The AngioVac Device: Understanding the Failures on the Road to Success
Objective: Current percutaneous thromboembolectomy techniques may obviate surgical intervention in high-risk patients with iliocaval thrombus or thrombus of the right side of the heart, but typically require thrombus fragmentation and thrombolysis with associated bleeding and thromboembolic complications. The AngioVac (Angiodynamics, Latham, NY USA) device uses a percutaneous venovenous bypass circuit to aspirate intact thrombus. A review of the literature was performed with regard to the AngioVac device to determine the factors correlating with successful thrombus extraction. Methods: A literature search was performed wi...
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - November 1, 2016 Category: Cardiovascular & Thoracic Surgery Tags: Original Articles Source Type: research

Transaortic Edge-to-Edge Repair for Functional Mitral Regurgitation During Aortic Valve Replacement: A 13-Year Experience
Objective: The study evaluated the feasibility of a transaortic edge-to-edge mitral valve repair (Alfieri stitch) for moderate or greater (≥2+) functional mitral regurgitation (MR) in high-risk patients undergoing aortic valve replacement. Methods: We retrospectively evaluated 40 consecutive patients who underwent aortic valve replacement combined with a transaortic edge-to-edge mitral valve repair for 2+ or greater functional MR, between February 2002 and April 2015. The MR was graded semiquantitatively as 0 (trace/none), mild (1+), moderate (2+), or moderate to severe (3–4+). Results: Thirty-two patients had a...
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - November 1, 2016 Category: Cardiovascular & Thoracic Surgery Tags: Original Articles Source Type: research

Myocardial Protection and Financial Considerations of Custodiol Cardioplegia in Minimally Invasive and Open Valve Surgery
Objective: Single-dose antegrade crystalloid cardioplegia with Custodiol-HTK (histidine-tryptophan-ketoglutarate) has been used for many years. Its safety and efficacy were established in experimental and clinical studies. It is beneficial in complex valve surgery because it provides a long period of myocardial protection with a single dose. Thus, valve procedures (minimally invasive or open) can be performed with limited interruption. The aim of this study is to compare the use of Custodiol-HTK cardioplegia with traditional blood cardioplegia in patients undergoing minimally invasive and open valve surgery. Methods: A si...
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - November 1, 2016 Category: Cardiovascular & Thoracic Surgery Tags: Original Articles Source Type: research

Strategies to Improve the Efficacy of Epicardial Linear Ablation on the Beating Heart
Objective: Creating transmural linear lesions on the beating heart is an important component of minimally invasive surgical ablation for atrial fibrillation. Animal studies have shown poor efficacy for surface bipolar radiofrequency ablation (RFA). Clinicians have developed strategies including multiple device applications and vena caval occlusion (VCO) to improve ablation efficacy. These techniques were evaluated in an acute porcine model. Methods: In the first experiment, an RFA device was used to perform two 40-second epicardial ablations on the right atrium of six pigs. Ablations were performed with and without VCO. U...
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - November 1, 2016 Category: Cardiovascular & Thoracic Surgery Tags: Original Articles Source Type: research

Frailty Assessed by the FORECAST Is a Valid Tool to Predict Short-Term Outcome After Transcatheter Aortic Valve Replacement
Conclusions: The FORECAST is a valid tool to assess frailty in TAVR patients. The FORECAST is easily assessable and can be included in daily clinical routine. (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 Automated Expanded Polytetrafluoroethylene Suturing and Coaxial Fastener System for Mitral Chordae Replacement: Strength, Feasibility, and Healing
Conclusions: This technology successfully enabled the implantation of artificial chordae while providing real-time adjustment of chordae length during MV repair. These results encourage further investigation of its use clinically. (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

Minimally Invasive Fundoplication Is Safe and Effective in Patients With Severe Esophageal Hypomotility
Conclusions: Minimally invasive fundoplication is both safe and effective in treating patients with severe GERD and concomitant esophageal hypomotility. Those with postoperative dysphagia are successfully managed by endoscopic treatments. (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

Transcatheter Aortic Valve Implantation in Nonagenarians
Conclusions: Transcatheter aortic valve implantation can be performed in nonagenarians despite very high preoperative risk scores and substantial multimorbidity, with acceptable outcomes. (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

