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  • The Beat With Joel Dunning Ep. 127: Patient Blood Management
    This week on The Beat, CTSNet Editor-in-Chief Joel Dunning speaks with Dr. Marc Pelletier, division chief of cardiac surgery for the Department of Surgery at Yale School of Medicine, about patient blood management. Chapters 00:00 Intro 01:45 EACTS 2025 07:19 JANS 1, HVD Management Guidelines 16:26 JANS 2, Low-Risk AVR Evidence 19:21 JANS 3, Warden Procedure Selection 20:36 JANS 4, Primary Repair of CAT 21:48 JANS 5, NEWTON-CABG Cardiolink-5 23:20 Video 1, Acute Aortic Syndrome 24:54 Video 2, Redo TVR Under Bypass 27:13 Video 3, Giant Tension Bulla 28:47 Dr. Pelletier Interview 34:25 Outro They delve into the Society of Thoracic Surgeons (STS) guidelines on patient blood management, along with key tips. They also explore preoperative optimization, provide an example, and discuss cell savers and reducing dead space during surgery. Additionally, they touch on postoperative transfusion and the importance of performing meticulous surgery.  Joel also highlights recent JANS articles on the 2025 ESC/EACTS guidelines for the management of valvular heart disease, low-risk aortic valve replacement at the crossroads of evidence, ideal age and weight for the Warden procedure in patients with partial anomalous pulmonary venous return, a systematic meta-analysis of short- and long-term outcomes of the primary repair of common arterial trunk, and an international, randomized, double-blind, placebo-controlled trial on the effect of Evolocumab on saphenous vein graft patency after coronary artery bypass surgery.  In addition, Joel explores the surgical treatment of acute aortic syndrome, a redo tricuspid valve replacement technique under right heart bypass for a previously repaired tricuspid valve, and thoracoscopic resection of a giant tension bulla. Before closing, Joel highlights upcoming events in CT surgery.    JANS Items Mentioned  1.) 2025 ESC/EACTS Guidelines for the Management of Valvular Heart Disease: Developed by the Task Force for the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)   2.) Low-Risk Aortic Valve Replacement at the Crossroads of Evidence  3.) Is There an Ideal Age or Weight for the Warden Procedure in Patients With Partial Anomalous Pulmonary Venous Return?  4.) Primary Repair of Common Arterial Trunk: A Systematic Meta-Analysis of Short- and Long-Term Outcomes  5.) Effect of Evolocumab on Saphenous Vein Graft Patency After Coronary Artery Bypass Surgery (NEWTON-CABG CardioLink-5): An International, Randomized, Double-Blind, Placebo-Controlled Trial  CTSNet Content Mentioned  1.) Surgical Treatment of Acute Aortic Syndrome   2.) Redo Tricuspid Valve Replacement Technique Under Right Heart Bypass for a Previously Repaired Tricuspid Valve   3.) Thoracoscopic Resection of a Giant Tension Bulla   Other Items Mentioned  1.) STS/SCA/AmSECT/SABM Update to the Clinical Practice Guidelines on Patient Blood Management  2.) Transcatheter vs Surgical Aortic Valve Replacement in Lower-Risk Patients: An Updated Meta-Analysis of Randomized Controlled Trials  3.) Perfecting TAVR Removal | Skills Sharpening With Vince Gaudiani  4.) Career Center   5.) CTSNet Events Calendar  Disclaimer The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.
