Introduction

Article Outline

• Right Ventricular Outflow Tract Reconstruction
• Sleeve Lobectomy and Robotic Segmentectomy
• Aortic and Mitral Valve Endocarditis: Surgical Approaches to Complex Lesions
• Copyright

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Right Ventricular Outflow Tract Reconstruction 

Reconstruction of the right ventricular outflow tract continues to occupy a significant portion of the congenital heart surgeon's time and is likely to do so until tissue-engineered conduits achieve clinical use. The congenital section of this issue contains 3 articles pertaining to this topic. Makato Ando, from the Sakakibara Heart Institute, Tokyo, describes freehand construction of a trileaflet polytetrafluoroethylene valve within a Dacron conduit. A.K. Kaza, from Primary Children's Medical Center, Salt Lake City, describes the details of placement of the stentless porcine aortic root in the outflow tract. George Alfieris, from the University of Rochester, covers his approach to the outflow tract in the setting of truncus arteriosus. This unique approach is aimed at maintaining the architecture of the branch pulmonary arteries. The surgical options for right ventricular outflow tract reconstruction are numerous. These 3 approaches add to those previously covered in the Winter 2008 issue of Operative Techniques in Thoracic and Cardiovascular Surgery.

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Sleeve Lobectomy and Robotic Segmentectomy 

Parenchymal-sparing operations for lung cancer are increasingly important techniques for thoracic surgeons to incorporate into their practices. In this edition of Operative Techniques, Dr. Cerfolio, from the University of Alabama-Birmingham, describes his approach for performing segmentectomies using a left posterior segmentectomy performed with the assistance of the robot as an example. In the companion article, Drs. Isbell and Jones, from the University of Virginia, describe their approach for performing a sleeve resection of all the lobes of the lung. Both of these articles have excellent artwork illustrating the anatomy of the resections, and both provide appropriate advice to the reader regarding some of the nuances of the techniques.

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Aortic and Mitral Valve Endocarditis: Surgical Approaches to Complex Lesions 

The topic for the adult cardiac surgery section of Operative Techniques for the Fall issue of 2011 is surgery for endocarditis of the aortic and mitral valves. Ikonomidis describes “Surgery for Aortic Valve Endocarditis,” including numerous techniques for debriding, patching, and otherwise repairing aortic leaflets, debriding annular abscess(es), and replacing the valve with either mechanical or bioprosthetic devices, or, in extreme cases, an aortic homograft. In addition, this author presents a novel technique for managing massive bleeding following these challenging operations. Ramlawi and Reardon describe their approach to “Endocarditis Involving the Aorto-Mitral Curtain.” A careful depiction of the anatomy of this complex area of the heart is presented. Techniques for dealing with infections of various depths of penetration and complexity are included. Again, the emphasis is on adequate debridement. The necessary techniques for reconstruction of this intricate area of the heart are provided. These are elegant techniques and are very well described and illustrated. These techniques can include the use of aortic homografts, and, in extreme cases, total allograft double-valve replacement procedures.