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

Sternal dehiscence incidence ranges from 0.2% to 5%]. Risk factors include obesity, advanced age, use of bilateral internal thoracic arteries, diabetes mellitus and chronic obstructive pulmonary disease [1]. Traditional techniques with steel wires have been associated with dehiscence rates of up to 11.8% [2]. Utilizing titanium plates, the incidence of sternal dehiscence has reduced to 1.5% [3]. The STERN FIX Sternal Stabilization System is a biocompatible carbon-fibre reinforced poly-ether-ether-ketone tool constituting two components, both with a curved arm that embraces the sternum at the level of an intercostal space and does not perforate the intercostal fascia, reducing the retrosternal bleeding [4]. The sternal closure is performed following five steps: sizing using a gauger (device available for sternal bone thicknesses between 9.5 and 17mm); marking the selected intercostal space bilaterally to allow the passage of the device; placement of both device parts; closure of the device; and cutting the excess segment. The sternal closure is complemented with cerclage wire. The first results are very satisfactory, with 0% sternal dehiscence at 6 months on 30 patients [5], comparable to those achieved by adopting the Robicsek technique [6]. We present a video tutorial case of ministernotomy closure using the STERN FIX system.

Infectious aortitis is an uncommon but life-threatening condition due to its potential to cause mycotic aneurysms, which may lead to vascular rupture. When signs of vascular disruption are present, isolated antibiotic therapy is insufficient, requiring combined open surgical resection of the infected aorta. A 68-year-old woman diagnosed with Streptococcus pneumoniae aortitis is presented. Multiple saccular mycotic aneurysms of varying sizes along the thoracoabdominal aorta, with intense fluorodeoxyglucose uptake on positron emission tomography scan were present in conjunction with extravascular infectious sources. Urgent Crawford extent II thoracoabdominal aortoiliac reconstruction was indicated. Due to extensive atheromatosis of the proximal descending aorta and the relative contraindication to cerebrospinal fluid drainage (spondylodiscitis), repair was performed with profound hypothermia (18°C). Renal protection was achieved using Custodiol and visceral perfusion maintained with cold blood. Each visceral artery was individually reimplanted using a 26mm multibranched graft. Distal reconstruction was completed with a bifurcated prosthesis, given the presence of severe aortic bifurcation calcification. Despite negative intra-operative cultures, histopathology confirmed extensive aortic inflammatory/reparative findings. Post-operative recovery was uneventful. At 1-year follow-up, the patient remains in good condition, with no clinical recurrence, no pathological positron emission tomography/computed tomography uptake, and a stable aortic repair without suppressive antibiotics.

We present the technical steps and pitfalls of minimally invasive resection of a recurrent subaortic membrane via a redo right axillary thoracotomy in a child.

Accidental ingestion of dentures is a relatively infrequent yet clinically significant problem, often resulting in oesophageal impaction, particularly in edentulous patients who wear removable dentures. Ingestion of dentures poses a significant risk of mucosal injury or perforation during endoscopic retrieval, owing to their large size, sharp edges and metal clasps, and hence requires a low threshold for surgical intervention. This video tutorial demonstrates the technique of robotic-assisted thoracoscopic oesophagotomy and removal of the impacted denture followed by repair of the oesophagotomy.

Our objective is to underline that patients with small aortic annulus can present with concomitant left outflow tract obstruction, and both pathologies need to be addressed during surgery to avoid residual symptoms and early re-intervention. We present a third-time re-operation where intra-operative findings revealed degenerated sutureless valve with pannus underneath, which was explanted after meticulous dissection of the prosthesis cuff from the left ventricular outflow tract. The fibrotic ridge was excised and a basal septal myectomy was performed, removing 2.8 g of septal muscle. The aortotomy was extended through the left-non coronary commissure and toward the right and left fibrous trigones. A posterior bovine pericardium 'Y' patch was used for annular enlargement to accommodate a 25 mm INSPIRIS valve. Nonetheless, the mitral valve was repaired with a 29 mm posterior annuloplasty ring, and the tricuspid valve with a 30 mm annuloplasty ring.

