九州心臓弁膜症カンファレンス2016 江石先生

大動脈弁形成術

ARのメカニズムの詳細が大切
　弁輪、STJ、バルサルバ径、逸脱の有無、eH、gH
二尖弁、弁尖逸脱のないDavid手術の結果は良好
基部拡大のない三尖弁のgHの少ない逸脱症例が問題。
　patch augunmanntation?

Measuring graft flow

Measuring graft flow
SCTSeducation
G Di Giammarco (Chieti, Italy)
https://www.youtube.com/watch?v=FYiFjQlmCIc&index=6&list=PLC9uVfWun4-QcEPD2CJKbW4imsaZ9LLYz

CABG graft flow measurement
failure
　Q mean <15 p="">　PI>3
False positives (20-69%) in flow meters
Epicardial echo might be useful to detect dissections of IMA.

False positives (20-69%) because of competition?
Dissection must be detected by flow meters.

Cut and Sew Cox-Maze III Procedure With Mexican Modification

Cut and Sew Cox-Maze III Procedure With Mexican Modification

Ovidio Garcia-Villarreal
http://www.ctsnet.org/article/cut-and-sew-cox-maze-iii-procedure-mexican-modification

This video demonstrates a Mexican modification to the traditional Maze III procedure, which was initially described by Dr. James Cox. This technique is ideal for patients with mitral valve disease and atrial fibrillation who are undergoing surgery. This modification allows the surgeon to better control the base of the left atrial appendage and the surrounding area, as well as perform the mitral valve procedure more easily. The author has performed this technique in over 50 cases.

No ablation devices.
Around mitral and tricuspid valves, he cut just muscular layer not epicardial fat in atrials by a 15 brade knife.
After counter clockwise rotation of heart, LA appendage is fully exposed and cut out from outside of LA.
Use 3-0 prolene
This patient has not fragile LA wall.

Hannover experience with the Frozen Elephant Trunk

Hannover experience with the Frozen Elephant Trunk
M Shrestha (Hannover, Germany)

https://www.youtube.com/watch?v=aQH0q-WpAdw&index=4&list=PLC9uVfWun4-QcEPD2CJKbW4imsaZ9LLYz&t=213s


In true aneurysms, FET is better results than standard elephant trunk method.
In acute dissections, FET stabilizes the flap and true lumed expansion.
In chronic dissections, more data needed.

九州心臓弁膜症カンファレンス2016 紙谷先生

大動脈弁形成術

複合手術の際の大動脈弁形成術、弁輪縫縮suture annnuloplastyと弁尖plication
手術の簡略化は可能だがAR制御は不十分
コロナリーボタンの吻合の際はヘガール持針器使用

川添先生のコメント
ARの量をもっと見るべき。適応を厳密に。
Davidとsuture annnuloplastyは目的が違うので比べるのは意味がない
ARの原因に応じて手術術式を決めるべき

TV Repair

50-year-old Male with Severe MR Mild to Moderate Tricuspid Regurgitation, and Severe Annular Dilatation: Isolated MV Repair or Concommitant TV Repair
By AATS Mitral Conclave - Key Thoughts from World’s Leaders Featuring Gilles Dreyfus

https://www.vumedi.com/video/50-year-old-male-with-severe-mr-mild-to-moderate-tricuspid-regurgitation-and-severe-annular-dilatati/?utm_campaign=FAST+Procedure++with+Ultrasound+guidance+for+Lateral+Elbow+Tendinopathy&utm_term=Mitral+Valve+Surgery&utm_content=50-year-old+Male+with+Severe+MR+Mild+to+Moderate+Tricuspid+Regurgitation%2C+and+Severe+Annular+Dilatation%3A+Isolated+MV+Repair+or+Concommitant+TV+Repair+&utm_source=USERS+cardiac+surgery_16000&mail_id=16000&utm_medium=Video&token=40f94581-8c12-4546-bf09-1a4939f9785f

Preoperative not intraoperative cardiac echo is important because the situation is normal.
Definition of annular dilatation is difficult because it is dynamic.
We should decide to do TAP or not preoperatively not intraoperatively.
TEE transgastric view is reliable
Tips of TAP: AVB, RCA kinking

