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TSRA Operative Dictations in Cardiothoracic Surgery
Editors
David D. Odell, MD MMSc
University of Pittsburgh
Cardiothoracic Surgery Resident
Advanced Thoracic Surgery Fellow
TSRA President 2013-2014
Damien J. LaPar, MD MSc
University of Virginia
Cardiothoracic Surgery Fellow
TSRA President 2014-2015
Section Editors
Shawn S. Groth, MD MS
Brigham and Women’s Hospital
Cardiothoracic Surgery Resident
University of Pittsburgh
Advanced Thoracic Surgery Fellow
Thoracic Surgery Section
Michael P. Robich, MD MPH
Cleveland Clinic Foundation
Cardiothoracic Surgery Fellow
Adult Cardiac Surgery Section
Muhammed Aftab, MD
Texas Heart Institute, Baylor University
Cardiothoracic Surgery Resident
Congenital Cardiac Surgery Section
Copy Editor
Ernest G. Chan, BS
Stony Brook School of Medicine
4
th
Year Medical Student
Thoracic Surgery Residents Association
www.tsranet.org
TSRA Review of Cardiothoracic Surgery
Copyright © 2014 by the Thoracic Surgery Residents Association, Damien J. LaPar, David D. Odell.
TSRA / TSDA
633 N. Saint Clair Street
Suite 2320
Chicago, IL 60611
www.tsranet.org
Disclaimer
The material presented herein is to the best of our knowledge, accurate and factual to date. The text is provided as a basic
outline of a dictated description of the stated operative procedure. The text is not intended to serve as a guide for the actual
performance of the operation and this book should not be construed as a surrogate for formalized operative instruction.
Further, the descriptions contained in this book represent one safe approach to an operation. The TSRA and the authors make
no claims regarding the superiority of these described approaches relative to other operative strategies as we recognize that
alternate strategies may be safely and efficaciously employed by practicing surgeons.
All rights reserved. This book is protected by copyright. No part of this book may be reproduced in any form or by any means,
electronic or mechanical, including photocopying or the use of any information storage and retrieval system without written
permission from the copyright owners.
Cover artwork by: Carmina Mery, Ramón Mery, and Mari Pili Guzmán (age 3)
“To Kelly and Jacqueline”
- Damien J. LaPar
“To Alessia, Pietra and Wilson for your unwavering support and love.”
- David D. Odell
Foreword
With this publication, the TSRA extends its record of outstanding contributions to Thoracic Surgical
Education. It provides the reader with a concise and clearly focused overview of the steps of a given
operative procedure, and provides excellent advice on potential pitfalls of the procedure. Such pearls are
invaluable. By providing templates for the dictation of operative notes, it serves as an excellent resource for
the student of Thoracic Surgery as one learns such a large number of procedures.
This volume helps to address an important gap in Thoracic Surgical Education and once again points to the
valuable contributions that the TSRA has made to our specialty. It will go a long way in helping with the
education Thoracic Surgical Residents at all levels.
David A. Fullerton, MD
President, TSDA
Preface
The Thoracic Surgery Residents Association (TSRA) was established in 1997 under the guidance of the Thoracic Surgery
Directors Association (TSDA) to create a unified voice to represent residents during cardiothoracic surgery training. The
organization has developed as a core mission a focus on improving the quality, accessibility and utility of resident education.
In 2010, we released the TSRA Review of Cardiothoracic Surgery. This would be the first of a series of publications, written
by residents, which have sought to address areas of perceived need in cardiothoracic education. The Review provided a
series of short reference chapters introducing key knowledge and concepts in an easily digestible point-of-care format. The
book was a phenomenal success and has now been downloaded in pdf format more than 9000 times and been translated into
several languages. The TSRA followed this publication with the release in 2013 of the Primer in Cardiothoracic Surgery a
book focused on basic concepts within the field of CT surgery which form the foundation for further learning. At the other end
of the continuum of learning, the TSRA Clinical Scenarios in Cardiothoracic Surgery provided a compilation of common, high-
yield, and important scenarios which might arise in the course of a surgeon’s training or practice.
The current publication seeks to provide a resource which may be used in the surgeon’s daily practice as a resource for the
review of the major steps of an operation as well as a guide to the appropriate documentation of the conduct of that operation.
