452 Works

Minimally Invasive Aortic Valve Replacement by Thoracotomy: Step-by-Step Guide

Tom C. Nguyen & Juan B. Umana
The video provides a step-by-step guide for performing a minimally invasive aortic valve replacement via right thoracotomy, with an emphasis on the pearls and pitfalls. The implantation of a bioprosthetic tissue and sutureless valve is described. The video is organized according to the following phases of the operation: preoperative, cannulation, exposure, and implantation.
Dr Nguyen is a proctor for Edwards LifeSciences and Abbott.Learn more: https://www.ctsnet.org/article/minimally-invasive-aortic-valve-replacement-thoracotomy-step-step-guide

Roos Procedure for Thoracic Outlet Syndrome

, Karthik Panchanatheeswaran & B.V. Sai Chandran
The cervical rib is an extra rib that arises from the seventh cervical vertebra. It is present in approximately 1% of the general population, and it is bilateral in half of these patients. Women are affected more than men. It is clinically significant when it causes neurovascular compression in the thoracic outlet.
This video demonstrates a Roos procedure done for thoracic outlet syndrome (TOS) due to the presence of a left cervical rib in a...

VATS Pulmonary Artery Sealing: A Multi-Center Study

Joel Dunning, & Eric Goudie
Filmed at the 2017 STS Annual Meeting, Joel Dunning of James Cook University Hospital in Middlesbrough, United Kingdom, moderates a discussion with Moishe Liberman and Eric Goudie, both of the University of Montreal. They discuss Dr Liberman's method of dividing pulmonary vessels using an energy device and the multi-center study Dr Liberman and Mr Goudie are running to evaluate energy sealing on pulmonary arteries.
Learn more: https://www.ctsnet.org/article/vats-pulmonary-artery-sealing-multi-center-study

Resection of Fibroelastoma in Left Ventricular Outflow Tract by Minimally Invasive Approach

Mariano Vrancic, Manuel Cervetti, Julian Benavidez, Mario Acosta, Manuel Chiappe, Mariano Camporrotondo, Fernando Piccinini & Daniel Navia
This video demonstrates the resection of a fibroelastoma in the left ventricular outflow tract using a minimally invasive approach. The 83-year-old female patient was asymptomatic. Her cardiovascular history included a stent for infrarenal aortic aneurysm. Computed tomography angiography showed no lesions. The transesophageal echocardiography showed a hyperechoic mobile image that protruded towards the left ventricular outflow tract, impacted the noncoronary valve, and was attached to the septum by a small pedicle. Mild aortic insufficiency was...

Recent Advances in Tracheal Surgery

Sacha Mussot
Sacha Mussot of the Marie Lannelongue Hospital in Le Plessis-Robinson, France, discusses tracheal resection. He focuses on advances in replacing or reconstructing the trachea in cases where too much tissue is removed for a tracheal anastomosis to be possible.This presentation was originally given during the SCTS Ionescu University program at the 2017 Annual Meeting of the Society for Cardiothoracic Surgery in Great Britain and Ireland. This content is published with the permission of SCTS. Please...

Minimally Invasive Stage I Elephant Trunk and Aortic Valve Repair

Konstadinos Plestis, Matthew Thomas, Oleg Orlov, Kristen Lee & Cinthia Orlov
Case Presentation A 70-year-old woman presented with a symptomatic aortic aneurysm and mild-to-moderate central aortic regurgitation. Preoperative CT-C showed enlargement of her ascending and descending aorta and her aortic arch. Her aortic root was not dilated. Transesophageal echocardiogram demonstrated a trileaflet aortic valve with mild-to-moderate central aortic regurgitation and preserved ejection fraction.
Procedure The patient underwent a “J-type” partial upper sternotomy with extension into the right fourth intercostal space. Her right axillary artery was...

Open Window Thoracostomy in a Patient With Broncopleural Fistula After Left Pneumonectomy

Lorenzo Spaggiari & Alessio Vincenzo Mariolo
IntroductionDr Oscar Clagett described the open window thoracostomy in 1963 for treating postpneumonectomy empyema. This technique is still used in the management of bronchopleural fistula after lung resection. The opening into the chest wall allows repeated drainage, irrigation, and dressing of the cavity, and it lets the wound granulate and close over time. It can also act as a bridge to secondary wound closure with muscle or omental flaps, once the infection of the pleural...

