Caveat Emptor
The use of minimally invasive incisions for mitral valve surgery began in the mid 1990 ’s. Pioneers include Cohn, Cosgrove, Chitwood and Carpentier.1,2 Others who blazed the trail include Mohr, Vanermen and the NYU group.1,3,4 In 1995 Toby Cosgrove at the Cleveland Clinic (CCF) had a video conference where he used a right paramedian incision (with rib removal) to approach the mitral valve.5 Although the excellent was exposure (I used it myself), this approach was abandoned because of lung herniation. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - October 18, 2019 Category: Cardiovascular & Thoracic Surgery Authors: W. Clark Hargrove, Andrew B. Goldstone Tags: ADULT – Editorial Commentary Source Type: research

Cognitive Engineering to Improve Patient Safety and Outcomes in Cardiothoracic Surgery
Cognitive Engineering is focused on how humans can cope and master the complexity of processes and technological environments. In cardiothoracic surgery, the goal is to support safe and effective human performance by preventing medical errors. Strategies derived from cognitive engineering research could be introduced in cardiothoracic surgery practice in the near future to enhance patient safety and outcomes. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - October 17, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Marco A. Zenati, Lauren Kennedy-Metz, Roger D. Dias Tags: ADULT – State of the Art Source Type: research

Disparities in Follow-up After Low-Dose Lung Cancer Screening
The objective of this study was to determine predictors of follow-up after a positive lung cancer screening test. The NLST database was queried for participants with a positive lung cancer screening exam. This cohort was then subdivided into patients who had follow-up and those that did not. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - October 16, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Joanna Sesti, Timothy J. Sikora, Dusty S. Turner, Amber L. Turner, Russell C. Langan, Andrew B. Nguyen, Subroto Paul Tags: THORACIC – Original Submission Source Type: research

Left Ventricular Stroke Work Index Associated with Outcome After Mitral Valve Surgery for Functional Regurgitation in Non-Ischemic Dilated Cardiomyopathy
The indications for mitral valve surgery in patients with advanced non-ischemic dilated cardiomyopathy and functional mitral regurgitation are still unclear. We reviewed our experience of mitral valve surgery in such patients and explored factors that were predictive of outcomes. Fifty-three consecutive patients with non-ischemic dilated cardiomyopathy and an ejection fraction (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - October 16, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Noriyuki Kashiyama, Koichi Toda, Shigeru Miyagawa, Yasushi Yoshikawa, Hiroki Hata, Daisuke Yoshioka, Yoshiki Sawa, Osaka Cardiovascular Surgery Research (OSCAR) Group Tags: ADULT – Original Submission Source Type: research

Commentary: Difficulty weaning from bypass following a Norwood procedure: Revise or Support?
While results following Norwood palliation have improved over time, a large proportion continues to have difficulty weaning from CPB.1 The surgeon is then faced with a significant time-sensitive dilemma analogous to what Odysseus encountered when he was caught between Scylla and Charybdis.2 This situation demands a rapid, thorough and step-wise elimination of potential causes, technical / anatomical, physiologic or both. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - October 16, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Minoo N. Kavarana Source Type: research

Commentary: Regionalization of Congenital Heart Care in the United States: Small Improvements in Outcomes – but At What Expense?
In this issue of Seminars, Welke and associates revisit the important question of whether regionalization of congenital heart surgery (CHS) in the United States (U.S.) would lead to improved outcomes. To investigate the potential impact of regionalization of care, they simulated progressive closure of programs beginning with the lowest volume hospitals. Patients were moved to the next closest hospital. Mortality rates were then re-calculated using the new hospital's original mortality rate and an estimated mortality rate based on the new hospital volume. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - October 16, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Petros V. Anagnostopoulos, J. Carter Ralphe, C. Greenberg Tags: CONGENITAL – Editorial Commentary Source Type: research

Simultaneous Norwood And Aortic Uncrossing In Neonate with Aortic Atresia And Right Circumflex Aorta
Right circumflex aorta is a rare vascular ring formed by right aortic arch that follows a retro-esophageal course, crossing midline above the carina level to join a left-sided descending aorta, in addition to left-sided arterial duct / ligamentum arteriosum.1,2 This abnormal vascular anatomy results in compression of the trachea and esophagus by: 1- the ring created by the right aortic arch and left ligamentum arteriosum. 2- the retro-esophageal course of the right aortic arch. Therefore, division of the ligamentum arteriosum alone often fails to relieve the posterior compression caused by the right aortic arch. (Source: S...
Source: Seminars in Thoracic and Cardiovascular Surgery - October 15, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Bahaaldin Alsoufi, Philip Dydynski, Erle Austin, Deborah Kozik Tags: CONGENITAL – Case Report Source Type: research

