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Multimedia Manual of Cardiothoracic Surgery: MMCTS

Etienne Abdelnour-Berchtold, Jean Perentes, Thorsten Krueger, Michel Gonzalez
The surgical treatment of myasthenia gravis involves the complete resection of the thymus and the mediastinal fat between the two phrenic nerves. This procedure has been shown to have a positive impact on the rate of remission. In this video tutorial we illustrate the technical aspects of radical thymectomy using a left thoracoscopic approach.
September 3, 2018: Multimedia Manual of Cardiothoracic Surgery: MMCTS
Luke Rogers, Jaime Villaquiran, Ian Cox, Malcolm Dalrymple-Hay, Clinton Lloyd
Transcatheter mitral valve implantation (TMVI) is a relatively novel intervention used to replace the mitral valve of individuals deemed too high risk or unsuitable for surgery. It is associated with a number of specific risks, including left ventricular outflow tract obstruction (LVOTO).  In this video tutorial we present the case of a 75-year-old man who was unable to undergo redo surgical repair and had a number of risk factors for LVOTO. To minimize these risks, we deployed the TMVI within the anterior mitral valve leaflet...
August 28, 2018: Multimedia Manual of Cardiothoracic Surgery: MMCTS
Peyman Sardari Nia, Jules Olsthoorn, Samuel Heuts, Jos Maessen
Minimally invasive mitral valve surgery demands a different mind-set from surgeons due to its high complexity and steep learning curve, especially in a fully endoscopic approach. Smaller incisions, working with long-shafted instruments, and a relatively fixed camera position in a limited working space necessitate the development of new surgical routines.  We used a high-fidelity mitral valve simulator to develop a suturing map for placement of the annuloplasty ring with minimal tissue manipulation and maximal visual exposure...
July 26, 2018: Multimedia Manual of Cardiothoracic Surgery: MMCTS
Federica Caldaroni, Timofey Nevvazhay, Sojak Vladimir, Mark Hazekamp
Creation of a subclavicular arteriovenous fistula is a minimally invasive procedure that provides an additional source of arterial blood flow to the pulmonary arteries in patients who have a Glenn shunt but are unsuitable for or at high risk for Fontan completion.
July 26, 2018: Multimedia Manual of Cardiothoracic Surgery: MMCTS
Davida Robinson, Fabio Sagebin, Amanda Yap, Carl Johnson, Peter Knight
A minimally invasive approach to aortic valve replacement offers many advantages compared to the conventional median sternotomy. However, minimally invasive approaches are technically challenging. In this video tutorial, we describe an aortic valve replacement performed via a right anterior minithoracotomy, facilitated by the use of videoscopic and automated suturing technologies.  Briefly, a right anterior minithoracotomy incision is made in the 2nd intercostal space and the 3rd rib is disarticulated. A retractor is placed, pericardiotomy performed, and stay sutures placed...
July 26, 2018: Multimedia Manual of Cardiothoracic Surgery: MMCTS
Joel Ramirez, Georg Wieselthaler, Johannes Kratz
Giant coronary artery aneurysms are rare, difficult to diagnose, and have variable clinical presentations and treatment options. We demonstrate a case of a patient presenting with acute onset chest pain and signs of cardiac tamponade who then underwent a computed tomography pulmonary embolus protocol and was found to have hemopericardium with accumulation of contrast adjacent to the aorta. She then underwent emergent sternotomy and was found to have a large hemorrhagic mass on the right ventricle, which upon further dissection was determined to be a giant right coronary artery aneurysm with a site of contained rupture...
July 24, 2018: Multimedia Manual of Cardiothoracic Surgery: MMCTS
Stoyan Kondov, Bartosz Rylski, Friedhelm Beyersdorf, Martin Czerny, Matthias Siepe
Correction of extensive aortic pathology often requires a combined surgical approach. This video tutorial presents the technical aspects of beating-heart aortic arch replacement in the frozen elephant trunk technique in combination with valve-sparing aortic root replacement.
