Pub Date : 2025-12-01Epub Date: 2025-09-06DOI: 10.1053/j.optechstcvs.2025.08.003
Aroub Alkaaki MD, Daniela Molena MD
Endoluminal vacuum therapy is a promising minimally invasive technique that promotes the healing of anastomotic leaks after esophagectomy. It offers an effective alternative to major surgical intervention. However, its widespread use is limited by the need for multiple sponge exchanges and the lack of commercially available systems. This paper presents a practical approach to creating a customized endoluminal vacuum therapy system, with the aim of improving accessibility and patient care.
{"title":"Customized Endoluminal Vacuum Therapy for Anastomotic Leak After Esophagectomy","authors":"Aroub Alkaaki MD, Daniela Molena MD","doi":"10.1053/j.optechstcvs.2025.08.003","DOIUrl":"10.1053/j.optechstcvs.2025.08.003","url":null,"abstract":"<div><div>Endoluminal vacuum therapy is a promising minimally invasive technique that promotes the healing of anastomotic leaks after esophagectomy. It offers an effective alternative to major surgical intervention. However, its widespread use is limited by the need for multiple sponge exchanges and the lack of commercially available systems. This paper presents a practical approach to creating a customized endoluminal vacuum therapy system, with the aim of improving accessibility and patient care.</div></div>","PeriodicalId":35965,"journal":{"name":"Operative Techniques in Thoracic and Cardiovascular Surgery","volume":"30 4","pages":"Pages 303-310"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145565774","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: 2025-07-16DOI: 10.1053/j.optechstcvs.2025.06.002
Carolina Rodrigues MD , Igor E. Konstantinov MD, PhD
Isolated right pulmonary artery that comes forms the residual patent ductus arteriosus is rare. Multiple techniques have been described to anastomose the right pulmonary artery to the main pulmonary artery. Herein we detail our technique of reconstruction using pulmonary artery flap and autologous pericardium.
{"title":"Anomalous Origin of the Right Pulmonary Artery: Reconstruction With Autologous Tissue in Neonatal Period","authors":"Carolina Rodrigues MD , Igor E. Konstantinov MD, PhD","doi":"10.1053/j.optechstcvs.2025.06.002","DOIUrl":"10.1053/j.optechstcvs.2025.06.002","url":null,"abstract":"<div><div>Isolated right pulmonary artery that comes forms the residual patent ductus arteriosus is rare. Multiple techniques have been described to anastomose the right pulmonary artery to the main pulmonary artery. Herein we detail our technique of reconstruction using pulmonary artery flap and autologous pericardium.</div></div>","PeriodicalId":35965,"journal":{"name":"Operative Techniques in Thoracic and Cardiovascular Surgery","volume":"30 4","pages":"Pages 275-279"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145610247","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: 2025-08-05DOI: 10.1053/j.optechstcvs.2025.06.004
Aybala Tongut MD , Sofia Hanabergh MSc , Yves d’Udekem MD, PhD , Can Yerebakan MD, PhD
Biventricular repair following hybrid palliation offers a refined approach for patients with borderline hypoplastic left heart structures, balancing early-stage palliation with deferred surgical decision-making. This manuscript outlines the operative strategies for achieving biventricular repair posthybrid palliation, detailing techniques such as aortic arch reconstruction, ventricular septal defect closure, and advanced procedures like the Ross-Konno and Yasui operations. Patient selection criteria, perfusion strategies, and technical considerations are emphasized to optimize outcomes. By leveraging the hybrid approach to enable staged physiological adaptation, biventricular repair expands therapeutic possibilities for select patients, improving long-term survival and functional outcomes.
