Multimedia manual of cardiothoracic surgery : MMCTS / European Association for Cardio-Thoracic Surgery最新文献_第9页

Explant of a 21-mm homograft with redo aortic root replacement with a 25-mm bioprosthesis. 用25毫米生物假体置换21毫米同种异体主动脉根部。

Multimedia manual of cardiothoracic surgery : MMCTS / European Association for Cardio-Thoracic Surgery Pub Date : 2026-03-09 DOI: 10.1510/mmcts.2025.152

Kyle McCullough, Vanessa Klopfer, Suguru Ohira

{"title":"Explant of a 21-mm homograft with redo aortic root replacement with a 25-mm bioprosthesis.","authors":"Kyle McCullough, Vanessa Klopfer, Suguru Ohira","doi":"10.1510/mmcts.2025.152","DOIUrl":"10.1510/mmcts.2025.152","url":null,"abstract":"Re-operative management of a failing aortic homograft presents substantial technical challenges due to progressive calcification of the valve leaflets, annulus, coronary button attachments and surrounding aortic root structures. In this video tutorial, we demonstrate the explantation of a heavily calcified 21-mm aortic homograft and performance of a redo aortic root replacement using a handmade composite Bentall graft with a 25-mm bioprosthesis and 28-mm straight Dacron graft. A 73-year-old man, 23 years post-homograft root replacement, presented with torrential aortic regurgitation and a small, densely calcified aortic root. Following redo sternotomy and cardiopulmonary bypass initiation, the homograft was meticulously debrided with careful preparation of the coronary buttons, which required extensive decalcification. A composite graft was created with a tailored skirt to accommodate upsizing of the valve despite the small native annulus. Reimplantation of the left coronary button was performed, followed by distal aortic anastomosis. After removing the aortic cross-clamp, the anastomotic site of the right coronary button anastomosis was identified. The aorta was cross-clamped again, and the right coronary button was anastomosed.","PeriodicalId":53474,"journal":{"name":"Multimedia manual of cardiothoracic surgery : MMCTS / European Association for Cardio-Thoracic Surgery","volume":"2026 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147391671","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

Re-operative hemi-commando operation without a homograft: an alternative approach for complex aortic root abscess. 无同种移植物的再手术半突击手术：复杂主动脉根部脓肿的另一种方法。

Multimedia manual of cardiothoracic surgery : MMCTS / European Association for Cardio-Thoracic Surgery Pub Date : 2026-03-09 DOI: 10.1510/mmcts.2025.165

Kyle McCullough, Dina Al Rameni, Suguru Ohira

{"title":"Re-operative hemi-commando operation without a homograft: an alternative approach for complex aortic root abscess.","authors":"Kyle McCullough, Dina Al Rameni, Suguru Ohira","doi":"10.1510/mmcts.2025.165","DOIUrl":"10.1510/mmcts.2025.165","url":null,"abstract":"The patient was in his late 70s with a prior history of aortic valve replacement, recent emergent percutaneous coronary intervention for the right coronary artery (RCA), and a chronic type A aortic dissection and a 6-cm ascending aortic aneurysm. He developed Staphylococcus epidermidis bacteraemia and was found to have an aortic root abscess. Echocardiography demonstrated dehiscence of the aortic bioprosthesis with an aortic root abscess and moderate-to-severe mitral regurgitation. Radical debridement was performed, including resection of the aorto-mitral curtain through an extended transseptal approach. The protruding RCA stent was partially resected to allow selective cardioplegia. Mitral valve repair was performed with implantation of a 30-mm partial annuloplasty ring. A rectangular double-patch technique was used. The first bovine pericardial patch was sewn to the dome of the left atrium, and the second patch reconstructed the aortic annulus, with reinforcement of the fibrous trigones using pledgeted sutures. A handmade composite Bentall graft was constructed using a 30-mm Dacron graft with a skirted 25-mm bioprosthesis, and implanted with non-everting sutures. Both coronary buttons were reimplanted, followed by hemiarch replacement. The right atrium was closed with a separate pericardial patch, and a saphenous vein graft was placed to the distal RCA.","PeriodicalId":53474,"journal":{"name":"Multimedia manual of cardiothoracic surgery : MMCTS / European Association for Cardio-Thoracic Surgery","volume":"2026 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147391699","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 ramicotomy for palmar and axillary hyperhidrosis. 手掌和腋窝多汗症的机器人切开术。