July 20, 2018: Multimedia Manual of Cardiothoracic Surgery: MMCTS
Patrick Myers, Tornike Sologashvili, Maurice Beghetti, René Prêtre
Selecting the optimal treatment for transposition of the great arteries with pulmonary stenosis is a challenge. The Rastelli procedure has long been the method of choice, but it carries the risk of subaortic obstruction. The dysplastic pulmonary valve, which cannot function under systemic pressure, can sometimes be recycled in the pulmonary position.  "En bloc" rotation of the outflow tracts has been proposed for treatment of complex transposition of the great arteries and is demonstrated in the following videos...
July 3, 2018: Multimedia Manual of Cardiothoracic Surgery: MMCTS
Shegu Gilbert, Devender Singh, M K Sivakumar
Ambidexterity is the state of being equally adept in the use of both the left and right hands. It is advantageous in surgeons, but the degree of ambidexterity found among them varies greatly. It is a very desirable attribute in laparoscopic surgery. It provides the surgeon with additional options for performing critical surgical steps when positioning and space are constrained, as is often the case in cardiac surgery and even more so in minimally invasive cardiac surgery. Mentoring for ambidexterity training can be initiated as early as during medical school...
June 27, 2018: Multimedia Manual of Cardiothoracic Surgery: MMCTS
Azumi Hamasaki, Tetsuro Uchida, Masahiro Mizumoto, Shuto Hirooka, Ai Ishizawa, Mitsuaki Sadahiro
In the mid-1990s, a novel saphenous vein harvesting technique, in which the vein is harvested with its surrounding tissue without manual distention, was introduced. This no-touch technique provides an excellent long-term patency; however, graft twisting and kinking can be a problem.  In order to fully take advantage of the benefit of the no-touch method while reducing the risk of twisting and kinking we have modified the anastomosis strategy. Our simple modified strategy involves performing a proximal anastomosis prior to the distal anastomosis...
June 26, 2018: Multimedia Manual of Cardiothoracic Surgery: MMCTS
Roberto Di Bartolomeo, Giacomo Murana, Jacopo Alfonsi, Luca Di Marco, Davide Pacini
The frozen elephant trunk technique, which involves complete arch replacement and antegrade stenting of the descending thoracic aorta, represents an appealing procedure for treating extensive thoracic aorta disease in a single-step operation. The Frozenix J Graft open stent graft (Japan Lifeline, Tokyo, Japan) launched on the Japanese market in July 2014 and is the newest available hybrid graft for this procedure.  This video tutorial demonstrates the step-by-step surgical implantation technique of the open J Graft in a 79-year-old male patient with a distal aortic arch aneurysm...
June 12, 2018: Multimedia Manual of Cardiothoracic Surgery: MMCTS
Torben Hoffmann, Henrik Vad, Frank de Paoli
Pectus excavatum is the most common chest wall anomaly; it is often present at birth and may worsen during adulthood. In 1998 the minimally invasive Nuss procedure for correcting pectus excavatum was introduced. It uses curved Lorenz bars to push the sternum into a normal position and is an alternative to the Ravitch technique, where costal cartilages are removed using a sternal midline incision.  Since 2001 pectus excavatum corrections at Aarhus University Hospital have been performed using the modified Nuss procedure ad modum Pilegaard, which calls for a short asymmetrical pectus bar and no additional stabilizing sutures...
June 12, 2018: Multimedia Manual of Cardiothoracic Surgery: MMCTS
Carl A Johnson, Juan A Siordia, Davida A Robinson, Peter A Knight
Bentall procedures are traditionally performed through a median sternotomy. However, minimally invasive approaches are increasingly being utilized. A right mini-thoracotomy approach may improve postoperative recovery.  A 5-cm mini-thoracotomy is performed in the right 2nd intercostal space. A camera port is placed lateral to this incision. Peripheral cannulation is performed. The ascending aorta is cross-clamped. Cardioplegia is administered and the patient is placed in deep hypothermic circulatory arrest to construct the distal aortic anastomosis...
May 18, 2018: Multimedia Manual of Cardiothoracic Surgery: MMCTS
Takashi Shirakawa, Masao Yoshitatsu, Yasushi Koyama, Hiroki Mizoguchi, Koichi Toda, Yoshiki Sawa
Surgical simulation devices can be helpful and cost-effective adjuncts to on-the-job training. In this tutorial we present our method for creating an aortic stenosis model with realistically fragile and crushable calcifications, using modern 3D-printing techniques.  The model can be used for training and surgical simulation and is an effective aid to learning for young cardiovascular surgeons.
