Multiple-time redo cardiac valvular procedures are
|
|
- Jeffrey Newman
- 6 years ago
- Views:
Transcription
1 Left Thoracotomy for Multiple-Time Redo Mitral Valve Surgery Using On-Pump Beating Heart Technique Yoshikazu Suzuki, MD, Francis D. Pagani, MD, PhD, and Steven F. Bolling, MD Section of Cardiac Surgery, Department of Surgery, Cardiovascular Center, University of Michigan Health System, Ann Arbor, Michigan Background. There are limited reports describing multiple-time redo mitral valve surgery using a left thoracot-descending thoracic aorta inflow and left femoral vein or monary bypass (32 to 37 C). Left femoral artery or omy approach and on-pump beating heart technique. left main pulmonary artery venous drainage with vacuum assist were used. Operation time was Methods. A retrospective review of medical records for 16 patients from March 2002 to June 2007 was performed. minutes and cardiopulmonary bypass time was 7127 Results. Mean age was (mean SD) years (8 minutes. Postoperative ventilation time was males). Preoperative mitral valve regurgitation was 3.6 hours, intensive care unit stay was days, and 0.6 in 14, and 2 had severe mitral valve stenosis. Newhospital stay was days. There were two 30-day York Heart Association symptom class was and mortalities and two died late with a follow-up of ejection fraction was (range, 0.2 to 0.6). Previous cardiac operations were performed twice in 14 and Conclusions. Left thoracotomy using the on-pump months. three times in 2 patients with an interval of beating heart technique is safe, effective, and should be years since the last. The procedures included repair (5), considered for multiple-time redo mitral valve surgery. replacement (8), and re-replacement (3). All were performed through a fifth intercostal space, left posterolateral thoracotomy with the heart beating on cardiopul by The Society of Thoracic (Ann Thorac Surg 2008;86:466 71) Surgeons Multiple-time redo cardiac valvular procedures are becoming more frequent as the population ages and cardiac valvular procedures continue to increase [1]. ral valve surgery using the on-pump beating heart technique. These complex cases, sometimes felt to have a prohibitive operative mortality, challenge surgeons not only Material and Methods because of advanced patient morbidity, but also because Data were collected retrospectively from the medical of technical issues including extensive dissection, bleeding, and injury to cardiac structures or previous coronarythrough June 2007 who underwent the left thoracotomy records of 16 consecutive patients from March 2002 artery grafts. A right thoracotomy approach has been for multiple-time redo mitral valve surgery using the popularized for first-time redo mitral valve surgery as anon-pump beating heart technique at the University of alternative to the standard redo median sternotomy Michigan. Indications were previous median sternotomy [2 10]. For the second time, or more, a left thoracotomyand right thoracotomy, or any reasons that precluded approach represents a possible option. both sternotomy and right thoracotomy for mitral valve A left thoracotomy approach for minimally invasive surgery after second-time or more cardiac procedures. mitral valve surgery, including 36 redo and 9 multiple-comprehensivtime redo cases, was reported by New York Universityprior to the operation, including for the purposes of data written informed consent was obtained [11]. However, we have found no reports of left thoracot-collectioomy using an on-pump beating heart technique. We cardiovascular surgery database has been approved by in our cardiovascular surgery database. The describe a case series of 16 patients who underwent the the Institutional Review Board at the University of Michigan Medical School. left thoracotomy approach for multiple-time redo mit- Data were presented as the proportions (%) and the mean and standard deviation (range) for categorical Accepted for publication April 14, variables and numeric variables, respectively. The proportions (%) of ordinal categories for some numeric Presented at the Poster Session of the Forty-fourth Annual Meeting of The Society of Thoracic Surgeons, Fort Lauderdale, FL, Jan 28 30, variables were also shown as appropriate. The SAS Address correspondence to Dr Bolling, Section of Cardiac Surgery, Department of Surgery, Cardiovascular Center, University of Michigan Health for Windows (SAS Institute Inc, Cary, NC) was used for System, 5144 Cardiovascular Center, SPC#5864, 1500 East Medical Center statistical analysis. As outcome variables, 30-day and Drive, Ann Arbor, MI ; sbolling@med.umich.edu. total mortality were chosen. Evaluated predictor vari by The Society of Thoracic Surgeons /08/$34.00 Published by Elsevier Inc doi: /j.athoracsur
2 Ann Thorac Surg SUZUKI ET AL 2008;86: LEFT THORACOTOMY MULTIPLE-REDO MITRAL VALVE SURGERY 467 Fig 1. A cross-sectional computed tomographic image at the level of the left inferior pulmonary vein illustrates the location, dimensions, and orientation of the mitral valve in the left thorax. Note the point of a longitudinal left atrial incision and the counterclockwise rotation for the exposure of the valve (arrows). ables included age, gender, preoperative degree of mitral valve regurgitation (MR), New York Heart Association (NYHA) congestive heart failure (CHF) class, ejection fraction (EF), endocarditis, previous stroke, previous coronary artery bypass grafting (CABG), previous types of mitral valve surgery, number of previous cardiac operations, interval from the last cardiac operation, types of mitral valve procedure, operation time, and cardiopulmonary bypass (CPB) time. The Pearson 2 exact test for categorical variables and Wilcoxon rank sum exact test for numeric variables were adopted. Variables were identified as significant if the p value was less than 0.05 (p 0.05). Surgical Technique ANESTHESIA AND MONITORING. A double-lumen endotracheal tube was used for general anesthesia. Radial artery and pulmonary artery pressure monitoring lines and a transesophageal echocardiography (TEE) probe were placed while the patient was in the supine position. The correct position of the endotracheal tube was verified with bronchoscopy before and after positioning the patient. A prophylactic external defibrillator pad was placed on the side of the right chest prior to positioning. POSITIONING AND INCISION. The patient was placed in a right lateral decubitus position with a bean bag and the table flexed to facilitate exposure for a fifth intercostal space, posterolateral left thoracotomy incision. The neck was maintained in a neutral position with a pillow. All bony prominences were padded and the brachial plexus was protected with an axillary roll. The pelvis was half rotated to the back to allow access to the femoral vessels. CPB AND MYOCARDIAL PROTECTION. After systemic heparinization, CPB was performed through the left femoral artery or descending thoracic aorta inflow and left femoral vein or left main pulmonary artery venous drainage with vacuum assist. A long venous cannula into the mid-right atrium was used through the left femoral vein with an open technique using a long wire under the TEE guidance. The heart was kept warm at 32 C to 37 C and beating on CPB. EXPOSURE OF THE MITRAL VALVE. The left lung was deflated and retracted posteriorly. The course of the phrenic nerve in the left thorax is more anterior to the hilum than in the right thorax so that the pericardium was incised either anterior or posterior to the phrenic nerve according to the specific anatomy. The surface of the left atrial and ventricular wall was dissected extending into both the cephalad and caudad directions to facilitate the Fig 2. A schematic drawing illustrates a surgeon s view of the upside-down mitral valve exposed through a fifth intercostal space, left posterolateral thoracotomy approach using the on-pump beating heart technique. Note the location of the longitudinal left atrial incision and the cardiotomy suction kept positioned through the valve.
