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5 Courses
Credit Offered
70 CME Credits
This 13th edition of Self-Education, Self-Assessment in Thoracic Surgery (SESATS) continues the tradition of providing a completely online educational tool that is available on any internet-accessible device. SESATS XIII features multimedia elements to augment the 400 questions and critiques. It offers access to the PubMed full text of references, including real-time delivery of abstracts. This assembly of topical information offers students of thoracic and cardiac surgery a rich opportunity for study throughout the assessment, and it becomes a reference after completion. This platform opens the learning opportunity to a worldwide audience. As in the past, SESATS seeks to offer a balanced sampling of advancing knowledge in all areas of cardiac and thoracic surgery.
I would like to thank Dr. Stephen Yang (SESATS Editor-in-Chief, ABTS Director) and the ABTS Board of Directors who provided invaluable leadership and guidance on this project.

The ABTS would also like to acknowledge and thank the following SESATS XIII Section Editors, who spent a considerable amount of their own time preparing and reviewing the content in this version: Dr. Jennifer Romano (Congenital), Dr. John Mitchell (General Thoracic), Dr. Thoralf Sundt (Adult Cardiac), Dr. Christine Lau (Critical Care), and Dr. Anne Rizzo (Critical Care).

The Board is also indebted to the Sub-section Editors and the 100+ question writers who, without their commitment to thoracic and cardiac surgery education, SESATS XIII would not have been possible.

SESATS content remains integral to the evolution of Maintenance of Certification within our specialty. The examination format is intended to prompt thoughtful consideration of topics and to offer additional information and perspective in the critiques. The online reference links to PubMed material provide a genuine, evidence-based study opportunity. The newly designed search tool allows users to review items after completing SESATS and study questions answered incorrectly, adding enduring value to this edition as a review tool.

Lastly, I would like to personally thank the IT development team at RKO Technology Consulting, LLC (Rob Oberteuffer) and OasisLMS (Thomas Wong and team). Patricia Watson and Aleisha Gardner at the American Board of Thoracic Surgery provided invaluable oversight, input, and editing. Patty Linton in the CME office of Penn State Health Milton S. Hershey Medical Center continues to manage CME-related inquiries. It has been my great good fortune to enjoy the help of these individuals.

David A. Fullerton, M.D.
American Board of Thoracic Surgery
Executive Director
When you have completed all 4 assessments, a popup message will appear to take you to the required survey. You must complete the survey in order to request or receive any CME credits for the activity. After answering the survey questions, click “Complete Evaluation”. You will then see a popup message prompting you to enter the number of Category I CME hours you are requesting to claim.

SESATS XIII provides a comprehensive review of the disorders of the lung, chest wall, and mediastinum, of acquired and congenital heart disease and of issues in critical care. Completing SESATS XIII will assess your knowledge of the cardiothoracic specialty as it relates to the best available evidence in the field.

After completion of this activity, you should be able to:

  • Assess and improve your cognitive knowledge within cardiac and thoracic surgery
  • Discuss new innovations in the treatment of cardiac and thoracic diseases and integrate them into practice
  • Implement current standards of diagnosis and care for surgical cardiac and thoracic diseases
“Self-Education Self-Assessment in Thoracic Surgery (SESATS)” is a comprehensive computer-based tool and examination intended to be used by physicians to study and review essential aspects of cardiac and thoracic surgery. Completion of the study process and examination is expected to require approximately 70 hours. You must successfully complete the entire SESATS activity to receive CME credit. You are required to report the actual time of participation in the activity. The computer program tracks your responses and time spent on review and completion of self-study sessions. This information, analyzed in the summary performance report, influences the CME hours that can be awarded.
  • Note the learning objectives
  • Study and work through all the questions
  • Complete the post-test evaluation and survey questions
  • Submit all final data electronically via the internet. You must be connected to the internet to upload your progress.

This activity will no longer be designated for credit after May 26, 2023.

A CME certificate will be sent via email within two weeks of receipt of records indicating completion of the entire SESATS activity.

For questions regarding CME credit or the evaluation, please call Penn State Continuing Education at (717) 531-6483 or e-mail Please reference activity code G6474-20-T.

This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Penn State College of Medicine and the American Board of Thoracic Surgery (ABTS). Penn State College of Medicine is accredited by the ACCME to provide continuing medical education for physicians.

