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Are We Implanting Too Few Mechanical Valves?

Norman Briffa
Norman Briffa of the Sheffield Teaching Hospitals NHS Trust in the UK discusses the decision between mechanical and biological aortic valves, focusing on patients between the ages of 50 and 70 years old. He begins by reviewing the guidelines and evidence related to valve durability and bleeding risk. Concluding that the decision should be patient-specific, he notes that consideration should be given to advances in anticoagulation care, improvements in patient follow-up surveillance, and device innovation.This...

Are We Implanting Too Few Mechanical Valves?

Norman Briffa
Norman Briffa of the Sheffield Teaching Hospitals NHS Trust in the UK discusses the decision between mechanical and biological aortic valves, focusing on patients between the ages of 50 and 70 years old. He begins by reviewing the guidelines and evidence related to valve durability and bleeding risk. Concluding that the decision should be patient-specific, he notes that consideration should be given to advances in anticoagulation care, improvements in patient follow-up surveillance, and device innovation.This...

When Things Go Wrong in Thoracic Surgery: A Middle Lobectomy With Bleeding That Required Cardiopulmonary Bypass to Address

Joel Dunning, Jonathan Ferguson, Magyar Kanani & Izanee Mydin
This is a video showing a procedure performed by open thoracotomy with a head camera that records audio. The patient had a large middle lobe tumor and had an ICD, an impaired left ventricular function, and previous coronary artery bypass grafting. Unfortunately, the operating surgeon got into a bleeding scenario that required the whole team to work together to get out of this problem.
This is a 34 minute video where the viewer can hear exactly...

When Things Go Wrong in Thoracic Surgery: A Middle Lobectomy With Bleeding That Required Cardiopulmonary Bypass to Address

Joel Dunning, Jonathan Ferguson, Magyar Kanani & Izanee Mydin
This is a video showing a procedure performed by open thoracotomy with a head camera that records audio. The patient had a large middle lobe tumor and had an ICD, an impaired left ventricular function, and previous coronary artery bypass grafting. Unfortunately, the operating surgeon got into a bleeding scenario that required the whole team to work together to get out of this problem.
This is a 34 minute video where the viewer can hear exactly...

How We Do It: Epiaortic Scanning

Giuseppe Rescigno, Ramesh Giri, Abdul Nasir & Patrick Yiu
Epiaortic scanning is a simple and low-cost technique that could improve results in terms of postoperative neurological complications. This video is a step-by-step tutorial that could allow every surgeon to perform an epiaortic scan safely. The findings from the scan may help in choosing the optimal surgical strategy for every single patient. The authors show how to set up the probe, the different views, and how to analyze the findings.
ReferenceJoo HC, Youn YN, Kwak...

How We Do It: Epiaortic Scanning

Giuseppe Rescigno, Ramesh Giri, Abdul Nasir & Patrick Yiu
Epiaortic scanning is a simple and low-cost technique that could improve results in terms of postoperative neurological complications. This video is a step-by-step tutorial that could allow every surgeon to perform an epiaortic scan safely. The findings from the scan may help in choosing the optimal surgical strategy for every single patient. The authors show how to set up the probe, the different views, and how to analyze the findings.
ReferenceJoo HC, Youn YN, Kwak...

A Novel and Versatile Tool for Mitral Valve Repair: The Memo 4D System

Gianluca Torregrossa, Elbert E. Williams, Andrea Amabile & John D. Puskas
The Memo 4D System by LivaNova is a novel semi-rigid annuloplasty ring. Ideal for the minimally invasive approach, this ring allows neochord implantation without physical measurement or further adjustments in chordal heights, simplifying the decision process of the neochords’ length. In this video, the authors present their experience using the Memo 4D ring to repair three different types of mitral valve disease: fibroelastic deficiency (FED), Barlow’s disease, and anterior leaflet prolapse.
FEDThe patient was a 55-year-old...

A Novel and Versatile Tool for Mitral Valve Repair: The Memo 4D System

Gianluca Torregrossa, Elbert E. Williams, Andrea Amabile & John D. Puskas
The Memo 4D System by LivaNova is a novel semi-rigid annuloplasty ring. Ideal for the minimally invasive approach, this ring allows neochord implantation without physical measurement or further adjustments in chordal heights, simplifying the decision process of the neochords’ length. In this video, the authors present their experience using the Memo 4D ring to repair three different types of mitral valve disease: fibroelastic deficiency (FED), Barlow’s disease, and anterior leaflet prolapse.
FEDThe patient was a 55-year-old...

