The Atrium: Segmentectomy

This week on The Beat, CTSNet Editor-in-Chief Joel Dunning speaks with Adanna Akujuo, a cardiothoracic surgeon and the surgical director of the Structural Heart Program at UVA Health University Medical Center, about the Voom Foundation and its trips to Africa. Chapters 00:00 Intro 01:39 Dr. Akujuo, Medical Missions 21:57 JANS 1, Ticagrelor and Aspirin Coronary 25:20 JANS 2, Long-Term MVR Durability Model 27:37 JANS 3, Duration of Donor Ventilation 29:18 JANS 4, Min Inv Concomitant Tri VR 31:40 JANS 5, Soft Robotic Artificial Hybrid Heart 33:32 Career Center 34:20 Video 1, RVOT Injury During Dissection 37:05 Video 2, Min Inv ASD Closure 38:31 Video 3, Redo AVR via Partial U Resternotomy 40:08 Upcoming Events 40:54 Closing They explore the foundation’s goals, including training and educating local medical staff and providing essential care. Additionally, Dr. Akujo offers insights into the upcoming trip, discussing what a typical day entails, transportation logistics, accommodation, and the expenses that surgeons participating in the trip will need to cover, as well as what costs are taken care of by the foundation. The conversation also covers security measures in place, the average number of staff members on these trips, the daily surgical volume, and the most common cases.   Joel also highlights recent JANS articles on which is best, ticagrelor and aspirin or aspirin alone after coronary surgery for acute coronary syndrome; an artificial intelligence and machine learning model for personalized prediction of long-term mitral valve repair durability; effect of duration of donor ventilation on lung transplant outcomes; surgical decision-making for concomitant tricuspid valve repair in minimally invasive mitral valve surgery; and a soft robotic total artificial hybrid heart.  In addition, Joel explores right ventricular outflow tract injury during deep dissection in valve-sparing aortic root replacement, a minimally invasive approach for atrial septal defect closure, and redo aortic valve replacement via partial upper resternotomy. Before closing, Joel highlights upcoming events in CT surgery.    JANS Items Mentioned  1.) Ticagrelor and Aspirin or Aspirin Alone After Coronary Surgery for Acute Coronary Syndrome  2.) An Artificial Intelligence and Machine Learning Model for Personalized Prediction of Long-Term Mitral Valve Repair Durability  3.) Effect of Duration of Donor Ventilation on Lung Transplant Outcomes  4.) Surgical Decision-Making for Concomitant Tricuspid Valve Repair in Minimally Invasive Mitral Valve Surgery  5.) A Soft Robotic Total Artificial Hybrid Heart  CTSNET Content Mentioned  1.) Right Ventricular Outflow Tract Injury During Deep Dissection in Valve-Sparing Aortic Root Replacement   2.) Minimally Invasive Approach for Atrial Septal Defect Closure  3.) Redo Aortic Valve Replacement Via Partial Upper Resternotomy  Other Items Mentioned  1.) Voom Foundation   2.) Career Center   3.) 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 Dr. Nicholas Smedira, a cardiac surgeon at the Cleveland Clinic, about mitral valve-induced left ventricular outflow tract (LVOT) obstruction with minimal septal hypertrophy. Chapters  00:00 Intro 02:25 JANS 1, Transcervical Robotic AVR 07:49 JANS 2, Post Cor-Knot vs Manual Tying 10:18 JANS 3, Valve Therapy vs Volume Reduction 12:55 JANS 4, Cardiac Early Extraction vs Management 15:17 Career Center 16:18 Video 1, Repair of Ruptured RCAA 17:57 Video 2, Right Atrial Myxoma from IVC Junction 20:05 Video 3, Modified Re-Do Commando 22:43 Dr. Smedira Interview 45:44 Upcoming Events 46:58 Closing They discuss the importance of understanding the anatomy and physiology of the papillary muscles, as well as flow vortices. They also cover various techniques for mitral valve repair and replacement, emphasizing the importance of making the leaflet coaptation zone as posterior as possible. Additionally, they explore how learning techniques for mitral valve-induced LVOT obstruction with minimal septal hypertrophy have evolved through exposure and experience.   Joel also highlights recent JANS articles on the world's first transcervical robotic AVR procedures successfully performed in four Cleveland Clinic patients, a comparison of outcomes post Cor-Knot vs manual tying in valve surgery, endobronchial valve therapy vs lung volume reduction surgery in the United States, and early extraction vs conservative management in patients with noninfected cardiac implantable electronic devices undergoing cardiac surgery for left-sided infective endocarditis.   