Commentary: Cerebral embolization after minimally invasive mitral valve surgery without aortic-cross clamp: Pay attention to the details.
The goals of minimally invasive cardiac surgery procedures are a) to perform the same operation as through a median sternotomy, and b) to minimize the physiological impact associated with a large chest incision, decreasing recovery time and operative complications. Stroke is a rare but devastating complication after cardiac surgery that results in increased operative and long-term mortality and significant impairment in the quality of life. Therefore, prevention of stroke during cardiac surgery is of paramount importance, particularly in procedures performed through a minimally invasive approach with the goal of decreasing...
Source: Seminars in Thoracic and Cardiovascular Surgery - October 15, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Juan A. Crestanello Tags: ADULT – Editorial Commentary Source Type: research

Commentary: To Graft or Not to Graft a previously stented coronary artery: this is the question
The work by Luthra et al, is a further to answer on whether prior percutaneous coronary interventions (PCI) can increase mortality after coronary bypass grafting (CABG) using a meta-analytic approach.1 Their results are not conclusive, but the authors suggested that an association between centres with higher rate of PCI and mortality may exist. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - October 15, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Umberto Benedetto Tags: ADULT – Editorial Commentary Source Type: research

Commentary: Tracheo-innominate fistula - Stent or Sternotomy?
Tracheo-innominate fistula(TIF) is a life-threatening condition in patients with an existing tracheostomy and carries a high mortality rate. Mild bleeding from the tracheostomy site arises more often from mucosal trauma, but a ‘herald’ bleed from a TIF may be easily missed and so is the window to intervene in a controlled situation. In the setting of a major bleed from an old tracheostomy site, a majority of our readers may believe the standard of care for these patients is an emergent trip to the operating room and a STAT page to the on call cardiac surgeon. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - October 14, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Sashi Inkollu Tags: ADULT – Editorial Commentary Source Type: research

Novel use of cangrelor with heparin during cardiopulmonary bypass in patients with heparin-induced thrombocytopenia who require cardiovascular surgery: A case series
We describe our strategy and experience with utilizing cangrelor in combination with heparin for anticoagulation during CPB in patients with different phases of HIT undergoing a wide range of urgent/emergent cardiovascular surgery. Cangrelor is an intravenous direct-acting P2Y12 platelet receptor antagonist that achieves therapeutic effect and eliminates rapidly. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - October 11, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Yan K. Gernhofer, Dalia A. Banks, Eugene Golts, Victor Pretorius Tags: ADULT – Original Submission Source Type: research

Intra-pleural impedance sensor real-time tracking of pneumothorax in a porcine model of air leak
In patients with alveolar-to-pleural air leak due to recent surgery or trauma, clinicians tend to manage chest tubes with suction therapy. Non-suction therapy is associated with shorter chest tube duration but also a higher risk of pneumothorax. We sought to develop an intrapleural electrical impedance sensor for continuous, real-time monitoring of pneumothorax development in a porcine model of air leak as a means of promoting non-suction therapy. Using thoracoscopy, two chest tubes and the pleural impedance sensor were introduced into the pleural space of three pigs. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - October 11, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Daniel T. DeArmond, Nitin A. Das, Carlos S. Restrepo, Mitch A. Katona, Scott B. Johnson, Brian S. Hernandez, Joel E. Michalek Tags: THORACIC – Original Submission Source Type: research

Histopathological analysis of explanted polytetrafluoroethylene valved pulmonary conduits
The expanded polytetrafluoroethylene (ePTFE) valved conduits as alternative material for right ventricular outflow reconstruction provides satisfactory long-term outcomes. The purpose of this study was to investigate degenerative changes in failed conduits through histopathological analysis of the explanted specimens. All leaflets of explanted conduits were observed macroscopically, and their longitudinal sections were examined microscopically. Three typical findings, i.e. calcification of the leaflet, neointimal proliferation, and proteinaceous infiltration into the leaflet, were evaluated quantitatively by measuring thei...
Source: Seminars in Thoracic and Cardiovascular Surgery - October 10, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Yusuke Yamamoto, Masaaki Yamagishi, Yoshinobu Maeda, Satoshi Asada, Hisayuki Hongu, Shuhei Fujita, Hitoshi Yaku Tags: CONGENITAL – Original Submission Source Type: research