3 468 SUZUKI ET AL Ann Thorac Surg LEFT THORACOTOMY MULTIPLE-REDO MITRAL VALVE SURGERY 2008;86: Demographics of 16 patients who underwent left thoracotomy for multiple-time redo mitral valve surgery using the on-pump beating heart technique are shown in Table 1. Previous cardiac operations included mitral valve repair or replacement, aortic or tricuspid valve surgery, CABG, tetralogy of Fallot repair, left ventricular aneurysm repair, and iatrogenic coronary sinus rupture repair. All patients underwent a right thoracotomy approach for the first-time redo mitral valve surgery except one patient who had a history of combined CABG and aortic valve surgery twice, and additional right pectoralis muscle flap operation for mediastinitis. Other preoperative critical comorbidities included inotropic infusion support (1; 6%), intraaortic balloon pumping (0; 0%), mechanical ventilation (0; 0%), diabetic chronic renal failure on hemodialysis (1; 6%), chronic obstructive pulmonary disease (1; 6%), and stroke (4; 25%) (rheumatic [1], endocarditis [1], carotid disease [2]). Operations performed included mitral valve re-repair (4; 25%), replacement (8; 50%), re-replacement (3; 19%), and suture repair of paravalvular leak (1; 6%); additionally CABG (descending aorta-obtuse marginal) (2; 13%), left-side maze (1; 6%), and left femoral artery plasty (1; 6%). Arterial inflow included the left femoral artery (14; 88%) and the descending thoracic aorta (2; 13%). Venous Fig 3. Picture illustrates a shallow exposure of the mitral valve through a fifth intercostal space, left posterolateral thoracotomy approach using the on-pump beating heart technique. anterior rotation and the exposure of the mitral valve (Fig 1). A longitudinal left atrial incision was made starting from the base of the left atrial appendage and going down below the left inferior pulmonary vein (Fig 2). Cardiotomy suctions and a vent through the left pulmonary vein were used to keep the operative field bloodless. Note that either one of the cardiotomy suctions or the vent cannula was kept positioned through the mitral valve to keep the mitral valve incompetent and avoid air being ejected into the ascending aorta during the entire mitral valve procedure while the left atrium was open. Traction sutures were put inside the left atrial wall close to the posterior mitral valve annulus. Standard mitral valve repair or replacement technique was used with excellent exposure (Fig 3). The left atriotomy was closed in two layers. After the patient was put in a steep Trendelenburg position, the air in the left cardiac chambers was evacuated with a vent through the valve. A small Foley balloon catheter was used through the valve in the cases of mechanical valve replacement to keep the mitral valve incompetent. Cardiac and mitral valve function and intracardiac air were monitored by TEE. Results Table 1. Demographics of Patients Undergoing Multiple- Time Redo Mitral Valve Surgery Using Left Thoracotomy and the On-Pump Beating Heart Technique (n 16) a Variables Data Age (years) (range, 20 82) Number of males 8 (50%) Primary pathology: MR 14 (88%) 2 1 (7%) 3 3 (21%) 4 10 (71%) Postrepair 9 (64%) Prosthetic paravalvular leak 4 (29%) Native 1 (7%) Endocarditis 6 (43%) Hemolysis 2 (14%) MS 2 (13%) rheumatic 1 (50%) ring pannus 1 (50%) NYHA CHF class 3 or 4 11 (69%) EF (%) (range ) EF (25%) 0.30 EF (31%) 0.50 EF 7 (44%) The number of previous cardiac procedures 2 times 14 (88%) 3 times 2 (13%) Duration since the last cardiac (range, 3 204) procedure (month) 1 year 5 (31%) 1 3 years 4 (25%) 4 10 years 4 (25%) 10 years 3 (19%) a Values are presented as mean standard deviation or number of patients (%). CHF congestive heart failure; EF ejection fraction; MR mitral valve regurgitation; MS mitral valve stenosis; NYHA New York Heart Association.
4 Ann Thorac Surg SUZUKI ET AL 2008;86: LEFT THORACOTOMY MULTIPLE-REDO MITRAL VALVE SURGERY 469 Table 2. Perioperative and Postoperative Outcomes of Patients Undergoing Multiple-Time Redo Mitral Valve Surgery Using Left Thoracotomy and the On-Pump Beating Heart Technique (n 16) a Variables Data Operation time (minutes) (range, ) (25%) (50%) (25%) CPB time (minutes) (range, ) 60 7 (44%) (44%) 90 2 (13%) Packed red blood cell (range, 0 12) (median 2.0) (unit) Fresh frozen plasma (range, 0 4) (median 0.5) (pack) Platelet (pack) (range, 0 5) (median 0.5) Number of inotropic or (range, 0 4) vasopressor infusions at the conclusion of the operation Ventilation support (range, ) (hours) ICU stay (days) (range, 1 7) Hospital stay (days) (range, 3 11) 30 day mortality 2 (13%) Follow-up death 2 (13%) a Values are presented as mean standard deviation or number of patients (%). CPB cardiopulmonary bypass; ICU intensive care unit. drainage included the left femoral vein (15; 94%) and the left main pulmonary artery (2; 13%). All patients underwent the surgery solely with the on-pump beating heart technique (32 C to 37 C) except 2 patients (13%) who had a short duration of ventricular fibrillation; one for a spontaneous ventricular fibrillation and one for a coronary artery anastomosis. Perioperative and postoperative outcomes are shown in Table 2. No transfusion was required in 5 patients (31%). No inotropic or vasopressor infusions were required in 5 patients (31%). Complications included low cardiac output syndrome (1: 6%), sepsis, pneumonia, and multiple organ failure (1; 6%), prolonged CHF (2; 13%), mild hemolysis (1; 6%), and superficial wound infection 1 (6%). There was no inadvertent injury to coronary artery grafts or cardiac structures. There was no reexploration for bleeding. There were no postoperative stroke or delirium related to the surgery. There were 2 (13%) 30-day mortalities. The first was a 65-year-old female with diabetic chronic renal failure on hemodialysis and with severe peripheral vascular obstructive disease, who had previous history of a stroke and a carotid endarterectomy. Previous cardiac operations were a combined CABG and aortic and mitral valve replacement through median sternotomy and a redo mitral valve rereplacement through a right thoracotomy 5 months prior. Ejection fraction was 0.2. The patient underwent rereplacement for paravalvular leak and died from low cardiac output syndrome. The second was an 82-year-old female who had previous history of CABG twice through median sternotomy and mitral and tricuspid valve repair through a right thoracotomy two years prior. EF was The patient presented with 4 MR and 2 aortic and tricuspid valve regurgitation, and severe CHF symptoms controlled on dobutamine infusion. The patient underwent re-repair for ring dehiscence and died from sepsis, pneumonia, and multiple organ failure. There were 2 (13%) deaths during a follow-up of months. The first had prolonged CHF symptoms and severe depression of bipolar disorders when discharged from hospital on postoperative day 7 and died suddenly at 6 weeks. The second had a left ventricular assist device for idiopathic dilated cardiomyopathy 33 months after the left thoracotomy multiple-time redo mitral valve surgery and died from stroke. All patients who died had EF less than 0.3. The statistical analysis showed that age (p ) and EF (p ) were associated with 30-day mortality, but none of them was significant. The EF (p ) and CPB time (p ) were associated with total mortality and only EF was significant. Comment In our initial experience of 16 patients who underwent the left thoracotomy approach for multiple-time redo mitral valve surgery using the on-pump beating heart technique, the exposure of the mitral valve was uniformly excellent (Figs 2; 3). The CPB time was short. There was no inadvertent injury to previous coronary artery grafts or cardiac structures. There was no reexploration for bleeding or postoperative stroke. There