In addition, Joel explores the repair of a ruptured right coronary artery aneurysm, removal of a right atrial myxoma from the IVC junction with patch repair using the left atrial appendage, and a modified redo Commando procedure in a patient with septic shock due to aortic and mitral valve endocarditis. Before closing, Joel highlights upcoming events in CT surgery.    JANS Items Mentioned  1.) World's First Transcervical Robotic AVR Procedures Successfully Performed in 4 Cleveland Clinic Patients  2.) Comparison of Outcomes Post Cor-Knot Versus Manual Tying in Valve Surgery: Our 8-year Analysis of Over 1000 Patients  3.) Endobronchial Valve Therapy Versus Lung Volume Reduction Surgery in the United States  4.) Early Extraction Versus Conservative Management in Patients With Noninfected Cardiac Implantable Electronic Devices Undergoing Cardiac Surgery for Left-Sided Infective Endocarditis  CTSNET Content Mentioned  1.) Repair of Ruptured Right Coronary Artery Aneurysm  2.) Removal of a Right Atrial Myxoma From the IVC Junction With Patch Repair Using the Left Atrial Appendage  3.) Modified Re-Do Commando Procedure in a Patient With Septic Shock Due to Aortic and Mitral Valve Endocarditis   Other Items Mentioned  1.) A Surgeon’s Toolkit for Mitral Valve-Induced Left Ventricular Outflow Tract Obstruction With Minimal Septal Hypertrophy  2.) Cardiac Surgical Arrest—An International Conversation Series    3.) Career Center   4.) 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 Dr. Robert Cerfolio, Chief of the Division of Thoracic Surgery at NYU Langone Health, about NYU Langone Health’s rise in hospital rankings. Chapters 00:00 Intro 02:19 Best Hospitals Report 08:52 JANS 1, Physician Compensation 13:54 JANS 2, International Challenges 18:36 Career Center 19:40 JANS 3, Rib Fracture Guidelines 23:16 JANS 4, Endovasc Concepts & Devices 26:05 Video 1, Redo Aortic Root David 26:43 Video 2, Removal of LAM 28:16 Video 3, Posterior MAD Correction 30:23 Dr. Cerfolio Interview 51:29 Upcoming Events 53:18 Resident Video Competition 54:10 Closing They discuss the process that contributed to this improvement, including the efficiency quality index and the benefits of discharging patients on postoperative day one while maintaining constant communication with them as opposed to keeping them hospitalized for extended stays. Additionally, they emphasize the importance of patients going home to a safe environment, postoperative protocols, and the future of NYU Langone Health.  Joel also highlights recent JANS articles on the 2025 Doximity Physician Compensation Report, the current landscape and challenges facing international medical graduates in cardiothoracic surgery training, Chest Wall Injury Society guidelines for surgical stabilization of rib fractures, and foundational endovascular concepts and devices for cardiac surgeons.   In addition, Joel explores the David procedure in a patient with a previous Type A dissection surgery, removal of a left atrial myxoma with a ministernotomy, and surgical correction of the posterior mitral annular disjunction associated with structural abnormalities of the mitral valve. Before closing, Joel highlights upcoming events in CT surgery.   JANS Items Mentioned  1.) Physician Compensation Report 2025  2.) The Current Landscape and Challenges Facing International Medical Graduates in Cardiothoracic Surgery Training  3.) Chest Wall Injury Society Guidelines for Surgical Stabilization of Rib Fractures: Indications, Contraindications, and Timing  4.) Foundational Endovascular Concepts and Devices for Cardiac Surgeons  CTSNET Content Mentioned  1.) Redo Aortic Root Surgery: The David Procedure in a Patient With a Previous Type A Dissection Surgery  2.) Removal of a Left Atrial Myxoma With a Ministernotomy  3.) Surgical Correction of the Posterior Mitral Annular Disjunction Associated With Structural Abnormalities of the Mitral Valve  Other Items Mentioned  1.) Best Hospitals for Cardiology, Heart & Vascular Surgery  2.) NYU Langone Health Leads the Nation with Four No. 1–Ranked Specialties by U.S. News & World Report  3.) Cardiac Surgical Arrest—An International Conversation Series    4.) Resident Video Competition  5.) Career Center   6.) 