{"title":"Biventricular Repair After Hybrid Palliation: A Technical and Conceptual Review","authors":"Aybala Tongut MD , Sofia Hanabergh MSc , Yves d’Udekem MD, PhD , Can Yerebakan MD, PhD","doi":"10.1053/j.optechstcvs.2025.06.004","DOIUrl":"10.1053/j.optechstcvs.2025.06.004","url":null,"abstract":"<div><div>Biventricular repair following hybrid palliation offers a refined approach for patients with borderline hypoplastic left heart structures, balancing early-stage palliation with deferred surgical decision-making. This manuscript outlines the operative strategies for achieving biventricular repair posthybrid palliation, detailing techniques such as aortic arch reconstruction, ventricular septal defect closure, and advanced procedures like the Ross-Konno and Yasui operations. Patient selection criteria, perfusion strategies, and technical considerations are emphasized to optimize outcomes. By leveraging the hybrid approach to enable staged physiological adaptation, biventricular repair expands therapeutic possibilities for select patients, improving long-term survival and functional outcomes.</div></div>","PeriodicalId":35965,"journal":{"name":"Operative Techniques in Thoracic and Cardiovascular Surgery","volume":"30 4","pages":"Pages 280-294"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145610248","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 : 2025-09-01Epub Date: 2025-03-21DOI: 10.1053/j.optechstcvs.2025.01.004
Muhammed Hebala FRCS(CTh) , Mohamed Nassar FRCS(CTh) , Conal Austin FRCS(CTh) , Louise Kenny FRCS(CTh)
The ROSS-PEARS describes the addition of a Personalized External Aortic Root Support to the pulmonary autograft in the aortic position. It is well documented that the vulnerability of the free root Ross is autograft dilatation, and various techniques have been described to prophylactically manage this. A bespoke PEARS prosthesis supporting the autograft when performing an elective Ross in patients with adult size aortic root may avoid such vulnerability. Here we describe our indications, rationale and technical considerations.
{"title":"Personalized External Root Support for the Pulmonary Autograft in the Aortic Position: The ROSS-PEARS Procedure","authors":"Muhammed Hebala FRCS(CTh) , Mohamed Nassar FRCS(CTh) , Conal Austin FRCS(CTh) , Louise Kenny FRCS(CTh)","doi":"10.1053/j.optechstcvs.2025.01.004","DOIUrl":"10.1053/j.optechstcvs.2025.01.004","url":null,"abstract":"<div><div>The ROSS-PEARS describes the addition of a Personalized External Aortic Root Support to the pulmonary autograft<span> in the aortic position. It is well documented that the vulnerability of the free root Ross is autograft<span> dilatation, and various techniques have been described to prophylactically manage this. A bespoke PEARS prosthesis supporting the autograft when performing an elective Ross in patients with adult size aortic root may avoid such vulnerability. Here we describe our indications, rationale and technical considerations.</span></span></div></div>","PeriodicalId":35965,"journal":{"name":"Operative Techniques in Thoracic and Cardiovascular Surgery","volume":"30 3","pages":"Pages 232-243"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144891851","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 : 2025-09-01Epub Date: 2025-02-26DOI: 10.1053/j.optechstcvs.2024.11.004
Hani K. Najm MD, MSc, Munir Ahmad MD, BSc, John P. Costello MD, Brittany Potz MD, Tara Karamlou MD, MSc
Single-ventricle (SV) palliation of neonates with either moderately hypoplastic left ventricle (LV) or complex intracardiac routing anatomy is frequently chosen as an initial step to facilitate survival out of the newborn period. In the case of borderline left heart structures, uncertainty around the adequacy of LV often continues, leading to further progression on the SV pathway with bidirectional cavopulmonary shunt and eventual Fontan despite the presence of a descent second ventricle. Similarly, SV pathway also continues beyond the neonatal period in those patients in whom intracardiac routing is deemed “too complex” in infancy. Frequently, this initial commitment to the SV pathway is never reconsidered later in life and never reversed, leaving the patient with SV physiology. Thus, these patients are continuously subjected to the detrimental effects of SV circulation despite having the presence of 2 ventricles. Some of these patients, however, can be reconsidered for biventricular (BV) conversion at a later stage via either a 2-ventricle or a one-and-a-half-ventricle circulation. We present 2 examples of patients with different anatomical lesions who were initially managed in an SV pathway and highlight the different surgical techniques employed to achieve either a 2 or a one-and-a-half-ventricle conversion from a Fontan circulation.
