Easy Placement of Annular Sutures During Minimally Invasive Aortic Valve Replacement
Abstract: Placing annular sutures at the right coronary cusp is difficult during minimally invasive aortic valve replacement. We propose the partial everting mattress method, whereby a prosthetic valve is implanted in a supra-annular position at the left coronary and noncoronary cusps, with pledgets on the left ventricular side, but in an intra-annular position at the right coronary cusp, with pledgets on the aortic side. Needles can be grasped in forehand pass at all three coronary cusps. Our method enables easy placement of annular stitches even in the small surgical field, without adversely influencing the hemodynamic p...
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - May 1, 2017 Category: Cardiovascular & Thoracic Surgery Tags: How-To-Do-It Articles Source Type: research

Assistive Techniques for Proximal Anastomosis in Minimally Invasive Coronary Artery Bypass Grafting
Abstract: We introduce assistive techniques for proximal anastomosis in off-pump minimally invasive coronary artery bypass grafting (MICS CABG) to overcome difficult access to the ascending aorta in MICS CABG. An 8-cm left thoracotomy is made in the fifth intercostal space. ThoraTrak retractor (Medtronic Inc, Minneapolis, MN USA) is used to open the thoracotomy and is pulled to the cephalad and rightward direction toward to the ascending aorta. The pericardium is opened from the ascending aorta to the left ventricular apex and to the inferior vena cava. Two retraction sutures on the pericardial edge are used to laterally d...
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - May 1, 2017 Category: Cardiovascular & Thoracic Surgery Tags: How-To-Do-It Articles Source Type: research

Off-Pump Transapical Removal of an Embolized Transcatheter Aortic Valve
We report the successful off-pump retrieval of an embolized valve after transfemoral transcatheter aortic valve replacement through a left anterior thoracotomy. We maintained the embolized valve on the guidewire and snared it using a transapical approach. We then deployed a valve in an adequate position to ensure hemodynamic stability before transapical removal of the embolized valve. Transapical exteriorization of the femoral guidewire offers additional support, particularly in patients with a horizontal aortic annulus. (Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery)
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - May 1, 2017 Category: Cardiovascular & Thoracic Surgery Tags: Case Reports Source Type: research

Transareolar Video-Assisted Approach to the Atrial Septal Defect and Tricuspid Valve
Abstract: Minimally invasive atrial septal defect closure and tricuspid annuloplasty in female patients are normally performed through a right submammary anterior minithoracotomy approach. However, when the aortic root is located higher, the direction of aortic cannulation becomes not ideal through the submammary incision. In such cases, transareolar approach is useful. Through this approach, aortic cannulation and tricuspid operation can be performed with endoscopic assistance, and ASD closure can be performed under direct vision. (Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery)
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - May 1, 2017 Category: Cardiovascular & Thoracic Surgery Tags: Case Reports Source Type: research

Pulmonary Transplant Salvage Using Ultrasound-Assisted Thrombolysis of Subacute Occlusive Main Pulmonary Artery Embolus
Abstract: A 53-year-old woman who underwent bilateral lung transplantation 14 months before presented with 2 to 3 weeks of severe exertional dyspnea. Workup revealed a complete embolic occlusion of her left main pulmonary artery related to a femoral deep venous thrombosis. The occlusion did not respond to systemic anticoagulation, and a trial of catheter-directed thrombolysis was pursued. Flow to the left lower lobe was restored after 2 days of thromobolytic therapy. The patient is alive and well at more than 1 year of follow-up. (Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery)
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - May 1, 2017 Category: Cardiovascular & Thoracic Surgery Tags: Case Reports Source Type: research