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 episode of The Atrium, host Dr. Alice Copperwheat speaks with Dr. Agathe Seguin-Givelet, a thoracic surgeon at Ambroise Pare-Hartmann Hospital in France, about segmentectomy. Chapters 00:00 Intro 01:09 Choosing CT Surgery 02:52 Background 05:23 Indications 10:20 Evidence & Key Trials 16:52 Preop Planning 20:42 Surgical Anatomy 23:14 Approaches 24:39 Step-by-Step 38:40 Pearls & Pitfalls 41:25 Postop Care & Complications 42:55 Key Points 44:03 Training Tips They explain what segmentectomy is, the differences between segmentectomy and lobectomy, preoperative planning, and the surgical anatomy of the segments. They also explore various approaches, provide a step-by-step guide on how to perform segmentectomy, discuss potential pitfalls, and share training tips.   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 proximal anastomosis with Dr. John Puskas.   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 Dr. Kenneth Liao, professor of surgery and chief of the Division of Cardiothoracic Transplantation and Circulatory Support at Baylor College of Medicine, about performing the world’s first adult robotic heart surgery in the United States using a subxiphoid approach. Chapters 00:00 Intro 02:31 JANS 1, Endocarditis Guidelines 13:02 JANS 2, Hybrid vs Catheter 16:16 JANS 3, Full Sternotomy Trial 18:07 JANS 4, Buttressing the BA 19:05 JANS 5, Intraspinal Vasc Perf 20:15 Career Center 20:37 Video 1, Root Replace & Ann Reconstr 21:56 Video 2, Bi-Atrial Cann for BVAD 24:17 Video 3, Pediatric Device Implant 26:23 Dr. Liao Interview 49:07 Upcoming Events 49:39 Closing They discuss the details of the procedure, including its background, ischemic time, technique, and postoperative outcomes. Additionally, they explore the application of the subxiphoid approach for robotic heart transplants and robotic mitral valve repair vs traditional open-chest (sternotomy) repair. Dr. Liao shares insights into the training and practice required for this operation and discusses the advantages of using robotics in heart transplants. He also reflects on what he would do differently in future procedures.   Joel also highlights recent JANS articles on the surgical implications of the 2023 ESC endocarditis guidelines endorsed by EACTS, the two-year results from the randomized CEASE-AF trial on the durable effectiveness and safety of hybrid ablation vs catheter ablation, a randomized trial on superficial parasternal intercostal plane block and full sternotomy, a comparison of the short- and long-term outcomes in patients undergoing sleeve lobectomy with or without buttressing the bronchial anastomosis, and intraspinal vascular perfusion territories of the descending thoracic aorta.  In addition, Joel explores free-style root replacement and annular reconstruction for destructive aortic root endocarditis, bi-atrial cannulation for biventricular assist device in children, and a device implantation in a 26 kg child. Before closing, Joel highlights upcoming events in CT surgery.    JANS Items Mentioned  1.) Surgical Implications of the 2023 ESC Endocarditis Guidelines Endorsed by EACTS: Bridging Guidelines and Practice   2.) Durable Effectiveness and Safety of Hybrid Ablation Versus Catheter Ablation: 2-year Results From the Randomized CEASE-AF Trial  3.) Superficial Parasternal Intercostal Plane Block and Full Sternotomy; A Randomized Trial  4.) Comparison of Short- and Long-Term Outcomes in Patients Undergoing Sleeve Lobectomy With or Without Buttressing the Bronchial Anastomosis  5.) Intraspinal Vascular Perfusion Territories of the Descending Thoracic Aorta  CTSNET Content Mentioned  1.) Free-Style Root Replacement and Annular Reconstruction for Destructive Aortic Root Endocarditis  2.) Bi-Atrial Cannulation for Biventricular Assist Device in Children  3.) Device Implantation in a 26 kg Child  Other Items Mentioned  1.) Guest Editor Series Webinar: Insights Into Pediatric Mechanical Circulatory Support  2.) Cardiac Surgical Arrest—An International Conversation Series    3.) Career Center   4.) 