九州心臓弁膜症カンファレンス2016 北大内科 山田先生

エコー
ASの最大圧較差の違う理由。エコーではpeak to peakでなく差delta値が最大となるところを取っているため、時相の違うところを比較している。当然エコー値の方が高くなる。
しかし平均圧較差値でもエコーのほうが25％程度大きくなる。エコーでは左室内と狭窄部の差を見ているのに対し、カテでは左室内と大動脈内（圧回復後）の差を見ている。
PPMの指標が厳しいのもここから来ている。

Incidence of Sternal Wound Infection following Tracheostomy in Cardiac Surgery Patients: A Systematic Review and Meta-Analysis

Incidence of Sternal Wound Infection following Tracheostomy in Cardiac Surgery Patients: A Systematic Review and Meta-Analysis

Source Name: JTCVS

Source URL: http://www.jtcvsonline.org/article/S0022-5223(16)31635-X/fulltext

http://www.ctsnet.org/jans/incidence-sternal-wound-infection-following-tracheostomy-cardiac-surgery-patients-systematic?utm_source=iContact&utm_medium=email&utm_campaign=CTSNet&utm_content=JANS+12%2F16%2F16


This systematic review and meta-analysis

The overall incidence of SWI after tracheostomy in patients undergoing cardiac surgery was 7.0% (95% confidence interval [CI], 4-10) (Figure 1).

The proportion of SWI after percutaneous tracheostomy was 3% (95% CI, 1-8), whereas after open tracheostomy this was 9% (95% CI, 5-14) (Figure 2).

The incidence of sternal wound infection with early (<14 3-11="" 3="" 4-10="" 95="" ci="" days="" igure="" late="" p="" similar="" tracheostomy="" versus="" was="">
Suprise!!

I believed that the earlier and percutaneous tracheostomy was better.

Future of Valve Surgery

Future of Valve Surgery
By AATS Mitral Conclave - Key Thoughts from World’s Leaders Featuring Tirone David

https://www.vumedi.com/video/future-of-valve-surgery/


Surgeon should do mitral and aortic valve repair.
Surgery will remain in catheter era because the long-term surgical results is good and the valve disease is complex.

Internal Thoracic Artery (ITA) Skeletonization for CABG

Internal Thoracic Artery (ITA) Skeletonization for CABG
By Ahmed Ouda Featuring Utz Kappert

https://www.vumedi.com/video/internal-thoracic-artery-ita-skeletonization-for-cabg/

Cut the plueral on the LITA first and dissect the pleural from ITA.
Dissect ITA on side of anterior chest wall by cold dissection like SVG harvesting.

九州心臓弁膜症カンファレンス 小宮先生

Aortic valve plasty

Lansac: External band, ring annulus -1mm
Schafers: Sutureannuloplasty, 24mm: univarsal, 25mm(BSA>1.8), 23mm(BSA<1 .8="" p="">Cusp height: Various length on conditions, bigger on CT, smaller intraop

Repair of Ruptured Type A Dissection

Repair of Ruptured Type A Dissection
By Arie Blitz

https://www.vumedi.com/video/repair-of-ruptured-type-a-dissection/?utm_campaign=Laser+and+Balloon+Angioplasty+for+Posterial+Tibial+Live+Case&utm_term=Surgery+-+Cardiac&utm_content=Repair+of+Ruptured+Type+A+Dissection&utm_source=USERS+cardiac+surgery_16040&mail_id=16040&utm_medium=Video&token=90dbef5a-e08b-4b15-93e8-4233a66903fd


Femoral and innomuinate artery cannulation.
Selective cerebral perfusion (one arterial cannulation?).
Bioglue was used to both stumps.
The site of proximal stump of arch was longer than I expected.
Jacobson type of needle holder was used.

The Argument for Open Vein Harvest

The Argument for Open Vein Harvest

Wednesday, December 7, 2016
By
Domingos Souza


http://www.ctsnet.org/article/argument-open-vein-harvest?utm_source=iContact&utm_medium=email&utm_campaign=CTSNet&utm_content=Non-U.S.+Pulse+w%2F+SJM+Banner+12%2F13%2F16



No touch harvesting was significantly better than conventional harvesting and also was compatible to LITA in long-term results.

Is One Arterial Graft Sufficient?

Is One Arterial Graft Sufficient?
http://www.ctsnet.org/article/one-arterial-graft-sufficient
By
Gianni Angelini

We should learn more in how to manage, handle and preserve the SVGs.

