VOL 26 · ISSUE 4 FALL 2021 THE SOCIETY OF THORACIC .

PRESIDENT’S COLUMNSince assuming the role of STS President, onequestion that I have been asked frequently is“How is a member chosen for a volunteer STSleadership position?”.In this article, I would like to provide answers tothat question by describing the currentselection processes for various STS leadershippositions. I also will highlight some of theinitiatives being undertaken to review and,where appropriate, amend existing processesfor filling leadership roles.Officers and Board MembersEach year at the annual STS Business Meeting,the Chair of the Nominating Committeepresents a slate of Officers and Boardmembers nominated to fill vacant positions formember approval. Upon approval, an STSOfficer (e.g., Secretary, Treasurer, Second VicePresident) is appointed to a 1-year term; aDirector-at-Large is typically appointed for a3-year term, with eligibility for a 3-year renewal(for a potential total of 6 years).By way of background, the STS NominatingCommittee is composed of the five most recentSTS Past Presidents and the current STSPresident, who serves as an ex-officio, nonvoting member. Through its six members’ diverseexperiences and broad knowledge accumulatedover many years of STS service and leadership,the Committee is tasked with nominations to theSTS Board, as well as the yearly nomination ofthe STS Treasurer, Secretary, Second VicePresident, First Vice President (President-Elect),and President. All Committee members areinvested fully in nominating an effective,representative STS leadership team best able torepresent our cardiothoracic surgeon communityand our patients.With this as a foundational goal, the Committeetakes into consideration many criteria whenmaking nominations for Board and Officerpositions such as the relevant leadershipexperience of nominees within and outsideSTS in areas such as education, advocacy andgovernmental affairs, quality, database/registryexpertise, and global outreach. In addition,broad expertise in clinical areas relevant toSTS such as structural heart, transplant,esophageal and mediastinal surgery, robotics,aortic disease, and thoracic oncology, as wellas experience in novel surgical techniques, areconsidered in the selection process.While the slate of candidates is prepared bythe Nominating Committee based on criteriapreviously outlined, the nominees also arevetted through the lens of diversity, whichincludes but is not limited to gender, ethnicity,practice type (private practice vs. academicsetting), discipline (cardiac, general thoracic,and congenital), and geography.Workforce and Committee MembersThe selection of individuals for STS leadershiproles, including Standing Committee andWorkforce members/Chairs and Council Chairs,is voted on each December by the ExecutiveCommittee based on a slate developed by theSTS First Vice President, with significant inputfrom the STS President, Secretary, and seniorSTS Staff. Per STS Bylaws, Workforce membersare appointed to an initial 3-year term and areeligible for a 3-year renewal. To maintainefficient functionality, most workforces have 1020 members and typically 1-3 vacant positionsare open for appointment each year.To appoint new Standing Committee orWorkforce members, input is sought from theresponsible Standing Committee, Workforce,and/or Council Chair(s). Nominations also maybe received from STS members at large, aswell as through the STS Self-NominationProcess. On average, a total of 25 nominationsfor consideration are received for each openStanding Committee or Workforce position.Improve the Appointment ProcessesSignificant efforts are under way to revisit ourinternal selection processes to help ensurethat we are identifying and utilizing the fullarray of expertise and experience to provideeffective leadership today and in the future.Presidential Task Force Appointed – APresidential Task Force led by Drs. DougMathisen and Richard Prager and made up of adiverse group of leaders has been created toreview the current nomination processes andpolicies. As well, this group is reviewing thecurrent STS governance structure, includingWorkforce and Council composition, to ensureappropriate alignment of their respectiveactivities to streamline efficiency, minimizeoverlap of responsibilities, and improvereporting. Recommendations from thisPresidential Task Force are due to bepresented to the STS Board in November.Expanding the candidate pool ofcardiothoracic surgeon leaders – STS isreviewing existing resources and developingnew STS tools to help identify individualswith specific interests or skills to fill specificleadership roles. For example, creating a listof physicians who self-nominated in the pastbut were not appointed to a Workforce couldpotentially serve as a valuable resource forWorkforce Chairs in selecting members topopulate their respective task forces in thefuture. Also, the Women in Thoracic Surgery(WTS) “Find an Expert” resource designed toenhance the process of identifying qualifiedwomen for STS leadership positions hasbeen proposed and is being reviewed bySTS leadership.Reviewing individual STS surgeon leaderinvolvement and limiting participation whereappropriate are very practical ways to enhancethe breadth of member participation andexpand