Multimedia manual of cardiothoracic surgery : MMCTS / European Association for Cardio-Thoracic Surgery最新文献

The rising number of people with heart failure is leading to a corresponding increase in heart failure-related deaths. End-of-life care for these patients involves supplementing standard treatments with therapies aimed at managing symptoms that don't respond to guideline-directed medical care. The INCOR, a lightweight (200 g), implantable, magnetically levitated axial flow pump (providing non-pulsatile flow), is designed for long-term left ventricular support. This video tutorial details the initial single-centre clinical experience with this device.

An anterior mediastinal mass can comprise a wide variety of benign and malignant tumours that can present with diverse clinical symptoms. Diagnosis often requires multiple imaging modalities along with laboratory tests and, in specific cases, tissue biopsies. Upfront tumour resection is often preferred in cases with a substantial suspicion of malignancy whenever complete resection is deemed possible. We present a relatively common case of a substantial anterior mediastinal mass with a high suspicion of thymoma in a 73-year-old male patient without myasthenia gravis. Based on his computed tomography scan, a 3-dimensional model was built. Upfront resection without neo-adjuvant therapy was deemed feasible and therefore preferable. A DaVinci robot-assisted 3-port resection of the tumour was performed from the patient's left side. The intra- and postoperative courses were uneventful, after which the patient was discharged home on postoperative day 3.

We present a case of a young male with severe aortic regurgitation and an aortic root aneurysm who underwent a valve-sparing aortic root replacement using a remodelling technique with annuloplasty, and bicuspid aortic valve repair.

Robotic-assisted thoracic surgery is increasingly recognized for its utility in complex pulmonary resections, offering enhanced dexterity, superior 3-dimensional visualization and precise, 'tremor-free' tissue manipulation. Compared to open thoracotomy, minimally invasive robotic techniques are associated with reduced perioperative morbidity, shorter hospital stays and faster recovery. Sublobar lung resections, however, remain technically demanding, especially in the deep anatomical segments such as S8. Three-dimensional reconstructive imaging provides detailed preoperative visualization of the pulmonary anatomy, allowing for precise surgical planning and identification of individual bronchovascular structures. Despite its advantages, the integration of virtual 3-dimensional imaging into routine thoracic practice remains limited and under-reported in the literature. This video tutorial contributes to a growing video atlas series on robotic segmentectomy guided by high-resolution three-dimensional reconstruction. We demonstrate a robotic-assisted left S8 segmentectomy for a deep pulmonary metastasis, where three-dimensional reconstruction enabled identification of an alternative, 'parenchyma-sparing' approach via the inferior pulmonary vein. This video tutorial provides a step-by-step guide, from port placement to segmental dissection and resection, illustrating how advanced imaging technologies can enhance anatomical precision and optimize outcomes in robotic segmental lung surgery.

We present an enhanced percutaneous decannulation technique for a patient undergoing veno-arterial extracorporeal membrane oxygenation. This innovative approach uses two distinct percutaneous vascular devices, offering a more reliable and more effective method for decannulation.

Surgical isolation of left atrial posterior wall (box lesion) with left atrial appendage closure are good options for treating patients with atrial fibrillation concomitant with another cardiac surgical procedure in case we prefer not to open the left atrium. We describe a full box ablation, left atrial appendage closure and aortic valve replacement through a J-shaped ministernotomy through the fourth intercostal space. The box lesion ablation is performed using the Isolator Synergy and Bipolar RF Ablation Clamp with the jaws placed in the oblique and transverse sinuses from the right side. The left appendage is excluded and electrically isolated with the AtriClip Flex-V; the aortic valve is replaced by a sutureless Perceval bioprosthesis. This technique allows us to perform a complete box lesion and left atrial appendage  closure easily for patients with paroxysmal or persistent atrial fibrillation in which we do not open the left atrium, such as those with aortic valve surgery and/or coronary artery bypass grafting.

Tracheobronchomalacia is a condition of dynamic airway collapse due to weakness of the tracheobronchial wall. When conservative management, including continuous positive airway pressure, fails to control symptoms or improve quality of life, surgical intervention may be warranted. In this case report, we present a surgical technique of tracheobronchoplasty via the right posterolateral thoracotomy in a patient with severe tracheobronchomalacia.

Bronchogenic cysts are rare congenital foregut anomalies, often detected incidentally. We report the case of a 24-year-old female who was incidentally detected during a routine health check-up to have a mediastinal mass. Preoperative chest computed tomography imaging suggested a benign bronchogenic cyst. Minimally invasive video-assisted thoracoscopic surgery was planned for its excision. Intraoperatively, a pericardial defect and a feeding artery arising from the aortic arch were noted. The patient recovered uneventfully and was discharged on postoperative day 3. This case demonstrates the utility of video-assisted thoracoscopic surgery in the excision of bronchogenic cysts, in the presence of these intraoperative findings with the advantages of less surgical trauma and faster recovery.

Left ventricular pseudoaneurysms are rare but serious mechanical complications of acute myocardial infarction. These defects are most often approached surgically, though there are insufficient data supporting certain surgical techniques over others. In this video tutorial, we demonstrate the surgical repair of a large left ventricular pseudoaneurysm in a patient who presented two weeks after an acute myocardial infarction. The patient underwent a transatrial endoventricular patch repair with mitral valve replacement and was weaned off cardiopulmonary bypass without the need for additional mechanical circulatory support. She recovered uneventfully and was discharged home.

Robotic-assisted, minimally invasive direct coronary artery bypass is a surgical technique that involves robotic-assisted harvest of the left internal mammary artery, small left-anterior thoracotomy and minimally invasive, off-pump, direct left internal mammary artery to left anterior descending artery anastomosis. It is indicated in the setting of proximal or diffuse single-vessel left anterior descending artery disease, chronic total occlusion of the left anterior descending artery or a hybrid approach to revascularization in combination with percutaneous treatment of other lesions. Benefits include avoidance of sternotomy and rapid recovery, particularly in medically complex patients, while achieving the survival benefit associated with a left internal mammary artery-left anterior descending artery anastomosis. Although there is an initial learning curve for surgeons, an understanding of positioning and exposure techniques can minimize early challenges. We present a step-by-step video tutorial of robotic-assisted, minimally invasive direct coronary artery bypass, including patient positioning, robotic port orientation, analgesic and local anaesthetic strategies, conduit harvest and anastomotic technique.