Rank #1: Pain Management in Cardiothoracic Surgery
The opioid epidemic, especially in the United States, has prompted many physicians to re-evaluate their prescription writing habits when it comes to narcotics. Because pain management is an important part of the recovery process after cardiothoracic surgery, Dr. Robbin Cohen recently moderated a panel discussion with both cardiac and general thoracic surgeons about ways they are modifying surgical techniques and pharmacological strategies, deploying multidisciplinary team-based efforts, and supporting the Society’s legislative priorities aimed at helping to ease the crisis.
Rank #2: Anticoagulation During Cardiopulmonary Bypass
In January, The Society of Thoracic Surgeons, the Society of Cardiovascular Anesthesiologists, and the American Society of ExtraCorporeal Technology released a clinical practice guideline on the use of blood thinning medication (anticoagulants) during heart surgery. In this episode, guideline coauthor John Hammon, MD speaks with two cardiothoracic surgeons (Gaetano Paone, MD and Richard Engelman, MD) and a perfusionist (Theron Paugh, CCP) about how the guideline will change clinical practice.
Rank #3: Current Advances in Lung Cancer Early Detection and Therapy
Lung cancer morbidity and mortality remains high in the United States and beyond despite major changes over the past few years in early detection and treatment for advanced disease. Dr. Douglas E. Wood, from the University of Washington in Seattle, moderates a roundtable discussion with prominent lung cancer surgeons—Drs. Shanda H. Blackmon, Lisa M. Brown, and Mitchell J. Magee—who explain how results from the recent NELSON study are game-changing, ways to improve access to screening, how vaping is creating a new generation of cigarette smokers, and advances in systemic therapy and immunotherapy for lung cancer.
Rank #4: Transcatheter-Based Mitral Valve Repair and Replacement
The latest advances in mitral valve repair and replacement include a shift toward the transseptal platform. Gorav Ailawadi, Vinay Badhwar, Steven F. Bolling, and T. Sloan Guy discuss how catheter-based techniques will re-emulate the gold standard for mitral valve surgery, the important role of 3D Echo technology, the need for transseptal puncture skills, and navigating the local politics.
Rank #5: Addressing the Impending Shortage of Cardiothoracic Surgeons
Numerous studies predict growing shortages in the physician workforce in the United States, especially among cardiothoracic surgeons. Five cardiothoracic surgeons and a fourth-year medical student discuss ways to address this impending shortage, including increasing the cap on residency slots, reducing the burden of training costs, and improving work-life balance.
Rank #6: Evolving Trends in TAVR
The volumes of two aortic valve replacements (AVR) procedures have changed dramatically over the past few years, with more transcatheter procedures now being performed than open surgical procedures. Four cardiac surgeons discuss the evolving trends in TAVR, why the changes are occurring, and what’s ahead for TAVR and SAVR. Wilson Y. Szeto, MD moderates the discussion that also features Michael J. Mack, MD, John V. Conte, MD, and Thomas E. MacGillivray, MD.
Rank #7: Quality and Innovation in Cardiothoracic Surgery: Colliding Imperatives?
The fine line between delivering quality treatment and embracing innovation may sometimes make cardiothoracic surgeons feel trapped between conflicting goals. In his Presidential Address at the 2017 STS Annual Meeting in Houston, Texas, Joseph E. Bavaria, MD challenged that paradigm. He encouraged his colleagues to continually experiment and adapt, but also to always keep the patient in mind.
Rank #8: Mentorship in Cardiothoracic Surgery
Mentorship is an important component to success for many up-and-coming cardiothoracic surgeons. For established surgeons, being a good mentor is equally as important. Vinay Badhwar, MD moderates a discussion that includes Shanda H. Blackmon, MD, MPH, Melanie A. Edwards, MD, and David D. Odell, MD, MMSc talking about how mentorship is critical to the future of the specialty and what STS is doing to promote mentorship for early career surgeons.
Rank #9: How to Recruit More Women Into Surgery
Women make up 46% of medical school graduates; however, only 22% of cardiothoracic surgery trainees are women. Of the 8,617 people who have been certified by The American Board of Thoracic Surgery to date, only 308 (3.6%) are women. STS Director-at-Large Shanda H. Blackmon, MD, MPH says that has to change. She provides 10 tips on how to attract more female candidates into the specialty. Her talk originally was given at the 2018 European Society of Thoracic Surgeons Annual Meeting in Ljubljana, Slovenia. It also is available at https://youtu.be/yHqijGPF9L8.
Rank #10: Take It to the Limit
Taking it to the limit is what cardiothoracic surgery has done for the past 50 years and what STS has done on behalf of the specialty for that same half century; however, some things that once made CT surgery successful may now be counterproductive. In his Presidential Address at the 2014 STS Annual Meeting in Orlando, Florida, Douglas E. Wood, MD challenged his colleagues in the male-dominated profession to welcome in more women and transition away from a masculine, autocratic leadership style.