are limited reports describing the outcomes of multiple-time redo mitral valve surgery. Saunders and colleagues [11] reported 40 minimally invasive isolated mitral valve cases including 9 multiple-time redo and 27 first-time redo. They used a left posterior minithoracotomy and cardioplegic ischemic arrest or hypothermic fibrillation. The CPB time was minutes. Hospital mortality occurred in 2 patients (5%), both octogenarians. Stroke occurred in 3 patients (7.5%). Magilligan and colleagues [12] reported in 1978 that 28 rheumatic patients underwent second-time redo mitral valve surgery through median sternotomy, and 26 patients (93%) were NYHA CHF class 3 or 4. There were 4 (14%) hospital mortalities. They concluded that deaths were related to poor ventricular function and not to the number of previous operations. Svensson and colleagues [13] reported mitral valve reoperation through median sternotomy (n 2,444) and through right thoracotomy (n 80), including 2 or more previous operations in 619 (25%) and 40 (50%), respectively. For right thoracotomy, 73 (91%) used hypothermic ventricular fibrillation and the rest used cardioplegia. Preoperative left ventricular function was not reported. Concomitant CABG (955; 39%), aortic valve replacement
5 470 SUZUKI ET AL Ann Thorac Surg LEFT THORACOTOMY MULTIPLE-REDO MITRAL VALVE SURGERY 2008;86: (724; 30%), and tricuspid valve surgery (717; 29%) were frequent in sternotomy. The CPB time was minutes in sternotomy and minutes in right thoracotomy. Stroke occurred in 66 (2.7%) and in 6 (7.5%), no transfusion required in 652 (27%) and in 13 (16%), and hospital mortality was 163 (6.7%) and 5 (6.3%), respectively. Borger and colleagues [14] reported 1,521 cases of mitral valve replacement through median sternotomy, which included 398 first-time redo and 115 multiple-time redo. Among the 513 redo cases, 75 (15%) had EF less than 0.4. Cross-clamp time was minutes and CPB time was minutes. Hospital mortality was 46 (9.0%). Hospital mortality tended to increase with the number of prior operations (7% for first-time redo, 11% for second-time redo, 29% for third time redo, 8% for fourth-time redo, and 33% for fifth-time redo). Compared with these reports, our experience showed that the left thoracotomy approach using the on-pump beating heart technique can be performed with shorter CPB time and with an acceptable morbidity and mortality for multipletime redo mitral valve surgery. For the first-time redo operation, a right thoracotomy approach has been reported with less transfusion requirements [3, 4, 6, 10]. In our series, one third were transfusion free. The median transfusion requirements for packed red blood cell, fresh frozen plasma, and platelet were small and much less than the mean. This may imply that the left thoracotomy approach and the on-pump beating heart technique require less transfusion, but sick patients with multiple comorbidities may still require a considerable amount of transfusion. Technically, exposure of the mitral valve is of paramount importance for mitral valve surgery. We chose to use a posterolateral incision in the fifth intercostal space for two reasons (Fig 1). First, the mitral valve faces to the right posteriorly. Second, the location of the longitudinal left atriotomy near the hilum is posterior and closest to this incision. The exposure of the mitral valve is upsidedown, in contrast to that in sternotomy or right thoracotomy as discussed by Saunders and colleagues [11], because the mitral valve faces to the right posteriorly and the direction of rotating the heart for the exposure is opposite. The upside-down image of the mitral valve does not present any technical difficulties. The exposure of the mitral valve is excellent with a wider view angle and less depth in dimensions [15]. We did not have any problem when an assistant surgeon exposes the left femoral vessels at the same time as an operator exposes the left chest. We rotate the table toward the back of the patient for cannulation of the femoral vessels and toward the front of the patient in turn for the mitral valve procedure once cardiopulmonary bypass is commenced. The left main pulmonary artery is a good option for venous drainage but the tissue can be friable. We routinely use a pledgetted suture and cannulate the left main pulmonary artery abutted on the pleura. The mitral valve procedure is feasible even if the patient has mild aortic valve regurgitation. Cardiotomy suctions and a vent through the left pulmonary vein keep the operative field bloodless. In addition to the vacuum assist for the venous drainage, controlling the flow rate of CPB as low as tolerated by monitoring total venous blood oxygen saturation is useful. Historically, the mitral valve has been approached through median sternotomy, transverse sternotomy, right thoracotomy, and left thoracotomy. It was left thoracotomy through which Bailey and Harken first successfully performed closed mitral valve commissurotomy in 1948 [16 19]. Bailey and Harken approached through a third to fifth intercostal space left anterior thoracotomy; then, this approach was abandoned in open procedures because of no versatility, initial difficulties with venous drainage access, and poor visibility of the mitral valve [16, 18 20]. This approach is not the first or second option when no versatility is a serious concern. However, long femoral venous cannula or pulmonary artery venous drainage with vacuum assist is enough for the beating heart technique. The exposure of the mitral valve is excellent through the fifth intercostal space, left posterolateral approach with the techniques stated above [11, 15]. A major disadvantage is that this approach is limited to the procedures of the left side of the heart, such as mitral valve surgery, CABG, and left ventricular procedures [20]. Other disadvantages related to the on-pump beating heart technique include a possible risk of air embolism, blood in the field, undue tension to the heart, and technical difficulties [10]. Contraindications of this approach include severe left pleural adhesion and poor pulmonary function [4]. Our statistical analysis showed that the outcomes and prognosis were only limited by the left ventricular function of the patients, similar to the median sternotomy approach [12, 14]. It has been controversial whether the right thoracotomy approach has higher incidence of stroke [4, 7, 8, 10, 13, 21]. First, stroke may be caused by femoral artery cannulation and reversed CPB flow in patients with a severely atherosclerotic aorta. Showering of atheromas from retrograde perfusion flow is a serious issue to be contemplated in those patients. Even though the second option of arterial inflow could be the descending thoracic aorta, redo sternotomy could be an option for those patients if the risk is still considered high. Second, stroke may also be caused by air embolism from incomplete removal of air from the left ventricle [4, 7, 8, 10]. The possibility of the left ventricle ejecting air during the mitral valve procedure, and particularly during the closure of the left atrium, is a paramount concern for the on-pump beating heart technique. We do not think the left ventricle ejects air into the ascending aorta against systemic mean blood pressure from CPB pump flow as long as the mitral valve is kept incompetent. Therefore, it is important to keep either one of the cardiotomy suctions or the vent positioned through the mitral valve and to keep the mitral valve incompetent during the entire mitral valve procedure while the left atrium is open. We routinely use TEE as a monitoring of the intracardiac air. We did not use additional techniques of carbon dioxide or fibrillation to prevent air embolism. There were no postoperative
