Introduction

Article Outline

• The Test of Time or the Gold Standard
• Aortic Translocation: The Nikaidoh Operation
• Video-Assisted Thoracic Surgery Pulmonary Resections
• Copyright

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The Test of Time or the Gold Standard 

This section contains two articles on composite valve-graft replacement (CVG) of the aortic root. Gleason presents a thorough treatise on the subject, including a description of the alternative methods of aortic root replacement, as well as a germane discussion of the indications for surgery for aneurysm of the aortic root and ascending aorta. Girardi also provides a comprehensive description of the topic. He also includes some interesting historical perspective regarding the evolution of techniques for CVG, and details the manner by which the current “exclusion” technique was derived. He also describes a technique for a biologic CVG for elderly patients, or those wishing to avoid lifelong anticoagulation. Both articles are well-illustrated and contain the respective author's insights regarding the safe performance of this operation.

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Aortic Translocation: The Nikaidoh Operation 

The congenital section of this issue is devoted to aortic translocation, or the Nikaidoh operation. This innovative procedure provides an alternative to the Rastelli and REV (reparation l'etage ventriculaire) procedures for biventricular repair in patients with transposition of the great arteries, ventricular septal defects, and pulmonary stenosis. Depending on the surgical approach, aortic translocation can include components of the Ross, Konno, and arterial switch procedures. Points of technical variation include mobilization of the aortic root on a beating heart, reimplantation of one or both coronary arteries, use of the LeCompte maneuver, and placement of a valve in the right ventricular outflow tract. Steven Leonard and Hisashi Nikaidoh from Children's Medical Center Dallas present the approach they have used since Dr. Nikaidoh's original report in 1984. Victor Morell and Peter Wearden from Children's Hospital of Pittsburgh present a contrasting approach. These two articles provide excellent illustrations of the surgical options available in performing aortic translocation.

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Video-Assisted Thoracic Surgery Pulmonary Resections 

In this edition of Operative Techniques in Thoracic and Cardiovascular Surgery we highlight two video-assisted minimally invasive approaches to anatomic resection of the lung. While still slow to be adopted by many thoracic surgeons, there is no question that advances in instrumentation and surgical approaches are steadily enhancing the ability of surgeons to perform these resections minimally invasively. In the first article Dr. Tommy D'Amico describes his approach for performing thoracoscopic segmentectomies. Dr. D'Amico is a champion for video-assisted thoracic surgery approaches to lung disease, particularly lung cancer, and this article offers the reader a simple, yet complete, description of how to perform a number of segmental resections. In the companion article Dr. Kemp Kernstine from the City of Hope describes his approach to performing robotic-assisted lobectomies. Use of the robot by thoracic surgeons has been very slow, largely secondary to cost, availability, instrumentation limitations, and the time required to perform these procedures. Dr. Kernstine has embraced the use of the robot in thoracic surgery and shares with us in detail how he and his team have integrated it into his practice. Collectively, these two articles emphasize how technologic advances have allowed thoracic surgeons to perform more complicated thoracic surgical procedures safely and with good results in a minimally invasive manner.