Comparative Analysis of Perioperative and Mid-Term Results of TECAB and MIDCAB for Revascularization of Anterior Wall
Objective: Totally endoscopic coronary artery bypass (TECAB) and minimally invasive direct coronary artery bypass (MIDCAB) grafting through minithoracotomy are currently the two minimally invasive surgical techniques of left ventricular anterior wall revascularization. We aimed to compare both techniques in terms of perioperative and mid-term results. Methods: Arrested heart TECAB was carried out in 204 patients with a median (range) age of 60 (53–76) years and a median (range) EuroSCORE I of 2 (0–3). Minimally invasive direct coronary artery bypass was performed in 60 patients with a median (range) age of 66 ...
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - May 1, 2017 Category: Cardiovascular & Thoracic Surgery Tags: Original Articles Source Type: research

The Use of Rapid Deployment Valves in Combined Aortic and Mitral Valve Surgery: One-Year Clinical and Echocardiographic Outcomes
Conclusions: Rapid deployment aortic valve replacement with the EDWARDS INTUITY valve system in combined aortic and mitral valve surgery can be performed safely with reproducible results. One-year follow-up data of this small series shows encouraging results potentially justifying the extension of the indication for rapid deployment valves to patients with concomitant mitral disease. Especially elderly patients undergoing multiple valve surgery may benefit from a reduction of cardiopulmonary bypass and myocardial ischemic times. (Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery)
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - May 1, 2017 Category: Cardiovascular & Thoracic Surgery Tags: Original Articles Source Type: research

A Contemporary Approach to Reoperative Aortic Valve Surgery: When is Less, More?
Conclusions: With appropriate preoperative evaluation and careful surgical planning, a minimally invasive approach to reoperative aortic valve surgery can be performed in a safe and effective manner. (Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery)
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - May 1, 2017 Category: Cardiovascular & Thoracic Surgery Tags: Original Articles Source Type: research

Consequences of Hybrid Procedure Addition to Robotic-Assisted Direct Coronary Artery Bypass
Conclusions: Despite similar preoperative demographics in the two groups, we have observed a significant difference in the blood transfusion rate in group 1. However, this did not lead into a statistically significant re-exploration rate for bleeding. Hence, we assume that dual antiplatelet therapy usage in the hybrid group might be the cause of the increase in blood transfusion rate. Nevertheless, it did not affect postoperative morbidity and length of hospital stay. A randomized multicenter clinical trial is needed. (Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery)
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - May 1, 2017 Category: Cardiovascular & Thoracic Surgery Tags: Original Articles Source Type: research

A Minimally Invasive Stand-alone Cox-Maze Procedure Is as Effective as Median Sternotomy Approach
Conclusions: Stand-alone Cox-Maze IV via minithoracotomy was as effective as via sternotomy with a shorter hospital stay. A minimally invasive approach is our procedure of choice. (Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery)
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - May 1, 2017 Category: Cardiovascular & Thoracic Surgery Tags: Original Articles Source Type: research

Endoscopic Fundoplication: Effectiveness for Controlling Symptoms of Gastroesophageal Reflux Disease
Objective: Transoral incisionless fundoplication (TIF) is a completely endoscopic approach to treat gastroesophageal reflux disease (GERD). We previously reported our initial results demonstrating safety and early effectiveness. We now present an updated experience describing outcomes with longer follow-up. Methods: For a three-year period, TIF procedures were performed on 80 patients. Preoperative workup routinely consisted of contrast esophagram and manometry. PH testing was reserved for patients with either atypical symptoms or typical symptoms unresponsive to proton-pump inhibitors (PPIs). Heartburn severity was longi...
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - May 1, 2017 Category: Cardiovascular & Thoracic Surgery Tags: Original Articles Source Type: research

Hybrid Coronary Revascularization has Improved Short-term Outcomes but Worse Mid-term Reintervention Rates Compared to CABG: A Propensity Matched Analysis
Objective: We evaluated short-term outcomes and mid-term survival and reintervention of hybrid coronary revascularization versus conventional coronary artery bypass grafting using a propensity score matched cohort. Methods: We conducted a retrospective review of patients undergoing surgery for multivessel coronary artery disease from 2007 to 2015 at a single institution. Patients were propensity matched 1:1 to receiving hybrid coronary revascularization or conventional bypass grafting by multivariate logistic regression on preoperative characteristics. Short-term outcomes were compared. Freedom from reintervention and dea...
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - May 1, 2017 Category: Cardiovascular & Thoracic Surgery Tags: Original Articles Source Type: research