leadership opportunities. A detailedreview of Standing Committee, Workforce, andTask Force membership is under way.Ensuring the diversity of STS leaders – STSleadership is committed to all forms of diversityas a means of enhancing the organization’sability to represent the profession more fully.As such, efforts are under way to obtainadditional STS membership data on diversity inareas related to underrepresented minoritiesand gender diversity as part of a process toestablish “where we are now” and “where andhow we can improve.” Enhancing engagementwith stakeholder organizations such as WTSand the Association of Black Cardiovascularand Thoracic Surgeons, as well as seekingongoing assistance from the STS Workforce onDiversity and Inclusion to help guide decisionson relevant issues also is being prioritized tohelp ensure that a variety of viewpoints andexperiences are represented.Through these initiatives, our objective is toevaluate these procedures in a transparentmanner with a goal towards improving ourlongstanding approach of selecting STSleaders. We recognize that organizationsshould reflect not only the current membershipbut also the future membership, and thatproportional representation of groups does notautomatically infer equitable representation.STS is very thankful for the members who haveserved and are currently dedicating theirvaluable time and expertise as volunteerleaders to support our activities.Being an active member and volunteer leaderof STS has been among the most rewardingaspects of my professional life. I wouldstrongly encourage anyone interested inexploring STS leadership opportunities to usethe self-nomination process or seekmentorship from an STS leader in your area ofinterest or expertise. STS.ORG 5

ANNUAL MEETINGSTS 2022 Program Makes It Worththe Wait to Be ‘Together Again’ CONTINUED FROM COVERDeserving of attention is a presentationaddressing why cardiac surgeons should beinvolved with acute pulmonary emboli, as wellas an aortic session that focuses on both theascending and descending aorta. “This one willbe accompanied by a talk called ‘A Brief Walk inTime: A History of Aortic Surgery,’” he added.Cancer Breakthroughs, Quality,Robots Shine in General ThoracicSurgery“Our abstract session on novel technology innon-small cell lung cancer looks at newtechniques that aren’t part of current care,” saidJessica S. Donington, MD, MSCR, a member ofthe Program Task Force. These applicationsinclude artificial intelligence applications forpredicting malignancy and nodal metastasisduring resection, virtual reality planning ofsegmentectomy, transbronchial microwaveablation of lung nodules in a hybrid operatingroom, and CT radiomics and serumhistoplasmosis testing for improving diagnosis.In the arena of bronchoscopy, the “EM, Robots,Ablation” session will explore robotic andelectromagnetic navigation, ablation, and otheradvances in therapy.“We also have a very good group ofesophageal cancer papers, looking ateverything from new neoadjuvant therapies torobotic esophagectomy,” Dr. Donington said.Additional lung cancer sessions will addressclinical care, quality issues, and access to careand disparities within the health system—aprevailing theme in this year’s abstracts, saidDr. Donington. The J. Maxwell ChamberlainMemorial Paper in the general thoraciccategory will use a statewide collaborative toidentify racial differences in lung cancersurgery. “The authors found pretty significantdifferences in terms of staging and workup andthe care delivered,” she said.A joint session, “Regional Quality Collaboratives,”will explore metrics and perspectives from facultyat the University of Michigan in Ann Arbor, as wellas from the Northern New EnglandCardiovascular Disease Study Group and theCanadian Association of Thoracic Surgeons.6 STS NEWS · FALL 2021Congenital Sessions Employ HardData, Expert DemonstrationsTransplantation, MCS ShareSpotlight with Critical CareAbstract sessions in the congenital realm willdelve into an abundance of neonatal topics,from tackling surgical challenges to exploringthe pathway to surgical innovation, said S. AdilHusain, MD, Vice Chair of the Program TaskForce. The “It’s Not in the Books So How DoThey Do It?” session will demonstrate an arrayof techniques, including cone repair for Ebsteinanomaly and prophylactic commissuralresuspension during unroofing procedures foranomalous coronary arteries.To help ensure that attendees have a richexperience with the latest devices—and thatthey can attend high-priority concurrentsessions without missing others of interest—STS 2022 will include cardiothoracictransplantation assist devices within the “criticalcare” category. Ahmet Kilic, MD, from theProgram Task Force, oversaw programming forthe mechanical circulatory support (MCS),critical care, and transplant arenas.“We also have really nice basic science abstracts,and we’re sprinkling them in with two invitedtalks—one that looks at stem cell use within thesingle-ventricle population and one thatdemonstrates how to establish a basic sciencelab and use it as a transition into creating noveltechniques within the OR,” Dr. Husain said. “Asession on the aortic valve and the leftventricular outflow tract covers anatomicregions of congenital heart surgery thatcontinue to have quite a bit of controversy.”Another session will examine advancements inpediatric heart failure and transplantation,addressing issues such as the impact ofpersistent renal dysfunction and high-panelreactive antibody, transplantation in pediatricpatients with heterotaxy syndrome, andre-intervention for superior vena cavaobstruction, culminating in an invited talk onimplantation and outcomes for systemicventricular assist devices.