The Atrium: Median Sternotomy

This week on The Beat, CTSNet Editor-in-Chief Joel Dunning had the opportunity to speak with Professor Enoch Akowuah about challenges facing cardiothoracic surgery. They discuss the importance of clinical trials, the best aortic valve replacement technique, and the vision for the future of cardiothoracic surgery. They also discuss how to improve the specialty, what changes are needed in training, and the great part about being a member of a national society.   Joel also reviews recent JANS articles on better survival with lobectomy versus sublobar resection in patients with hypermetabolic c-stage IA lung cancer on positron emission tomography/computed tomography, right anterior minithoracotomy approach for aortic valve replacement, clinical and financial outcomes of pulmonary resection for lung cancer in safety net hospitals, and the 10 commandments for proximal anastomosis during CABG.   In addition, Joel celebrates the winners of the 2024 CTSNet Innovation Video Competition: “How to Perform MIDCAB Using BIMA,” “Mitral Valve Replacement and Coronary Revascularization Via the Left Anterior Minithoracotomy,” and “The Mitral Patch Technique for Mitral Annular Calcification (MAC).” He also discusses a recent interview with professor and surgeon Dr. Shaf Keshavjee. Before closing, he shares upcoming events in CT surgery.   JANS Items Mentioned  1.) Better Survival With Lobectomy Versus Sublobar Resection in Patients With Hypermetabolic C-Stage IA Lung Cancer on Positron Emission Tomography/Computed Tomography    2.) Right Anterior Minithoracotomy Approach for Aortic Valve Replacement  3.) Clinical and Financial Outcomes of Pulmonary Resection for Lung Cancer in Safety-Net Hospitals  4.) The 10 Commandments for Proximal Anastomosis During CABG: Techniques and Technologies for Vein and Arterial Grafts  CTSNET Content Mentioned  1.) How to Perform MIDCAB Using BIMA  2.) Mitral Valve Replacement and Coronary Revascularization Via the Left Anterior Minithoracotomy  3.) The Mitral Patch Technique for Mitral Annular Calcification (MAC)  4.) Keynote Speech: An Interview With Shaf Keshavjee  Other Items Mentioned  CTSNet Events Calendar  Disclaimer The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.

This week on The Beat, CTSNet Editor-in-Chief Joel Dunning had the opportunity to speak with Dr. Hazem Fallouh about his latest invention for diagnosing cardiac tamponade at the 2024 Birmingham Review Course. They discussed the purpose of this invention, how it went from an idea to being created, and how Dr. Hazem will get this product on the market.   Joel also reviews recent JANS articles on initial experience with transcatheter aortic valve replacement before and after lung transplant, a report of salaries of academic cardiothoracic surgeons based on race and ethnicity, chest wall resection and reconstruction for primary chest wall sarcomas, and seven-year outcomes following aortic valve replacement with a novel tissue bioprosthesis.   In addition, Joel explores an introduction to redo sternotomy, emergency VATS esophagectomy for T4 esophageal cancer with massive hematemesis in an elderly patient, and pectus excavatum with hemodynamic repercussion corrected by the cross-bar technique with cryoanalgesia. Before closing, he shares upcoming events in CT surgery.  JANS Items Mentioned 1.) Initial Experience With Transcatheter Aortic Valve Replacement Before and After Lung Transplant  2.) A Report of Salaries of Academic Cardiothoracic Surgeons Based on Race and Ethnicity  3.) Chest Wall Resection and Reconstruction for Primary Chest Wall Sarcomas: Analysis of Survival, Predictors of Outcome, and Long-Term Functional Status  4.) Seven-Year Outcomes Following Aortic Valve Replacement With a Novel Tissue Bioprosthesis. THE COMMENCE Trial - Looking at RESILIA   CTSNet Content Mentioned  1.) An Introduction to Redo Sternotomy   2.) Emergency VATS Esophagectomy for T4 Esophageal Cancer With Massive Hematemesis in an Elderly Patient  3.) Pectus Excavatum With Hemodynamic Repercussion Corrected by the Cross-Bar Technique With Cryoanalgesia  Other Items Mentioned  CTSNet Events Calendar  Disclaimer The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.