Novel Approach to Concomitant Maze and Proximal Aortic Operation and/or CABG

Novel Approach to Concomitant Maze and Proximal Aortic Operation and/or CABG
By Ali Khoynezhad

https://www.vumedi.com/video/novel-approach-to-concomitant-maze-and-proximal-aortic-operation-andor-cabg/

Atricure
PVI
Cut the tip of LAA
Through the hole, the box lesion was performed
Through the aortic valve, the lesion toward the mitral valve was performed.

Incidence and Burden of Disease Following Cardiac Surgery

Incidence and Burden of Disease Following Cardiac Surgery
By ConvaTec Featuring Gorav Ailawadi

https://www.vumedi.com/video/incidence-and-burden-of-disease/

The sound is terrible.

Survival impact of major infection
10yr survuival after CABG
-without DSWI: 70%
-with DSWI: 39% !!!!

Timing of DSWI
POD30: Methicillin-sensitive 90%, Methicillin-resistant 50% !!!

Mitral Valve Repair – Barlow’s Disease

Mitral Valve Repair – Barlow’s Disease
By Piedmont's Marcus Heart Valve Center Featuring Randolph Martin, Federico Milla, Marcus Heart Valve Center
https://www.vumedi.com/video/mitral-valve-repair-barlows-disease/


33 yo male
Assessment TEE: A1 big prolapse at 30 degree and a cleft between P2&3 on 3D-TEE
Surgery:
at 1 st, annular sutures
Sliding of posterior
Artificial chordae x2 on A1 after ink on coaptation zone

Impact of Left Atrial Appendage Closure During Cardiac Surgery on the Occurrence of Early Postoperative Atrial Fibrillation, Stroke, and Mortality: A Propensity Score Matched Analysis of 10,633 Patients

Impact of Left Atrial Appendage Closure During Cardiac Surgery on the Occurrence of Early Postoperative Atrial Fibrillation, Stroke, and Mortality: A Propensity Score Matched Analysis of 10,633 Patients

http://www.ctsnet.org/jans/impact-left-atrial-appendage-closure-during-cardiac-surgery-occurrence-early-postoperative?utm_source=iContact&utm_medium=email&utm_campaign=CTSNet&utm_content=JANS+12%2F8%2F2016


Surprise!!!

In a propensity score matched retrospective analysis, LAA closure was independently associated with increased risk of early POAF and did not significantly influence the risk of stroke or long-term mortality.

LAA closure is not appropriate?
Most of patients with LAA closure would likely have preoperative Af and be performed arrhythmia surgery as well.
How about their interaction?
The subject is no arrhythmia?
We should check our data.

Valve-Sparing Aortic Root Replacement in Bicuspid Valve With Papillary Fibroelastoma

By Matthias Siepe

http://www.ctsnet.org/article/valve-sparing-aortic-root-replacement-bicuspid-valve-papillary-fibroelastoma?utm_source=iContact&utm_medium=email&utm_campaign=CTSNet&utm_content=Pulse+12%2F6%2F2016


Aortic valve-sparing root replacement (David procedure) in bicuspid valve 
using 180° commissure orientation and both cusp plications
A 34 mm straight Dacron graft (very short length!)
1st row: 5 mattress sutures in wach cusp
The base of the prosthesis and the coronary ostia were marked with radiopaque markers

Approach to Functional Mitral Regurgitation

Wednesday, November 30, 2016
By
Hans-Joachim Schäfers

http://www.ctsnet.org/article/approach-functional-mitral-regurgitation?utm_source=iContact&utm_medium=email&utm_campaign=CTSNet&utm_content=Pulse+12%2F6%2F2016

Result MVP=MVR?
Alfieri technique: alternatives
Which ring? complete
If Ring-Dilatation + tenting height >10 mm, MAP + String (CV-4 in PPM exteriorized through AML ring, aorto-mitral continuity)
Double string for DCM n=88

Recurrent Mitral Regurgitation in the OR: What to Do

Recurrent Mitral Regurgitation in the OR: What to Do
By AATS Mitral Conclave - Key Thoughts from World’s Leaders
https://www.vumedi.com/video/recurrent-mitral-regurgitation-in-the-or-what-to-do/

Points: Diagnosis, See TEE, What cause residual MR?, your surgery ineffective?
If possible, wait for 10-15 minmutes
As LV function was improving, MR chnage.