Maryland Thoracic LigaSure and Signia Powered Right Upper Lobectomy

Marco Nardini, Angelo Giulio Citarella & Felice Granato
This video demonstrates a three-port anterior video-assisted thoracoscopic right upper lobectomy, for early stage lung cancer, performed with the aid of novel sealing and stapling devices.
The LigaSure™ is used as the only dissecting instrument, for the sealing of small vessels (less than 7 mm in diameter) and for the lymphadenectomy. This can save cost and time of additional instrumentation, and it also can reduce the number of stapler reloads consumed. The authors describe the use...

Maryland Thoracic LigaSure and Signia Powered Right Upper Lobectomy

Marco Nardini, Angelo Giulio Citarella & Felice Granato
This video demonstrates a three-port anterior video-assisted thoracoscopic right upper lobectomy, for early stage lung cancer, performed with the aid of novel sealing and stapling devices.
The LigaSure™ is used as the only dissecting instrument, for the sealing of small vessels (less than 7 mm in diameter) and for the lymphadenectomy. This can save cost and time of additional instrumentation, and it also can reduce the number of stapler reloads consumed. The authors describe the use...

Tips for Building a Practice in Early Career

Mara Antonoff, Damien J. LaPar & David D. Odell
Filmed at the 2019 STS Annual Meeting in San Diego, California, Mara Antonoff of the University of Texas MD Anderson Cancer Center in Houston, USA, moderates a discussion on the tips for building a practice in early career. Dr Antonoff is joined by Damien LaPar of Columbia University in New York, USA, and David Odell of Northwestern University in Chicago, Illinois, USA. The panel discusses the importance of seeking mentorship, building relationships with referring physicians,...

Tips for Building a Practice in Early Career

Mara Antonoff, Damien J. LaPar & David D. Odell
Filmed at the 2019 STS Annual Meeting in San Diego, California, Mara Antonoff of the University of Texas MD Anderson Cancer Center in Houston, USA, moderates a discussion on the tips for building a practice in early career. Dr Antonoff is joined by Damien LaPar of Columbia University in New York, USA, and David Odell of Northwestern University in Chicago, Illinois, USA. The panel discusses the importance of seeking mentorship, building relationships with referring physicians,...

Trisegmentectomy

Marco Nardini & Joel Dunning
Microlobectomy is a surgical technique conceived by Mr Joel Dunning, in Middlesbrough, UK, in 2014 and previously described in the literature. In this video, the authors demonstrate the adoption of this technique for a sublobar resection, namely a left upper division segmentectomy. The aim is to reduce the postoperative pain and use of opioids, and therefore to reduce the postoperative complications and the hospital stay. About 20% of patients who underwent lobectomy through a microlobectomy...

Trisegmentectomy

Marco Nardini & Joel Dunning
Microlobectomy is a surgical technique conceived by Mr Joel Dunning, in Middlesbrough, UK, in 2014 and previously described in the literature. In this video, the authors demonstrate the adoption of this technique for a sublobar resection, namely a left upper division segmentectomy. The aim is to reduce the postoperative pain and use of opioids, and therefore to reduce the postoperative complications and the hospital stay. About 20% of patients who underwent lobectomy through a microlobectomy...

Off-Pump Coronary Artery Bypass With Bilateral Internal Mammary Arteries

Fernando Barbosa
The bilateral internal mammary arteries technique for off-pump coronary artery bypass is a safe technique with long-term patency and low morbidity and mortality. The author usually uses total arterial myocardial revascularization using bilateral internal mammary arteries for patients younger than 75 years old. The left and right mammary arteries have the longest patency described of any type of graft that can be use in cardiac surgery.
LLeft and right mammary artery composite Y-grafts were constructed...

Off-Pump Coronary Artery Bypass With Bilateral Internal Mammary Arteries

Fernando Barbosa
The bilateral internal mammary arteries technique for off-pump coronary artery bypass is a safe technique with long-term patency and low morbidity and mortality. The author usually uses total arterial myocardial revascularization using bilateral internal mammary arteries for patients younger than 75 years old. The left and right mammary arteries have the longest patency described of any type of graft that can be use in cardiac surgery.
LLeft and right mammary artery composite Y-grafts were constructed...

Minimally Invasive Mitral Valve-in-Ring Explant for Prosthetic Stenosis

Mario Castillo-Sang
This video shows the technical challenges of explanting a valve-in-ring mitral valve.
The patient was a 40-year-old woman who presented with a failed mitral valve repair in which a P2 triangular resection and 28 mm Edwards Physio 2 ring were used 5 years prior via a limited sternotomy at an outside institution. Her original operation was complicated by cardiogenic shock requiring mechanical support and inotropic support.The patient’s left ventricular ejection fraction (LVEF) decreased from 55%...

