The Beat With Joel Dunning Ep. 142: CKD and CSA-AKI–Addressing the Unmet Need in Cardiac Surgery

This week on The Beat, CTSNet Editor-in-Chief Joel Dunning spoke with Drs. Daniel Engelman, Medical Director of the Cardiac Surgical Critical Care & Inpatient Services at Baystate Health, Professor of Surgery at the University of Massachusetts Chan Medical School—Baystate, and President of the ERAS Cardiac Society, and Marlies Ostermann, consultant in critical care and nephrology at Guy's and St. Thomas Foundation Trust and a Director of Research for the Intensive Care Society, about chronic kidney disease (CKD) and cardiac surgery-associated acute kidney injury (CSA-AKI). Chapters 00:00 Intro 02:11 Definition & Background 10:55 Burden of CSA-AKI 12:58 Unmet Medical Need 19:47 Identification & Collaboration 26:07 KDIGO, O2 Delivery 32:15 CKD CSA-AKI Final Remarks 35:10 JANS, Success in African CT Surgery 38:49 Video, Modified Root Inclusion Technique 40:53 Closing They delve into the complexities of CSA-AKI, exploring the percentage of patients affected, defining the condition, and highlighting the overall significance of this issue. They also address creatinine as a late marker for AKI, the long-term scarring that can occur from AKI, and the critical need for thorough preoperative assessments to identify high-risk patients. Additionally, they emphasize the importance of a complete health assessment before surgery. Furthermore, they discuss the dangers of reaching stage 3 AKI, the increased costs of care once that point is reached, and what actions to take if a patient has a positive marker but appears stable. They also highlight the premature use of diuretics contributing to AKI and hyperbilirubinemia. Moreover, they consider how CKD along elevates mortality risk and the importance of developing targeted therapies in the future. Finally, they discuss approaches to reduce ischemia-reperfusion (IR) AKI and the optimization of hemodynamics, as well as potential drugs for treating AKI effectively.   Joel also highlights a recent JANS article on aligning training, patient profiles, and outcomes to redefine success in cardiac surgery in Africa. In addition, he explores the modified root inclusion technique for a fourth sternotomy with Ross/Konno after previous mechanical aortic valve replacement.   Before closing, Joel highlights upcoming events in CT surgery.    JANS Items Mentioned  1.) Redefining Success in Cardiac Surgery in Africa: Aligning Training, Patient Profiles, and Outcomes  CTSNet Content Mentioned  1.) Fourth Sternotomy With Ross/Konno After Previous Mechanical Aortic Valve Replacement: The Modified Root Inclusion Technique  Other Items Mentioned  1.) Career Center   2.) CTSNet Events Calendar  3.) Instructional Video Competition   Disclaimer The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.

In this episode of The Atrium, host Dr. Alice Copperwheat speaks with Dr. Randolph Chitwood, retired cardiac surgeon and Founding Director of the East Carolina Heart Institute at East Carolina University, about the future of minimally invasive cardiac surgery (MICS). Chapters 00:00 Intro 00:58 Dr. Chitwood Background 04:20 Inspiration for MI 07:12 Reason for Mitral Valve Robotics 07:38 Strong Resistance from Specialty 08:35 Beginning Training 10:24 Origins of MI 13:37 Developmental Research 16:19 Steps in MI Mitral Valve Surgery 17:00 Bypass 17:57 Aortic Valve Surgery 19:10 Root Replacement & Dissection 19:27 Extracurricular Hobbies 20:23 Surgery Training Advice They delve into Dr. Chitwood’s professional background and why he chose to study cardiothoracic surgery. They also discuss the evolution of minimally invasive surgery, including incisions and instruments. Additionally, they highlight robotics, minimally invasive techniques for the mitral valve, and coronary artery bypass grafting (CABG). They also cover aortic valve replacement (AVR) and minimally invasive techniques for the aortic valve. Furthermore, Dr. Chitwood provides advice for trainees, including how they can get involved in using minimally invasive techniques.   The Atrium is a monthly podcast presenting clinical and career-focused topics for residents and early career professionals across all cardiothoracic surgery subspecialties. Watch for next month’s episode on extended resection with Dr. Maninder Kalkat.     Disclaimer The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.