Valvular Regurgitation After Implantation Of Prostheses Secured With Cor-Knot Automated Fasteners

Valvular Regurgitation After Implantation Of Prostheses Secured With Cor-Knot Automated Fasteners
http://www.ctsnet.org/jans/valvular-regurgitation-after-implantation-prostheses-secured-cor-knot-automated-fasteners?utm_source=iContact&utm_medium=email&utm_campaign=CTSNet&utm_content=JANS+12%2F2%2F2016



New knot devise complication
Cor-Knot Automated Fasteners
http://www.lsisolutions.com/corknot

Total Aortic Arch Replacement With Vascular Ring Connectors in Type A Aortic Dissection

Total Aortic Arch Replacement With Vascular Ring Connectors in Type A Aortic Dissection
By Jeng Wei
https://www.vumedi.com/video/total-aortic-arch-replacement-with-vascular-ring-connectors-in-type-a-aortic-dissection/

Why vascular ring connector now?
developing ? Cheap?

Exercise + Cardiac Rehab: What's the Latest

Exercise + Cardiac Rehab: What's the Latest
By Pam Taub
https://www.vumedi.com/video/exercise-cardiac-rehab-whats-the-latest/

Improved mitochondrial function and increased NO production
1992 Circ Drexler

Using apps telemedicine
HFPef
PAD

Repair of Type V TAAA Using Selective Celiac, Superior Mesenteric, and Renal Artery Perfusion

Repair of Type V TAAA Using Selective Celiac, Superior Mesenteric, and Renal Artery Perfusion

• http://www.ctsnet.org/article/repair-type-v-taaa-using-selective-celiac-superior-mesenteric-and-renal-artery-perfusion?utm_source=iContact&utm_medium=email&utm_campaign=CTSNet&utm_content=Pulse+11%2F29%2F16
• 
  
• By　Konstadinos Plestis
• 78- male
• a symptomatic Type V thoracoabdominal aortic aneurysm
• A left retroperitoneal approach via the 8th intercostal space
• 4-0 prolene for branch anastomosis
• CSF drainage
• The left renal artery was anastomosed via a separate graft in an end-to-side fashion to the main graft after all anastomosises. 

Optimising vein graft outcomes

Optimising vein graft outcomes
John Pepper
http://www.ctsnet.org/article/optimizing-vein-graft-outcomes?utm_source=iContact&utm_medium=email&utm_campaign=CTSNet&utm_content=Pulse+11%2F29%2F16

Minimal information on type of anastomosis versus SVG failure
Endoscopic harvest  not good
Buffered solution good

Hybrid Repairs of Arch Aneurysms

Hybrid Repairs of Arch Aneurysms
http://www.ctsnet.org/article/hybrid-repairs-arch-aneurysms

Hybrid Repairs does not replace open repairs.
Why
for morbidity
hybrid results is not so good
the Critical complication : new type A dissection
Zero: WD Kent JTCVS 2014
Open mortality 14%!!

Proper selection of patients

Valve Sparing Aortic Root Replacement

Valve Sparing Aortic Root Replacement

By Gabriel Loor

https://www.vumedi.com/video/valve-sparing-aortic-root-replacement/

Indication: above 50mm

1st row 6 mattress sutures 2-0 pledget

Minimally Invasive Mitral Valve Repair of Bi-leaflet Prolapse

Minimally Invasive Mitral Valve Repair of Bi-leaflet Prolapse

By Hugo Vanermen

https://www.vumedi.com/video/minimally-invasive-mitral-valve-repair-of-bi-leaflet-prolapse/

MICS

1st: valve annular sutures (start from 10 o'clock)

2nd: assessment

He uesd pledgets and artificial chordae on anterior mitral valve to prevent malformation of leaflet.

Effect of aortic pericardial valve choice on outcomes and left ventricular mass regression in patients with left ventricular hypertrophy

Effect of aortic pericardial valve choice on outcomes and left ventricular mass regression in patients with left ventricular hypertrophy
J Thorac Cardiovasc Surg 2016;152:1291-8


I was surprised of the bigger difference than I expected.

Trifecta use was associated with significantly increased left ventricular mass regression and improved intermediate-term clinical outcome in patients with left ventricular hypertrophy undergoing AVR for AS, compared with use of the Perimount Magna Ease.

Because
The orifice area of Trifecta is bigger than that of Perimount Magna Ease. 

I should check our data.