Quantification of Multiple Bacteria in Calcified Structural Valvular Heart Disease
Genome studies of heart valve tissue (HVT) in patients with structural valvular heart disease (sVHD) and acute infective endocarditis (aIE) showed polymicrobial infections. Subject of this study is the quantification of bacterial DNA in HVT of sVHD in comparison to aIE. It will be examined whether the bacterial DNA concentration can be used as surrogate marker to differentiate chronic and acute infections. DNA was isolated from HVT of 100 patients with sVHD and 23 microbiologically positively tested patients with aIE. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - October 9, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Andreas Oberbach, Nadine Schlichting, Maik Friedrich, Stefanie Lehmann, Yvonne Kullnick, Maximilian Pichlmaier, Christian Hagl, Erik Bagaev, the CardiOmics group, the Clinical Microbiology group, the Clinical Management group Tags: ADULT – Original Submission Source Type: research

Complete Atrioventricular Canal Defects: Is there a superior repair technique?
The article by Fong et al in this issue of Seminars provides a commendable retrospective analysis of complete atrioventricular canal defect (AVCD) repairs over a twenty-five year period at their institution.1 All patients included in the study received either a modified single patch or double patch repair technique. The authors should be applauded for the lengthy follow up of their patients in the modified single patch group. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - October 7, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Fawwaz Shaw, Paul Chai Tags: CONGENITAL – Editorial Commentary Source Type: research

Thoracic Aortic Surgery in the 21st Century
Before a look to the future, we should reflect and acknowledge the contributions of those who came before us, starting with the first description of aneurysm by Galen of Pergamon in the 2nd century.1 Antyllus, a Greek surgeon, suggested and discussed that aneurysms were due to clotting phenomena.2 In 1555, the Flemish surgeon Vesalius offered description of thoracic and abdominal aneurysms3 and Ambroise Par é, of Paris, stated that opening an aneurysm would result in fatal bleeding and that “the aneurysms which happen in the internal parts are incurable.” Those historical observations created a reticence...
Source: Seminars in Thoracic and Cardiovascular Surgery - October 4, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Mohamad Bashir, Duke Cameron, Ed Chen Tags: Editorial Source Type: research

Shunting between the left ventricle and right atrium can be produced by straddling tricuspid valve with dual orifices
In the current issue of the journal, Guenther and colleagues describe their experience with a rare combination of findings, which produced a shunt from the left ventricle to the right atrium, along with so-called “double outlet right atrium”.1 There are two ways of dealing with such an unexpected constellation of findings. One way is to use the principle known as Occam's razor, and opt for the simplest explanation. The other is to invoke as yet unproven developmental hypotheses, and still further complic ate the situation. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - October 2, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Bruno Santos Lopes, Louise Coats, Robert H. Anderson Tags: CONGENITAL – Editorial Commentary Source Type: research

Transesophageal Echocardiographic Predictor of Significant Right Ventricular Outflow Tract Obstruction after Tetralogy of Fallot Repair
The optimal method for reconstruction of the right ventricular outflow tract in tetralogy of Fallot repair is yet to be established. Transatrial repair with pulmonary valve preservation avoids the detrimental effects of ventriculotomy and transannular patch, however because of moderately hypoplastic pulmonary valve these techniques are associated with undesirable residual right ventricular outflow tract gradients resulting in reoperations. The study sought to define intraoperative echocardiographic predictors of significant right ventricular outflow tract obstruction after tetralogy of Fallot repair. (Source: Seminars in T...
Source: Seminars in Thoracic and Cardiovascular Surgery - September 24, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Olga Borodinova, Yaroslav Mykychak, Illya Yemets Tags: CONGENITAL – Original Submission Source Type: research

