Operative Techniques in Thoracic and Cardiovascular Surgery最新文献

The concept of a short esophagus defined as less than 2.5 cm of intra-abdominal esophageal is still a highly debated topic among benign UGI surgeons. Giant hiatal hernias and peptic strictures are a few conditions associated with lack of intra-abdominal esophageal length. All paraesophageal hernia operations necessitate adequate mediastinal esophageal mobilization until the inferior pulmonary vein. However, if despite this maneuver, a short esophagus is encountered, then a lengthening procedure is recommended to reduce the risk of a slipped wrap and hernia recurrence. Several options for esophageal lengthening are available including a left transthoracic, or a right transthoracic Collis stapled approach, modified collis gastroplasty and wedge gastroplasty.

Transapical ventriculotomy is an important technique in the surgical management of hypertrophic cardiomyopathy (HCM). It is our preferred method for addressing complex long-segment subaortic obstruction and isolated midventricular HCM, as it provides better exposure of the midcavity than alternate methods such as the transaortic or transmitral approach. The procedure can also be used to improve symptoms of diastolic heart failure caused by reduced left ventricular end-diastolic volume as may occur in patients with apical HCM. In this article, we describe our surgical method for transapical myectomy to relieve midventricular obstruction or enlarge the left ventricular cavity to improve diastolic dysfunction in cases of extensive apical hypertrophy.

Since the recall of the HeartWare HVAD device in 2021, the management of the remaining implants range from medical management, transplant, to exchange. This article describes 2 feasible approaches to exchange the HVAD to the HeartMate3 device through a combination of a left lateral thoracotomy with a superior hemi-sternotomy. These approaches minimize dissection and complications of a redo-sternotomy and minimizes bypass time. Pitfalls and solutions are also herein described.

Despite excellent outcomes of tetralogy of Fallot (TOF) repair, reinterventions for recurrent or residual stenosis of branch pulmonary arteries are still required in many patients. The development of these lesions may be related to 2 inherent characteristic morphologies of TOF: Pulmonary ductal coarctation and acute angulation of branch pulmonary artery, especially the left pulmonary artery. I developed a main pulmonary artery rotation flap angioplasty technique to deal with acute-angle branch pulmonary artery stenosis without using any patch. Since 1998, 68 TOF patients have undergone this technique. During a median follow-up of 13.5 years, 20 (29%) patients underwent catheter or surgical-based intervention for branch pulmonary stenosis. Overall freedom from any intervention was 87%, 76%, 70%, and 59% at 1-year, 5-year, 10-year, and 20-year periods, respectively. I believe that this technique is reproducible and provides excellent intermediate and long-term outcomes in TOF patients with complicated branch pulmonary artery stenosis.

Single-ventricle palliation starting with a Norwood procedure which culminates in a failed Fontan palliation poses certain unique operative challenges for cardiac transplantation. In this manuscript, we describe some of these challenges and our particular approach in management.

In standard bilateral living-donor lobar lung transplantation (LDLLT), right and left lower lobes donated by 2 healthy donors are implanted into a recipient after right and left pneumonectomies. Because only 2 lobes are implanted, the grafts may be too small for an adult recipient. To overcome size mismatch, we have developed a technique of right-to-left inverted LDLLT based upon the fact that the right lower lobe is generally larger than the left lower lobe. In right-to-left inverted LDLLT, 2 donors donate their right lower lobes. The right graft is implanted in the right side of the recipient. The left graft is inverted and implanted in the left side. This operation is indicated when total graft forced vital capacity (FVC) is less than 60% of the recipient's predicted FVC or when donor's left lower lobectomy is technically difficult due to interlobar pulmonary artery anatomy.