Clinical Significance of Spontaneous Echo Contrast on Extracorporeal Membrane Oxygenation

http://www.annalsthoracicsurgery.org/article/S0003-4975(16)30914-6/fulltext


Spontaneous echo contrast (SEC)　= moyamoya echo

SEC on VA-ECMO resulted in an increased risk of intracardiac thrombus and stroke. Maintaining pulsatility while the patient is on ECMO may result in a decreased chance of developing SEC and stroke.


My Question
Maintaining pulsatility might lead to improve LV function and survival?

Distasl Bypassのこだわりの手術手技

第3回　関西血管外科倶楽部
Distasl Bypassのこだわりの手術手技

１
下腿切断後の義肢装具の固定位置を考慮しSVGを通す経路を考えたほうが良い。可能なら解剖学的経路。
下腿切断時（前）にBKバイパスは必要なのか。大腿動脈内膜摘除で十分ではないか。

2
Dual Bypass (Y-shape composite)
日本でしかされていない。本当にいいのかわからない。
遠隔期に片方が閉塞すると言われている。
CABGでは通常の手技。3本の冠動脈それぞれが独立しコネクションが少ないため。
Distasl Bypassではコネクション多いため意義が少ない。一方でAngiosomeという冠動脈に近い考え方もあるが、最近はやや言われなくなってきている。
SVGを採取した創は、閉じずに人工真皮で対応する。

大動脈解離に対する新しい治療戦略 ～現在, 過去, 未来～

大動脈解離に対する新しい治療戦略 ～現在, 過去, 未来～／Keys to a Durable
Endovascular Repair with TX2-PF　-TX2の特性を活かした留置のコツ-
演者：朝倉　利久・土肥　静之 先生
2016年10月1日（土）胸部外科学会ランチョンセミナー　

TEVAR

ゼニスTX2　プロフォーム　中枢側を後で開くことができる。中枢ランディングが困難な時に良さそう。
一個目のステントを開いた後、押し入れながら開くとステント間にシワができて良い。　ステントの元に戻る力が弱いため、大動脈へのかかる力が少ない。
大動脈の屈曲が強いとき、ステントはショートカットで入る。慢性期にリモデリングして外れる。ショートカットせず押しながら入れる。
ちょっと足りないとき　エクステンションが有用。1/5の価格。

ゼニスTX-D 解離用
TAG-Talent-Vaeiant-
ペチコートテクニック可能
入れ方は腹腔動脈上にエクステンションを2本下から入れて、上にDを入れる。最後に下を入れる。
ラピッドペーシング　上の造影がよく見える。上下にもピッグテイル造影用を入れておく。

心房細動治療の次なるステージへ ～小切開手術での可能性～

2016年9月28日（水）胸部外科学会ランチョンセミナー　
心房細動治療の次なるステージへ　 ～小切開手術での可能性～ ：藤田　知之　先生


心房細動に対する推奨度は、カテーテルアブレーションがI-IIaなのに対して、外科的メイズ手術はIIa (僧帽弁疾患の同時手術ならI）でおかしい。
また　カテならデバイス代の請求可　Opはできない。病院負担になる。

カテの奏効率　クライオ＞RF
メイズの際に注意すること。サイナスノード、横隔神経損傷。

CryoICE
新しいデバイス：　速く温度が上下する。2分。一瞬で凍り外れる。先端の長さの調節可能。
メーカー推奨　従来のAtricureと組み合わせるのが良い。僧帽弁、三尖弁周囲。
短所は経済面。しかし楽、速い。

LAAのデバイス　
基部であればあるほど良い　手前の付け根を電メスで剥離。

RFの種類
メドトロ　アルゴン　弱い
センチュリー　N2O　強い

冠動脈損傷が怖い　一般的にはほとんどない。
安静期に内膜肥厚　５０％狭窄が起こる　三尖弁側　RCA

The Future of Aortic Stenosis: Sternotomy, Minimally Invasive, or TAVR?

The Future of Aortic Stenosis: Sternotomy, Minimally Invasive, or TAVR?

https://www.youtube.com/watch?v=ZRilu5WOxgA&list=PLC9uVfWun4-QcEPD2CJKbW4imsaZ9LLYz&index=4

Many options
Gold standard is AVR through stenotomy!
Trials of TAVI will show the answers,
So far, TAVI mortality 1%, stroke less than 1%!!!