Penn State College of Medicine designates this enduring material for a maximum of 70 AMA PRA Category 1 Credit(s)TM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Original release date: May 27, 2020

Review/approval date: May 27, 2020

Expiration date: No credit will be given after December 31, 2023

Faculty members are required to inform the audience when they are discussing off-label or unapproved uses of devices or drugs. Devices or drugs that are still undergoing clinical trials are identified as such and should not be portrayed as standard, accepted therapy. Please consult full prescribing information before using any product mentioned in this activity. If using products in an investigational, off-label manner, it is the responsibility of the prescribing physician to monitor the medical literature to determine recommended dosages and uses of the drugs. Neither the publisher nor the providers promote the use of any agent outside of approved labeling.

Penn State is committed to on-line privacy and confidentiality. This website is managed by Echo360, Meta Ingenuity, and/or the American Board of Thoracic Surgery (ABTS), and their printed privacy policy applies to this site. CME credit for "Self-Education Self-Assessment in Thoracic Surgery XIII (SESATS XIII)” is provided by Penn State College of Medicine. If you register for CME credit for this educational activity, Echo360, Meta Ingenuity and/or ABTS will forward relevant personally identifiable information to Penn State College of Medicine so that we can maintain records concerning credits we issue to you. We may share data concerning registrations, evaluations, and CME credit on request of our joint sponsor (American Board of Thoracic Surgery). Penn State College of Medicine may use the information you provide on this site to contact you about your CME credit or other examination feedback. For more information, contact

The content of SESATS is prepared based on a review of multiple sources of information but is not exhaustive of the subject matter. Therefore, health-care professionals and other individuals should review and consider other publications and materials and not rely solely on the information contained in this material.

SESATS XIII was constructed by a panel of practicing surgeons, educators, and experts in tests and measurement. The statements expressed in this volume reflect the opinions of the authors and the consensus of the SESATS XIII committee, but not necessarily the opinions of Penn State College of Medicine.
Editor-in-Chief: Stephen Yang, MD (Johns Hopkins Hospital)

Examination Chair: Yolonda Colson, MD (Massachusetts General Hospital)

Section Editors:

Anne Rizzo, MD (Inova Fairfax Hospital)
Christine Lau, MD (University of Maryland Medical System)
Jennifer Romano, MD (University of Michigan)
John D. Mitchell, MD (University of Colorado)
Thoralf Sundt, MD (Massachusetts General Hospital)

Sub-section Editors:

Aaron Cheng, MD (University of Washington)
Ashok Muniappan, MD (Brigham and Women’s Hospital)
Betty Tong, MD (Duke)
Cameron Wright, MD (Massachusetts General Hospital)
Charles Murphy, MD (Inova Medical Group)
David Bull, MD (Arizona)
Edward Chen, MD (Emory)
Edward Sako, MD (UT Health San Antonio)
Harold Burkhart, MD (OU Medicine)
Hersh Maniar, MD (Washington University)
James Huang, MD (Memorial Sloan Kettering)
James Isbell, MD (Memorial Sloan Kettering)
James Tweddell, MD (Cincinnati Childrens Hospital)
Jay Shake, MD (University of Mississippi Health Center)
John Conte, MD (Penn State Health)
John E. Mayer, MD (Boston Children’s Hospital)
Jonathan Chen, MD (CHOP)
Jules Lin, MD (University of Michigan)
K. Robert Shen, MD (Mayo Clinic)
Kevin Lobdell, MD (Atrium Health)
Lena Napolitano, MD (University of Michigan)
Max Mitchell, MD (Childrens Colorado)
Michael Weyant, MD (UC Denver)
Nahush Mokadam, MD (Ohio State)
Robert Jaquiss, MD (UT Southwestern)
Robert Sade, MD (Medical University of South Carolina)
Ross Bremner, MD (Dignity Health)
Shari Meyerson, MD (University of Kentucky)
Stephanie Mick, MD (Cleveland Clinic)
Subroto Paul, MD (RWJBarnabas Health)
Tom Nguyen, MD (UT Health)

Question Writers:

A.J. Carpenter, MD (UT Health San Antonio)
Aaron Eckhauser, MD (University of Utah)
Ahmet Kilic, MD (Johns Hopkins Hospital)
Andrew Chang, MD (University of Michigan)
Anthony Kim, MD (USC)
Brendon Stiles, MD (Cornell)
Bryan Burt, MD (Baylor College of Medicine)
Chris Malaisrie, MD (Northwestern Medicine)
Chris Sciortino, MD (UPMC)
Christian Pizarro, MD (Alfred I. duPont Hospital for Children)
Christopher Seder, MD (Rush)
Chun (Dan) Choi, MD (Johns Hopkins Hospital)
Craig Selzman, MD (University of Utah)
Dan Miller, MD (Wellstar Health System)
Daniel T. Engelman, MD (Bay State Health)
Daniela Molena, MD (Memorial Sloan Kettering)
Danny Chu, MD (UPMC)
David Bichell, MD (Vanderbilt)
David D’Alessandro, MD (Brigham and Women’s Hospital)
David Lehenbauer, MD (University of Texas)
David Odell, MD (Northwestern Medicine)
David S. Cooper, MD (Cincinnati Childrens)
Dawn Hui, MD (University Health System)
Dean McKenzie, MD (Texas Childrens)
Faisal Bakaeen, MD (Cleveland Clinic)
Francis Pagani, MD (University of Michigan)
Gabe E. Owens, MD (University of Michigan)
George J. Arnaoutakis, MD (University of Florida Health)
George Tolis, MD (Brigham and Women’s Hospital)
HelenMari Merritt-Genore, MD (Nebraska Medicine)
James Gangemi, MD (University of Virginia)
James St. Louis, MD (Childrens Mercy Kansas City)
Jay Pal, MD (University of Colorado)
Jennifer Wilson, MD (Brigham and Women’s Hospital)
John Entwistle, MD (Jefferson University Hospitals)
John Ikonomidis, MD (UNC)
John Kucharczuk, MD (UPenn)
Jonathan Haft, MD (UMichigan)
Jonathan Stulak, MD (Mayo Clinic)
Jorge Salazar, MD (UT Health)
Joseph Brian Clark, MD (Penn State Health)
Joseph Cleveland, MD (UC Denver)
Joseph Shrager, MD (Stanford)
Karen Brasel, MD (Oregon Health&Science)
Lauren Kane, MD (University of Central Florida)
Linda Martin, MD (University of Virginia)
Lisa Brown, MD (UC David)
M. Blair Marshall, MD (Georgetown University Hospital)
Mani Daneshman, MD (Duke)
Mara Antonoff, MD (MD Anderson)
Marc Sussman, MD (Johns Hopkins Hospital)
Mark Berry, MD (Stanford)
Mark Ferguson, MD (UChicago Medicine)
Mark Iannettoni, MD (East Carolina Heart Institute)
Mark Russo, MD (RWJBarnabas Health)
Mary Mancini, MD (Louisiana State University)
Matthew Blum, MD (University of Colorado)
Min Kim, MD (Houston Methodist)
Muhammed Nuri, MD (Seattle Childrens)
Paul Chai, MD (Columbia University)
Paul Schipper, MD (Oregon Health&Science)
Pirooz Eghtesady, MD (St. Louis Childrens )
Prashanth Vallabhajosyula, MD (UPenn)
Ram Subramanyan, MD (USC)
Reshma Biniwale, MD (UCLA)
Richard Freeman, MD (St. Vincent Health)
Richard Mainwaring, MD (Stanford)
Rita Milewski, MD (UPenn)
Riyad Karmy-Jones, MD (PeaceHealth)
Robbin Cohen, MD (USC)
Robert Dabal, MD (University of Alabama –UAB)
Robert Love, MD (Northwestern University)
Robert Merritt, MD (Ohio State Medical Center)
S. Adil Husain, MD (University of Utah)
Sandra Starnes, MD (University of Cincinnati)
Scott B. Johnson, MD (UT Health San Antonio)
Scott Bradley, MD (Medical University of Southern Carolina)
Serguei Melnitchouk, MD (Brigham and Women’s Hospital)
Seth Krantz, MD (NorthShore University Health)
Sibu Saha, MD (UK Healthcare)
Sidhu Gangadharan, MD (Brigham and Women’s Hospital)
Stephanie Fuller, MD (CHOP)
Stephen McKellar, MD (University of Utah)
Sudish Murthy, MD (Cleveland Clinic)
Sunil Singhal, MD (UPHS)
Sunjay Kaushal, MD (University of Maryland)
T. Sloane Guy, MD (Cornell)
Thomas Beaver, MD (University of Florida)
Thomas Brett Reece, MD (UC Denver)
Thomas Carmody, MD (Mayo Clinic)
Thomas MacGillivray, MD (Houston Methodist)
Thomas Varghese, MD (University of Utah)
Tommy D’Amico, MD (Duke)
Tsuyoshi Kaneko, MD (Brigham and Women’s Hospital)
Virginia Litle, MD (Boston Medical Center)
Wayne Hofstetter, MD (MD Anderson)
Winfield Wells, MD (USC)
Penn State College of Medicine is committed to offering CME programs that promote improvements or quality in health care and are developed free of the control of commercial interests. Reasonable efforts have been taken to ensure that our programs are balanced, independent, objective, scientific, and in compliance with regulatory requirements. Faculty and course directors have disclosed all relevant financial relationships with commercial companies, and Penn State has a process in place to resolve any conflict of interest. Disclosure of a relationship is not intended to suggest or condone bias, but is made to provide participants with information that might be of potential importance to their evaluation of this educational activity.

