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Basic Clinical & Surgical

Disclaimer: All material on this page at the current time will take you to the CTSNet. CSiI or its members have not contributed to any material provided as external link on this page. It has been collated here for the convenience of our students in accredited courses in Cardiovascular and Thoracic Surgery in India. CSiI gratefully acknowledges the contributions by all the authors on CTSNet. Admin

Basic Clinical and Surgical

Newest (latest): At the end of each section


General (1)
1. Glycemic Control, Cardiac Surgery, and Infection Glycemic control after cardiac surgery has been somewhat controversial. Congenital heart defects are the most common birth defects in children with relatively higher postoperative morbidity and mortality are relatively high. Tight glucose control has been hypothesized as a potential mode for preventing or reducing morbidity and mortality. The incidence of hyperglycemia (≥ 126 mg/dL) has been reported to be as high as 90% in some studies. In a study performed in post-cardiac surgery pediatric intensive care unit by Vlasselaers et. al. (Intensive insulin therapy for patients in paediatric intensive care: a prospective, randomised controlled study. Lancet. 2009;373:547-556.) showed that normalizing glucose postoperatively can reduce mortality from 6% to 3%, shorten length of stay, and reduce overall morbidity. A contrasting study published by Agus et. al. (Tight glycemic control versus standard of care after pediatric surgery. N Engl J Med. 2012;367:1208-1219) cardiac surgery patients in two different US centers undergoing cardiopulmonary bypass suggets a different view point. In the study, investigators maintained an aim to achieve a blood glucose of 80-110 mg/dL. They used a subcutaneous glucose monitor and an explicit insulin dosing algorithm. They enrolled 989 patients, 9 of whom were excluded, for a total of 980 children up to 3 years of age. A total of 24 healthcare-associated infections occurred in both groups, with no difference between groups (8.6 vs 9.9 infections per 1000 patient days). Although they normalized glucose more rapidly (6 hours vs 16 hours)
postoperatively, and normoglycemia was maintained for a greater proportion of critical illness phase (50% vs 33%), they still were unable to achieve a significant reduction in healthcare-associated infections. This study shows that a normalization of blood glucose postoperatively in pediatric cardiac surgery patients in the intensive care unit has no impact on postoperative morbidity or mortality. Tight glucose control can raise the risk for hypoglycemia (which was actually rare in this study at 3%) and doesn't produce any benefit for these post-cardiac surgery patients.

2.Vitamin D deficiency is associated with poor outcomes anincreased mortality in severely ill patients. Vitamin D plays a seminal role in many homeostatic mechanisms. In this study, assessement of the correlation between circulating vitamin D levels and mortality rates in critically ill patients is made indicating that low vitamin D levels are common among patients admitted to ICU. Study observed longer survival times among vitamin D sufficient patients. Results indicate that vitamin D concentration may be either a biomarker of survival or a co-factor.

3. Carbon dioxide field flooding reduces neurologic impairment after open heart surgery.
Air emboli released from incompletely deaired cardiac chambers may cause neurocognitive decline after open heart surgery. Carbon dioxide (CO2) field flooding is reported to reduce residual intracavital air during cardiac surgery. A protective effect of carbon dioxide insufflation on postoperative brain function remains unproven in clinical trials. Shorter P300 peak latencies after surgery indicate less brain damage in patients who underwent heart valve operations with CO2 flooding of the thoracic cavity. Even if these findings were not supported by clinical results or neurocognitive test batteries in our cohort, carbon dioxide field flooding has proven efficiency and should be advocated for all patients undergoing open heart surgery.

4. October 14, 2014 (Newest) Insertion and Removal of the Intra-Aortic Balloon Pump

Intra-aortic balloon pump (IABP) counterpulsation has emerged as one of the most effective and most frequently employed methods of mechanical circulatory support. Specifically, it relies on the twin concept of diastolic augmentation and afterload reduction to facilitate the functioning of an ischemic and failing myocardium. The concept was originally proposed by Moulopoulos et al in 1962 and documented improvement in hemodynamic parameters in an experimental animal model. The first clinical report of human use by Adrian Kantrowitz appeared 6 years later in 1968. In the last 4 decades, there have several technological evolutions, which every student and cardiac surgeon must be aware. 