Robotically Assisted Thoracic Surgery: Proposed Guidelines for Privileging and Credentialing
Conclusions: Safety concerns with the introduction of novel and complex technologies such as RATS must be paramount. Our algorithm takes into consideration appropriate use and serves as a basic guideline for institutions that wish to implement a RATS program. (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

2015 Best Manuscript Awards
No abstract available (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: Editorial Source Type: research

Thank You From Innovations to Our Reviewers
No abstract available (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: Acknowledgment Source Type: research

New Small-Diameter Forceps for Thoracoscopic Surgery: Technical Adaptations and Initial Experiences
In this report, we describe the use of new small-diameter forceps (Endo Relief forceps) for port-reduced thoracoscopic surgery. Forceps were designed with end that were the same size and shape as conventional 5-mm forceps, except that the diameter of the shaft was decreased to 2.4 mm. Endo Relief forceps were used for thoracoscopic surgery in 18 patients. We retrospectively compared the frequency of grasping error between conventional small-diameter forceps and Endo Relief group. The mean surgical time was 57.5 minutes (range, 45–75 minutes). There were no complications, no recurrences of pneumothorax and lung cancer...
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - September 1, 2016 Category: Cardiovascular & Thoracic Surgery Tags: How-To-Do-It Articles Source Type: research

Aspergilloma of the Lung: Strategy to Prevent Endobronchial Spillage
Abstract: Aspergilloma of the lung eroding into the airway may lead to perioperative endobronchial spillage and contamination of the normal lung. Our aim in this group of patients who are undergoing robotic- or video-assisted thoracoscopic lobectomy is to protect the contralateral lung and, if possible, uninvolved lobes of ipsilateral lung. Double-lumen endobronchial tubes do provide lung protection to the contralateral lung intraoperatively, but there is no protection to the ipsilateral lung lobes not involved by the disease process. Moreover, there is no lung protection against endobronchial spillage during the period of...
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - September 1, 2016 Category: Cardiovascular & Thoracic Surgery Tags: How-To-Do-It Articles Source Type: research

Onyx Embolization as Single Rescue Treatment for Ruptured Abdominal Aortic Aneurysm After EVAR
Abstract: A 76-year-old man who had undergone endovascular repair for an infrarenal aortic aneurysm, presented with a late type Ia endoleak 3 years after his operation. Deployment of an aortic cuff did not achieve a better seal at the proximal neck, and the aneurysm developed a rupture. We successfully treated the ruptured aneurysm using transcatheter Onyx embolization only. At 6-month and 1-year follow-ups with contrast-enhanced duplex scanning, no endoleak was seen and sac shrinkage was observed. Onyx is a relatively new liquid embolic agent that is slowly transformed into a solid state by contact with blood. Owing to th...
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - September 1, 2016 Category: Cardiovascular & Thoracic Surgery Tags: Case Reports Source Type: research

Type IIIb Endoleak Associated With an Infected Thoracoabdominal Endograft
We present a 63-year-old male patient who presented with vague abdominal pain after an endoluminal thoracoabdominal aneurysm repair. He was found to have an infected endograft and an associated type IIIb endoleak. We believe that the infection contributed to the fabric degradation along the endograft and resulted in an expanding endoleak. Graft explantation was not performed because of the patient's multiple comorbidities, and the endoleak was treated with an additional stent graft and suppressive antibiotics. Endograft infection may lead to endograft degradation and associated leak. Therefore, an infectious etiology, alth...
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - September 1, 2016 Category: Cardiovascular & Thoracic Surgery Tags: Case Reports Source Type: research

Transaortic Transcatheter Aortic Valve Implantation and Concomitant Off Pump Revascularization
We present 4 successfully combined off-pump procedures consisting of a transcatheter aortic valve implantation (Edwards SAPIEN XT) via the transaortic approach and an off-pump coronary artery bypass grafting. All patients were discharged free from stroke, myocardial infarction, or access site complications either to rehabilitation facility or to the referring hospital with none or trace aortic regurgitation and patent grafts. These cases confirm the feasibility of those combined operations and should be considered as realistic alternative for surgical treatment in high-risk patients who are clearly identified to benefit fr...
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - September 1, 2016 Category: Cardiovascular & Thoracic Surgery Tags: Case Reports Source Type: research

