The Beat With Joel Dunning Ep. 77: The Nuss Procedure

In this month’s episode of The Atrium, Dr. Alice Copperwheat explores bronchoscopy with expert guest Dr. Benjamin Waterhouse. They discuss indications, contraindications, types of bronchoscopies (flexible versus rigid), and the benefits of utilizing the rigid technique over the flexible technique. They also discuss the fundamentals of bronchoscopy—equipment, preprocedural checklists, and positioning—details on how to perform the procedure, complications, and the future of bronchoscopy.  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 the next episode featuring a discussion with Dr. Valerie Rusch.  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 latest salaries and conditions of cardiothoracic surgeons in the United States. He explores the highest versus lowest compensation areas, areas with the highest growth for compensation, and where cardiothoracic surgeons rank among other surgeons. He also highlights the highest paid specialties, burnout rates, early retirement, and noncompete clauses.   Joel also reviews recent JANS articles on transcatheter aortic valve replacement for asymptomatic severe aortic stenosis, transcatheter aortic valve replacement in patients with systolic heart failure and moderate aortic stenosis, valve-in-valve transcatheter aortic valve replacement versus isolated redo surgical aortic valve replacement, and the seven pillars of techniques to treat and repair tricuspid endocarditis.  In addition, Joel explores surgical aortic annulus enlargement using a balloon technique, quadruple valve replacement for carcinoid heart disease, and Fontan conversion in a patient with hypoplastic left heart syndrome. Before closing, he highlights upcoming events in CT surgery. JANS Items Mentioned  1.) Transcatheter Aortic-Valve Replacement for Asymptomatic Severe Aortic Stenosis—EARLY TAVR Trial  2.) Transcatheter Aortic Valve Replacement in Patients With Systolic Heart Failure and Moderate Aortic Stenosis: TAVR UNLOAD  3.) Valve-in-Valve Transcatheter Aortic Valve Replacement Versus Isolated Redo Surgical Aortic Valve Replacement  4.) The Seven Pillars of Techniques to Treat and Repair Tricuspid Endocarditis  CTSNET Content Mentioned  1.) Surgical Aortic Annulus Enlargement Using a Balloon Technique  2.) Quadruple Valve Replacement for Carcinoid Heart Disease  3.) Fontan Conversion in a Patient With Hypoplastic Left Heart Syndrome: A 38-Year-Old Norwood Saga  Other Items Mentioned  1.) Doximity Pay Report 2023   2.) 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 how to be a better trainer. He explores tips for training people, the five levels of training, and sensory overload. Later in the podcast, he further explores the topic of training trainers with Professor Mark Coleman, co-founder of Lapco, an innovative training consultancy focused on safer surgeries. They highlight details of Professor Coleman’s courses, the program’s learning curve, and how this training could be beneficial for cardiothoracic surgeons worldwide.   Joel also reviews recent JANS articles on clinical outcomes of mitral valve surgery in atrial functional mitral regurgitation in the REVEAL-AFMR registry, risk of transfusion in isolated coronary artery bypass graft, the efficacy of loco-regional ropivacaine analgesia via intercostal catheters after lung resection, and percutaneous transcatheter edge-to-edge repair for functional mitral regurgitation in heart failure.  In addition, Joel explores a case report of coronary stentectomy, principles of complex mitral valve repair with Leonard Lee and Vince Gaudiani, and uniportal robotic-assisted extended thymectomy. Before closing, he highlights upcoming events in CT surgery.   JANS Items Mentioned  1.) Clinical Outcomes of Mitral Valve Surgery in Atrial Functional Mitral Regurgitation in the REVEAL-AFMR Registry  2.) Risk of Transfusion in Isolated Coronary Artery Bypass Graft: Models Developed From The Society of Thoracic Surgeons Database  3.) The Efficacy of Loco-Regional Ropivacaine Analgesia Via Intercostal Catheters After Lung Resection: A Randomized, Double-Blind, Placebo-Controlled, Superiority Study  4.) Percutaneous Transcatheter Edge-to-Edge Repair for Functional Mitral Regurgitation in Heart Failure: A Meta-Analysis of Three RCTs  CTSNET Content Mentioned  1.) Undressing the “Full Metal Jacket”—A Case Report of Coronary Stentectomy  2.) Principles of Complex Mitral Valve Repair: An Exploration With Leonard Lee and Vince Gaudiani  3.) Uniportal Robotic-Assisted Extended Thymectomy  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 Professor Mark Redmond about the ROSS procedure at the 2024 Birmingham Review Course. They discuss the current status of the ROSS procedure, the evolution of this procedure, and its benefits. They also discuss the steps for a surgeon to become experienced enough to perform the ROSS procedure and how trainee techniques have changed.    Joel also reviews recent JANS articles on rigid sternal fixation and enhanced recovery for opioid-free analgesia after cardiac surgery, long-term health outcomes of young patients with low complexity coronary disease, evaluation of the nonstapling bullectomy by manual suturing for young men with primary spontaneous pneumothorax, and risk factors and early outcomes associated with prolonged pleural effusion/chylothorax after pediatric cardiac surgery.   In addition, Joel explores the Bedi-IMA buttress, transfer technique from femoro-jugular veno-venous ECMO to veno-pulmonary ECMO with a ProtekDuo cannula, and modified Lecompte combined with pulmonary valve replacement and reduction pulmonary arterioplasty for TOF/APV-like syndrome. He also shows a recent clip from Professor Enoch Akowuah and his colleagues about their first day in Ghana. Before closing, he highlights upcoming events in CT surgery.   JANS Items Mentioned  1.) Rigid Sternal Fixation and Enhanced Recovery for Opioid-Free Analgesia After Cardiac Surgery  2.) Long-Term Health Outcomes of Young Patients With Low Complexity Coronary Disease: A Weighted Analysis According to Revascularization Strategy  3.) Evaluation of the Nonstapling Bullectomy by Manual Suturing for Young Men With Primary Spontaneous Pneumothorax  4.) Risk Factors and Early Outcomes Associated With Prolonged Pleural Effusion/Chylothorax After Paediatric Cardiac Surgery  CTSNET Content Mentioned  1.) The Bedi-IMA Buttress  2.) Transfer Technique From Femoro-Jugular Veno-Venous ECMO to Veno-Pulmonary ECMO With a ProtekDuo Cannula: Step-by-Step  3.) Modified Lecompte Combined With Pulmonary Valve Replacement and Reduction Pulmonary Arterioplasty for TOF/APV-Like Syndrome  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 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.