Content from the Journal of the American Neurological Surgeons.
Norman Briffa of the Sheffield Teaching Hospitals NHS Trust in the UK discusses the decision between mechanical and biological aortic valves, focusing on patients between the ages of 50 and 70 years old. He begins by reviewing the guidelines and evidence related to valve durability and bleeding risk. Concluding that the decision should be patient-specific,…
This is a video showing a procedure performed by open thoracotomy with a head camera that records audio. The patient had a large middle lobe tumor and had an ICD, an impaired left ventricular function, and previous coronary artery bypass grafting. Unfortunately, the operating surgeon got into a bleeding scenario that required the whole team…
The Memo 4D System by LivaNova is a novel semi-rigid annuloplasty ring. Ideal for the minimally invasive approach, this ring allows neochord implantation without physical measurement or further adjustments in chordal heights, simplifying the decision process of the neochords’ length. In this video, the authors present their experience using the Memo 4D ring to repair…
This video demonstrates a three-port anterior video-assisted thoracoscopic right upper lobectomy, for early stage lung cancer, performed with the aid of novel sealing and stapling devices. The LigaSure™ is used as the only dissecting instrument, for the sealing of small vessels (less than 7 mm in diameter) and for the lymphadenectomy. This can save cost…
Filmed at the 2019 STS Annual Meeting in San Diego, California, Mara Antonoff of the University of Texas MD Anderson Cancer Center in Houston, USA, moderates a discussion on the tips for building a practice in early career. Dr Antonoff is joined by Damien LaPar of Columbia University in New York, USA, and David Odell…
Microlobectomy is a surgical technique conceived by Mr Joel Dunning, in Middlesbrough, UK, in 2014 and previously described in the literature. In this video, the authors demonstrate the adoption of this technique for a sublobar resection, namely a left upper division segmentectomy. The aim is to reduce the postoperative pain and use of opioids, and…
This video shows the technical challenges of explanting a valve-in-ring mitral valve. The patient was a 40-year-old woman who presented with a failed mitral valve repair in which a P2 triangular resection and 28 mm Edwards Physio 2 ring were used 5 years prior via a limited sternotomy at an outside institution. Her original operation…
This video demonstrates the common pitfalls of robot-assisted esophagectomy and presents tips and techniques to performing the Ivor Lewis and McKeown procedures. To begin making the conduit, it is advisable to begin at the lesser curvature and to use a 4.0 cm silk tie in order to gauge the width of the conduit—this helps to…
Epiaortic scanning is a simple and low-cost technique that could improve results in terms of postoperative neurological complications. This video is a step-by-step tutorial that could allow every surgeon to perform an epiaortic scan safely. The findings from the scan may help in choosing the optimal surgical strategy for every single patient. The authors show…
Blase Carabello of the East Carolina Heart Institute in Greenville North Carolina, USA, and Jean-François Obadia of the Hopital Cardiothoracique Louis Pradel in Lyon, France, discuss the COAPT and the Mitra.fr trials. Both trials investigated the use of the MitraClip for secondary mitral regurgitation, but they found strikingly different results on patient outcomes. Drs Carabello…
Filmed at the 2019 AATS Annual Meeting in Toronto, Canada, Daniel Engelman of Baystate Medical Center in Springfield, Massachusetts, USA, moderates a discussion on enhanced recovery after surgery (ERAS) for cardiac surgery guidelines for perioperative care. Dr Engelman, who is also the President of the ERAS Cardiac Society, is joined by Louis Perrault of the Montreal…
Since the introduction of video-assisted thoracoscopic lobectomy more than 25 years ago, the focus for thoracic surgeons has been to enhance the surgeon’s technical skills. This has been implemented with success across the world, and a minimal invasive approach to lung cancer is standard of care in many units today. However, major intraoperative complications occur…
The bilateral internal mammary arteries technique for off-pump coronary artery bypass is a safe technique with long-term patency and low morbidity and mortality. The author usually uses total arterial myocardial revascularization using bilateral internal mammary arteries for patients younger than 75 years old. The left and right mammary arteries have the longest patency described of…
This is a video on how the authors are working as a team to improve the outcomes of people who arrest or have an acute emergency in the catheterization laboratory (cath lab) during procedures of all types including transcatheter aortic valve replacement (TAVR), percutaneous coronary intervention, pacing, atrial fibrillation ablation, and soon transcatheter mitral valve…
The quality of our decision making is proportional to the decision-making models we use and our ability to match them to the appropriate situation. This short video explores the decision-making models currently used in healthcare, and it aims to offer an introduction to the optimal way of matching these models to the context with the…
To deal with nontechnical skills (Notechs) is a matter of culture and is hard to implement in surgical training. Communication, cooperation, decision-making, leadership, and situational awareness are concepts for many and their application in surgical practice is challenging. The competency framework in cardiothoracic surgery has evolved towards wider components including Notechs as a cornerstone in…
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