“There's been a lot of push within thecongenital population to look at the concept ofprogram regionalization and how data andoutcomes may be employed as tools to definemetrics and approaches,” said Dr. Husain.Accordingly, a data-centric session—featuringthe congenital Clark paper—includespresentations that explore risk stratification foradults and mortality predictive models utilizingthe STS National Database.“Two sessions are dedicated to critical caredevices, including for MCS, lung transplant,and heart transplant,” Dr. Kilic explained. “Onefocuses on identifying issues while you’re oncircuit. We’re going to talk about topics like leftventricular dilatation pulmonary edema, theuse of veno-arterial ECMO for pulmonaryembolism, recalcitrant hypoxia, and harlequinsyndrome. We expect a lively discussion on thekey problems surgeons are having.”The next session will be “Same Toys, NewIndications,” and it explores novel applicationssuch as axillary access with a balloon pump andflow pumps to get patients safely totransplantation. “In addition, we’ll be talkingabout a total artificial heart, as well as the unmetneeds with current left ventricular assist devicesthat are already out there,” said Dr. Kilic.“Our abstract session on noveltechnology in non-small cell lungcancer looks at a lot of new techniquesthat aren’t part of current care.”Jessica S. Donington, MD, MSCRFor lung transplantation, experts will examinethe euthermia approach with ex vivo donors.Still more must-attend sessions will addressthe impact of COVID positivity in recipients anddonors, a data-driven analysis on howweekends, holidays, and thoracic conferencesimpact the acceptance of heart transplantoffers, as well as transplant controversies inthe ICU and extended-criteria donors for heart/lung transplantation in the modern era.

ANNUAL MEETINGQuality, Wellness Sessions HelpSurgeons Be Their Best SelvesElizabeth A. David, MD, MAS, a member of theProgram Task Force, identified a great varietyof topics in the areas of education, wellness,and quality. During a wellness session, anexpert in physician resilience will addressissues that surgeons may bring home to theirfamilies. “Then we have invited panelists whorepresent a diverse array of surgical families,such as dual-physician and dual-surgeonfamilies, single parents, those who hadchildren at different phases of their careers,and those with children who neededcongenital cardiac surgery,” Dr. David said.A session on global health and cardiothoracicsurgery will feature a diverse internationalpanel, Dr. David continued, and it will addresstopics such as how to craft a career in globalcardiothoracic surgery, how genderdisparities limit capacity building, differentmodels of providing care, complementing acareer using databases, and the status ofglobal health disparities.For surgeons looking to enhance their publishingprowess, a panel of statisticians and editorialboard members will lead an “Annals Academy”session aiming to demystify artificial intelligenceand machine learning. “They’ll explain how touse these methodologies—and appropriatelywrite them up,” said Dr. David. “There are fewerissues with manuscripts submitted using thesemethods, so this should be a very helpful session.”A session on cultural competence in surgicalleadership will explore strategies to buildleadership and inclusive cultures in health caresystems. Another will be geared toward theconcept of “psychological safety”—a person’slevel of willingness to speak up in a group setting.Abstracts in quality initiatives are a highscoring mix of adult cardiac and thoracic topics,with several related to emergencydepartments, Dr. David said. “And there’s asession on the Negotiation Toolkit, with topicssuch as rules of engagement, understandingthe landscape in which you are negotiating,showing your value and what you need tobring to the table, and the nuts and bolts ofnegotiation lessons from the business world.” The STS 58th Annual Meeting will bring the cardiothoracic surgery specialty together again in Miami Beach, Florida.In a moderated expert discussion, attendees willbe presented with sample scenarios ofburnout-inducing issues in surgeons, saidDr. David. “I’ll give you an example: ‘I’m feelinggrowing resentment toward patients who choosenot to get vaccinated. I feel they imperil the livesof other patients, health care workers, and theirfamilies. I fear that my compassion is beginningto wane, and I weigh the sheer magnitude ofresources that have been consumed.’”360 and Deep Dive Sessions Returnfor More Unforgettable ExperiencesTwo popular programs launched at the STS 2021Annual Meeting again will be available in MiamiBeach. “In the OR with ” sessions will feature360 videos, offering attendees panoramic andup-close views of challenging cardiothoracicprocedures from beginning to