Multimedia manual of cardiothoracic surgery : MMCTS / European Association for Cardio-Thoracic Surgery最新文献_第3页

Limited transseptal approach to the mitral valve: a practical step-by-step surgical tutorial. 二尖瓣有限经鼻中隔入路：一步一步实用的外科教程。

Multimedia manual of cardiothoracic surgery : MMCTS / European Association for Cardio-Thoracic Surgery Pub Date : 2026-09-04 DOI: 10.1510/mmcts.2026.039

Živojin Jonjev, Andjela Božić, Ilija Bjeljac, Mirko Todić, Aleksandar M Milosavljevic, Strahinja Mrvić

{"title":"Limited transseptal approach to the mitral valve: a practical step-by-step surgical tutorial.","authors":"Živojin Jonjev, Andjela Božić, Ilija Bjeljac, Mirko Todić, Aleksandar M Milosavljevic, Strahinja Mrvić","doi":"10.1510/mmcts.2026.039","DOIUrl":"https://doi.org/10.1510/mmcts.2026.039","url":null,"abstract":"The mitral valve is conventionally accessed through a left atriotomy; however, adequate visualization may be challenging in selected patients, particularly those undergoing redo surgery, minimally invasive procedures, or with a small or non-compliant left atrium. In such cases, a transseptal interatrial approach can provide improved exposure of the mitral apparatus while facilitating concomitant tricuspid valve procedures. The limited transseptal (LTS) approach represents a partial, anatomy-preserving modification of the classic extended vertical transatrial septal incision. By confining the septal incision to the region of the fossa ovalis, and avoiding superior extension toward the atrial roof, this technique provides sufficient mitral valve exposure while minimizing the risk of injury to the sinus node artery and atrial conduction tissue. Alternative strategies, including the superior transseptal approach and the extended vertical transseptal incision have been associated with a higher incidence of atrial conduction disturbances and postoperative pacing requirements. In contrast, the LTS approach preserves atrial anatomy and reduces surgical trauma while maintaining excellent access to both atrioventricular valves. This video tutorial outlines the anatomical principles, indications and step-by-step surgical technique of the LTS approach, highlighting technical pearls and potential pitfalls to facilitate its safe and reproducible application in contemporary mitral valve surgery.","PeriodicalId":53474,"journal":{"name":"Multimedia manual of cardiothoracic surgery : MMCTS / European Association for Cardio-Thoracic Surgery","volume":"2026 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148892975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Impella 5.5-supported coronary artery bypass grafting in severe left ventricular dysfunction. Impella 5.5支撑冠状动脉旁路移植术治疗严重左心室功能不全。

Multimedia manual of cardiothoracic surgery : MMCTS / European Association for Cardio-Thoracic Surgery Pub Date : 2026-09-04 DOI: 10.1510/mmcts.2026.077

Samuel Heuts, Ehsan Natour, Rick Schreurs, Erik Körver, Gerhardus Kuiper, Ralph Dudink, Jan Sels, Thijs Delnoij, Mustafa Ilhan, Theo Lankveld, Elham Bidar, Roberto Lorusso

{"title":"Impella 5.5-supported coronary artery bypass grafting in severe left ventricular dysfunction.","authors":"Samuel Heuts, Ehsan Natour, Rick Schreurs, Erik Körver, Gerhardus Kuiper, Ralph Dudink, Jan Sels, Thijs Delnoij, Mustafa Ilhan, Theo Lankveld, Elham Bidar, Roberto Lorusso","doi":"10.1510/mmcts.2026.077","DOIUrl":"10.1510/mmcts.2026.077","url":null,"abstract":"Surgical revascularization carries a class I recommendation for the treatment of ischaemic cardiomyopathy and multivessel coronary artery disease, yet coronary artery bypass grafting carries substantial risk of postoperative low cardiac output syndrome and subsequent mortality in patients with severe left ventricular systolic dysfunction. Off-pump coronary artery bypass grafting avoids cardiopulmonary bypass and cardioplegic arrest, but may not be feasible in severe left ventricular systolic dysfunction because of intraoperative haemodynamic instability and impaired exposure of the dilated heart. Pre-emptive mechanical circulatory support may resolve these tensions. This video tutorial presents the Impella 5.5-supported coronary artery bypass procedure, as an application of the 'protected cardiac surgery' concept. During this procedure, a surgically implanted microaxial flow pump (Impella 5.5) enables complete off-pump revascularization. Patient selection, preoperative planning and the step-by-step procedure are detailed, and illustrated by a patient with an ejection fraction of 19%, severe left ventricular dilatation, viable myocardium and three-vessel disease. The Impella 5.5-supported coronary artery bypass procedure was performed successfully, with planned postoperative support maintained, and eventual awake explantation. Consequently, this video tutorial demonstrates the feasibility and reproducibility of the Impella 5.5-supported coronary artery bypass procedure, allowing the conduct of future prospective comparative studies to define its eventual role, and to establish how pre-emptive support may improve outcomes.","PeriodicalId":53474,"journal":{"name":"Multimedia manual of cardiothoracic surgery : MMCTS / European Association for Cardio-Thoracic Surgery","volume":"2026 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148892991","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Robotic radical thymectomy using the Hugo RAS system - a step-by-step right thoracic approach. 使用雨果RAS系统的机器人胸腺根治术-一步一步的右胸入路。

