Dissection Roulette: How to Survive the Most Unforgiving Surgery

This month’s episode focuses on the complex management of acute aortic dissection. Our hosts are joined by Florian Schoenhoff and Chris Malaisrie to discuss current strategies in surgical planning and intraoperative decision-making. Topics include CT-based assessment, cannulation techniques, malperfusion management, and valve preservation. The conversation also considers how to optimise outcomes, the role of conservative management in select cases, and the potential future impact of endovascular approaches. Listen for a practical overview of key considerations in this complex procedure.

Recorded at the AATS annual meeting in Seattle, our hosts are joined by Dr. El-Hamamsy & Dr. Ouzounian to explore the resurgence of the Ross procedure. The discussion covers the evolving evidence base, training requirements, and technical considerations surrounding this increasingly prevalent operation. Dr. El-Hamamsy and Dr. Ouzounian share their own learning curves, views on centralising care, and the importance of surgical volume for patient outcomes. Listeners will also hear about best practices in patient selection, graft support strategies, and the future of Ross—including potential innovations to expand access globally.

In this thought-provoking discussion, our hosts explore the multifaceted world of leadership in cardiac surgery. Joined by Shirin Bemelmans-Lalezari and Volkmar Falk, we delve into how leadership styles evolve, the balance between authority and empathy, and the importance of team dynamics. Learn of the real-life challenges in managing surgical teams and navigating hierarchy. With insights from both clinical and coaching perspectives, this episode offers valuable reflections for anyone considering or currently in a leadership role within cardiothoracic surgery.

We are pleased to announce the first of a new series of upcoming episodes, titled ‘Pulse Check – Key Papers at a Glance’. Our host Can discuss two recent and impactful EJCTS articles on infective endocarditis. Joined by the renowned, Michael Borger and Torsten Doenst, we explore firstly the implications of preoperative septic cerebral embolism for patients undergoing valve surgery. Then followed by an exploration into the use of haemoadsorption therapy, addressing the key issue of controlling inflammation during cardiac surgery for endocarditis. Listen to gain rapid insight into the associated articles: Effect of haemoadsorption during cardiac surgery for Staphylococcus aureus endocarditis: a REMOVE trial post hoc analysis Outcomes following heart valve surgery in patients with infective endocarditis and preoperative septic cerebral embolism: insights from the CAMPAIGN study group'

Are you curious about the origins and future of aortic root enlargement surgery? In this episode, our hosts discuss the surgical horizons of this underutilised technique. Featuring the well-respected Bo Yang, Can Gollmann-Tepeköylü and Miia L Lehtinen explore the creation of this innovative technique, as well as its reputation and utility in the surgical community. Listeners can expect to hear firsthand how Dr Yang discovered his esteemed procedure, as well as detailed comparisons to similar interventions and how patient suitability is assessed.

Are you looking to deepen your understanding of perioperative medication? Join us for the first episode of 2025, where we offer listeners an author insight into the recently published ‘2024 EACTS Guidelines on perioperative medication in adult cardiac surgery’. With working group members Anders Jeppsson and Emma Hansson, our host Miia L Lehtinen explores the fundamental intricacies considered to ensure these diverse guidelines are current and clinically applicable. Discussions include how the varied specialities of clinical intervention contribute to individual patient needs, including indication specific medication schedules, and the nuanced effects these bring to patients. We also encourage our listeners to view the recently published perioperative guidelines here: https://academic.oup.com/ejcts/advance-article/doi/10.1093/ejcts/ezae355/7815986?searchresult=1&login=false

In our final episode of the year, our hosts discuss the notorious complexities of the tricuspid valve, joined by specialists Nikos Bonaros and Victoria Delgado. Join Miia L Lehtinen and Can Gollmann-Tepeköylü in their exploration of the increasing relevance of tricuspid valve interventions, analysing the dynamic considerations of diagnostics, imaging, anatomy, cardiology and surgical interventions. Listeners can expect to learn of the fundamental principles of tricuspid disease, as well as how experts navigate nuanced challenges faced in challenging cases.

Join our hosts Can Gollmann-Tepeköylü and Miia L Lehtinen for their late-breaking trials highlights presented at the 38th EACTS Annual Meeting in Lisbon, including: (0:39 - 4:31) Long-term mortality after PCI or CABG in patients with diabetes and multivessel coronary artery disease: A SWEDEHEART study by Dr Emma C Hansson (4:32 - 8:33) Long-term (>10 years) results of transcatheter Mitral valve-in-valve implantation for degenerated surgical mitral bioprosthesis: Italian MItral VIV registry (MIVIV registry) by Dr Edoardo Zancanaro  (8:34 - 11:55) Personalized multimodal teleprehabilitation in elective cardiac surgery: results from the Digital Cardiac Counselling multicentered randomized Controlled Trial (ClinicalTrials.gov number, NCT04393636.) by Dr Bart Scheenstra   (11:55 - 16:15) 5-Year Results on Aortic Remodeling in the Dissected Aorta Repair Through Stent (DARTS) Implantation Trial by Dr Ryaan EL-Andari (16:16 - 19:49) Clinical impact of continuous postoperative pericardial flushing on bleeding-related complications after cardiac surgery by Dr Robert Klautz

Following the European Society of Cardiology’s (ESC) guidelines publication in collaboration with EACTS, Miia L Lehtinen and Can Gollmann-Tepeköylü host the esteemed Atrial Fibrillation experts, Manuel Castella and Niv Ad. In this month’s episode, our guests explore the nuances of how a surgical approach might be used to treat Atrial Fibrillation and why cardiac surgeons are increasingly interested in this complex electrophysiological condition. In light of the developing accepted practices, listeners can expect comparisons between the Maze procedure and non-surgical approaches, as well as an exploration of the endpoints used to determine patient outcomes.

This month’s episode is hosted by Miia L Lehtinen and Can Gollmann-Tepeköylü, who are joined by Wouter Oosterlinck, exploring his experience and expertise in the field of robotic cardiac surgery. Although already popular amongst thoracic surgeons, Wouter discusses the creation of his fast growing minimally invasive programme, which has been influential in this emerging field. Listen in for insight into the ever-developing applications of robotic cardiac surgery as well as the challenges being faced, such as nuanced medical device regulations.