The Perceval Sutureless Aortic Valve: Review of Outcomes, Complications, and Future Direction
Abstract: Surgical aortic valve replacement with a stented prosthesis has been the standard of care procedure for aortic stenosis. The Perceval (LivaNova, London, United Kingdom) is a sutureless aortic valve bioprosthesis currently implanted in more than 20,000 patients. The purpose of this article was to review the literature available after 9 years of clinical experience of the Perceval aortic valve. PubMED, Embase, and the Cochrane Library databases were searched. A meta-analysis of summary statistics from individual studies was conducted. A total of 333 studies were identified and 84 studies were included. Thirty-day m...
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - May 1, 2017 Category: Cardiovascular & Thoracic Surgery Tags: Review Article Source Type: research

Figure 4 Knot: Simple Tying Technique for Robotic and Endoscopic Sutures
Abstract: Various endoscopic suturing and tying methods have been reported, but these methods remain imperfect because knots are sometimes not tied completely and additional stitches are needed. To address this problem, we developed the “Figure 4” technique in which the knot can be easily slid to the suture point and tied by pulling suture tail—these knots will never come untied. This technique requires very simple technique and can be used in other surgical procedures such as conventional laparoscopic surgery. (Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery)
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - March 1, 2017 Category: Cardiovascular & Thoracic Surgery Tags: How-To-Do-It Articles Source Type: research

Antegrade Cardioplegia Decannulation Using the COR-KNOT System in Minimally Invasive Mitral Valve Surgery
Abstract: A right mini-thoracotomy approach may be used for mitral valve repair without compromising clinical outcomes. Compared with conventional sternotomy, there is an increased distance to the cardiac structures from the mini-thoracotomy incision, which makes certain technical acts more demanding. One particular challenge is hemostasis at the antegrade cardioplegia cannula site. We propose a novel technique to remove an antegrade cardioplegia cannula using the COR-KNOT system. This technique negates the need for tying with a knot pusher and reduces the risk of aortic injury and troublesome bleeding. (Source: Innovation...
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - March 1, 2017 Category: Cardiovascular & Thoracic Surgery Tags: How-To-Do-It Articles Source Type: research

Concomitant Valve-in-Valve Transcatheter Aortic Valve Replacement and Left Ventricular Assist Device Implantation
Abstract: Redo aortic valve replacement (AVR) performed simultaneously with left ventricular assist device (LVAD) implantation carries potential for increased mortality rates. Although transcatheter AVR has been used for patients with previous LVAD placement, no literature reports concomitant valve-in-valve transcatheter AVR and LVAD implantation. Our patient had severe aortic prosthetic valve deterioration and advanced heart failure. Given the risks associated with reoperative aortic valve surgery, we chose transcatheter AVR at the time of LVAD implantation. Transthoracic echocardiography results showed severe aortic pros...
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - March 1, 2017 Category: Cardiovascular & Thoracic Surgery Tags: Case Reports Source Type: research

Veno-Venous Extracorporeal Membrane Oxygenation Use in the Treatment of Bleomycin Pulmonary Toxicity
We report the case of a 45-year-old man who developed bleomycin pulmonary toxicity, which failed to respond to treatment with high-dose corticosteroids. We used protective mechanical ventilatory settings while supported on veno-venous extracorporeal membrane oxygenation using a bicaval dual-lumen, single cannula system to allow for lung recovery. This case demonstrates the feasibility of using veno-venous extracorporeal membrane oxygenation to treat bleomycin pulmonary toxicity in a patient who has failed traditional therapy. (Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery)
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - March 1, 2017 Category: Cardiovascular & Thoracic Surgery Tags: Case Reports Source Type: research

