Operative Techniques in Thoracic and Cardiovascular Surgery最新文献

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Surgical Technique of Donation after Circulatory Death using Normothermic Regional Perfusion

Q3 Medicine

Operative Techniques in Thoracic and Cardiovascular Surgery

Pub Date : 2024-12-01 DOI: 10.1053/j.optechstcvs.2024.06.001

Akshay Kumar MD , Syed T. Hussain MD , Michael Dorsey MD , Amit Alam MD , Nader Moazami MD , Deane Smith MD

Heart transplantation (HT) is the gold standard treatment of end-stage heart disease. Waitlist mortality remains high due to a shortage of available donor organs. Donation after circulatory death (DCD) has shown potential to increase transplant volumes by 15%-20%. Resuscitation of the organs after circulatory death can be performed ex vivo using machine perfusion or in situ using either extracorporeal membrane oxygenation (ECMO) or cardiopulmonary bypass (CPB). Thoracoabdominal normothermic regional perfusion (TA-NRP) entails reperfusing the heart in-situ after circulatory death. It also involves total body reperfusion under physiological conditions, correction of metabolic abnormalities, and allows unloading of the left ventricle to facilitate myocardial recovery. After weaning off support, direct visual and hemodynamic assessment of heart function is possible. Safe and expeditious establishment of cardiopulmonary bypass after death is the key to success of this technique. Here, we review the history of donation after circulatory death, our protocol and surgical technique of establishing TA-NRP with cold static preservation, and briefly describe the outcomes after DCD heart transplantation.

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引用次数: 0

Modified Aortic Arch Reconstruction Combined With Pulmonary Artery Reconstruction in the Comprehensive Stage II Operation Following a Hybrid Stage I for Hypoplastic Left Heart Syndrome 左心发育不全综合征混合Ⅰ期手术后综合Ⅱ期手术中的改良主动脉弓重建术与肺动脉重建术相结合

Q3 Medicine

Operative Techniques in Thoracic and Cardiovascular Surgery

Pub Date : 2024-12-01 DOI: 10.1053/j.optechstcvs.2023.11.001

Takaaki Suzuki MD, Kentaro Hotoda MD

The hybrid approach for hypoplastic left heart syndrome is a well-accepted alternative strategy to the conventional staged surgical approach. However, in the typical comprehensive stage II operation, bilateral branch pulmonary artery stenosis is a risk factor for postoperative catheter and/or surgical interventions. In addition to addressing the stenosis from the bands, the branch pulmonary arteries are at risk of compression from the dilated main pulmonary trunk and the resultant large neo-aorta. Here, we present a new aortic arch reconstruction technique combined with the pulmonary artery reconstruction in the comprehensive stage II operation to address these issues. In our experience of 11 patients who underwent hybrid strategy, Fontan completion was achieved in 8 cases (73%) during a median follow-up duration of 84 months (range; 45-161 months), and the 3-year, 5-year, and 10-year survival rates were 73% each. While 6 of 8 cases (75%) required catheter interventions to the branch pulmonary arteries, the Nakata Index was 204 ± 11 before the stage II and 185 ± 19 before Fontan completion, indicating that good pulmonary artery growth. Our modified comprehensive stage II technique optimizes the pulmonary arteries for the Fontan and beyond by addressing both anatomic stenoses and external compression for future growth.

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引用次数: 0

Senning Procedure: Use of a 3D Printed, Silicone Molded Model for Surgical Training

Q3 Medicine

Operative Techniques in Thoracic and Cardiovascular Surgery

Pub Date : 2024-12-01 DOI: 10.1053/j.optechstcvs.2024.02.002

David J. Barron FRCS , Ankavipar Saprungruang MD , Shi-Joon Yoo MD

The atrial switch is a technically complex procedure that requires considerable judgement and appreciation of the 3-dimensional anatomy of the heart. It is now rarely performed other than as part of the double-switch procedures for congenitally corrected transposition (ccTGA). Silicone molded models based on 3D printed hearts are the latest, and most realistic simulation models for practicing and training in congenital heart surgery and the atrial switch is an ideal substrate since the procedure is difficult to teach and rarely performed. The Senning procedure has become the most widely used type of atrial switch as it is associated with the best long-term outcomes and freedom from baffle obstructions or leaks.

