Operative Techniques in Thoracic and Cardiovascular Surgery最新文献

Ductal origin of the pulmonary artery is a rare cardiovascular anomaly; it is often mislabeled as absent pulmonary artery or pulmonary artery agenesis resulting in delayed interventions. We present a case of ductal origin of the right pulmonary artery highlighting the need for early detection and prompt intervention to reestablish perfusion to the lung. This approach allows for continued lung development and reduces the morbidity related to single lung physiology. The aim of this article is to describe a refinement in the operative technique used in the reconstruction of the ductal origin of the right pulmonary artery via creation of an interposition homograft roll for centralization.

Myocardial bridges (MB) are a congenital variant in which an epicardial coronary artery—most commonly the left anterior descending (LAD)—is contained within an intramyocardial segment. The clinical significance of this lesion varies from no symptoms to debilitating angina, ventricular arrhythmia, and even sudden cardiac arrest Traditionally difficult to diagnose, symptomatic myocardial bridges remain an elusive entity with a lack of clarity regarding medical treatment and surgical indications. Importantly, studies have shown that with appropriate patient selection, MB unroofing is an effective treatment for symptomatic lesions, in both the adult and pediatric populations. This article describes the pre-operative evaluation and the surgical approach for myocardial bridges.

The lung transplant community has long ignored the importance of bronchial arterial blood supply. We review relevant history, published articles addressing post-transplant ischemia, and single-center reports of lung transplant with bronchial artery revascularization (BAR), followed by details of surgical technique. In our experience, although BAR requires cardiopulmonary bypass (CPB) and there is increased risk of bleeding, ischemic time was shorter and length of ICU and hospital stays were similar. Technical success was achieved in > 95% of cases, which guarantees normal airway healing. Lung transplant with BAR is safe, reproducible, and may provide benefits beyond airway healing, with potential for decreasing BOS/CLAD and improving long-term survival. Multicenter study and long-term follow-up are needed.

A dysfunctional bicuspid aortic valve (BAV) with associated an aortic root aneurysm represents complex pathology with multiple options for surgical repair. Traditionally Bentall aortic root replacement has been the gold standard to ensure a properly functioning valve and minimize the risk of recurrent root disease. Given the known disadvantages of prosthetic valve conduits with either a mechanical or bioprosthetic valve in these often young patients, there has recently been increasing interest and application of valve-sparing operations in BAV patients with aortic root enlargement. Over the pasts 15 years, our institution has been able to safely perform valve-sparing root replacement in select patients with diseased bicuspid aortic valve and root aortopathy. The outcomes are excellent and long-term follow-up data shows 10-year freedom from aortic valve or root replacement at 96%. This success can be attributed to appropriate patient selection, sound operative technique with meticulous post-operative care as well as a lifetime post-operative follow-up strategy. Here in we describe our operative technique and key tenets to ensure optimal patient outcomes.

Valve-sparing aortic root replacement (VSARR) has become an appealing choice for replacing an aneurysmal root when the patient's anatomic characteristics are favorable, especially in patients with heritable thoracic aortic disease. It is a technically challenging procedure, and the learning curve is considerable. This approach's chief advantages are that the patient's own aortic valve apparatus is preserved, the repair (in expert hands) is durable, and it avoids the need for lifelong anticoagulation associated with the mechanical valves in the aortic root prostheses. In this report, we provide a step-by-step approach for aortic root replacement in patients with a tricuspid aortic valve suitable for VSARR.

Direct true lumen cannulation through aortic incision for cardiopulmonary bypass during surgery for acute Stanford type A aortic dissection was reported by Jacob, followed by Conzelmann who used a Mersilene tourniquet to snag the ascending aorta. Since 2013, Samurai cannulation, a modified version of the direct true lumen cannulation, has been used in surgery for acute type A aortic dissection at Kitasato University Hospital. Here, this surgical technique is described.