Right Axillary Artery Cannulation for Endovascular Repair of an Acute Type A Aortic Dissection
This report demonstrates a case of acute type A aortic dissection successfully treated using thoracic endovascular aortic repair and illustrates the utility of axillary cannulation for precise deployment of stent grafts in the ascending aorta. (Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery)
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - March 1, 2017 Category: Cardiovascular & Thoracic Surgery Tags: Case Reports Source Type: research

Reconstruction of a Long-Segment Tracheal Defect Using an AlloDerm Conduit
Abstract: This case describes successful reconstruction of a long-segment tracheal defect using AlloDerm as the conduit for reconstruction. A 38-year-old woman who had undergone a thyroid lobectomy in 2011 presented several months later unable to swallow. Chest computed tomography results revealed a tracheal/esophageal mass and a subsequent bronchoscopy, and esophagogastroduodenoscopy results revealed an upper esophageal/tracheal mass with two areas concerning for fistula. She underwent a bronchoscopy with a tracheal stent and percutaneous endoscopic gastrostomy placement. All biopsies were nondiagnostic for malignancy and...
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - March 1, 2017 Category: Cardiovascular & Thoracic Surgery Tags: Case Reports Source Type: research

Respiratory System Function in Patients After Minimally Invasive Aortic Valve Replacement Surgery: A Case Control Study
Objective: The aim of the study was to comparatively analyze respiratory system function after minimally invasive, through right minithoracotomy aortic valve replacement (RT-AVR) to conventional AVR. Methods: Analysis of 201 patients scheduled for RT-AVR and 316 for AVR between January 2010 and November 2013. Complications of the respiratory system and pulmonary functional status are presented. Results: Complications of the respiratory system occurred in 16.8% of AVR and 11.0% of RT-AVR patients (P = 0.067). The rate of pleural effusions, thoracenteses, pneumonias, or phrenic nerve dysfunctions was not significantly diff...
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - March 1, 2017 Category: Cardiovascular & Thoracic Surgery Tags: Original Articles Source Type: research

Eligibility for Minimally Invasive Coronary Artery Bypass: Examination of Epicardial Adipose Tissue Using Computed Tomography
Conclusions: The addition of CT angiography measurements of the epicardial adipose tissue overlying the left anterior descending coronary artery may enhance preoperative surgical planning for this procedure, thereby reducing the instances of procedural changes. (Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery)
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - March 1, 2017 Category: Cardiovascular & Thoracic Surgery Tags: Original Articles Source Type: research

Mid-Term Follow-up of Minimally Invasive Multivessel Coronary Artery Bypass Grafting: Is the Early Learning Phase Detrimental?
Conclusions: Minimally invasive coronary artery bypass grafting can be safely initiated as a minimally invasive, multivessel alternative to open surgical coronary revascularization, with excellent mid-term results. Learning phase effects were not observed with regard to overall procedural safety, but rather in terms of improved freedom from conversion to sternotomy and from repeat revascularization. (Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery)
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - March 1, 2017 Category: Cardiovascular & Thoracic Surgery Tags: Original Articles Source Type: research

Modeling Outcomes: Modified Aortic Arch Advancement for Neonatal Hypoplastic Arch
We report early outcomes from neonates undergoing modified aortic arch advancement with an anterior patch and our experience using computational fluid dynamic modeling to better understand the hemodynamic consequences associated with this repair. Methods: A retrospective review of neonates undergoing aortic arch advancement with anterior patch in 2014 at a single institution was performed. Anatomical, perioperative, and follow-up data were collected. Three-dimensional cardiac magnetic resonance images were used to generate computational fluid dynamic models of the modified anterior patch and direct end-to-side repairs. Ca...
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - March 1, 2017 Category: Cardiovascular & Thoracic Surgery Tags: Original Articles Source Type: research

Advantages of Minimal Access Versus Conventional Aortic Valve Replacement in Elderly or Severely Obese Patients
Conclusions: Minimal access AVR is a reproducible, safe, and effective surgical option in patients candidate for isolated AVR, and our study suggests a faster recovery when used in severely obese or older patients. (Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery)
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - March 1, 2017 Category: Cardiovascular & Thoracic Surgery Tags: Original Articles Source Type: research

