846 Works

VATS Lung Volume Reduction Surgery Is Still the Gold Standard

Sridhar Rathinam
Mr Sridhar Rathinam of the Glenfield Hospital in Leicester, UK, discusses the surgical treatment of emphysema. He focuses on the risks and benefits of lung volume reduction surgery, taking a historical perspective, as well as comparing the surgical approach to other approaches that are currently available.
Learn more: https://www.ctsnet.org/article/vats-lung-volume-reduction-surgery-still-gold-standardThis 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...

Endotracheal Repair of an Iatrogenic Tracheal Laceration

Stefan Welter
The author presents an endotracheal repair, performed for a 72-year-old woman who was mechanically ventilated for a heart failure due to lung edema and hypoxia. She developed severe mediastinal and subcutaneous emphysema due to a 4.5 cm iatrogenic tracheal laceration. A completely endotracheal repair with a running suture was performed using the optical needle holder from Karl Storz Company (Tuttlingen, Germany). The patient needed prolonged ventilation for the underlying disease but could be weaned from...

The ORBITA Trial Results: What Do They Mean for Surgeons?

Patrick O. Myers, David P. Taggart & Michael J. Mack
Patrick Myers of Geneva University in Switzerland moderates a discussion on the recently published ORBITA trial. Dr Meyers is joined by David Taggart of the University of Oxford in the UK and Michael Mack of Baylor Scott and White Health in Dallas, Texas, US. The group discusses the importance of the sham-control design of the trial, ORBITA’s context within previous and upcoming trials, and what the results mean for cardiac surgeons.Read the paper here:Al-Lamee R,...

Excision of a Pleuropericardial Cyst

Mundayat Gopalakrishnan
An 80-year-old woman was diagnosed with a huge anterior and middle mediastinal cyst that was causing compression of the right atrium and ventricle. Computed tomography of the thorax and transthoracic echocardiography confirmed the diagnosis. She underwent complete excision of the cyst through a median sternotomy. She made an uneventful recovery and was discharged from the hospital in six days.

CTSNet Step-by-Step Series: Chest Drains

Caryl Richards, Aleksandra Bartnik, Shruti Jayakumar, Leanne Harling, Jason Varzaly & James Edwards
At the end of a cardiac procedure, two or three chest tubes are placed in the mediastinal space to continuously monitor postoperative blood loss and to prevent undesirable blood collection, especially in the pericardial space. Pleural tubes are sometimes used when the pleural space is entered, for example, when left or right internal mammary arteries are used as a graft. In this case, a left pleural chest tube will also be placed before closing the...

3D VATS Diaphragm Plication

Joel Dunning
This video demonstrates a VATS diaphragm plication in the full 3D in which it was performed. To appreciate the 3-dimensional quality of the video, you will need a 3D screen. The patient had significant shortness of breath and a high and paralyzed left hemidiaphragm. The authors repaired it using one 10 mm port and a 5 mm port.

Congenital Right Coronary Artery to Right Ventricle Fistula Ligation Without Cardiopulmonary Bypass

Le Quang Thuu & Duc An Vinh Bui
The authors present a case of congenital coronary artery to right ventricle fistula that was treated successfully by direct ligation without the use of cardiopulmonary bypass.
An 11-month-old boy was hospitalized because of a complaint of mild dyspnea and continuous cardiac murmur. A chest x-ray revealed heart shade enlargement. Multidetector computed tomography and coronary angiography revealed that the right coronary artery (RCA) was dilated (6.37 mm maximum diameter) with a fistula directly connecting into the right...

Robotic Left-Sided Excision of a Bronchogenic Cyst

Omar Zibdeh, Christopher Bayliss, Chirantha Puwalani Vidanapathirana & Joel Dunning
The patient was a 35-year-old woman who had reported experiencing an intermittent and really productive cough for several years that was very offensive and troublesome in nature. She also reported intermittent chest infections over the years. She was diagnosed with a left main bronchus cyst from her noncontrast computed tomography scan after excluding an esophageal anomaly on a barium swallow.
The cyst was interestingly collapsed because obviously it had a connection to the airways, and the...

How to Maximize Career and Networking Opportunities at Cardiothoracic Surgery Meetings

Jacqueline Olive, Jessica G. Y. Luc, Marc R. Moon, Ourania Preventza & Doug J. Mathisen
Filmed at the 2019 STS Annual Meeting in San Diego, California, Jacqueline Olive of Baylor College of Medicine in Houston, Texas, USA, moderates a discussion on making the most of networking and career development opportunities at cardiothoracic surgery meetings. Ms Olive is joined by Jessica Luc of the University of British Columbia in Vancouver, Canada, Marc Moon of Washington University School of Medicine in St. Louis, Missouri, USA, Ourania Preventza of Baylor College of Medicine,...

