Pub Date : 2026-03-01Epub Date: 2025-09-06DOI: 10.1053/j.optechstcvs.2025.08.002
Yasuyuki Kobayashi MD, PhD, Sitaram M. Emani MD
In an atrial switch operation, the choice between the Senning and Mustard procedures depends on the patient’s anatomy and is at the surgeon’s discretion. The comparative study of these procedures has been controversial in terms of survival and reintervention rates. Previous evidence has shown that baffle-related reoperations are not uncommon after the Mustard procedure with an autologous pericardial patch. The primary advantage of the Mustard procedure with a Gore-Tex graft is that the graft's curvature maintains the shape and lumen of the baffle, thereby reducing the risk of kinking, especially immediately after surgery. In this report, we describe the Mustard procedure as part of double-switch operations for usual levocardia, approached from the right-sided atrium, and for dextrocardia, approached from the left-sided atrium.
{"title":"Mustard Procedure With Gore-Tex Graft","authors":"Yasuyuki Kobayashi MD, PhD, Sitaram M. Emani MD","doi":"10.1053/j.optechstcvs.2025.08.002","DOIUrl":"10.1053/j.optechstcvs.2025.08.002","url":null,"abstract":"<div><div>In an atrial switch operation, the choice between the Senning and Mustard procedures depends on the patient’s anatomy and is at the surgeon’s discretion. The comparative study of these procedures has been controversial in terms of survival and reintervention rates. Previous evidence has shown that baffle-related reoperations are not uncommon after the Mustard procedure with an autologous pericardial patch. The primary advantage of the Mustard procedure with a Gore-Tex graft is that the graft's curvature maintains the shape and lumen of the baffle, thereby reducing the risk of kinking, especially immediately after surgery. In this report, we describe the Mustard procedure as part of double-switch operations for usual levocardia, approached from the right-sided atrium, and for dextrocardia, approached from the left-sided atrium.</div></div>","PeriodicalId":35965,"journal":{"name":"Operative Techniques in Thoracic and Cardiovascular Surgery","volume":"31 1","pages":"Pages 57-67"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147661613","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}
Pub Date : 2026-03-01Epub Date: 2024-12-03DOI: 10.1053/j.optechstcvs.2024.10.004
Toshiya Ohtsuka MD
Minimally invasive heart surgery is developing to treat non-valvular atrial fibrillation, which can achieve rhythm-control and prevention of cardiogenic thromboembolisms. Our procedure is a port-access totally thoracoscopic technique: radio-frequency bipolar endoscopic clamp-isolators and pen-coagulator perform endocardial isolations of the left atrium and superior vena cava and an endoscopic stapler removes the left atrial appendage. This communication briefly explains the procedural indications, clinical settings, surgical technique (and its tips and pitfalls) and medication protocols associated with the operative course. The clinical outcomes, which were published before, are shared and the procedural characteristics, such as extensive clamp-isolations which can exclude important ganglionated plexi on the left atrium, is discussed. Our port-access totally thoracoscopic procedure for treatment of nonvalvular atrial fibrillation is a promising minimally invasive choice, which can satisfactorily maintain sinus rhythm and prevent cardiogenic stroke.
