Introduction

Article Outline

• Pulmonary Thromboendarterectomy for Chronic Thromboembolic Pulmonary Hypertension: Low-Flow Bypass or Circulatory Arrest
• Obstructed Infraphragmatic Total Anomalous Pulmonary Venous Connection: Eversion Compared with In Situ Technique
• Lung-Sparing Operations
• Copyright

This issue continues our format of point/counterpoint, as described in the following paragraphs.

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Pulmonary Thromboendarterectomy for Chronic Thromboembolic Pulmonary Hypertension: Low-Flow Bypass or Circulatory Arrest 

Thanks to the pioneering efforts of a truly distinguished lineage of surgeons and pulmonologists at the University of California San Diego as well as from other institutions, pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension has become a realistic option for selected candidates. The mortality and morbidity remain considerable, and the learning curve is steep; however, the procedure has been sufficiently refined by the University of California San Diego team that it is now practiced at a number of centers at a considerable volume in the United States and throughout the world. In this issue, we have included a procedural description from Stuart Jamieson, unquestionably the most experienced surgeon at this procedure in the world, and a variation from Christopher McGregor, who learned the technique from Dr. Jamieson. The latter prefers to perform the operation under low-flow bypass when possible, whereas the former has been pleased with circulatory arrest and continues to rely on it. Both surgeons have important and practical insights to share with the reader who wishes to embark on developing a program in this procedure.

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Obstructed Infraphragmatic Total Anomalous Pulmonary Venous Connection: Eversion Compared with In Situ Technique 

The congenital topic contrasts two techniques for the management of the difficult problem of obstructed infradiphragmatic total anomalous pulmonary venous connection. These babies can present with a profound degree of cyanosis as well as systemic acidosis. Unlike virtually every other congenital anomaly, this problem cannot be palliated medically and urgent surgery is usually required. One approach that has been beautifully illustrated by Charles Fraser from the Texas Children’s Hospital is the “eversion” technique, in which the heart is lifted out of the pericardial well while an external anastomosis is fashioned between the confluence of pulmonary veins and the left atrium. Associate Editor Richard Jonas describes the contrasting technique, the so-called “in situ technique.” With this method, the heart is left in the pericardial well and the anastomosis is fashioned working from within the left atrium. We believe that readers will find that the back-to-back presentation of these alternative methods will help to clarify the advantages and disadvantages of these two techniques.

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Lung-Sparing Operations 

In common with those in other areas of surgical oncology, thoracic surgeons engage in a perennial controversy regarding the optimal oncologic operation for lung cancer; namely, how much lung should be resected? The traditional focus of this debate is patients with compromised lung function who will not tolerate a pneumonectomy or even a lobectomy. More recently, acceptance is growing for lung-sparing operations in patients with otherwise adequate lung function. In this issue, we describe two nonstandard parenchymal-sparing surgical approaches to lung cancer. As an alternative to lobectomy, Drs. Whitson, Andrade, and Maddaus describe anatomic segmentectomy using both a traditional posterolateral thoractomy and a minimally invasive approach. Drs. DeCamp and Ashiku describe sleeve resection as an alternative to pneumonectomy in patients with proximal or hilar lung cancers.

As I transition to Editor of The Journal of Thoracic and Cardiovascular Surgery, I have the distinct pleasure of turning over the editorship of Operative Techniques in Thoracic and Cardiovascular Surgery to Dr. Fred Crawford from the Medical University of South Carolina in Charleston. I wish him well, and I am confident he will do an outstanding job. I would also like to thank the managing editor of Operative Techniques, Pamela Fried, and her associate, Meg Etherington, for excellent editorial support. To the Associate Editors, Drs. Jonas, Sundt, and Mentzer, my sincerest thanks for their support and commitment. Most important, I thank our authors and readership, who have made my role as Editor quite gratifying.