Operative Techniques in Thoracic and Cardiovascular Surgery最新文献

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Reconstruction of the Sternum, Manubrium, and Sternoclavicular Joints With Cadaveric Femur: A Novel Approach 用尸体股骨重建胸骨、柄骨和胸锁关节：一种新方法

Q3 Medicine

Operative Techniques in Thoracic and Cardiovascular Surgery

Pub Date : 2025-06-01 DOI: 10.1053/j.optechstcvs.2025.01.001

Sadia Tasnim MD , Nathan W. Mesko MD , Daniel P. Raymond MD

Objective: To describe a novel sternal and sterno-clavicular joint reconstruction technique using cadaveric femoral allograft. Case Description: A 58-year-old male presented with 14.8 cm Grade 1 sternal chondrosarcoma requiring extensive resection and reconstruction. The goal was to create a semi-rigid reconstruction preserving some mobility of the sternoclavicular joint for optimal patient quality of life. After appropriate oncologic resection, a cadaveric femur was fashioned into a neo-sternal profile and anchored to the clavicles and residual basilar sternum using multiple fixation techniques which are discussed below. The final prosthesis was covered by bilateral pectoralis muscle flaps. The patient had an uneventful postoperative course. On 16 months follow-up, the patient was able to carry out normal activities including work, and self-care, with no evidence of graft failure, fracture, and infections and good cosmetic outcome. Conclusions: We have successfully performed a semi-rigid sternal and sternoclavicular joint reconstruction for large, low-grade chondrosarcoma using bio-prosthesis with good short-term patient outcomes and preservation of functionality. Multidisciplinary care is essential for the performance of such complex chest wall reconstructions. Longer-term follow-up will be necessary to determine the durability of the construct over time.

目的：介绍一种利用尸体股骨异体移植重建胸骨和胸骨锁骨关节的新技术。病例描述：一名58岁男性，患14.8厘米的1级胸骨软骨肉瘤，需要广泛切除和重建。目的是建立半刚性重建，保留胸锁关节的一些活动能力，以获得最佳的患者生活质量。在适当的肿瘤切除后，将尸体股骨塑成新胸骨轮廓，并使用多种固定技术将其固定在锁骨和残余的基底胸骨上。最终假体由双侧胸肌瓣覆盖。病人的术后过程平安无事。在16个月的随访中，患者能够进行正常的活动，包括工作和自我护理，无移植物衰竭、骨折和感染的迹象，美容效果良好。结论：我们成功地使用生物假体对大型低级别软骨肉瘤进行了半刚性胸骨和胸锁骨关节重建，患者短期预后良好，功能保存良好。多学科的护理对这种复杂的胸壁重建术至关重要。长期随访将是必要的，以确定建设的耐久性随着时间的推移。

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引用次数: 0

Introduction to Summer 2025 夏季2025简介

Q3 Medicine

Operative Techniques in Thoracic and Cardiovascular Surgery

Pub Date : 2025-06-01 DOI: 10.1053/j.optechstcvs.2025.06.001

引用次数: 0

Modified Horizontal Right Mini-Thoracotomy for Pediatric Congenital Heart Surgery 改良水平右小开胸在小儿先心病手术中的应用

Q3 Medicine

Operative Techniques in Thoracic and Cardiovascular Surgery

Pub Date : 2025-06-01 DOI: 10.1053/j.optechstcvs.2024.11.003

Hannah E. Neiger MS , Naruhito Watanabe MD , Teimour Nasirov MD, MBA

Classically, pediatric cardiac surgery repairs relied on the median sternotomy for optimal access and visualization of the heart and relevant anatomy. In recent years minimally invasive approaches have developed to reduce recovery times, postoperative complications, and cosmesis in pediatric cardiac surgery patients. The horizonal right mini thoracotomy provides an alternative method of access into the thorax that leaves behind a significantly reduced scar, and when paired with operative visualization techniques we discuss here, does not sacrifice the surgeon's view of critical anatomical structures. In this discussion, we describe this technique exercised in cases of several pediatric cardiac embryonic anomalies including the repairs of ASD, VSD, partial AV canal, and PAPVR.