Pseudoaneurysm as a Late Complication of Hybrid Aortic Arch Repair
Abstract: Hybrid aortic arch repair is increasingly used for the management of aortic arch aneurysm. Pseudoaneurysm is a newly described late complication of this procedure. A 57-year-old man underwent emergent supra-aortic debranching and aortic arch stent grafting after rupture of an arch aneurysm. Three years later, the patient presented with a pseudoaneurysm at the junction between the stent graft's proximal landing zone and the origin of the debranching graft. At reoperative repair, the proximal stent graft had eroded through the aortic wall at the junction of the endograft proximal landing zone and the proximal anast...
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - September 1, 2016 Category: Cardiovascular & Thoracic Surgery Tags: Case Reports Source Type: research

Ascending Aortic Endoballoon Occlusion Feasible Despite Moderately Enlarged Aorta to Facilitate Robotic Mitral Valve Surgery
Conclusions: Our experience suggests that it is possible to successfully use endoaortic balloon occlusion in patients with ascending aortic dilation with proper preoperative imaging and planning. (Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery)
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - September 1, 2016 Category: Cardiovascular & Thoracic Surgery Tags: Original Articles Source Type: research

The Application of Liquid Nitrogen Spray Cryotherapy in Treatment of Bronchial Stenosis
Conclusions: The median change in grade after treatment was 2 grades of improvement for both the benign and malignant groups. These results provide evidence that the use of SCT is equally efficacious for both types of stenosis with an expectation of overall improvement in luminal patency, offering a safe and effective method of achieving airway patency in a minimally invasive fashion. This study contributes to the small but growing body of literature supporting the use of SCT in benign and malignant disease. (Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery)
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - September 1, 2016 Category: Cardiovascular & Thoracic Surgery Tags: Original Articles Source Type: research

Early Results of the Modified Right Atrial Lesion Set for the Cox-CryoMaze Procedure
Conclusions: These results suggest the modified RAL set to be an effective alternative to the traditional RALs of Cox-Maze III. By substituting this lateral RAA lesion for the more technically difficult medial lesion, the procedure becomes easier to perform and favorably impacts operative time while achieving comparable results in reducing AF burden. (Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery)
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - September 1, 2016 Category: Cardiovascular & Thoracic Surgery Tags: Original Articles Source Type: research

Proof of Concept of an Endoscopic Sutureless Valve Sizer
Conclusions: The use of the endoscopic expandable sizer is technically possible. In this early-stage test in the flaccid heart, selection of the valve size was satisfactory during thoracoscopic sutureless aortic bioprosthesis implantation. Further laboratory evaluation with fluid dynamics (aortic root pressurization) will be performed before a clinical study is started. (Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery)
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - September 1, 2016 Category: Cardiovascular & Thoracic Surgery Tags: Original Articles Source Type: research

Prosthetic Aortic Valve Fixation Study: 48 Replacement Valves Analyzed Using Digital Pressure Mapping
Objective: Prostheses attachment is critical in aortic valve replacement surgery, yet reliable prosthetic security remains a challenge. Accurate techniques to analyze prosthetic fixation pressures may enable the use of fewer sutures while reducing the risk of paravalvular leaks (PVL). Methods: Customized digital thin film pressure transducers were sutured between aortic annulus models and 21-mm bioprosthetic valves with 15 × 4-mm, 12 × 4-mm, or 9 × 6-mm-wide pledgeted mattress sutures. Simulating open and minimally invasive access, 4 surgeons, blinded to data acquisition, each secured 12 valves using man...
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - September 1, 2016 Category: Cardiovascular & Thoracic Surgery Tags: Original Articles Source Type: research

Robotic Resection of 3 cm and Larger Thymomas Is Associated With Low Perioperative Morbidity and Mortality
Objective: The approach to thymoma resection has usually been determined by tumor size, although established guidelines do not exist. Minimally invasive approaches have been limited to tumors smaller than 5 cm, although 3 cm has been the suggested cutoff for performing an adequate oncologic procedure. No study has compared the perioperative outcomes of patients with 3 cm or larger tumors resected robotically versus sternotomy. Methods: We reviewed patients who underwent resection of 3 cm or larger thymomas from 2004 to 2014. Patients were divided based on approach: robotic and open thymectomy/thymomectomy. Results: Forty...
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - September 1, 2016 Category: Cardiovascular & Thoracic Surgery Tags: Original Articles Source Type: research