Combined EBUS and EUS staging in high-risk patients: measure twice, cut once – or not at all
Increasing adoption of PET/CT has placed the onus on thoracic surgeons to better familiarize themselves with its limitations. At its best, it offers a comprehensive, non-invasive approach to stage the patient. Yet there are many situations where PET/CT can lead us astray, prompting the need for more intensive evaluation. In this issue of the Seminars in Thoracic and Cardiovascular Surgery, Hegde and colleagues1 take this challenge head-on: how well do our more invasive, non-surgical staging techniques catch high-risk patients with occult disease missed by PET/CT? The authors focused in particular on a combined endobronchia...
Source: Seminars in Thoracic and Cardiovascular Surgery - September 24, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Alexander Gregor, Kazuhiro Yasufuku Tags: THORACIC – Editorial Commentary Source Type: research

Predictors of Stroke after Minimally Invasive Mitral Valve Surgery Without the Cross-Clamp
Minimally invasive mitral valve surgery (mini-MVS) with hypothermic fibrillatory arrest has been associated with an increased risk of stroke. We aim to investigate the incidence, predictors, and outcomes of stroke in a large cohort of patient who underwent clampless mini-MVS. Between January 2008 and June 2017, we performed 1,247 mini-MVSs. The clinical, operative, and postoperative outcomes were analyzed. Univariable and multivariable regression analyses were used to identify predictors of postoperative stroke. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - September 23, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Renaldo D. Williams, Neal M. Foley, Rushikesh Vyas, Shi Huang, Miklos D. Kertai, Keki R. Balsara, Michael R. Petracek, Ashish S. Shah, Tarek S. Absi Tags: ADULT – Original Submission Source Type: research

Prior percutaneous coronary interventions may be associated with increased mortality after coronary bypass grafting: A meta-analysis
There is conflicting evidence for adverse outcomes after coronary artery bypass surgery (CABG) with prior percutaneous intervention (PCI). A literature search was performed for 1998-2017 and articles with primary or secondary outcomes of survival, major adverse cardiovascular events, myocardial infarction in CABG patients with prior PCI were included. Forest plots were generated from odds ratios for survival, major adverse cardiovascular events and myocardial infarction for unmatched and propensity matched data. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - September 23, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Suvitesh Luthra, Miguel M. Leiva-Ju árez, Brian Shine, Nawwar Al-Attar, Sunil Ohri, David P. Taggart Tags: ADULT – Original Submission Source Type: research

4D-flow MRI: Beyond the Images
4D-flow MRI evaluation allows a qualitative and quantitative analysis of flow velocity, volume and direction, wall shear stress as well as pressure gradients and flow complexity.1 In addition, this method offers the possibility of visualizing blood flow through the cavities of the heart and large vessels, showing intuitively its multidirectional variations.2 (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - September 21, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Pietro Sergio, Antonio Miceli Tags: ADULT – Editorial Commentary Source Type: research

Enlargement rate of the ascending aorta after thoracic endovascular aortic repair
It is known that the elasticity of the thoracic aorta decreases when it is covered with endografts. It remains to be clarified, however, whether endografts in the descending aorta affect aortic stiffening in the ascending aorta. We analyzed 46 patients who underwent thoracic endovascular aortic repair for descending thoracic aortic aneurysm between January 2008 and June 2016. We calculated the preoperative and postoperative rate of enlargement of the mid-ascending aorta using enhanced computed tomography. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - September 20, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Toshifumi Hiraoka, Tatsuhiko Komiya, Takeshi Shimamoto Tags: ADULT – Original Submission Source Type: research

Left Ventricle to Right Atrial Shunt Associated with Ventricular-Atrial Malalignment, Double Outlet Right Atrium, and Subaortic Membrane
We describe an asymptomatic 7 year old boy who was taken to the operating room for repair of a subaortic membrane and possible Gerbode's defect. He was found to have a double outlet right atrium associated with an accessory atrioventricular valve in addition to a small atrial septal defect and subaortic membrane. Regurgitant flow through this accessory valve led to the left ventricle to right atrial shunt that was seen on pre-operative ECHO. The atrial septal defect was repaired and a baffle was used to isolate blood flow across the accessory valve from the left atrium to the left ventricle. (Source: Seminars in Thoracic a...
Source: Seminars in Thoracic and Cardiovascular Surgery - September 11, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Timothy Guenther, Luis Godoy, Sarah Chen, Jay Yeh, Gary Raff Tags: CONGENITAL – Case Report Source Type: research