Minimally Invasive Mitral Valve-in-Ring Explant for Prosthetic Stenosis

Mario Castillo-Sang
This video shows the technical challenges of explanting a valve-in-ring mitral valve.
The patient was a 40-year-old woman who presented with a failed mitral valve repair in which a P2 triangular resection and 28 mm Edwards Physio 2 ring were used 5 years prior via a limited sternotomy at an outside institution. Her original operation was complicated by cardiogenic shock requiring mechanical support and inotropic support.The patient’s left ventricular ejection fraction (LVEF) decreased from 55%...

Quick Tips and Tricks for Robot-Assisted Esophagectomy: Ivor Lewis and McKeown

Frans Van Wagenberg, Kemp Kernstine, Kayla Maaraoui & Anya Kalsbeek
This video demonstrates the common pitfalls of robot-assisted esophagectomy and presents tips and techniques to performing the Ivor Lewis and McKeown procedures.
To begin making the conduit, it is advisable to begin at the lesser curvature and to use a 4.0 cm silk tie in order to gauge the width of the conduit—this helps to avoid creating a conduit that is either too narrow, too wide, or uneven. Using a 45 mm staple load, rather than...

Quick Tips and Tricks for Robot-Assisted Esophagectomy: Ivor Lewis and McKeown

Frans Van Wagenberg, Kemp Kernstine, Kayla Maaraoui & Anya Kalsbeek
This video demonstrates the common pitfalls of robot-assisted esophagectomy and presents tips and techniques to performing the Ivor Lewis and McKeown procedures.
To begin making the conduit, it is advisable to begin at the lesser curvature and to use a 4.0 cm silk tie in order to gauge the width of the conduit—this helps to avoid creating a conduit that is either too narrow, too wide, or uneven. Using a 45 mm staple load, rather than...

Optimal Treatment for the Failing Prosthesis is Redo Aortic Valve Replacement

Clifford W. Barlow & Carlo Olevano
Clifford W. Barlow of the Southampton General Hospital in the United Kingdom presents a discussion on the optimal treatment for failing surgical prosthetic valves within the context of aortic valve disease.
This presentation was originally given during the SCTS Ionescu University program at the 2018 Annual Meeting of the Society for Cardiothoracic Surgery in Great Britain and Ireland. This content is published with the permission of SCTS. Please click here for more information on SCTS educational...

Roundtable on Medical Volunteerism

Jay Pal, HelenMari Merritt, Adil Husain & Fred Grover
Filmed at the 2018 STS Annual Meeting in Fort Lauderdale, Florida, Jay Pal of the University of Colorado moderates a discussion on medical volunteerism. He is joined by HelenMari Merritt of the University of Nebraska Medical Center in Omaha, Adil Husain of the University of Utah Primary Children's Hospital in Salt Lake City, and Fred Grover of the University of Colorado Denver. They discuss how they got involved with surgical volunteerism opportunities, the types of...

From Bench to Reality: Development of Simulation, 3D Printing, and Air-Pilot-Training Concept Course for Endoscopic Mitral Valve Surgery

Peyman Sardari Nia
Endoscopic mitral valve repair is one of the most difficult procedures to learn. The learning curve is steep. This steep learning curve has partially to do with the fact that the operation is done with long-shafted instruments, with surgeon looking at the monitor rather than into the wound. Acquiring endoscopic skills with long-shafted instruments is a process that no one can escape from, and acquiring these skills in patients is not logical or efficient. In...

Technical Innovations in Minimally Invasive Surgery: The Process and the Future

Mark Ferguson, Thomas D'Amico, Gaetano Rocco, Robert Cerfolio & Linda Martin
Mark Ferguson of the University of Chicago presents a discussion on technical innovations in minimally invasive thoracic surgery. He is joined by Thomas D'Amico of Duke University Medical Center in Durham, North Carolina; Gaetano Rocco of the National Cancer Institute, Pascale Foundation in Naples, Italy; Robert Cerfolio of the University of New York University Langone Medical Center; and Linda Martin of the University of Virginia in Charlottesville.

Right Coronary Aneurysm with Coronary Arteriovenous Fistula to Right Atrium

Eden C. Payabyab, Luigi Pirelli, Michael Poon, Chad A. Kliger, Jonathan M. Hemli, Niray Chandrakant Patel, S. Jacob Scheinerman & Derek R. Brinster
A 56-year-old man presented with shortness of breath and palpitations. Workup and evaluation revealed paroxysmal atrial fibrillation, severe tricuspid regurgitation, and a giant right coronary aneurysm with an arteriovenous fistula to the right atrium. An echocardiogram revealed an aneurysm of the proximal right coronary artery. Cardiac catheterization and cardiac magnetic resonance imaging showed the aneurysm coursing between the right pulmonary artery and the ascending aorta. The caliber of the right coronary artery distal to the...

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