Introduction

Article Outline

• Distal Arch Aneurysm Repair—Open or Endovascular?
• Congenital Tracheal Stenosis
• Carinal Pneumonectomy
• Copyright

This issue of Operative Techniques in Thoracic and Cardiovascular Surgery describes alternative approaches to three important cardiothoracic surgical problems: (1) distal aortic aneurysm repair; (2) congenital tracheal stenosis; and (3) carinal pneumonectomy. We hope the reader will enjoy the description of these different approaches from groups with particular interest and expertise in these areas.

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Distal Arch Aneurysm Repair—Open or Endovascular? 

Repair of aneurysmal disease of the distal aortic arch and upper descending thoracic aorta is among the most challenging problems we face. The repair can be technically complex, and the risk of significant neurologic morbidity is sizable. Of late, however, technical advancements have been made in approaches to both open and endovascular repair. In this issue, we contrast the open approach developed by Ogino and colleagues in Osaka with a hybrid open/endovascular repair used by Coselli and associates at Baylor/Texas Heart. We believe these descriptions, provided by two of the most experienced aortic surgical units in the world, will serve as a basis for discussion and debate over the optimal approach to these lesions.

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Congenital Tracheal Stenosis 

Congenital tracheal stenosis is characterized by complete tracheal rings with obstruction and encompasses a wide range of anatomic configurations. It may be associated with a variety of non-airway anomalies, most notably a pulmonary artery sling. Historically, technical approaches to congenital tracheal stenosis have included dilation, resection, pericardial or cartilage tracheoplasty, tracheal prostheses, and homografts. The variety of these approaches is a testament to the difficulty in achieving success with any single technique. Two of the more recent approaches are described in this issue. Drs. Backer, Holinger, and Mavroudis from Children’s Memorial Hospital, Chicago illustrate the tracheal autograft, a technique that they originated. Dr. Manning from Cincinnati Children’s Hospital presents the use of slide tracheoplasty. Both articles emphasize the importance of a multidisciplinary pediatric airway program, which includes the presence of a pediatric cardiac surgeon and an otolaryngologist in the operating room.

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Carinal Pneumonectomy 

A carinal pneumonectomy for either a primary tracheobronchial neoplasm or lung cancer is a formidable operation that requires experience, judgment, and technical expertise. Although these operations are indicated in a small number of patients, it is vitally important for those surgeons who are considering performing this operation to have a technical guide to help them in their planning. This issue provides classic descriptions of both left and right carinal pneumonectomies as well as a right lung parenchymal-sparing carinal pneumonectomy with reimplantation of the bronchus intermedius into the left main bronchus. Drs. Banki and Wood from the University of Washington describe the different approaches to performing a left carinal pneumonectomy, with an emphasis on the left thoracotomy approach. This is a superb, well-illustrated article that highlights the important technical points of this procedure. The companion article on right carinal pneumonectomy is written by Dr. Paolo Macchiarini from Barcelona, Spain and is remarkable for its clarity, superb illustrations, and intraoperative photographs. An added bonus in this article is the description of the techniques of reimplanting the right bronchus intermedius into the left main bronchus following a right carinal pneumonectomy. Collectively, these two contributions provide perhaps the best, and certainly the most current, illustrated descriptions of these procedures available today.