Multiscale Modeling of Superior Cavopulmonary Circulation: Hemi-Fontan And Bidirectional Glenn Are Equivalent
Superior cavopulmonary circulation (SCPC) can be achieved by either the Hemi-Fontan (hF) or Bidirectional Glenn (bG) connection. Debate remains as to which results in best hemodynamic results. Adopting patient-specific multiscale computational modeling, we examined both the local dynamics and global physiology to determine if surgical choice can lead to different hemodynamic outcomes. Six patients (age: 3-6 months) underwent cardiac magnetic resonance imaging and catheterization prior to SCPC surgery. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - September 11, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Ethan Kung, Chiara Corsini, Alison Marsden, Irene Vignon-Clementel, Giancarlo Pennati, Richard Figliola, Tain-Yen Hsia, for the Modeling of Congenital Hearts Alliance (MOCHA)+ Investigators Tags: CONGENITAL – Original Submission Source Type: research

Port-Access Mitral Valve Surgery —An Evolution of Technique
Port-access mitral valve surgery has been around since 1995; and many variations upon the technique have been developed. Since 1996, we have performed more than 2500 port-access mitral valve surgeries, and thus gained a substantial experience. The purpose of this document is to describe the current status of port-access mitral surgery at 1 institution, and to share the “know how” and life lessons behind the patient selection and conduct of the operation to accomplish results similar to those achieved from sternotomy mitral valve surgery. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - September 10, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Yaron D. Barac, Donald D. Glower Tags: ADULT – Review Source Type: research

Risk factors for the exacerbation of myasthenic symptoms after surgical therapy for myasthenia gravis and thymoma
Extended thymectomy is employed for patients with myasthenia gravis (MG) and/or thymoma with elevated serum antiacetylcholine receptor antibody (AchR) titers. However, MG symptoms occasionally worsen in postthymectomy patients. We explored the risk factors for exacerbation of MG symptoms after surgical therapy for patients with MG and/or thymoma with an elevated AchR titer. We retrospectively analyzed 90 patients suffering from MG and/or thymoma with an elevated AchR titer who underwent thymectomy in our institute. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - September 10, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Taketo Kato, Koji Kawaguchi, Takayuki Fukui, Shota Nakamura, Shuhei Hakiri, Masahiro Nakatochi, Kohei Yokoi Tags: THORACIC – Original Submission Source Type: research

Port-Access Mitral Valve Surgery - An Evolution of Technique
Port-Access mitral valve surgery has been around since 1995; and many variations upon the technique have been developed. Since 1996 we have performed more than 2,500 port-Access mitral valve surgeries, and thus gained a substantial experience. The purpose of this document is to describe the current status of port access mitral surgery at one institution, and to share the “know how” and life lessons behind the patient selection and conduct of the operation to accomplish results similar to those achieved from sternotomy mitral valve surgery. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - September 10, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Yaron D. Barac, Donald D. Glower Tags: ADULT – Review Source Type: research

Regionalization of Congenital Heart Surgery in the United States
The objective of this study is to simulate regionalization of congenital heart surgery (CHS) in the United States and assess the impact of such a system on travel distance and mortality. Patients ≤18 years of age that underwent CHS were identified in 2012 State Inpatient Databases. Operations were stratified by the Risk Adjustment for Congenital Heart Surgery, version 1 (RACHS-1) method, with high risk defined as RACHS-1 levels 4-6. Regionalization was simulated by progressive closure of h ospitals, beginning with the lowest volume hospital. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - September 10, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Karl F. Welke, Sara K. Pasquali, Paul Lin, Carl L. Backer, David M. Overman, Jennifer C. Romano, Tara Karamlou Tags: CONGENITAL – Original Submission Source Type: research

A Floating Stitch on the Anterior Mitral Leaflet Can Eliminate Systolic Anterior Motion in Hypertrophic Obstructive Cardiomyopathy
Reducing the SAM is a key way of resolving LVOT obstruction in surgery for HOCM. We developed a new technique using a floating stitch on the anterior mitral leaflet (AML). It is applied just to the middle of the tip of the AML and fixed to the annuloplasty ring at the middle of the posterior annulus. The AML is prevented from touching the interventricular septum and SAM can theoretically be solved. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - September 10, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Masato Mutsuga, Yuji Narita, Akihiko Usui Tags: ADULT - Surgical Technique Source Type: research

