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Surgical Hot Topics

Author: The Society of Thoracic Surgeons

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Listen to leaders in cardiothoracic surgery discuss hot topics in the field. Founded in 1964, The Society of Thoracic Surgeons is a not-for-profit organization representing more than 7,600 surgeons, researchers, and allied health care professionals worldwide.

Please note: The comments included in these episodes are that of the individuals involved and not necessarily that of The Society of Thoracic Surgeons.
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The numerous professional and personal stressors experienced by cardiothoracic surgeons can—if not well managed—lead to errors in clinical judgment, burnout, early departure from practice, health issues, and substance abuse. In the latest episode of “Beyond the Abstract,” a program that explores the “whys” behind an article in The Annals of Thoracic Surgery, Dr. Michael Maddaus joins host Dr. Tom Varghese to discuss six habits that can make a significant difference in managing stress when proactively integrated into a daily routine. Read the related Annals article, “The Resilience Bank Account: Skills for Optimal Performance” at http://bit.ly/2q8XMFA.
Are surgeon-scientists a dying breed? Dr. John Ikonomidis is the lead author of a new paper that explores the decline of surgeons who are applying for and receiving grants, publishing less, and feeling that research is not a part of their role. He joins host Dr. Tom Varghese in the latest episode of “Beyond the Abstract,” a program that explores the “whys” behind an article in The Annals of Thoracic Surgery and discusses next steps with authors and thought leaders. Read The Annals article, “Attrition of the Cardiothoracic Surgeon-Scientist: Definition of the Problem and Remedial Strategies,” at  http://bit.ly/2ZLg8ZR
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 the latest episode, Drs. Robert Kormos and David Morales join host Dr. Thomas K. Varghese Jr. to explore the motivation for developing registries that examine clinical outcomes and quality-of-life metrics for patients who received FDA-approved durable mechanical circulatory support devices. They also discuss how these data will impact future devices, patient selection, and outcomes. Read the related Annals articles online:“The Society of Thoracic Surgeons Intermacs Database Annual Report: Evolving Indications, Outcomes, and Scientific Partnerships” (http://bit.ly/2NmLNPs)“Third Annual Pediatric Interagency Registry for Mechanical Circulatory Support (Pedimacs) Report: Preimplant Characteristics and Outcomes” (http://bit.ly/2J5vSzY)    
The job market for cardiothoracic surgeons is more promising now than it has been in decades. So how can residents and fellows be successful in finding that first job? Vinay Badhwar, MD asks seasoned and early career colleagues for tips on making a good impression during an interview, making sure that the job is a great fit, how to find the best career resources, and how to engage and maintain good mentors.
More cardiothoracic surgery programs are incorporating robotics training for residents and fellows. But should robotics be a standard part of the curriculum and have a presence on the in-training and board exams? Dr. Rishinda M. Reddy moderates a discussion with colleagues about the principles of robotics training, how they obtained funding for their robotics programs, and the importance having expanded minimally invasive skills.
The STS National Database is known worldwide as the “gold standard” for quality improvement and patient safety in cardiothoracic surgery. Launched in 1989, the Database includes approximately 8 million patient records. In this roundtable discussion, Drs. Dave Shahian, Felix Fernandez, Jeff Jacobs, and Vinod Thourani explain how they’ve used data from the Database for making improvements at their own hospitals, for research projects, to understand the cost-effectiveness of various procedures, and to demonstrate the importance of the care that cardiothoracic surgeons provide.
Despite mandates that determinants of health and differences in sex be incorporated into clinical trials, some groups—such as minorities, women, and those of lower socioeconomic status—are still underrepresented. Drs. David T. Cooke, Loretta Erhunmwunsee, and Linda W. Martin discuss why diverse groups are important, how to improve clinical trial design, and strategies to enroll more broadly representative groups into clinical trials.
Endocarditis is one of the most challenging infections to treat for cardiothoracic surgeons, and the opioid epidemic has led to a staggering increase in the number of infective endocarditis cases seen in the United States. Dr. Robbin G. Cohen talks with some of the world’s leading experts in treating valve disease and endocarditis—Drs. Joseph E. Bavaria, Eric E. Roselli, and Scott Goldman—about when surgeons should get involved in the treatment process, when and how long to treat with antibiotics, the best candidates for surgery, and the ethics surrounding treating IV drug abusers.
Media coverage can be a powerful way for cardiothoracic surgeons to help more patients and their families understand important health care information. But how can you handle a reporter’s tough questions and still get your message across? Todd K. Rosengart, MD leads a panel discussion with cardiothoracic surgeons who have had experience with handling awkward media situations, connecting with a lay audience, and helping to change the course of a conversation when a reporter has incorrect information.
The Society is offering a new opportunity for self-assessment and quality improvement in cardiothoracic surgery—surgeon-specific outcomes reports from the Adult Cardiac Surgery Database (ACSD). For those who affirmatively opt in, these feedback reports will be available beginning in fall 2019 and will include data on coronary artery bypass grafting (CABG), aortic valve replacement (AVR), CABG+AVR, mitral valve repair and replacement (MVRR), and CABG+MVRR. Four STS leaders, Drs. Richard Prager, David M. Shahian, Alan M. Speir, and Domenico Pagano, recently discussed the importance of this initiative and how it will lead to better patient care.
Some of the most successful cardiothoracic surgeons credit mentors for part of their achievements. Whether you are still in training, an early careerist, or a senior surgeon, taking part in a productive mentor/mentee arrangement has long-term benefits. But how do you identify a good mentor or mentee and cultivate that relationship? Drs. Mara B. Antonoff, Vinod H. Thourani, John D. Mitchell, and Elizabeth A. David describe the qualities to look for in a mentor, the importance of communication, setting realistic expectations, avoiding “mentor malpractice,” and why mentees should under promise and over deliver. 
Artificial intelligence and electronic health technologies are changing how physicians conceptualize and treat diseases. Although these futuristic advancements are leading to improvements in quality, safety, and patient outcomes, these technologies also are dramatically changing the cyber threat landscape. Kevin W. Lobdell, MD talks with colleagues in cardiothoracic surgery, cardiology, and anesthesiology about embracing virtual reality, augmented reality, and machine learning, while also finding ways to protect against cyberattacks.
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. 
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.
An important element of building and maintaining a successful cardiothoracic surgery practice is the relationship with referring physicians such as cardiologists and primary care physicians. Dr. V. Seenu Reddy moderates a panel discussion about the elements of forming good relationships, breaking through the anonymity resulting from electronic health records, creating a patient-centered experience, how to communicate bad news, and building a solid reputation.
The Centers for Medicare & Medicaid Services is reevaluating the scientific evidence supporting volume requirements for hospitals and heart team members who perform transcatheter aortic valve replacement procedures. Drs. Joe Bavaria, Tom Gleason, Richard Shemin, Vinod Thourani, and Michael Deeb discuss the value of The Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry for quality improvement initiatives, outcomes research, and device surveillance.
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, Leah M. Backhus, MD and David T. Cooke, MD join Dr. Varghese to discuss the importance of gender diversity in the specialty. Read the Annals article, “Culture of Safety and Gender Inclusion in Cardiothoracic Surgery,” at http://bit.ly/2EqllPI.
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.
The Society has expanded its Surgical Hot Topics podcast series with a new program called “Beyond the Abstract.” Hosted by Thomas K. Varghese Jr., MD, MS, Annals Deputy Editor, Digital Media and Digital Scholarship, the program explores the “whys” behind an article in The Annals of Thoracic Surgery and discusses next steps with authors and thought leaders. This brief introductory episode explains what you can expect in each episode.
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.
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