Operative Techniques in Thoracic and Cardiovascular Surgery最新文献

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.

Per oral endoscopic myotomy is an endoscopic procedure that accesses the potential third space of the esophageal wall—the submucosa—to perform a myotomy of the distal esophagus and gastroesophageal junction. This article describes the series of steps along with tips and suggested solutions to performing a POEM in patients with achalasia.

Durable mechanical circulatory support options for patients with biventricular failure are limited. One emerging strategy is the use of 2 fully magnetically levitated durable ventricular assist devices (HeartMate 3s) in a biventricular configuration. The use of a HeartMate 3 as a right ventricular assist device (RVAD) requires several complex technical modifications. Here, we provide step-wise detailed figures and a comprehensive description of bilateral HeartMate 3 insertion, with a particular focus on right atrial inflow cannulation for the RVAD. Potential pitfalls and solutions are also described.

Ebstein anomaly (EA) is a congenital heart disease, which main feature is the rotational displacement of the tricuspid valve (TV) into the right ventricle (RV). Tricuspid regurgitation and RV dysfunction are common findings. The Cone procedure is a well-recognized technique for anatomical repair of EA. The basic principles of Cone repair are mobilization of all available TV leaflets and construction of a cone-like valve that is reattached to the normal atrioventricular junction. Since creation of the technique in 1993, we have introduced many technical refinements to improve TV performance, prevent cardiac arrhythmias, and improve RV function. Here, we provide some surgical details to avoid atrioventricular block and coronary compromise, facilitate patient recovery, and provide sustainable long-term results. From 2016, we have applied these refinements to 110 consecutive patients at our institution, including those with previous Starnes procedure or valve replacement, resulting in no mortality, very low morbidity, and excellent valve function.

Surgical management of critically ill neonates with Ebstein anomaly (EA) remains challenging with most published hospital and 1-year mortalities approximating 30%-40% irrespective of the surgical or palliative strategy. We have adopted an initial bi-ventricular repair strategy for most symptomatic neonates and young infants since 1994 and sought to identify whether our simplified tricuspid valve repair will be associated with improved outcome by a wider audience of experienced surgeons. The essential principles of the repair include (i) monocusp tricuspid valve repair based on the anterior leaflet, (ii) fenestrated ASD closure), (iii) repair of all associated cardiac defects, and (iv) reduction right atrioplasty. The technique of tricuspid valve repair depicted in the following figures was associated with a 100% 1-year survival for the most recent 6 years (n = 9).