大動脈弁逆流制御における弁輪縫縮の役割 小宮先生

第３回九州心臓弁膜症カンファレンス
日本ライフライン社提供DVD

大動脈弁逆流制御における弁輪縫縮の役割　小宮先生
Annulus 20-24mm
外側からシェファーズ・スティッチ

Apical Edwards SAPIEN 3 Transcatheter Mitral Valve Replacement

Apical Edwards SAPIEN 3 Transcatheter Mitral Valve Replacement
Tuesday, August 9, 2016
By
Ilir Hysi
Olivier Fabre

https://www.youtube.com/watch?v=dULr6GMh_hk&list=PLC9uVfWun4-QcEPD2CJKbW4imsaZ9LLYz&index=5
http://www.ctsnet.org/article/apical-edwards-sapien-3-transcatheter-mitral-valve-replacement

81F
MVR Mosaic 27 in 2009
Severe MR
Transapical, Mitral!!!, Valve in valve

New stentress valve SOLO SMART

New stentress valve SOLO SMART

Japan Lifeline社提供　DVD
ステントレス生体弁SOLO SMARTの使用経験
宮崎病院　金城先生

86F　AS+ Asc Ao dilatation

Operator head camera

1, Valve resection
2, Stay sutures for commissure x3, 4-0 prolene?
3, Valve sizing
4, Marking commissures with violete pen
5, Stay sutures for nadias
6, Cuff sutures x6 tie
7, Nadia-commissure suture (x8?x6) like reimplantation
8, Valve holder remove

Very similar to Ozaki method

Rarely Seen Surgical Footage of Carcinoid Heart Disease By Piedmont's Marcus Heart Valve Center Featuring Federico Milla

Rarely Seen Surgical Footage of Carcinoid Heart Disease
By Piedmont's Marcus Heart Valve Center Featuring Federico Milla

https://www.vumedi.com/video/rarely-seen-surgical-footage-of-carcinoid-heart-disease/



66F Carcinoid syndrome
Severe TR & Severe PR
PVR + RV outflow reconstruction + TVR
on-pump beating

Clampless Technique in Open Revascularization of Acute Mesenteric Ischemia

Clampless Technique in Open Revascularization of Acute Mesenteric Ischemia


http://www.ctsnet.org/article/clampless-technique-open-revascularization-acute-mesenteric-ischemia?utm_source=iContact&utm_medium=email&utm_campaign=CTSNet&utm_content=Pulse+9%2F13%2F16


The PAS-Port Proximal Anastomotic System (Cardica Inc., Redwood City, CA) creates sutureless proximal aortic anastomoses without the need for cross-clamping, although its use elsewhere in the body has not been reported.

Proximal anastomosis: abdominal aorta below diaphragm above liver

ASのエコー診断

ASエコー　
Real ASの診断が大切　測定誤差の可能性も考慮しないといけない。
poor LV function : classical 昔から知られているAS末期の状態: low outputのために大動脈弁が広がらない。ドブタミン負荷でわかる
preserved LV function: paradoxical : LV小さい
動脈硬化で後負荷が増加。CI減少。よくわかっていない。中等度AS、Hefpefも入っていると考えられている。心筋疾患？ドブタミン負荷、運動負荷でもわからない。
最近は弁口面積より圧較差を重視している。

Debate Topic: 65-year-old Male with Severe Bi-Leaflet Prolapse: Midline Approach vs. Mini-Thoracotomy

By AATS Mitral Conclave - Key Thoughts from World’s Leaders Featuring Hugo Vanermen, Patrick McCarthy

https://www.vumedi.com/video/debate-topic-65-year-old-male-with-severe-bi-leaflet-prolapse-midline-approach-vs-mini-thoracotomy/?utm_campaign=Top+5+Trials+in+Peripheral+Vascular+Disease&utm_term=Surgery+-+Cardiac&utm_content=Debate+Topic%3A+65-year-old+Male+with+Severe+Bi-Leaflet+Prolapse%3A+Midline+Approach+vs.+Mini-Thoracotomy+&utm_source=USER+cardiac+%26+thoracic+surgery_13536&mail_id=13536&utm_medium=Video&token=0526aafa-7395-4333-84be-2f4cc492ec29

Approach: Team, Safety, Comfotable for surgeon, MAC

Posterior Middle Segment Prolapse Repair - Triangular Resection

Posterior Middle Segment Prolapse Repair - Triangular Resection
By Mitral Foundation Featuring David Adams, Javier Castillo, Percy Boateng

https://www.vumedi.com/video/posterior-middle-segment-prolapse-repair-triangular-resection/

1. Annular suture
2. P2 resection
3. Valve suture continuous 5-0 x2
4. Ring
5. Test ink

Mitraclip case

Challenging Case Direct Myocardial Revascularization
By Scottsdale Interventional Forum 2015 Featuring Saibal Kar

https://www.vumedi.com/video/challenging-cases-dmr/

Mitraclip case?