传统的儿科心脏手术修复依赖于胸骨正中切开术，以获得最佳的通道和心脏及相关解剖的可视化。近年来，微创方法的发展减少了儿童心脏手术患者的恢复时间、术后并发症和美容。水平右小开胸术提供了另一种进入胸腔的方法，留下了显著减少的疤痕，当与我们在这里讨论的手术可视化技术相结合时，不会牺牲外科医生对关键解剖结构的观察。在这个讨论中，我们描述了这种技术在几个儿科心脏胚胎异常的情况下的应用，包括ASD、VSD、部分房室管和PAPVR的修复。

引用次数: 0

Commentary: Breaking Barriers in Sternal Reconstruction With Allograft Innovation 评论：用同种异体骨移植创新打破胸骨重建的障碍

Q3 Medicine

Operative Techniques in Thoracic and Cardiovascular Surgery

Pub Date : 2025-06-01 DOI: 10.1053/j.optechstcvs.2025.04.002

Alberto Antonicelli MD , Bryan M. Burt MD, FACS

引用次数: 0

Brain First: Carotid Artery Access for Cerebral and Arterial Perfusion in Complex Aortic Surgery 脑优先：颈动脉通路在复杂主动脉手术中的脑和动脉灌注

Q3 Medicine

Operative Techniques in Thoracic and Cardiovascular Surgery

Pub Date : 2025-06-01 DOI: 10.1053/j.optechstcvs.2024.09.002

Jaishankar Raman MBBS, MMed, FRACS, PhD , Pankaj Saxena MBBS, MCh, FRACS, PhD , Bashi V. Velayudhan MBBS, MS, MCh , Shiv Choudhary MBBS, MS, MCh

The common carotid artery (CCA) is an easily accessible means of providing cerebral and systemic perfusion during complex aortic surgery. Our technique for using CCA perfusion through a graft sutured to the right common carotid artery is described with a brief overview of experience.

在复杂的主动脉手术中，颈总动脉（CCA）是提供大脑和全身灌注的一种容易接近的方法。我们的技术使用CCA灌注通过一个移植物缝合到右颈总动脉简要概述了经验。

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Aortic Annular Enlargement with Y-Incision/Rectangular Patch: Tips and Pitfalls 用y形切口/矩形补片扩大主动脉环：提示和缺陷

Q3 Medicine

Operative Techniques in Thoracic and Cardiovascular Surgery

Pub Date : 2025-06-01 DOI: 10.1053/j.optechstcvs.2024.07.005

Alexander A. Brescia MD, MSc , Sarah A. Chen MD, MA , Katelyn Monaghan BS , Bo Yang MD, PhD

The Y-incision/rectangular patch aortic annular enlargement (Y-incision AAE) was developed in August 2020 as a simple, reproducible, and effective approach for annular enlargement. The goal of the Y-incision AAE is to enlarge the crown-shaped surgical aortic annulus and root to accommodate a larger valve with an orifice that matches the diameter of the patient's basal ring. A complete or partial transverse aortotomy is performed 2.0 cm above the sinotubular junction anteriorly. A Y-incision is made through the left-non commissure onto the aortomitral curtain, extending underneath the crown-shaped surgical aortic annulus into the left and right fibrous trigones. A rectangular patch is sewn to the aortomitral curtain from trigone to trigone, and aortic annulus on both sides. A valve sizer touches all 3 nadirs of the aortic annulus to size the prosthesis. Nonpledgetted 2-0 Ethibond valve sutures are placed in a noneverting fashion. The valve sutures are divided by 3 and distributed evenly to each cusp of the sewing ring after aligning 1 valve strut at the left-right commissure. After the prosthesis is tied down, A 2-3 cm longitudinal aortotomy is performed in the posterior side of the proximal ascending aorta. The patch is trimmed to a triangular shape at distal end and incorporated into the longitudinal aortotomy for the aortic closure while enlarging the sinotubular junction and proximal ascending aorta. The simple and reproducible Y-incision AAE technique upsizes 3-4 valve sizes to achieve optimal hemodynamics and durability while also preparing patients for the next intervention in the lifetime management of aortic valve disease.