{"title":"Biventricular Conversion of Single Ventricle: Adopting the Left Ventricle as the Systemic Pump","authors":"Hani K. Najm MD, MSc, Munir Ahmad MD, BSc, John P. Costello MD, Brittany Potz MD, Tara Karamlou MD, MSc","doi":"10.1053/j.optechstcvs.2024.11.004","DOIUrl":"10.1053/j.optechstcvs.2024.11.004","url":null,"abstract":"<div><div>Single-ventricle (SV) palliation<span> of neonates with either moderately hypoplastic left ventricle<span><span> (LV) or complex intracardiac routing anatomy is frequently chosen as an initial step to facilitate survival out of the </span>newborn period<span>. In the case of borderline left heart structures, uncertainty around the adequacy of LV often continues, leading to further progression on the SV pathway with bidirectional cavopulmonary shunt and eventual Fontan despite the presence of a descent second ventricle. Similarly, SV pathway also continues beyond the neonatal period in those patients in whom intracardiac routing is deemed “too complex” in infancy. Frequently, this initial commitment to the SV pathway is never reconsidered later in life and never reversed, leaving the patient with SV physiology. Thus, these patients are continuously subjected to the detrimental effects of SV circulation despite having the presence of 2 ventricles. Some of these patients, however, can be reconsidered for biventricular (BV) conversion at a later stage via either a 2-ventricle or a one-and-a-half-ventricle circulation. We present 2 examples of patients with different anatomical lesions who were initially managed in an SV pathway and highlight the different surgical techniques employed to achieve either a 2 or a one-and-a-half-ventricle conversion from a Fontan circulation.</span></span></span></div></div>","PeriodicalId":35965,"journal":{"name":"Operative Techniques in Thoracic and Cardiovascular Surgery","volume":"30 3","pages":"Pages 219-231"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144891850","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 : 2025-09-01Epub Date: 2025-02-03DOI: 10.1053/j.optechstcvs.2025.01.002
Douglas M. Overbey MD, MPH , John A. Kucera MD , Rachel Gambino BS, CCP, FPP , Smith M. Ngeve BA , Joseph R. Nellis MD , Joseph W. Turek MD, PhD, MBA
Background: The gold standard for treatment of patients with end-stage heart failure remains heart transplantation. Time spent on the active waiting list, notably for pediatric patients, contributes to alarmingly high mortality. Donation after circulatory death (DCD) marks an evolution in heart transplantation that has proven to expand the donor pool and shorten waitlist times in adult heart recipients. Normothermic regional perfusion (NRP) is a procedure where veno-arterial extracorporeal membrane oxygenation is initiated after clamping the head vessels to reperfuse and reanimate the heart after cardiac death. NRP also allows the procuring team to evaluate heart function in vivo to determine organ suitability after warm ischemia.
Results: DCD NRP has allowed our team to procure pediatric hearts in donors as small as 3 kg.
Conclusions: DCD NRP is a viable technique to increase the cardiac donor pool in even the smallest donors with the right team, resources, and adequate planning.
{"title":"How I Do It: Donation After Circulatory Death With Normothermic Regional Perfusion in Small Babies","authors":"Douglas M. Overbey MD, MPH , John A. Kucera MD , Rachel Gambino BS, CCP, FPP , Smith M. Ngeve BA , Joseph R. Nellis MD , Joseph W. Turek MD, PhD, MBA","doi":"10.1053/j.optechstcvs.2025.01.002","DOIUrl":"10.1053/j.optechstcvs.2025.01.002","url":null,"abstract":"<div><div><span><span><span>Background: The gold standard for treatment of patients with end-stage heart failure remains heart transplantation. Time spent on the active waiting list, notably for </span>pediatric patients, contributes to alarmingly high mortality. Donation after circulatory death (DCD) marks an evolution in heart transplantation that has proven to expand the donor pool and shorten waitlist times in adult heart recipients. Normothermic </span>regional perfusion (NRP) is a procedure where veno-arterial </span>extracorporeal membrane oxygenation<span> is initiated after clamping the head vessels to reperfuse and reanimate the heart after cardiac death. NRP also allows the procuring team to evaluate heart function in vivo to determine organ suitability after warm ischemia.</span></div><div>Results: DCD NRP has allowed our team to procure pediatric hearts in donors as small as 3 kg.</div><div>Conclusions: DCD NRP is a viable technique to increase the cardiac donor pool in even the smallest donors with the right team, resources, and adequate planning.</div></div>","PeriodicalId":35965,"journal":{"name":"Operative Techniques in Thoracic and Cardiovascular Surgery","volume":"30 3","pages":"Pages 213-218"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144891849","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 : 2025-09-01Epub Date: 2025-04-17DOI: 10.1053/j.optechstcvs.2025.03.005
Tedy Sawma MD, Hartzell V. Schaff MD
Hypertrophic cardiomyopathy is a relatively common cardiac disorder, and associated left ventricular outflow tract (LVOT) obstruction may significantly impair quality of life and long-term survival. A comprehensive understanding of the anatomy and physiology of the disease is important in planning surgical septal reduction (septal myectomy) in order to minimize operative risk and achieve optimal late outcomes. Depending on the location of the obstruction, surgical relief may involve a transaortic, transapical, or a combined approach. In the present article, we illustrate our operative techniques derived from an experience in the surgical management of more than 4000 patients with HCM.