This week on The Beat, CTSNet Editor-in-Chief Joel Dunning spoke with Drs. Jan Vojacek, a cardiac surgeon in the department of cardiac surgery at University Hospital Hradec Kralove, Czech Republic, and president of the Czech Society for Cardiovascular Surgery, and Maral Ouzounian, cardiac surgeon and head of the division of cardiac surgery at the Peter Munk Cardiac Center, Toronto, Canada, and president of the Canadian Society of Cardiac Surgeons, about the EACTS expert consensus statement on the Ross procedure in adult patients. Chapters 00:00 Intro 02:21 JANS 1, ARISE III Stent Graft Enrollment 04:25 JANS 2, Mech vs Biopros Valves in Hemodialysis 07:37 JANS 3, Surgical Sealants After Pulm Resection 09:54 JANS 4, Constrictive Pericarditis Procedures 12:45 Video 1, VATS CO2 Insufflation Technique 14:03 Third Place, Ascending Aortic Stenting Repair-Bridge 15:05 Second Place, Mustard & En Bloc Rotation of Tracts 16:49 First Place, Supracardiac Anomalous Pulm Ven Return 19:43 Drs. Vojacek & Ouzounian, Ross Procedure 42:02 Upcoming Events 42:21 Instructional Video Competition 42:49 Career Center They discussed the task force and process of getting this statement published, as well as important elements of the guidelines. Additionally, they addressed the significance of shared decision-making with patients, survival rates following the Ross procedure, and overall quality of life. They also compared the Ross procedure to mechanical and biological aortic valve replacements. They explored various surgical techniques related to the Ross procedure, including the native inclusion technique and the prosthetic inclusion technique, emphasizing the importance of technical details, patient selection, and intraoperative management. Furthermore, they discussed the Ross centers of excellence and how to start them.   Joel also highlights recent JANS articles on the ARISE III trial of gore ascending stent graft begins enrollment, mechanical vs bioprosthetic heart valves in hemodialysis patients, an individual patient data meta-analysis of randomized controlled trials on the clinical efficacy of surgical sealants after pulmonary resection, and radical pericardiectomy and use of cardiopulmonary bypass for constrictive pericarditis.  In addition, Joel explores a new approach for thymic pathologies, robotic-assisted repair of supracardiac total anomalous pulmonary venous return, and combined Mustard and en bloc rotation of the outflow tracts. Before closing, Joel highlights upcoming events in CT surgery.    JANS Items Mentioned  1.) ARISE III Trial of Gore Ascending Stent Graft Begins Enrollment  2.) Mechanical Versus Bioprosthetic Heart Valves in Hemodialysis Patients  3.) Clinical Efficacy of Surgical Sealants After Pulmonary Resection: An Individual Patient Data Meta-Analysis of Randomized Controlled Trials  4.) Radical Pericardiectomy and Use of Cardiopulmonary Bypass for Constrictive Pericarditis  CTSNet Content Mentioned  1.) A New Approach for Thymic Pathologies: VATS CO₂ Insufflation Technique  2.) Robotic-Assisted Repair of Supracardiac Total Anomalous Pulmonary Venous Return   3.) Combined Mustard and En Bloc Rotation of the Outflow Tracts   Other Items Mentioned  1.) EACTS Expert Consensus Statement on the Ross Procedure in Adult Patients   2.) Winners of the 2025 CTSNet Resident Video Competition  3.) Instructional Video Competition   4.) Career Center   5.) CTSNet Events Calendar  Disclaimer The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.

In this episode of The Cardiac Recovery Room, moderator Dr. Daniel Engelman, Medical Director of the Cardiac Surgical Critical Care & Inpatient Services at Baystate Health, Professor of Surgery at the University of Massachusetts Chan Medical School—Baystate, and President of the ERAS Cardiac Society, spoke with Drs. Kevin Lobdell, Professor and the Director of Regional Cardiovascular and Thoracic Quality, Education, and Research at Atrium Health; Rawn Salenger, Chief of Cardiac Surgery at the University of Maryland St. Joseph Medical Center; Marjan Jahangiri, Professor of Cardiac Surgery at St. George's Hospital, University of London; and Serdar Gunaydin, Head of Department at the University of Health Sciences in Turkey, about the attitudes toward and realities of ERAS across the globe.   Chapters 00:00 Intro  01:19 ICU & Early Extubation  05:07 Acceptance of ERAS Protocols  09:38 Lead Staff Advocate for ERAS  12:59 Sternotomy Perception  14:43 QoL Data Collection  17:09 Rehabilitation  19:04 Discharged Patients & Monitoring  They discussed the intensive care unit and early extubation, highlighting differences between countries. They also covered the acceptance of the ERAS protocol and the regions that are more hesitant to implement it, as well as its application in cardiac surgery specifically. Additionally, they explored who leads the charge within the team responsible for implementing ERAS and addressed perceptions regarding sternotomy. The conversation also included improving quality of life, reducing complications, and patient-reported outcomes measures, emphasizing the importance of shared decision-making. Furthermore, they discussed rehabilitation, discharging patients, and remote monitoring.   The Cardiac Recovery Room is the place to hear the conversations colleagues are having after the meetings. Each month, a new episode will be released featuring a leadership panel from the ERAS Cardiac Society.  Disclaimer The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.

