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Letter From the Guest Editor: Cardiac Surgery Essentials

Wednesday, February 13, 2019

For this cardiac-focused CTSNet Guest Editor Series, Cardiac Surgery Essentials, we asked Dr Tsuyoshi Kaneko of Brigham and Women’s Hospital to bring together videos from experts highlighting techniques that are foundational for cardiac procedures but that are often glossed over when demonstrating a full operation.

Dear CTSNet Reader,

This new series, Cardiac Surgery Essentials, focuses on the basic skills that cardiac surgeons need to possess in their everyday practice. Today, we have access to the newest textbook—surgical videos and of course, CTSNet—however, it is sometimes difficult to find a great resource on basic but important aspects of surgery or procedures.

Left internal thoracic artery (ITA) harvesting is one of the basic skills that trainees learn during their residency and fellowship. At least in the United States, most institutions harvest LITA in a pedicled fashion. With the growing interest in all-arterial revascularization, especially bilateral ITA usage, skeletonized technique may be required. Dr Dinh Hoang Nyugen describes his excellent technique in this video.

Femoral vessel cannulation using either percutaneous technique or cutdown technique is part of the essential armamentarium for cardiac surgeons, especially in reoperative or minimally invasive surgery. The nuance of Seldinger’s technique and what to look for on transesophageal echocardiogram is key to prevent disastrous complications from this procedure. Dr Tom C. Nyugen elegantly describes his technique, both percutaneous and cutdown.

Coronary arteriotomy is a technique that must be used to perform our bread and butter surgery: coronary artery bypass grafting. However, most of the focus is on anastomosis and there is minimal guidance on how to perform this fundamental technique. Dr Isaac George shows his technique to identify the coronary artery and perform coronary arteriotomy.

As Dr Lawrence Cohn said, mitral valve inspection during mitral valve repair is the most critical portion of this procedure. Oftentimes, the focus of a mitral valve repair is given to the repair technique, and assessment of mitral valve is often overlooked by trainees. Dr Michael Borger, with his elegant video, focuses on mitral valve inspection and mitral valve annular sizing. We all can learn from his expertise.

Axillary artery cannulation is another essential technique for a cardiac surgeon, especially in the setting of aortic surgery. It can also be used to provide antegrade cerebral perfusion, or to prevent retrograde embolic showering in atherosclerotic descending aorta from femoral cannulation when peripheral cannulation is needed. Dr G. Chad Hughes takes the viewer through the axillary cannulation technique, exactly the way that I learned from him.

Transcatheter valve therapies have been disruptive technology in the field of cardiovascular medicine and surgery. Transcatheter aortic valve replacement (AVR) numbers surpassed that of surgical AVR in the United States, and future technologies are around the corner for other valves. Transcatheter skill is something the cardiac surgeon must possess in the future. One of the key techniques is the use of the Perclose® suture device to allow a total percutaneous approach. Dr Farhang Yazdchi shows the step-by-step Perclose® demonstration, both ex vivo and during a procedure, which is a great resource for trainees.


Tsuyoshi Kaneko, MD
CTSNet Guest Editor

Left Internal Mammary Artery Harvesting: The Skeletonization Technique
by Anh Vo, Tuong Nguyen, Dinh Nguyen

Percutaneous and Open Cannulation for Peripheral Cardiopulmonary Bypass: Pearls and Pitfalls
by Alexander Nissen, Juan Abreu, Vahram Ornekian, Stephanie Nguyen, Tom C. Nguyen

Coronary Arteriotomy
by Alexander Kossar, Isaac George

Mitral Annular Sizing for Mitral Valve Repair Surgery
by Michael Borger, Bettina Pfannmueller

Perclose Suture Mediated Closure Technique
by Farhang Yazdchi, Brian Plunkett, Pinak Bipin Shah, Tsuyoshi Kaneko

Axillary Artery Cannulation
by Ashraf A. Sabe, G. Chad Hughes

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