Video-Based Sessions Offer Pearls for Common, Complex Procedures

Cardiothoracic surgeons are visual, hands-on practitioners and learners. Textbooks can be a useful starting point, but the most effective way to learn the technical nuances of common, yet challenging operations is by watching them being performed with expert commentary and extra time for questions. Three video-based “how-to” sessions will bring that visual focus to adult cardiac, congenital and pediatric cardiac, and general thoracic surgeries.

“Historically, we have had video sessions where a presenter creates a case video with narration, and we essentially press play,” said S. Adil Husain, MD, of the University of Utah in Salt Lake City, who will co-moderate the congenital and pediatric cardiac surgery session. “Our presenters have video clips, but they are presenting a specific topic, not showing how they managed an unusual case. These sessions are fixated on certain surgical interventions that we perform on a regular basis and are thought of as being more complex. This gives the more skilled and experienced surgeons in our field an opportunity to provide the pearls that helped them tackle a particular operation with greater precision and success.”

Adult Cardiac Surgery
A new generation of devices and changes in surgical approaches are expanding life-saving treatments to ever-larger patient populations that may not have been good candidates for earlier technologies. These latest and greatest techniques in aortic valve surgery, mitral valve surgery, and heart failure surgery will be on display during the adult cardiac how-to video session.

“My Tube” Adult Cardiac How-To Video Session

Tuesday

1:00 p.m. – 5:00 p.m.

Room30ABCD

One example is the MitraClip. Approved for use in the United States in 2013, it offered hope for patients with mitral regurgitation who were not eligible for conventional repair. The transcatheter device not only offers a new way to treat refractory mitral regurgitation, but also allows interventional cardiologists and cardiac surgeons to work together.

“We also have emergent techniques with aortic valve surgery that are expanding patient populations,” said co-moderator Ahmet Kilic, MD, of The Johns Hopkins Medical School in Baltimore. “It is no longer just aortic valve replacement; there are now techniques that allow us to repair aortic valves and retain the patient’s native aortic valve.”

Another technique that will be featured during the session is sutureless aortic valve replacement, which is moving into the mainstream. The technique relies on one or two guiding stitches and allows surgeons to replace a diseased valve in an expeditious manner. Sutureless replacement is not just a matter of saving time, Dr. Kilic noted. It also improves outcomes.

“As a whole, our patients are becoming increasingly complex,” he explained. “They need not just one procedure, but often multiple valves or bypasses at the same time. This is the patient population that could most benefit from these new techniques.”

Heart failure presentations will highlight extracorporeal membrane oxygenation and ventricular assist devices. Novel left ventricular assist devices (LVADs) are not only more durable than earlier generations, but can be implanted using a less invasive, non-sternotomy lateral approach. And for patients whose right hearts begin to fail after LVAD implantation, improved right-sided devices may be useful. Other patients may benefit from axial balloon pumps that allow them to be ambulatory and wait longer for a heart transplant.

Congenital and Pediatric Cardiac Surgery
A dozen how-to videos will help surgeons avoid common pitfalls and simplify congenital and pediatric cardiac operations. The half-day session will focus on atrioventricular canal repairs, complex coronary anomalies in congenital heart defects, cardiac transplantation and mechanical circulatory support, and complex neonatal repairs for more unusual diagnostic challenges.

How-To Video Session: Technical Tips to Avoid Pitfalls and Simplify Congenital and Pediatric Cardiac Surgery Procedures

Tuesday

1:00 p.m. – 5:00 p.m.

Room 32

“The textbooks we employ do a good job of giving surgeons basic principles and guidelines for routine, straightforward presentations, but any pediatric heart surgeon will tell you that no two cardiac lesions are the same,” said Dr. Husain. “That variety can create a good deal of anxiety and can clearly impact the development of a junior-level surgeon’s career.”

Pediatric cardiac surgery is a subspecialty in which surgeons commonly practice alone or with one or two partners, Dr. Husain added. The solo or small practice settings can be particularly difficult for junior and mid-level surgeons who do not have older, more experienced colleagues to share insights and wisdom gained from years of surgical experience.

“These sessions are profoundly important because they help fill a gap in terms of how we share our experiences with more junior and mid-level surgeons as they progress through their careers,” Dr. Husain said.

General Thoracic Surgery
The half-day general thoracic surgery session will focus on three areas: esophagectomy, segmentectomy for resection of non–small-cell lung cancer (NSCLC), and minimally invasive thymectomy for management of thymoma and myasthenia gravis.

How-To Video Session: General Thoracic

Tuesday

1:00 p.m. – 5:00 p.m.

Room 33

“We will start with strategies to manage celiac nodal disease following neoadjuvant treatment for esophageal carcinoma,” said session co-moderator Robert E. Merritt, MD, of The Ohio State University Wexner Medical Center in Columbus. “The other videos will focus more on the technical aspects of esophagectomy, starting with avoiding pitfalls during robotic esophagostomy, creating the ideal gastric conduit, and preventing anastomotic leaks.”

Segmentectomy for NSCLC resection is a technically challenging procedure, but also is an increasingly popular alternative to conventional lobectomy. One of the keys to success, Dr. Merritt noted, is recognizing when it may be appropriate to abandon segmentectomy for lobectomy.

Other presentations will focus on tips and tricks for identifying nodules, bronchial, and vascular anatomy during minimally invasive segmentectomy, different types of robotic and/or video-assisted thoracoscopic surgery, and strategies to deal with unusual anatomy and anatomic variants during minimally invasive segmentectomy.

“The final session will focus on the mediastinum with both thoracoscopic and robotic thymectomy for myasthenia gravis and different approaches to the excision of large thymomas,” Dr. Merritt said. “That is going to be a particularly interesting set of videos.”

None of the videos or presenters were chosen at random, he added. “These are procedures you encounter in daily practice, and you’ll learn from the best—the surgeons who have the highest volumes and the best outcomes,” he said. “These video how-to sessions are gold.”

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