This week on The Beat, CTSNet Editor-in-Chief Joel Dunning spoke with Dr. Michael Lanuti, Director of Thoracic Oncology in the Division of Thoracic Surgery at Massachusetts General Hospital and an Associate Professor at Harvard Medical School, and thoracic surgeon and CTSNet Senior Editor Leanne Ashrafian about Dr. Lanuti’s thoughts on the JCOG0802 trial and how he believes the wrong parameters were measured. Chapters 00:00 Intro 01:52 JANS 1, ESTS Guidelines 05:09 JANS 2, Resident-Led Operating 06:57 JANS 3, Fasting Impact on Pulm Aspiration 10:02 JANS 4, What Does a Dr Look Like 12:00 Video 1, Robotic Resection & Reconstruction 13:31 Video 2, Neonatal Off-Pump Shunt DORV 15:11 Video 3, Min Inv Bi-IMA OPCAB 16:12 Dr. Lanuti, JCOG0802 Results 44:58 Upcoming Events 45:38 Instructional Video Competition 45:49 Career Center They discussed local recurrence rates, pulmonary function, and the subtypes of adenocarcinoma. Additionally, they explored how to apply these results to future patients, central and peripheral lesions, and other randomized trials. They also covered the five-year results of the JCOG0802 trial and future studies and the implications for future studies, focusing on the parameters that should be considered. Furthermore, they addressed pulmonary function tests and wedge resection.   Joel also highlights recent JANS articles on European Respiratory Society and European Society of Thoracic Surgeons clinical practice guideline on fitness for curative intent treatment of lung cancer, a 10-year propensity-matched analysis on the impact of resident-led operating on outcomes in adult cardiac surgery, a systematic review and meta-analysis on no association between preprocedural fasting and witnessed pulmonary aspiration, and asking AI what a doctor looks like.  In addition, Joel explores robotic anterolateral approach for left secondary carinal tumor resection and reconstruction, neonatal Blalock-Taussig-Thomas shunt for double outlet right ventricle with RVOTO, and minimally invasive Bi-IMA OPCAB via left thoracotomy. Before closing, Joel highlights upcoming events in CT surgery.    JANS Items Mentioned  1.) European Respiratory Society and European Society of Thoracic Surgeons Clinical Practice Guideline on Fitness for Curative Intent Treatment of Lung Cancer  2.) Impact of Resident-Led Operating on Outcomes in Adult Cardiac Surgery: A 10-Year Propensity-Matched Analysis  3.) No Association Between Preprocedural Fasting and Witnessed Pulmonary Aspiration: A Systematic Review and Meta-Analysis  4.) What Does a Doctor Look Like? Asking AI  CTSNet Content Mentioned  1.) Robotic Anterolateral Approach for Left Secondary Carinal Tumor Resection and Reconstruction   2.) Neonatal Off-Pump Blalock-Taussig-Thomas Shunt for Double Outlet Right Ventricle With RVOTO   3.) Minimally Invasive Bi-IMA OPCAB Via Left Thoracotomy   Other Items Mentioned  1.) Instructional Video Competition   2.) Career Center   3.) CTSNet Events Calendar  Disclaimer The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.