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 Dr. Todd Rosengart, professor and chair of the Michael E. DeBakey Department of Surgery at Baylor College of Medicine, about his team performing the world’s first adult robotic heart surgery in the United States. Chapters 00:00 Intro 02:27 JANS 1, On-Table Extubation 14:13 JANS 2, Intraop Broncho Biopsies 18:26 JANS 3, Stroke After Transplant 20:51 JANS 4, Pulm Carcinoid Tumors 22:56 Career Center 24:05 Video 1, Robotic LAAO 25:36 Video 2, Bedside VV ECMO 26:44 Video 3, Inverted Y AE 28:01 Dr. Rosengart Interview, Novel Approaches 40:57 Upcoming Events 42:58 Closing They discuss postoperative outcomes and the 100-day follow-up appointment, the benefits of the robotic technique in transplants, and the surgeons who participated in this procedure. Additionally, Dr. Rosengart shares advice for individuals performing robotic transplants, his experience leading this unit, and its notable accomplishments, including other world-first procedures.   Joel also highlights recent JANS articles on the 10 best practices of on-table extubation after cardiac surgery, if we can rely on intraoperative bronchoscopic biopsies for surgical decision making, increased prevalence of stroke after heart transplant in the new allocation system era, and the surgical management of both stage III and stage IV pulmonary carcinoid tumors confers survival benefit.  In addition, Joel explores robotic left atrial appendage occlusion, bedside veno-venous extracorporeal membrane oxygenation cannulation technique in an awake patient, and a stepwise surgical approach for inverted Y annular enlargement in the bicuspid aortic valve. Before closing, Joel highlights upcoming events in CT surgery.    JANS Items Mentioned  1.) The 10 Commandments of On-Table Extubation After Cardiac Surgery: Why and How to Increase Adoption  2.) Can We Rely on Intraoperative Bronchoscopic Biopsies for Surgical Decision Making? 78 Single Anesthetic Robotic Bronchoscopy to Anatomic Resections  3.) Increased Prevalence of Stroke After Heart Transplant in the New Allocation System Era  4.) Surgical Management of Both Stage III and Stage IV Pulmonary Carcinoid Tumors Confers Survival Benefit  CTSNET Content Mentioned  1.) Robotic Left Atrial Appendage Occlusion   2.) Bedside Veno-Venous Extracorporeal Membrane Oxygenation Cannulation Technique in an Awake Patient  3.) Inverted Y Annular Enlargement in Bicuspid Aortic Valve: A Stepwise Surgical Approach  Other Items Mentioned  1.) Guest Editor Series: Insights Into Pediatric Mechanical Circulatory Support  2.) Cardiac Surgical Arrest—An International Conversation Series    3.) Career Center   4.) 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 Dr. Mara Antonoff, Associate Professor of Thoracic and Cardiovascular Surgery and Program Director for Education at the University of Texas MD Anderson Cancer Center, and President of Women in Thoracic Surgery, about chest tubes. Chapters 00:00 Intro 02:21 JANS 1, Ross Long-Term Outcomes 04:12 JANS 2, Valve Replacement Pregnancy 07:09 JANS 3, Bronchopleural Fistula 09:36 JANS 4, AUTHEARTVISIT Study 11:51 Career Center 13:56 Video 1, Bicuspid AVR & AAR 16:15 Video 2, Cold Head-Warm Body Perfusion 19:00 Video 3, Dr. Kappetein Podcast 20:23 Dr. Antonoff Interview, Chest Tube Management 38:45 Closing They discuss single chest tube vs double chest tube, the benefits of single chest tubes, and various chest tube sizes. They also explore reducing chest drain pain, stitching the chest tube, and chest tube output thresholds for removal. Additionally, they cover drain removal, air leaks, and clamping.   Joel also highlights recent JANS articles on whether the Ross procedure in young adults delivers favorable long-term clinical and QOL outcomes, a literature review including new data from the registry of pregnancy and cardiac disease III regarding valve replacement during pregnancy, a multi-institutional analysis of the treatment outcomes and prognostic factors in the ESSG-01 study, and the choice of surgical aortic valve replacement type and midterm outcomes in 50 to 65-year-olds.   In addition, Joel explores bicuspid aortic valve repair and ascending aorta replacement, a guide to isolated cerebral perfusion using two bypass circuits, and an episode of The Atrium podcast featuring host Dr. Alice Copperwheat speaking with Professor Pieter Kappetein about the future of revascularization. Before closing, Joel highlights upcoming events in CT surgery.    