CARDIOVASCULAR PATHOLOGY:
SURGERY AND INTERVENTIONS.
Proceedings of the Third Moscow International Course
May 16–17, 2015
Editors
Leo A. Bockeria
Marko Turina
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UDC 616.12-089+616.1322-07-08
CARDIOVASCULAR PATHOLOGY: SURGERY AND INTERVENTIONS.
Proceedings of the Third Moscow International Course. May 16–17,
2015. L.A. Bockeria, M. Turina (Eds). M.: Bakoulev Scientific Center
for Cardiovascular Surgery; 2016
Acquisitions Editors:
Zalina F. Kudzoeva, M.D.
Aleksey V. Sergeev, M.D., PhD.
ISBN 978-5-7982-0361-1
© Bakoulev SCCVS, 2016
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Content
Leo A. Bockeria (Moscow, Russia)
Marko Turina (Zurich, Switzerland)
Opening Remarks ...........................................................................................III
James L. Cox
Maze myths .....................................................................................................3
Roberto Chiesa
Updated strategy for organ protection during TAAA open repair .........................24
Claudio Muneretto
Hybrid coronary revascularization: techniques and results .................................44
Paul Sergeant
Can we teach, qualify and quantify a good coronary anastomosis.......................69
Peter Zilla
Heart valve surgery at the interface between first and third world........................88
Leo A. Bockeria
Cardiovascular surgery and interventions in Russian Federation .......................107
Ralph J. Damiano
Surgical treatment of atrial fibrillation in patients
with mitral valve disease ................................................................................123
Friedrich W. Mohr
The development of TAVI ...............................................................................150
Francis Wellens
Cardiac surgery for heart failure.....................................................................175
David Taggart
Is it time to abandon off-pump CABG .............................................................192
Roberto Chiesa
Open conversion after TEVAR. Tips & Tricks....................................................209
Leslie Miller
Use of stem cells in cardiac surgery ...............................................................236
Gino Gerosa
The role of MCS in acute cardiogenic shock: from ECMO to TAH......................255
Victor Hraska
ASO in complex transposition with criss–cross heart,
multiple VSD’s, straddling of TV, and PS .........................................................304
Francis Wellens
Video session on thoracoscopic implantation of ICD........................................315
Viktor Hraska
Cone reconstruction of Ebstein’s malformation...............................................319
Gino Gerosa
Evolution of LVAD implantation techniques: from conventional
to micro-invasive surgery...............................................................................328
I
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James L. Cox
The Cox-Maze-IV procedure..........................................................................336
Francis Wellens
The cardiac surgeon and the treatment of arrhythmias ....................................340
Gino Gerosa
Miniaturized LVAD: what is in the pipeline?......................................................353
David Taggart
What is the 2nd best arterial graft? IMA or RA...................................................388
Paul Sergeant
It can happen to you one day.........................................................................407
Leslie Miller
Left ventricular assist devices for advanced heart failure:
patient selection ..........................................................................................421
Roland Hetzer
New strategies in valve repair: anterior leaflet retention plasty
for systolic anterior motion in hypertrophic obstructive
cardiomiopathy, posterior leaflet augmentation for ischemic
mitral incompetence and double orifice valve technique
for tricuspid valve insufficience ......................................................................443
Ralph J. Damiano
Recent advances in the surgical treatment
of lone atrial fibrillation ..................................................................................463
Friedrich W. Mohr
Bilateral internal thoracic arteries: skeletonize and T-off ..................................492
Marko Turina
Grown-up congenital heart disease:
a condition in search of optimal treatment ......................................................505
Roland Hetzer
Pediatric mechanical circulatory support ........................................................527
Peter Zilla
Tackling the disparity: rheumatic heart disease and the lack
of cardiac surgery in developing world............................................................552
Claudio Muneretto
Endoscopic treatment of lone AF....................................................................570
Viktor Hraska
Anatomic correction of ccTGA: new ideas of management...............................593
Leo A. Bockeria
Surgical treatment of atrial fibrillation: the why and the how .............................612
Roland Hetzer
Repair techniques to correct the tricuspid valve incompetence
in Ebstein’s anomaly .....................................................................................623
James L. Cox
Hybrid Maze procedures vs. hybrid non-Maze procedures...............................631
II
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Opening Remarks
Leo A. Bockeria.