This week on The Beat, CTSNet Editor-in-Chief Joel Dunning had the opportunity to speak with Dr. Donald Nuss about the NUSS procedure at the 24th Annual Congress: Chest Wall International Group and Phoenix Advanced Pectus Course 2024. They discussed how this procedure was created, how it has evolved, and bar stabilization. They also discuss treatments for pectus excavatum and the Ravitch procedure.  Joel also reviews recent JANS articles on real-world outcomes of lobectomy, segmentectomy and wedge resection for the treatment of stage C-IA lung carcinoma, branched stented anastomosis frozen elephant trunk repair, selection for transcatheter versus surgical aortic valve replacement and mid-term survival, and treatment patterns and clinical outcomes of patients with resectable non-small cell lung cancer receiving neoadjuvant immunochemotherapy. In addition, Joel explores the Chrysalis technique, updates on Y-incision aortic annular enlargement, and redo mitral valve repair and left ventricular myectomy. Before closing, he shares upcoming events in CT surgery.  JANS Items Mentioned 1.) Real-World Outcomes of Lobectomy, Segmentectomy and Wedge Resection for the Treatment of Stage C-IA Lung Carcinoma 2.) Branched Stented Anastomosis Frozen Elephant Trunk Repair: Early Results From a Physician-Sponsored Investigational Device Exemption Study 3.) Selection for Transcatheter Versus Surgical Aortic Valve Replacement and Mid-Term Survival: Results of the AUTHEARTVISIT Study 4.) Treatment Patterns and Clinical Outcomes of Patients With Resectable Non–Small Cell Lung Cancer Receiving Neoadjuvant Immunochemotherapy: A Large-Scale, Multicenter, Real-World Study (NeoR-World) CTSNET Content Mentioned 1.) The Chrysalis Technique: A Unique New Way to Perform an Aortic Root Replacement 2.) Updates on Y-Incision Aortic Annular Enlargement 3.) Redo Mitral Valve Repair and Left Ventricular Myectomy Other Items Mentioned CTSNet Events Calendar Disclaimer The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.

In this month’s episode of The Atrium, Dr. Alice Copperwheat explores cannulation with expert guest Dr. Vince Gaudiani. They discuss preparation, aortic cannulation, aortic cannulation complications, and aortic root vents. They also discuss atrial and venous cannulation, atrial cannulation complications, final steps, and central versus peripheral cannulation.   Don’t forget that The Atrium is a monthly podcast presenting clinical and career-focused topics for residents and early career professionals across all cardiothoracic surgery subspecialties. Watch for next month’s episode on bronchoscopy. Disclaimer The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.

This week on The Beat, CTSNet Editor-in-Chief Joel Dunning explores the value of working together. He discusses the importance of working not only with others in your own specialty but with teams outside your comfort zone. He also shares examples of these situations and explains how you can learn from them.   Joel also reviews recent JANS articles on the impact of incomplete revascularization on long-term survival based on revascularization strategy, impact of residual entry tears in the descending aorta after type A dissection, aortic valve replacement versus conservative treatment in asymptomatic severe aortic stenosis, and potassium supplementation and prevention of atrial fibrillation after cardiac surgery.   In addition, Joel explores aortic valve reimplantation in a Marfan syndrome patient, aortic root replacement with a Bio-Bentall, and Cox maze III procedure and complex mitral valve repair of a calcified annulus. Before closing, he shares upcoming events in CT surgery.  JANS Items Mentioned  1.) Impact of Incomplete Revascularization on Long-Term Survival Based on Revascularization Strategy  2.) Impact of Residual Entry Tears in the Descending Aorta After Type A Dissection  3.) Aortic Valve Replacement vs Conservative Treatment in Asymptomatic Severe Aortic Stenosis: Long-Term Follow-Up of the AVATAR  4.) Potassium Supplementation and Prevention of Atrial Fibrillation After Cardiac Surgery—The TIGHT K Randomized Clinical Trial  CTSNET Content Mentioned  1.) Aortic Valve Reimplantation in a Marfan Syndrome Patient  2.) Aortic Root Replacement With a Bio-Bentall   3.) Cox Maze III Procedure and Complex Mitral Valve Repair of a Calcified Annulus   Other Items Mentioned  CTSNet Events Calendar  Disclaimer The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.

