Constantine D. Mavroudis, MD, MS, Constantine Mavroudis, MD, Jeffrey P

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Presentation transcript:

Simulation and Deliberate Practice in a Porcine Model for Congenital Heart Surgery Training Constantine D. Mavroudis, MD, MS, Constantine Mavroudis, MD, Jeffrey P. Jacobs, MD, William M. DeCampli, MD, PhD, James S. Tweddell, MD The Annals of Thoracic Surgery Volume 105, Issue 2, Pages 637-643 (February 2018) DOI: 10.1016/j.athoracsur.2017.10.011 Copyright © 2018 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Neonatal piglet model simulating regional perfusion with snuggers engaged at the proximal brachiocephalic arteries and distal aortic clamp. Noted also are the transected pulmonary artery, distal pulmonary artery patch isolation, ductus arteriosus resection, and proposed (dashed line) aortic incisions for the neoaortic reconstruction. The Annals of Thoracic Surgery 2018 105, 637-643DOI: (10.1016/j.athoracsur.2017.10.011) Copyright © 2018 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 The aorta and pulmonary artery were joined as the pulmonary homograft was used to complete the aorta-pulmonary artery amalgamation. The Annals of Thoracic Surgery 2018 105, 637-643DOI: (10.1016/j.athoracsur.2017.10.011) Copyright © 2018 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 The modified Sano shunt is shown to the left of the neoaorta using a ringed polytetrafluoroethylene vascular graft (W.L. Gore & Associates, Newark, DE) that was telescoped into the right ventricle (RV [insert]). Cannulas have been removed. The Annals of Thoracic Surgery 2018 105, 637-643DOI: (10.1016/j.athoracsur.2017.10.011) Copyright © 2018 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Simulated arterial switch operation in normal piglet anatomy. Pulmonary artery and the aorta (cross clamp) were transected with the dissected/mobilized coronary artery buttons being prepared for transfer to the neoaortic facing sinuses of Valsalva (dotted lines). The Annals of Thoracic Surgery 2018 105, 637-643DOI: (10.1016/j.athoracsur.2017.10.011) Copyright © 2018 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Proximal neoaortic reconstruction was completed. Lecompte maneuver was omitted. Neopulmonary artery reconstruction was performed before the neoaortic reconstruction owing to limited neopulmonary artery exposure. A pantaloon pericardial or other biologic patch can be used to perform the neopulmonary artery reconstruction. The Annals of Thoracic Surgery 2018 105, 637-643DOI: (10.1016/j.athoracsur.2017.10.011) Copyright © 2018 The Society of Thoracic Surgeons Terms and Conditions

Fig 6 Completed neopulmonary artery reconstruction. Proximal to distal neoaortic reconstruction is shown. The Annals of Thoracic Surgery 2018 105, 637-643DOI: (10.1016/j.athoracsur.2017.10.011) Copyright © 2018 The Society of Thoracic Surgeons Terms and Conditions

Fig 7 Completed arterial switch operation without cross clamp. In this model, the right ventricle was connected to the neoaorta; the left ventricle to the neopulmonary artery. The Annals of Thoracic Surgery 2018 105, 637-643DOI: (10.1016/j.athoracsur.2017.10.011) Copyright © 2018 The Society of Thoracic Surgeons Terms and Conditions