Impressions from San Diego

There are definitely worse places to spend a couple of January days in than San Diego, California – or any other days in the year, actually. The Society of Thoracic Surgeons (STS) held its first in-person annual meeting after the Covid-break there between January 21st and 23rd. Here are some impressions.

It was said that ∼2.500 people attended the meeting, which again leaves the event held by the European Association for Cardio-Thoracic Surgery still the largest one for this community. Apart from that, everybody seems to feel the same strain. The duration was shortened to two and a half days with (very) full days Saturday and Sunday, followed by half a Monday, thus cutting “lost” working days to a minimum. To accomplish this, numerous sessions were held in parallel, sometimes making the choice difficult. The industry exhibition was concentrated in the middle area of one of these typically oversized convention center halls. While still featuring impressive stands by the usual suspects, the overall impression was that money has become scarce – or is at least not spent at this congress anymore.

Regarding scientific content, a major feature was the rebuttal to the huge disappointment following the downgrading of the recommendation for CABG by the cardiological societies AHA and ACC, based on data from the ISCHEMIA trial. Joe Sabik, Cleveland, the freshly elected second vice president of the STS, summed up the differences brilliantly in his keynote lecture “The ISCHEMIA study does not reflect patients undergoing coronary surgery: an STS Adult Cardiac Database Analysis”, proving that “the randomized interventions in ISCHEMIA had NOTHING TO DO with CABG”. Quite sobering was the information that talks to the cardiological societies regarding an amendment based on these more in-depth data analyses had apparently “been difficult, to say the least”. Apart from this opinionated and very important paper, several presentations had already highlighted the benefits of coronary surgery if appropriately applied, including an impressive database analysis of more than 100.000 Medicare/Medicaid patients by J.H. Mehaffey from West Virginia University – aptly awarded the J. Maxwell Chamberlain Memorial Paper in Adult Cardiac Surgery.

The comprehensive STS database, which accumulates the largest amount of data in cardiac surgery worldwide, has become a valuable asset of the society over the years. Several presentations of various analyses showed the power of these data for drawing the right conclusions from experience, but also for the development of new strategies, for instance the “Creation of a Novel STS Adult Congenital Heart Surgery Mortality Risk Model” by Jennifer Nelson and coworkers from Nemours Children's Health in Florida, which was the James S. Tweddell Memorial Paper, honoring this popular congenital heart surgeon who had succumbed to brain cancer in 2022.

Unanimously supported was the feeling that aortic surgery will remain one of the foundations of cardiovascular surgery despite numerous advances in endovascular techniques. Several presenters showed that, although seemingly less-invasive and catheter-based, these interventions do still require a surgeon's expertise and handling. This was exemplified by reports of necessary reoperations following a stent device placed in the ascending aorta in aortic dissection. Confirmatory studies supplemented the notion that in type A aortic dissection the early outcome is determined by malperfusion and the late one by growth of the aortic arch.

In valve surgery the growing potential of TAVI (or TAVR as it is known in the USA) has been acknowledged but it seems that cardiac surgeons do play a more active role in this treatment modality in the US than they are (allowed to) in Germany. Mitral valve surgery of the future will be minimally invasive with a small right submammarian incision and 3D visualization or completely robotic. It was felt that the continued success of these approaches would limit transcatheter implantations to very high-risk patients in the future, the same being true for tricuspid valve reconstruction. A warning was given, however, that catheter interventions were heavily patient driven, and that there is an ongoing investment of 4 billion dollars in mitral devices where a remuneration is certainly expected.

The Annals Academy, organized by the new Editor-in-Chief of The Annals of Thoracic Surgery, Jo Chikwe, gave an excellent overview over the recent developments of this seminal journal, followed by insights what about and how to write a paper, and also how to review one. These expert keynote lectures gave a wealth of important information - so overwhelming, in fact, that at the end there was no time left for the intendend plenary discussion.

Numerous other sessions dealt with the surgical treatment of congenital heart disease, perioperative care, transplantation and assist devices, but, as stated above, a lot ran in parallel. Fortunately, the substantial congress fee includes access to a lot of video-taped presentations to look at during the long and cold winter nights back home.

Speaking of which, the weather in San Diego presented itself in best Southern Californian fashion with blue skies and daytime temperatures around 20°C. A bit depressing was the number of homeless people wandering the streets of the otherwise touristy Gaslamp Quarter. A look at the prices in your average supermarket provides a quick explanation of why many cannot cope with the cost of living anymore. San Diego may be America's Fairest City, but, just as its country, it does have its problems as well.

To end this on a positive note, let us take a quick trip to beautiful La Jolla to enjoy the pleasures of beach walking on La Jolla Shores Beach. Should you ever go there, by all means drop by at the Cheese Shop on Avenida de la Playa and have a sandwich, preferably the Turkey, Jack Cheese and Avocado variety, but there are numerous tasty options including vegetarian ones. Whatever you choose: sandwiches don't come any better than that. Enjoy.

Publication History

Article published online:
09 March 2023