This week on The Beat, CTSNet Editor-in-Chief Joel Dunning discusses the highlights of the 38th EACTS Annual Meeting and reviews several important presentations. He discusses the presentation from engineer Amy Kertok on the interdisciplinary intersection of medicine and technology, and the presidential speech delivered by Franca Melfi on perseverance. He also shares the guidelines that were presented at the meeting, including blood management, perioperative medications, myocardial revascularization and aortic.  Joel also reviews recent JANS articles on ultrasonic emulsification of severe mitral annular calcification to enable mitral valve repair, the perceval sutureless bioprosthetic aortic valve, impact of radiological follow-up frequency on resected lung cancer, heart transplantation after donation after circulatory death, and more.   In addition, Joel explores the world's first robotic heart transplant at the King Faisal Hospital in Riyadh, direct cannulation through right anterior mini thoracotomy for aortic valve replacement, an indigenous technique of surgical management in a case of acute on chronic type A and type B aortic dissection, and robotic-assisted left first rib resection. Before closing, he shares upcoming events in CT surgery.   JANS Items Mentioned  1.) Ultrasonic Emulsification of Severe Mitral Annular Calcification to Enable Mitral Valve Repair  2.) The Perceval Sutureless Bioprosthetic Aortic Valve: Evolution of Surgical Valve Technology  3.) Impact of Radiological Follow-Up Frequency on Resected Lung Cancer: A Propensity Score Matching Analysis  4.) Heart Transplantation After Donation After Circulatory Death: Early United States Experience  5.) Surgical Myocardial Revascularization with a Composite T-graft from the Left Internal Mammary Artery—Comparison of the Great Saphenous Vein with the Radial Artery  6.) SURgical vs. PERcutaneous ACCESS in Transfemoral Transcatheter Aortic Valve Implantation (SU-PER-ACCESS Study)  7.) Composite End Points and Competing Risks Analysis  8.) Increased Lung Cancer Recurrence Following Transthoracic Needle Biopsy  CTSNET Content Mentioned  1.) The World’s First Robotic Heart Transplant at the King Faisal Hospital in Riyadh   2.) Direct Cannulation Through Right Anterior Mini Thoracotomy for Aortic Valve Replacement  3.) An Indigenous Technique of Surgical Management in a Case of Acute on Chronic Type A and Type B Aortic Dissection  4.) Robotic-Assisted Left First Rib Resection  Other Items Mentioned  CTSNet Events Calendar  Disclaimer The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.

This week on The Beat, CTSNet Editor in Chief Joel Dunning speaks with EACTS Secretary General Patrick Myers about the highlights of the upcoming 38th EACTS Annual Meeting. They discuss what speakers they are looking forward to hearing from and the compelling topics that will be covered. They also share information about EACTS TV and hints and tips for those attending the meeting.    Joel also reviews recent JANS articles on mitral leaflet shortening as an ancillary procedure in obstructive hypertrophic cardiomyopathy and priorities and strategy for the implementation of enhanced recovery after surgery (ERAS) in thoracic surgery.   In addition, Joel explores a Yacoub II valve conserving operation for aortic root remodeling, robotic application of an AtriClip, and tricuspid replacement and mitral valve repair after a failed MitraClip to the tricuspid leaflets. Before closing, he shares upcoming events in CT surgery.   The Beat is taking a quick break and will return with a new episode on October 18, 2024.   JANS Items Mentioned  1.) Mitral Leaflet Shortening as an Ancillary Procedure in Obstructive Hypertrophic Cardiomyopathy  2.) Priorities and Strategy for the Implementation of Enhanced Recovery After Surgery (ERAS) in Thoracic Surgery  CTSNET Content Mentioned  1.) Yacoub II Valve Conserving Operation for Aortic Root Remodeling  2.) Robotic Application of an AtriClip for Chronic Atrial Fibrillation  3.) Tricuspid Replacement and Mitral Valve Repair After a Failed MitraClip to the Tricuspid Leaflets  Other Items Mentioned  CTSNet Events Calendar  Disclaimer The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.