Multimedia manual of cardiothoracic surgery : MMCTS / European Association for Cardio-Thoracic Surgery Pub Date : 2026-08-17 DOI: 10.1510/mmcts.2026.060

Ananthakrishnan Balakrishnan, Naveena Kumar, Akhil Palod, Nawaz Usman, Preethi Shetty

引用次数: 0

Intercostal nerve cryoablation as an adjunct to the Nuss procedure for pectus excavatum: surgical technique and practical considerations. 肋间神经冷冻消融作为Nuss手术治疗漏斗胸的辅助：手术技术和实际考虑。

Multimedia manual of cardiothoracic surgery : MMCTS / European Association for Cardio-Thoracic Surgery Pub Date : 2026-08-17 DOI: 10.1510/mmcts.2026.059

Elise van Polen, Chiel Franssen, Jean Daemen, Aimée Franssen, Karel Hulsewé, Yvonne Vissers, Erik de Loos

{"title":"Intercostal nerve cryoablation as an adjunct to the Nuss procedure for pectus excavatum: surgical technique and practical considerations.","authors":"Elise van Polen, Chiel Franssen, Jean Daemen, Aimée Franssen, Karel Hulsewé, Yvonne Vissers, Erik de Loos","doi":"10.1510/mmcts.2026.059","DOIUrl":"https://doi.org/10.1510/mmcts.2026.059","url":null,"abstract":"Thoracoscopic intercostal nerve cryoablation is increasingly used as an adjunct to the Nuss procedure for pectus excavatum to reduce postoperative pain, yet detailed stepwise descriptions remain limited. This video tutorial presents a practical, structured description of the operative technique with emphasis on reproducible procedural steps. The patient is placed supine with both arms elevated, and single lung ventilation is established, commencing with the left-sided procedure. Thoracoscopic access is obtained through small lateral ports, followed by carbon dioxide insufflation to improve visualization. The thoracoscope is introduced to identify the third to eighth intercostal spaces. A cryoprobe is inserted through a lateral intercostal access point and positioned directly onto the intercostal nerve along the inferior border of each rib. A palpation instrument is used to retract the lung and facilitate safe exposure of the target nerve. Once correct positioning is confirmed, a controlled freezing cycle is initiated to achieve targeted nerve ablation, after which complete thawing is ensured before probe repositioning. The process is repeated sequentially for each intercostal level. After completion of cryoablation, an adjunctive intercostal block may be administered, followed by reinflation of the lung under thoracoscopic visualization. After the left-sided procedure is completed, it may be reproduced on the right. Once the right-sided procedure is completed, standard Nuss bar placement is performed. Technical pitfalls related to probe positioning, rib level identification, and tissue protection are highlighted to support safe and consistent application of the technique.","PeriodicalId":53474,"journal":{"name":"Multimedia manual of cardiothoracic surgery : MMCTS / European Association for Cardio-Thoracic Surgery","volume":"2026 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148765597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Robotic tracheal resection/reconstruction under extracorporeal membrane oxygenation after rigid bronchoscopy. 刚性支气管镜术后体外膜氧合下机器人气管切除/重建。

Multimedia manual of cardiothoracic surgery : MMCTS / European Association for Cardio-Thoracic Surgery Pub Date : 2026-08-13 DOI: 10.1510/mmcts.2026.061

Emeline Plubel, Leslie Madelaine, Chloé Bernard, Jacinthe Fili, Florian Dhérissard, Halim Hanna, Pierre-Benoît Pagès

{"title":"Robotic tracheal resection/reconstruction under extracorporeal membrane oxygenation after rigid bronchoscopy.","authors":"Emeline Plubel, Leslie Madelaine, Chloé Bernard, Jacinthe Fili, Florian Dhérissard, Halim Hanna, Pierre-Benoît Pagès","doi":"10.1510/mmcts.2026.061","DOIUrl":"10.1510/mmcts.2026.061","url":null,"abstract":"Tracheal resection/reconstruction is among the most technically demanding procedures in thoracic surgery, traditionally requiring open approaches with complex airway management. The emergence of robotic-assisted surgery combined with venovenous extracorporeal membrane oxygenation (VV-ECMO) offers a minimally invasive alternative providing enhanced surgical precision, reduced postoperative morbidity and optimal apnoeic operative conditions. We report a robotic tracheal resection/reconstruction under VV-ECMO in a 65-year-old patient with a tracheal mucoepidermoid carcinoma following endoscopic debulking with incomplete margins. Key surgical highlights include a percutaneous VV-ECMO enabling complete apnoeic conditions, lymph node dissection to initiate progressive tracheal exposure, preserving the vagus nerve and tracheal vascularization, an original fluorescence-guided transillumination technique for intraoperative resection margin identification, and end-to-end anastomosis using three continuous V-Loc sutures. The patient was discharged on postoperative Day 7 with no major complications. Resection was finally complete, and anastomotic integrity was confirmed at two-month bronchoscopy. Given the rarity of this tumour and the steep learning curve of robotic airway surgery, a step-by-step video tutorial was necessary to establish a reproducible, didactic framework for this combined approach.","PeriodicalId":53474,"journal":{"name":"Multimedia manual of cardiothoracic surgery : MMCTS / European Association for Cardio-Thoracic Surgery","volume":"2026 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148724414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Neochordae for robotic repair of posterior leaflet prolapse. 机器人修复后小叶脱垂的新脊索。