Coronary Artery Disease Complexity on the Outcomes of a Staged Approach of PCI Followed by Minimally Invasive Valve Surgery
Conclusions: A staged approach of PCI followed by MIVS is a safe and feasible alternative for patients with valvular heart disease and concomitant CAD. However, it may confer an increased incidence of repeat target vessel revascularization in patients with intermediate- to high-complexity CAD. (Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery)
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - March 1, 2017 Category: Cardiovascular & Thoracic Surgery Tags: Original Articles Source Type: research

Minimally Invasive Aortic Valve Replacement via Right Anterior Minithoracotomy and Central Aortic Cannulation: A 13-Year Experience
This study reports the evolution of a minimally invasive aortic valve replacement (mini-AVR) technique that uses a right anterior minithoracotomy approach with central cannulation, for a 13-year period. This technique has become our standard approach for isolated primary AVR in nearly all patients. Methods: This observational study evaluated perioperative clinical outcomes of patients 18 years or older who underwent mini-AVR from November 2003 to June 2015. Results: The mini-AVR technique was used in 202 patients during two periods of 2003 to 2009 (n = 65, “early”) and 2010 to 2015 (n = 137, “late&rdquo...
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - March 1, 2017 Category: Cardiovascular & Thoracic Surgery Tags: Original Articles Source Type: research

Is the Future of Coronary Arterial Revascularization a Hybrid Approach?: The Canadian Experience Across Three Centers
Conclusions: Hybrid coronary revascularization seems to be a promising and safe revascularization strategy. It provides selected patients with an alternative, functionally complete revascularization with minimal surgical trauma and good long-term clinical outcomes. (Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery)
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - March 1, 2017 Category: Cardiovascular & Thoracic Surgery Tags: Original Articles Source Type: research

Standardizing Robotic Lobectomy: Feasibility and Safety in 128 Consecutive Lobectomies Within a Single Healthcare System
Conclusions: By standardizing how a robotic lobectomy is performed, we were able to show that RA-VATS lobectomy is safe and may allow for the expansion of minimally invasive lobectomy to surgeons who otherwise have failed to adopt traditional VATS. When compared with the most recent national meta-analysis, we had reduced morbidity, mortality, bleeding, and length of stay. Robotic nodal upstaging for stage I nonsmall lung cancer was consistent with larger multicenter study. We hope that these results will help lead to the standardization robotic lobectomy and a larger multisurgeon/institutional study that could pave the way...
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - March 1, 2017 Category: Cardiovascular & Thoracic Surgery Tags: Original Articles Source Type: research

A Novel Robotic Bilateral Internal Mammary Artery Harvest Using Double Docking Technique for Coronary Artery Bypass Grafting
Abstract: da Vinci Surgical System (da Vinci) enabled port access for internal mammary arteries (IMA) harvesting. However, bilateral IMA (BIMA) harvesting is difficult when performed on single side. We developed a novel technique of double docking the da Vinci by transpositioning from the left side to the right and examined the feasibility. Twelve patients underwent BIMA harvesting using the double-docking technique. First, the da Vinci was set on the patient's left side for the right IMA harvesting. Afterward, the da Vinci was undocked and transpositioned from the patient's left side to the right side. The time elapsed du...
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - January 1, 2017 Category: Cardiovascular & Thoracic Surgery Tags: How-To-Do-It Articles Source Type: research

Minimally Invasive Robotically Assisted Repair of Partial Anomalous Venous Connection
We describe a novel robotically assisted minimally invasive surgical technique for repair of partial anomalous pulmonary vein connection (PAPVC). Partial anomalous pulmonary vein connection is a rare congenital anomaly that consists in drainage of one or more pulmonary veins into the systemic venous system. Traditionally, large thoracotomy incision and sometimes establishment of cardiopulmonary bypass are needed to redirect the abnormal pulmonary vein to the left-sided reservoir. We describe a robotically assisted, minimally invasive, off-pump technique for the treatment of the left PAPVC in a 57-year-old patient with sign...
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - January 1, 2017 Category: Cardiovascular & Thoracic Surgery Tags: How-To-Do-It Articles Source Type: research

