Thoracic Surgery Workforce: Report of STS/AATS Thoracic Surgery Practice and Access Task Force—Snapshot 2010

BackgroundThe Society of Thoracic Surgeons (STS) and the American Association for Thoracic Surgery (AATS) have intermittently surveyed their combined membership. These manpower surveys have provided snapshots of thoracic surgery, documenting practice changes over time. At this critical time in US health care reform the physician workforce is of critical importance. This survey updates the data obtained from the 2000 and 2005 surveys.MethodsThe survey instrument was updated from the 2005 survey. It was received by 5265 surgeon members of the STS/AATS during November and December 2009. There was a superb 50% return rate. The data were entered into a comprehensive database. Perception Solutions, Inc, independently performed the analysis.ResultsThe median age of the active US thoracic surgeons is 52.9 years. Women comprise 3.4% of adult cardiac, 5.2% of congenital heart, and 7.9% of general thoracic surgeons. The decision to pursue a career in thoracic surgery was made before or in medical school by 45.3% of surgeons. The majority of survey respondents had a mean of 8.7 years of residency training after medical school graduation. The cumulative average educational debt was $56,000. Overall career satisfaction was 46$55,947 to $59,673. The number of additional years the currently active US cardiothoracic surgeon plans to practice is 12.6 years. Therefore, the projected retirement age of the thoracic surgery workforce will be 65. This is consistent among all surgeons: adult cardiac, 66 years; congenital heart, 65 years; and general thoracic, 67 years.ConclusionsThese data give a clear profile of the specialty at this time. The major challenges remain length of training and educational debt of the thoracic surgeon. Case volume, scope of practice, malpractice costs, and career satisfaction remain major elements to provide a positive environment to recruit new surgeons in to the specialty. The resident pool has contracted while the workforce ages and retirement looms. Significant shortages may develop as the US population ages in the environment of health care reform

Comparison of David V valve-sparing root replacement and bioprosthetic valve conduit for aortic root aneurysm

ObjectiveValve sparing root replacement (VSRR) is an attractive option for the management of aortic root aneurysms with a normal native aortic valve. Therefore, we reviewed our experience with a modification of the David V VSRR and compared it with stented pericardial bioprosthetic valve conduit (BVC) root replacement in an age-matched cohort of older patients.MethodsA total of 48 VSRRs were performed at our institution, excluding those on bicuspid aortic valves. We compared these cases with 15 aortic root replacements performed using a BVC during the same period. Subgroup analysis was performed comparing 16 VSRR cases and 15 age-matched BVC cases.ResultsThe greatest disparity between the VSRR and BVC groups was age (53 vs 69 years, respectively; P < .0005). The matched patients were similar in terms of baseline demographics and differed only in concomitant coronary artery bypass grafting (2 VSRR vs 7 BVC patients; P = .036). None of the VSRR and 3 of the BVC procedures were performed for associated dissection (P = .101). Postoperative aortic insufficiency grade was significantly different between the 2 groups (P = .004). The cardiopulmonary bypass, crossclamp, and circulatory arrest times were not different between the VSRR and BVC groups (174 vs 187 minutes, P = .205; 128 vs 133 minutes, P = .376; and 10 vs 13 minutes, respectively; P = .175). No differences were found between the 2 groups with respect to postoperative complications. One postoperative death occurred in the BVC group and none in the VSRR group. The postoperative length of stay and aortic valve gradients were less in the VSRR group (6 vs 8 days, P = .038; 6 vs 11.4 mm Hg, P = .001). The intensive care unit length of stay was significantly less in the VSRR group (54 vs 110 hours, P = .001).ConclusionsVSRR is an effective alternative to the BVC for aortic root aneurysm

New Directions in Diagnostics for Aortic Aneurysms: Biomarkers and Machine Learning