This week on The Beat, CTSNet Editor-in-Chief Joel Dunning spoke with Dr. Gavin Wright, thoracic surgeon and Director of Surgical Oncology at St Vincent’s Hospital Melbourne, Australia, and thoracic surgeon and CTSNet Senior Editor Leanne Ashrafian about Dr. Wright’s thoughts on the JCOG0802 trial and why he prefers segmentectomy over lobectomy. Chapters 00:00 Intro 02:59 JANS 1, Chest Tube Removal Review 05:33 JANS 2, Tricuspid Ann Remodeling 07:53 JANS 3, The Cost of Gender in MV Surgery 09:42 JANS 4, Endo Balloon vs Clamping 11:53 AVR & LIMA to LAD via Bi Minithorac 13:13 Surgical Reimplant ARCAPA 14:14 Editors Picks 2025 20:41 Gavin Wright, Segmentectomy vs Lob 44:33 Upcoming Events 45:56 Instructional Video Competition 46:12 Career Center 46:35 Closing They discussed the findings of the JCOG0802 trial and compared it to the CALGB 140503 trial. They also covered the use of FEV1 as an assessment tool, the significance of p-values, local recurrence, and Type I errors. Additionally, they reviewed The Lancet paper addressing segmentectomy vs lobectomy. Furthermore, they explored potential future trials, including the debate over wedge resection vs segmentectomy.   Joel also highlights recent JANS articles on a systematic review and meta-analysis on chest tube removal after cardiac surgery in first vs. second postoperative day, tricuspid annular remodeling in tachycardia induced cardiomyopathy with functional tricuspid regurgitation, a propensity-score matched analysis on the silent cost of gender in mitral valve surgery, and endo-aortic balloon occlusion versus transthoracic clamping in minimally invasive mitral valve surgery.  In addition, Joel explores endoscopic AVR and LIMA to LAD via bilateral minithoracotomy, surgical reimplantation of the anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA), and the 2025 CTSNet Editors' Picks. Before closing, Joel highlights upcoming events in CT surgery.    JANS Items Mentioned  1.) Chest Tube Removal After Cardiac Surgery in First vs. Second Post-Operative Day: A Systematic Review and Meta-Analysis  2.) Tricuspid Annular Remodeling in Tachycardia Induced Cardiomyopathy With Functional Tricuspid Regurgitation  3.) The Silent Cost of Gender in Mitral Valve Surgery: A Propensity-Score Matched Analysis   4.) Endo-Aortic Balloon Occlusion Versus Transthoracic Clamping in Minimally Invasive Mitral Valve Surgery  CTSNet Content Mentioned  1.) Endoscopic AVR and LIMA to LAD Via Bilateral Minithoracotomy   2.) Surgical Reimplantation of the Anomalous Origin of the Right Coronary Artery From the Pulmonary Artery (ARCAPA)   3.) CTSNet Summarized—Editors’ Picks 2025  Other Items Mentioned  1.) Instructional Video Competition   2.) 2025 CTSNet Recruitment Guide    3.) Career Center   4.) CTSNet Events Calendar  Disclaimer The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.

This week on The Beat, CTSNet Editor-in-Chief Joel Dunning reflects on the most popular content of 2025 on CTSNet. Chapters 00:00 Intro 02:15 Top Interview 03:52 Top Webinar 05:23 Top Clinical Video 06:24 Top JANS Article 07:01 Top Video Series 08:02 Top Contributor 08:59 Top Cardiac Procedures 12:14 Top Podcasts 17:02 JANS 1, Doctor Story 21:28 JANS 2, Ex Vivo Heart Perfusion 22:41 JANS 3, PCI vs CABG 24:04 JANS 4, NEOpredict-Lung 25:29 2026 Plans He discusses the top interview, the most popular webinar, and reveals the leading CTSNet contributor of the year. He also highlights the most-read JANS article, the most viewed CTSNet series, the top clinical videos in cardiac surgery, and the leading podcast episodes of 2025 from both The Beat and The Atrium. Additionally, he shares key statistics about CTSNet, including website viewership, YouTube subscribers, and listener demographics.   Joel also highlights recent JANS articles on if ex vivo heart perfusion offsets ischemic penalties with six-hour or greater preservation in adult donation after brain death heart transplantation, an impactful article titled “This Man Saved My Life—I Live by His Example,” the long-term outcomes for women with chronic coronary artery disease after percutaneous coronary intervention vs coronary artery bypass grafting, and the long-term outcomes of preoperative nivolumab with or without relatlimab in patients with resectable non-small-cell lung cancer (NEOpredict-Lung).    In addition, Joel outlines CTSNet’s goals and initiatives to look forward to in 2026. Before closing, he highlights upcoming events in CT surgery.    JANS Items Mentioned  1.)  Ex Vivo Heart Perfusion Offsets Ischemic Penalties With ≥6-Hour Preservation in Adult Donation-After-Brain-Death Heart Transplantation  2.) This Man Saved My Life—I Live by His Example  3.) Women With Chronic Coronary Artery Disease: Long-Term Outcomes After Percutaneous Coronary Intervention vs Coronary Artery Bypass Grafting  4.) Long-Term Outcomes of Preoperative Nivolumab With or Without Relatlimab in Patients With Resectable Non-Small-Cell Lung Cancer (NEOpredict-Lung)  CTSNet Content Mentioned  1.) CTSNet Summarized—Most Popular Content of 2025  2.) CTSNet Summarized—Most Popular Podcast Episodes of 2025  3.) CTSNet Summarized—Top Cardiac Procedure Videos of 2025   Other Items Mentioned  1.) All CTSNet Summarized Content   2.) 2025 CTSNet Recruitment Guide   3.) Career Center   4.) CTSNet Events Calendar  Disclaimer The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.

