The Beat With Joel Dunning Ep. 125: Ticagrelor vs Aspirin Post-Coronary Surgery

This week on The Beat, CTSNet Editor-in-Chief Joel Dunning shares insights from his recent trip to Ghana. Chapters 00:00 Intro  02:18 Ghana Mission Trip  04:35 Failures of a Heart Surgeon   09:27 JANS 1, Accelerometer-Measured Physical Activity   12:57 JANS 2, Utility of GERAADA Score   14:41 JANS 3, Aortic Valve Neocuspidization   17:33 JANS 4, Procedural Planning in Thoracoscopic Segmentectomy  19:09 JANS 5, The Outlet Orifice Diameter   22:28 Video 1, Clampless Aortic Valve Replacement   24:01 Video 2, Multiportal Robot-Assisted Extended LLS S6  25:13 Video 3, The Atrium  26:00 EACTS 2025 & Upcoming Events  27:35 Footage From Ghana  He discusses the various procedures that he and his team performed during their visit, as well as his overall experience collaborating with the local surgeons. The episode also features surgical footage from his time in Ghana and includes discussion with several surgeons about their work. Additionally, Joel addresses a recent news story from the UK regarding the failures of a heart surgeon that have contributed to multiple patient deaths. He provides an overview of the circumstances surrounding these events and emphasizes the critical importance of teamwork in surgical practice.   Joel also highlights recent JANS articles on an analysis of the UK mini mitral randomized controlled trial for accelerometer-measured physical activity after mitral valve surgery, the utility of GERAADA score for predicting long-term survival following surgical repair of aortic dissection, early to mid-term results of aortic valve neocuspidization for rheumatic aortic valve disease, a systematic review and meta-analysis for three-dimensional reconstruction and virtual simulation of patient-specific anatomy for procedural planning in thoracoscopic segmentectomy, and the outlet orifice diameter of surgical bioprosthetic aortic stented valves is predominantly much smaller than the inlet orifice diameter.  In addition, Joel explores a clampless aortic valve replacement in a partial porcelain aorta with aortic root enlargement and CABG with two grafts, multiportal robot-assisted extended lower left segmentectomy, and an episode of The Atrium podcast featuring host Dr. Alice Copperwheat speaking with Dr. John D. Puskas about proximal coronary anastomosis. Before closing, Joel highlights upcoming events in CT surgery.    JANS Items Mentioned  1.) Accelerometer-Measured Physical Activity After Mitral Valve Surgery: An Analysis of the UK Mini Mitral Randomized Controlled Trial  2.) Utility of GERAADA Score for Predicting Long-Term Survival Following Surgical Repair of Aortic Dissection  3.) Early to Mid-Term Results of Aortic Valve Neocuspidization for Rheumatic Aortic Valve Disease  4.) Three-Dimensional Reconstruction and Virtual Simulation of Patient-Specific Anatomy for Procedural Planning in Thoracoscopic Segmentectomy: A Systematic Review and Meta-Analysis  5.) The Outlet Orifice Diameter of Surgical Bioprosthetic Aortic Stented Valves Is Predominantly Much Smaller Than the Inlet Orifice Diameter   CTSNet Content Mentioned  1.) Clampless Aortic Valve Replacement in a Partial Porcelain Aorta With Aortic Root Enlargement and CABG With Two Grafts  2.) Multiportal Robot-Assisted Extended Lower Left Segmentectomy: Superior Segment S6 With Lateral S9 Resection  3.) The Atrium: Proximal Coronary Anastomosis   Other Items Mentioned  1.) Joel Dunning YouTube Channel | The Arrhythmia Alliance Hearts of Ghana Mission 2025   2.) Heart Surgeon’s Failures Contributed to Multiple Deaths   3.) The 10 Commandments for Proximal Anastomosis During CABG: Techniques and Technologies for Vein and Arterial Grafts  4.) Perfecting TAVR Removal | Skills Sharpening With Vince Gaudiani  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.