This review article presents an appraisal of pioneering technologies poised to revolutionize the diagnosis and management of aortic aneurysm disease, with a primary focus on the thoracic aorta while encompassing insights into abdominal manifestations. Our comprehensive analysis is rooted in an exhaustive survey of contemporary and historical research, delving into the realms of machine learning (ML) and computer-assisted diagnostics. This overview draws heavily upon relevant studies, including Siemens’ published field report and many peer-reviewed publications. At the core of our survey lies an in-depth examination of ML-driven diagnostic advancements, dissecting an array of algorithmic suites to unveil the foundational concepts anchoring computer-assisted diagnostics and medical image processing. Our review extends to a discussion of circulating biomarkers, synthesizing insights gleaned from our prior research endeavors alongside contemporary studies gathered from the PubMed Central database. We elucidate the prevalent challenges and envisage the potential fusion of AI-guided aortic measurements and sophisticated ML frameworks with the computational analyses of pertinent biomarkers. By framing current scientific insights, we contemplate the transformative prospect of translating fundamental research into practical diagnostic tools. This narrative not only illuminates present strides, but also forecasts promising trajectories in the clinical evaluation and therapeutic management of aortic aneurysm disease

Interrelated modulation of endothelial function in Behcet's disease by clinical activity and corticosteroid treatment

Corticosteroids are commonly used in empirical treatment of Behçet's disease (BD), a systemic inflammatory condition associated with reversible endothelial dysfunction. In the present study we aimed to dissect the effects of clinical disease activity and chronic or short-term corticosteroid treatment on endothelial function in patients with BD. In a case-control, cross-sectional study, we assessed endothelial function by endothelium dependent flow mediated dilatation (FMD) at the brachial artery of 87 patients, who either were or were not receiving chronic corticosteroid treatment, and exhibiting variable clinical disease activity. Healthy individuals matched for age and sex served as controls. Endothelial function was also assessed in a prospective study of 11 patients before and after 7 days of treatment with prednisolone given at disease relapse (20 mg/day). In the cross-sectional component of the study, FMD was lower in patients than in control individuals (mean ± standard error: 4.1 ± 0.4% versus 5.7 ± 0.2%, P = 0.003), whereas there was a significant interaction between the effects of corticosteroids and disease activity on endothelial function (P = 0.014, two-factor analysis of variance). Among patients with inactive BD, those who were not treated with corticosteroids (n = 33) had FMD comparable to that in healthy control individuals, whereas those treated with corticosteroids (n = 15) had impaired endothelial function (P = 0.023 versus the respective control subgroup). In contrast, among patients with active BD, those who were not treated with corticosteroids (n = 20) had lower FMD than control individuals (P = 0.007), but in those who were receiving corticosteroids (n = 19) the FMD values were comparable to those in control individuals. Moreover, FMD was significantly improved after 7 days of prednisolone administration (3.7 ± 0.9% versus 7.6 ± 1.4%, P = 0.027). Taken together, these results imply that although corticosteroid treatment may impair endothelial function per se during the remission phase of the inflammatory process, it restores endothelial dysfunction during active BD by counteracting the harmful effects of relapsing inflammation

STS 2019 Workforce Report: Ad Hoc Analysis of Women in Cardiothoracic Surgery

The Society of Thoracic Surgeons (STS) is the world’s largest cardiothoracic surgical organization, representing more than 7500 surgeons, researchers, and allied health care professionals worldwide. In response to the ever-changing working environment of cardiothoracic surgery, STS conducts a workforce survey approximately every 5 years. The 2019 Practice Survey was performed in the fall of 2019, the results of which were discussed at the STS 2020 annual meeting and were published by Ikonomidis and associates. 1 Because women remain an extremely small subset of the cardiothoracic workforce, Women in Thoracic Surgery, in conjunction with STS, reviewed the 2019 workforce survey results with a focus on female respondents

Progressive induction of left ventricular pressure overload in a large animal model elicits myocardial remodeling and a unique matrix signature