6 Ann Thorac Surg SUZUKI ET AL 2008;86: LEFT THORACOTOMY MULTIPLE-REDO MITRAL VALVE SURGERY 471 stroke or delirium related to the surgery in our series, but the number was small. Note that the advantage of the left posterolateral thoracotomy approach with the on-pump beating heart technique compared with the right thoracotomy approach is that the aortic valve stays at the most dependent portion of the left ventricle, and that the lesser curvature of the aortic arch stays higher level than the arch vessels. Air can be removed from the left ventricle with a vent through the valve or a puncture needle in the apex during and after the closure of the left atrium. Therefore, we consider the left thoracotomy approach to be safer than the right thoracotomy approach regarding the risk of air embolism using the on-pump beating heart technique. Furthermore, the left thoracotomy approach is most advantageous in combination with the on-pump beating heart technique in multiple-time redo mitral valve surgery because the ascending aorta can be extremely difficult to dissect and expose for cross-clamping when approached from the left thorax. Avoiding this is a crucial advantage. In conclusion, the left thoracotomy approach using the on-pump beating heart technique is a safe, effective, and valuable option and should be considered for multipletime redo mitral valve surgery. This paper is a description of a case series of 16 patients and the results should be interpreted as such. To delineate the comparability among the three approaches for multiple-time redo mitral valve surgery, further accumulation of the cases and analytic studies are warranted. References 1. STS National Cardiac Surgery Database. Annual first vs reoperative summary: U.S. data mitral valve replacement. STS Data Analysis January 1999: Annual Trends and Summaries. Available at: db/us98/gchart30.gif. Accessed January 22, Berreklouw E, Alfieri O. Revival of right thoracotomy to approach atrio-ventricular valves in reoperations. Thorac Cardiovasc Surg 1984;32: Tribble CG, Killinger WA Jr, Harman PK, Crosby IK, Nolan SP, Kron IL. Anterolateral thoracotomy as an alternative to repeat median sternotomy for replacement of the mitral valve. Ann Thorac Surg 1987;43: Braxton JH, Higgins RS, Schwann TA, et al. Reoperative mitral valve surgery via right thoracotomy: decreased blood loss and improved hemodynamics. J Heart Valve Dis 1996; 5: Steimle CN, Bolling SF. Outcome of reoperative valve surgery via right thoracotomy. Circulation 1996;94(9 suppl): II Vleissis AA, Bolling SF. Mini-reoperative mitral valve surgery. J Card Surg 1998;13: Holman WL, Goldberg SP, Early LJ, et al. Right thoracotomy for mitral reoperation: analysis of technique and outcome. Ann Thorac Surg 2000;70: Byrne JG, Aranki SF, Adams DH, Rizzo RJ, Couper GS, Cohn LH. Mitral valve surgery after previous CABG: with functioning IMA grafts. Ann Thorac Surg 1999;68: Burfeind WR, Glower DD, Davis RD, Landolfo KP, Lowe JE, Wolfe WG. Mitral surgery after prior cardiac operation: port-access versus sternotomy or thoracotomy. Ann Thorac Surg 2002;74:S Thompson MJ, Behranwala A, Campanella C, Walker WS, Cameron EW. Immediate and long-term results of mitral prosthetic replacement using a right thoracotomy beating heart technique. Eur J Cardiothorac Surg 2003;24: Saunders PC, Grossi EA, Sharony R, et al. Minimally invasive technology for mitral valve surgery via left thoracotomy: experience with forty cases. J Thorac Cardiovasc Surg 2004; 127: Magilligan DJ Jr, Lam CR, Lewis JW Jr, Davila JC. Mitral valve the third time around. Circulation 1978;58(3 Pt 2): I Svensson LG, Gillinov AM, Blackstone EH, et al. Does right thoracotomy increase the risk of mitral valve reoperation? J Thorac Cardiovasc Surg 2007;134: Borger MA, Yau TM, Rao V, Scully HE, David TE. Reoperative mitral valve replacement: importance of preservation of the subvalvular apparatus. Ann Thorac Surg 2002;74: Repossini A, Kotelnikov IN, Parenzan L, Arena V. Left-side approach to the mitral valve. J Heart Valve Dis 2001;10: Balasundaram SG, Duran C. Surgical approaches to the mitral valve. J Card Surg 1990;5: Khan MN. The relief of mitral stenosis. An historic step in cardiac surgery. Tex Heart Inst J 1996;23: Bailey CP. The surgical treatment of mitral stenosis (mitral commissurotomy). Dis Chest 1949;15: Harken DE, Ellis LB, Ware PF, Norman LR. The surgical treatment of mitral stenosis. I. Valvuloplasty. N Engl J Med 1948;239: Pratt JW, Williams TE, Michler RE, Brown DA. Current indications for left thoracotomy in coronary revascularization and valvular procedures. Ann Thorac Surg 2000;70: Glower DD, Clements FM, Debruijn NP, et al. Comparison of direct aortic and femoral cannulation for port-access cardiac operations. Ann Thorac Surg 1999;68:
Kinsing Ko, Thom de Kroon, Najim Kaoui, Bart van Putte, Nabil Saouti. St. Antonius Hospital, Nieuwegein, The Netherlands
Minimal Invasive Mitral Valve Surgery After Previous Sternotomy Without Aortic Clamping: Short- and Long Term Results of a Single Surgeon Single Institution Kinsing Ko, Thom de Kroon, Najim Kaoui, Bart
More informationIs a minimally invasive approach for re-operative aortic valve replacement superior to standard full resternotomy?
Interactive CardioVascular and Thoracic Surgery Advance Access published May 7, 2012 Interactive CardioVascular and Thoracic Surgery 0 (2012) 1 5 doi:10.1093/icvts/ivr141 BEST EVIDENCE TOPIC Is a minimally
More informationLess Invasive Reoperations for Aortic and Mitral Valve Disease. Peter Bent Brigham Hospital 1913
Shapiro CV Center 2008 Peter Bent Brigham Hospital 1913 Lawrence H. Cohn, MD, Professor of Cardiac Surgery, HMS Division of Cardiac Surgery, BWH, Boston, MA 70% of US valve patients select bioprosthetic
More informationUniversity of Florida Department of Surgery. CardioThoracic Surgery VA Learning Objectives
University of Florida Department of Surgery CardioThoracic Surgery VA Learning Objectives This service performs coronary revascularization, valve replacement and lung cancer resections. There are 2 faculty
More informationMinimal access aortic valve surgery has become one of
Minimal Access Aortic Valve Surgery Through an Upper Hemisternotomy Approach Prem S. Shekar, MD Minimal access aortic valve surgery has become one of the accepted forms of surgical therapy for patients
More informationCARDIOCHIRURGIA MINI-INVASIVA: INVASIVA: efficacia per il paziente efficienza per la sanita. Dott. Davide Ricci
CARDIOCHIRURGIA MINI-INVASIVA: INVASIVA: efficacia per il paziente efficienza per la sanita Dott. Davide Ricci SC Cardiochirurgia U Universita degli Studi di Torino Minimally Invasive Surgical approaches
More informationHURDLES FOR STARTING MINISTERNOTOMY AORTIC VALVE REPLACEMENT PROGRAM IN OUR INSTITUTE
HURDLES FOR STARTING MINISTERNOTOMY AORTIC VALVE REPLACEMENT PROGRAM IN OUR INSTITUTE *Suraj Wasudeo Nagre Department of CVTS, Grant Medical College, Mumbai *Author for Correspondence ABSTRACT It s our
More informationMinimally Invasive Aortic Surgery With Emphasis On Technical Aspects, Extracorporeal Circulation Management And Cardioplegic Techniques
Minimally Invasive Aortic Surgery With Emphasis On Technical Aspects, Extracorporeal Circulation Management And Cardioplegic Techniques Konstadinos A Plestis, MD System Chief of Cardiothoracic and Vascular
More informationIntra-operative Echocardiography: When to Go Back on Pump
Intra-operative Echocardiography: When to Go Back on Pump GREGORIO G. ROGELIO, MD., F.P.C.C. OUTLINE A. Indications for Intraoperative Echocardiography B. Role of Intraoperative Echocardiography C. Criteria
More informationClinical Results of Minimally Invasive Open-Heart Surgery in Patients with Mitral Valve Disease: Comparison of Parasternal and Low-Sternal Approach