CTSNet Step-by-Step Series: Tricuspid Annuloplasty

Kirtiga Naguleswaran, 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,...

Pioneers in Cardiac Surgery With John McKenna

Leanne Harling & John McKenna
Leanne Harling of Imperial College in London, UK, interviews John McKenna of Edinburgh, UK, about his experience in the device industry side of cardiothoracic surgery. They discuss the history of replacement heart valve development and current challenges that face the development of technology, both generally and in the UK. Mr McKenna emphasizes the importance of collaboration between engineers and surgeons and the continuing need for innovation even where there is little commercial gain.
John McKenna is...

Challenging Case: Ventricular Septal Defect Device Removal

Brian Elliot Kogon & Craig A. Mathis
ObjectivesTreatment of perimembranous ventricular septal defects (VSD) has traditionally been surgical. Surgery most often includes midline sternotomy, cardiopulmonary bypass with cardioplegic arrest, and patch closure of the defect. Devices have become available that allow for percutaneous perimembranous ventricular septal defect closure in the cardiac catheterization lab, thereby eliminating the risks of open heart surgery. Risks of device closure include incomplete closure, heart block, and interference with aortic and tricuspid valve function.MethodsThe authors present a challenging...

VATS Microportal Utility Incision For Mediastinal Lymph Node Biopsy

Abraham Nashaat, Guillermo Martinez, Guiseppe Aresu, Adam Peryt & Aman S Coonar
A 31-year-old woman was referred for investigation of mediastinal lymphadenopathy. A large right-sided paratracheal mass of lymph nodes was identified. Possible approaches included the mediastinoscopy via a cervical incision, right video-assisted thoracic surgery (VATS), or even a subxiphoid approach. Of course, open approaches might also be considered by some surgeons.A very straightforward approach is a two-port operation via incisions slightly smaller than 1 cm, through which conventional VATS instruments can be passed. These incisions also...

Surgical Treatment of Biventricular Outflow Tract Obstruction in Hypertrophic Cardiomyopathy

Ziyad M. Binsalamah, Rodrigo Zea-Vera, Marco A. Rodriguez, Susan W. Denfield & Jeffrey S. Heinle
ObjectivesHypertrophic cardiomyopathy is usually associated with left ventricular outflow tract obstruction. It is rare to have a concomitant obstruction of the right ventricular outflow tract requiring resection. Patients with biventricular outflow tract obstruction tend to have more severe symptoms than patients with left ventricular outflow tract obstruction alone and non-obstructive hypertrophic cardiomyopathy. The authors present the successful surgical treatment performed for a child with the aforementioned diagnosis.MethodsIn this video, the authors demonstrate the successful surgical...

Lessons Learned in Humanitarian Medicine

Vinicius Jose Nina, William M. Novick & Marcelo G. Cardarelli
Filmed at the 2018 EACTS Annual Meeting in Milan, Italy, Vinicius Nina of the University Hospital of the Federal University of Maranhão in Brazil moderates a discussion on approaches for success in humanitarian heart surgery. Dr Nina is joined by Marcelo Cardarelli of the Inova Children's Hospital in Falls Church, Virginia, USA, and William Novick of the University of Tennessee in the USA and Medical Director of the Novick Cardiac Alliance. The panel discusses the...

Left Atrial Appendage Closure Using the Xi Robotic System

Hamzah Mansoura & C. Patrick Murrah
This is a case presentation of a left atrial appendage closure using the Xi robotic system. The indication for the procedure was an elevated ChADVASC score and a contraindication to anticoagulation. The patient was placed supine with the left arm allowed to fall back to expose the left axilla. A left-sided double lumen tube was used. Transesophageal echocardiography was used intraoperatively to rule out LAA thrombus and to assess the LAAC.The majority of the 25...

Three-Minute Review: Essentials of Cardiopulmonary Bypass

Abdelhadi Ismail, Sunil Ohri & Szabolcs Miskolczi
The aim of this Three-Minute Review is to enable junior doctors to study and memorize topics in cardiac surgery in a simplified manner based on the rationale of things rather than rote memorization. In this publication, the authors set a mind map of how to study cardiopulmonary bypass. They simplify the major criteria, processes, and components in a rational manner, which helps one recall it easily.

