel of leaders in cardiothoracic surgery will explore the cost of patient safety relative to the effects on education, how public reporting of patient safety is often confusing to patients, and how expected patient safety results may lead to disproportionate investments and difficult prioritization decisions.
July 25, 2023, Chicago, Ill… The Society of Thoracic Surgeons has launched its next-generation Operative Risk Calculator to assess the risk of adult cardiac surgery operations.