{"title":"Port-Access Totally Thoracoscopic Atrial Fibrillation Procedure: Epicardial Isolations and Left Atrial Appendage Stapler-Closure","authors":"Toshiya Ohtsuka MD","doi":"10.1053/j.optechstcvs.2024.10.004","DOIUrl":"10.1053/j.optechstcvs.2024.10.004","url":null,"abstract":"<div><div>Minimally invasive heart surgery<span> is developing to treat non-valvular atrial fibrillation, which can achieve rhythm-control and prevention of cardiogenic thromboembolisms<span><span>. Our procedure is a port-access totally thoracoscopic technique: radio-frequency bipolar endoscopic clamp-isolators and pen-coagulator perform endocardial<span> isolations of the left atrium and </span></span>superior vena cava<span> and an endoscopic stapler removes the left atrial appendage. This communication briefly explains the procedural indications, clinical settings, surgical technique (and its tips and pitfalls) and medication protocols associated with the operative course. The clinical outcomes, which were published before, are shared and the procedural characteristics, such as extensive clamp-isolations which can exclude important ganglionated plexi on the left atrium, is discussed. Our port-access totally thoracoscopic procedure for treatment of nonvalvular atrial fibrillation is a promising minimally invasive choice, which can satisfactorily maintain sinus rhythm and prevent cardiogenic stroke.</span></span></span></div></div>","PeriodicalId":35965,"journal":{"name":"Operative Techniques in Thoracic and Cardiovascular Surgery","volume":"31 1","pages":"Pages 27-33"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147661615","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}
The right ventricular (RV) overhaul procedure was proposed by Joshi and Mee as a part of early palliation of pulmonary atresia and intact ventricular septum (PAIVS) in 1986. The purpose of this procedure was to immediately improve RV capacity, promote growth of right-sided cardiac structures, and foster successful biventricular repair (BVR). Although the number of cases of BVR has increased due to RV overhaul procedure, cases of RV dysfunction after RV overhaul procedure have been reported. The original RV overhaul procedure included transatrial and transpulmonary resection of hypertrophied infundibular muscle, sinus myectomy, and adjustment of an interatrial communication. Sinus myectomy may create RV free wall thinning, fibrosis at cutting edge of the infundibular myocardium and impaired RV function. Therefore, we have developed modified RV overhaul procedure, which is a transatrial and transpulmonary resection of hypertrophied infundibular muscle and transection/ resection only the muscle bundle at inlet and apical trabecular portion of RV instead of RV sinus myectomy. Modified RV overhaul procedure increased RV volume but also to promote growth of right-sided cardiac structures and improved RV diastolic function.
{"title":"Modified right ventricular overhaul procedure: Indications, techniques and outcome for pulmonary atresia with an intact ventricular septum","authors":"Shunji Sano MD, PhD , Yasuyuki Kobayashi MD , Yasuhiro Kotani MD. PhD , Hirofumi Seo MD, PhD , Nguyen Ly Thinh Truong MD, PhD","doi":"10.1053/j.optechstcvs.2024.10.006","DOIUrl":"10.1053/j.optechstcvs.2024.10.006","url":null,"abstract":"<div><div><span>The right ventricular (RV) overhaul procedure was proposed by Joshi and Mee as a part of early palliation<span> of pulmonary atresia and intact </span></span>ventricular septum<span> (PAIVS) in 1986. The purpose of this procedure was to immediately improve RV capacity, promote growth of right-sided cardiac structures, and foster successful biventricular repair (BVR). Although the number of cases of BVR has increased due to RV overhaul procedure, cases of RV dysfunction<span><span> after RV overhaul procedure have been reported. The original RV overhaul procedure included transatrial and transpulmonary resection of hypertrophied infundibular muscle, sinus myectomy<span>, and adjustment of an interatrial communication. Sinus myectomy may create RV free wall thinning, fibrosis at cutting edge of the infundibular myocardium and impaired </span></span>RV function<span>. Therefore, we have developed modified RV overhaul procedure, which is a transatrial and transpulmonary resection of hypertrophied infundibular muscle and transection/ resection only the muscle bundle at inlet and apical trabecular portion of RV instead of RV sinus myectomy. Modified RV overhaul procedure increased RV volume but also to promote growth of right-sided cardiac structures and improved RV diastolic function.</span></span></span></div></div>","PeriodicalId":35965,"journal":{"name":"Operative Techniques in Thoracic and Cardiovascular Surgery","volume":"31 1","pages":"Pages 44-56"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147661603","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}
Pub Date : 2026-03-01Epub Date: 2026-03-14DOI: 10.1053/j.optechstcvs.2026.03.001
{"title":"Recent Articles in AATS Journals","authors":"","doi":"10.1053/j.optechstcvs.2026.03.001","DOIUrl":"10.1053/j.optechstcvs.2026.03.001","url":null,"abstract":"","PeriodicalId":35965,"journal":{"name":"Operative Techniques in Thoracic and Cardiovascular Surgery","volume":"31 1","pages":"Pages e3-e5"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147661617","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}
Long standing persistent atrial fibrillation has a complex physiopathology with limited effective therapeutic options. We describe an alternative approach to the convergent hybrid ablation that is effective and allows an extended ablation with left atrial appendage exclusion through one access. We present the details of this surgical technique.
