Surgical Hot Topics

Recognizing and Treating the Frail Cardiothoracic Surgery Patient

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.

What Is the Best Way to Treat Heart Disease?

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.

Strategies for Surgeons to Prevent Burnout

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 Changing Landscape of Tobacco Use

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.

Which Low-Risk Patients Should Receive TAVR?

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.

The NextGen STS National Database Is Finally Here

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.

Beyond the Abstract: The Future is Now

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. 

Beyond the Abstract: Understanding and remediating lapses in professionalism

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

Beyond the Abstract: The Resilience Bank Account

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.

Beyond the Abstract: Attrition of the Cardiothoracic Surgeon-Scientist

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