ObjectivePatients with severe left ventricular pressure overload secondary to aortic stenosis can present with signs and symptoms of heart failure despite normal left ventricular ejection fraction. This process occurs, at least in part, as a result of left ventricular pressure overload–induced extracellular matrix remodeling that promulgates increased left ventricular stiffness and impaired diastolic function. However, the determinants that drive extracellular matrix remodeling in this form of left ventricular pressure overload remain to be fully defined.MethodsLeft ventricular pressure overload was induced in mature pigs (n = 15) by progressive ascending aortic cuff inflation (once per week for 4 weeks), whereby left ventricular mass, left ventricular ejection fraction, and regional myocardial stiffness (rKm) were compared with referent controls (n = 12). Determinants of extracellular matrix remodeling were assessed by measuring levels of mRNA expression for fibrillar collagens, matrix metalloproteinases, and tissue inhibitors of matrix metalloproteinase 1 and 4.ResultsWith left ventricular pressure overload, left ventricular mass and rKm increased by 2- and 3-fold, respectively, compared with control, with no change in left ventricular ejection fraction. Left ventricular myocardial collagen increased approximately 2-fold, which was accompanied by reduced solubility (ie, increased cross-linking) with left ventricular pressure overload, but mRNA expression for fibrillar collagen and matrix metalloproteinases remained relatively unchanged. In contrast, a robust increase in mRNA expression for tissue inhibitors of matrix metalloproteinase-1 and 4 occurred with left ventricular pressure overload.ConclusionsIn a progressive model of left ventricular pressure overload, which recapitulates the phenotype of aortic stenosis, increased extracellular matrix accumulation and subsequently increased myocardial stiffness were not due to increased fibrillar collagen expression but rather to determinants of post-translational control that included increased collagen stability (thereby resistant to matrix metalloproteinase degradation) and increased endogenous matrix metalloproteinase inhibition. Targeting these extracellular matrix post-translational events with left ventricular pressure overload may hold both diagnostic and therapeutic relevance

Telemedicine in Congenital Heart Disease

BACKGROUND: The primary rationale for the development of telemedicine has been to serve populations that have limited access to traditional, high quality medical services. These include those living in rural areas or other underserved areas, like islands, or even urban areas when a rare medical subspecialty, such as pediatric cardiology is not available. OBJECTIVE: The aim of the present study was to present our results with use of telemedicine during the European project TELEREMEDY over a period of 26 months when adult cardiologists and pediatricians of our hospital communicated with pediatric cardiologists at the tertiary Children&rsquo;s Hospital &ldquo;Agia Sofia&rdquo; in Athens and at the Royal Brompton Hospital in London, as well as with physicians at the &ldquo;Venizelio&rdquo; Hospital in Crete. METHODS AND RESULTS: Over 26 months, 31 teleconference sessions were organized. During this period, 155 children with suspected congenital heart disease (CHD) underwent echocardiographic examination, which confirmed CHD in 83 (54%), acquired heart disease in 13 (8%) and normal anatomy in 59 (38%). Ventricular septal defect was diagnosed in 26/83 (31%), complex CHD in 20 (24%), atrial septal defect in 12 (14%) and patent ductus arteriosus in 8 (10%) children. Our hospital with the adult electrophysiology team was the expertise center for diagnosis and treatment of 30 children with arrhythmia. During 23 sessions with the tertiary Children&rsquo;s Hospital &ldquo;Agia Sofia&rdquo; in Athens, an immediate transfer to the pediatric intensive care unit of the tertiary center was decided for 27 cases (17%). During 3 sessions with one participating hospital we provided consultation for 10 cases with arrhythmias. During 6 sessions with the Royal Brompton Hospital in London, rare cases of CHD, both adult and pediatric, were discussed. Two multilane conferences were organized among all participants and the systems capabilities in each hospital were discussed. CONCLUSION: Telemedicine systems, like the one used herein in the context of the TELEREMEDY program, facilitate a timely diagnosis and management of children with CHD in hospitals lacking pediatric cardiology service. In the present series, use of this program obviated unnecessary and costly transfers in 83% of cases. Thus, immediate access to specialists can guide patient management and may potentially alter the morbidity and mortality in this patient population