Congenital (7)
  1. Modified Fontan by Glenn J. Pelletier, MD and Marshall L. Jacobs, MD
  2. PTFE Monocusp Valve for RVOT Reconstruction by Mark W. Turrentine, MD
  3. Aortic Implantation for Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery by Carl L. Backer, MD and Constantine Mavroudis, MD
  4. Brom Aoroplasty for Supravalvar Aortic Stenosis by Carl L. Backer, MD
  5. The Gerbode Defect: A Ventriculo-Atrial Defect By Angela M. Kelle, Luciana Young, MD, Sunjay Kaushal, MD, et al
  6. Longer-term survival and health outcomes for children living with congenital heart defects. Paediatrics and Child Health by Knowles Rachel L et al. (Journal subscription required for full article) Abstract: Cardiac function as measured objectively poorly predicts children's activity in daily life and some children are actively limited by personal habit or family concern, which is often inappropriate. Enough is now known about the prevalence of problems that survivors of childhood cardiac surgery experience in the education system that support may be justified, even when the original cardiac condition is no longer an ongoing problem. As mortality after major cardiac surgery in early childhood falls, it becomes clearer that there is a high prevalence of ‘non-cardiac’ problems in survivors. Patient support groups for cardiac children have long lobbied for better access to general paediatric expertise and upcoming organizational changes underwrite this.
  7. Recent update (Review article): Tetralogy of Fallot repair: Optimal z-score use of transannular patch insertion (TAP). Transannular patching is often required to relieve significant pulmonary annular stenosis during TOF repair. Although recent literature has focused on the deleterious effects of pulmonary regurgitation, inadequate relief of stenosis may increase postoperative morbidity and mortality and re-intervention rate. Patching criteria based on standard pulmonary annular z-score are ambiguous because of the use of varied z-score datasets. This study aims to generate data that could be used to optimise z-score use for patch insertion Criteria that recommends a TAP insertion only when the PA diameter z-score is significantly smaller than -1.3 (i.e. z= -3) may result in significant numbers of patients with an acceptable post-repair gradient.
Adult Cardiac (26)
  1. Left Ventricular Assist Device Exchange: Replacement of a HeartMate XVE with a HeartMate II Device by Mehmet H. Akay, MD, Igor D. Gregoric, MD, William E. Cohn, MD, and O. H. Frazier, MD 
  2. Ascending-To-Descending Aortic Bypass For Coarctation of the Aorta by John S. Thurber, MD, Subrato J. Deb, MD and Lucas R. Collazo, MD 
  3. Off-Pump Insertion of the Jarvik 2000 Left Ventricular Assist Device by Craig H. Selzman, MD 
  4. Technique for Percutaneous Transfemoral Stent Graft Repair of Traumatic Aortic Transection by Howard K. Song, MD, PhD, Matt S. Slater, MD and John Kaufman, MD
  5. Bilateral VATS Pulmonary Vein Isolation, Left Atrial Appendage Excision, Directed Partial Cardiac Denervation and EP Mapping (MiniMAZE-Wolf Technique) by John R. Mehall, MD, E. William Schneeberger, MD and Randall K. Wolf, MD 
  6. Valve Sparing Aortic Replacement ? Root Remodelling by Hans-Joachim Schaefers, MD 
  7. VATS Transmyocardial Laser Revascularization (TMR) For Patients With Endstage Coronary Artery Disease (CAD) by Gary S. Allen, MD 
  8. Aortic Valve Repair for Aortic Insufficiency by Stephen H. McKellar, MD and Kenton J. Zehr, MD 
  9. Valve Sparing Aortic Root Replacement with Aortic Valve Re-Implantationby George Tolis Jr., MD 
  10. Completely endoscopic microwave ablation of atrial fibrillation on the beating heart using bilateral thoracoscopy by Adam E. Saltman, MD, PhD 
  11. Surgical Options for Total Aortic Arch Replacement Utilizing a Trifurcated Vascular Graft and Individual Head Vessel Re-implantation by George Tolis Jr., MD
  12. The Cryosurgical Maze Procedure by Niv Ad, MD 
  13. Electrical Isolation of the Pulmonary Veins With Bipolar Radio Frequency Ablation on the Beating Heart by S. Thomas Rayburn III, MD
  14. The Edge-To-Edge Technique For Barlow’s Disease by Francesco Maisano MD and Ottavio Alfieri MD 
  15. Repair of an Anterior Postinfarction Ventricular Septal Rupture by the Technique of Infarct Exclusion by John Alfred Carr, MD, Jonathan David Hoffberger, DO and Edward B. Savage, MD 
  16. Implantation of the Syncrus(TM) Internal Cardioversion System for Postoperative Atrial Fibrillation by Amit N. Patel MD, MS, Robert F. Hebeler Jr. MD, Baron L Hamman MD, et al 
  17. Modified Endoventricular Circular Plasty (Dor procedure) by Patrick M. McCarthy, MD and Christiano Caldeira, MD 
  18. Mitral Valve Repair by Robert Riley, MD and Neal D. Kon, MD 
  19. Freestyle(R) Aortic Root Bioprosthesis: Modified Subcoronary Insertion Technique by G. Michael Deeb, MD 
  20. Minimally Invasive Mitral Valve Repair Surgery Through a Lower Mini-Sternotomy by Lawrence A. Cohn, MD 
  21. Off Pump Coronary Artery Bypass (OPCAB) by Marco A. Zenati, MD 
  22. Stentless Xenograft Aortic Valve Replacement: Subcoronary insertion of the Toronto SPV valve by Edward R. Ferguson, MD 
  23. Minimally Inavsive Aortic Valve Surgery by Delos M. Cosgrove, MD 
  24. Heart Transplant Donor Retrieval Protocol by Edward B. Savage, MD 
  25. Aortic Valve Replacement with a Homograft Valve by Donald B. Doty, MD.
  26. Latest: Differences in Performance of Five Types of Aortic Valve Prostheses by Jeffrey P Khoo et. al, Heart. 2013;99(1):41-47.