Rank #11: STS Key Contacts: Advocates for Cardiothoracic Surgery
One way that cardiothoracic surgeons can have a direct impact on federal policy affecting the specialty is by participating in the STS Key Contact program, which offers grassroots advocacy opportunities. In this episode, experienced Key Contacts share why they participate in political advocacy, describe the importance of STS-PAC, and role-play a meeting with a Congressional staff member—showing both how things can go wrong and how to make them go right.
Rank #12: Beyond the Abstract: Individual Surgeon Performance in Adult Cardiac Surgery
Hosted by Thomas K. Varghese Jr., MD, MS, Annals Deputy Editor, Digital Media and Digital Scholarship, the “Beyond the Abstract” program explores the “whys” behind an article in The Annals of Thoracic Surgery and discusses next steps with authors and thought leaders. In this episode, David M. Shahian, MD and Keith S. Naunheim, MD join Dr. Varghese to discuss the motivation for developing surgeon-level outcomes metrics and why it’s important. Read the Annals article, “Individual Surgeon Performance in Adult Cardiac Surgery,” at http://bit.ly/2ACEs6b.
Rank #13: Emerging Game-Changing Technologies in the Management of Lung Cancer
New technologies and innovative treatments are making it easier to successfully diagnose and treat patients with lung cancer. Douglas E. Wood, MD (University of Washington) moderates a discussion with Leah Backhus, MD, MPH (Stanford University), Elizabeth David, MD (UC Davis), and Moishe Liberman, MD, PhD (University of Montreal) about how low-dose computed tomography, wearable devices, energy sealing devices, and robots are changing patient outcomes and experiences.
Rank #14: Innovation for Life
Even though an operation or a process has been around for a long time and may seem "normal," an innovative idea can change it all. In his Presidential Address at the 2016 STS Annual Meeting in Phoenix, Arizona, Mark S. Allen, MD described five common characteristics shared by innovators inside and outside of medicine and urged cardiothoracic surgeons to embrace innovation and ultimately make the specialty better for themselves and their patients.
Rank #15: A New Global Health Crisis
Over the last several decades, deaths from noncommunicable diseases—including cardiovascular disease and lung and esophageal cancer—have increased in the developing world. In his Presidential Address at the 2015 STS Annual Meeting in San Diego, California, David A. Fullerton, MD outlined the problem, the Society’s efforts to fund charitable surgical missions in developing nations, and STS members who are making a difference.
Rank #16: Discrepancies Between Evidence-Based and Real-World Practices
On average, it takes 17 years before new innovation is disseminated into clinical practice. How can cardiothoracic surgery change that statistic and speed up the process? Juan A. Sanchez, MD moderates a discussion with Michael S. Kent, MD, Kevin W. Lobdell, MD, and W. Chance Conner, MD about why there is a gap, strategies for implementation, and quicker adoption by the end user (hospital, clinician, etc.).
Rank #17: The Debate Over Exercise Restrictions in Cardiac Surgery
Should patients remain active before, during, and after cardiac surgery? Some surgeons have opposing views. Thomas G. Gleason, MD, from the University of Pittsburgh, and Edward P. Chen, MD, from Emory University, discuss the role of exercise in the treatment and recovery process following surgery for various forms of heart disease, especially among active patients.
Rank #18: How to Successfully Implement Surgical Innovations and New Technologies into Practice
Health care professionals tend to be traditional and conservative when it comes to practice, so incorporating new technologies and innovations into the hospital and the operating room can be a challenge. Four cardiothoracic surgery change drivers—Shanda H. Blackmon, MD, MPH, James D. Luketich, MD, T. Sloan Guy, MD, MBA, and Linda W. Martin, MD, MPH—provide advice on how to get buy-in from hospital administrators, as well as team members.
Rank #19: Eye of the Beholder: The Reinvention of Seeing
Cardiothoracic surgeons and their professional societies must be leaders in accountability and transparency. In his Presidential Address at the 2018 STS Annual Meeting in Fort Lauderdale, Florida, Richard L. Prager, MD noted that surgeons must embrace their failures and always think about getting better—not winning, but getting better—in order to be successful.
Rank #20: The STS National Database Expands
The STS National Database recently expanded to include a registry for clinical outcomes of patients who receive a mechanical circulatory support device to treat advanced heart failure. The STS Intermacs Database adds important longitudinal data to an already comprehensive, highly respected clinical outcomes database. David Shahian, Frank Pagani, and Robert Kormos discuss how Intermacs will complement the STS National Database and how the data can be used for research and performance improvement.