Dear colleagues,
Let me welcome you here in Bakoulev Center for Cardiovascular Surgery in Moscow for the third
time. It is a great privilege for us to have such a wonderful team as it was also before. In my view,
we have a very interesting program and here are the people in the audience, who would like to learn
the new trends in cardiovascular surgery, interventional cardiology, electrophysiology. So you have
an opportunity to share your knowledge and experience with the younger professionals.
Welcome again and I wish to all of us to have these two days applying new knowledge not only
in medicine, but also around the city, around the country and culture.
Marko Turina.
Ladies and Gentlemen. Welcome to the III-d Moscow International Course: Cardiovascular
pathology: surgery and interventions. We have invited a group of international experts to share
with the most actual information on the treatment of cardiovascular pathology. Within two days
a series of lectures and presentations will be presented. As in previous years we thank professor
Leo Bockeria for the organization of this Course and financial support for this Course.
III
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Fig. 27
Firstly a box lesion around the pulmonary veins, a lesion up to the left atrial appendage and
a clip on it are performed. (Fig. 28)
Fig. 28
Then some radiopaque vascular clips are put. If there is a reentrant circuit around here, a cardiologist
has to go to the coronary sinus, make a lesion between those clips and solve the problem.
(Fig. 29)
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Fig. 29
On the right side we documented right atrial macro-reentrant circuits. I have shown
Haissaguerre this slide and asked if he agrees with the documented reentrant circuits and he
said “yes”. Now almost all of them use the cavo-tricupid isthmus. (Fig. 30, 31)
Documented Righ t Atria l
Macro-Reentran t Circuit s i n N-PAF
Fig. 30
So the initial thoracoscopic procedure would be the box lesion in the left, lesion up to the left
atrial appendage, put a radiopaque vascular clip, SVC to IVC lesion up to the right atrial appendage
and stop. Notice that this is not the complete Maze procedure. (Fig. 32)
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Fig. 31
Fig. 32
After 6 weeks to 3 months the follow-up catheter ablation is performed. If a patient has
perimitral flutter a lesion onto a coronary sinus with a catheter between the radiopaque clip and
the myocardium inside is performed. That is the left sided Maze. (Fig. 33, 34)
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Fig. 33
Fig. 34
If a patient has anything on the right side, the cavo-tricuspid isthmus line is performed. (Fig. 35)
The initial thoracoscopic surgery and follow-up catheter ablation. That in fact is a complete
Maze procedure. (Fig. 36)
So the promises of hybrid Maze procedure are:
– Outcomes for the catheter ablation of AF will not improve until better catheter tools are
developed.
– New off-pump thoracoscopic procedures make surgery a viable option as the initial treatment
for stand-alone AF, provided there is an obligatory follow-up catheter ablation.
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Fig. 35
Fig. 36
– New “Hybrid Non-Maze Procedures” are based on EP mapping, a concept that has failed
in the past. The risk is that these map-guided procedures will fail with time.
– “Hybrid Maze Procedures” should produce outcomes equal those for the open-heart surgical
Maze Procedure.
Thank you.
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CARDIOVASCULAR PATHOLOGY: SURGERY AND INTERVENTIONS.
Proceedings of the Third Moscow International Course
May 16–17, 2015
Editors Leo A. Bockeria, Marko Turina
Typesetting 24.05.2016. Signed to printing 27.06.2016
Format 60×90/8. Offset
Publ.-sign.79.34. Cond.-print. sh. 82.75. Circulation 500. Order No 330
Bakoulev Scientific Center for Cardiovascular Surgery
(licence No 071268)
Set up and printed in Bakoulev Scientific Center for Cardiovascular Surgery
Russia, 119049, Moscow, Leninsky pr., 8
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