JANS Items Mentioned  1.) Ross Procedure in Young Adults Delivers Favorable Long-Term Clinical and QOL Outcomes  2.) Valve Replacement During Pregnancy: Literature Review Including New Data From the Registry of Pregnancy and Cardiac Disease III  3.) Bronchopleural Fistula: A Multi-Institutional Analysis of the Treatment Outcomes and Prognostic Factors in the ESSG-01 Study   4.) The Choice of Surgical Aortic Valve Replacement Type and Mid-Term Outcomes in 50 to 65-Year-Olds: Results of the AUTHEARTVISIT Study   CTSNET Content Mentioned  1.) Bicuspid Aortic Valve Repair and Ascending Aorta Replacement   2.) Cold Head-Warm Body Perfusion: A Guide to Isolated Cerebral Perfusion Using Two Bypass Circuits  3.) The Atrium: The Future of Revascularization   Other Items Mentioned  1.) Guest Editor Series: Insights Into Pediatric Mechanical Circulatory Support  2.) Cardiac Surgical Arrest—An International Conversation Series    3.) Career Center   4.) 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 Dr. Joseph Zacharias, a consultant cardiothoracic surgeon at the Lancashire Cardiac Center in Blackpool, England, about lifetime management of heart valve disease. Chapters 00:00 Intro 02:13 Early Intervention, Disease Management 04:40 JANS 1, Sept on Placental Support 07:04 JANS 2, Surgeon Well-Being 09:41 JANS 3, Cardiac 10:58 JANS 4, PPM in SAVR 12:57 JANS 5, Cardiac Registry 14:22 Video 1, Close U Ministernotomy 15:19 Video 2, Endo AVR & MVR 16:03 Video 3, VATS 17:20 Dr. Zacharias Interview, HVD 38:04 Upcoming Events 38:51 Closing They delve into Dr. Zacharias’s recent paper titled “Lifetime Management of Heart Valve Disease—Treat It Early and Treat It Right, First Time,” and discuss how the idea for the paper originated highlighting key takeaways. They also address perceived risks vs actual risks and why less than 25 percent of patients are referred for necessary interventions. Additionally, they examine the future of cardiac surgery, endoscopic cardiac surgery, and endoscopic vein harvesting.   Joel also highlights recent JANS articles on a novel and logistic approach for hypoplastic left heart syndrome with intact atrial septum, a European Society of Thoracic Surgery survey on member well-being, transcatheter management of left-sided valvular heart disease following heart transplantation, a multi-institutional study on the prevalence and clinical impact of patient-prosthesis mismatch in surgical aortic valve replacement, and a systematic review and meta-analysis of the German registry of acute aortic dissection type A score for 30-day mortality prediction in type A acute aortic dissection surgery.   In addition, Joel explores how to close an upper ministernotomy, endoscopic aortic valve replacement and mitral valve replacement, and uniportal VATS decortication for late-stage TB empyema. Before closing, Joel highlights upcoming events in CT surgery.    JANS Items Mentioned  1.) Open Atrial Septectomy on Placental Support: A Novel and Logistic Approach for Hypoplastic Left Heart Syndrome With Intact Atrial Septum  2.) Fit2Perform: European Society of Thoracic Surgery Survey on Member Well-Being  3.) Transcatheter Management of Left-Sided Valvular Heart Disease Following Heart Transplantation  4.) A Multi-Institutional Study on the Prevalence and Clinical Impact of Patient-Prosthesis Mismatch in Surgical Aortic Valve Replacement  5.) The German Registry of Acute Aortic Dissection Type A Score for 30-Day Mortality Prediction in Type A Acute Aortic Dissection Surgery: A Systematic Review and Meta-Analysis  CTSNet Content Mentioned  1.) How to Close an Upper Ministernotomy   2.) Endoscopic Aortic Valve Replacement and Mitral Valve Replacement   3.) Uniportal VATS Decortication for Late-Stage TB Empyema   Other Items Mentioned  1.) Lifetime Management of Heart Valve Disease—Treat It Early and Treat It Right, First Time  2.) Guest Editor Series Webinar: Coronary Arterial Anomalies—Pediatric and Adult Congenital 3.) Cardiac Surgical Arrest—An International Conversation, Part 4 4.) Career Center   5.) CTSNet Events Calendar 