Separation of Conjoined Hearts in Thoracopagus Twins

Frank Edwin, , & Martin Tamatey
Introduction Eight hours after delivery of thoracopagus twins, the right twin developed circulatory failure forcing an emergency separation to save the left twin. The twins had conjoined livers and conjoined hearts in a common pericardial cavity, and they appeared to have no ventricular-level fusion. Procedure Surgery was performed on the second day of life using general anesthesia and full invasive monitoring. The twins were placed with the ventral side uppermost; the ventral side being the...

Predicting the Impact of Sutureless Valves: An Analysis of Trials and Registries

Christopher Young
Christopher Young of St Thomas’ Hospital in London, UK, reviews clinical trials evaluating sutureless aortic valve implantation. He focuses on patient outcomes, valve hemodynamics, and the combination of rapid deployment valves with minimally invasive surgical approaches.This presentation was originally given during the SCTS Ionescu University program at the 2017 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...

Three-Dimensional Printing-Guided Precise Surgery for Complex Pulmonary Arteriovenous Malformation

Harinder Singh Bedi
IntroductionThree-dimensional (3D) printing is a new modality which makes a true-to-life 3D model using sophisticated technology. The authors report its first use in a complex case of a large pulmonary arteriovenous (AV) malformation.Case SummaryA 23-year-old patient presented with severe central cyanosis and clubbing. His echocardiogram was normal. A chest computed tomography (CT) and pulmonary angiogram revealed a large AV malformation. A repeat echocardiogram with injection of agitated saline into a peripheral vein showed appearance of...

Rare Case of Vascular Sling With Left Main Bronchus Compression

& Vijay Raju
This 2-year-old girl was evaluated for a recurrent respiratory tract infection and palpitations. She was further evaluated and diagnosed with a large secundum atrial septal defect (ASD) with dilated right atrium (RA) and right ventricle. However, the left pulmonary artery was not visible on the echocardiogram. A chest computed tomography scan showed that the left pulmonary artery (LPA) arose from the right pulmonary artery (RPA). The LPA traveled between the trachea and esophagus, causing a...

Operative Tips and Tricks to Preserve Tissue for a Good Repair

Patrick Perier
Patrick Perier of the Herz und Gefäß Klinik in Bad Neustadt an der Saale, Germany, discusses the problem of excess tissue in mitral valve repair. He focuses on the posterior leaflet, presenting the strengths and limitations of approaches that preserve tissue and discussing tips for a quality repair.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...

CTSNet Step-by-Step Series: Tricuspid Annuloplasty

, Omar Jarral, Shruti Jayakumar, Jason Varzaly, Leanne Harling & James Edwards
In the case shown in this video, a midline sternotomy was used, which is ideal for multiple procedures. However, a right thoracotomy can be done as a minimally invasive approach if tricuspid repair is being done in isolation. This procedure requires cannulation of both the superior (SVC) and inferior vena cavae (IVC) as well as the aorta. In this video, bicaval cannulation can be seen. This involves placing purse-string sutures in to the right atrium,...

Minimally Invasive Techniques are Safer Than Median Sternotomy

Torsten Doenst
Torsten Doenst of the University Hospital Jena in Germany presents the argument for minimally invasive techniques over median sternotomy in the treatment of mitral 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 programs..

Video-Assisted Thoracoscopic Surgery Resection of a Large Esophageal Diverticulum With Esophageal Myotomy

Edward D. Percy, Azra Panjwani & Ahmad S. Ashrafi
IntroductionEsophageal diverticulum is a rare condition characterized by protrusion of the esophageal mucosa through an area of weakness in the surrounding muscular layers. Generally, esophageal diverticula can be categorized as pulsion or traction. The former constitutes a false diverticulum, as the mucosa is the only protruding layer (1). Traction diverticula, on the other hand, include all muscular layers of the esophagus and tend to occur as a result of mediastinal inflammation (1, 2). Midesophageal, also...

Double Valve Repair for Marfan Aortic Root Aneurysm and Bileaflet (Barlow’s) Mitral Valve

George T. Stavridis, George Kantidakis, Vaios V. Kaminiotis, &
ObjectivesRepair of simultaneous complex aortic and mitral valve defects in patients with Marfan syndrome can be difficult. This video illustrates a double valve repair using two remodeling annuloplasty rings, as a technical simplification for simultaneous reconstruction. Video SummaryRisk-adjusted outcomes of multiple valve procedures may be better with repair than with prosthetic valve replacement (1, 2). The patient in this video was a 38-year-old woman with Marfan syndrome, along with aortic root aneurysm and severe aortic...

