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

Pectus excavatum presents challenges in cardiac operations due to anatomical abnormalities and limited exposure. We report a case of a 58-year-old male with severe pectus excavatum and significant mitral regurgitation successfully treated with minimally invasive mitral valve repair. Preoperative imaging revealed leftward heart displacement and a Haller index of 3.8. Surgical intervention involved adaptations in atrial retraction and valve repair technique. Postoperative outcomes were favourable, with normal mitral function and a short hospital stay. Despite technical challenges, minimally invasive approaches offer benefits in pectus excavatum patients. This case underscores the feasibility and safety of minimally invasive surgery in patients with extensive pectus excavatum, emphasizing its potential as a preferred approach.

Surgical robots have been utilized to facilitate a truly minimally invasive approach in cardiac surgery. Robotic aortic valve replacement allows for a totally endoscopic approach with better visualization in a wider range of patients with varying anatomies. It has the potential advantages of faster functional recovery and superior cosmetic outcomes compared to traditional sternotomy or thoracotomy approaches. In this case report, we show the details of robotic totally endoscopic aortic valve replacement.

As a consequence of the growing number of implanted transcatheter aortic valve prostheses, the increasing incidence of early and late complications of biological valves requires in several cases surgical explantation of the transcatheter valve and subsequent aortic root or surgical aortic valve replacement. In this video tutorial, we show how to avoid aortic root damage in the surgical explantation of a transcatheter aortic valve bioprosthesis in a patient with a dysfunctional transcatheter aortic valve prosthesis affected by endocarditis 15 months after implantation. The infected prosthesis and all foreign materials, concomitant to the calcified native valve, were excised en bloc in preparation for the extensive debridement of infected tissue in the abscess cavity. The defect on the aortic annulus was reconstructed using a pericardial patch, followed by a surgical valve implant.

The fissureless technique in a lobectomy is considered useful to avoid postoperative prolonged air leak when a fissure is fused because it is not dissected. In particular, this technique has been used most frequently in right upper lobectomies because the dense fissure was most frequently found between the right upper and middle lobes. We believe that the surgical steps in this technique should be modified depending on the surgical approach, although the concept that the hilar structures, including the pulmonary vessels and bronchi, are each transected prior to division of a dense fissure is the same. We demonstrate a robotic right upper lobectomy with an explanation of the nuances of its performance. The operating time was 135 minutes with a blood loss of 50 ml. The patient's postoperative course was uneventful. We removed the chest tube on postoperative day 1, and the patient was discharged on postoperative day 3. The final pathology report was pT1bN0M0, stage 1A2, squamous cell carcinoma. These good perioperative results indicate the feasibility of this technique.

We present the cannulation technique for venopulmonary extracorporeal membrane oxygenation using the ProtekDuo dual-lumen cannula in a patient who, after a bilateral orthotopic lung transplant and coronavirus disease 2019 infection, was converted from a multisite venovenous extracorporeal membrane oxygenation configuration, using the same vessel.

Atrial fibrillation poses significant stroke risks, particularly in patients undergoing cardiac surgery. Left atrial appendage occlusion has emerged as a crucial strategy for stroke prevention, garnering a Class I recommendation. This paper presents a technical framework for performing robotic left atrial appendage occlusion as an isolated procedure or concurrently with robotic coronary artery bypass grafting using the AtriCure AtriClip Pro2 device.

The standard treatment for primary mediastinal yolk sac tumour involves neoadjuvant chemotherapy followed by residual tumour resection, typically performed through a median sternotomy or a thoracotomy. However, in this case, a 16-year-old patient with a large anterior mediastinal tumour underwent less invasive, subxiphoid, robot-assisted surgery using a 4-arm da Vinci Xi system with CO2 insufflation at 8 mmHg. The tumour, located in the right thymic lobe, was dissected using a technique similar to blunt dissection, bipolar electrocautery and vessel sealer. Pericardiotomy was performed suspecting tumour invasion, with the thickened pericardial border incised circularly from the left side. Preservation of the right phrenic nerve involved careful separation from the densely adherent tumour. A pulmonary wedge resection was also performed using a stapler. The pericardial defect was reconstructed using an expanded polytetrafluoroethylene sheet, sutured together with nylon threads, and the resected tumour was extracted with a retrieval bag. This subxiphoid robot-assisted approach is a minimally invasive option for malignant mediastinal tumours.

In this case report, we illustrate the minimally invasive endoscopic repair of an atrial septal defect via a right minithoracotomy in a young patient with a dislocated Amplatzer Septal Occluder.

Bronchopulmonary sequestration is a congenital abnormality characterized by non-functioning lung tissue, abnormal connection with the tracheobronchial tree and anomalous systemic arterial supply. Although considered a rare phenomenon presenting early in life, sequestration may also present with recurrent chest infections in late adulthood. Additionally, bronchopulmonary sequestration may rarely be incidentally encountered during thoracic surgery. Several subtypes exist including intralobar, extralobar and hybrid bronchopulmonary sequestration (congenital pulmonary artery malformation). Surgical resection is curative and serves as the treatment of choice for symptomatic patients. Radiological imaging prior to surgery is essential in these patients because the arterial supply may be anatomically complex, and aberrant artery branches are common. Utilization of virtual 3-dimensional remodelling and computed tomography reconstruction imaging can not only establish a diagnosis of bronchopulmonary sequestration but can also optimize preoperative planning. This approach will ultimately prove useful in anticipating surgically challenging steps and avoiding unnecessary intraoperative complications. We present a video tutorial on the role of 3-dimensional reconstruction imaging in bronchopulmonary sequestration and a step-by-step guide for performing a right robotic-assisted surgical resection of an S2 hybrid bronchopulmonary sequestrated segment. This case is followed by a second case of intralobar bronchopulmonary sequestration encountered incidentally during thoracic surgery.

The definitive management of combined aortic arch and descending aortic pathologies such as aneurysms and dissections is either a single or staged operation associated with high morbidity and mortality. Stroke, kidney dysfunction, coagulopathy and high blood transfusion requirements are all affiliated with hypothermic circulatory arrest and prolonged cardiopulmonary bypass times. Considering the perilous nature of these operations, the authors describe a step-by-step zone 2 arch replacement as a staged frozen elephant trunk procedure, which provides an adequate landing zone for a later-placed endovascular stent yet maintains a short cardiopulmonary bypass time and no circulatory arrest.