Predictors and Outcomes of Sternotomy Conversion and Cardiopulmonary Bypass Assistance in Minimally Invasive Coronary Artery Bypass Grafting
Objective: This work's objective was to identify the determinants of conversion of minimally invasive coronary artery bypass grafting to sternotomy, with and without cardiopulmonary bypass assistance, and to compare clinical outcomes in patients who needed conversion. Methods: This is a prospectively collected data on patients who underwent minimally invasive coronary bypass done by a single surgeon from February 2005 to September 2014. Statistical analyses were expressed as mean values ± standard deviation or proportions. Results: The total number of patients was 266, with an average age of 62 years. The median n...
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - September 1, 2016 Category: Cardiovascular & Thoracic Surgery Tags: Original Articles Source Type: research

Mechanical Circulatory Support: Heart Failure Therapy “in Motion”
Abstract: Because the first generation of pulsatile-flow devices was primarily used to bridge the sickest patients to transplantation (bridge-to-transplant therapy), the current generation of continuous-flow ventricular assist devices qualifies for destination therapy for patients with advanced heart failure who are ineligible for transplantation. The first-generation devices were associated with frequent adverse events, limited mechanical durability, and patient discomfort due device size. In contrast, second-generation continuous-flow devices are smaller, more quiet, and durable, thus resulting in less complications and ...
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - September 1, 2016 Category: Cardiovascular & Thoracic Surgery Tags: Review Article Source Type: research

Right Minithoracotomy Approach for Replacement of the Ascending Aorta, Hemiarch, and Aortic Valve
Abstract: A minimally invasive right anterior thoracotomy approach is the preferred technique used at our institution for isolated aortic valve pathology. We have recently introduced more complex concomitant minimally invasive procedures through this access site. Here, we describe how we perform a replacement of the ascending aorta and aortic valve with and without the use of circulatory arrest through a 6-cm right minimally invasive thoracotomy incision. (Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery)
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - July 1, 2016 Category: Cardiovascular & Thoracic Surgery Tags: How-To-Do-It Article Source Type: research

Anterior Mitral Leaflet Augmentation for Ischemic Mitral Regurgitation Performed Via a Right Thoracotomy Approach
Abstract: Ischemic mitral regurgitation (MR) after myocardial infarction is associated with poor long-term survival, and the optimal treatment strategy remains debated. The most common repair technique used is a restrictive annuloplasty. However, up to 15% to 30% of patients experience recurrent MR owing to progressive left ventricular remodeling and geometric distortion of the mitral valve apparatus. Anterior mitral leaflet augmentation using a pericardial patch, in combination with a true-sized mitral annuloplasty, has been proposed as an adjunctive technique to increase the durability of valve repair for ischemic MR. He...
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - July 1, 2016 Category: Cardiovascular & Thoracic Surgery Tags: Case Reports Source Type: research

A Novel Technique to Reconstruct Tricuspid Valve Anterior Leaflet in Massive Endocarditis
Abstract: Tricuspid valve (TV) endocarditis is a common complication in intravenous drug addicts. In case of TV replacement, the main issue is the high risk of new endocarditis on TV prosthesis. On November 2014, a 44 year-old male patient with a history of intravenous drug addiction was referred for TV endocarditis owing to Staphylococcus aureus and severe regurgitation complicated by pulmonary embolism and heart failure. Preoperative echocardiography showed a large vegetation of the anterior leaflet (1.95 × 0.92 cm) covering a huge hole in the leaflet itself. Herein, a novel technique for the treatment of massive e...
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - July 1, 2016 Category: Cardiovascular & Thoracic Surgery Tags: Case Reports Source Type: research

Computed Tomography–Guided Percutaneous Thoracic Duct Sclero-Embolization for Persistent Chylothorax
Abstract: Postoperative chylous leak is often a consequence of thoracic duct injury during surgical procedures. Persistent chylothorax can be an extremely morbid condition. The authors describe a case of a refractory and long-standing chylous leak after thoracotomy for mediastinal lymphangioma removal. The patient was treated with a computed tomography–guided percutaneous thoracic duct sclero-embolization after failure of the conventional therapies. The chest tube output abruptly decreased after the procedure and was removed at 13th day. Percutaneous thoracic duct sclero-embolization proved to be safe and effective i...
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - July 1, 2016 Category: Cardiovascular & Thoracic Surgery Tags: Case Reports Source Type: research