The Role of Thoracic Endovascular Repair in Chronic Type B Aortic Dissection
Continued device improvements along with refined implantation techniques have revolutionize the use of thoracic endovascular repair (TEVAR) for both aortic dissections and aneurysms. This is now considered standard of care for acute, complicated type B aortic dissection in patients with appropriate anatomy. However, the treatment of chronic, uncomplicated type B dissection continues to present challenges for the aortic surgeon, as the long-held dogma of medical management and surveillance for aneurysm degeneration has recently come into questions. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - September 4, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Christopher R. Burke, Joseph E. Bavaria Tags: ADULT – Review Source Type: research

Association Officers
(Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - September 1, 2019 Category: Cardiovascular & Thoracic Surgery Source Type: research

Contents
(Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - September 1, 2019 Category: Cardiovascular & Thoracic Surgery Source Type: research

Masthead (copyright and information page)
(Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - September 1, 2019 Category: Cardiovascular & Thoracic Surgery Source Type: research

Propensity-Matched Comparison of Two Different Access Modes for Minimally Invasive Mitral Valve Surgery
Mitral valve surgery is being performed routinely using minimally invasive operative techniques. We aimed comparing perioperative and long-term outcomes of minimally invasive mitral valve surgery using 2 different surgical approaches, partial upper sternotomy (PUS) vs right anterolateral minithoracotomy (RAT). From January 1998 through December 2015, 1006 patients underwent mitral valve surgery using a minimally invasive access in our institution. Logistic regression analysis was used to identify covariates among 18 patient variables including the type of mitral valve surgery. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - August 21, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Medhat Radwan, Dimitra Bon, Laura Dressen, Thomas Walther, Alexandra Miscovic, Anton Moritz, Nestoras Papadopoulos Tags: ADULT – Original Submission Source Type: research

Propensity Matched Comparison of Two Different Access Modes for Minimally Invasive Mitral Valve Surgery
Mitral valve surgery is being performed routinely using minimally invasive operative techniques. We aimed comparing perioperative and long-term outcomes of minimally invasive mitral valve surgery using two different surgical approaches, partial upper sternotomy (PUS) versus right anterolateral minithoracotomy (RAT). From January 1998 through December 2015 1006 patients underwent mitral valve surgery using a minimally invasive access in our institution. Logistic regression analysis was used to identify covariates among 18 patient variables including the type of mitral valve surgery. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - August 21, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Medhat Radwan, Dimitra Bon, Laura Dressen, Thomas Walther, Alexandra Miscovic, Anton Moritz, Nestoras Papadopoulos Tags: ADULT – Original Submission Source Type: research

Commentary: Solitary Fibrous Tumor of the Esophagus —Rare but With Typical Characteristics
Solitary fibrous tumors typically arise from the pleura, but can originate from soft tissue in any other extrapleural locations. They can present in a sessile or pedunculated form with either benign or malignant pathologic features. Their histopathologic characteristics are similar regardless of the location and the diagnosis is typically made postoperatively on the resected specimen. The large size and sessile presentation can carry higher risk of malignancy.1 Solitary fibrous tumors share similarities with hemangiopericytomas and can present with NGFI-A-binding protein 2 (NAB2) —signal transducer and activator of t...
Source: Seminars in Thoracic and Cardiovascular Surgery - August 20, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Jonathan Yeung, Marc de Perrot Tags: THORACIC – Editorial Commentary Source Type: research

Commentary: Sucking the Air out of the Pericardium: Lessons Regarding Bronchial Anastomotic Complications
Example is always more efficacious than precept.Samuel Johnson, Rasselas (1759) chapter 30 (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - August 20, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Ashok Muniappan Tags: THORACIC – Editorial Commentary Source Type: research

THE ETERNAL DEBATE WITH A CONSISTENT ANSWER: CABG vs PCI
An ongoing debate exists over the role of percutaneous coronary intervention and coronary artery bypass grafting for revascularization in patients with multi-vessel or left main disease. Despite improvements in stent technology, bypass surgery still provides the best long-term results in the majority of patients. The present review focuses on randomized controlled trials and a meta-analysis published over the last 4 years. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - August 20, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Piero Farina, Mario Fulvio Luigi Gaudino, David Paul Taggart Tags: ADULT – Current Readings Source Type: research