引用次数: 0

Introduction to Winter 2024

Q3 Medicine

Operative Techniques in Thoracic and Cardiovascular Surgery

Pub Date : 2024-12-01 DOI: 10.1053/j.optechstcvs.2024.11.001

引用次数: 0

Operative management of a difficult problem: Cervical esophagogastric anastomotic stricture

Q3 Medicine

Operative Techniques in Thoracic and Cardiovascular Surgery

Pub Date : 2024-12-01 DOI: 10.1053/j.optechstcvs.2024.06.002

Mai G. Al Khadem MBBCh , Arvind Krishnamurthy MS. MCh , Puja Gaur Khaitan MD, FACS

Cervical esophagogastric anastomotic stricture is a vexing problem both for the patient and the treating surgeon. Given the location of the anastomosis at the thoracic inlet and its proximity to vocal cords and upper esophageal sphincter, management of such a stricture can be challenging. In this comprehensive review, we will first discuss the various endoscopic options that are available for the management of such strictures such as dilation, topical injections, electrocautery incision, and stenting. However, the focus of our chapter is to discuss surgical options for those patients who develop strictures or fistulae that are refractory to endoscopic management and require operative intervention. Surgical options including cervical esophageal reconstruction such as strictureplasty and myocutaneous flaps, as well as alternative conduits will therefore be highlighted. Finally, we will discuss and review the data that potentially explains how to avoid such anastomotic strictures.

引用次数: 0

Recent Articles in AATS Journals

Q3 Medicine

Operative Techniques in Thoracic and Cardiovascular Surgery

Pub Date : 2024-12-01 DOI: 10.1053/j.optechstcvs.2024.10.001

引用次数: 0

Modified Aortic Valve Neocuspidization (Ozaki AVNeo) Procedure

Q3 Medicine

Operative Techniques in Thoracic and Cardiovascular Surgery

Pub Date : 2024-12-01 DOI: 10.1053/j.optechstcvs.2024.07.004

Leah Bourgan BS , Teimour Nasirov MD , Olaf Reinhartz MD , Danny Chu MD

There is a substantial need for interventions to replace or repair diseased aortic valves. As an alternative to conventional replacement with prostheses, we illustrate a modified technique of aortic valve neocuspidization (AVNeo).

The procedure includes harvesting of autologous pericardium and cutting it into shapes analogous to the patient's aortic valve cusps to create neocusps. The native cusps are then resected and replaced with the neocusps. We highlight details of how to create, size, and attach the autologous cusps to ensure efficacy and durability.

The AVNeo technique offers abundant advantages to standard aortic valve treatments. The technique is versatile and can be applied in the treatment of essentially all underlying aortic valve pathologies, whether congenital, rheumatic, degenerative, or infectious in etiology. AVNeo appears to be suitable in the growing annuli of children. The technique avoids foreign material and its drawbacks, like stiffness of the annulus and the need for anticoagulation. Though it leads to superior hemodynamic performance and low intervention rates in the short and medium term, long term durability has yet to be proven.