Edwards SAPIEN XT in Native Stenotic Mitral Valve, Open Technique on Cardiopulmonary Bypass: An Option, But Safe?
Abstract: A 73-year-old woman underwent open mitral valve replacement with the transcatheter Edwards SAPIEN XT valve (Edwards Lifesciences, Corp, Irvine, CA USA) on cardiopulmonary bypass in a native, stenotic mitral valve. Because of left ventricular outflow tract obstruction, the patient died 25 days after implantation. There are previous reports of transcatheter valve implantation in native mitral valve with procedural success. However, in one case report, the patient died 10 days postoperatively. (Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery)
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - July 1, 2016 Category: Cardiovascular & Thoracic Surgery Tags: Case Reports Source Type: research

Complete Obliteration of the Left Atrial Appendage: An Analysis of Epicardial Excision and Novel Pericardial Patch Exclusion
Conclusions: Conventional epicardial excision of the LAA results in significantly more residual LAA volume, which may have important implications in persistent stroke risk. Pericardial patch exclusion seems to achieve near-total elimination of the LAA and may be a superior surgical option. (Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery)
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - July 1, 2016 Category: Cardiovascular & Thoracic Surgery Tags: Original Articles Source Type: research

New, Virtually Wall-less Cannulas Designed for Augmented Venous Drainage in Minimally Invasive Cardiac Surgery
Conclusions: At the well-accepted pump inlet pressure of −80 mm Hg, the new, thinner, virtually wall-less, braided cannulas provide unmatched venous drainage in vivo. Early clinical analyses have confirmed these findings. (Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery)
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - July 1, 2016 Category: Cardiovascular & Thoracic Surgery Tags: Original Articles Source Type: research

Comparison of Endoscopic Robotic Versus Sternotomy Approach for the Resection of Left Atrial Tumors
Objective: Primary cardiac tumors most commonly occur in the left atrium. The aim of this study was to compare outcomes among patients undergoing isolated left atrial tumor resection via sternotomy or robotic approach. Methods: From 2003 to 2013, 69 patients underwent isolated left atrial tumor resection at 3 affiliated hospitals with either a sternotomy (n = 39) or robotic approach (n = 30). A retrospective review of prospectively collected data was performed, and outcomes were compared between the sternotomy and robotic groups. Univariate and multivariate analyses controlling for pertinent preoperative characteristics w...
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - July 1, 2016 Category: Cardiovascular & Thoracic Surgery Tags: Original Articles Source Type: research

Attaining Proficiency in Robotic-Assisted Minimally Invasive Esophagectomy While Maximizing Safety During Procedure Development
Conclusions: Excellent perioperative and short-term patient outcomes with minimal mortality can be achieved using a standardized RAMIE procedure and a dedicated team approach. The structured process described may serve as a model to maximize patients' safety during development and assessment of complex novel procedures. (Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery)
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - July 1, 2016 Category: Cardiovascular & Thoracic Surgery Tags: Original Articles Source Type: research

Minimally Invasive Mitral Valve Surgery III: Training and Robotic-Assisted Approaches
Abstract: Minimally invasive mitral valve operations are increasingly common in the United States, but robotic-assisted approaches have not been widely adopted for a variety of reasons. This expert opinion reviews the state of the art and defines best practices, training, and techniques for developing a successful robotics program. (Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery)
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - July 1, 2016 Category: Cardiovascular & Thoracic Surgery Tags: Original Articles Source Type: research

Minimally Invasive Mitral Valve Surgery II: Surgical Technique and Postoperative Management
Abstract: Techniques for minimally invasive mitral valve repair and replacement continue to evolve. This expert opinion, the second of a 3-part series, outlines current best practices for nonrobotic, minimally invasive mitral valve procedures, and for postoperative care after minimally invasive mitral valve surgery. (Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery)
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - July 1, 2016 Category: Cardiovascular & Thoracic Surgery Tags: Original Articles Source Type: research