This week on The Beat, CTSNet Editor in Chief Joel Dunning speaks with lead surgeon Feras Khaliel about the world's first fully robotic heart transplant. They explore the steps taken before and after the procedure, provide details of the operation itself, and share clips of this procedure. They also discuss the history of King Faisal Specialist Hospital and Research Centre (KFSHRC) and Khaleil’s experience in robotic-assisted surgery.   Joel also shares more about how Riyadh KFSHRC performed the world's first fully robotic heart transplant, multiarterial vs single-arterial coronary surgery, current indications and surgical strategies for myocardial revascularization in patients with left ventricular dysfunction, and simulation training for emergency sternotomy in the cardiovascular intensive care unit.   In addition, Joel highlights a re-commando procedure for recurrent endocarditis, chest wall reconstruction techniques, and robotic-assisted ligation of the aberrant right subclavian artery for dysphagia lusoria. Before closing, he shares upcoming events in CT surgery.   JANS Items Mentioned  1.) Riyadh KFSHRC Performs World's First Fully Robotic Heart Transplant   2.) Multiarterial vs Single-Arterial Coronary Surgery: Ten-Year Follow-Up of One Million Patients  3.) Current Indications and Surgical Strategies for Myocardial Revascularization in Patients With Left Ventricular Dysfunction  4.) Simulation Training for Emergency Sternotomy in the Cardiovascular Intensive Care Unit  CTSNet Content Mentioned  1.) Re-Commando Procedure for Recurrent Endocarditis  2.) Chest Wall Reconstruction Techniques  3.) Robotic-Assisted Ligation of the Aberrant Right Subclavian Artery for Dysphagia Lusoria  Other Items Mentioned  CTSNet Events Calendar     Disclaimer The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.

In this month’s episode of The Atrium, Dr. Alice Copperwheat explores chest drains with Leanne Ashrafian, thoracic surgeon and CTSNet Senior Editor. They discuss patient considerations, equipment used, positioning of the patient, and how to identify landmarks. They also discuss the steps required when performing chest drains, removal of chest tubes, complications, and so much more.     Don’t forget that The Atrium is a monthly podcast presenting clinical and career-focused topics for residents and early career professionals across all cardiothoracic surgery subspecialties. Watch for next month’s episode on cannulation.  Disclaimer The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.

This week on The Beat, Editor in Chief Joel Dunning speaks with Brian Houseman about VATS vs robotic lobectomy. They discuss training programs, the speed and efficiency of VATS, advanced chemotherapy cases, instruments used, safety, and the difference in pain for robotic-assisted surgery vs VATS.   Joel also discusses EACTS/STS guidelines for diagnosing and treating acute and chronic syndromes of the aortic organ, percutaneous versus surgical femoral cannulation in minimally invasive cardiac surgery, 2024 ESC guidelines for the management of chronic coronary syndromes, and transcatheter myotomy to reduce left ventricular outflow obstruction SESAME technique.   In addition, Joel highlights a robotic-assisted left lower lobectomy for NSCLC after neoadjuvant chemoimmunotherapy, chordal repair of P2 and P3 and left atrial appendage stapling through an upper mini sternotomy, and the Bookwalter retractor. Before closing, he shares upcoming events in CT surgery.  JANS Items Mentioned  1.) EACTS/STS Guidelines for Diagnosing and Treating Acute and Chronic Syndromes of the Aortic Organ  2.) Percutaneous Versus Surgical Femoral Cannulation in Minimally Invasive Cardiac Surgery: A Systematic Review and Meta-Analysis  3.) 2024 ESC Guidelines for the Management of Chronic Coronary Syndromes  4.) Transcatheter Myotomy to Reduce Left Ventricular Outflow Obstruction   CTSNET Content Mentioned  1.) Robotic-Assisted Left Lower Lobectomy for NSCLC After Neoadjuvant Chemoimmunotherapy  2.) Chordal Repair of P2 and P3 and Left Atrial Appendage Stapling Through an Upper Mini Sternotomy  3.) The Bookwalter Retractor—A Resident’s Best Friend  Other Items Mentioned  CTSNet Events Calendar  Disclaimer The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.