This week on The Beat, CTSNet Editor-in-Chief Joel Dunning speaks with Dr. Anders Jeppsson, a cardiothoracic surgeon at Sahlgrenska University Hospital in Gothenburg, Sweden, about his paper on “Ticagrelor and Aspirin or Aspirin Alone After Coronary Surgery for Acute Coronary Syndrome,” published in The New England Journal of Medicine. Chapters 00:00 Intro  01:54 Ghana Mission Trip  06:23 JANS 1, Pig-to-Human Transplant  08:08 JANS 2, CABG Acute Type A AD  10:06 JANS 3, Chylothorax Lymph Node Management  11:22 JANS 4, ICU Resternotomy Adoption  13:38 JANS 5, Octogenarians Repair vs MV Surgery  15:10 Career Center  15:31 Video 1, MVR Patent Bilateral IMammary Grafts  16:36 Video 2, Repeat RA Thoracotomy  17:39 Video 3, Vascular Injuries in Robotics  19:12 Dr. Jeppsson Interview  33:30 EACTS 2025 & Upcoming Events  They began by providing an overview of the study, including the reason for conducting it, the expansion of the study to other Nordic countries, and its results. They also discuss the funding for the research and the recruitment process. Additionally, they cover dual antiplatelet therapy and compare this study with similar research. Finally, they explore registry-based studies and future research on ticagrelor and aspirin, or aspirin alone, following coronary surgery for acute coronary syndrome.  Joel also highlights recent JANS articles exploring whether protective coronary artery bypass grafting improves surgical outcomes in acute type A aortic dissection with coronary ostial involvement, the association of chylothorax with aggressiveness of lymph node management during pulmonary resection, if intensive care unit resternotomy should be practiced in all facilities that perform cardiac surgery, transcatheter edge-to-edge repair vs mitral valve surgery in octogenarians, and research using pig-to-human lung xenotransplantation into a brain-dead recipient.  In addition, Joel explores robotic mitral valve replacement in a patient with patent bilateral internal mammary grafts, repeat right axillary thoracotomy as a safe and feasible approach for repair of recurrent LAVVR after previous AVSD repair, and handling vascular injuries in robotic thoracic surgery. Before closing, Joel highlights upcoming events in CT surgery.    JANS Items Mentioned  1.) Protective Coronary Artery Bypass Grafting Improves Surgical Outcomes in Acute Type A Aortic Dissection With Coronary Ostial Involvement  2.) The Association of Chylothorax With Aggressiveness of Lymph Node Management During Pulmonary Resection  3.) Expert Opinion: Intensive Care Unit Resternotomy Should Be Practiced in All Facilities That Perform Cardiac Surgery  4.) Transcatheter Edge-to-Edge Repair Versus Mitral Valve Surgery in Octogenarians: Comparative Analysis of Safety, Durability, and Survival  5.) Pig-to-Human Lung Xenotransplantation Into a Brain-Dead Recipient  CTSNet Content Mentioned  1.) Robotic Mitral Valve Replacement in a Patient With Patent Bilateral Internal Mammary Grafts: A Case Video  2.) Repeat Right Axillary Thoracotomy Is a Safe and Feasible Approach for Repair of Recurrent LAVVR After Previous AVSD Repair   3.) Handling Vascular Injuries in Robotic Thoracic Surgery: Real-Life Cases Using a Fibrin-Based Hemostatic Technique  Other Items Mentioned  1.) Ticagrelor and Aspirin or Aspirin Alone After Coronary Surgery for Acute Coronary Syndrome   2.) Perfecting TAVR Removal | Skills Sharpening With Vince Gaudiani  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.

In this episode of The Atrium, host Dr. Alice Copperwheat speaks with Dr. John Puskas, professor of surgery at Emory University, Chief of Cardiothoracic Surgery at Emory University Hospital Midtown, and Wilton Looney Director at the Emory Carlyle Fraser Heart Center in Atlanta, Georgia, USA, about proximal coronary anastomosis. Chapters 00:00 Intro 00:44 About Dr. Puskas 03:35 Background & History 06:56 10 Commandments for PA 10:34 When to Do It? 13:57 Aorta Site Selection 19:32 Step-by-Step 29:21 Sewing Onto Aorta 33:15 Variations & Alternatives 44:50 Key Messages 46:08 Advice to Trainees They discuss the 10 principles for proximal anastomosis during coronary artery bypass grafting, saphenous vein grafts vs free arterial grafts, as well as the optimal site selection on the aorta. They also explored key aspects of preparation and arteriotomy, and highlighted various variations and alternatives, such as clampless techniques and sequential grafting. Additionally, they examined the pitfalls and complications associated with proximal coronary anastomosis and the future of proximal coronary anastomosis.    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 extended resection with Dr. Erinoangelo Rendina.   