The Beat With Joel Dunning Ep. 165: Valve-Sparing Aortic Root Replacement Techniques

In this episode of The Cardiac Recovery Room, moderator Rawn Salenger, Chief of Cardiac Surgery at the University of Maryland St. Joseph Medical Center, USA, spoke with T. Sloane Guy, a cardiovascular surgeon at Georgia Heart Institute at Northeast Georgia Medical Center, and Chase Brown, Director of Robotic Coronary Surgery at the University of Pennsylvania, USA, about robotics and enhanced recovery after surgery (ERAS). Chapters 00:00 New Cardiac Surgery Indication 04:59 Training, Mentorship 08:54 Robotics & ERAS Synergy 12:47 Need for Less Invasiveness 17:26 Accessible Training Pathway 19:16 Surgeon Commitment 19:56 Technique Innovation 23:04 Perioperative Phase They explore the growth of robotic systems, the increasing number of robotic systems gaining FDA approval, and resistance to the adoption of robotics. They also discussed training and learning robotics, the importance of mentorship, and what robotics adds to ERAS programs—and vice versa. Additionally, they examine nonrobotic endoscopic surgery, the challenges of establishing a robotic program, the importance of committing to robotics, and the advantages of robotic mitral valve surgery over minithoractomy. The Cardiac Recovery Room is the place to hear the conversations colleagues are having after the meetings. Each month, a new episode featuring a leadership panel from the ERAS Cardiac Society is released.

This week on The Beat, CTSNet Editor-in-Chief Joel Dunning spoke with David Waller, Chair of the EACTS Emphysema Taskforce and Director of the EACTS Fundamentals Course in Thoracic Surgery, about the EACTS expert consensus document on lung volume reduction for emphysema. Chapters 00:00 Intro02:10 EACTS Technocollege03:23 Robotic Cardiac Focus07:34 EACTS Highlights13:17 Influence of Stenosis on Patency14:58 Repair vs Replace Degen MR16:08 Drain Strategy & Outcomes17:20 Postcardiotomy Cardiogenic Shock19:11 Bilateral Lung Transplant20:11 Bicuspid Valve-Sparing ARR21:08 Neoadjuv Chemoimmunotherapy Podcast22:04 Post-Intubation Tracheal Injury22:32 Value of the Heart Team Interview23:50 Dr. Waller, LVRS Guidelines35:37 Virtual Career Fair36:22 Oral Board AI Simulator36:36 Resident Video Competition They discussed the task force responsible for developing the document, the potential benefits of the guidelines, and key topics addressed in the document, including patient selection and complications. They also explored the benefits of lung volume reduction for emphysema, screening programs, controversial areas of emphysema, and the importance of team decision-making. Joel also highlights recent JANS articles on influence of LAD-diagonal stenosis on long-term patency and ischemic events after CABG, mitral valve repair vs replacement for degenerative mitral regurgitation in patients with poor ejection fraction, contemporary chest drain practice after pulmonary resection, and ten guiding principles for the management of postcardiotomy cardiogenic shock. In addition, Joel explores a sequential bilateral lung transplant in situs inversus totalis and Kartagener syndrome, bicuspid valve-sparing aortic root replacement, surgical repair of a post-intubation tracheal injury, perspectives from Vincent Gaudiani and Chad Rammohan on the value of the heart team, and an episode of The Atrium podcast featuring host Alice Copperwheat speaking with Jessica Donington about neoadjuvant chemoimmunotherapy. Before closing, Joel highlights upcoming events in CT surgery. JANS Items Mentioned

In this episode of the CTSNet podcast, The Lifeline, host and nurse educator Jill Ley, Clinical Professor at the University of California San Francisco School of Nursing, Founder of the Essentials of Cardiac Surgical Resuscitation, and former Cardiac Surgery Clinical Nurse Specialist at California Pacific Medical Center in San Francisco, California, USA, speaks with Lakhmir Chawla, Assistant Clinical Professor (Voluntary) of Medicine at the University of California San Diego, USA, and Chief Medical Officer of ExThera Medical. Together, they discuss the science behind new therapies for vasoplegia and potential treatment algorithms to rapidly restore vascular tone and hemodynamic stability. Chapters 00:00 Intro 00:43 Clinical Challenge & Angiotensin II 15:41 Issue of Vasoplegia, Patient Example 22:15 Angiotensin II Protocol 25:56 Potential Concerns 27:52 Multi-Mode, Low Dose Approach 29:50 Patient Population 32:39 Key Takeaways The discussion explores the history of angiotensin II, including how it emerged as a treatment for vasoplegia, the oxygen transport hypothesis, vasopressin dosing, dopamine and renal blood flow, and the benefits of angiotensin II. They also discuss a patient who underwent left ventricular assist device (LVAD) explantation followed by heart transplantation and how they would approach the patient to achieve positive outcomes. Additional topics include angiotensin II protocols, thromboembolic events, and potential studies involving this patient population. Every month, The Lifeline features intensive care specialists sharing their expert insights into the rapid and effective management of critically ill cardiac surgical patients. Don’t miss next month’s episode!

