Category Archives: Cardiac Surgery

Cardiac Surgery, Print Release

PUBLISHED: Aortic Hemiarch and Valve Replacement for Severe Aortic Stenosis with Ascending Aortic Ectasia

Aortic Hemiarch and Valve Replacement for Severe Aortic Stenosis with Ascending Aortic Ectasia
Adeel Ahmad, MD; Peter A. Collings, MD; Kirill Zakharov, DO
University of Michigan Health-Sparrow

Severe aortic valvular stenosis is a prevalent condition with potentially fatal consequences. Presenting symptoms may include dyspnea with angina/chest pains that can be significantly lifestyle limiting. Early detection and treatment are paramount to effective management, as untreated severe aortic stenosis has a five-year mortality of 50–70%. Treatment options range from the minimally invasive transcatheter approach to open heart surgery. Each strategy is tailored to the respective patient’s presentation, with considerations for cardiac anatomy, comorbidities, and patient frailty. When concomitant aortopathy is present, an open approach allows for definitive management of both conditions.

Aortic ectasia is an abnormal dilation of the ascending aorta that, while itself is not as serious, can be a precursor to aortic aneurysm or dissection. In patients undergoing surgical aortic valve replacement, a composite replacement strategy can also address concomitant aortic ectasia by incorporating the new valve into an aortic graft segment as a single implant.

Cardiac Surgery, Print Release

PUBLISHED: Combined Replacement of Aortic Valve and Ascending Aorta with Patent Foramen Ovale (PFO) Closure

Combined Replacement of Aortic Valve and Ascending Aorta with Patent Foramen Ovale (PFO) Closure
David W. Miranda, MD, MS; Jordan P. Bloom, MD, MPH
Massachusetts General Hospital

Aortic valve disease in adults has many etiologies and requires careful operative planning when severe enough to require intervention. A common cause of aortic valve dysfunction in adults is a congenitally bicuspid valve that may also be associated with aortic aneurysm. Here, we describe the presentation and management of a middle-aged woman with symptomatic severe aortic stenosis due to a bicuspid aortic valve. She required an aortic valve replacement as well as replacement of an aneurysmal ascending aorta and closure of a patent foramen ovale (PFO).

Cardiac Surgery, Print Release

PUBLISHED: Minimally Invasive Direct Coronary Artery Bypass (MIDCAB)

Minimally Invasive Direct Coronary Artery Bypass (MIDCAB)
Ory Wiesel, MD; Marco Zenati, MD
VA Boston Healthcare System

Minimally invasive direct coronary artery bypass (MIDCAB) utilizes a small (4–5 cm) left anterior thoracotomy incision for direct visualization of the diseased coronary artery on the anterior wall of the left ventricle without the use of cardiopulmonary bypass (CPB).

This article describes the basics of the MIDCAB surgery, emphasizing both the left anterior thoracotomy for the harvest of LIMA and direct anastomosis on a beating heart without CPB. This procedure is done on a 72-year-old patient who had significant long LAD stenosis and presented with effort angina. Following a multidisciplinary “heart team” conference, he underwent a successful MIDCAB and was discharged home on postoperative day 4.

Cardiac Surgery, Print Release

PUBLISHED: Cox-MAZE IV with Coronary Artery Bypass Graft (CABG) and Mitral Valve Replacement (MVR)

Cox-MAZE IV with Coronary Artery Bypass Graft (CABG) and Mitral Valve Replacement (MVR)
Andrew Del Re1; Marco Zenati, MD2
1 The Warren Alpert Medical School of Brown University
2 Brigham & Women’s Hospital, VA Boston Healthcare System

Cardiovascular disease is a leading cause of morbidity and mortality in the United States and abroad, manifesting as shortness of breath, exercise intolerance, palpitations, and chest pain. While the majority of cases are treated medically, more advanced or severe cases are treated surgically or endovascularly, warranting an open discussion between the provider and the patient to decide the most appropriate treatment modality given the specific characteristics and preferences of the procedure and the patient.

The Cox-MAZE IV combined with CABG and Mitral Valve Replacement is a singular surgical procedure that is carefully planned and executed to address arrhythmic, coronary, and valvular disease while minimizing time on cardiopulmonary bypass with an arrested heart.

Cardiac Surgery, Print Release, Trauma

PUBLISHED: Introduction to Bedside Cardiac Ultrasound

Introduction to Bedside Cardiac Ultrasound

Allyson Peterson, MD
UChicago Medicine

Nadim Michael Hafez, MD
UChicago Medicine

Point of care cardiac ultrasound is a key diagnostic tool in evaluating any patient who is in extremis. Indications for a bedside cardiac ultrasound include cardiac arrest, unexplained hypotension, syncope, shortness of breath, chest pain, and altered mental status. There are no absolute contraindications for a limited bedside cardiac ultrasound. Point of care cardiac ultrasound mainly consists of four views: the parasternal long, parasternal short, apical four chamber, and subxiphoid views. Here, Dr. Peterson and Dr. Hafez at UChicago Medicine discuss image acquisition, pearls and pitfalls, and pathology for each of these views as an introduction to the bedside cardiac ultrasound.

Announcement, Cardiac Surgery, Preprint Release

PREPRINT RELEASE: Minimally Invasive Direct Coronary Artery Bypass (MIDCAB)

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Minimally Invasive Direct Coronary Artery Bypass (MIDCAB)
VA Boston Healthcare System
Marco Zenati, MD
Chief of Cardiothoracic Surgery, VA Boston Healthcare System & Professor of Surgery, Harvard Medical School

After experiencing chest pressure while exercising, a 72-year-old patient tested positive in both a stress test and nuclear medicine study, triggering a left heart catheterization that revealed a high grade lesion of the proximal left anterior descending coronary artery. His cardiologist determined the lesion would not be amenable to angioplasty or stenting, so Dr. Marco Zenati performs a minimally invasive coronary artery bypass (MIDCAB).
Announcement, Cardiac Surgery, Preprint Release

PREPRINT RELEASE: Cox-MAZE IV with Coronary Artery Bypass Graft (CABG) & Mitral Valve Replacement (MVR)

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Cox-MAZE IV with Coronary Artery Bypass Graft and Mitral Valve Replacement
VA Boston Healthcare System
Marco Zenati, MD
Chief of Cardiothoracic Surgery, VA Boston Healthcare System & Professor of Surgery, Harvard Medical School

In this long and complicated case, Dr. Marco Zenati performs a full, biatrial Cox-MAZE IV procedure with coronary artery bypass grafting (CABG) and a mitral valve replacement (MVR), moving between the three procedures as necessary to minimize time on the ischemic heart. The patient suffers from congestive heart failure that recently escalated from class II to class III.