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引用次数: 0

Approach to Severe Mitral Annular Calcification Using Ultrasonic Aspiration

Q3 Medicine

Operative Techniques in Thoracic and Cardiovascular Surgery

Pub Date : 2024-12-01 DOI: 10.1053/j.optechstcvs.2024.05.004

Nicholas J. Goel MD, Mauer Biscotti III MD, Michael A. Catalano MD, Michael A. Acker MD

Severe mitral annular calcification (MAC) is perhaps the greatest challenge faced in mitral valve surgery. Valve replacement in the setting of severe MAC carries with it the risk of numerous surgical complications and modes of technical failure, including catastrophic atrioventricular (AV) groove disruption. In the face of these challenges, a variety of surgical approaches to severe MAC have been described but without clear consensus. We describe an approach using the Cavitron Ultrasonic Surgical Aspirator (CUSA) emphasizing minimal, focal disruption of annular calcium. Ultrasonic aspiration is applied only when needed and only at the precise site of valve suture placement to aspirate away or merely soften dense calcium such that sutures can be placed through or around the calcified annulus. Our approach is simple and eliminates the need for complete annular decalcification which risks avoidable AV groove destabilization and requires complex annular reconstruction. In our experience of 55 cases of high-risk mitral replacement in the setting of very severe MAC, we report 2 cases of AV groove disruption (4%), 2 cases of coronary injury (4%), and 2 cases of stroke (4%), with no cases of paravalvular leak worse than mild. In-hospital mortality was 16%, due largely to significant underlying cardiac and non-cardiac comorbidity and underscoring the often underestimated nontechnical risks inherent in these cases. While no single approach may be optimal in every case of severe MAC, we feel our technique of limited ultrasonic aspiration is an important tool in the mitral surgeon's armamentarium.

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引用次数: 0

Reply: “Samurai Cannulation for Acute Stanford Type A Aortic Dissection” 回复："Samurai 插管术治疗急性斯坦福 A 型主动脉夹层

Q3 Medicine

Operative Techniques in Thoracic and Cardiovascular Surgery

Pub Date : 2024-09-01 DOI: 10.1053/j.optechstcvs.2024.03.003

引用次数: 0

Modified Starnes Procedure With Patch Occlusion of the Main Pulmonary Artery and Other Technical Modifications to Facilitate Subsequent Biventricular Repair of Ebstein Anomaly 修改后的 Starnes 手术，采用补片闭塞主肺动脉和其他技术修改，以促进随后的双心室埃布斯坦畸形修补术。

Q3 Medicine

Operative Techniques in Thoracic and Cardiovascular Surgery

Pub Date : 2024-09-01 DOI: 10.1053/j.optechstcvs.2023.12.005

The Starnes procedure, introduced in 1991, has been a valuable advancement in the surgical treatment of critically ill neonates with Ebstein's anomaly (EA). However, it used to be followed by the single ventricle pathway, which presents long-term outcome limitations. In 2019, this management concept was modified by taking down the Starnes procedure and performing the Cone repair of the tricuspid valve, which resulted in a biventricular reconstruction. This approach rehabilitates the right ventricle, likely improving the patients' long-term outcomes. However, it requires modifications in the classical Starnes operation and observing certain surgical details. In cases of circular shunt, we use a patch to occlude the pulmonary artery instead of dividing and oversewing it, simplifying the succeeding pulmonary artery reconstruction. Regarding the tricuspid valve we use a PTFE fenestrated patch placed in a supra-valvar position, preserving the underneath valve integrity, facilitating the tricuspid valve repair, and decreasing the possibility of heart block.

1991 年推出的 Starnes 手术是埃布斯坦氏畸形（EA）重症新生儿外科治疗的一大进步。然而，该手术一直沿用单心室路径，这带来了长期疗效的局限性。2019年，这一管理理念得到了修正，取消了Starnes手术，并对三尖瓣进行了锥体修复，从而实现了双心室重建。这种方法可修复右心室，从而改善患者的长期预后。不过，这需要对经典的 Starnes 手术进行修改，并注意某些手术细节。在环形分流的病例中，我们使用补片闭塞肺动脉，而不是分割和覆盖肺动脉，从而简化了后续的肺动脉重建。至于三尖瓣，我们使用的是瓣上位置的聚四氟乙烯（PTFE）瓣膜补片，这样可以保持瓣膜下方的完整性，方便三尖瓣修复，并降低心脏传导阻滞的可能性。

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