The Beat With Joel Dunning Ep. 115: First Successful EXIT-to-Open Septectomy for HLHS

This week on The Beat, CTSNet Editor-in-Chief Joel Dunning speaks with CTSNet Senior Editor Dr. Sameh Said, Chief of the Division of Pediatric and Adult Congenital Cardiac Surgery at Maria Fareri Children's Hospital and Professor of Surgery and Pediatrics at the New York Medical College, about performing the first successful ex utero intrapartum treatment (EXIT)-to-open atrial septectomy-to-rapid stage I Norwood palliation in a neonate with hypoplastic left heart syndrome and intact interatrial septum. They discuss the surgical steps involved in this groundbreaking procedure, including specific details about the surgery, the preparation undertaken prior to the operation, and the key factors that contributed to its success. Additionally, they covered the challenges encountered during this first successful EXIT procedure case, as well as the standard management practices for these cases at medical centers, such as fetal balloon atrial septostomy, along with postnatal transcatheter, surgical, or hybrid interventions and their associated surgical risks. Furthermore, they address the broader challenges faced when operating on patients with hypoplastic left heart syndrome, including the differences between restrictive atrial septum and intact atrial septum.  

Joel also highlights recent JANS articles on the current state and future directions of cardiac xenotransplantation, if age is a contraindication for lung transplantation in the elderly, a summary of the International Society for Heart and Lung Transplantation consensus conference on emerging understanding of antibodies and antibody-mediated rejection in heart transplantation, inflammatory diseases and risk of lung cancer among individuals who have never smoked, and active chest tube clearance added to an Enhanced Recovery After Cardiac Surgery (ERAS) program improves outcomes and reduces resource utilization. 

In addition, Joel explores a single incision mitral valve repair and LIMA-to-LAD bypass via a left anterior minithoracotomy, repair of post-infarction ventricular septal defect using a double patch sandwich technique, and reconstruction of the left trigone during the Commando procedure for invasive prosthetic aortic valve endocarditis. Before closing, Joel highlights upcoming events in CT surgery.   

JANS Items Mentioned 

1.) Cardiac Xenotransplantation: Current State and Future Directions 

2.) Lung Transplantation in the Elderly: Is Age a Contraindication? 

3.) Summary of the International Society for Heart and Lung Transplantation Consensus Conference on Emerging Understanding of Antibodies and Antibody-Mediated Rejection in Heart Transplantation 

4.) Inflammatory Diseases and Risk of Lung Cancer Among Individuals Who Have Never Smoked 

5.) Active Chest Tube Clearance Added to an Enhanced Recovery After Cardiac Surgery (ERAS) Program Improves Outcomes and Reduces Resource Utilization 

CTSNET Content Mentioned 

1.) Single Incision Mitral Valve Repair and LIMA-to-LAD Bypass via a Left Anterior Minithoracotomy 

2.) Repair of Post-Infarction Ventricular Septal Defect Using a Double Patch Sandwich Technique 

3.) Reconstruction of the Left Trigone During the Commando Procedure for Invasive Prosthetic Aortic Valve Endocarditis 

Other Items Mentioned 

1.) Guest Editor Series: Coronary Arterial Anomalies—Pediatric and Adult Congenital  

2.) Cardiac Surgical Arrest—An International Conversation Series  

3.) Career Center  

4.) CTSNet Events Calendar 

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