Related Resources   The 10 Commandments for Proximal Anastomosis During CABG: Techniques and Technologies for Vein and Arterial Grafts   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 Drs. Daniel Brockman, Professor of Small Animal Surgery at The Royal Veterinary College, London, England, and Matteo Rossanese, Senior Lecturer in Small Animal Surgery at The Royal Veterinary College, about performing cardiothoracic surgery in animals. Chapters 00:00 Intro 01:44 Innovation Competition Results 07:18 JANS 1, Modified Bio-Bentall 08:45 JANS 2, External Aortic Root 11:53 JANS 3, Re-Redo Pulm Valve 13:19 JANS 4, Tracheal Regeneration Model 16:15 Career Center 16:56 Video 1, EXIT-to-Open Atrial Septectomy 17:16 Video 2, Incision Repair of Tetra Fallot 19:40 Video 3, Isolated Pulm Leaflet Autograft 22:33 Dr. Brockman and Rossanese Interview 51:11 Upcoming Events 53:30 Closing They explore the evolution of cardiothoracic surgery in veterinary medicine, discussing a variety of cases and the techniques employed, including mitral valve repair. Additionally, they highlight the anatomical differences between animals and humans, explaining how surgical techniques must be adapted accordingly. They also cover methods for testing valves, measuring the quality of repairs, and monitoring postoperative outcomes and follow-ups. Furthermore, they touch upon various conditions, such as tetralogy of Fallot, heart valve defects, etc.   Joel also highlights recent JANS articles on modified Bio-Bentall operation with a rapid deployment valve, personalized external aortic root support, clinical success of re-redo pulmonary valve and pulmonary trunk homograft replacement during the second trimester of pregnancy, and lessons learned from various 3D-printed tracheal grafts in an extensive porcine model for de novo tracheal regeneration.  In addition, Joel explores an EXIT-to-open atrial septectomy for hypoplastic left heart syndrome with intact atrial septum, incision of the moderator band during repair of tetralogy of Fallot, and a new solution for aortic valve repair, isolated pulmonary leaflet autograft. Before closing, Joel highlights upcoming events in CT surgery.    JANS Items Mentioned  1.) Modified Bio-Bentall Operation With A Rapid Deployment Valve  2.) Personalized External Aortic Root Support: The Dutch Experience  3.) Clinical Success of Re-Redo Pulmonary Valve and Pulmonary Trunk Homograft Replacement During the Second Trimester of Pregnancy  4.) Lessons Learned From Various 3D-Printed Tracheal Grafts in an Extensive Porcine Model for De Novo Tracheal Regeneration  CTSNet Content Mentioned  1.) EXIT-to-Open Atrial Septectomy for Hypoplastic Left Heart Syndrome With Intact Atrial Septum: Gone in 90 Seconds!  2.) Incision of the Moderator Band During Repair of Tetralogy of Fallot   3.) Isolated Pulmonary Leaflet Autograft: A New Solution for Aortic Valve Repair  Other Items Mentioned  1.) Career Center   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 speaks with Alexis Shafii, professor of surgery and surgical director of heart transplantation at The Texas Heart Institute at Baylor College of Medicine, about the first in-human BiVACOR total artificial heart implantation. Chapters 00:00 Intro 01:54 JANS 1, Validation of SYNTAX 04:58 JANS 2, Long-Distance ECMO Bridge 09:05 JANS 3, Segmentectomies Made Easy 10:49 JANS 4, MI Total Arterial BG 12:56 Career Center 13:46 Video 1, MI ASD Closure 15:43 Video 2, Basics of MV Surgery 17:03 Video 3, Construct Autologous P MV 20:19 Dr. Shafii Interview 33:37 Upcoming Events 34:56 Closing They discuss the preclinical work and the history behind the development of this innovative device. Dr. Shafii also showcases the device and explains its functionality in detail. They also highlight the first patient who received the BiVACOR total artificial heart implantation and provide insights into learning the nuances of this operation.  Additionally, they explore the critical aspects of explanting the device and the importance of understanding how to explant the heart. Furthermore, they discuss the next steps for gaining approval of the BiVACOR total artificial heart, including the feasibility trial, and speculate on where we might be in five years regarding total artificial heart implantation.   Joel also highlights recent JANS articles on the external validation of SYNTAX score II in a real-world cohort undergoing coronary artery bypass grafting, successful extracorporeal membrane oxygenation bridge to lung transplant with a patient transported from Hawaii to Nashville, Tennessee, USA, robotic-assisted left S3 segmentectomy, and minimally invasive total arterial bypass grafting via left minithoracotomy in obese patients.  In addition, Joel explores direct cannulation for minimally invasive ASD closure, an instructional video for residents on the basics of mitral valve surgery, and how to construct an autologous pericardial mitral valve for infants and small children. Before closing, Joel highlights upcoming events in CT surgery.    JANS Items Mentioned  1.) External Validation of SYNTAX Score II in a Real-World Cohort Undergoing Coronary Artery Bypass Grafting  2.) Successful Extracorporeal Membrane Oxygenation Bridge to Lung Transplant With a Patient Transported From Hawaii to Nashville, Tennessee  3.) Segmentectomies Made Easy Series: Robotic-Assisted Left S3 Segmentectomy  4.) Minimally Invasive Total Arterial Bypass Grafting via Left Minithoracotomy in Obese Patients  CTSNet Content Mentioned  1.) Minimally Invasive ASD Closure: Direct Cannulation   2.) Basics of Mitral Valve Surgery: An Instructional Video for Residents   3.) How to Construct an Autologous Pericardial Mitral Valve for Infants and Small Children   Other Items Mentioned  1.) Career Center   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 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.