y切口/矩形补片主动脉环扩大术（y切口AAE）于2020年8月被开发出来，是一种简单、可重复、有效的主动脉环扩大方法。y切口AAE的目的是扩大冠状手术主动脉环和根部，以容纳一个更大的瓣膜，该瓣膜带有与患者基环直径相匹配的孔。在窦管连接处前方2.0 cm处行完全或部分横断主动脉。通过左侧非接合处在主动脉二尖瓣幕上做一个y形切口，在冠状手术主动脉环下延伸至左右纤维三角区。从三角区到三角区，在主动脉二尖瓣幕布和两侧的主动脉环上缝合一个长方形的补片。瓣膜尺寸测量仪触摸主动脉环的所有3个底部来确定假体的尺寸。无质押2-0瓣膜缝合线采用无质押方式。在左右接合处对齐1个瓣膜支柱后，将瓣膜缝线分成3个，均匀分布到缝合环的每个尖端。固定假体后，在近端升主动脉后侧行纵2- 3cm主动脉切开术。在远端将补片修剪成三角形，并纳入纵向主动脉切开术，用于主动脉关闭，同时扩大窦小管交界处和近端升主动脉。简单且可重复的y切口AAE技术可扩大3-4个瓣膜大小，以达到最佳的血流动力学和耐久性，同时也为患者在主动脉瓣疾病的终身管理中进行下一次干预做好准备。

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引用次数: 0

Surgical Implantation of Melody Valve in Mitral Position in Infants and Small Children: Toronto SickKids Method 婴儿和儿童二尖瓣位置的外科植入：多伦多病童方法

Q3 Medicine

Operative Techniques in Thoracic and Cardiovascular Surgery

Pub Date : 2025-06-01 DOI: 10.1053/j.optechstcvs.2024.11.002

Osami Honjo MD, PhD , Mimi X. Deng MD

In infants and small children with critical mitral valve disease nonamenable to repair is a high-risk population with high mortality after mechanical mitral valve replacement (MVR). Placement of the Melody™ valve (Medtronic, Minneapolis, MN, USA) in the mitral position has emerged as a palliative surgical strategy that provides time for somatic growth, until mechanical MVR becomes an appropriate option. Advantages of the Melody valve include its excellent early hemodynamics, no necessary extensive anticoagulation, and relative ease of implantation. Valve sizing is determined by preoperative echocardiography and intraoperative Hegar insertion. Toronto Melody valve modification includes a polytetrafluoroethylene skirt for anchoring to the mitral annulus and a large wedge resection of the stent to prevent left ventricular outflow tract obstruction. Once implanted and tied in standard fashion to conventional MVR, serial balloon dilations are performed to ensure that the valve is well expanded along the length of the stent. Left atrial augmentation may be required to ensure the valve is not obstructing pulmonary vein orifices. Our experience suggests that close surveillance for structural valve deterioration is imperative beyond 2-years post-implantation. In summary, the Melody valve is a safe and efficient temporizing strategy for infants requiring MVR.

不能修复的危重二尖瓣疾病的婴幼儿是机械二尖瓣置换术（MVR）后死亡率高的高危人群。在二尖瓣位置放置Melody™瓣膜（Medtronic, Minneapolis， MN， USA）已成为一种姑息性手术策略，为躯体生长提供时间，直到机械MVR成为合适的选择。梅洛迪瓣膜的优点包括其良好的早期血流动力学，不需要广泛的抗凝，相对容易植入。通过术前超声心动图和术中Hegar插入确定瓣膜大小。多伦多梅洛蒂瓣膜改良包括聚四氟乙烯支架固定在二尖瓣环和大楔形切除支架以防止左心室流出道阻塞。一旦植入并以标准方式捆绑到传统的MVR上，就需要进行一系列球囊扩张，以确保瓣膜沿着支架的长度得到良好的扩张。可能需要左心房增强术以确保瓣膜不阻塞肺静脉口。我们的经验表明，在植入术后2年内密切监测瓣膜结构恶化是必要的。综上所述，梅洛迪瓣膜对于需要MVR的婴儿是一种安全有效的延迟策略。