{"title":"Step-by-Step Approach for Septal Myectomy in Patients With Obstructive Hypertrophic Cardiomyopathy","authors":"Tedy Sawma MD, Hartzell V. Schaff MD","doi":"10.1053/j.optechstcvs.2025.03.005","DOIUrl":"10.1053/j.optechstcvs.2025.03.005","url":null,"abstract":"<div><div>Hypertrophic cardiomyopathy<span> is a relatively common cardiac disorder, and associated left ventricular outflow tract (LVOT) obstruction may significantly impair quality of life<span> and long-term survival. A comprehensive understanding of the anatomy and physiology of the disease is important in planning surgical septal reduction (septal myectomy) in order to minimize operative risk and achieve optimal late outcomes. Depending on the location of the obstruction, surgical relief may involve a transaortic, transapical, or a combined approach. In the present article, we illustrate our operative techniques derived from an experience in the surgical management of more than 4000 patients with HCM.</span></span></div></div>","PeriodicalId":35965,"journal":{"name":"Operative Techniques in Thoracic and Cardiovascular Surgery","volume":"30 3","pages":"Pages 184-197"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144892281","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 : 2025-09-01Epub Date: 2025-08-05DOI: 10.1053/j.optechstcvs.2025.07.001
{"title":"Adult Articles in AATS Journals","authors":"","doi":"10.1053/j.optechstcvs.2025.07.001","DOIUrl":"10.1053/j.optechstcvs.2025.07.001","url":null,"abstract":"","PeriodicalId":35965,"journal":{"name":"Operative Techniques in Thoracic and Cardiovascular Surgery","volume":"30 3","pages":"Pages e3-e4"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144891854","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 : 2025-09-01Epub Date: 2025-05-20DOI: 10.1053/j.optechstcvs.2025.04.001
Alexander P. Nissen MD, Bradley G. Leshnower MD
Acute Type A aortic dissection (ATAAD) remains a life-threatening diagnosis, requiring rapid diagnosis and surgical management for optimal outcomes. In many cases, whether due to root aneurysm or destruction by the dissection process, aortic root replacement is required for complete repair, and to ensure adequate aortic valve competency. While the reimplantation technique for valve sparing root replacement (VSRR) was originally conceived for treating aneurysmal, nondissected, isolated root pathology, expertise with this procedure has led to expansion of indications and application to include bicuspid aortopathy, cases requiring complex aortic valve repair, and ATAAD in well-selected patients at high volume centers. Here we outline our operative technique for the application of VSRR in ATAAD.
{"title":"Valve Sparing Root Replacement in Acute Type A Dissection","authors":"Alexander P. Nissen MD, Bradley G. Leshnower MD","doi":"10.1053/j.optechstcvs.2025.04.001","DOIUrl":"10.1053/j.optechstcvs.2025.04.001","url":null,"abstract":"<div><div><span><span>Acute Type A aortic dissection (ATAAD) remains a life-threatening diagnosis, requiring rapid diagnosis and surgical management for optimal outcomes. In many cases, whether due to root aneurysm or destruction by the dissection process, </span>aortic root replacement is required for complete repair, and to ensure adequate </span>aortic valve<span><span> competency. While the reimplantation technique for valve sparing root replacement (VSRR) was originally conceived for treating aneurysmal, nondissected, isolated root pathology, expertise with this procedure has led to expansion of indications and application to include bicuspid </span>aortopathy<span>, cases requiring complex aortic valve repair, and ATAAD in well-selected patients at high volume centers. Here we outline our operative technique for the application of VSRR in ATAAD.</span></span></div></div>","PeriodicalId":35965,"journal":{"name":"Operative Techniques in Thoracic and Cardiovascular Surgery","volume":"30 3","pages":"Pages 198-212"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144891848","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 : 2025-09-01Epub Date: 2025-08-23DOI: 10.1053/j.optechstcvs.2025.08.001
{"title":"Introduction to Autumn 2025","authors":"","doi":"10.1053/j.optechstcvs.2025.08.001","DOIUrl":"10.1053/j.optechstcvs.2025.08.001","url":null,"abstract":"","PeriodicalId":35965,"journal":{"name":"Operative Techniques in Thoracic and Cardiovascular Surgery","volume":"30 3","pages":"Page 183"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144892280","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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