Commentary: Salvage Resection for Stage IIIA Lung Cancer in the Era of Immunotherapy
The management of stage IIIA (N2) non-small cell lung cancer (NSCLC) is an area of thoracic oncology in constant controversy and evolution. Historically, the high rate of distant metastatic disease and poor long-term survival made maximal loco-regional disease control obsolete. The role of surgical therapy, which offers the best chance for durable loco-regional disease control in stage IIIA lung cancer, has been debated. This is mainly because of the lack of level I evidence demonstrating benefit of surgery over chemoradiation alone. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - August 20, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Erin M. Corsini, Boris Sepesi Tags: THORACIC – Editorial Commentary Source Type: research

Commentary: Solitary fibrous tumor of the esophagus .- rare but with typical characteristics
Solitary fibrous tumors typically arise from the pleura, but can originate from soft tissue in any other extrapleural locations. They can present in a sessile or pedunculated form with either benign or malignant pathological features. Their histopathological characteristics are similar regardless of the location and the diagnosis is typically made postoperatively on the resected specimen. The large size and sessile presentation can carry higher risk of malignancy.1 Solitary fibrous tumors shares similarities with haemangiopericytomas and can present with NGFI-A-binding protein 2 (NAB2) –signal transducer and activato...
Source: Seminars in Thoracic and Cardiovascular Surgery - August 20, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Jonathan Yeung, Marc de Perrot Tags: THORACIC – Editorial Commentary Source Type: research

Sucking the air out of the pericardium: Lessons regarding bronchial anastomotic complications
Example is always more efficacious than precept.Samuel Johnson, Rasselas (1759) chapter 30 (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - August 20, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Ashok Muniappan Tags: THORACIC – Editorial Commentary Source Type: research

Endovascular Treatment of Tracheoinnominate Artery Fistula: Case Report and Literature Review With Pooled Cohort Analysis
To pool data from published cases of tracheoinnominate artery fistula (TIF) treated with surgical or endovascular techniques along with reporting a case of similar presentation. A total of 261 cases in 137 published case reports and case series were identified through a comprehensive systematic literature review. Data regarding patient characteristics, treatment, and follow-up were extracted. A local case of a 14-year-old boy with TIF due to longstanding tracheostomy treated with stent-graft placement was added to the data. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - August 16, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Thotsophon Taechariyakul, Frederick S. Keller, Younes Jahangiri Tags: ADULT – Original Submission Source Type: research

Endovascular treatment of tracheo-innominate artery fistula: case report and literature review with pooled cohort analysis
To pool data from published cases of tracheoinnominate artery fistula (TIF) treated with surgical or endovascular techniques along with reporting a case of similar presentation. 261 cases in 137 published case report and case series were identified through a comprehensive systematic literature review. Data regarding patient characteristics, treatment, and follow-up were extracted. A local case of a 14-year-old boy with TIF due to longstanding tracheostomy treated with stent graft placement was added to the data. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - August 16, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Thotsophon Taechariyakul, Frederick Keller, Younes Jahangiri Tags: ADULT – Original Submission Source Type: research

Higher flow on cardiopulmonary bypass in pediatrics is associated with a lower incidence of acute kidney injury
This study examines two different perfusion strategies and their impact on various outcome measures including acute kidney injury (AKI), urine output on CPB, ICU length of stay, time to extubation, and mortality. Predicated upon surgeon preference, the study institution employs two different perfusion strategies (PS) during congenital cardiac surgery requiring CPB. (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - August 16, 2019 Category: Cardiovascular & Thoracic Surgery Authors: James A. Reagor, Sean Clingan, Zhiqian Gao, David L.S. Morales, James S. Tweddell, Roosevelt Bryant, William Young, Jesse Cavanaugh, David S. Cooper Tags: CONGENITAL – Original Submission Source Type: research

Oncological Outcomes of Lobar Resection, Segmentectomy, and Wedge Resection for T1a Non –Small-Cell Lung Carcinoma: A Systematic Review and Meta-Analysis
The optimal treatment of early-stage non –small-cell lung cancer (NSCLC) remains subject to debate. Lobar resection is considered the standard of care, but sublobar resections are a lung parenchymal-sparing treatment offering promising results. We conducted a systematic review and meta-analysis to compare oncological outcomes of lobar re sections and parenchymal-sparing resections for T1a NSCLC. PubMed, EMBASE, Web of Knowledge Search, and the Cochrane Central Register of Controlled Trials were searched for studies reporting oncological outcomes following lobar or parenchymal-sparing resections. (Source: Seminars in ...
Source: Seminars in Thoracic and Cardiovascular Surgery - August 9, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Michiel A. Ijsseldijk, Melina Shoni, Charles Siegert, Jan Seegers, Anton K.C. van Engelenburg, Thomas C. Tsai, Abraham Lebenthal, Richard P.G. ten Broek Tags: THORACIC – Original Submission Source Type: research