Thoracic (49)
  1. Robotic Thymectomy via Right Chest ApproachBy Brian E. Louie, MD, Eric Vallières, MD, Ralph W. Aye, MD, and Alexander S. Farivar, MD
  2. Technical Options In Carinal Resection And Reconstruction by Marco Schiavon, MD, Giuseppe Marulli, MD, PhD, Fabio De Filippis, MD, et al 
  3. Robotic Thoracoscopic First Rib Resection for Paget Schroetter Disease byMark Meyer, MD, Farid Gharagozloo, MD, Marc Margolis, MD, et al 
  4. Robotic Right Upper Lobectomy by Alexander S. Farivar, MD, Oliver Wagner, MD, Eric Vallieres, MD, et al 
  5. Video-Assisted Harvest of an Intercostal Muscle Flap by Brandon H Tieu, MD and Mithran Sukumar, MD 
  6. Transcervical Extended Mediastinal Lymphadenectomy by Sai Yendamuri MBBS, FACS and Todd L. Demmy MD, FACS 
  7. Veritas® and STRATOS™: An Innovative Paradigm for Chest Wall Reconstruction With a Biological Patch and Titanium Bars by Marco Scarci, MD, FRCS, Andrea Bille, MD, Imran Zahid, BA, and Tom Routledge MA, FRCS(Cth) 
  8. Pericardial Reconstruction in Thoracic Surgery by Teodor Horvat, MD and Daniel Fudulu, MD 
  9. Exposure of the cervical esophagus by Christopher B. Komanapalli, MD, James Cohen, MD, PhD and Mithran S. Sukumar, MD
  10. Endobronchial Ultrasound (EBUS) Biopsy of Mediastinal Lymph Nodes by David C. Rice, MB, BCh, FRCSI 
  11. Stent Placement and Catheter-Directed Thrombolysis in SVC Syndrome by Paul S. Lajos, MD and Richard C. Pennell, MD 
  12. Postero-Lateral (Shaw-Paulson) Approach to Pancoast Tumor by Federico Rea, MD, Giuseppe Marulli, MD and Francesco Sartori, MD 
  13. Thoracotomy for Exposure of the Spine by Christopher B. Komanapalli, MD, Jorge L. Eller, MD and Mithran S. Sukumar, MD 
  14. Surgical Management Of Epiphrenic Diverticula by Subrato J. Deb, MD and Claude Deschamps, MD 
  15. Video-assisted Extended Transcervical Thymectomy by Christopher B. Komanapalli, MD, James I. Cohen, MD, PhD and Mithran S. Sukumar, MD
  16. Thoracoscopic Management of Spontaneous Pneumothorax by Christopher B. Komanapalli, MD and Mithran S. Sukumar, MD 
  17. Thoracoscopic Decortication by Christopher B. Komanapalli, MD and Mithran S. Sukumar, MD 
  18. Thoracoscopic Pericardial Window by Christopher Komanapalli, MD and Mithran Sukumar, MD 
  19. Thoracoscopic Ligation of the Thoracic Duct by Mithran Sukumar, MD, Paul Schipper, MD and Christopher Komanapalli, MD 
  20. Thoracoscopic LVRS by Mithran S. Sukumar, MD, Paul H. Schipper, MD and Christopher B. Komanapalli, MD 
  21. Pericardial Fat Pad Flap Buttress by Christopher Komanapalli, MD and Mithran Sukumar, MD 
  22. Wedge Resection of Solitary Pulmonary Nodules Through Uniportal VATS by Gaetano Rocco, MD, FRCS (Ed), FECTS
