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.