RT @NekspineX: Long hours. High precision. Demanding posture. Nekspine is the spinal support exoskeleton built to meet the physical demand….

Mastering root enlargement is essential, it's the foundation. Leverage the dome of the LA; it's a vital ally for exposure & orientation. Success in LVOT surgery hinges on a deep understanding of anatomic relationships. Commando isn’t just advanced, it’s root enlargement 2.0.

Tough redo, previous AVR, Left and Right coronaries 2mm above prosthetic annulus. Endocarditis & Severe MR with massive posterior annular calcification. Near impossible exposure. Without understanding Commando "de-" and "re-"construction, cases like these are inoperable.

Creases on LV septal surface can be a hint. Next, look for distal Lad if it expresses itself on epicardium. 3rd, find a diag branch & work back to origin/LAD. When that fails, find the lateral edge of the PA & LV surface, and carefully dissect. Re-examine angio when in doubt.

Correction. @NekSpineX . fairly new company, but idea of surgical "exoskeleton" long overdue.

Interesting idea/product I found at #STS2025. We/surgeons deliver ⬆️ load on our neck/spine, supporting our heads (7-12 lbs) over the field x thousands of hours. @NekSpine supports the head when flexed, mitigating cervical spine injuries. Wore it today in OR. Game-changer.

Another improperly harvested LIMA done years ago in a man who needs redo CABG. STS risk calc does not account for grafts stuck to chest wall. The 2 proximal clips on LIMA do not move. Graft is pushed medially. Beware. Now at high risk for injury. 🤬@AspiringCTS @STS_CTsurgery

Down-sizing a mitral with a small rigid ring is invites dehissence of prosthesis from annulus. Nature's physiology will win. 76 yo s/p MV repair 7 years ago. Required valve replacement for severe MR with 33mm Epic valve. @M_Pompeu_Sa_MD @tomcnguyen @AspiringCTS @StanCVFellows

RT @BarackObama: Here's our statement on the results of the 2024 presidential election:

Thank you @MarcMoonMD & @JCoselli_MD for putting together a fantastic Aortic program in Houston! I was able to share thoughts on root enlargement, & feel strongly that every surgeon who replaces the aortic valve should be able to safely enlarge the root to avoid PPM.

For trainees: if the path of a coronary artery appears a bit too straight, it's usually intra-myocardial. Patient I operated on today with an occluded LAD, intra-myocardial Ramus, and high grade Circ. @AspiringCTS @STS_CTsurgery @StanCVFellows

Undersizing a mitral valve with a small ring is a bad idea, & "nature" (heart contracting >100,000x/day) will win. I am witnessing more dehissed rings requiring re-operations for recurrent MR. Rethink how to size the mitral valve orifice. @ovidiogarciav @M_Pompeu_Sa_MD

Watching Paris Olympics has me reflecting on success vs mastery. Success is hitting that goal(an event), but mastery is knowing that it means nothing if you can't repeat it over & over again. It's not a commitment to a specific goal but instead to a constant pursuit. Thoughts?.

60 yo man s/p Ao homograft 26 years ago, now w endocarditis, severe AI & massively calcified root. Excising graft required "garden shears"(!). Coronary buttons were porcelainized, requiring direct amputation & reconstruction w end-to- end Art-SVG. New homograft implanted. 😅

Patient with Protein C&S deficiencies, h/o multiple PE's, progressive and severe AI with dilated and impaired LV. Required SAVR, mini incision. Path pending, but probable organized thrombus under each cusp. @AortaSurg @DrZeigler1 @AspiringCTS @M_Pompeu_Sa_MD

The point is that there many good ways to repair the mitral valve. It's amazing to me that they actually work given the fact that the valve is tested 100,000 times a day with each beat! I hope that my attempt will be durable.

Young man, underwent mitral valve repair one year ago w all chordal "respect" technique. Developed recurrent MR several months after. Underwent redo MV repair w "resect" technique. @CristianRosuMD @M_Pompeu_Sa_MD @ovidiogarciav @StephenSpindel

60 yo man, remote endocarditis w perforation of anterior leaflet. Repair included autologous pericardial patch closure, cleft (s) closure, 3 pledgetted annular sutures @ P2 base, and 35mm Tailor band. @ovidiogarciav @rafatinm @CristianRosuMD @garciasol65bis

The repair illustrated. Pledgetted sutures are used as annular sutures for the band.

Contained chronic root dissection/rupture status post tissue AVR 1999 and 2011. 15 yr old Mosaic explant pristine, no calcification. Important to excise subannular fibrous ring to max size of aortic prosthesis (permitted 27mm valve conduit). @M_Pompeu_Sa_MD @AortaSurg @BoYangMD