  23. VATS Mediastinal Nodal Dissection by Michael J. Weyant, MD and Raja M. Flores, MD 
  24. How to help your patients stop smoking. A guide for surgeons by Carolyn M. Dresler, MD, MPA
  25. Surgical Stabilization of Severe Flail Chest by Christian Casali, MD, Giuseppe Fontana, MD and Uliano Morandi, MD 
  26. VATS Lobectomy for Early Stage Lung Cancer by Raja M. Flores, MD 
  27. Airway Stenting by Federico Venuta, MD , Erino A. Rendina, MD and Tiziano de Giacomo, MD 
  28. Laparoscopic Nissen Fundoplication by Mark E. Freeman, MD, Kevin L. Huguet, MD and Ronald A. Hinder, MD, PhD 
  29. Surgical Management of Primary Mediastinal Germ Cell Tumors by Raja M. Flores, MD 
  30. Resection of Symptomatic, Complex Aspergilloma by John C. Kucharczuk, M.D. and Larry R. Kaiser, M.D 
  31. Laparoscopic Myotomy and Fundoplication for Achalasia by Mary S. Maish, MD and Steven R. DeMeester, MD 
  32. Sternal Splitting Approaches to Thymectomy for Myasthenia Gravis and Resection of Thymoma by Sina Ercan , MD and Victor F. Trastek, MD 
  33. Bronchial and Pulmonary Arterial Sleeve Resection by Erino A Rendina, MD 
  34. Ligation of the Thoracic Duct for Chylothorax by Robert J. Cerfolio, MD
  35. Thoracoscopic Sympathectomy by Mark J. Krasna, MD and Xiaolong Jiao, MD
  36. Carinal Resection by Douglas J. Mathisen, MD 
  37. Minimally Invasive Endoscopic Repair of Pectus Excavatum by Jeffrey P. Jacobs, MD 
  38. Extrapleural Pneumonectomy by Daniel L. Miller, MD
  39. Videomediastinoscopy by Thomas M. Daniel, MD and David R. Jones, MD 
  40. Giant Bullous Emphysema by Federico Venuta, MD and Tiziano de Giacomo, MD 
  41. Esophagectomy with Three-Field Lymph Node Dissection by Nasser K. Altorki, MD
  42. Minimally Invasive Esophagectomy by Virginia R. Litle, MD and James D. Luketich, MD 
  43. VATS Major Pulmonary Resection by Anthony P.C. Yim, MD 
  44. Extended VATS Thymectomy for Myasthenia Gravis Extrapleural Pneumonectomy by Tommaso C. Mineo, MD and Eugenio Pompeo, MD 
  45. Laparoscopic Repair of Giant Paraesophageal Hernias by Andrew F. Pierre, MD and James D. Luketich, MD 
  46. Surgery of the Superior Vena Cava: Resection and Reconstruction by Federico Venuta, MD , Erino A. Rendina, MD and Giorgio F. Coloni 
  47. Transhiatal Esophagectomy by Edward McCarron, MD, John R. Doty, MD and Richard F. Heitmiller, MD 
  48. Transcervical Thymectomy for Myasthenia Gravis by Bryan F. Meyers, MD and Joel D. Cooper, MD
  49. New Technological Approach to Pulmonary Nodulectomy by Anthony P.C. Yim, MD 
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