We hope that the text will be useful for both practicing surgeons and residents in training. While the list of operations included
in the text is extensive it is by no means intended to be inclusive of the entire breadth of the field of cardiothoracic surgery.
Additionally, the text provides descriptions of one approach to the operations included. We acknowledge that the approach to
a given operation may vary among surgeons, and institutions. This text is not intended to establish a uniform ‘correct’
approach, nor is it intended as a surrogate for formal residency training.
We strove to attain a high level of technical accuracy with the operative descriptions contained in this text with four levels of
peer review. Each chapter was carefully reviewed by an established faculty member, a section editor as well as the two main
editors. Our main goal was to ensure that the operative dictations contained descriptions of a safe approach to practice.
Despite this rigorous review process, the reader will likely notice differences between the described operations and the
practice in their institutions. The book is intended to be a dynamic resource and space has been left at the end of each section
for the reader to make notes highlighting their individual approach to the operation. We welcome feedback from the reader and
encourage the submission of additional operative descriptions beyond what is included in the text to David D. Odell, MD
MMSc (daviddodell@gmail.com) and Damien J. LaPar, MD MSc (dlapar@virginia.edu). We hope you enjoy the book and
find it a useful resource.
DDO and DJL
Contributors
Muhammad Aftab, MD
Baylor College of Medicine/Texas Heart Institute
Aortic Root Replacement With Homograft For Aortic Root Abscess (Native And Or Prior Bentall), Infra-Cardiac Total
Anomalous Pulmonary Venous Return (TAPVR), Aortic Coarctation Repair With Extended End-To-End Anastomosis,
Modified Blalock-Taussig Shunt (Using Interposition Gore-Tex Tube Graft), Bidirectional Glenn Procedure, Extra-Cardiac
(Non-Fenestrated) Completion Fontan Procedure, Arterial Switch Procedure, Tetralogy Of Fallot Repair - Infundibular
Sparing (Transatrial Repair), Pulmonary Valve Replacement And Reconstruction Of Right Ventricle Outflow Tract, Pediatric
Lung Transplantation: Bilateral Sequential Lung Transplantation
Magdy M. El-Sayed Ahmed, MD
Texas Heart Institute
Pediatric Lung Transplantation: Bilateral Sequential Lung Transplantation
Gorav Ailawadi, MD
University of Virginia
Coronary Artery Bypass Grafting With Cardiopulmonary Bypass
Luis F. Alberton, MD
North Shore Long Island Jewish Health System
Laparoscopic Nissen Fundoplication
Uthman Aluthman, MD
University of Calgary
Coronary Artery Bypass Grafting With Mammary and Vein Grafts - Off Pump
Parth Amin, MD
Loyola University Medical Center
Elephant Trunk Part 1, Elephant Trunk Part 2, Endovascular Management of Acute Type B Dissection
Mara B. Antonoff, MD
Washington University
Lung Procurement, Lung Transplantation
Anelechi Anyanwu, MD, MSc, FRCS
Mount Sinai Medical Center
Repair of Post-Infarction Ventricular Septal Defect, Pulmonary Embolectomy
Nicholas Baker, MD
University of Pittsburgh Medical Center
Mediastinoscopy
Jamil Bashir, MD
St. Paul’s Hospital
Biatrial Cox-Maze Ablation for Atrial Fibrillation, Permanent Pacemaker Insertion
Kfir Ben-David, MD
University of Florida
Esophageal Stent Placement
Thomas Birdas, MD
Indiana University School of Medicine
Open Thoracostomy (Eloesser Flap and Clagett Window)
Mark Bleiweis MD
University of Florida
Repair of Partial Anomalous Pulmonary Venous Return
Andrew I.M. Campbell
British Columbia's Children's Hospital
Ventricular Septal Defect: Perimembranous, Completion Lateral Tunnel Fontan, Ross Procedure for the Correction of
