877 Works

Redo Aortic Surgery: Thoughts on New Technologies

Om P. Yadava & Roberto Di Bartolomeo
Om P Yadava of the National Heart Institute in New Delhi, India, and Roberto Di Bartolomeo of the University of Bologna in Italy discuss the redo aortic surgeries and recent advances like the frozen elephant trunk and endovascular repair.
Dr Yadava begins by asking why redo aortic surgeries are needed and what their incidence is. Dr Di Bartolomeo responds that the incidence of redo aortic surgeries is increasing for multiple reasons: the increasing age of the...

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,...

Tricuspid Valve Replacement Using CorMatrix® Extracellular Matrix Cylindrical Construct

Anna Xue, Amir Sarkeshik & Paul Perry
This is the case of a 23-year-old woman with a history of long-term IV drug abuse and tricuspid valve endocarditis. She had a status of post-tricuspid valve replacement seven weeks prior with porcine bioprosthesis, and her history was notable for extensive annular abscess and vegetation burden. She completed six weeks of IV antibiotics and remained sober in a rehab program. She was readmitted with bacteremia and multiple vegetations on the tricuspid bioprosthesis, which was concerning...

Tricuspid Valve Replacement Using CorMatrix® Extracellular Matrix Cylindrical Construct

Anna Xue, Amir Sarkeshik & Paul Perry
This is the case of a 23-year-old woman with a history of long-term IV drug abuse and tricuspid valve endocarditis. She had a status of post-tricuspid valve replacement seven weeks prior with porcine bioprosthesis and her history was notable for extensive annular abscess and vegetation burden. She completed six weeks of IV antibiotics and remained sober in a rehab program. She was readmitted with bacteremia and multiple vegetations on the tricuspid bioprosthesis, which was concerning...

Robotic-Assisted Total Decortication of Right Lung for Fibrothorax

G. Kimble Jett
This video describes robotic-assisted decortication for a recurrent pleural effusion secondary to fibrothorax. Technical aspects of the decortication are demonstrated, including port placement, robot docking, and closure.
Decortication is occasionally needed for an infected pleural space or recurrent pleural effusion caused by a trapped lung resulting from fibrothorax or malignant process (1). Outcomes of video-assisted thoracoscopic decortication have been shown to reduce complications and mortality (2), and conversion to open thoracotomy is more frequent with longer...

Donation After Cardiac Death Heart Transplantation: The New Frontier

Maziar Khorsandi, Philip Curry & Simon Messer
Simon Messer, a specialist trainee registrar in cardiothoracic surgery and a researcher on heart donation after cardiac death (DCD) at the Royal Papworth Hospital in the UK, presents his center’s experience on DCD heart transplantation as means of increasing the donor pool and reducing the waiting times for heart transplant recipients.
This lecture was presented during the Glasgow Cardiopulmonary Transplantation and Mechanical Circulatory Support Symposium, a one-day symposium held at the Golden Jubilee National Hospital in...

Mediastinal Tracheostomy in the Management of Recurrent Laryngeal Cancer

Charles Bakhos, Lisa Galati & Richard Agag
A 61-year-old man was treated for laryngeal squamous cell cancer with radiation in 2004. He presented again in 2012, with squamous cell cancer on the floor of his mouth. He underwent a right mandibulectomy with a free forearm flap, followed by radiation. A year later, he was found to have recurrent laryngeal cancer and underwent a total laryngectomy. Unfortunately, one of the margins was positive on the final pathology. The patient presented again in 2013...

Debate: Tissue Engineered Valves Will Dominate in the Future

Magdi Yacoub & Patrick Serruys
Sir Magdi Yacoub of the Imperial College London in the UK and Patrick Serruys of the Thoraxcenter Erasmus University in Rotterdam, Netherlands, discuss the use of tissue-engineered valves versus endogenous tissue restoration.
This debate was presented at the Heart Valve Society (HVS) Annual Meeting 2019 in Sitges, Spain, and is presented here with permission from HVS. For more information on upcoming events, please visit the HVS website.

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...

Thymoma Resection Using Subxiphoid Uniportal Approach

Deping Zhao, Samer Al Al Sawalhi, Yuxing Jin & Haomin Cai
There are different types of anterior mediastinal tumors, such as thymoma, germ cell tumors, ectopic parathyroid tumors, and lymphoid tumors. Completeness of tumor resection has been considered the most important determinant of long-term survival, therefore surgical resection of these tumors should be both safe and radical. Subxiphoid access is a novel approach for anterior mediastinal tumor resection. To perform surgery via this access, specially designed long instruments are required. Subxiphoid access provides excellent visualization of...

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...

Off-Pump Coronary Artery Bypass With Bilateral Internal Mammary Arteries

Fernando Barbosa
Editorial note: The video in version 1 of this article is of disputed ownership. Version 2 or later should be referenced.
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...

Robotic Left Upper Lobectomy

Stephanie G. Worrell & Jules Lin
Interest and access to robot thoracic surgery has increased over the last decade. This increased interest from surgeons, hospitals, and patients has led many surgeons to transition from their standard practice of open or thoracoscopic lobectomy to robotic lobectomy. High-volume robotic programs have shown a decrease in the length of hospital stay, 30-day mortality, and postoperative transfusion requirements when lung resection is performed with the robotic technique compared to video-assisted thoracoscopic surgery and thoracotomy (1).
...

Common Carotid Artery Cannulation: A Potential Alternative Site for Establishing CPB in Special Situations

Ishtiaque Al-Manzo & Prasanta Chanda
For establishing regular cardiopulmonary bypass, the ascending aorta is obviously the standard site of arterial cannulation, ensuring adequate blood supply to the whole body. However, when the aortic arch has to be replaced, finding a suitable arterial cannulation site becomes more challenging.
The femoral artery is an answer to this situation, and for a long period of time its cannulation was established as a routine practice. However, in a small number of patients, particularly those...