Flexible Bronchoscopy Mediated Foreign Body Removal From Right Lower Lobe Bronchus Using a Cryoprobe

Rajan Santosham, Rajiv Santosham, Rahul Sharma & Vamshidhar Tirunagari
Impaction of a foreign body in the bronchus is common. Flexible bronchoscopy with use of a cryoprobe can be conveniently used to remove an impacted foreign body in the bronchus. This video demonstrates this process. Sometimes the diagnosis can be missed. Surgeons should have a suspicion of a foreign body whenever there are atelectatic changes and consolidation on radiographic imaging.

Enhanced Recovery After Surgery Cardiac Panel Part II: Intraoperative and Postoperative

Daniel T. Engelman, Rakesh Christopher Arora, Michael Grant, Kevin Wallace Lobdell & Louis P. Perrault
Filmed at the 2019 STS Annual Meeting in San Diego, California, Daniel Engelman of Baystate Medical Center in Springfield, Massachusetts, USA, moderates a discussion on enhanced recovery after surgery (ERAS) for cardiac surgery. Dr Engelman, who is also the President of the ERAS Cardiac Society, is joined by Rakesh Arora of Saint Boniface Hospital in Winnipeg, Manitoba, Canada, Michael Grant of the Johns Hopkins Hospital in Baltimore, Maryland, USA, Kevin Lobdell of Atrium Health in...

Norwood With Right-Ventricle-to-Pulmonary-Artery Conduit

James Scott Tweddell & Alan O'Donnell
The first stage of hypoplastic left heart syndrome (HLHS) palliation typically occurs within the first week of life. There are three competing surgical strategies for this palliation: the Norwood procedure with modified Blalock-Taussig-Thomas shunt (innominate-artery-to-pulmonary-artery), the Norwood procedure with right-ventricle-to-pulmonary-artery (RV-to-PA, Sano) modification, and the hybrid procedure, which includes a stent across the ductus arteriosus and branch pulmonary artery bands. While there are three major surgical strategies, the objectives of each procedure are essentially the...

What to Do With the Aortic Root in Acute Type A Aortic Dissection: The French Experience

Jean-Philippe Verhoye
Jean-Philippe Verhoye of the Pontchaillou University Hospital in Rennes, France, discusses the decision between root replacement and root sparing approaches in the treatment of type A aortic dissection. He posits that this decision relies on the answers to three questions: first, what is the fate of a spared root; second, what is the risk carried by later reoperation on root that was spared; and finally, does the technique of root replacement affect patient outcomes? Dr...

Minimally Invasive Versus Open Surgery for Aortic Valve Replacement

Bil Kirmani
Bil Kirmani of the Liverpool Heart and Chest Hospital in the UK compares minimally invasive and open surgical approaches for aortic valve replacement. He presents a review comparing full to limited sternotomy and discusses the available data on anterior right minithoracotomy.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...

Diversity and Inclusion in Cardiothoracic Surgery

Ourania Preventza, Robert S. D. Higgins, Jessica Donington & Anthony L. Estrera
Filmed at the 2018 STS Annual Meeting in Fort Lauderdale, Florida, Ourania Preventza of Baylor College of Medicine in Houston, Texas, moderates a discussion on diversity and inclusion in cardiothoracic surgery. Dr Preventza is joined by Robert Higgins of John Hopkins University School of Medicine in Baltimore, Maryland, Jessica Donington of the University of Chicago in Illinois, and Anthony Estrera of McGovern Medical School in Houston, Texas. The group builds on topics from the Diversity...

Robotic Right Upper Lobe Apical Segmentectomy

Ricardo Mingarini Terra & Alessandro Wasum Mariani
This video demonstrates a robotic right upper lobe apical segmentectomy as surgical treatment for a lung metastasis from colorectal carcinoma, performed with the da Vinci Si platform using a three-arm technique plus a 10 mm assistant port. In the right arm, the authors used the fenestrated Marlyland bipolar forceps and the Cardiere forceps were used on the left arm. The assistant helped the lung exposition with a regular laparoscopic grasper and performed all vessel, bronchial,...

Subxiphoid Uniportal Nonintubated Thymectomy

Giuseppe Aresu, Giacomo Argento, Guillermo Martinez, Kunal Bhakri, Adam Peryt, Aman Coonar & Joel Dunning
The authors present a thymectomy that was performed for a 49-year-old woman with a history of breast carcinoma who had a positron emission tomography–positive lesion at the level of the anterior mediastinum.
Her care was discussed at a multidisciplinary meeting and, although there was a suspicion of a malignant thymoma, the radiologist did not consider a computed tomography-guided biopsy to be a feasible option due to the position of the lesion. The patient was then referred...

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