Penn State College of Medicine staff and faculty involved in the development and review of this activity have disclosed no relevant financial relationships.
George Arnaoutakis, MD
Consultant/Advisor: Boston Medical, Inc.

Faisal Bakaeen, MD
Royalties/Patents: Jace Medical

Thomas Beaver, MD
Consultant/Advisor: Gore, Cryolife

Bryan Burt, MD
Research Grant: AstraZeneca, Momotaro-Gene Inc.
Stock Ownership: Bayou Surgical

Andrew Chang, MD
Consultant/Advisor: Biostage

Jonathan Chen, MD
Consultant/Advisor: Medtronic, Gore

Danny Chu, MD
Consultant/Advisor: Terumo Cardiovascular Systems Corporation, Japanese Organization for Medical Device Development, Inc., The Osler Institute
Employment Affiliation: Wolters Kluwer Health

Joseph Cleveland Jr., MD
Research Grant: Abbott Medical

Robbin Cohen, MD
Consultant/Advisor: Medtronic
Speakers Bureau: Edwards Heart Valve, Medtronic

David Cooper, MD
Speakers Bureau: AstraZeneca, Mallinckrodt, Medtronic, Synagis

Thomas D’Amico, MD
Consultant/Advisor: Scanlan Instruments

Daniel Engelman, MD
Consultant/Advisor: Astute Medical, Edwards Lifesciences, Zimmer Biomet

Mark Ferguson, MD
Employment Affiliation: Society of Thoracic Surgeons
Royalties/Patents: Elsevier, Springer

Sidharta Gangadharan, MD
Research Grant: On Target Laboratories

T. Sloane Guy, MD
Consultant/Advisor: Verb Surgical/Ethicon, Edwards Lifesciences, Medtronic, Intuitive Surgical

Wayne Hofstetter, MD
Research Grant: Johnson & Johnson
Consultant/Advisor: NeuWave
Speakers Bureau: Boston Scientific

James Isbell, MD
Stock Ownership: LumaCyte, LLC

Tsuyoshi Kaneko, MD
Speakers Bureau: Edwards Lifesciences, Medtronic, Abbott, Baylis Medical

Anthony Kim, MD
Consultant/Advisor: Medtronic, Roche Genentech

Min Kim, MD
Speakers Bureau: Intuitive Surgical, Medtronic, Boston Scientific, Veran

Jules Lin, MD
Speakers Bureau: Intuitive Surgical

S. Chris Malaisrie, MD
Consultant/Advisor: Edwards Lifesciences, Medtronic, Cryolife
Speakers Bureau: Terumo, Baxter

M. Blair Marshall, MD
Speakers Bureau: Ethicon: Johnson & Johnson

John Mayer, Jr., MD
Consultant/Advisor: Medtronic,
Stock Ownership: Johnson & Johnson, Merck, Inc., Eli Lilly

HelenMari Merritt-Genore, MD
Consultant/Advisor: Atricure

Robert Merrit, MD
Speakers Bureau: Intuitive Surgical

Daniel Miller, MD
Speakers Bureau: Acute Innovations, Inc.
Consultant/Advisor: Ethicon, Inc.

John Mitchell, MD
Consultant/Advisor: Medtronic

Nahush Mokadam, MD
Consultant/Advisor: Medtronic, Abbott, SynCardia

Gabe Owens, MD
Consultant/Advisor: HistoSonics, Inc.

Jay Pal, MD
Research Grant: Medtronic

Thomas Reece, MD
Consultant/Advisor: Terumo, Gore, McKesson

Edward Sako, MD
Stock Ownership: Medtronic

Joseph Shrager, MD
Consultant/Advisor: Carefusion/Becton Dickinson
Research Grant: Varian, Inc.
Stock Ownership: Chest Innovations, Inc.

Brendon Stiles, MD
Consultant/Advisor: AstraZeneca, Medtronic, Lung Cancer Research Foundation
Speakers Bureau: AstraZeneca, Medtronic
Employment Affiliation: Pfizer, PPI (spouse)
Stock Ownership: PPI (spouse)

Thoralf Sundt, MD
Consultant/Advisor: Medpace

Betty Tong, MD
Consultant/Advisor: Medtronic

Michael Weyant, MD
Consultant/Advisor: Medtronic

All other contributors/question writers involved in the development of this activity have reported no financial relationship to disclose.
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