We Know What the Cardiac Surgeon Did During Last Hybrid Arrhythmia Procedure
Abstract: Superior vena cava (SVC) is an important source of origin of atrial fibrillation (AF) triggers other than a pulmonary vein. Because of the proximity of SVC-aorta ganglionic plexi to the SVC and the extension of myocardium in the SVC from the right atrium, SVC frequently becomes an important source of ectopic beats initiating AF. The potential complications of SVC isolation may include sinus node injury. Sinus node isolation was observed in a patient who had undergone previous surgical isolation of SVC for AF, while attempting to ablate endocardially, near the superior part of interatrial septum for an atrial tach...
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - January 1, 2017 Category: Cardiovascular & Thoracic Surgery Tags: Case Reports Source Type: research

Schwannoma of the Recurrent Laryngeal Nerve: A Rare Entity
Abstract: Neurogenic tumors are the most common posterior mediastinal tumors in adults. Schwannomas originating from the recurrent laryngeal nerve are rare. The present study describes a 46-year-old man with a tumor in the left superior mediastinum. Because of the narrow relationship with the aorta and the left pulmonary artery, the tumor was excised by left-sided minithoracotomy. The tumor, a schwannoma, originated from and encased the left recurrent laryngeal nerve. Six months after surgery, the patient was free of recurrence without symptoms other than hoarseness. “Additional imaging by magnetic resonance imaging ...
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - January 1, 2017 Category: Cardiovascular & Thoracic Surgery Tags: Case Reports Source Type: research

Robot-Assisted Mitral Valve Repair With Posterior Leaflet Extension for Rheumatic Disease
Abstract: Mitral valve repair has been one of the widely used applications of robotic surgery. Patients with rheumatic mitral disease usually present at an early age with thickening, retraction, or fusion of the leaflets and subvalvular apparatus. Robotic mitral repair can be feasible among this group of patients, rather than replacement. Herein, we describe a young woman who presented with rheumatic mitral valve insufficiency. A complex mitral repair with posterior leaflet extension with an autologous pericardial patch was successfully conducted using robot assistance. (Source: Innovations: Technology and Techniques in Ca...
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - January 1, 2017 Category: Cardiovascular & Thoracic Surgery Tags: Case Reports Source Type: research

Noninvasive Quantification of Blood Flow in Epicardial Coronary Arteries, Coronary Artery Bypass Grafts, and Anastomoses
Conclusions: Rheologic flow interaction between conduit and native coronary at the anastomosis remains the most poorly understood technical aspect of CABG. A noninvasive, noncontact, no-risk imaging technology as simple as a snapshot can provide this critical physiologic information, validate and document intraoperative quality, and improve even further CABG outcomes. (Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery)
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - January 1, 2017 Category: Cardiovascular & Thoracic Surgery Tags: Original Articles Source Type: research

Totally Endoscopic Robotic Left Atrial Appendage Closure Demonstrates High Success Rate
Conclusions: We have demonstrated excellent success with RLAAC; we postulate that this may be due to improved intracardiac visualization. Robotic LAA closure was more successful (87.7%) than previously reported results from the Left Atrial Appendage Occlusion Study for suture exclusion (45.5%) and staple closure (72.7%). With success rates equivalent to transcatheter device closures, RLAAC should be considered for robotic mitral valve surgical patients. (Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery)
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - January 1, 2017 Category: Cardiovascular & Thoracic Surgery Tags: Original Articles Source Type: research

Mini-Bentall: An Interesting Approach for Selected Patients
Conclusions: A partial upper sternotomy is considered a safe option for aortic valve replacement. Our experience confirms that a minimally invasive approach using a partial upper J-shaped sternotomy can be a safe alternative approach to the standard in selected patients presenting with complex aortic root pathology. (Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery)
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - January 1, 2017 Category: Cardiovascular & Thoracic Surgery Tags: Original Articles Source Type: research