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...

Joel Cooper Discusses Lung Volume Reduction Surgery

Joel Dunning & Joel Cooper
In this interview, Joel Dunning of the James Cook University Hospital in Middlesbrough, UK, discusses lung volume reduction surgery (LVRS) with Joel Cooper of the Hospital of the University of Pennsylvania in Philadelphia, USA. LVRS is a technique that Dr Cooper pioneered and with which he has achieved consistently good results. Dr Cooper discusses indications for the procedure, his views on the NETT trial (1), and the critical role that postoperative care plays in ensuring...

Motherhood and Cardiothoracic Surgery

Blair Marshall, Virginia Litle, Andrea Wolf & Mara Antonoff
Filmed at the 2017 STS Annual Meeting in Houston, Texas, Blair Marshall of Georgetown University Hospital in Washington, DC, moderates a discussion on the experience of motherhood as a cardiothoracic surgeon. Dr Marshall is joined by Virginia Litle of Boston Medical Center in Massachusetts, Andrea Wolf of the Icahn School of Medicine at Mount Sinai in New York, and Mara Antonoff of the University of Texas MD Anderson Cancer Center in Houston. The panelists discuss...

Ectopic Thyroid in the Anterior Mediastinum Resected Through a Video-Assisted Transcervical Approach: Case Report

Carlos Henrique Boasquevisque
Introduction
The most frequent tumors in the anterior mediastinum are thymomas/thymic lesions (40%), lymphomas (25%), and germ cell tumors (20%). Substernal or retrosternal goiters/ectopic thyroid comprise 15% of anterior mediastinal masses (1).
Ectopic thyroid is a rare entity with an estimated prevalence of 1:100,000-300,000 (2) and 1:4,000-8,000 in patients with thyroid diseases (2). Ectopic thyroid tissue (ETT) can coexist with an orthotopic thyroid, although in the majority of the cases it is the...

Intramural Coronary Artery Unroofing

Patrick Myers, Raymond Pfister & Tornike Sologashvili
IntroductionIntramural coronary arteries are a rare congenital coronary malformation that are infrequently seen in adult patients. This video shows the management of two intramural coronary arteries: one of the right coronary artery and one of the left.Case 1 - Intramural Right Coronary ArteryThe first case involves a 48-year-old woman who presented with episodes of angina and was admitted for an NSTEMI. The coronary computed tomography (CT) scan showed an anomalous right coronary artery, with the...

Intramural Coronary Artery Unroofing

Patrick Myers, Raymond Pfister & Tornike Sologashvili
IntroductionIntramural coronary arteries are a rare congenital coronary malformation that are infrequently seen in adult patients. This video shows the management of two intramural coronary arteries: one of the right coronary artery and one of the left.Case 1 - Intramural Right Coronary ArteryThe first case involves a 48-year-old woman who presented with episodes of angina and was admitted for an NSTEMI. The coronary computed tomography (CT) scan showed an anomalous right coronary artery, with 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...

Surgical Treatment of Phrenic Nerve Injury

Matthew R. Kaufman & Thomas L. Bauer
Unilateral phrenic nerve injury often results in symptomatic hemidiaphragm paralysis. Although diaphragmatic plication is a treatment option, phrenic nerve repair may also be considered in an attempt to restore function of the paralyzed hemidiaphragm and it may be the optimal first line treatment when feasible. Persistently symptomatic patients with phrenic nerve injury and favorable electrodiagnostic testing results may be candidates for phrenic nerve reconstruction. Phrenic nerve reconstruction may involve neurolysis, interposition nerve grafting, and/or neurotization,...

Transsternal Transpericardial Approach for Left Main Bronchus Sleeve Resection Due to Pulmonary Glomus Tumor

Lorenzo Spaggiari, Alessio Vincenzo Mariolo, Francesco Petrella, Rosalia Romano & Massimo Torre
IntroductionGlomus tumors (GT) are rare benign neoplasms mostly affecting the deep dermis of extremities, and they constitute less than 2% of all soft tissue tumors. GTs can sporadically appear extracutaneously in the gastrointestinal tract, bone, cervix, and ovary, but GT occurrence in major airways is extremely rare. Only about 40 cases have been reported in the English literature. Patients are usually asymptomatic or present nonspecific symptoms such as cough, dyspnea, or hemoptysis, due to intrabronchial...

CTSNet Step-by-Step Series: Central Cannulation

Andrel Yoong, Omar A. Jarral, Shruti Jayakumar, Jason Varzaly, Leanne Harling & James Edwards
This video demonstrates a central cannulation in a step-by-step fashion, using diagrams and surgical video to illustrate key technical elements.Step 1Aortic cannulation is always done prior to atrial cannulation. At this step in the video, you can see partial thickness purse string sutures being placed into the aorta, which are then snared. Next, an incision is made into the aorta through the middle of the purse string suture, and a cannula is placed into the...

Uniportal VATS Fissureless Resection of the Anterior Segment of the Right Upper Lobe

Davor Stamenovic & Antje Messerschmidt
A 79-year-old female patient was admitted to the author’s clinic for the treatment of a solitary tumorous formation, which appeared to be a metachronous metastatic tumor of a colon carcinoma located in the anterior segment of the right upper lobe.Due to enlarged mediastinal lymph nodes, the patient underwent an endobronchial ultrasound prior to surgery. Since the results were favorable, surgery was offered. An anatomical anterior segment resection of the upper right lobe was conducted, followed...

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