This report presents a novel robotic-assisted surgical technique for bronchial reimplantation in patients with complete bronchial stenosis after tuberculosis treatment. A 34-year-old female patient with progressive dyspnoea was diagnosed with complete bronchial stenosis and total left lung atelectasis. After unsuccessful bronchial dilation attempts, robotic-assisted bronchial reimplantation with veno-venous extracorporeal membrane oxygenation support was undertaken. Intra-operative bronchoscopy ensured airway patency throughout the procedure. At 1-year follow-up, the patient remained asymptomatic in daily activities, with no late complications or restenosis, reinforcing the long-term efficacy of the procedure. This technique demonstrates the potential for enhanced surgical outcomes in managing complex bronchial stenosis. The findings highlight the viability of this advanced technique in improving respiratory function and patient recovery.

Ganglioneuromas are rare, benign neurogenic tumours, most often located in the posterior mediastinum. We present an exceptional case of a stellate ganglion ganglioneuroma at the left cervicothoracic junction, abutting the subclavian artery, oesophagus, sympathetic chain and vertebral bodies. The patient presented with significant shortness of breath and paraesthesia in the left arm. Cross-sectional imaging confirmed a well-encapsulated paravertebral mass in the left posterior mediastinum. Given the intricate anatomy of the thoracic inlet and proximity to multiple critical structures, a robotic-assisted thoracic surgical approach using the da Vinci Xi platform was employed. Robot-assisted resection transformed this complex and confined space into a clear, magnified operative field, enabling micro-instrument precision to safely mobilize the mass while avoiding injury to adjacent neurovascular structures. Complete excision was achieved with histopathology confirming ganglioneuroma. The patient's compressive symptoms resolved, though she developed Harlequin syndrome as a direct consequence of partial stellate ganglion resection. This case highlights both the rarity of stellate ganglion ganglioneuromas and the unique value of robotic-assisted surgery in navigating anatomically complex regions. The enhanced visualization and precision of the da Vinci Xi system enabled safe resection with reduced morbidity and expedited recovery.

Persistent and long-standing persistent atrial fibrillation are associated with numerous adverse outcomes and significantly impaired quality of life. Endocardial catheter ablation (CA) alone has limited efficacy in this population. Hybrid approaches combining epicardial ablation, including left atrial appendage exclusion, with complementary endocardial CA have demonstrated improved outcomes. This video tutorial illustrates a hybrid technique involving left atrial dome ablation and left atrial appendage exclusion via left thoracotomy, along with posterior left atrial wall ablation through a subxiphoid approach. Endocardial CA is subsequently performed during the same procedure.

We report a case of a 77-year-old woman with an aneurysmal coronary-pulmonary artery fistula, which was incidentally identified on contrast-enhanced computed tomography. To prevent rupture and other potential complications, surgical repair was indicated. The procedure was performed via bilateral minithoracotomy, providing sufficient exposure while minimizing invasiveness. The aneurysmal segment was successfully excluded without intra-operative complications. Post-operative contrast-enhanced computed tomography confirmed complete exclusion of the lesion with no residual opacification. The patient's recovery was uneventful. This video tutorial demonstrates the step-by-step surgical technique used in this case, highlighting key considerations in exposure, fistula identification and closure. A bilateral minimally invasive approach may be a safe and effective option for selected patients with aneurysmal coronary-pulmonary artery fistulae, especially when conventional sternotomy is not desirable. This case adds to the limited literature on minimally invasive treatment of this rare condition and may assist surgeons in planning similar procedures.

Robotic mitral repair is often associated with longer ischaemic and cardiopulmonary bypass times, particularly early in the learning curve. We demonstrate a semi-continuous, three-suture technique for robotic annuloplasty that retains the mechanical principles of traditional interrupted sutures while leveraging the advantages of robotic precision and exposure. The use of pre-knotted sutures minimizes intra-cardiac knot tying, further enhancing procedural efficiency.