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引用次数: 0

Adult Articles in AATS Journals 成人文章在AATS期刊

Q3 Medicine

Operative Techniques in Thoracic and Cardiovascular Surgery

Pub Date : 2025-06-01 DOI: 10.1053/j.optechstcvs.2025.05.001

引用次数: 0

The Ventricular Switch Procedure Atlas: Adopting the Right Ventricle for the Systemic Circulation 心室开关程序图集：采用右心室进行体循环

Q3 Medicine

Operative Techniques in Thoracic and Cardiovascular Surgery

Pub Date : 2025-06-01 DOI: 10.1053/j.optechstcvs.2024.07.007

Hani K. Najm MD, MSc, Munir Ahmad MD, John P. Costello MD, Tara Karamlou MD, MSc

Patients born with complex heterotaxy syndromes and patients with complex intra-cardiac connections are generally routed to univentricular pathways. This subgroup of patients typically carries poor long-term prognosis due to the frequent presence of unpartitioned atrioventricular valve and other morphological determinants that are associated with univentricular failure. Adopting the left ventricle in the systemic circulation would be the ideal choice if achievable. However, the presence of complex venous or arterial connections may make this infeasible. To overcome these limitations, we have introduced the concept of the “Ventricular Switch Procedure” (VSP) wherein the right ventricle is harnessed to serve as the systemic ventricle, while utilizing the left ventricle for the subpulmonary ventricle. The VSP paradigm offers prospect of a either a one-and-a-half or biventricular circulation for these patients. Here, we present 4 examples of complex congenital cardiac malformations and their surgical management to exemplify the principles of this surgical concept and illustrate how different techniques may be employed to achieve a right ventricle-based biventricular circulation.

先天性复杂异位综合征和心脏内连接复杂的患者通常会进入单室通路。由于房室瓣不分割和其他与单心室衰竭相关的形态学决定因素的存在，这类患者通常具有较差的长期预后。如果可行，在体循环中采用左心室将是理想的选择。然而，复杂的静脉或动脉连接的存在可能使这种方法不可行。为了克服这些限制，我们引入了“心室转换程序”（VSP）的概念，其中利用右心室作为系统心室，同时利用左心室作为肺下心室。VSP模式为这些患者提供了一个半或双心室循环的前景。在这里，我们提出了4例复杂的先天性心脏畸形及其外科治疗的例子，以举例说明这种外科概念的原则，并说明如何使用不同的技术来实现以右心室为基础的双心室循环。

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引用次数: 0

Valve Sparing Root Replacement in Acute Type A Dissection 保留瓣膜根置换术治疗急性A型夹层

Q3 Medicine

Operative Techniques in Thoracic and Cardiovascular Surgery

Pub Date : 2025-05-20 DOI: 10.1053/j.optechstcvs.2025.04.001

Alexander P. Nissen MD, Bradley G. Leshnower MD

Acute Type A aortic dissection (ATAAD) remains a life-threatening diagnosis, requiring rapid diagnosis and surgical management for optimal outcomes. In many cases, whether due to root aneurysm or destruction by the dissection process, aortic root replacement is required for complete repair, and to ensure adequate aortic valve competency. While the reimplantation technique for valve sparing root replacement (VSRR) was originally conceived for treating aneurysmal, nondissected, isolated root pathology, expertise with this procedure has led to expansion of indications and application to include bicuspid aortopathy, cases requiring complex aortic valve repair, and ATAAD in well-selected patients at high volume centers. Here we outline our operative technique for the application of VSRR in ATAAD.

急性A型主动脉夹层（ATAAD）仍然是一种危及生命的诊断，需要快速诊断和手术治疗才能获得最佳结果。在许多情况下，无论是由于根部动脉瘤还是由于剥离过程的破坏，主动脉根部置换都需要完全修复，并确保足够的主动脉瓣功能。虽然瓣膜保留根置换术（VSRR）的再植技术最初是用于治疗动脉瘤性、非解剖性、孤立性根病理学，但该技术的专业知识已导致适应症和应用范围的扩大，包括双尖主动脉病变、需要复杂主动脉瓣修复的病例，以及在高容量中心精心选择的患者的ATAAD。本文概述了VSRR在ATAAD中应用的手术技术。

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Operative Techniques in Thoracic and Cardiovascular Surgery

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