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  • The Beat With Joel Dunning Ep. 126: Another Successful Experience in Ghana
    This week on The Beat, CTSNet Editor-in-Chief Joel Dunning shares insights from his recent trip to Ghana. Chapters 00:00 Intro  02:18 Ghana Mission Trip  04:35 Failures of a Heart Surgeon   09:27 JANS 1, Accelerometer-Measured Physical Activity   12:57 JANS 2, Utility of GERAADA Score   14:41 JANS 3, Aortic Valve Neocuspidization   17:33 JANS 4, Procedural Planning in Thoracoscopic Segmentectomy  19:09 JANS 5, The Outlet Orifice Diameter   22:28 Video 1, Clampless Aortic Valve Replacement   24:01 Video 2, Multiportal Robot-Assisted Extended LLS S6  25:13 Video 3, The Atrium  26:00 EACTS 2025 & Upcoming Events  27:35 Footage From Ghana  He discusses the various procedures that he and his team performed during their visit, as well as his overall experience collaborating with the local surgeons. The episode also features surgical footage from his time in Ghana and includes discussion with several surgeons about their work. Additionally, Joel addresses a recent news story from the UK regarding the failures of a heart surgeon that have contributed to multiple patient deaths. He provides an overview of the circumstances surrounding these events and emphasizes the critical importance of teamwork in surgical practice.   Joel also highlights recent JANS articles on an analysis of the UK mini mitral randomized controlled trial for accelerometer-measured physical activity after mitral valve surgery, the utility of GERAADA score for predicting long-term survival following surgical repair of aortic dissection, early to mid-term results of aortic valve neocuspidization for rheumatic aortic valve disease, a systematic review and meta-analysis for three-dimensional reconstruction and virtual simulation of patient-specific anatomy for procedural planning in thoracoscopic segmentectomy, and the outlet orifice diameter of surgical bioprosthetic aortic stented valves is predominantly much smaller than the inlet orifice diameter.  In addition, Joel explores a clampless aortic valve replacement in a partial porcelain aorta with aortic root enlargement and CABG with two grafts, multiportal robot-assisted extended lower left segmentectomy, and an episode of The Atrium podcast featuring host Dr. Alice Copperwheat speaking with Dr. John D. Puskas about proximal coronary anastomosis. Before closing, Joel highlights upcoming events in CT surgery.    JANS Items Mentioned  1.) Accelerometer-Measured Physical Activity After Mitral Valve Surgery: An Analysis of the UK Mini Mitral Randomized Controlled Trial  2.) Utility of GERAADA Score for Predicting Long-Term Survival Following Surgical Repair of Aortic Dissection  3.) Early to Mid-Term Results of Aortic Valve Neocuspidization for Rheumatic Aortic Valve Disease  4.) Three-Dimensional Reconstruction and Virtual Simulation of Patient-Specific Anatomy for Procedural Planning in Thoracoscopic Segmentectomy: A Systematic Review and Meta-Analysis  5.) The Outlet Orifice Diameter of Surgical Bioprosthetic Aortic Stented Valves Is Predominantly Much Smaller Than the Inlet Orifice Diameter   CTSNet Content Mentioned  1.) Clampless Aortic Valve Replacement in a Partial Porcelain Aorta With Aortic Root Enlargement and CABG With Two Grafts  2.) Multiportal Robot-Assisted Extended Lower Left Segmentectomy: Superior Segment S6 With Lateral S9 Resection  3.) The Atrium: Proximal Coronary Anastomosis   Other Items Mentioned  1.) Joel Dunning YouTube Channel | The Arrhythmia Alliance Hearts of Ghana Mission 2025   2.) Heart Surgeon’s Failures Contributed to Multiple Deaths   3.) The 10 Commandments for Proximal Anastomosis During CABG: Techniques and Technologies for Vein and Arterial Grafts  4.) Perfecting TAVR Removal | Skills Sharpening With Vince Gaudiani  5.) Career Center   6.) CTSNet Events Calendar  Disclaimer The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.