This week on The Beat, CTSNet Editor-in-Chief Joel Dunning discusses how to get involved with Pace4Life, a charity he supports that provides reconditioned pacemakers to Ghana. He also previews upcoming podcast episodes and guests, including discussions on the Ross procedure guidelines and more interviews related to the JCOG0802 trial.  Chapters 00:00 Intro  02:31 JANS 1, Ethiopian Surgeon  07:08 JANS 2, RCA to Cor Sinus Fistula  09:30 JANS 3, Y-Incision Hemodynamics  12:38 JANS 4, Endograft Infection  15:06 Instructional Video Competition  16:01 Career Center  16:40 Video 1, Complications Podcast  19:34 Video 2, Totally Endoscopic Case  21:23 Video 3, Post-Infarction VSD Repair  23:15 Closing, Upcoming Events  Joel also highlights recent JANS articles on a heart surgeon who saved another surgeon’s life as a teen and how they now perform surgeries together, right coronary artery to coronary sinus fistula, a surgical aortic valve replacement with Y-incision aortic annular enlargement provided better hemodynamics than transcatheter aortic valve replacement, and management of endograft infection after thoracic endovascular aortic repair.  In addition, Joel explores totally endoscopic mitral and tricuspid valve repair, ASD with APVR repair, and LAA occlusion, as well as the repair of a post-infarction VSD, and an episode of The Atrium podcast featuring host Dr. Alice Copperwheat speaking with Dr. Samer Nashef about complications in cardiothoracic surgery. Before closing, Joel highlights upcoming events in CT surgery.    JANS Items Mentioned  1.)  A Heart Surgeon Saved His Life as a Teen. Now They Perform Surgeries Together.  2.) Right Coronary Artery to Coronary Sinus Fistula: A Rare Problem With an Elegant Solution  3.) Surgical Aortic Valve Replacement With Y-incision Aortic Annular Enlargement Provided Better Hemodynamics Than Transcatheter Aortic Valve Replacement  4.) Management of Endograft Infection After Thoracic Endovascular Aortic Repair  CTSNet Content Mentioned  1.) The Atrium: Complications  2.) Totally Endoscopic Mitral and Tricuspid Valve Repair, ASD With APVR Repair, and LAA Occlusion  3.) Repair of a Post-Infarction VSD  Other Items Mentioned  1.) Pace4Life   2.) MICS and Robotic-Assisted Surgery: A Roundtable Discussion With the Endoscopic Cardiac Surgeons Club  3.) Instructional Video Competition  4.) 2025 CTSNet Recruitment Guide   5.) Career Center   6.) CTSNet Events Calendar  Disclaimer The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.