In this episode of The Atrium, host Dr. Alice Copperwheat speaks with Professor Pieter Kappetein, Professor of Cardiothoracic Surgery at Erasmus Medical Center and Vice President and Chief Medical Officer of Medtronic, about the future of revascularization. Chapters 00:00 Introduction 00:47 Dr. Kappetein Background 04:19 Getting Into Research 05:36 Work Balance 06:35 Industry Role in Career 09:30 Status of Revascularization 12:20 SYNTAX Trial 13:40 EXCEL Trial 15:54 AHA Guidelines & Heart Teams 18:59 Heart Teams 21:15 Future of Revascularization 24:10 Hybrid Approaches 25:55 Advice for Surgery Training They discuss the history of revascularization, the SYNTAX trial, the EXCEL trial, and the new American Heart Association (AHA) guidelines. They also explore the Heart Team approach and what’s on the horizon in this important surgery specialty.    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 segmentectomy with thoracic surgeon Dr. Agathe Seguin-Givelet. 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 CTSNet Senior Editor Dr. Sameh Said, Chief of the Division of Pediatric and Adult Congenital Cardiac Surgery at Maria Fareri Children's Hospital, Professor of Surgery and Pediatrics at the New York Medical College, and Consultant Cardiac Surgeon at King Faisal Specialist Hospital and Research Center about performing the first successful ex utero intrapartum treatment (EXIT)-to-open atrial septectomy-to-rapid stage I Norwood palliation in a neonate with hypoplastic left heart syndrome and intact interatrial septum. Chapters 00:00 Intro 03:13 JANS 1, Cardiac Transplant 09:04 JANS 2, Lung Transplant 10:19 JANS 3, Cardiac Transplant 11:08 JANS 4, Lung Cancer 13:01 JANS 5, Thoracic 15:44 Video 1, Congenital Cardiac 17:53 Video 2, Cardiac 19:49 Video 3, Cardiac 21:50 Dr. Said Interview, EXIT Procedure 37:28 Upcoming Events 39:32 Closing They discuss the surgical steps involved in this groundbreaking procedure, including specific details about the surgery, the preparation undertaken prior to the operation, and the key factors that contributed to its success. Additionally, they covered the challenges encountered during this first successful EXIT procedure case, as well as the standard management practices for these cases at medical centers, such as fetal balloon atrial septostomy, along with postnatal transcatheter, surgical, or hybrid interventions and their associated surgical risks. Furthermore, they address the broader challenges faced when operating on patients with hypoplastic left heart syndrome, including the differences between restrictive atrial septum and intact atrial septum.   Joel also highlights recent JANS articles on the current state and future directions of cardiac xenotransplantation, if age is a contraindication for lung transplantation in the elderly, a summary of the International Society for Heart and Lung Transplantation consensus conference on emerging understanding of antibodies and antibody-mediated rejection in heart transplantation, inflammatory diseases and risk of lung cancer among individuals who have never smoked, and active chest tube clearance added to an Enhanced Recovery After Cardiac Surgery (ERAS) program improves outcomes and reduces resource utilization.  In addition, Joel explores a single incision mitral valve repair and LIMA-to-LAD bypass via a left anterior minithoracotomy, repair of post-infarction ventricular septal defect using a double patch sandwich technique, and reconstruction of the left trigone during the Commando procedure for invasive prosthetic aortic valve endocarditis. Before closing, Joel highlights upcoming events in CT surgery.    JANS Items Mentioned  1.) Cardiac Xenotransplantation: Current State and Future Directions  2.) Lung Transplantation in the Elderly: Is Age a Contraindication?  3.) Summary of the International Society for Heart and Lung Transplantation Consensus Conference on Emerging Understanding of Antibodies and Antibody-Mediated Rejection in Heart Transplantation  4.) Inflammatory Diseases and Risk of Lung Cancer Among Individuals Who Have Never Smoked  5.) Active Chest Tube Clearance Added to an Enhanced Recovery After Cardiac Surgery (ERAS) Program Improves Outcomes and Reduces Resource Utilization  CTSNET Content Mentioned  1.) Single Incision Mitral Valve Repair and LIMA-to-LAD Bypass via a Left Anterior Minithoracotomy  2.) Repair of Post-Infarction Ventricular Septal Defect Using a Double Patch Sandwich Technique  3.) Reconstruction of the Left Trigone During the Commando Procedure for Invasive Prosthetic Aortic Valve Endocarditis  Other Items Mentioned  1.) Guest Editor Series: Coronary Arterial Anomalies—Pediatric and Adult Congenital   2.) Cardiac Surgical Arrest—An International Conversation Series   3.) Career Center   4.) 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.