Cardiothoracic surgery is a clinical and scientific discipline which has evolved enormously over the last decades. Cardiac problems which were historically death sentences can now be addressed with approaches that only continue to improve. In the late 1950s, while cardiothoracic surgery was still a nascent field, Nina Starr Braunwald emerged as a pioneer for this exponential improvement. As the first woman cardiac surgeon in an era in which general surgery and surgical specialties were dominated by men, Dr. Braunwald not only made revolutionary contributions to cardiothoracic surgery but did so while balancing roles as a dedicated mother and supportive partner.Iatrogenic ventricular septal defect is a rare complication in patients undergoing septal myectomy for hypertrophic obstructive cardiomyopathy and it necessitates closure in the post-operative period. We describe a novel surgical technique for closure of the ventricular septal defect using a biventricular approach with a custom made Polytetrafluoroethylene device. Our method is easily reproducible.
This study evaluates the safety and feasibility of combined resection for patients with synchronous pulmonary and esophageal cancer.
Patients undergoing esophagectomy between 1997 and 2019 were identified from prospectively collected databases at three tertiary referral centers, and those with combined anatomic lung resection at the same setting were identified. This cohort was then matched in a 13 ratio to esophagectomy alone cases, based on age, sex, pathologic stage, neoadjuvant therapy, and surgical procedure. Demographic data, peri-operative data, post-operative complications were compared. Statistical analysis included unpaired t-test, Fisher's exact or chi-squared test and Gehan-Breslow analysis.
Of 4729 esophagectomies, combined anatomic lung resection was performed in 18 patients with discrete pulmonary lesions. Matching yielded 49 patients who underwent esophagectomy only and was statistically similar compared to patients undergoing combined resections. Ivor Lewis esophagectomy and lobectomy wer significantly from esophagectomy alone in this highly selected group of patients.Reporting of risk-adjusted surgical outcomes is commonly used to compare providers and track changes over time. Preferred graphical methods use the relationship of the observed to the expected values of outcome events, including their ratio (O/E), cumulative sum (CUSUM) of their differences over time, called Risk-Adjusted CUSUM (RA-CUSUM) or Variable Life Adjusted Display (VLAD). We demonstrate these methods using operative mortality data for 7,255 isolated coronary artery bypass graft patients from January 2014 to June 2017. RA-CUSUM and VLAD are excellent techniques to display risk-adjusted outcomes and, unlike O/E, can provide continuous monitoring as performance varies over time.Mitral annular calcification (MAC) represents a surgical challenge to mitral valve replacement. Pamiparib The presence of MAC at the time of mitral valve replacement is associated with perivalvular leak and atrial-ventricular groove injury. Although percutaneous and hybrid approaches may offer alternatives to surgical mitral valve replacement, the early and late results from these techniques remain unknown. As such, the surgical management of MAC remains relevant in the contemporary treatment of patients with MAC. Herein, we present a systematic approach to the management of MAC at the time of mitral valve replacement.
This study investigated the incidences of various conduction abnormalities after rapid-deployment aortic valve replacement(RDAVR) using Edwards Intuity and the temporal changes of these abnormalities during the postoperative course.
We modified the procedure by placing additional anchoring sutures and using a 5-mm videoscope to achieve 'complete annulus fitting'. Direct visual inspection by videoscopy inside and outside the valve guaranteed 'complete annulus fitting'.
Overall 167 patients who underwent RDAVR during the study period were included in the analysis of postoperative conduction abnormalities. After RDAVR, third-degree atrioventricular block occurred in 18 patients(10.8%), but 15 patients recovered to sinus rhythm at median postoperative 10 days. Left or right bundle branch block occurred in 67 patients(40.1%), but 44 patients returned to their original rhythm at median postoperative 12 days. Delayed-onset conduction abnormalities occurred in 35 patients(21.0%) at median postoperative day 4, but they spontaneously regressed in 28 patients.
The incidence of conduction abnormalities after RDAVR was high, but most of these abnormalities spontaneously recovered. These good results may be attributed to our implantation technique.
The incidence of conduction abnormalities after RDAVR was high, but most of these abnormalities spontaneously recovered. These good results may be attributed to our implantation technique.The Society of Thoracic Surgeons (STS) is a highly impactful professional organization in cardiothoracic surgery and an important network of mentors for trainees. Annually, STS presidents deliver an address encapsulating their professional experiences, lessons learned, and future vision for the field. We sought to summarize these lessons into salient points for trainees. Transcriptions from 1964 to 2018 were reviewed by residents and expounded into categories of importance for readers. Six overarching themes were identified which included (1) leadership, (2) education, (3) clinical excellence and innovation, (4) humanism and professionalism, (5) diversity and inclusion, and (6) the future of cardiothoracic surgery.The complex three-dimensional (3D) anatomy of the cardiovascular system presents a steep learning obstacle to patients in understanding cardiovascular diseases and surgical procedures. Although 3D printed models have become very popular in surgical education, 2D cross-sections remain standard in clinical practice due to costs and availability. In this report, we demonstrate how the free 3D modeling software Meshmixer can be used to add a fourth dimension to patient education by exploiting interactive 3D modeling. This report serves as proof of concept for the feasibility and potential utility of interactive 3D modeling as an inexpensive tool for cardiovascular surgery patient education.Pamiparib
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