Introduction

Article Outline

• Aortic Valve Repair: Surgery Tailored to Patient Anatomy
• The Arterial Switch Procedure: Closed versus Open Coronary Transfer
• Single Incision Thoracic Surgery: Uniportal Minimally Invasive Thoracic Surgery and Transcervical Extended Mediastinal Lymphadenectomy
• Copyright

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Aortic Valve Repair: Surgery Tailored to Patient Anatomy 

For the cardiac surgery portion of the Winter issue of Operative Techniques in Thoracic and Cardiovascular Surgery, we have three excellent articles detailing approaches to aortic valve repair. Professor Gebrine El Khoury presents a detailed treatise on his approach to aortic valve repair. He presents a systematic approach to the various types of valve and aortic pathologic conditions encountered and describes an approach of tailoring the repair approach to the pathologic condition encountered. Drs. Ikonomidis and Cameron focus on the valve-sparing aortic root replacement, describing their approach to aneurysms associated with trileaflet and bicuspid aortic valves, respectively. Ikonomidis describes the classic “T. David V” approach employing Dacron grafts of two different sizes, one for the aortic root reconstruction and one for the ascending aorta. He adds his own minor modifications that make this procedure more “user-friendly” for the operating surgeon. Cameron describes his technique for implantation of the Valsalva prosthesis for valve-sparing aortic root replacement. This has become the favored operation for Marfan patients at Johns Hopkins Hospital and is another of the many contributions to aortic root surgery that have emanated from that institution.

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The Arterial Switch Procedure: Closed versus Open Coronary Transfer 

The congenital section of this issue examines the operative technique of the arterial switch operation for transposition of the great arteries. Although it is now one of the “bread and butter” operations in neonatal heart surgery, the arterial switch remains a technically exacting operation, in which small details of the approach directly affect the outcome. This is particularly true of the approach to coronary artery reimplantation in the neoaortic root, for which there are two primary alternatives. Edward Bove from the University of Michigan presents closed coronary artery transfer, in which the coronaries are transferred after reconstruction of the neoaortic root. Dr. Bove was an early advocate of this approach, which allows precise selection of reimplantation sites in a distended neoaortic root. Joseph Forbess from Children's Medical Center Dallas presents open coronary transfer, in which coronary transfer is performed before neoaortic reconstruction. This approach allows clear visualization of the interior of the neoaortic root and the aortic valve during reimplantation. Both techniques are applicable to a wide range of anatomic variants and provide excellent options for the congenital heart surgeon.

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Single Incision Thoracic Surgery: Uniportal Minimally Invasive Thoracic Surgery and Transcervical Extended Mediastinal Lymphadenectomy 

Advances in technology are permitting the introduction of increasingly minimally invasive thoracic surgery to be performed. In the Winter edition of Operative Techniques in Thoracic and Cardiovascular Surgery, we have two articles that highlight this concept. In the first article Dr. Gaetano Rocco describes the single-port (uniportal) technique for performing a number of thoracic procedures including wedge resections, sympathectomies, pleural space procedures, and others. This technique is certainly applicable to many clinical situations and with minimal effort could be adopted by many thoracic surgeons. The companion article from Marcin Zielínski, is a superb description of transcervical extended mediastinal lymphadenectomy or TEMLA. This single-incision approach allows a very aggressive removal of all mediastinal nodes, regardless of station, with the exception of station 9. In addition, in highly select patients, other procedures such as thymectomies, esophageal procedures, and pulmonary resections have been performed using this incision. A unifying theme in both of these articles is the commitment and careful, thoughtful approach by both authors in working out the technical aspects of the procedures, as well as reporting their results in peer-reviewed journals.