Video-Based Sessions Highlight Unique Insights into Common Procedures

Textbooks and peer-reviewed publications are not ideal formats for showing the technical nuances of challenging operations. Cardiothoracic surgeons are visual learners, and videos are an important educational tool. To showcase this dynamic learning format, the 2018 Annual Meeting will feature three sessions that focus exclusively on videos within adult cardiac, general thoracic, and congenital heart surgery.

“Most meetings present a lot of data. The video presentations step away from the data and show you how to perform a typical operation,” said Gorav Ailawadi, MD, co-moderator of the adult cardiac session. “Attendees will get advice from experts on how to perform these operations quickly and safely.”

“MY TUBE” ADULT CARDIAC HOW-TO VIDEO SESSION

Sunday, January 28
10:00 a.m. – 4:30 p.m.
Grand Ballroom A-B

Adult Cardiac Surgery

In a daylong session, 24 videos will be shown in the categories of mitral/atrial fibrillation surgery, coronary artery disease, aortic valve/aortic surgery, and heart failure surgery.

“A lot of different topics will be covered, but the theme is to provide surgeons with something they can take back to their practices and institute immediately,” Dr. Ailawadi said.

In the first part of the session, videos will demonstrate challenging scenarios for mitral valve repairs, including patients with mitral annular calcification, rheumatic disease, and hypertrophic obstructive cardiomyopathy. Two of the videos will demonstrate a robotic repair and minimally invasive techniques to reposition the papillary muscles together,  Dr. Ailawadi said.

Another two videos will demonstrate techniques to close the left atrial appendage during cardiac surgery. One is effective surgical closure using sutures, while the other uses clips and devices to close the appendage, he said.

During the section on coronary artery disease, videos will show a coronary endarterectomy to remove plaque, minimally invasive and robotic approaches to coronary artery bypass grafting procedures, and robotic hybrid coronary revascularization.

Several presentations will feature aortic valve procedures, such as sutureless aortic valve replacement, transcatheter aortic valve replacement (TAVR) through alternative approaches including the carotid and transcaval arteries, removing a dysfunctional TAVR valve, arch reconstruction, and dealing with abscesses in the aortic root.

Extracorporeal membrane oxygenation (ECMO) and left ventricular assist devices (LVADs) will be among the topics highlighted in presentations about treating heart failure. Videos will demonstrate how to maintain perfusion to the lower extremities and how to decompress the left ventricle. Other videos will demonstrate techniques for the use of short- and long-term LVADs, as well as the subcostal approach for a pump exchange and a non-sternotomy approach for implanting an LVAD.

HOW-TO VIDEO SESSION: TECHNICAL TIPS TO AVOID PITFALLS AND SIMPLIFY CONGENITAL AND PEDIATRIC CARDIAC SURGICAL PROCEDURES

Sunday, January 28
1:00 p.m. – 4:30 p.m.
Floridian Ballroom A

Congenital and Pediatric Cardiac Surgery

Twelve video presentations in a half-day session will explore Ebstein anomaly, systemic atrioventricular (AV) valve disease, complex biventricular repairs, and mechanical surgical support.

“We’ve focused the videos in categories that highlight the procedures that congenital heart surgeons face every day. We want to emphasize interaction between the presenters and the audience so that attendees have all their questions answered,” said co-moderator James S. Tweddell, MD.

Videos will highlight approaches for treating newborns with severe Ebstein anomaly, including surgery on the tricuspid valve to achieve a two-ventricle repair, as well as a conversion of single-ventricle palliation. Patient selection for the various approaches also will be explained.

The second group of presentations will explore repair options for the left side systemic AV valve. Videos will show the use of a CorMatrix cylinder valve in newborns and infants with mitral valve disease, the use of a Melody valve as a mitral valve replacement, and an AV repair for patients with single-ventricle anatomy, Dr. Tweddell said.

Complex biventricular repairs will be highlighted in three videos. The first will explain the use of a Nikaidoh procedure to achieve a two-ventricle repair in patients with complex transposition, he said. A second video will demonstrate biventricular repairs in patients with complex heterotaxy, and a third will show a double-switch procedure for patients with a congenitally corrected transposition.

The final group of presentations will examine mechanical surgical support options, including an ECMO simulation training program, how to identify treatment options for patients with heart failure with congenital heart disease, and how to manage the complex anatomic challenges seen in older Fontan patients, Dr. Tweddell said.

HOW-TO VIDEO SESSION: TIPS AND TRICKS TO MAXIMIZE EFFICIENCY IN MINIMALLY INVASIVE GENERAL THORACIC SURGERY

Sunday, January 28
1:00 p.m. – 4:30 p.m.
Floridian Ballroom D

General Thoracic Surgery

Minimally invasive approaches for lobectomies, segmentectomies, and esophagectomies will be demonstrated in a series of general thoracic surgery video presentations. Other videos in the session will explain lean approaches to surgery and recovery, as well as novel techniques for finding nodules during procedures.

“This session is set up to help STS members engage in the process of higher quality, minimally invasive surgery. These videos are about better ways to do it and better ways to do it faster with higher quality and at lower cost,” said session moderator Robert J. Cerfolio, MD.

Video-assisted thoracoscopic (VATS) and robotic approaches to lobectomies and segmentectomies will be shown. For esophagectomies, presenters will detail three approaches—robotic Ivor Lewis, transhiatal, and endoscopic.

“The robotic platform allows more patients to get a minimally invasive operation, but it comes down to the surgeon,” said Dr. Cerfolio. “If we can teach surgeons how to perform really good surgery with VATS, they don’t need a robot. If you have a robot, you can do it without VATS. We want high-quality surgery either way. We want them to do it with a robot or VATS, not an open technique.”

The one non-technical presentation in the session will be “Lean and Efficient Surgery and Recovery: A Systems Approach.” Lean systems can be used to reduce variables by optimizing processes supporting surgeries, from developing a surgery team to setting up the operating room.

“Reducing variables reduces costs and increases quality. That improves value,”  Dr. Cerfolio said. “The goal of this session is to show via video what quality surgery looks like. As in sports, everything is on the videotape. All of your mistakes and all of your victories are videotaped and can be broken down and assessed. That is true for surgery.”

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