This week on The Beat, CTSNet Editor-in-Chief Joel Dunning speaks with Dr. Nasser Altorki, thoracic surgeon at Weill Cornell Medicine in New York, and thoracic surgeon and CTSNet Senior Editor Leanne Ashrafian about the 10-year results from the JCOG0802 trial. Chapters 00:00 Intro 02:56 JANS 1, Re-Repair vs Replacement 05:07 JANS 2, Mini Mitral Multicentre RCT 07:01 JANS 3, PERSEVERE Study 08:54 JANS 4, Parietal Pleurectomy vs Pleural Abrasion 11:38 Career Center 12:33 Video 1, Endoscopic Post-Infarction VSD Repair 14:11 Video 2, 3D Dor Procedure & MVR Huge LV Aneurysm 15:19 Video 3, Non-Cardioplegic Myo Protection Robotic 17:16 Nasser Altorki Interview, JCOG 45:16 Upcoming Events 47:20 Closing They discuss key aspects of the trial, including the noninferiority primary endpoint. Dr. Altorki shares his overall thoughts on the trial, and they also examine topics such as pulmonary function, lobar vs sublobar resection, and segmentectomy vs wedge resection. Additionally, they explore secondary primary lung cancer, the importance of thoracic surgeons presenting data to patients, and best practices for segmentectomy to ensure patient safety. They also examine good wedge resection vs bad wedge resection, planning for segmentectomy, and the future of lobectomy and segmentectomy.   Joel also highlights recent JANS articles on the outcomes of re-repair vs replacement after failed primary mitral regurgitation repair, minimally invasive thoracoscopically-guided right minithoracotomy vs conventional sternotomy for mitral valve repair, one-year results of novel aortic arch hybrid prosthesis for repair of acute DeBakey Type I dissection with malperfusion, and a meta-analysis of efficacy and safety of parietal pleurectomy vs pleural abrasion in treating spontaneous pneumothorax.  In addition, Joel explores endoscopic post-infarction VSD repair, 3D video-assisted endoscopic Dor procedure and MVR for post-infarction huge LV aneurysm, and non-cardioplegic myocardial protection for robotic mitral surgery. Before closing, Joel highlights upcoming events in CT surgery.    JANS Items Mentioned  1.) Outcomes of Re-Repair Versus Replacement After Failed Primary Mitral Regurgitation Repair: STS Adult Cardiac Surgery Database Analysis  2.) Minimally Invasive Thoracoscopically-Guided Right Minithoracotomy Versus Conventional Sternotomy for Mitral Valve Repair: The UK Mini Mitral Multicentre RCT  3.) One-Year Results of Novel Aortic Arch Hybrid Prosthesis for Repair of Acute DeBakey Type I Dissection With Malperfusion: PERSEVERE Study  4.) A Meta-Analysis of Efficacy and Safety of Parietal Pleurectomy Versus Pleural Abrasion in Treating Spontaneous Pneumothorax  CTSNet Content Mentioned  1.) Endoscopic Post-Infarction VSD Repair  2.) Pushing Surgical Boundaries: 3D Video-Assisted Endoscopic Dor Procedure and MVR for Post-Infarction Huge LV Aneurysm  3.) Non-Cardioplegic Myocardial Protection for Robotic Mitral Surgery  Other Items Mentioned  1.) Instructional Video Competition  2.) 2025 Endoscopic Cardiac Surgeons Club Video Competition  3.) 2025 CTSNet Recruitment Guide   4.) Career Center   5.) CTSNet Events Calendar  Disclaimer The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.

In this episode of The Cardiac Recovery Room, moderator Vicki Morton, Director of Clinical and Quality Outcomes at Providence Anesthesiology Associates in North Carolina, USA, spoke with Alexander Gregory, a cardiovascular anesthesiologist and assistant professor in the Department of Anesthesiology, Perioperative and Pain Medicine, and the Libin Cardiovascular Institute at the Cumming School of Medicine, University of Calgary, Canada, and Dr. V. Seenu Reddy, a cardiothoracic surgeon at HCA’s TriStar Cardiovascular Surgery in Nashville, Tennesee, USA, about the 10 things they hate about Enhanced Recovery After Surgery (ERAS).   Chapters 00:00 Introduction  01:38 Overcomplication  05:29 Simple Barriers  08:54 Change Obstructionists  10:52 Status Quo  12:49 Messing with Protocol  14:21 Giving Up on Protocol  16:48 Need for Patient-Reported Outcomes  19:18 Struggle Into Cardiac Subspecialty  21:30 Takeaways  The goal of this discussion was to identify specific challenges and propose potential solutions. They emphasize the importance of having two leaders—a champion and a co-champion—to effectively guide ERAS initiatives. Additionally, they discuss creating standing orders and issues related to microbarriers and resistance to change. They also highlight the need for customization of protocols, acknowledging the differences between surgeons who utilize ERAS and those who do not, as well as the tendency to maintain the status quo. Patient perspectives are another key focus, with a call to implement changes that enhance tracking and monitoring of patient outcomes. Furthermore, they explore the role of technology designed for patients, as well as applying ERAS principles to surgeries that fall “outside of the box.”   The Cardiac Recovery Room is the place to hear the conversations colleagues are having after the meetings. Each month, a new episode will be released featuring a leadership panel from the ERAS Cardiac Society.  Disclaimer The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.