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  • The Beat With Joel Dunning Ep. 125: Ticagrelor vs Aspirin Post-Coronary Surgery
    This week on The Beat, CTSNet Editor-in-Chief Joel Dunning speaks with Dr. Anders Jeppsson, a cardiothoracic surgeon at Sahlgrenska University Hospital in Gothenburg, Sweden, about his paper on “Ticagrelor and Aspirin or Aspirin Alone After Coronary Surgery for Acute Coronary Syndrome,” published in The New England Journal of Medicine. Chapters 00:00 Intro  01:54 Ghana Mission Trip  06:23 JANS 1, Pig-to-Human Transplant  08:08 JANS 2, CABG Acute Type A AD  10:06 JANS 3, Chylothorax Lymph Node Management  11:22 JANS 4, ICU Resternotomy Adoption  13:38 JANS 5, Octogenarians Repair vs MV Surgery  15:10 Career Center  15:31 Video 1, MVR Patent Bilateral IMammary Grafts  16:36 Video 2, Repeat RA Thoracotomy  17:39 Video 3, Vascular Injuries in Robotics  19:12 Dr. Jeppsson Interview  33:30 EACTS 2025 & Upcoming Events  They began by providing an overview of the study, including the reason for conducting it, the expansion of the study to other Nordic countries, and its results. They also discuss the funding for the research and the recruitment process. Additionally, they cover dual antiplatelet therapy and compare this study with similar research. Finally, they explore registry-based studies and future research on ticagrelor and aspirin, or aspirin alone, following coronary surgery for acute coronary syndrome.  Joel also highlights recent JANS articles exploring whether protective coronary artery bypass grafting improves surgical outcomes in acute type A aortic dissection with coronary ostial involvement, the association of chylothorax with aggressiveness of lymph node management during pulmonary resection, if intensive care unit resternotomy should be practiced in all facilities that perform cardiac surgery, transcatheter edge-to-edge repair vs mitral valve surgery in octogenarians, and research using pig-to-human lung xenotransplantation into a brain-dead recipient.  In addition, Joel explores robotic mitral valve replacement in a patient with patent bilateral internal mammary grafts, repeat right axillary thoracotomy as a safe and feasible approach for repair of recurrent LAVVR after previous AVSD repair, and handling vascular injuries in robotic thoracic surgery. Before closing, Joel highlights upcoming events in CT surgery.    JANS Items Mentioned  1.) Protective Coronary Artery Bypass Grafting Improves Surgical Outcomes in Acute Type A Aortic Dissection With Coronary Ostial Involvement  2.) The Association of Chylothorax With Aggressiveness of Lymph Node Management During Pulmonary Resection  3.) Expert Opinion: Intensive Care Unit Resternotomy Should Be Practiced in All Facilities That Perform Cardiac Surgery  4.) Transcatheter Edge-to-Edge Repair Versus Mitral Valve Surgery in Octogenarians: Comparative Analysis of Safety, Durability, and Survival  5.) Pig-to-Human Lung Xenotransplantation Into a Brain-Dead Recipient  CTSNet Content Mentioned  1.) Robotic Mitral Valve Replacement in a Patient With Patent Bilateral Internal Mammary Grafts: A Case Video  2.) Repeat Right Axillary Thoracotomy Is a Safe and Feasible Approach for Repair of Recurrent LAVVR After Previous AVSD Repair   3.) Handling Vascular Injuries in Robotic Thoracic Surgery: Real-Life Cases Using a Fibrin-Based Hemostatic Technique  Other Items Mentioned  1.) Ticagrelor and Aspirin or Aspirin Alone After Coronary Surgery for Acute Coronary Syndrome   2.) Perfecting TAVR Removal | Skills Sharpening With Vince Gaudiani  3.) Career Center   4.) CTSNet Events Calendar  Disclaimer The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.