Traditional Sternotomy Versus Minimally Invasive Aortic Valve Replacement in Patients Stratified by Ejection Fraction
Objective: Low ejection fraction (EF (Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery)
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - January 1, 2017 Category: Cardiovascular & Thoracic Surgery Tags: Original Articles Source Type: research

Initial Experience With Minimally Invasive Surgical Exclusion of the Left Atrial Appendage With an Epicardial Clip
Conclusions: Isolated epicardial left atrial clipping is a safe treatment option in high-risk patients with AF. Long-term success in preventing stroke is still to be determined, but short-term results are very encouraging. (Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery)
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - January 1, 2017 Category: Cardiovascular & Thoracic Surgery Tags: Original Articles Source Type: research

A Novel Treatment Using an Intraventricular Stent Graft for Postinfarction Ventricular Septal Rupture in a Porcine Model
Conclusions: The use of our new IVSG in this VSR animal experiment model significantly decreased the left-to-right shunt. The new device was able to control the acute heart failure associated with VSR with a minimally invasive procedure during the hyperacute phase of heart failure. Potential improvements in VSR treatment outcomes are expected with its clinical application. (Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery)
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - January 1, 2017 Category: Cardiovascular & Thoracic Surgery Tags: Original Articles Source Type: research

Video-Assisted Thoracic Surgery in Patients With Previous Sternotomy and Cardiac Surgery
Conclusions: Previous sternotomy for cardiac surgery does increase the risk for VATS lobectomy. Conversion to thoracotomy should be considered if dense adhesions are found. Techniques to reduce the risk for the heart are discussed. (Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery)
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - January 1, 2017 Category: Cardiovascular & Thoracic Surgery Tags: Original Articles Source Type: research

Right Internal Mammary Artery Use in 140 Robotic Totally Endoscopic Coronary Bypass Cases: Toward Multiarterial Grafting
Objective: Benefits of adding a second arterial graft in coronary bypass are well documented. In patients requiring mulitvessel grafting robotic totally endoscopic coronary bypass (TECAB) has allowed for routine harvesting and use of the right internal mammary artery (RIMA). We retrospectively reviewed the technical considerations and target choice in 140 cases of beating heart TECAB where a RIMA graft was used. Methods: In 2008, we introduced beating heart TECAB with anastomotic connectors into our practice, first with single IMA and then with bilateral internal mammary artery. A robotic stabilizer was used not only to f...
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - January 1, 2017 Category: Cardiovascular & Thoracic Surgery Tags: Original Articles Source Type: research

Outcomes of a Combined Approach of Percutaneous Coronary Revascularization and Cardiac Valve Surgery
Abstract: A subset of patients requiring coronary revascularization and valve surgery may benefit from a combined approach of percutaneous coronary intervention (PCI) and valve surgery, as opposed to the standard median sternotomy approach of combined coronary artery bypass and valve surgery. To evaluate its potential benefits and limitations, a literature search was performed using PubMed, EMBASE, Ovid, and the Cochrane library, through March 2016 to identify all studies involving a combined approach of PCI and valve surgery in patients with coronary artery and valvular disease. There were five studies included in the stu...
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - January 1, 2017 Category: Cardiovascular & Thoracic Surgery Tags: Review Article Source Type: research

Consideration of Native Coronary Disease Progression in the Decision to Perform Hybrid Coronary Revascularization
No abstract available (Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery)
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - January 1, 2017 Category: Cardiovascular & Thoracic Surgery Tags: Editorial Source Type: research

A Simple and Effective Technique for Anatomical Approximation of the Upper Pericardium Using Hemostatic Clips
Abstract: Closure of the pericardium is important to protect bypass grafts, the great vessels, and the heart from injury due to sternal dehiscence. Furthermore, it is reported to reduce the formation of pericardial adhesions and thus facilitate entry into the chest at resternotomy. We here describe a simple, reproducible, and effective technique for tension-free approximation of the upper pericardium by applying small hemostatic clips to the preserved thymic fascia overlying the pericardium. (Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery)
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - November 1, 2016 Category: Cardiovascular & Thoracic Surgery Tags: How-To-Do-It Article Source Type: research

