The Atrium: Median Sternotomy

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.

This week on The Beat, Editor in Chief Joel Dunning speaks with Ahmed Abbas about the recent 2024 Warith International Cardiology and Cardiothoracic Surgery Conference he organized at the University of Warith Al-Anbiyaa in Karbala, Iraq. They discuss the quality of heart surgery in Iraq, how many available facilities there are, how cardiothoracic surgery differs in Iraq from other countries, and the challenges of performing cardiothoracic surgery in Iraq. Additionally, Joel spoke with medical students to gain their perspectives on studying medicine in Iraq and their aspirations for the future.  He also discusses several JANS items including VATS thoracoscopic S1 segmentectomy, restoring discarded porcine lungs, emergent coronary revascularization with PCI and CABG, heart transplant for a patient with left superior vena cava, pathways to cardiothoracic surgery, defining resectability, and outcomes following heart valve surgery in patients with infective endocarditis.  In addition, Joel discusses a trans-subxiphoid robotic-assisted thymectomy, Apple Vision Pro spatial computing for endoscopic mitral valve, and the Aswan technique for extended septal myectomy. Before closing, Joel discusses upcoming events in CT surgery.  JANS Items Mentioned 1.) VATS Thoracoscopic S1 Segmentectomy, Right Upper Lobe: Alternative Posterior Approach 2.) Restoring Discarded Porcine Lungs by Ex Vivo Removal of Neutrophil Extracellular Traps  3.) Emergent Coronary Revascularization With PCI and CABG in Patients Receiving Extracorporeal Cardiopulmonary Resuscitation  4.) Heart Transplant for a Patient With Left Superior Vena Cava—Case Report and Surgical Technique 5.) Pathway to Cardiothoracic Surgery: A Primer for Aspiring Students  6.) Defining Resectability: When Do You Try to Take It Out? 7.) Outcomes Following Heart Valve Surgery in Patients With Infective Endocarditis and Preoperative Septic Cerebral Embolism  CTSNet Content Mentioned 1.) The Aswan Technique for Extended Septal Myectomy  2.) Apple Vision Pro Spatial Computing for Endoscopic Mitral Valve and VSD Surgery 3.) Trans-Subxiphoid Robotic-Assisted 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, Editor in Chief Joel Dunning discusses the 38th EACTS Annual Meeting in Lisbon.  He provides a comprehensive overview of the conference, including details about the featured speakers and the topics to be addressed by these distinguished surgeons.  He also discusses operating room extubation for patients undergoing cardiac surgery, how small airway brush gene expression predicts chronic lung allograft dysfunction and mortality, strategies to prevent and manage hemocompatibility-related adverse events in VAD patients, and mentoring pediatric heart surgeons.  In addition, Joel discusses a beating heart implant technique in donation after circulatory death, an excellent explanation of the full anatomy and physiology of the mitral valve, and neonatal aortic arch repair and the Warden procedure. Before closing, Joel discusses upcoming events in CT surgery.  The Beat is taking a quick break and will be back with a new episode on September 9, 2024!  JANS Items Mentioned 1.) Operating Room Extubation for Patients Undergoing Cardiac Surgery: A National Society of Thoracic Surgeons Database Analysis  2.) Small Airway Brush Gene Expression Predicts Chronic Lung Allograft Dysfunction and Mortality  3.) ISHLT Consensus Statement on Strategies to Prevent and Manage Hemocompatibility Related Adverse Events in VAD Patients  4.) Mentoring Pediatric Heart Surgeons: A Difficult Road for Both Mentors and Mentees CTSNet Content Mentioned 1.) Beating Heart Implant Technique in Donation After Circulatory Death Utilizing Ex Vivo Normothermic Organ Perfusion  2.) The Full Anatomy and Physiology of the Mitral Valve Explained   3.) Expert Techniques: Neonatal Aortic Arch Repair and the Warden Procedure  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, Editor in Chief Joel Dunning speaks with Dr. Raja Flores about VATS lobectomy. They discuss his experience and studies in VATS lobectomy and Dr. Flores’s technique for this procedure.   He also discusses the evolution of the treatment of non-small cell lung cancer, percutaneous coronary intervention versus coronary artery bypass grafting for left main disease, current indications and surgical strategies for myocardial revascularization in patients with left ventricular dysfunction, and pneumonectomy following penetrating trauma with ECMO as postoperative support.  In addition, Joel discusses a bilateral internal mammary artery harvest using an SSi MANTRA, sinus venosus atrial septal defect repair using a beating heart technique, and another installment in Dr. Tristan Yan’s aortic repair series focused on mega-thoracic aortic aneurysm repair. Before closing, Joel discusses upcoming events in CT surgery.  JANS Items Mentioned  1.) The Evolution of the Treatment of Non-Small Cell Lung Cancer: A Shift in Surgical Paradigm to a More Individualized Approach  2.) Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting for Left Main Disease According to Age  3.) Current Indications and Surgical Strategies for Myocardial Revascularization in Patients With Left Ventricular Dysfunction  4.) Pneumonectomy Following Penetrating Trauma With ECMO as Postoperative Support: Case Report—(Lung Trauma and ECMO)  CTSNET Content Mentioned  Bilateral Internal Mammary Artery Harvest Using an SSi MANTRA  Sinus Venosus Atrial Septal Defect Repair Using a Beating Heart Technique  Deep Dive Into Aortic Surgery: Mega-Thoracic Aortic Aneurysm Repair  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, host Dr. Alice Copperwheat speaks with Dr. Emily Farkas about median sternotomy. They discuss the indications and background of median sternotomy, patient preparation, the incision and its different variations, and preparation of the tissue. They also discuss osteotomy, spreading, and closure of median sternotomy.   