Yonsei Medical Journal Vol. 47, No. 2, pp. 230-236, 2006 Clinical Results of Minimally Invasive Open-Heart Surgery in Patients with Mitral Valve Disease: Comparison of Parasternal and Low-Sternal Approach
More informationThe operative mortality rate after redo valvular operations
Clinical Outcomes of Redo Valvular Operations: A 20-Year Experience Naoto Fukunaga, MD, Yukikatsu Okada, MD, Yasunobu Konishi, MD, Takashi Murashita, MD, Mitsuru Yuzaki, MD, Yu Shomura, MD, Hiroshi Fujiwara,
More informationMinimally invasive mitral valve surgery: tips, tricks and technique
Surgical Technique on Cardiac Surgery Page 1 of 6 Minimally invasive mitral valve surgery: tips, tricks and technique Allen Cheng, Amy M. Ramsey Division of Cardiovascular and Thoracic Surgery, Oklahoma
More informationConcomitant procedures using minimally access
Surgical Technique on Cardiac Surgery Concomitant procedures using minimally access Nelson Santos Paulo Cardiothoracic Surgery, Centro Hospitalar de Vila Nova de Gaia, Oporto, Portugal Correspondence to:
More informationThe recent interest in minimal access surgery throughout
Partial Versus Full Sternotomy for Aortic Valve Replacement Michael F. Szwerc, MD, Daniel H. Benckart, MD, Robert J. Wiechmann, MD, Edward B. Savage, MD, Gary W. Szydlowski, MD, George J. Magovern, Jr,
More informationMINIMALLY INVASIVE MITRAL VALVE SURGERY. Rohinton J. Morris, MD Chief, Cardiothoracic Surgery Jefferson University and Health Systems
MINIMALLY INVASIVE MITRAL VALVE SURGERY Rohinton J. Morris, MD Chief, Cardiothoracic Surgery Jefferson University and Health Systems OVERVIEW History Anatomy Indications Techniques Variants Outcomes &
More informationThe radial procedure was developed as an outgrowth
The Radial Procedure for Atrial Fibrillation Takashi Nitta, MD The radial procedure was developed as an outgrowth of an alternative to the maze procedure. The atrial incisions are designed to radiate from
More informationStandard AVR. Full Sternotomy CPB
16.03.2013 by Dr. M. D. Dixit MS (Gen. Surg.), DNB (CVTS), PhD Professor & HOD, CVTS Director, KLES Heart Foundation, KLES Dr. Prabhakar Kore Hospital & MRC, Belgaum Standard AVR Full Sternotomy CPB
More informationNOTES. Left-Sided Cannulation of the Right. Atrium for Mitral Surgery. Ronald P. Grunwald, M.D., A. Attai-Lari, M.D., and George Robinson, M.D.
NOTES Left-Sided Cannulation of the Right Atrium for Mitral Surgery Ronald P. Grunwald, M.D., A. Attai-Lari, M.D., and George Robinson, M.D. T here are several approaches to the mitral valve which yield
More informationIschemic mitral regurgitation (IMR) is an insufficiency of
Repair Techniques for Ischemic Mitral Regurgitation Damien J. LaPar, MD, MSc, and Irving L. Kron, MD Ischemic mitral regurgitation (IMR) is an insufficiency of the mitral valve (MV) secondary to myocardial
More informationOutcomes of Mitral Valve Repair for Mitral Regurgitation Due to Degenerative Disease
Outcomes of Mitral Valve Repair for Mitral Regurgitation Due to Degenerative Disease TIRONE E. DAVID, MD ; SEMIN THORAC CARDIOVASC SURG 19:116-120c 2007 ELSEVIER INC. PRESENTED BY INTERN 許士盟 Mitral valve
More informationRetrospective Study Of Redo Cardiac Surgery In A Single Centre. R Karthekeyan, K Selvaraju, L Ramanathan, M Rakesh, S Rao, M Vakamudi, K Balakrishnan
ISPUB.COM The Internet Journal of Anesthesiology Volume 12 Number 2 Retrospective Study Of Redo Cardiac Surgery In A Single Centre R Karthekeyan, K Selvaraju, L Ramanathan, M Rakesh, S Rao, M Vakamudi,
More informationCardiothoracic Fellow Expectations Division of Cardiac Anesthesia, Beth Israel Deaconess Medical Center
The fellowship in Cardiothoracic Anesthesia at the Beth Israel Deaconess Medical Center is intended to provide the foundation for a career as either an academic cardiothoracic anesthesiologist or clinical
More informationMechanical Bleeding Complications During Heart Surgery
Mechanical Bleeding Complications During Heart Surgery Arthur C. Beall, Jr., M.D., Kenneth L. Mattox, M.D., Mary Martin, R.N., C.C.P., Bonnie Cromack, C.C.P., and Gary Cornelius, C.C.P. * Potential for
More informationAtrial fibrillation (AF) is associated with increased morbidity
Ablation of Atrial Fibrillation with Concomitant Surgery Edward G. Soltesz, MD, MPH, and A. Marc Gillinov, MD Atrial fibrillation (AF) is associated with increased morbidity and mortality in coronary artery
More informationObstructed total anomalous pulmonary venous connection
Total Anomalous Pulmonary Venous Connection Richard A. Jonas, MD Children s National Medical Center, Department of Cardiovascular Surgery, Washington, DC. Address reprint requests to Richard A. Jonas,
More informationDivision of Cardiothoracic Surgery, University of Miami, Miller School of Medicine, and Jackson Memorial Hospital, Miami, Florida
Multiple Valve Surgery with Beating Heart Technique Marco Ricci, MD, Francisco Igor B. Macedo, MD, Maria R. Suarez, MD, Michael Brown, CCP, Julia Alba, MD, and Tomas A. Salerno, MD Division of Cardiothoracic
More informationMinimally invasive aortic valve replacement in high risk patient groups
Review Article Minimally invasive aortic valve replacement in high risk patient groups Daniel Fudulu, Harriet Lewis, Umberto Benedetto, Massimo Caputo, Gianni Angelini, Hunaid A. Vohra Department of Cardiac
More informationChapter 24: Diagnostic workup and evaluation: eligibility, risk assessment, FDA guidelines Ashwin Nathan, MD, Saif Anwaruddin, MD, FACC Penn Medicine
Chapter 24: Diagnostic workup and evaluation: eligibility, risk assessment, FDA guidelines Ashwin Nathan, MD, Saif Anwaruddin, MD, FACC Penn Medicine Mitral regurgitation, regurgitant flow between the
More information(Ann Thorac Surg 2008;85:845 53)
I Made Adi Parmana The utility of intraoperative TEE has become increasingly more evident as anesthesiologists, cardiologists, and surgeons continue to appreciate its potential application as an invaluable
More informationPartial anomalous pulmonary venous connection to superior
Cavo-Atrial Anastomosis Technique for Partial Anomalous Pulmonary Venous Connection to the Superior Vena Cava The Warden Procedure Robert A. Gustafson, MD Partial anomalous pulmonary venous connection
More informationAortic Valve Replacement By Mini-Sternotomy
Aortic Valve Replacement By Mini-Sternotomy Steven R. Gundry The introduction of the laparoscopic procedure, as well as later scope-based interventions by other surgical disciplines have resulted in the
More informationStrategies for the High Risk Redo in CHD
Strategies for the High Risk Redo in CHD Joseph A. Dearani, MD AATS, Minneapolis 2013 Strategies for the High Risk Redo in CHD Joseph A. Dearani, MD AATS, Minneapolis 2013 No Disclosures 2011 MFMER slide-3
More informationMyocardial enzyme release after standard coronary artery bypass grafting
Cardiopulmonary Support and Physiology Schachner et al Myocardial enzyme release in totally endoscopic coronary artery bypass grafting on the arrested heart Thomas Schachner, MD, a Nikolaos Bonaros, MD,
More informationSince the advent of minimally invasive cardiac surgery, the right
Minimally invasive technology for mitral valve surgery via left thoracotomy: Experience with forty cases Paul C. Saunders, MD Eugene A. Grossi, MD Ram Sharony, MD Charles F. Schwartz, MD Greg H. Ribakove,
More informationThe Edge-to-Edge Technique f For Barlow's Disease
The Edge-to-Edge Technique f For Barlow's Disease Ottavio Alfieri, Michele De Bonis, Elisabetta Lapenna, Francesco Maisano, Lucia Torracca, Giovanni La Canna. Department of Cardiac Surgery, San Raffaele
More informationMinimally invasive left ventricular assist device placement
Original Article on Cardiac Surgery Minimally invasive left ventricular assist device placement Allen Cheng Department of Cardiovascular and Thoracic Surgery, University of Louisville, Louisville, USA
More informationWhat s New in Mitral Valve Repair?