Minimally Invasive Mitral Valve Surgery I: Patient Selection, Evaluation, and Planning
Abstract: Widespread adoption of minimally invasive mitral valve repair and replacement may be fostered by practice consensus and standardization. This expert opinion, first of a 3-part series, outlines current best practices in patient evaluation and selection for minimally invasive mitral valve procedures, and discusses preoperative planning for cannulation and myocardial protection. (Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery)
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - July 1, 2016 Category: Cardiovascular & Thoracic Surgery Tags: Original Articles Source Type: research

Transcatheter Aortic Valve Replacement: Current Technology and Future Directions
Abstract: Transcatheter aortic valve replacement as an alternative to open surgical repair is rapidly becoming more used in high-risk patients with aortic stenosis. Transcatheter aortic valve replacement offers the benefit of being much less invasive than traditional surgical repair and has evolved as a therapeutic option for patients with prohibitive surgical risk or those deemed surgically inoperable. Nevertheless, despite its potential to mitigate risk in this frail population, it comes with its own unique set of complications. Technological advancements in valve structure, function, and delivery have and continue to at...
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - July 1, 2016 Category: Cardiovascular & Thoracic Surgery Tags: Review Article Source Type: research

Minimally Invasive Mitral Valve Surgery: Moving Toward Consensus and Standardization
No abstract available (Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery)
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - July 1, 2016 Category: Cardiovascular & Thoracic Surgery Tags: Editorial Source Type: research

Novel Utilization of the Bridge During Weaning Off Venoarterial ECMO: The Hoffman Clamp Method
Abstract: Standard practice for weaning patients off venoarterial extracorporeal membrane oxygenation (ECMO) occurs by decreasing pump flows until idle flow is achieved. This method is limited in its use because it is difficult to assess a patient's true potential to successfully come off ECMO when supported by idle flow. We have developed a weaning technique that uses a Hoffman clamp on the bridge to decrease blood flow to the patient beyond idle flow. This method was used to wean eight patients from venoarterial ECMO. No patients weaned with this technique required emergent reinstitution of ECMO. The Hoffman clamp techni...
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - May 1, 2016 Category: Cardiovascular & Thoracic Surgery Tags: How-To-Do-It Articles Source Type: research

Right Ventricular Assist Device Configuration for Remote Decannulation
Abstract: Preoperative risk factors, intraoperative fluid shifts, and transfusions place patients at increased risk for right ventricular failure during left ventricular assist device implantation. Despite aggressive use of inotropes and pulmonary vasodilators, in severe cases of RV failure, a right ventricular assist device may be required. For the past several years, we have been implanting right ventricular assist devices in the presented configuration, allowing less invasive removal without sternotomy. The method is presented herein. (Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery)
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - May 1, 2016 Category: Cardiovascular & Thoracic Surgery Tags: How-To-Do-It Articles Source Type: research

Transapical Mitral Valve-in-Valve Replacement in Patient With Previous Complex Sternal Reconstruction
We present a complex case of a transapical redo mitral valve-in-valve replacement. Repeat mitral valve replacement was indicated for severe symptomatic bioprosthetic stenosis. In addition to the patient's numerous comorbidities that included diabetes, hepatic cirrhosis, ischemic cardiomyopathy, and atrial flutter, he had undergone a previous open mitral valve replacement that was complicated by sternal dehiscence requiring extensive chest wall reconstruction. Transapical approach was performed through left minithoracotomy incision with balloon-expandable valve. Transapical valve-in-valve replacement of a stenotic mitral bi...
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - May 1, 2016 Category: Cardiovascular & Thoracic Surgery Tags: Case Reports Source Type: research

Modified Valsalva Maneuver for Venous Cannulation in Cardiopulmonary Bypass for Minimal Incision Mitral Valve Surgery
Abstract: A 69-year-old man underwent minimal incision mitral valve repair for severe symptomatic mitral regurgitation. The echocardiography showed that he had normal left ventricular function with a moderately to severely dilated left atrium, a mildly dilated right atrium, and a large patent foramen ovale. The multistage venous cannulation was very challenging because we could not negotiate the guide wire from the inferior vena cava via the right atrium into the superior vena cava. Despite several attempts, the guide wire would pass into the patent foramen ovale. Methods that we routinely attempt with difficult cannulatio...
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - May 1, 2016 Category: Cardiovascular & Thoracic Surgery Tags: Case Reports Source Type: research