85yo Male　Post CABG　NYHA3
eccentric MR PISA1.1 EVOA0.42
severe MAC  no MS
Bi leaflet prolapse

Mitraclip x2 (medial side)

Robotic Mitral Valve Surgery: Current Status and a Look into the Future

Robotic Mitral Valve Surgery: Current Status and a Look into the Future
By AATS Mitral Conclave - Key Thoughts from World’s Leaders Featuring Rakesh Suri

https://www.vumedi.com/video/robotic-mitral-valve-surgery-current-status-and-a-look-into-the-future/

Echocardiography was improved
Mitral physiology
500 pts long term f/u
Team, Learning-curve

Valve selection for AVR

Edwards社提供　2015年胸部外科学会　ランチョンセミナー　2015/10/18
Tirone David
Valve selection for AVR

No interactions with valve type
Age, LV function, CAD, preoperative NYHA, co-mobilities affect survival
Durability of tissue valve highly depend on pt's age
TAVI: comparative mortality (AVR)

Cabrol Technique for Composite Replacement of the Aortic Valve and Ascending Aorta

Cabrol Technique for Composite Replacement of the Aortic Valve and Ascending Aorta

https://www.vumedi.com/video/redo-aortic-surgery-the-cabrol-technique/


47 yo man
tyoe A dissection repair 13 years ago
heart failure

Severe AR + pseudoaneurysm 7.2cm of Asc Ao.

Cabrol technique: 8mm Dacron graft + 5-0 prolene
1, RCA end to end
2, LCA end to end
3, Proximal anast
4, Distal anast
5, side to side of grafts

Good
no need mobilization of coronary button
Bad
patency

What is the Risk of Adding Aortic Replacement to Cardiac Surgery?

What is the Risk of Adding Aortic Replacement to Cardiac Surgery?
By Cleveland Clinic Heart and Vascular Institute

https://www.vumedi.com/video/what-is-the-risk-of-adding-aortic-replacement-to-cardiac-surgery/


Matched pair study might lead misunderstandings because there were no high risk patients.

Asc Ao did not add risk to cardiac surgery.
Circulatory arrest add risk? No!
The unmatched patietns ' orange'

Minimally Invasive Aortic Valve Replacement via Anterolateral Thoracotomy

https://www.youtube.com/watch?v=AjdL0JagAKI

right thracotomy no thracoscope 7cm skin insion
Venous cannulation (right atrium) from another skin incision site (thoracotomy)
Arterial cannulation was inserted through asc. aorta by using of with a 19 F uncoated ECMO cannula
No groin cannulations
Sutureless valve (Edwards intuity) : just three suture at commisures

Good
Central cannulation, no groin cannulations
Less bleeding and infection
Cosmetic

Bad
Postoperative pain?
Sacrifice of RIMA
Difficult technique

Questuion
need differential lung ventilation?

Ischemic MR By AATS Mitral Conclave - Key Thoughts from World’s Leaders Featuring Robert Dion

Ischemic MR By AATS Mitral Conclave - Key Thoughts from World’s Leaders Featuring Robert Dion

  https://www.vumedi.com/video/ischemic-mr/?utm_campaign=Endovascular+Revascularization+of+Left+Renal+Artery+Live+Case&utm_term=Mitral+Valve+Surgery&utm_content=Ischemic+MR+&utm_source=USERS+cardiac+surgery_13586&mail_id=13586&utm_medium=Video&token=d462012e-c84d-418e-8420-2fc430106105



Ischemic MR : Controvetial Because LV function is not so good

LVED 65: magic number
Less than 65: Annuloplasty OK
Over 65: need additional procedure (Relocation or suspention of posterior PM, PM approximation, augumantation of P2-3)
Try repair (not recommend replacement)

  http://webcast.aats.org/2013/files/Saturday/20130504_balla_1330_14.20%20Robert%20A.%20Dion.pdf