May 14, 2018: Multimedia Manual of Cardiothoracic Surgery: MMCTS
Antonio Lio, Antonio Miceli, Matteo Ferrarini, Andrea Montisci, Mattia Glauber
The use of artificial polytetrafluoroethylene (PTFE) chordae has been widely adopted in the setting of mitral valve repair. In this tutorial, we present a modified technique for neochordae placement using a semi-rigid complete ring, with a chordal sizing system. This ring was introduced with the aim of standardizing neo-chordae implantation and we introduce a modification of the implantation technique in the presence of myxomatous leaflets.
May 8, 2018: Multimedia Manual of Cardiothoracic Surgery: MMCTS
Marek Jasinski, Scott Rankin
Approximately one-third of patients suffering from aortic insufficiency (AI) present also with an ascending aortic aneurysm. AI is most commonly due to a combination of sinotubular junction and annular dilatation. Valve reimplantation or prosthetic valve replacement may not be ideal for these patients, and ascending aortic aneurysm resection with aortic valve repair using geometric internal ring annuloplasty is a simple, successful, and reproducible alternative treatment approach. In this video tutorial we demonstrate aortic valve repair using the HAART 300 annuloplasty ring with concomitant ascending aorta replacement...
May 2, 2018: Multimedia Manual of Cardiothoracic Surgery: MMCTS
Raymond Pfister, Piergiorgio Tozzi, Roger Hullin, Patrick Yerly, Fritz-Patrick Jahns, René Prêtre, Matthias Kirsch
Left ventricular assist devices (LVADs) are currently the best alternative to cardiac transplantation for patients with end-stage heart failure (HF) as a bridge to transplant or to decision, or as destination therapy. Full median sternotomy or minimally invasive techniques are the more standard approaches used at present.  LVADs are usually implanted between the left ventricle apex and the ascending aorta. An implantation through a left thoracotomy with an outflow graft connected to the descending aorta is much less performed nowadays due to the longer times to extubation, higher incidence of postoperative pain, and poorer hemodynamics in the ascending aorta, which may lead to thrombosis...
April 25, 2018: Multimedia Manual of Cardiothoracic Surgery: MMCTS
Piotr Suwalski, Anna Witkowska
Atrial fibrillation, as the most prevalent arrhythmia, has more impact on morbidity and mortality than any other rhythm disorder. It is often concomitant with structural heart diseases like coronary artery disease. The worst complication of atrial fibrillation is stroke, but the double or triple antithrombotic therapy especially in fragile and elderly patients is associated with significant risk of bleeding. The left atrial appendage occlusion may reduse both the risk of stroke and drug intake. Here we present, to our knowledge, the first description of a simultaneous totally thoracoscopic 3D augmented coronary artery bypass grafting and left atrial appendage occlusion...
March 15, 2018: Multimedia Manual of Cardiothoracic Surgery: MMCTS
Christopher Lau, Mario Gaudino
The radial artery is a versatile bypass conduit that is being used with increasing frequency for an arterial coronary bypass strategy due to its excellent long-term patency and survival benefits. Open radial artery harvesting allows for careful dissection of the radial artery with minimal risk for endothelial damage, which helps to prevent vasospasm. Our technique for open radial artery harvesting and preparation is presented here.
March 6, 2018: Multimedia Manual of Cardiothoracic Surgery: MMCTS
Vishal Shah, Oleg Orlov, Cinthia Orlov, Manabu Takebe, Matthew Thomas, Konstadinos Plestis
Atrial fibrillation is associated with increased morbidity and mortality in patients undergoing mitral valve surgery. There is a growing consensus that patients with preexisting atrial fibrillation should undergo surgical ablation at the time of mitral valve surgery. Novel surgical ablation techniques, including cryoablation, have been developed to facilitate concurrent minimally invasive procedures. This video tutorial describes a combined cryo-maze procedure and mitral valve repair through an upper ministernotomy in a patient with long-standing persistent atrial fibrillation and severe mitral regurgitation...
March 5, 2018: Multimedia Manual of Cardiothoracic Surgery: MMCTS
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