Content from the Journal of the American Neurological Surgeons.
Patient selectionAlthough overall outcomes of heart transplantation have improved over the last two decades, PGD remains one of the major limitations. The International Society for Heart and Lung Transplantation (ISHLT) defines PGD as affecting the left and/or right ventricle with echocardiographic and hemodynamic alterations, need for inotropic/vasopressor support, and commonly, the use of circulatory assistance…
Aortic arch disease commonly involves multiple segments, leading to the need for multi-staged procedures. E-vita Open NEO is the latest locally available hybrid device for total aortic arch replacement and frozen elephant trunk procedure. A 60-year-old woman with chronic type B aortic dissection with ascending and arch aneurysm was successfully treated with the E-vita Open…
Epicardial pacing wire insertion is an integral part of open-heart surgery. However, the use of epicardial pacing wire insertion is also associated with complications like bleeding, tamponade, and occasionally even death of the patient secondary to injury to the adjacent structures. Various techniques have been described for preparing, attaching, and removing epicardial pacing wires. The…
Webinar 2: Thoracic Surgery During COVID-19 Chair:Dr Bhuvaneswari Krishnamoorthy, President of The Association of CT Surgical Care Practitioners (ACT-SCP) and AHP Educational Lead Mr Sridhar RathinamConsultant Thoracic Surgeon and National Educational Chair SCTS Editor: Jeni Palima, Honorary National Secretary of ACT-SCP Speakers: Dr Sameer Hanna-Jumna, Consultant Anaesthetist, UHLAnaesthetic Consideration in COVID-19 Dr Amrita Bajaj, Consultant…
This video describes a superior approach for the correction of the supracardiac type of total anomalous pulmonary venous drainage (TAPVD) in a 2.8 kg newborn with a small patent foramen ovale (PFO). Surgical Technique:Through the standard median sternotomy, the great vessels were fully mobilized and the right pulmonary artery was surrounded with a vessel loop.…
Off-pump coronary artery bypass grafting (OPCAB) has some high ground in reduction of postoperative complications, including systematic inflammatory response, myocardial injury, renal injury, and cerebral injury, compared to on-pump coronary artery bypass grafting. It is important to reduce myocardial oxygen consumption during anesthesia for OPCAB (1). The anesthesiologists should collaborate with the cardiac surgeons and…
A 45-year-old male hypertension presented with severe chest and back pain. Computed tomography (CT) scan revealed a type A aortic dissection extending into the abdominal aorta. Intraoperative transesophageal echocardiogram demonstrated severe central aortic insufficiency with a dissection flap in the ascending aorta. The patient had distal palpable pulses and no signs of malperfusion. General anesthesia…
IntroductionIn this video, the authors offer tips and tricks in the conduct of a type A aortic dissection repair by demonstrating a standardized and reproducible ascending aorta and open distal hemiarch replacement with aortic valve resuspension. They use circulatory arrest with moderate hypothermia and antegrade cerebral perfusion through a right axillary arterial inflow. Patient presentationThe…
Acute type A aortic dissection confers considerable morbidity and mortality and can be extremely challenging to manage from a surgical perspective. It is critical that these patients receive emergent intervention as the periprocedural risk increases each hour following diagnosis (1). A CTA of the chest, abdomen, and pelvis can provide vital information regarding operative planning…
In this video, the authors discuss the three common approaches to reconstruct the aortic arch in the setting of a type A aortic dissection. First, they discuss a hemiarch replacement, followed by a total arch replacement, and finally a total arch replacement with a frozen elephant trunk and carotid artery replacement. Approximately 40% of patients…
A 53-year-old man with a history of hypertension and coronary artery disease, status postcoronary artery bypass grafting x3 with left internal mammary artery (LIMA) to left anterior descending artery, saphenous vein graft (SVG) to the first obtuse marginal branch, and SVG to the right coronary artery, presented to the emergency room with severe substernal and…
Surgical repair of type A aortic dissection (TAAD) carries a hospital mortality of 18% (1). The authors use bilateral upper extremity arterial monitoring and a Swan-Ganz catheter (Edwards Lifesciences, Irvine, USA) in all patients. They prefer central cannulation including direct true lumen cannulation of the aorta under transesophageal echocardiography guidance. A single stage cannula is…
Professor Konstadinos Plestis is a cardiothoracic surgeon at Jefferson Health, professor of surgery at Sidney Kimmel Medical College, and director of the Jefferson Aortic Center in Pennsylvania. After receiving his MD from the Aristotelian University Medical School in Thessaloniki, Greece, Dr Plestis moved to the United States to undertake a general surgery residency at the…
The treatment of acute Type I aortic dissection is an essential life-saving operation. This case presentation demonstrates one of the many methods to facilitate reconstruction, with narration offering tips and tricks. The video depicts the sizing for the antegrade frozen elephant trunk, central aortic cannulation guided by the TEE with the TEE images for reference,…
For this CTSNet Guest Editor Series, Surgical Management of Acute Aortic Dissections: Tricks and Tips to Simplify the Operation, we asked Konstadinos A. Plestis, MD, to bring together videos that highlight techniques to effectively treat this lethal disease. A series video will be released each day through December 7. Video titles are listed below this…
The second of twelve videos in a CTSNet series on Thoracic Surgical Oncology – Technical Approaches by Professor Tristan D. Yan is presented here. To see the complete list of videos in the Thoracic Surgical Oncology video series, click here. This video, narrated by Joel Dunning of Middlesbrough, UK, demonstrates a fascinating case of robotic…
