Interesting how many 3.8cm ascending aorta referrals we see but somehow the really big ones slip through the cracks. Did a 3rd time sternotomy, hemi arch, root replacement on this 7.2cm ascending aorta patient (prior BAV). What other large ones have you guys seen?

This 38 y.o. with bicuspid AV was found to have aortic and mitral endocarditis, plus 4.6cm aortic root. Intraop, a large vegetation on MV with perf meant MV replacement. What would be your strategy? I chose Ross plus mechanical MVR, an odd combo

With the flood of tricuspid endocarditis over the last few years, pacemaker implantation in these patients is undesirable post TV replacement. Here’s a nice trick Antonio Polanco, MD showed me which avoids conduction complications

One challenge with autograft and aortic homograft usage is the LVOT anastomosis. The floppy autograft/homograft annulus can create difficulties with accurate suture placement. Here’s an inverted graft trick which makes it very similar to performing a traditional AVR

It amazes me how isolated some aortic root aneurysms can be. This 35 year old had a 7.5cm Sinus of Valsalva but a 3.2cm proximal arch. Only a root/ascending aorta replacement with Ross (reinforced) was needed.

Surprisingly, there aren’t many technical videos out there focused on aortic arch debranching. Here is a step-by-step video for off pump arch debranching which is simplistic and easy to duplicate, via CTSNet

Today Salman and I fired up a total arterial CABG today, including a Y-anastamosis. Dr Zaheer did the entire case from the right side of the table! Come to Johns Hopkins Cardiothoracic Surgery and train with us!

We often see and operate on tumors in the left atrium, but rarely do we tackle any in the left ventricle, especially when it sits in the apex. Thoracoscopic instruments were perfect for removing this papillary fibroelastoma

As one of CTSNet’s most viewed videos this year, Stephen Spindel MD’s “Aortic Hemiarch Replacement: The 7-Minute Technique” demonstrates a streamlined technique for aortic hemiarch replacement. His interview with EIC Thoracic Surgeon - Joel Dunning ➡ ow.ly/BMyx50PXJGI

My fellow Tung Vu had this inverted graft idea which I’ve implemented for hemi arch replacements and found to be quite effective. Cuts 1 to 3 minutes of circ arrest times and fantastic hemostasis. Good addition to my earlier technique on CTSNet

I’ve seen a number of videos on how to perform a Yang Y-incision root enlargement, but none detailing the challenges of actually removing a Yang root enlargement. Aortomitral curtain reconstruction with a wide patch for redo root enlargement is key

Being the associate program director for cardiothoracic fellowship at Ochsner, I try to emphasize case preparation. This video we created details key steps and pitfalls for cardiopulmonary bypass. It’s helped the fellows/residents here and hopefully others will benefit too

Really enjoying this non-circulatory arrest hemi arch replacement. You can’t get as distal vs circ arrest methods due to the arch clamp, but still get into zone 1 arch and really nice to avoid hypothermia and circ arrest

Although Commando is usually for endocarditis, the approach is helpful for combined aortic/mitral stenosis with MAC, such as radiation heart disease. It can make a significant difference in decreasing the technical difficulty when dealing w severely calcified aortomitral curtains

Destruction of the aortomitral curtain may seem like a big undertaking to rebuild it, yet it is not as complicated as some may think. This video we put together provides the basic steps for reconstruction which may help out some folks in tricky situations mmcts.org/tutorial/1866

The beauty of a left-subclavian-anastomosis 1st approach is it allows you to perform zone 2 arch replacement without circ arrest. This 5’0” female w 5cm ascending and 5cm descending aorta underwent non-circ arrest stage 1 FET. 50min pump run, extubated 2 hrs later, home by POD 5

As surgeons, it’s key to pursue fresh perspectives. At times, reevaluating dogma can spur innovation. This AVR technique by Luis J Castro MD is precisely that: a pioneering approach to a conventional procedure. It’s my go-to technique and I recommend giving it a shot

This has been my go-to technique for hemi arch replacement in patients with non-calcified aortic arches. Nice to avoid hypothermia and circulatory arrest

It’s uncommon to operate solely for myocardial bridge over the LAD, but this 47 y.o. with recurrent angina had a rather impressive degree of dynamic LAD stenosis. Pretty straightforward operation to expose the intramyocardial LAD and great postop relief of symptoms

Grateful to have performed my final Ross procedure at Ochsner a few days ago. I’ve worked with an amazing team these past 6 years and am thrilled to join Montefiore next week, continuing my love of aortic surgery, heart and lung transplant, but now in New York!