Multimedia manual of cardiothoracic surgery : MMCTS / European Association for Cardio-Thoracic Surgery Pub Date : 2026-03-04 DOI: 10.1510/mmcts.2025.150

Francesco Petrella, Federico Raveglia

{"title":"Robotic ramicotomy for palmar and axillary hyperhidrosis.","authors":"Francesco Petrella, Federico Raveglia","doi":"10.1510/mmcts.2025.150","DOIUrl":"10.1510/mmcts.2025.150","url":null,"abstract":"Ramicotomy is a surgical approach that focuses on dividing the rami communicantes of the sympathetic chain and has been introduced as a treatment for palmar and axillary hyperhidrosis with the goal of reducing the incidence of compensatory sweating. Evidence from recent randomized controlled studies and meta-analyses suggests that this technique effectively reduces localized excessive sweating while resulting in lower rates of compensatory hyperhidrosis and less postoperative hand dryness compared with traditional sympathetic chain interruption. Despite these advantages, ramicotomy has been linked to a greater likelihood of symptom recurrence, underscoring the importance of thorough patient selection and detailed preoperative counseling about potential long-term outcomes. Overall quality of life improvements and patient satisfaction appear similar between ramicotomy and conventional sympathicotomy, although ramicotomy may provide benefits in decreasing the severity or extent of compensatory sweating. In cases of axillary hyperhidrosis, combining ramicotomy with endoscopic sympathetic blockade does not seem to significantly change patient satisfaction or overall rates of compensatory sweating compared with blockade alone, though it may influence the pattern or distribution of compensatory symptoms. In summary, ramicotomy is a reasonable surgical option for carefully selected patients who prioritize a lower risk of compensatory hyperhidrosis, accepting the trade-off of a potentially higher recurrence rate.","PeriodicalId":53474,"journal":{"name":"Multimedia manual of cardiothoracic surgery : MMCTS / European Association for Cardio-Thoracic Surgery","volume":"2026 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147357573","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

Stenting for external outflow graft obstruction of a left ventricular assist device via a surgical axillary approach. 经手术腋窝入路的左心室辅助装置外流出部移植物梗阻的支架置入。

Multimedia manual of cardiothoracic surgery : MMCTS / European Association for Cardio-Thoracic Surgery Pub Date : 2026-03-04 DOI: 10.1510/mmcts.2025.160

Carla L Schuering, Vanessa I T Zwaans, Stephan Dreysse, Christoph T Starck, Jörg Kempfert, Volkmar Falk, Evgenij V Potapov, Leonhard Wert

{"title":"Stenting for external outflow graft obstruction of a left ventricular assist device via a surgical axillary approach.","authors":"Carla L Schuering, Vanessa I T Zwaans, Stephan Dreysse, Christoph T Starck, Jörg Kempfert, Volkmar Falk, Evgenij V Potapov, Leonhard Wert","doi":"10.1510/mmcts.2025.160","DOIUrl":"10.1510/mmcts.2025.160","url":null,"abstract":"External outflow graft obstruction is an uncommon late complication in patients supported with a fully magnetically levitated left ventricular assist device. Progressive extrinsic compression of the outflow graft can impair pump performance and lead to symptomatic deterioration, requiring intervention to restore graft patency. This video tutorial presents a hybrid procedure combining surgical transaxillary access with endovascular stent implantation for treatment of external outflow graft obstruction when transfemoral access is not feasible. A 72-year-old woman with ventricular assist device support presented with exertional dyspnoea. Imaging demonstrated a persistent external narrowing of the outflow graft distal to the cannula, and invasive assessment confirmed a significant pressure gradient. Severe kinking of the femoral vessels excluded conventional femoral access. After induction of general anaesthesia, the axillary artery was exposed through an infraclavicular incision and accessed under direct vision. A vascular sheath was introduced, allowing retrograde advancement of guidewires across the stenotic graft segment. Two overlapping balloon-expandable covered stents were deployed under fluoroscopic guidance to restore luminal diameter and antegrade flow. Completion angiography confirmed satisfactory stent expansion and improved device flow.","PeriodicalId":53474,"journal":{"name":"Multimedia manual of cardiothoracic surgery : MMCTS / European Association for Cardio-Thoracic Surgery","volume":"2026 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147357635","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