Alternative Treatment for Residual Aortobronchial Fistula After Thoracic Endovascular Aortic Repair
Abstract: A patient with an aortobronchial fistula secondary to a thoracic endovascular aortic repair was successfully treated with a re–thoracic endovascular aortic repair with debranching technique. Five months postoperatively, the aneurysm had shrunk; however, computed tomography revealed air in the thrombo-excluded aortic aneurysmal sac without signs of infection. Because of worsening air finding at the eighth month, we performed a resection of the residual fistula and wrapped the stent graft in a pedicled muscle flap. (Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery)
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - November 1, 2016 Category: Cardiovascular & Thoracic Surgery Tags: Case Reports Source Type: research

Totally Endoscopic Robotic Correction of Cor Triatriatum Sinister Coexisting With Atrial Septal Defect
We described our successful novel surgical technique of totally robotic correction of CTS in one case of CTS with concomitant repair of atrial septal defect using da Vinci SI Surgical System (Intuitive Surgical, Inc, Sunnyvale, CA USA) with excellent surgical outcome. We conclude that robotic correction of CTS is a feasible and safe alternative to conventional surgical technique. (Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery)
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - November 1, 2016 Category: Cardiovascular & Thoracic Surgery Tags: Case Reports Source Type: research

Resolution of Intractable Ventricular Tachycardia After Surgical Repositioning of a HeartMate II Inflow Cannula
We present a case of intractable ventricular tachycardia that resolved after surgical repositioning of a HeartMate II inflow cannula. The diagnosis and management of this case demonstrate the utility of imaging studies for detecting inflow cannula malposition and the efficacy of inflow cannula repositioning for treatment. (Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery)
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - November 1, 2016 Category: Cardiovascular & Thoracic Surgery Tags: Case Reports Source Type: research

Extrapleural Pneumonectomy for Malignant Pleural Mesothelioma: A Novel Mini-Invasive Technique
We report a novel less-invasive extrapleural pneumonectomy for early-stage malignant pleural mesothelioma without rib spreading. Our approach is unique and differed from the previously reported cases, because we used one skin incision and two small intercostal incisions with videothoracoscopic viewing without rib spreading. The pleural dissection and approach to the hilum for pneumonectomy were performed through a 4- to 5-cm port incision in the sixth intercostal space. Another 4- to 5-cm port was made in the eight intercostal space through the same skin incision and was used for diaphragm resection and reconstruction. At ...
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - November 1, 2016 Category: Cardiovascular & Thoracic Surgery Tags: Case Reports Source Type: research

B-type Natriuretic Peptide Predicts Morbidity and Long-Term Mortality in Coronary Artery Bypass Grafting and Valve Surgery
Conclusions: B-type natriuretic peptide levels are an independent predictor of morbidity after CABG and/or valve surgery regardless of type of procedure or on/off bypass usage. B-type natriuretic peptide levels also correlate with time to death, highlighting the need for sustained follow-up and heart failure management to improve survival in patients with elevated BNP levels presenting for all cardiac surgery. (Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery)
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - November 1, 2016 Category: Cardiovascular & Thoracic Surgery Tags: Original Articles Source Type: research

An Early Canadian Experience With the Correx Automated Coring and Apical Connector Device for Aortic Valve Bypass
Conclusions: Aortic valve bypass seems to be an acceptable alternative for the treatment of severe AS in high-risk patients who are not candidates for aortic valve replacement. The Correx automated system may improve the clinical applicability and surgical reproducibility of AVB in appropriately selected patients in which conventional or transcatheter aortic valve replacement is not a feasible options. (Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery)
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - November 1, 2016 Category: Cardiovascular & Thoracic Surgery Tags: Original Articles Source Type: research