Original Article Daniel J. DiBardino, MD R. Saeid Farivar, MD, PhD From: Abbott Northwestern Hospital, Minneapolis, MN Address for correspondence: R. Saeid Farivar, MD, PhD Cardiothoracic Surgery Abbott
More informationMitral valve infective endocarditis (IE) is the most
Mitral Valve Replacement for Infective Endocarditis With Annular Abscess: Annular Reconstruction Gregory J. Bittle, MD, Murtaza Y. Dawood, MD, and James S. Gammie, MD Mitral valve infective endocarditis
More informationChapter 13 Worksheet Code It
Class: Date: Chapter 13 Worksheet 3 2 1 Code It True/False Indicate whether the statement is true or false. 1. A cardiac catheterization diverts blood from the heart to the aorta. 2. Selective vascular
More information2017 Cardiovascular Symposium CARDIAC SURGERY UPDATE: SMALLER INCISIONS AND LESS COUMADIN DAVID L. SAINT, MD
2017 Cardiovascular Symposium CARDIAC SURGERY UPDATE: SMALLER INCISIONS AND LESS COUMADIN DAVID L. SAINT, MD David L Saint M.D. Tallahassee Memorial Hospital Southern Medical Group Division of Cardiothoracic
More informationLong term outcomes of posterior leaflet folding valvuloplasty for mitral valve regurgitation
Featured Article Long term outcomes of posterior leaflet folding valvuloplasty for mitral valve regurgitation Igor Gosev 1, Maroun Yammine 1, Marzia Leacche 1, Siobhan McGurk 1, Vladimir Ivkovic 1, Michael
More informationIsolated Mitral Valve Repair in Patients With Depressed Left Ventricular Function
Isolated Mitral Valve Repair in Patients With Depressed Left Ventricular Function Ashish S. Shah, MD, Steven A. Hannish, MD, Carmelo A. Milano, MD, and Donald D. Glower, MD Department of General and Thoracic
More informationMinimally Invasive Approach for Complex Cardiac Surgery Procedures
Minimally Invasive Approach for Complex Cardiac Surgery Procedures Pasquale Totaro, MD, Simone Carlini, MD, Matteo Pozzi, MD, Francesco Pagani, MD, Giuseppe Zattera, MD, Andrea Maria D Armini, MD, and
More informationThe pericardial sac is composed of the outer fibrous pericardium
Pericardiectomy for Constrictive or Recurrent Inflammatory Pericarditis Mauricio A. Villavicencio, MD, Joseph A. Dearani, MD, and Thoralf M. Sundt, III, MD Anatomy and Preoperative Considerations The pericardial
More informationEbstein s anomaly is defined by a downward displacement
Repair of Ebstein s Anomaly Sylvain Chauvaud, MD Ebstein s anomaly is a tricuspid valve anomaly associated with poor right ventricular contractility in severe cases. Surgery is indicated in all symptomatic
More informationSurgery has been proven to be beneficial for selected patients
Thoracoscopic Lung Volume Reduction Surgery Robert J. McKenna, Jr, MD Surgery has been proven to be beneficial for selected patients with severe emphysema. Compared with medical management, lung volume
More informationTSDA ACGME Milestones
TSDA ACGME Milestones Short MW and Edwards JA. Assessing resident milestones using a CASPE March 2012 Short MW and Edwards JA. Assessing resident milestones using a CASPE March 2012 Short
More informationProf. Patrizio LANCELLOTTI, MD, PhD Heart Valve Clinic, University of Liège, CHU Sart Tilman, Liège, BELGIUM
The Patient with Aortic Stenosis and Mitral Regurgitation Prof. Patrizio LANCELLOTTI, MD, PhD Heart Valve Clinic, University of Liège, CHU Sart Tilman, Liège, BELGIUM Aortic Stenosis + Mitral Regurgitation?