Axillary Artery Access for Combined Endoaortic Balloon Occlusion and Perfusion During Robotic Mitral Valve Surgery
Abstract: We aimed to develop a method that provides an alternative cannulation site in robotic mitral valve surgery that allows simultaneous endo-occlusion and antegrade perfusion. A 71-year-old man with severe mitral regurgitation and history of coronary artery bypass grafting underwent totally endoscopic robotic mitral valve repair. A 23-mm endoreturn cannula was placed through a 10-mm graft that was sewn to the left axillary artery. An endoballoon was passed through the Dacron/cannula complex and into the ascending aorta. This complex was used for simultaneous antegrade perfusion, endoballoon occlusion, and antegrade c...
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - May 1, 2016 Category: Cardiovascular & Thoracic Surgery Tags: Case Reports Source Type: research

Surgical Management of Achalasia in a Patient With Previous Gastric Bypass
Abstract: Patients with previous foregut surgery who develop additional foregut pathology can be a challenge. Those who have formerly undergone gastric bypass and later develop achalasia are at increased risk related to previous surgery. In this case report, we describe an alternative approach for the Dor fundoplication after laparoscopic Heller myotomy in the setting of the altered anatomy. The technique and advantages of this approach are detailed in the discussion of this patient. (Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery)
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - May 1, 2016 Category: Cardiovascular & Thoracic Surgery Tags: Case Reports Source Type: research

A Novel Video-Assisted Approach to Excimer Laser–Guided Cardiac Implantable Electronic Devices Lead Extraction
Conclusions: Concomitant laser sheet extraction and video-assisted thoracoscopy are feasible and may offer benefits in high-risk patients. Further studies to document the actual safety and clinical value of our procedure are warranted. (Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery)
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - May 1, 2016 Category: Cardiovascular & Thoracic Surgery Tags: Original Articles Source Type: research

The ABLA-BOX: An In Vitro Module of Hybrid Atrial Fibrillation Ablation
We present the first testing study on the ABLA-BOX, a new in vitro module of hybrid atrial fibrillation ablation. Methods: ABLA-BOX consists of two chambers that mimic the epicardial and endocardial sides of the heart. The septum between chambers provides catheter access on both sites of the cardiac tissue. A circuit, filled with freshly obtained porcine blood, including a pump, an oxygenator, and a heating device, circulate the blood inside the system. Left atrial fresh tissue is mounted on a tissue holder and magnetically fixed. Epicardial and endocardial catheters are fixed on the catheter holders and blocked with the ...
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - May 1, 2016 Category: Cardiovascular & Thoracic Surgery Tags: Original Articles Source Type: research

Computer-Assisted Transcatheter Heart Valve Implantation in Valve-in-Valve Procedures
Conclusions: Our study demonstrates the feasibility of a computer-guided implantation of THV in ViV procedures. Moreover, it suggests that augmented reality may increase the reliability of THV implantation inside degenerated bioprostheses through better reproducibility. (Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery)
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - May 1, 2016 Category: Cardiovascular & Thoracic Surgery Tags: Original Articles Source Type: research

A Meta-Analysis of Early Versus Delayed Surgery for Valvular Infective Endocarditis Complicated by Embolic Ischemic Stroke
Conclusions: In patients with valvular IE complicated by ischemic stroke, early surgery is associated with an increased risk of operative mortality, with no observed benefit in 1-year survival. (Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery)
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - May 1, 2016 Category: Cardiovascular & Thoracic Surgery Tags: Original Articles Source Type: research

Adherence to a Clinical Pathway for Video-Assisted Thoracic Surgery: Predictors and Clinical Importance
Objective: A bespoke clinical pathway is increasingly often used to expedite patient's recovery after video-assisted thoracoscopic surgery (VATS). The importance and predictors of adherence to a clinical pathway have not been previously investigated. Methods: A defined clinical pathway was used for the perioperative management of 136 consecutive patients receiving major pulmonary resection surgery. The clinical pathway encompassed multiple aspects of clinical care, including chest drainage, analgesia, mobilization, physiotherapy, investigations, etc. Results: The cohort consisted of 76 males (56%), and had a median age o...
Source: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery - May 1, 2016 Category: Cardiovascular & Thoracic Surgery Tags: Original Articles Source Type: research