{"title":"Convergent Ablation and Left Atrial Appendage Exclusion: How to Do It Through a Unique Left Thoracoscopic Approach?","authors":"Tesnim Besbes MD , Claudio Zamorano MD , Nebil Ajmi MD , Raoul Biondi MD , Frédéric Sebag MD , Konstantinos Zannis MD","doi":"10.1053/j.optechstcvs.2025.06.003","DOIUrl":"10.1053/j.optechstcvs.2025.06.003","url":null,"abstract":"<div><div>Long standing persistent atrial fibrillation has a complex physiopathology with limited effective therapeutic options. We describe an alternative approach to the convergent hybrid ablation that is effective and allows an extended ablation with left atrial appendage exclusion through one access. We present the details of this surgical technique.</div></div>","PeriodicalId":35965,"journal":{"name":"Operative Techniques in Thoracic and Cardiovascular Surgery","volume":"31 1","pages":"Pages 34-40"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147661601","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}
Pub Date : 2026-03-01Epub Date: 2025-08-05DOI: 10.1053/j.optechstcvs.2025.07.002
Lise N. Tchouta MD, MS, Lucy Nam MD, Boateng Kubi MD, Jordan P. Bloom MD, MPH
Catheter-based thoracostomy using “pigtail catheters” has become a ubiquitous procedure for the management of pleural effusion or pneumothorax in many patient populations. Despite their widespread use, these small-bore catheters carry potential risks of significant morbidity and mortality, including intrathoracic vascular injury, parenchymal lung injury, and intra-abdominal placement. Moreover, malpositioned pigtail catheters are a notable cause of delayed care, increased cost, and frustration for patients and providers. Careful technique and understanding of the nuances in pigtail catheter placement can mitigate these complications and provide a roadmap for effective drainage.
{"title":"Mastering the Percutaneous Pigtail Thoracostomy Catheter Placement: A Technical Approach for Precision, Safety and Comfort","authors":"Lise N. Tchouta MD, MS, Lucy Nam MD, Boateng Kubi MD, Jordan P. Bloom MD, MPH","doi":"10.1053/j.optechstcvs.2025.07.002","DOIUrl":"10.1053/j.optechstcvs.2025.07.002","url":null,"abstract":"<div><div>Catheter-based thoracostomy using “pigtail catheters” has become a ubiquitous procedure for the management of pleural effusion or pneumothorax in many patient populations. Despite their widespread use, these small-bore catheters carry potential risks of significant morbidity and mortality, including intrathoracic vascular injury, parenchymal lung injury, and intra-abdominal placement. Moreover, malpositioned pigtail catheters are a notable cause of delayed care, increased cost, and frustration for patients and providers. Careful technique and understanding of the nuances in pigtail catheter placement can mitigate these complications and provide a roadmap for effective drainage.</div></div>","PeriodicalId":35965,"journal":{"name":"Operative Techniques in Thoracic and Cardiovascular Surgery","volume":"31 1","pages":"Pages 68-76"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147661614","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}
Pub Date : 2025-12-01Epub Date: 2025-08-15DOI: 10.1053/j.optechstcvs.2025.06.005
Hironori Matsuhisa MD, PhD
The 2 patch technique is the most standardized procedure for complete atrioventricular septal defect. However, patch insertion into the ventricular septal defect is sometimes difficult, especially in patients with Rastelli type A, and the technique itself does not address the deficiency of the left superior leaflet. We present the simplified patch augmentation technique of the left superior bridging leaflet as part of the 2 patch technique. This technique gives enough leaflet volume to establish the left atrioventricular valvular competency with minimal leaflet dehiscence risk.