end. Highlyacclaimed surgeons will walk participantsthrough each case and provide live feedbackthat’s nearly like standing beside the team in theoperating room. The four operations on theagenda this year are uniport lobectomy, complexaortic arch reconstruction, Ross procedure, andminimally invasive complex mitral valve repair.In addition, during eight “Deep Dive” courses,experts will walk attendees through theconsiderations, challenges, and real-timedecision making involved in an interdisciplinaryvariety of procedures and scenarios.Hands-On Courses Provide Accessto World-Class FacultyTrainees and veteran surgeons alike willbenefit from real-world wet lab sessions onvalve sparing root replacement, mitral valverepair, laryngeal tracheal resection, andcreation of both a bi-leaflet and a tri-leafletpolytetrafluoroethylene valved conduit.Exhibits, Learning Labs GetHands-On with New TechnologyThroughout the meeting, attendees will havededicated time to meet with industryrepresentatives. The Exhibit Hall will be openSunday and Monday, and newly reimaginedLearning Labs will allow participants to receivemore in-depth hands-on demonstrations of thelatest products and technologies in adedicated space in the hall.And as always, STS will offer a host of socialevents, wellness activities, and networkingopportunities for attendees to unwind andsocialize with colleagues.Registration Is Now OpenAttendees may choose to register for either anin-person or virtual event. Registration is opennow at sts.org/annualmeeting. Extra fees arerequired for some Saturday morning sessionsand the President’s Reception.COVID vaccination will be required foranyone attending the in-person meeting.STS 2022 COVID protocols are availableat sts.org/AMcovid. Scan to view theSTS Annual Meeting program.STS 2022 provides the unique opportunity tolearn from and practice with some of the mostcelebrated minds in cardiothoracic surgery.SCAN MESTS.ORG 7

TECH NEWSInnovations in 3DPrinting for ThoracicSurgeryBy Catherine T. Byrd, MD, H. Henry Guo, MD, PhD,and Natalie S. Lui, MD, MAS, from the StanfordUniversity School of Medicine, Californiabe implanted, or if the material needs similarmechanical properties as the native anatomy sothat it can be used for education or simulation.Models are then printed and undergopostprocessing, which involves removing anysupport structures requisite to the printingprocess, polishing, and additional steps suchas dimensional verification and sterilization.Operative GuidanceThe use of three-dimensional (3D) printing isexpanding in cardiothoracic surgery. It canfacilitate surgical planning and intraoperativeguidance, be used to develop customized,implantable prostheses, and aid in patient andtrainee education.Although 3D printing for medical purposesis a fairly recent phenomenon, the process—additive manufacturing—has been in existencesince the 1980s.Additive ManufacturingIn additive manufacturing, very thin layersof material are deposited to form a 3Dreconstruction of preoperative imaging. Thinslices (0.5 mm–1 mm) of a patient’s computedtomography or magnetic resonance imagingare optimal to gather details for the structureof interest.At our institution, cardiothoracicsurgery residents use a 3D printedmediastinum model to learnmediastinoscopy.The resulting images then undergo contouringand segmentation by a radiologist ortechnologist, who delineates structuresof interest either manually or by usingautomated software. The data are then savedas a standard tessellation language (STL) file,essentially a series of triangles that conveythe 3D nature of the anatomy. A surgeon maybe involved to guide processing and highlightappropriate anatomy.Next, the appropriate technique and materialsare selected to print the model. Considerationsinclude whether the material needs to bebiocompatible and sterilizable because it will8 STS NEWS · FALL 20213D models can serve as beneficial tools forpreoperative planning.In 2019, a multidisciplinary team ofcardiothoracic surgeons, radiologists, andengineers in Spain described its experiencewith 3D printing. Over the course of a year, theteam printed 26 models of general thoracicpathology, including tracheal stenosis, chestwall tumors, carcinoid tumors, mediastinaltumors, and a Pancoast tumor. A majority ofthe surgeons surveyed (78%) stated that 3Dmodels helped with preoperative planning,and 77% said that the models accuratelyrepresented the intraoperative experience.Specifically, during Pancoast tumor resections,3D models may be used for preoperativeplanning and intraoperative reference,allowing surgeons to carefully select theoperative approach and surgical instruments.Other surgeons have reported that 3D modelsare an improvement over conventionalradiographic imaging and may decreaseoperative times.Customizable ProsthesesCustomizable 3D printed prostheses alsooffer promise.One example is using a customized carbonfiber prosthesis to shift mediastinal conten

Natalie Boden, MBA Grahame Rush, PhD William Seward, MA Elaine Weiss, JD STS News 633 N. Saint Clair St. Suite 2100 Chicago, IL 60611 312-202-5800 stsnews@sts.org IN THIS ISSUE . William A. Killinger, MD, now serves as the chief medical officer for HCA Houston Healthcare Clear Lake and HCA Houston Healthcare Mainland in Texas. Most