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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.
49 Episodes
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Cardiothoracic surgeons are studying the use of artificial intelligence (AI) and machine learning (ML) to improve risk prediction in the hopes that patient outcomes also will improve. Arman Kilic, MD, and Ara A. Vaporciyan, MD, along with medical student Brian Ayers, discuss what AI and ML mean, how it can uncover previously unknown relationships in medical data, and how it can be used to assist the surgeon in the operating room.
More than 100,000 people in the United States currently are waiting for a lifesaving organ transplant, including 5,000 people on the transplant list for a heart and/or lungs, according to the United Network for Organ Sharing. Although some will die before they receive a transplant, surgeons and research teams are making great strides in expanding the pool of viable organs. Zachary N. Kon, MD, moderates a discussion with Ashish S. Shah, MD, Matthew G. Hartwig, MD, and Varun Puri, MD, MSCI, about new ways to assess organ quality, technologies to increase their viability, and ways to better match donors and recipients.
Understanding a patient’s frailty index is an important part of assessing the risks and benefits of a surgical procedure for a cardiothoracic surgery patient. Frailty sometimes is measured by a patient’s grip strength, weight, and walking test results, but standards for evaluating and treating frailty before surgery do not exist. Mark K. Ferguson, MD (The University of Chicago), moderates a panel discussion with Nimesh Desai, MD (University of Pennsylvania), Linda W. Martin, MD, MPH (University of Virginia), and Betty C. Tong, MD (Duke University Medical Center), about how to screen for frailty, interventions to help patients prepare for surgery, and optimizing post-operative treatment protocols for the frail patient.
Cardiovascular disease is the #1 killer of people around the world, with approximately 18 million deaths annually, according to the World Health Organization. Treatment options for heart disease include lifestyle changes, stenting, and surgery. But which option is best and for which patients? Thomas E. MacGillivray, MD, moderates a panel discussion with Jennifer S. Lawton, MD, John D. Puskas, MD, Marc Ruel, MD, MPH, and Joseph F. Sabik III, MD. They explore recent results from the ISCHEMIA trial, implications for the heart team, and which patients benefit the most from percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), or medical therapy.
Cardiothoracic surgeons are at significant risk of burnout because of long work hours, delayed career gratification, complex health care, intense personality, and poor work-life balance. In fact, recent data show that more than half of cardiothoracic surgeons reported feeling burned out. In this important roundtable discussion, Thomas K. Varghese Jr., MD, MS, gathers tips to avoid burnout from Oliver S. Chow, MD, Michal Hubka, MD, and Susan D. Moffat-Bruce, MD, PhD, MBA. Strategies include building strong networks, bonding with family and friends, meditation, spending time outdoors, and making wellness a goal of the entire health care team.
The biggest threat to lung health in the current era is vaping. Shanda H. Blackmon, MD, MPH, moderates a discussion about the changing landscape of tobacco use, which includes vaping as the new gateway to smoking. She and colleagues, J. Robert Headrick, MD, MBA, Matthew A. Steliga, MD, and Keith S. Naunheim, MD, describe the “terrifying” statistics about vaping, why patients are oftentimes afraid to seek help, the use of graphics warnings, and why bringing smoking cessation resources to patients may become more necessary.
The FDA recently expanded the indications for transcatheter aortic valve replacement (TAVR) to include patients at low surgical risk, but experts are urging caution about which low-risk patients should undergo TAVR until more information is gathered. In this episode, Joseph E. Bavaria, MD, explored recent clinical trials with Tsuyoshi Kaneko, MD, Michael J. Reardon, MD, and Vinod Thourani, MD. They discussed what these trials mean for cardiac surgeons, interventional cardiologists, and the heart team, as well as knowledge gaps about age, bicuspid patients, SYNTAX score, pacemakers, and mechanical valve durability.
More than 2 years in the making, the first phase of the next generation STS National Database launched during the STS Annual Meeting in New Orleans (January 2020). The phase 1 rollout includes a data uploader, missing variable report, interactive dashboard, and a data quality report that will provide feedback within minutes after upload. Vinay Badhwar, MD, leads a discussion about what this innovative new clinical data registry means for cardiothoracic surgeons, their data managers, hospitals, and patients. He is joined by Joseph A. Dearani, MD, Felix G. Fernandez, MD, MSc, Jonathan Morris, MD, and Diane E. Alejo. For the latest updates on the next generation Database, visit www.sts.org/database.
Hosted by Thomas K. Varghese Jr., MD, MS, the “Beyond the Abstract” program explores the “whys” behind articles in The Annals of Thoracic Surgery and discusses next steps with authors and thought leaders. In the latest episode, Dr. Felix Fernandez joins Dr. Varghese to reflect on the accomplishments of the STS National Database over the last 30 years and discuss the early 2020 transition to a user-friendly, cloud-based, real-time platform that will accelerate practice improvement and lead to better patient outcomes. Read the related Annals Article, "The Future is Now: The 2020 Evolution of The Society of Thoracic Surgeons National Database" at http://bit.ly/3afTrmj. 
When physicians regularly exhibit a lack of civility and respect, patient safety and quality of care are compromised. The latest episode of “Beyond the Abstract,” from The Annals of Thoracic Surgery and part of the Society’s Surgical Hot Topics podcast, covers a paper that explores unprofessional behavior in the workplace and recommends a new framework for the assessment, treatment, and remediation of physicians with professionalism transgressions. Lead author Dr. Betsy Williams joins host Dr. Tom Varghese to discuss why this article was written and next steps. Read the related Annals article, “Understanding and remediating lapses in professionalism: Lessons from the island of last resort,” at http://bit.ly/2spz457
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.
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