{"title":"Patch Augmentation of Superior Bridging Leaflet in Rastelli Type A Atrioventricular Septal Defect Repair","authors":"Hironori Matsuhisa MD, PhD","doi":"10.1053/j.optechstcvs.2025.06.005","DOIUrl":"10.1053/j.optechstcvs.2025.06.005","url":null,"abstract":"<div><div>The 2 patch technique is the most standardized procedure for complete atrioventricular septal defect. However, patch insertion into the ventricular septal defect is sometimes difficult, especially in patients with Rastelli type A, and the technique itself does not address the deficiency of the left superior leaflet. We present the simplified patch augmentation technique of the left superior bridging leaflet as part of the 2 patch technique. This technique gives enough leaflet volume to establish the left atrioventricular valvular competency with minimal leaflet dehiscence risk.</div></div>","PeriodicalId":35965,"journal":{"name":"Operative Techniques in Thoracic and Cardiovascular Surgery","volume":"30 4","pages":"Pages 295-302"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145610249","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}
Pub Date : 2025-12-01Epub Date: 2025-10-28DOI: 10.1053/j.optechstcvs.2025.10.001
{"title":"Recent Articles in AATS Journals","authors":"","doi":"10.1053/j.optechstcvs.2025.10.001","DOIUrl":"10.1053/j.optechstcvs.2025.10.001","url":null,"abstract":"","PeriodicalId":35965,"journal":{"name":"Operative Techniques in Thoracic and Cardiovascular Surgery","volume":"30 4","pages":"Pages e3-e5"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145610252","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}
Seventeen years have passed since the Ozaki procedure started in 2007. In the first series we reported in 2010, we used the first generation template and sizer, and we had already achieved excellent outcomes with them. Many surgeons worldwide have started using the Ozaki procedure, and their reports are now being published from all over the world. However, with the conventional templates, actual points to suture on the new cusp could vary depending on the surgeons because the dots on the template were not the actual suture points. We also experienced 3 cases in which coronary artery occlusion by the valve cusps occurred after releasing the aortic cross-clamp. The previous sizer also had some issues because of the position of the handle and the top corner height. And it might cause inaccurate measurements of each cusp size. Based on the above experience, we have gradually upgraded the template and sizer to improve the outcomes and standardize the procedure. The current ones are the third generation, and each shape is completely different from the previous ones. With this new template and sizer, the tips for actual procedures have also changed. Here, we will once again describe the Ozaki procedure using the third generation sizer and template as the “New Ozaki Procedure.”
{"title":"New Ozaki Procedure Overview","authors":"Takuya Fujikawa MD, Shigeyuki Ozaki MD, PhD, Nagaki Kiyohara MD, Masami Goda MD, Mikio Takatoo MD, Shinichiro Shimura MD, PhD","doi":"10.1053/j.optechstcvs.2025.03.003","DOIUrl":"10.1053/j.optechstcvs.2025.03.003","url":null,"abstract":"<div><div>Seventeen years have passed since the Ozaki procedure started in 2007. In the first series we reported in 2010, we used the first generation template and sizer, and we had already achieved excellent outcomes with them. Many surgeons worldwide have started using the Ozaki procedure, and their reports are now being published from all over the world. However, with the conventional templates, actual points to suture on the new cusp could vary depending on the surgeons because the dots on the template were not the actual suture points. We also experienced 3 cases in which coronary artery occlusion by the valve cusps occurred after releasing the aortic cross-clamp. The previous sizer also had some issues because of the position of the handle and the top corner height. And it might cause inaccurate measurements of each cusp size. Based on the above experience, we have gradually upgraded the template and sizer to improve the outcomes and standardize the procedure. The current ones are the third generation, and each shape is completely different from the previous ones. With this new template and sizer, the tips for actual procedures have also changed. Here, we will once again describe the Ozaki procedure using the third generation sizer and template as the “New Ozaki Procedure.”</div></div>","PeriodicalId":35965,"journal":{"name":"Operative Techniques in Thoracic and Cardiovascular Surgery","volume":"30 4","pages":"Pages 246-274"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145610246","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}
Pub Date : 2025-12-01Epub Date: 2025-11-28DOI: 10.1053/j.optechstcvs.2025.11.001
{"title":"Introduction to Winter 2025","authors":"","doi":"10.1053/j.optechstcvs.2025.11.001","DOIUrl":"10.1053/j.optechstcvs.2025.11.001","url":null,"abstract":"","PeriodicalId":35965,"journal":{"name":"Operative Techniques in Thoracic and Cardiovascular Surgery","volume":"30 4","pages":"Page 245"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145610561","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}
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