Recent Advances in Radiation Oncology in the Management of Lung Cancer

Kevin Franks
Kevin Franks of the Leeds Cancer Centre in the UK discusses recent advances in radiotherapy technology for the treatment of lung cancer.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 programs.

Concepts in CABG: An Interview With David Taggart

& David Taggart
Dr Om P. Yadava of the National Heart Institute in New Delhi, India, and Editor-in-Chief of the Indian Journal of Thoracic and Cardiovascular Surgery discusses contemporary issues in coronary artery bypass grafting (CABG) with Professor David Taggart of the University of Oxford in the UK at the 2018 Annual Conference of the Indian Association of Cardiovascular and Thoracic Surgeons.
Dr Yadava begins by suggesting that more ink has been spilt than blood over total arterial...

Rare Case of Vascular Sling With Left Main Bronchus Compression

& Vijay Raju
This 2-year-old girl was evaluated for a recurrent respiratory tract infection and palpitations. She was further evaluated and diagnosed with a large secundum atrial septal defect (ASD) with dilated right atrium (RA) and right ventricle. However, the left pulmonary artery was not visible on the echocardiogram. A chest computed tomography scan showed that the left pulmonary artery (LPA) arose from the right pulmonary artery (RPA). The LPA traveled between the trachea and esophagus, causing a...

Optimal Strategy for High Risk Coronary Patients: Hybrid Minimally Invasive Revascularization

Bob Kiaii
Bob Kiaii of the London Health Sciences Centre in Ontario, Canada, makes the case for a hybrid approach to coronary revascularization. He argues that hybrid revascularization is a useful component of one's armamentarium but that more data is needed to establish its usefulness for high-risk patients.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...

Ethics Debate: Neighborly Help or Itinerant Surgery?

Robert Sade, James Allan & Alberto Ferreres
Filmed at the 2018 STS Annual Meeting in Fort Lauderdale, Florida, Robert Sade of the Medical University of South Carolina in Charleston moderates a debate on the ethics of performing surgeries distant from one's primary center. The scenario for this debate considers a thoracic surgeon at a major medical center who performs surgeries at a distant hospital and leaves postoperative care to a local general surgeon with thoracic surgical experience. Dr Sade is joined by...

CTSNet Step-by-Step Series: Proximal Anastomosis

Christopher Chen, , Shruti Jayakumar, Jason Varzaly, Leanne Harling & James Edwards
This video demonstrates a proximal anastomosis, attaching a graft vessel to the aorta in a coronary artery bypass graft procedure. The authors break the anastomosis into five steps: preparation, creating the aortic hole, cutting the graft, parachuting the graft onto the aorta, and completing the anastomosis.
Suggested ReadingDoty DB, Doty JR. Cardiac Surgery: Operative Technique. 2nd ed. Philadelphia, PA: Saunders; 2012:406-407.

Leaflet Reconstructive Techniques for Aortic Valve Repair

Domenico Mazzitelli, Theodor Fischlein, , , Christof Stamm, Steffen Pfeiffer, Lawrence Wei & Vinay Badhwar
In patients with grade 3 or 4 aortic insufficiency (AI), leaflet defects may occur in up to 80%. For successful aortic valve repair (AVr), an in-depth knowledge of leaflet reconstruction is essential. This video illustrates a comprehensive approach that has been highly efficacious in this setting.
MethodsThe most commonly encountered cusp defect is leaflet prolapse. Two-thirds involve the isolated right coronary cusp, and the remainder are equally divided between isolated noncoronary, isolated left coronary, and multileaflet...

CTSNet Step-by-Step Series: Sternal Closure Using Stainless Steel Wires

Edward Lau, Leanne Harling, Shruti Jayakumar, Jason Varzaly & James Edwards
This video demonstrates the closure of a median sternotomy using stainless steel wires in a step-by-step fashion. The authors include both diagrams and surgical video to illustrate key technical elements.

Radical Thymectomy With Superior Vena Cava System Reconstruction

Lorenzo Spaggiari & Alessio Vincenzo Mariolo
Introduction Invasive thymic tumors with superior vena cava infiltration are rare and aggressive clinical entities. For these patients, chemotherapy and/or radiotherapy may be indicated, but when surgical intervention is feasible, en bloc resection of the tumor followed by vascular reconstruction represents the best treatment. Vascular reconstruction can be performed using a venous autograft, an artificial graft such as one made of polytetrafluoroethylene, or a heterologous graft. Venous replacement with autograft gives the best results, but...

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