This week on The Beat, CTSNet Editor-in-Chief Joel Dunning spoke with Bart P. van Putte, a cardiothoracic surgeon at the St. Antonius Hospital in Nieuwegein, Netherlands, and the Amsterdam University Medical Center about the excimer laser assisted non-occlusive anastomosis (ELANA) system in coronary artery bypass grafting (CABG). Chapters 00:00 Intro01:48 CMS NCD Webinar02:20 Oral Board AI Simulator02:57 Podcast Frequency Update04:09 CTSNet at EACTS 202604:44 Bi vs Single IMA Grafting in CABG06:40 Radial Artery vs Saph Vein Third Conduit08:37 Right-Sided Min Inv OPCAB10:17 Right Basilar Transplant w Carinal Reconstr12:12 Lymph Node Dissection & Chylothorax Analysis14:11 Type A AD Causing Hematoma & Compression16:13 Robotic Extended Sympathectomy17:27 Ross Procedure Child w Bicuspid AV19:56 Dr. van Putte, ELANA System CABG34:45 Career Center They discussed the purpose of the ELANA system, what it is, and how it works. They also reviewed the system’s critical procedural step and explored its potential application in jump grafts. Additionally, they analyzed the clinical cases in which the system was utilized, including the findings. They also outlined the next steps and evaluated the feasibility of implementing this system at other clinical centers. Joel also highlights recent JANS articles on midterm outcomes after bilateral vs single internal mammary artery grafting in minimally invasive direct coronary artery bypass, a comparison of radial artery and saphenous vein as the third conduit with bilateral internal mammary arteries in coronary bypass surgery, a case report on right basilar segmental autologous lung transplantation with carinal reconstruction in a patient with central lung squamous cell carcinoma, Type A aortic dissection causing pulmonary artery intramural hematoma and compression, and a Society of Thoracic Surgeons general thoracic surgery database analysis of the association between lymph node dissection and chylothorax. In addition, Joel explores a robotic extended sympathectomy for severe compensatory hyperhidrosis, right-sided minimally invasive off-pump coronary artery bypass, and the Ross procedure for infective endocarditis with extensive aortic root destruction in a child with a bicuspid aortic valve. Before closing, Joel highlights upcoming events in CT surgery. JANS Items Mentioned

In this episode of The Atrium, host Alice Copperwheat speaks with Jessica Donington, Professor of Surgery and Chief of the Section of Thoracic Surgery at the University of Chicago, Illinois, USA, about neoadjuvant chemoimmunotherapy. Chapters 00:00 Intro01:20 Why CT Surgery?04:16 History06:55 Patient Perception08:42 Function, Why?12:40 Patient Selection, Who?18:20 Resectability25:31 Types of Neoadj Therapy, What?30:06 Evidence33:01 Surgeon Responsibility39:02 Robotics39:54 Post Op Considerations41:29 Key Points43:12 Surgical Training Advice The discussion emphasizes the importance of being upfront and honest during patient conversations. It explores the benefits of neoadjuvant chemoimmunotherapy, how patients are selected for these treatments, and the various clinical trials on this topic. The conversation also addresses the chemo-radiation route and the clinical assessment of resectability. They also examine how to determine if a tumor is resectable and what factors are assessed during this process. It also highlights the need to consider whether a planned lobectomy might necessitate a pneumonectomy following neoadjuvant chemoimmunotherapy. The conversation also covers chemotherapy, immunotherapy, and targeted therapy, outlining what trainees should remember about each. Finally, they address the complexities of neoadjuvant chemoimmunotherapy, key takeaways for trainees, and the importance of working closely with the entire multidisciplinary team throughout the process. The Atrium is a monthly podcast presenting clinical and career-focused topics for residents and early career professionals across all cardiothoracic surgery subspecialties. Keep an eye out for next month’s episode.