More informationEchocardiography as a diagnostic and management tool in medical emergencies
Echocardiography as a diagnostic and management tool in medical emergencies Frank van der Heusen MD Department of Anesthesia and perioperative Care UCSF Medical Center Objective of this presentation Indications
More informationSurgical AVR: Are there any contraindications? Pyowon Park Samsung Medical Center Seoul, Korea
Surgical AVR: Are there any contraindications? Pyowon Park Samsung Medical Center Seoul, Korea Contents Decision making in surgical AVR in old age Clinical results of AVR with tissue valve Impact of 19mm
More informationSection 6 Intra Aortic Balloon Pump
Section 6 Intra Aortic Balloon Pump The Intra Aortic Balloon Pump (IABP) The balloon is synthetic and is made for single use only. It is threaded into the aorta, usually via a femoral approach. The balloon
More informationPort-Access Multivessel Coronary Artery Bypass Grafting
Port-Access Multivessel Coronary Artery Bypass Grafting James I. Fann, Mark A. Groh, Mario F. Pompili, Thomas A. Burdon, and Bruce A. Reitz In the 1950s and 1960s, Drs Dernikhov, Kolesov, and others successfully
More informationAPOLLO TMVR Trial Update: Case Presentation
APOLLO TMVR Trial Update: Case Presentation Anelechi Anyanwu, MD, MSc, FRCS-CTh Professor and Vice-Chairman Department of Cardiovascular Surgery Icahn School of Medicine at Mount Sinai New York, NY Disclosure
More informationEACTS Adult Cardiac Database
EACTS Adult Cardiac Database Quality Improvement Programme List of changes to Version 2.0, 13 th Dec 2018, compared to version 1.0, 1 st May 2014. INTRODUCTORY NOTES This document s purpose is to list
More informationAcute type A aortic dissection (Type I, proximal, ascending)
Acute Type A Aortic Dissection R. Morton Bolman, III, MD Acute type A aortic dissection (Type I, proximal, ascending) is a true surgical emergency. It is estimated that patients suffering this calamity
More informationAdult Echocardiography Examination Content Outline
Adult Echocardiography Examination Content Outline (Outline Summary) # Domain Subdomain Percentage 1 2 3 4 5 Anatomy and Physiology Pathology Clinical Care and Safety Measurement Techniques, Maneuvers,
More informationParasternal Approach for Minimally Invasive Aortic Valve Surgery
Parasternal Approach for Minimally Invasive Aortic Valve Surgery Lawrence H. Cohn Aortic valve replacement for the stenotic or regurgitant aortic valve has been one of the major advances of medical science
More informationSteph ani eph ani Mi M ck i MD Cleveland Clinic
Stephanie Mick MD Stephanie Mick MD Cleveland Clinic Upper hemisternotomy AVR Ascending Aorta MVr Thoracotomy Based Anterior AVR Lateral Thoracotomy Mitral/Tricuspid surgery Robotically assisted surgery
More informationResearch Article Transapical Approach for Mitral Valve Repair during Insertion of a Left Ventricular Assist Device
The Scientific World Journal Volume 2013, Article ID 925310, 4 pages http://dx.doi.org/10.1155/2013/925310 Research Article Transapical Approach for Mitral Valve Repair during Insertion of a Left Ventricular
More informationAn anterior aortoventriculoplasty, known as the Konno-
The Konno-Rastan Procedure for Anterior Aortic Annular Enlargement Mark E. Roeser, MD An anterior aortoventriculoplasty, known as the Konno-Rastan procedure, is a useful tool for the cardiac surgeon. Originally,
More informationMitral Gradients and Frequency of Recurrence of Mitral Regurgitation After Ring Annuloplasty for Ischemic Mitral Regurgitation
Mitral Gradients and Frequency of Recurrence of Mitral Regurgitation After Ring Annuloplasty for Ischemic Mitral Regurgitation Matthew L. Williams, MD, Mani A. Daneshmand, MD, James G. Jollis, MD, John
More informationAORTIC DISSECTIONS Current Management. TOMAS D. MARTIN, MD, LAT Professor, TCV Surgery Director UF Health Aortic Disease Center University of Florida
AORTIC DISSECTIONS Current Management TOMAS D. MARTIN, MD, LAT Professor, TCV Surgery Director UF Health Aortic Disease Center University of Florida DISCLOSURES Terumo Medtronic Cook Edwards Cryolife AORTIC
More informationMinimally Invasive Mitral Valve Surgery: A 6-Year Experience With 714 Patients
Minimally Invasive Mitral Valve Surgery: A 6-Year Experience With 714 Patients Eugene A. Grossi, MD, Aubrey C. Galloway, MD, Angelo LaPietra, MD, Greg H. Ribakove, MD, Patricia Ursomanno, MSN, Julie Delianides,
More informationInteresting Cases - A Case Report: Renal Cell Carcinoma With Tumor Mass In IVC And Heart. O Wenker, L Chaloupka, R Joswiak, D Thakar, C Wood, G Walsh
ISPUB.COM The Internet Journal of Thoracic and Cardiovascular Surgery Volume 3 Number 2 Interesting Cases - A Case Report: Renal Cell Carcinoma With Tumor Mass In IVC And Heart O Wenker, L Chaloupka, R
More informationRepair or Replacement
Surgical intervention post MitraClip Device: Repair or Replacement Saudi Heart Association, February 21-24 Rüdiger Lange, MD, PhD Nicolo Piazza, MD, FRCPC, FESC German Heart Center, Munich, Germany Division
More informationIndex. Note: Page numbers of article titles are in boldface type.
Index Note: Page numbers of article titles are in boldface type. A Ablation, radiofrequency, anesthetic considerations for, 479 489 Acute aortic syndrome, thoracic endovascular repair of, 457 462 aortic
More informationChairman and O. Wayne Isom Professor Department of Cardiothoracic Surgery Weill Cornell Medicine
Leonard N. Girardi, M.D. Chairman and O. Wayne Isom Professor Department of Cardiothoracic Surgery Weill Cornell Medicine New York, New York Houston Aortic Symposium Houston, Texas February 23, 2017 weill.cornell.edu
More informationReplacement of the mitral valve in the presence of
Mitral Valve Replacement in Patients with Mitral Annulus Abscess Christopher M. Feindel Replacement of the mitral valve in the presence of an abscess of the mitral annulus presents a major challenge to
More informationUseful? Definition of High-risk? Pre-OP/Intra-OP/Post-OP? Complication vs Benefit? Mortality? Morbidity?
Preoperative intraaortic balloon counterpulsation in high-risk CABG Stefan Klotz, M.D. Preoperative IABP in high-risk CABG Questions?? Useful? Definition of High-risk? Pre-OP/Intra-OP/Post-OP? Complication
More informationEmergency Intraoperative Echocardiography
Emergency Intraoperative Echocardiography Justiaan Swanevelder Department of Anaesthesia, Glenfield Hospital University Hospitals of Leicester NHS Trust, UK Carl Gustav Jung (1875-1961) Your vision will
More informationMinimally invasive video-assisted mitral valve surgery: the CardioMISS experience in more than 200 cases
Minimally invasive video-assisted mitral valve surgery: the CardioMISS experience in more than 200 cases V.G. RUGGIERI, A. Antonazzo, E. Gerbasi, A. Albertini, B. Madaffari, A. Agnino Cliniche Gavazzeni
More informationLong-term results (22 years) of the Ross Operation a single institutional experience
Long-term results (22 years) of the Ross Operation a single institutional experience Authors: Costa FDA, Schnorr GM, Veloso M,Calixto A, Colatusso D, Balbi EM, Torres R, Ferreira ADA, Colatusso C Department
More informationTERMS TOTAL ENDOSCOPIC ROBOTIC MITRAL SURGERY 3/17/2016 ROBOTIC MITRAL VALVE HISTORY PREPARED BY: DIANA FROEHLICH, CCP & AKILAH RICHARDS, CCP
TERMS TOTAL ENDOSCOPIC ROBOTIC MITRAL SURGERY PREPARED BY: DIANA FROEHLICH, CCP & AKILAH RICHARDS, CCP ROBOTIC MITRAL VALVE HISTORY 1 st Robotic MV Repair performed- 1998 Carpentier using early prototype
More informationRepair of Complete Atrioventricular Septal Defects Single Patch Technique
Repair of Complete Atrioventricular Septal Defects Single Patch Technique Fred A. Crawford, Jr., MD The first repair of a complete atrioventricular septal defect was performed in 1954 by Lillehei using
More informationPort-Access Approach for Minimally Invasive Mitral Valve Surgery
Port-Access Approach for Minimally Invasive Mitral Valve Surgery Eugene A. Grossi, Greg Ribakove, Daniel S. Schwartz, Aubrey C. Galloway, and Stephen B. Colvin Port-access (PA) mitral valve surgery is
More informationHeart transplantation is the gold standard treatment for
Organ Care System for Heart Procurement and Strategies to Reduce Primary Graft Failure After Heart Transplant Masaki Tsukashita, MD, PhD, and Yoshifumi Naka, MD, PhD Primary graft failure is a rare, but
More informationSurgical Mininvasive Approach for Mitral Repair Prof. Mauro Rinaldi
Surgical Mininvasive Approach for Mitral Repair Prof. Mauro Rinaldi SC Cardiochirurgia U Universita degli Studi di Torino PORT-ACCESS TECNIQUE Reduce surgical trauma Minimize disruption of the chest wall
More informationCardiovascular Nursing Practice: A Comprehensive Resource Manual and Study Guide for Clinical Nurses 2 nd Edition
Cardiovascular Nursing Practice: A Comprehensive Resource Manual and Study Guide for Clinical Nurses 2 nd Edition Table of Contents Volume 1 Chapter 1: Cardiovascular Anatomy and Physiology Basic Cardiac
More informationMinimally invasive aortic valve surgery: new solutions to old problems.
