211 Works

Minimally Invasive Valve-Sparing Aortic Root Replacement

Derek Brinster & Jonathan Hemli
This video demonstrates the basics of the valve-sparing aortic root replacement (VSARR) procedure, including the dissection, graft measurement, and surgical tips for a competent and durable repair. Minimally invasive procedures are continuing to evolve with the goal of providing reduced morbidity to the patient and earlier return to the activities of daily living. The VSARR procedure performed through a 5 cm incision and upper hemisternotomy is the natural evolution of the basic minimally invasive aortic...

Minimally Invasive Valve-Sparing Aortic Root Replacement

Derek Brinster & Jonathan Hemli
This video demonstrates the basics of the valve-sparing aortic root replacement (VSARR) procedure, including the dissection, graft measurement, and surgical tips for a competent and durable repair. Minimally invasive procedures are continuing to evolve with the goal of providing reduced morbidity to the patient and earlier return to the activities of daily living. The VSARR procedure performed through a 5 cm incision and upper hemisternotomy is the natural evolution of the basic minimally invasive aortic...

Making a Difference: A Cardiac Surgery Mission to Enugu, Nigeria

Joel Dunning & Emily Farkas
This video was filmed during a cardiac surgery mission to Enugu, Nigeria, led by Emily Farkas and sponsored by CardioStart and the VOOM Foundation. It documents the important work that surgical mission groups perform, and hopefully provides insights into what it is like to be on a cardiac surgery mission in a developing country.

Learn more at: https://www.ctsnet.org/article/making-difference-cardiac-surgery-mission-enugu-nigeria

Roundtable: How to Maximize Efficiency in Clinic and Practice

Shanda Blackmon, Brendon Stiles, Vinay Badhwar & Robert Cerfolio
Shanda Blackmon of the Mayo Clinic in Rochester, Minnesota, moderates a discussion - filmed at the 2017 STS Annual Meeting - on maximizing efficiency in a cardiothoracic surgery practice. Dr Blackmon is joined by Brendon Stiles of the New York-Presbyterian Weill Cornell Medical Center in New York City, Vinay Badhwar of West Virginia University in Morgantown, and Robert Cerfolio, now of New York University Langone Health in New York City. The panelists share the different...

Sutureless Aortic Valve Replacement Via Right Anterior Thoracotomy

Selim Isbir, Sinan Arsan, , Koray Ak, Alper Kararmaz, Nihal Kolbas & Elif Demirbas
The authors present a sutureless aortic valve replacement via a right anterior thoracotomy, using minimal extracorporeal circulation (MECC) in an 84-year-old patient with severe aortic stenosis.
Preoperative tomographic angiography showed a right-sided aorta. A 4 cm transverse incision was made through the right second intercostal space. Rib resection was not used. Femoral arterial and venous cannulation was used. MECC is known to reduce the deleterious effects of cardiopulmonary bypass, and the main advantages of MECC are...

TCD and Validating Brain Perfusion

Zsolt Garami
Zsolt Garami of Houston Methodist in Houston, Texas, discusses Transcranial Doppler (TCD) use in cardiac and major vascular surgery, and the potential role of perfusionists in TCD monitoring.

This educational presentation was originally given during the 2016 New Orleans Conference and is published with the permission of the New Orleans Conference.

VATS Pericardial Patch: Minimally Invasive Stitching

Khalid Amer
This video presents the case of a 65-year-old woman with a neuroendocrine tumor in her left lower lobe. The tumor invaded the pericardium and was staged as M1a, for which curative resection was not recommended. An initial single port VATS biopsy confirmed the pericardial invasion and obtained the histology. The tumor had a Ki 67 proliferation index of 10-15%, which put it in a moderate degree of malignancy. The tumor was expected to be indolent,...

Treatment of Difficult Sternal Non-union Using the RIA Bone Marrow Harvest System

, Joel Dunning & James McVie
This video shows a patient who was suffering from manubrium nonunion after a mini aortic valve replacement. The nonunion caused significant pain and clicking. The patient was a heavily built male and CT scanning showed several fragments, which suggested that simple plating would be ineffective. Femoral bone marrow is an ideal medium to induce good union and is used in many other areas of chronic nonunion. The orthopedic department joined the case and harvested bone...