Chest wall resection and reconstruction performed robotically using different techniques. 胸壁切除和重建采用不同的机器人技术。

Multimedia manual of cardiothoracic surgery : MMCTS / European Association for Cardio-Thoracic Surgery Pub Date : 2026-03-04 DOI: 10.1510/mmcts.2025.163

Munir Adamu Bala, Ra'fat Tawalbeh, Haisam Saad, Hammad Hassan, Ahmad Asqalan, Vasileios Kouritas

{"title":"Chest wall resection and reconstruction performed robotically using different techniques.","authors":"Munir Adamu Bala, Ra'fat Tawalbeh, Haisam Saad, Hammad Hassan, Ahmad Asqalan, Vasileios Kouritas","doi":"10.1510/mmcts.2025.163","DOIUrl":"10.1510/mmcts.2025.163","url":null,"abstract":"Chest wall resections have historically been performed via large thoracotomy incisions. A small number of minimally invasive resections have been reported so far. As robotic-assisted thoracic surgery (RATS) utilization is growing, chest wall resections via this approach will become necessary. In this video tutorial, we present tips and tricks drawn from our experience with totally robotic chest wall resections and reconstructions, which include chest wall resection en bloc with lung resections, Pancoast tumours, isolated rib resections, cartilaginous chest wall resections and reconstructions following chest wall resection or trauma. The use of a Gigli saw, Kerrison rongeur cutters, and ultrasound drills to divide the bony parts, detachment of the target chest wall area with monopolar or bipolar diathermy, and reconstruction of the defect with mesh, using either suturing or a fixation device, is presented. Finally, general recommendations are reported in an effort to render RATS chest wall resection widely utilized in the surgical practice.","PeriodicalId":53474,"journal":{"name":"Multimedia manual of cardiothoracic surgery : MMCTS / European Association for Cardio-Thoracic Surgery","volume":"2026 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147357504","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

One-stage repair of Taussig-Bing anomaly in a neonate with aortic arch hypoplasia and single coronary artery. 主动脉弓发育不全、单冠状动脉新生儿Taussig-Bing异常一期修复术。

Multimedia manual of cardiothoracic surgery : MMCTS / European Association for Cardio-Thoracic Surgery Pub Date : 2026-02-27 DOI: 10.1510/mmcts.2025.156

Sameh M Said, Mohannad Dawary, Ahmed Wahba

引用次数: 0

Left thoracotomy removal of a fenestrated stent graft and arch/descending aortic replacement for chronic aortic dissection. 慢性主动脉夹层左开胸取下开窗支架及弓/降主动脉置换术。

Multimedia manual of cardiothoracic surgery : MMCTS / European Association for Cardio-Thoracic Surgery Pub Date : 2026-02-17 DOI: 10.1510/mmcts.2026.013

Takahide Yoshio, Kensuken Ozaki, Susumu Oshima, Hirokami Tomohiro, Sakurai Shigeru, Makoto Okiyama, Ko Yamaguchi, Kazumasa Ishiko

引用次数: 0

Totally endoscopic beating-heart re-redo tricuspid valve repair using smartcanula. 全内窥镜下心脏跳动重做三尖瓣修复术。

Multimedia manual of cardiothoracic surgery : MMCTS / European Association for Cardio-Thoracic Surgery Pub Date : 2026-02-17 DOI: 10.1510/mmcts.2025.148

Florian Hecker, Matteo Montagner, Markus Kofler, Leonard Pitts, Thomas Walther, Tomas Holubec