Norwood Procedure —Difficulty in Weaning From Cardiopulmonary Bypass and Implications for Outcomes
Difficulty weaning from cardiopulmonary bypass (CPB) or the need to return to CPB (collectively D-CPB) may occur after the Norwood procedure. We sought to evaluate the relationship between D-CBP and survival. This was a retrospective chart review of all patients undergoing a Norwood procedure at our institution during the interval 2005 –2017. Primary outcome was survival for the Norwood procedure. Secondary outcomes included various measures of morbidity. Successful wean from CBP (S-CPB) was defined as no need to return to full-flow CPB during the initial definitive wean or after separation from CPB; otherwise, the c...
Source: Seminars in Thoracic and Cardiovascular Surgery - August 9, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Jaclyn A. Gellings, William K. Johnson, Nancy S. Ghanayem, Michael Mitchell, James Tweddell, George Hoffman, Viktor Hraska, Evelyn M. Kuhn, Ronald K. Woods Tags: CONGENITAL – Original Submission Source Type: research

Oncological outcomes of lobar resection, segmentectomy and wedge resection for T1a non-small cell lung carcinoma: a systematic review and meta-analysis
Objective: The optimal treatment of early-stage non-small cell lung cancer (NSCLC) remains subject to debate. Lobar resection is considered the standard of care, but sublobar resections are a lung parenchymal sparing treatment offering promising results. We conducted a systematic review and meta-analysis to compare oncologic outcomes of lobar resections and parenchymal sparing resections for T1a NSCLC. Methods: PubMed, EMBASE, Web of Knowledge Search and the Cochrane Central Register of Controlled Trials were searched for studies reporting oncological outcomes following lobar or parenchymal sparing resections. (Source: Sem...
Source: Seminars in Thoracic and Cardiovascular Surgery - August 9, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Michiel A.I. Jsseldijk, Melina Shoni, Charles Siegert, Jan Seegers, Anton K.C. van Engelenburg, Thomas C. Tsai, Abraham Lebenthal, Richard P.G. ten Broek Tags: THORACIC – Original Submission Source Type: research

Norwood Procedure – Difficulty in Weaning from Cardiopulmonary Bypass and Implications for Outcomes
Difficulty weaning from cardiopulmonary bypass (CPB) or the need to return to CPB (collectively D-CPB) may occur after the Norwood procedure. We sought to evaluate the relationship between D-CBP and survival. This was a retrospective chart review of all patients undergoing a Norwood procedure at our institution during the interval 2005-2017. Primary outcome was survival for the Norwood procedure. Secondary outcomes included various measures of morbidity. Successful wean from CBP (S-CPB) was defined as no need to return to full flow CPB during the initial definitive wean or after separation from CPB; otherwise the classific...
Source: Seminars in Thoracic and Cardiovascular Surgery - August 9, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Jaclyn A. Gellings, William K. Johnson, Nancy S. Ghanayem, Michael Mitchell, James Tweddell, George Hoffman, Viktor Hraska, Evelyn M. Kuhn, Ronald K. Woods Tags: CONGENITAL – Original Submission Source Type: research

Excellent restoration of left ventricular compliance after prolonged del Nido single-dose cardioplegia in an in vivo piglet model
The objective is to evaluate the left ventricular (LV) function recovery and accompanying biochemical and histological markers to clarify the tolerable ischemic time in an in vivo cardiopulmonary bypass (CPB) piglet model. Twenty-one piglets were subjected to either 90 min (with or without topical cooling; TC) or 120 min (with TC) of global ischemia induced by single-dose DN while the other seven served as the control group (CPB only). (Source: Seminars in Thoracic and Cardiovascular Surgery)
Source: Seminars in Thoracic and Cardiovascular Surgery - August 8, 2019 Category: Cardiovascular & Thoracic Surgery Authors: Mitsutaka Nakao, Kiyozo Morita, Gen Shinohara, Takashi Kunihara Tags: ADULT – Original Submission Source Type: research