The Expert Witness: Perfusion and the Law

Arie Blitz
Arie Blitz of McAllen Heart Hospital, Texas, discusses the potential role of perfusionists as expert witnesses in court cases. Dr. Blitz reflects on the value of having credible, unbiased medical professionals as expert witnesses in litigation.
This educational presentation was originally given during the 2016 New Orleans Conference. This content is published with the permission of the New Orleans Conference.

Robotic Sleeve Lobectomy of the Right Lower Lobe

Shruti Jayakumar, Marco Nardini & Joel Dunning
This is the case of 65-year-old male with a proven adenocarcinoma at the orifice of the apical segment of the right lower lobe. He underwent a robotic sleeve lobectomy with a station 7 lymphadenectomy. The right lower lobe artery and right lower lobe vein were divided using the Covidien Curved Tip Stapler with a leader catheter, which facilitated ease of stapling by the assistant. Initially, the right lower lobe bronchus was cut with scissors and...

Lung Volume Reduction Surgery for Emphysema

Jose Manuel Naranjo Gómez & Daniel Valdivia Concha
A 65-year-old patient was admitted to the author´s department to assess his inclusion in the lung transplantation program. The patient had a prior history of smoking (50-pack years) and emphysema (COPD GOLD IV). In the previous year, he had been treated with 2–4 lpm home oxygen, 24 hours a day. The patient commonly experienced severe dyspnea with daily routine activities and had some isolated exacerbation episodes in the previous three years.
The x-ray showed hyperinflation, and...

Mini-Bentall Procedure and Hemiarch Replacement: Coronary Button Reimplantation

Tristan D. Yan, Martin Misfeld & Joel Dunning
In this video, the sixth in a seven-part series, Tristan Yan completes the “French Cuff” annular anastomosis, and demonstrates the coronary button reimplantation technique via a mini-sternotomy incision.
Steps: 1. The second “French Cuff” layer is performed using a 4-0 running polypropylene suture, starting from the commissure between the left and right annulus and going clockwise, circumferentially. It is important to ensure that this layer of running suture incorporates the remnant of aortic wall and the...

Mini-Bentall Procedure and Hemiarch Replacement: CoronaryButton Reimplantation

Tristan D. Yan, Martin Misfeld & Joel Dunning
In this video, the sixth in a seven-part series, Tristan Yan completes the “French Cuff” annular anastomosis, and demonstrates the coronary button reimplantation technique via a mini-sternotomy incision.
Steps: 1. The second “French Cuff” layer is performed using a 4-0 running polypropylene suture, starting from the commissure between the left and right annulus and going clockwise, circumferentially. It is important to ensure that this layer of running suture incorporates the remnant of aortic wall and the...

TEST Mini-Bentall Procedure and Hemiarch Replacement: Coronary Button Reimplantation

, Tristan D. Yan, Martin Misfeld & Joel Dunning
In this video, the sixth in a seven-part series, Tristan Yan completes the “French Cuff” annular anastomosis, and demonstrates the coronary button reimplantation technique via a mini-sternotomy incision.
Steps: 1. The second “French Cuff” layer is performed using a 4-0 running polypropylene suture, starting from the commissure between the left and right annulus and going clockwise, circumferentially. It is important to ensure that this layer of running suture incorporates the remnant of aortic wall and the...

Repair of Aortic Valve, Large Periaortic Abscess, and LV-PA Fistula in a 5-Year-Old With Acute Bacterial Endocarditis

Matthew Johnston & Ross Ungerleider
Originally presented as an STSA/CTSNet Surgical Motion Picture at the 2016 STSA Annual Meeting. Objectives: The patient is a 5-year-old who presented with acute right hemispheric stroke, aphasia, fevers, and hemodynamic instability. Blood cultures were positive for Streptococcus Viridans. Echocardiography confirmed a small aneurysm near the right and left coronary cusps with a shunt from the left ventricular outflow tract (LVOT) to the pulmonary artery (PA). The patient was given an initial course of antibiotics,...

Minimally Invasive Repair of Severe Bicuspid Aortic Valve Endocarditis

Konstadinos Plestis, Alon Aharon & Oleg Orlov
For young patients with aortic valve endocarditis, preserving the native aortic valve, when feasible, may be the best option. The authors demonstrate the feasibility of performing a complex aortic valve repair for aortic valve endocarditis via an upper partial sternotomy.This is the case of 31-year-old man who presented with fever and lethargy. A CT scan of the abdomen showed multiple left renal infarcts. The blood cultures were positive for Streptococcus, and a TEE showed a...

