Operative Techniques in Thoracic and Cardiovascular Surgery最新文献

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Modified Aortic Valve Neocuspidization (Ozaki AVNeo) Procedure 改良主动脉瓣新瓣化（Ozaki AVNeo）手术

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.

病变主动脉瓣的置换或修复是非常必要的。作为传统假体置换的替代方案，我们介绍了一种改良的主动脉瓣新瓣置换术（AVNeo）技术。手术过程包括获取自体心包，并将其切割成类似于患者主动脉瓣尖的形状，以形成新的心包。然后切除原尖并用新尖代替。我们强调了如何创建、大小和连接自体尖端的细节，以确保疗效和耐用性。与标准主动脉瓣治疗相比，AVNeo技术有很多优点。该技术是通用的，基本上可以应用于治疗所有潜在的主动脉瓣病变，无论是先天性、风湿性、退行性或感染性病因。AVNeo似乎适用于正在生长的儿童环空。该技术避免了异物及其缺点，如环的刚度和抗凝的需要。虽然它在中短期内具有优越的血流动力学性能和较低的干预率，但其长期耐久性尚未得到证实。

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引用次数: 0

Approach to Severe Mitral Annular Calcification Using Ultrasonic Aspiration 超声抽吸治疗严重二尖瓣环钙化的方法

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.

严重的二尖瓣环钙化（MAC）可能是二尖瓣手术面临的最大挑战。在严重MAC的情况下，瓣膜置换术会带来许多手术并发症和技术失败的风险，包括灾难性的房室（AV）沟破坏。面对这些挑战，对严重MAC的各种手术入路进行了描述，但没有明确的共识。我们描述了一种使用空腔超声手术吸引器（CUSA）的方法，强调最小的、局部的环钙破坏。超声抽吸仅在需要时使用，并且仅在瓣膜缝线放置的精确位置抽吸掉或仅软化致密钙，以便缝合线可以穿过或围绕钙化环放置。我们的方法简单，不需要完全的环空脱钙，这有可能导致可避免的房室沟不稳定，并且需要复杂的环空重建。在我们55例非常严重MAC的高危二尖瓣置换术中，我们报告了2例房室沟破裂（4%），2例冠状动脉损伤（4%）和2例中风（4%），没有一例瓣旁漏严重于轻度。住院死亡率为16%，主要是由于严重的潜在心脏和非心脏合并症，并强调了这些病例中往往被低估的固有非技术风险。虽然没有单一的方法可能是最佳的，在每一个情况下严重的MAC，我们认为我们的有限超声抽吸技术是二尖瓣外科医生的重要工具。

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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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引用次数: 0

Introduction to Volume 29 Number 3 Autumn 2024 第 29 卷第 3 号导言 2024 年秋

Q3 Medicine

Operative Techniques in Thoracic and Cardiovascular Surgery

Pub Date : 2024-09-01 DOI: 10.1053/j.optechstcvs.2024.08.001

引用次数: 0

Per Oral Endoscopic Myotomy: Technique and Tricks for Challenging Anatomy 口腔内镜下肌切开术（POEM）：挑战解剖学的技术和技巧

Q3 Medicine

Operative Techniques in Thoracic and Cardiovascular Surgery

Pub Date : 2024-09-01 DOI: 10.1053/j.optechstcvs.2023.12.001

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.

口腔内镜下肌切开术是一种内镜手术，可进入食管壁潜在的第三空间--粘膜下层，对食管远端和胃食管交界处进行肌切开。本文介绍了为贲门失弛缓症患者实施 POEM 的一系列步骤以及提示和建议的解决方案。

引用次数: 0

Recent Articles in AATS Journals 最近在 AATS 期刊上发表的文章

Q3 Medicine

Operative Techniques in Thoracic and Cardiovascular Surgery

Pub Date : 2024-09-01 DOI: 10.1053/j.optechstcvs.2024.07.001

引用次数: 0

Fully Magnetically Levitated Durable Biventricular Assist Device Insertion 全磁悬浮耐用型双心室辅助装置植入术

Q3 Medicine

Operative Techniques in Thoracic and Cardiovascular Surgery

Pub Date : 2024-09-01 DOI: 10.1053/j.optechstcvs.2024.01.001

Luke A. Ziegler BA , Nicholas R. Hess MD , David J. Kaczorowski MD

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.

针对双心室衰竭患者的持久性机械循环支持方案非常有限。一种新出现的策略是在双心室配置中使用两个完全磁悬浮的耐用心室辅助装置（HeartMate 3s）。将 HeartMate 3 用作右心室辅助装置（RVAD）需要进行多项复杂的技术改造。在此，我们提供了详细的步骤图，并全面介绍了双侧 HeartMate 3 的插入方法，尤其侧重于 RVAD 的右心房流入插管。同时还介绍了潜在的隐患和解决方案。

引用次数: 0

Repair of Ebstein Anomaly in Children: Avoiding Pitfalls 修复儿童 Ebstein 异常：避免陷阱

Q3 Medicine

Operative Techniques in Thoracic and Cardiovascular Surgery

Pub Date : 2024-09-01 DOI: 10.1053/j.optechstcvs.2024.05.002

Luciana da Fonseca da Silva MD , Jose Pedro da Silva MD , Victor O. Morell MD

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.

埃布斯坦异常（EA）是一种先天性心脏病，主要特征是三尖瓣（TV）旋转移位到右心室（RV）。三尖瓣反流和右心室功能障碍是常见的症状。Cone 手术是一种公认的 EA 解剖修复技术。Cone 修复术的基本原理是调动所有可用的电视瓣叶，并构建一个与正常房室交界处重新连接的锥体状瓣膜。自 1993 年创立该技术以来，我们已对多项技术进行了改进，以提高 TV 性能、预防心律失常并改善 RV 功能。在此，我们将提供一些手术细节，以避免房室传导阻滞和冠状动脉受损，促进患者康复，并提供可持续的长期效果。自2016年起，我们已在本院连续110例患者中应用了这些改进措施，包括既往接受过Starnes手术或瓣膜置换术的患者，结果无一例死亡，发病率极低，瓣膜功能极佳。

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引用次数: 0

Commentary: To BE or NOT to be – That is the Conundrum ! 评论：要还是不要--这是一个难题......！

Q3 Medicine

Operative Techniques in Thoracic and Cardiovascular Surgery

Pub Date : 2024-09-01 DOI: 10.1053/j.optechstcvs.2024.03.002

引用次数: 0

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