Journal of Visualized Surgery

Transcatheter aortic valve replacement (TAVR) has emerged as a viable, minimally-invasive and widely adopted approach for the treatment of severe symptomatic aortic stenosis in patients who are intermediate-risk or greater for surgical aortic valve replacement. Numerous studies have demonstrated favorable outcomes with TAVR in this population, particularly with transfemoral access TAVR. Transfemoral TAVR has been shown to be safer and associated less morbidity, shorter lengths of hospital stay and more rapid recovery as compared with traditional thoracic alternative-access TAVR (transapical or transaortic)...

Background: Bicuspid aortic valve (BAV) is a common cardiac anomaly that affects 0.5-2% of adults. Valve sparing root replacement (VSRR) in bicuspid aortopathy is gaining popularity. We discuss the technical aspects of the procedure as well as the mid- to long-term results of performing VSRR in the setting of a bicuspid valve. Methods: A single institutional database identified 280 patients who underwent VSRR from 2005-2016. Outcomes were analyzed in 60 consecutive patients undergoing a VSRR in the setting of a BAV with aortic regurgitation (AR)...

The continuous evolution in robotic-, endoscopic- and trans-catheter cardiac interventions resulted in innovative techniques that simultaneously address left ventricular outflow tract obstruction (LVOTO) and concomitant atrioventricular valve (AVV) pathology in the context of hypertrophic obstructive cardiomyopathy (HOCM). We present our brief report of 13 consecutive HOCM patients with concomitant AVV disease, who underwent endoscopic left ventricular septal myomectomy (LVSM) and AVV surgery by Endoscopic Port AccessTM Surgery (EPAS) between March 1st 2010 and October 31st 2015...

A 23-year-old man presented with acute onset of dyspnea on exert. Preoperative echocardiography showed a severe regurgitation of the bicuspid aortic valve (due to prolapse of the fused cusp) creating a jet directed through the defect in the anterior leaflet of the mitral valve. Both valves were repaired. Endocarditis was excluded with cultures and polymerase chain reaction (PCR). Postoperative course was uneventful.

Background: Biologic valved-conduits avoids the need for anticoagulation and can exploit the excellent hemodynamic performance of stentless valves. Incorporation of the sinuses of Valsalva into the neoaortic root can improve the function and longevity of stentless valves. We report our experience in performing the Bentall procedure with a self-prefabricated composite valved-conduit and review the published experience with the Valsalva graft. Methods: From Feb 2005 through Sep 2017, 428 patients underwent aortic root replacement utilizing a composite graft constructed from a 27-29-mm Freestyle MS valve (Medtronic) sutured into a 28-30-mm Gelweave Valsalva prosthesis (Sulzer Vascutek, Renfrewshire, Scotland)...

No abstract text is available yet for this article.

No abstract text is available yet for this article.

Valve-sparing aortic root replacement (VSRR) with reimplantation technique is an effective alternative for young patients with dilated roots and preserved cusps, which avoids the risks of lifelong anticoagulation or valve degeneration. New grafts with anatomically-shaped sinuses have been developed in order to preserve aortic root physiology, which could decrease complication rates and improve durability. However, controversy remains regarding the effect of recreation of the sinuses of Valsalva during VSRR on long-term outcomes...

Composite valve graft implantation described by Bentall and De Bono is a well-documented technique of aortic root replacement used for a large spectrum of pathologic conditions involving the aortic valve and the ascending aorta. While mechanical valves were initially used, biological prostheses were later introduced in order to avoid long-term anticoagulation and its related complications. The increasing age of patients who undergo aortic root surgery, and data supporting the use of a biological aortic valve in the younger population, have significantly increased the need for a composite biological valved conduit...

We present an alternative treatment to resolve lower gastrointestinal bleeding by the application of FloSeal, a haemostatic matrix. Fundamentally, the treatment consists of inserting the tube containing the Sengstaken-Blakemore probe impregnated with FloSeal into the rectum-sigma. This procedure is simple, easy to reproduce and can be very useful to control bleeding in the last section of the gastrointestinal tract.

Thoracic endovascular aortic repair (TEVAR) of the ascending aorta is a developing alternative treatment strategy, which currently is specifically aimed at patients who are too high risk for open surgery. TEVAR has been applied to patients with a variety of pathologies of the ascending aorta including type A dissection, intramural hematoma (IMH), penetrating ulcers, aneurysm and pseudoaneurysm. Here we discuss the current evidence regarding the use of TEVAR for the ascending aorta as well as the latest techniques and pitfalls of the procedure...

No abstract text is available yet for this article.

Aortic valve surgery has been undergone continuous development over the last years, involving less invasive techniques and the use of new technologies to reduce the traumatic impact of the intervention and extend the operability toward increasingly high-risk patients. Minimally invasive aortic valve replacement (AVR) has gradually been recognized as a less traumatic technique compared to median sternotomy, becoming first choice approach in numerous experienced centers. Herein we present our multidisciplinary minimally invasive approach for AVR, involving: (I) reduced chest incision; (II) rapid deployment AVR; (III) minimally invasive extracorporeal circulation system; and (IV) ultra fast track (UFT) anaesthetic management...

No abstract text is available yet for this article.

Parathyroid cysts (PCs) are relatively rare entities, with an even smaller proportion that functionally produce parathyroid hormone (PTH). Given associated hypercalcemia, often symptomatic, as well as potentially related osteoporosis and/or nephrolithiasis, resection of these functional cysts is often indicated. This case report details the management course for a patient who presented with primary hyperparathyroidism and was ultimately found to have a functional intrathymic PC. During initial workup, 4-dimensional computed tomography (4D-CT) of the neck demonstrated enlarged left upper and right lower parathyroid glands; however, the patient's hyperparathyroid state persisted even after bilateral neck exploration and resection of these two glands...

Aortic stenosis has traditionally been addressed with surgical aortic valve replacement (AVR). In recent years, several technologies have emerged as alternative treatment methods for aortic valve disease. Among them, the Perceval (LivaNova, London, UK) is a sutureless valve that has been used in clinical practice for over 10 years. It has been implanted in over 20,000 patients worldwide. With nearly 600 Perceval implants since 2011, the Montreal Heart Institute has developed a worldwide expertise with this technology...

No abstract text is available yet for this article.

Minimally invasive surgery (MIS) in thoracic surgery became quite popular during the last years. The aim of introducing and performing more MIS is to reduce surgical trauma, pain and complications in patients. Training in MIS increases operative time and thus cost in theatre but thus improves with experience. For a resident, the cases should be well selected with experienced supervision in a suitable setting with supporting staff and optimal instruments. Understanding the anatomy of the lung, using simulators, and attending workshops makes the learning curve shorter...

Lung carcinoid tumours constitute approximately 1-2% of all pulmonary tumours. They are derived from enterochromaffin cells, which are also known as 'Kulchitsky cells' and generally have indolent growth and development patterns. Carcinoid tumours are categorized as typical or atypical, depending on the number of mitoses per high power field and the presence of necrosis. In terms of management, surgical resection has been recognized to be the standard treatment for pulmonary carcinoid tumours. To our knowledge, the da Vinci system and robotic surgery have not been applied in sleeve lobectomies and bronchoplasty for the removal of carcinoid tumours in the United Kingdom...

No abstract text is available yet for this article.