Multimedia manual of cardiothoracic surgery : MMCTS / European Association for Cardio-Thoracic Surgery Pub Date : 2026-08-12 DOI: 10.1510/mmcts.2026.037

Paul Cullen, Tarek Malas, Marc Gillinov

引用次数: 0

Quadricuspid truncal valve repair in a 6-year-old with severe annular dilatation. 6岁严重肺环扩张的四尖瓣瓣修复术。

Multimedia manual of cardiothoracic surgery : MMCTS / European Association for Cardio-Thoracic Surgery Pub Date : 2026-08-10 DOI: 10.1510/mmcts.2026.048

Igor E Konstantinov, Bakhytzhan Nurkeyev, Erbol Aldabergenov, Elmira Kuandykova, Assel Kabakanova, Bauyrzhan Tuyakbayev, Arailym Kenzhebaeva, Dariga Ismailova, Andrey Semyashkin

引用次数: 0

Aortic valve repair after arterial switch operation with autologous pulmonary artery wall. 自体肺动脉壁心房开关术后主动脉瓣修复。

Multimedia manual of cardiothoracic surgery : MMCTS / European Association for Cardio-Thoracic Surgery Pub Date : 2026-08-06 DOI: 10.1510/mmcts.2026.050

Igor E Konstantinov, Bakhytzhan Nurkeyev, Erbol Aldabergenov, Elmira Kuandykova, Assel Kabakanova, Bauyrzhan Tuyakbayev, Arailym Kenzhebaeva, Dariga Ismailova, Andrey Semyashkin

引用次数: 0

Endoscopic mitral valve replacement in extensive mitral annular calcification with a posterior pericardial patch. 内窥镜下二尖瓣置换术治疗广泛二尖瓣环钙化伴后心包补片。

Multimedia manual of cardiothoracic surgery : MMCTS / European Association for Cardio-Thoracic Surgery Pub Date : 2026-08-06 DOI: 10.1510/mmcts.2026.046

Carolina Orlandi, Ghazi Elshafie, Joseph Zacharias

{"title":"Endoscopic mitral valve replacement in extensive mitral annular calcification with a posterior pericardial patch.","authors":"Carolina Orlandi, Ghazi Elshafie, Joseph Zacharias","doi":"10.1510/mmcts.2026.046","DOIUrl":"10.1510/mmcts.2026.046","url":null,"abstract":"Extensive mitral annular calcification represents a major technical challenge in mitral valve surgery and is associated with increased operative mortality and morbidity, including atrioventricular disruption, circumflex artery injury and prosthetic valve dehiscence. Management strategies remain controversial, including in patients suitable for transcatheter interventions. We present a case of severe symptomatic mitral regurgitation in an elderly female patient with extensive circumferential mitral annular calcification. Preoperative imaging confirmed severe mitral regurgitation with restricted calcified mitral leaflets and preserved left ventricular systolic function. Transcatheter mitral valve implantation was considered, but deemed unsuitable because of annular size. The patient therefore underwent endoscopic mitral valve replacement through a right minithoracotomy using femoro-femoral cardiopulmonary bypass. An endoaortic balloon was used to arrest the heart with cardioplegia. After excision of the native valve and limited debridement of calcification, a bioprosthetic mitral valve was implanted and tied with pledgeted braided sutures and an automatic suture knotting device (CorKnot). A bovine pericardial patch was sutured to the posterior portion of the prosthetic sewing ring using a posterior skirt technique to reinforce the posterior annulus and reduce paravalvular leakage risk. Postoperative echocardiography demonstrated a well-functioning prosthetic valve with preserved ventricular function and a trivial paravalvular leak.","PeriodicalId":53474,"journal":{"name":"Multimedia manual of cardiothoracic surgery : MMCTS / European Association for Cardio-Thoracic Surgery","volume":"2026 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148680970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Surgical relief of supravalvular aortic stenosis. 瓣上主动脉狭窄的外科治疗。

Multimedia manual of cardiothoracic surgery : MMCTS / European Association for Cardio-Thoracic Surgery Pub Date : 2026-07-30 DOI: 10.1510/mmcts.2026.070

Vincent Le, Amine Mazine, Stephanie Perrier

引用次数: 0