A reminder that The Atrium airs once a month and presents foundational clinical and career-focused topics for residents and early career professionals across all cardiothoracic surgery subspecialties. Stay tuned for next month’s episode on chest drains!  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 highlights the Diego Gonzalez Rivas Foundation mobile surgical unit on its first trip to Accra, Ghana. He discusses the different surgeries that were performed on the first day in this mobile unit and how the mobile hospital will travel throughout Africa offering minimally invasive surgery to those who cannot afford thoracic surgery.   He also discusses a cross-sectional study on structural heart training experiences, long-term durability of bioprosthetic aortic valve replacement, mechanical versus biological mitral valve replacement, and a paradigm change in surgical management of the apical hypertrophic cardiomyopathy.  In addition, Joel discusses robotic bilateral internal mammary artery dissection, total arterial revascularization for multivessel coronary artery disease, and another installment in Dr. Tristan Yan’s aortic repair series focused on mini-access branch-first total arch replacement and the frozen elephant trunk procedure. Before saying goodbye, Joel discusses upcoming events in CT surgery.  JANS Items Mentioned Cross-Sectional Study on Structural Heart Training Experiences in Cardiothoracic Residency Programs Long Term Durability of Bioprosthetic Aortic Valve Replacement in Young Patients With Bicuspid Aortic Stenosis   Mechanical Versus Biological Mitral Valve Replacement: Insights From Propensity Score Matching on Survival and Reoperation Rates  Commentary: A Paradigm Change in Surgical Management of the Apical Hypertrophic Cardiomyopathy to Avoid Heart Transplantation  CTSNet Content Mentioned Robotic Bilateral Internal Mammary Artery Dissection   Total Arterial Revascularization for Multi-Vessel Coronary Artery Disease  Deep Dive Into Aortic Surgery: Mini-Access Branch-First Total Arch Replacement and Frozen Elephant Trunk Procedure  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, Editor in Chief Joel Dunning discusses the RESTORE trial for individuals with pectus excavatum. He discusses the goals for this trial, Castor EDC vs REDCap, and the statistical plan.  He also discusses risk factors influencing postoperative pleural empyema in patients with pleural mesothelioma, pre- and postoperative functional outcome parameters in patients receiving laryngotracheal surgery, surgical management of large tracheoesophageal fistulas in infants after button battery ingestion, and the “Seattle Shawl” procedure.  In addition, Joel discusses atrial septal defect closure in the setting of severe pectus excavatum, the Ravitch procedure with external rib plating to maximize relief of cardiac compression, and another installment in Dr. Tristan Yan’s aortic repair series focused on how to assess aortic valve competency of the mini-access CAVIAAR procedure. Before saying goodbye, Joel discusses upcoming events in CT surgery.  JANS Items Mentioned Risk Factors Influencing Postoperative Pleural Empyema in Patients With Pleural Mesothelioma: A Single-Centre Analysis  In-Depth Analysis of Pre- and Postoperative Functional Outcome Parameters in Patients Receiving Laryngotracheal Surgery  Surgical Management of Large Tracheoesophageal Fistula in Infants After Button Battery Ingestion  A Novel, Simplified Protected Ross Technique: The “Seattle Shawl” Procedure  CTSNet Content Mentioned Atrial Septal Defect Closure in the Setting of Severe Pectus Excavatum: A Unique Case The Ravitch Procedure With External Rib Plating to Maximize Relief of Cardiac Compression   Deep Dive Into Aortic Surgery: Mini-Access CAVIAAR Procedure, Part 1: How to Assess Aortic Valve Competency 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, Editor in Chief Joel Dunning discusses the implementation of the Versius robotic surgical system for thoracic surgery and summarizes the ability of the Versius surgical system to successfully and safely complete a range of thoracic procedures aligned with phase 2a of the (Development) of the Idea, Development, Exploration, Assessment and Long-term follow-up (IDEAL) framework for surgical innovation.   He also discusses the perioperative tools to predict neurocognitive outcomes in congenital heart surgery, the differences in right heart function after pulmonary valve replacement in patients with pulmonary valve stenosis versus tetralogy of Fallot, and the left atrial appendage closure for stroke prevention in atrial fibrillation.  In addition, Joel discusses neoarotic valve repair with a subannular ring for complex trileaflet prolapse after an arterial switch operation, the use of the autologous innominate vein as a substitute for the pulmonary arteries, and another installment in Dr. Tristan Yan’s aortic repair series focused on the technical details of the mini-access David procedure. Before saying goodbye, Joel discusses upcoming events in CT surgery.  JANS Items Mentioned Implementation of the Versius Robotic Surgical System for Thoracic Surgery: First Clinical Evaluation of Feasibility and Performance  Perioperative Tools to Predict Neurocognitive Outcome in Congenital Heart Surgery  Differences in Right Heart Function After Pulmonary Valve Replacement in Patients With Pulmonary Valve Stenosis Versus Tetralogy of Fallot  Left Atrial Appendage Closure for Stroke Prevention in Atrial Fibrillation: Current Status and Perspectives  CTSNet Content  Neoaortic Valve Repair With a Subannular Ring for Complex Trileaflet Prolapse After an Arterial Switch Operation  Deep Dive Into Aortic Surgery: Mini-Access David Procedure—Endoscopic Assessment of Valve Competency   The Use of the Autologous Innominate Vein as a Substitute for the Pulmonary Arteries in Pulmonary Atresia and Absent PAs  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.