SCDU DI CARDIOCHIRURGIA Università degli Studi di Torino Ospedale S. Giovanni Battista Direttore: Prof. Mauro Rinaldi Minimally invasive aortic valve surgery: new solutions to old problems. Prof. Mauro
More information2/7/2018. Minimally-invasive Mitral Valve surgery at NYU
Department of Cardiothoracic Surgery Mitral Valve Surgery in the 21 st Century Eugene Grossi, MD SB Colvin Professor of Cardiothoracic Surgery Didier Loulmet, MD Director of Robotic Surgery NYU 22nd Annual
More informationTotal arch replacement with separated graft technique and selective antegrade cerebral perfusion
Masters of Cardiothoracic Surgery Total arch replacement with separated graft technique and selective antegrade cerebral perfusion Teruhisa Kazui 1,2 1 Hamamatsu University School of Medicine, Hamamatsu,
More informationSurgical Options to Prevent and Treat Tricuspid Valve Regurgitation in Heart Transplant Recipients
Surgical Options to Prevent and Treat Tricuspid Valve Regurgitation in Heart Transplant Recipients Alejandro Bertolotti, MD Favaloro Foundation Argentina Disclosure: Conflict Of Interest Nothing to disclose
More informationMinimally invasive direct coronary artery bypass for left anterior descending artery revascularization analysis of 300 cases
Original paper Videosurgery Minimally invasive direct coronary artery bypass for left anterior descending artery revascularization analysis of 300 cases Lufeng Zhang, Zhongqi Cui, Zhiming Song, Hang Yang,
More informationMitral Regurgitation
UW MEDICINE PATIENT EDUCATION Mitral Regurgitation Causes, symptoms, diagnosis, and treatment This handout describes mitral regurgitation, a disease of the mitral valve. It explains how this disease is
More informationMinimally Invasive Mitral Valve Repair: Indications and Approach
Minimally Invasive Mitral Valve Repair: Indications and Approach Juan P. Umaña, M.D. Chief Medical Officer Director, Cardiovascular Medicine FCI - Institute of Cardiology Bogota Colombia 1 Mitral Valve
More informationComplications and conversions in minimally invasive aortic valve surgery
Safeguards and Pitfalls Complications and conversions in minimally invasive aortic valve surgery Martin Moscoso Ludueña, Ardawan J. Rastan Department of Cardiac and Vascular Surgery, Heart Center Rotenburg,
More informationDeclaration of conflict of interest NONE
Declaration of conflict of interest NONE Claudio Muneretto MD, PhD Director of Division of Cardiac Surgery University of Brescia Medical School Italy Hybrid Chymera Different features and potential advantages
More informationDoes Patient-Prosthesis Mismatch Affect Long-term Results after Mitral Valve Replacement?
Original Article Does Patient-Prosthesis Mismatch Affect Long-term Results after Mitral Valve Replacement? Hiroaki Sakamoto, MD, PhD, and Yasunori Watanabe, MD, PhD Background: Recently, some articles
More information14) A MODIFIED ANAESTHESIA PROTOCOL FOR PATIENTS UNDERGOING MINIMAL INVASIVE CARDIAC SURGERY BY RIGHT THORACOTOMY- A SINGLE CENTER EXPERIENCE.
14) A MODIFIED ANAESTHESIA PROTOCOL FOR PATIENTS UNDERGOING MINIMAL INVASIVE CARDIAC SURGERY BY RIGHT THORACOTOMY- A SINGLE CENTER EXPERIENCE. Thosani R.M. 1, Shah B.K. 2, Gandhi H.G. 3, Sharath Kumar
More informationTracheal stenosis in infants and children is typically characterized
Slide Tracheoplasty for Congenital Tracheal Stenosis Peter B. Manning, MD Tracheal stenosis in infants and children is typically characterized by the presence of complete cartilaginous tracheal rings and
More informationThe Role of ECMO in Thoracic Surgery. Matthew Hartwig, MD
The Role of ECMO in Thoracic Surgery Matthew Hartwig, MD Disclosure Slide Consultant for Mallincrodkt and Quark Pharmaceuticals Case #1 28 y.o. female with tracheal mass No previous medical or surgical
More informationPATIENT BOOKLET MEDTRONIC MITRAL AND TRICUSPID HEART VALVE REPAIR
PATIENT BOOKLET MEDTRONIC MITRAL AND TRICUSPID HEART VALVE REPAIR ARE MEDTRONIC HEART VALVE REPAIR THERAPIES RIGHT FOR YOU? Prosthetic (artificial) heart valve repair products are used by physicians to
More informationParenchyma-sparing lung resections are a potential therapeutic
Lung Segmentectomy for Patients with Peripheral T1 Lesions Bryan A. Whitson, MD, Rafael S. Andrade, MD, and Michael A. Maddaus, MD Parenchyma-sparing lung resections are a potential therapeutic option
More informationDr Nikolaos Baikoussis
Dr Nikolaos Baikoussis Cardiac Surgeon Evangelismos General Hospital of Athens, Greece STS database: any procedure not performed with a full sternotomy (FS) and cardiopulmonary bypass (CPB)..(TAVI) Schmitto
More informationPulmonary thromboendarterectomy (PTE) is indicated for
Pulmonary Thromboendarterectomy Steven R. Meyer, MD, PhD, and Christopher G.A. McGregor, MB, FRCS, MD (Hons) Division of Cardiovascular Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota.
More informationAdult Cardiac Surgery
Adult Cardiac Surgery Mahmoud ABU-ABEELEH Associate Professor Department of Surgery Division of Cardiothoracic Surgery School of Medicine University Of Jordan Adult Cardiac Surgery: Ischemic Heart Disease
More informationClinical outcomes of robotic mitral valve repair: a single-center experience in Korea
Featured Article Clinical outcomes of robotic mitral valve repair: a single-center experience in Korea Ho Jin Kim, Joon Bum Kim, Sung-Ho Jung, Jae Won Lee Department of Thoracic and Cardiovascular Surgery,
More informationPerioperative Management of DORV Case
Perioperative Management of DORV Case James P. Spaeth, MD Department of Anesthesia Cincinnati Children s Hospital Medical Center University of Cincinnati Objectives: 1. Discuss considerations regarding
More informationMitral Valve Disease, When to Intervene
Mitral Valve Disease, When to Intervene Swedish Heart and Vascular Institute Ming Zhang MD PhD Interventional Cardiology Structure Heart Disease Conflict of Interest None Current ACC/AHA guideline Stages
More informationThe Ins and Outs of Cardiac Surgery. Stephanie Wold RN MN NP
The Ins and Outs of Cardiac Surgery Stephanie Wold RN MN NP 1 The Ins and Outs of Cardiac Surgery Cardiac Surgery in a Nutshell 2 Outline Wait Times and Referral Process for Cardiac Surgery Getting Ready
More information