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  • The Atrium: Proximal Coronary Anastomosis
    In this episode of The Atrium, host Dr. Alice Copperwheat speaks with Dr. John Puskas, professor of surgery at Emory University, Chief of Cardiothoracic Surgery at Emory University Hospital Midtown, and Wilton Looney Director at the Emory Carlyle Fraser Heart Center in Atlanta, Georgia, USA, about proximal coronary anastomosis. Chapters 00:00 Intro 00:44 About Dr. Puskas 03:35 Background & History 06:56 10 Commandments for PA 10:34 When to Do It? 13:57 Aorta Site Selection 19:32 Step-by-Step 29:21 Sewing Onto Aorta 33:15 Variations & Alternatives 44:50 Key Messages 46:08 Advice to Trainees They discuss the 10 principles for proximal anastomosis during coronary artery bypass grafting, saphenous vein grafts vs free arterial grafts, as well as the optimal site selection on the aorta. They also explored key aspects of preparation and arteriotomy, and highlighted various variations and alternatives, such as clampless techniques and sequential grafting. Additionally, they examined the pitfalls and complications associated with proximal coronary anastomosis and the future of proximal coronary anastomosis.    The Atrium is a monthly podcast presenting clinical and career-focused topics for residents and early career professionals across all cardiothoracic surgery subspecialties. Watch for next month’s episode on extended resection with Dr. Erinoangelo Rendina.   Related Resources   The 10 Commandments for Proximal Anastomosis During CABG: Techniques and Technologies for Vein and Arterial Grafts   Disclaimer The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.
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  • The Beat With Joel Dunning Ep. 124: Veterinary vs Human Cardiothoracic Surgery
    This week on The Beat, CTSNet Editor-in-Chief Joel Dunning speaks with Drs. Daniel Brockman, Professor of Small Animal Surgery at The Royal Veterinary College, London, England, and Matteo Rossanese, Senior Lecturer in Small Animal Surgery at The Royal Veterinary College, about performing cardiothoracic surgery in animals. Chapters 00:00 Intro 01:44 Innovation Competition Results 07:18 JANS 1, Modified Bio-Bentall 08:45 JANS 2, External Aortic Root 11:53 JANS 3, Re-Redo Pulm Valve 13:19 JANS 4, Tracheal Regeneration Model 16:15 Career Center 16:56 Video 1, EXIT-to-Open Atrial Septectomy 17:16 Video 2, Incision Repair of Tetra Fallot 19:40 Video 3, Isolated Pulm Leaflet Autograft 22:33 Dr. Brockman and Rossanese Interview 51:11 Upcoming Events 53:30 Closing They explore the evolution of cardiothoracic surgery in veterinary medicine, discussing a variety of cases and the techniques employed, including mitral valve repair. Additionally, they highlight the anatomical differences between animals and humans, explaining how surgical techniques must be adapted accordingly. They also cover methods for testing valves, measuring the quality of repairs, and monitoring postoperative outcomes and follow-ups. Furthermore, they touch upon various conditions, such as tetralogy of Fallot, heart valve defects, etc.   Joel also highlights recent JANS articles on modified Bio-Bentall operation with a rapid deployment valve, personalized external aortic root support, clinical success of re-redo pulmonary valve and pulmonary trunk homograft replacement during the second trimester of pregnancy, and lessons learned from various 3D-printed tracheal grafts in an extensive porcine model for de novo tracheal regeneration.  In addition, Joel explores an EXIT-to-open atrial septectomy for hypoplastic left heart syndrome with intact atrial septum, incision of the moderator band during repair of tetralogy of Fallot, and a new solution for aortic valve repair, isolated pulmonary leaflet autograft. Before closing, Joel highlights upcoming events in CT surgery.    JANS Items Mentioned  1.) Modified Bio-Bentall Operation With A Rapid Deployment Valve  2.) Personalized External Aortic Root Support: The Dutch Experience  3.) Clinical Success of Re-Redo Pulmonary Valve and Pulmonary Trunk Homograft Replacement During the Second Trimester of Pregnancy  4.) Lessons Learned From Various 3D-Printed Tracheal Grafts in an Extensive Porcine Model for De Novo Tracheal Regeneration  CTSNet Content Mentioned  1.) EXIT-to-Open Atrial Septectomy for Hypoplastic Left Heart Syndrome With Intact Atrial Septum: Gone in 90 Seconds!  2.) Incision of the Moderator Band During Repair of Tetralogy of Fallot   3.) Isolated Pulmonary Leaflet Autograft: A New Solution for Aortic Valve Repair  Other Items Mentioned  1.) Career Center   2.) CTSNet Events Calendar  Disclaimer The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.
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