Introduction

Article Outline

• Hybrid Procedures for Hypoplastic Left Heart Syndrome: Columbus versus Nemours Approach
• Surgical Staging of the Mediastinum for Nonsmall Cell Lung Cancer
• Surgery for Aortic Dissection: Open for Ascending Dissection, Open versus Endovascular for Descending Dissection?
• Copyright

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Hybrid Procedures for Hypoplastic Left Heart Syndrome: Columbus versus Nemours Approach 

The hybrid approach to hypoplastic left heart syndrome provides one of the most innovative additions to our field over the last decade. It offers the potential advantages of avoiding an operation with cardiopulmonary bypass in the neonatal period. The hybrid approach requires close collaboration between surgeon and interventional cardiologist. It also requires planned coordination between the first and second stage procedures. Mark Galantowicz from Nationwide Children's Hospital and Christian Pizarro from the Nemours Cardiac Center present their respective approaches. Each article provides the reader with a detailed description of the technical steps for both the first and second stages of the hybrid approach.

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Surgical Staging of the Mediastinum for Nonsmall Cell Lung Cancer 

In this edition of Operative Techniques in Thoracic and Cardiovascular Surgery, 2 superb descriptions of the techniques used to surgically stage the mediastinum for patients with nonsmall cell lung cancer are provided. With the explosion of positron emission tomography/computed tomographic imaging, nonsurgeons have questioned the utility of performing these procedures despite overwhelming evidence of their long record of correctly staging the mediastinal nodes and the safety of the procedures. In the first article, Dr. Crabtree from Washington University provides a clear, concise description of endobronchial ultrasonography with fine-needle aspiration. His group has a large amount of experience with this technique and some of the salient points mentioned are very helpful to those beginning to use this procedure in their practice. In the companion article, Drs. Siracuse and DeCamp review the gold standard techniques of surgical staging of the mediastinum—mediastinoscopy and anterior mediastinostomy. Their article also discusses the role of video-mediastinoscopy and thoracoscopic nodal biopsy. Collectively, these are 2 operative techniques descriptions that every thoracic surgeon needs to be familiar with and should have well incorporated into their clinical practices.

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Surgery for Aortic Dissection: Open for Ascending Dissection, Open versus Endovascular for Descending Dissection? 

In the Adult Cardiac Surgery section of this issue of Operative Techniques in Thoracic and Cardiovascular Surgery, surgical approaches to acute aortic dissection are described. Technique for open surgical repair of type A (ascending) aortic dissection is presented by the Associate Editor. The most common scenario is depicted in detail, namely resuspension of the aortic valve and supracoronary Dacron graft replacement of the ascending aorta with open distal technique. The principles of cannulation, open distal aortic reconstruction, aortic valve resuspension, and terminal antegrade reperfusion are described. Scott Mitchell provides a treatise on the open surgical repair of type B (descending) aortic dissection. This author describes the indications for surgical intervention in these challenging patients. The operative details, including patient positioning, anesthetic management, intraoperative monitoring, and such, are nicely detailed. In addition, options for arterial inflow for cardiopulmonary bypass are described and illustrated. Circumstances warranting circulatory arrest for management of the proximal descending thoracic aorta are outlined, and the techniques are described and illustrated. Mitchell also describes the operative management of chronic descending dissection. Last, but not least, Joe Bavaria provides an excellent description of the endovascular treatment of acute descending thoracic aortic dissection. He describes the indications for intervention. Thoracic endovascular repair in the acute management of the dissected descending aorta is described and illustrated. The principles of the hybrid operating room and the management of a common malperfusion syndrome, namely limb malperfusion, are described. Details including specific catheters and wires, graft sizing, and the technical features of a successful stent graft deployment are depicted. Also discussed is the management of common complications of the endovascular approach.