Surgical Hot Topics

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.

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.

The Consequences of Refusing Surgery

Two studies presented at the recent STS Annual Meeting showed that surgical therapy is superior to alternative treatment approaches for both esophageal cancer and coronary artery disease in younger patients. In light of these findings, Robbin G. Cohen, MD, MMM, Mark S. Allen, MD, Sebron W. Harrison, MD, and Alan M. Speir, MD discuss why patients refuse surgery, how they respond to patients who opt against surgery, and the obligations of surgeons in an age of patient autonomy.

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.).

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.

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.

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.

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.

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.

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.