{"title":"Totally endoscopic beating-heart re-redo tricuspid valve repair using smartcanula.","authors":"Florian Hecker, Matteo Montagner, Markus Kofler, Leonard Pitts, Thomas Walther, Tomas Holubec","doi":"10.1510/mmcts.2025.148","DOIUrl":"10.1510/mmcts.2025.148","url":null,"abstract":"Tricuspid valve surgery inherently carries an increased peri-operative risk. In the redo setting, impaired right ventricular function and the frequent presence of hepatic dysfunction are further amplified by extensive adhesions. Conventional re-sternotomy, although well-established, requires substantial tissue trauma. Therefore, strategies that minimize surgical trauma-such as a minimally invasive approach on the beating heart with limited access-may be advantageous in this high-risk population. In this video tutorial, we present a minimally invasive (totally endoscopic) second re-operation in a 65-year-old male with severe tricuspid valve regurgitation and advanced right heart failure (New York Heart Association III) after prior double valve replacements for infective endocarditis. Given the elevated surgical risk (EuroSCORE II 5.4 %, Society of Thoracic Surgeons predicted risk of mortality 3.0 %, Model for End-Stage Liver Disease 19) and the presence of dense adhesions, a right microthoracotomy (periareolar incision) approach was chosen. The operation was performed with a beating heart without cardiac arrest, and the right atrium was opened directly through the pericardium to avoid extensive adhesiolysis. Full cardiopulmonary bypass was achieved using the smartcanula system, which obviated the need for neck venous cannulation and caval snaring. In a well-established minimally invasive cardiac surgery programme, this strategy is able to minimize surgical trauma and complexity in redo cases, providing safe and effective tricuspid valve surgery while reducing myocardial injury and procedural risk.","PeriodicalId":53474,"journal":{"name":"Multimedia manual of cardiothoracic surgery : MMCTS / European Association for Cardio-Thoracic Surgery","volume":"2026 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146214884","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

'Thinking outside the sternum' in redo CABG: radial artery from descending aorta to obtuse marginal branch. 重做冠脉搭桥“胸骨外思考”：桡动脉从降主动脉到钝缘支。

Multimedia manual of cardiothoracic surgery : MMCTS / European Association for Cardio-Thoracic Surgery Pub Date : 2026-02-12 DOI: 10.1510/mmcts.2025.141

Francesco Cabrucci, Akshaj Darbar, Alexander White, Vivek Rao, Piroze M Davierwala

{"title":"'Thinking outside the sternum' in redo CABG: radial artery from descending aorta to obtuse marginal branch.","authors":"Francesco Cabrucci, Akshaj Darbar, Alexander White, Vivek Rao, Piroze M Davierwala","doi":"10.1510/mmcts.2025.141","DOIUrl":"10.1510/mmcts.2025.141","url":null,"abstract":"Redo coronary artery bypass grafting (CABG) is arguably one of the most technically demanding procedures in cardiac surgery due to the presence of dense mediastinal/pericardial adhesions making target vessel identification challenging, limited conduit availability and the risk of injury to the heart and patent grafts. Resternotomy, in particular with the right ventricle and/or previous grafts adjacent/adherent to the posterior sternal table, could result in catastrophic complications. In selected patients, alternative strategies can be used to reduce these hazards and increase procedural safety. This video tutorial presents the surgical technique performed in a 77-year-old gentleman with a prior history of CABG, who underwent successful off-pump revascularization of the obtuse marginal branch with a radial artery graft anastomosed to the descending thoracic aorta through a left thoracotomy approach. The step-by-step video demonstrates conduit harvesting, patient positioning, descending aorta exposure and key technical nuances associated with both, proximal and distal anastomoses. This approach exemplifies how 'thinking outside the sternum' can transform a high-risk redo operation into a safe, reproducible procedure, thereby eliminating the above-mentioned risks associated with a resternotomy. The tutorial aims to provide practical guidance for experienced coronary teams seeking to expand their surgical armamentarium and improve outcomes of complex redo CABG procedures.","PeriodicalId":53474,"journal":{"name":"Multimedia manual of cardiothoracic surgery : MMCTS / European Association for Cardio-Thoracic Surgery","volume":"2026 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146167754","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

Manual three-dimensional reconstruction of patient specific lung anatomy from CT scans. 从CT扫描中手工三维重建患者特定的肺解剖结构。

Multimedia manual of cardiothoracic surgery : MMCTS / European Association for Cardio-Thoracic Surgery Pub Date : 2026-02-02 DOI: 10.1510/mmcts.2025.151

Quinten Mank, Alexander P W M Maat, Sabrina Siregar, Jolanda Kluin, Amir H Sadeghi

引用次数: 0