Left Carotid to Subclavian Artery Bypass

Daniel Gwan-Nulla
This video demonstrates a left carotid to subclavian artery bypass. Due to increased use of aortic stent grafts that sometimes cover or compromise the orifice of the left subclavian artery, cardiothoracic surgeons need to be familiar with revascularization of the extremity.

Staple Line on Staple Line Esophagogastric Anastomosis: A Novel Anastomotic Technique

Mark Mankins, , Karen Rieger, Thomas Birdas & Kenneth Kesler
Anastomotic complications represent a significant source of morbidity after esophagectomy. In this video, the authors demonstrate a novel “side-to-side, staple line on staple line” technique for intrathoracic esophagogastric anastomoses. This technique is designed to create a wide diameter esophagogastric anastomosis, while preserving stomach conduit blood supply.

Humanitarian Cardiothoracic Surgery: How and Why I Do It

Emily Farkas, Kathleen Fenton, Vinicius Nina & Virginia Litle
Filmed at the 2017 STS Annual Meeting in Houston, Texas, four cardiothoracic surgeons share why and how they have made humanitarian cardiothoracic surgery a part of their careers. Emily Farkas of the ThedaCare Appleton Heart Institute in Wisconsin, is joined by Kathleen Fenton of the William Novick Global Cardiac Alliance, Vinicius Nina of the Federal University of Maranh in Brazil, and Virginia Litle of the Boston Medical Center in Massachusetts. Each panelist shares how they...

Infraclavicular Approach for Surgical and Endovascular Management of Paget-Schroetter Syndrome

Daniel Gwan-Nulla
This video demonstrates an infraclavicular approach for the surgical and endovascular management of Paget-Schroetter Syndrome. Also known as effort thrombosis of the axillosubclavian vein, Paget-Schroetter Syndrome is a form of thoracic outlet obstruction that accounts for approximately 1-2% of all venous thromboses. Management includes thrombolysis and surgical decompression. Best practice results are seen with catheter-directed thrombolysis followed by early surgical decompression and angioplasty, as demonstrated in this video.

CTSNet Step-by-Step Series: Midline Sternotomy

Shruti Jayakumar, Leanne Harling, Joel Dunning, Jason Varzaly & James Edwards
This video demonstrates a midline sternotomy. The authors detail the procedure in a step-by-step fashion, using diagrams and surgical video to illustrate key technical elements.

Women Cardiothoracic Surgeons Accept the New Yorker OR Cover Challenge

Mara Antonoff & Nikki Stamp
The Health, Medicine & the Body Issue of The New Yorker depicting four women surgeons at the operating table has inspired women surgeons around the world to recreate the cover and share their photos as part of the #NYerORCoverChallenge.Women cardiothoracic surgeons took on the challenge, and CTSNet is excited to share the completed photo collage. The photos show teams of women cardiothoracic surgeons, as well as solo surgeons. “Many of us are the lone women...

VATS Biopsy of Left 4L Nodes From a Right Approach

Khalid Amer
General thoracic surgeons are faced with challenges thrown at them from time to time. This video demonstrates accessing multiple nodal stations, including a contralateral nodal station. Meticulous study of the computed tomography (CT) scan suggested that the 4L left nodal station was, in fact, not far away from the midline, and an access from a right VATS approach was worked out. The dangers of harvesting 4L nodes are discussed, and what the surgeon should be...

Step-by-Step Thoracoscopic Right Upper Lobe Posterior Segmentectomy

Jeremiah Martin, Jonathan Crist & Marion Hochstetler
The posterior segment of the right upper lobe lends itself to a straightforward anatomic resection. Understanding the anatomy is key, and the authors present two cases that illustrate a stepwise approach.The general steps of a posterior segmentectomy of the right upper lobe:Perform a bronchoscopy prior to the procedure to understand the segmental anatomy, as not all patients will have a typical trifurcated right upper lobe.Begin with a posterior dissection. Identify the bronchus and the take-off...

Double Superior Vena Cava Cannulation for Venous Drainage in Minimally Invasive Aortic Valve Surgery

Tomislav Klokocovnik & Matija Jelenc
Introduction
There are two main approaches to venous cannulation for cardiopulmonary bypass in minimally invasive aortic valve surgery. The first is cannulation of the right atrial appendage with a two stage venous cannula, as in full a sternotomy, which enables the best venous drainage. All surgeons are familiar with this approach; however, the large cannula occupies space, lifts the right atrial appendage, and limits access to the aortic root. Furthermore, the right atrium may not be...

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