Congenital Aortic Stenosis
Thomas Caranasos MD
University of Florida
Repair of Partial Anomalous Pulmonary Venous Return, Esophageal Stent Placement
Stephen D. Cassivi, MD, MSc
Mayo Clinic
Transcervical Thymectomy
Mohiuddin Cheema, MD
Cedars Sinai Medical Center
Endovascular Repair of Descending Thoracic Aortic Aneurysm (TEVAR)
Frederick Y. Chen, MD, PhD
Brigham and Women’s Hospital
Aortic Valve Replacement for Aortic Insufficiency Or Aortic Stenosis
Jordy C. Cox, MD
University of California San Francisco
Open Ivor-Lewis Esophagectomy
Jonathan D'Cunha, MD, PhD
University of Pittsburgh Medical Center
Tracheostomy
Joseph A. Dearani, MD
Mayo Clinic
Repair of Obstructive Hypertrophic Cardiomyopathy: (Septal Myomectomy), Cone Repair for Ebstein Malformation
Daniel T. DeArmond, MD
University of Texas Health Science Center
VATS Evacuation of Hemothorax
Walter F. DeNino, MD
Medical University of South Carolina
Valve Sparing Root Replacement, Carinal Pneumonectomy
Chadrick E. Denlinger, MD
Medical University of South Carolina
Carinal Pneumonectomy
Jessica S. Donington, MD
New York University School of Medicine
Chamberlain Procedure, Trans-sternal Thymectomy
Desmond M. D'Souza, MD
Cleveland Clinic
Lung Volume Reduction Surgery
Michelle C. Ellis, MD
University of Michigan
Coronary Artery Bypass Grafting With Aortic Valve Replacement, Transhiatal Esophagectomy
Nicholas Engstrom, MD
Oregon Health and Sciences Center
Diagnositic Thoracoscopy
Lloyd M. Felmly
Medical University of South Carolina
Carinal Pneumonectomy
Joss Fernandez, MD
Missouri Heart Center, Columbia, MO
Endovascular Management of Acute Type B Dissection
Amy Fiedler, M.D
Brigham and Women’s Hospital
Aortic Valve Replacement for Aortic Insufficiency or Aortic Stenosis
Charles D. Fraser Jr, MD
Texas Children’s Hospital/Baylor College of Medicine
Arterial Switch Procedure
James J. Gangemi, MD
University of Virginia
Complete Atrioventricular Canal Repair
Jose P. Garcia, MD
Massachusetts General Hospital
Orthotopic Heart Transplantation
Erin Gillaspie, MD
Mayo Clinic
Open Lobectomies
Leonard N. Girardi, MD
New York Presbyterian –Weill Cornell Medical Center
Thoracoabdominal Aneurysm Repair
David Graham, MD
Children’s Medical Center of Dallas
Repair of Supravalvular Aortic Stenosis, Pleural Decortication, Pleural Biopsy (Open/Thoracoscopic) (Open/Thoracoscopic)
Eugene Grossi, MD
New York University Langone Medical Center
Mitral Valve Replacement
Jonathon W. Haft, MD
University of Michigan
Coronary Artery Bypass Grafting With Aortic Valve Replacement
M. Scott Halbreiner, MD
Cleveland Clinic
Minimally Invasive Directed Coronary Artery Bypass
Michael E. Halkos, MD, MSc
Emory University
Aortic Root Replacement (Endocarditis)
Jeffrey S. Heinle, MD
Texas Children’s Hospital/Baylor College of Medicine
Infra-Cardiac Total Anomalous Pulmonary Venous Return (TAPVR), Extra-Cardiac (Non-Fenestrated) Completion Fontan
Procedure, Pulmonary Valve Replacement and Reconstruction of Right Ventricle Outflow Tract, Pediatric Lung
Transplantation: Bilateral Sequential Lung Transplantation
Joshua L. Hermsen, MD
Seattle Children’s Hospital
Repair of Truncus Arteriousus (TA)
Jonathan C. Hong, MD
St. Paul’s Hospital
Permanent Pacemaker Insertion, Completion Lateral Tunnel Fontan
John S. Ikonomidis, MD, PhD
Medical University of South Carolina
Total Arch/Hemiarch Replacement with DHCA – Dissection, Valve Sparing Root Replacement
David M. Jablons, MD
University of California San Francisco
Open Ivor-Lewis Esophagectomy
Mathéau A. Julien, MD, PhD
Tufts Medical Center
DeVega Tricuspid Valve Repair
Narongrit Kantathut, MD
Cleveland Clinic
Aortic Valve Surgery with Upper Hemisternotomy Approach
Sunjay Kaushal, MD, PhD
University of Maryland Medical Center
Pediatric Heart Transplantation
Michael O. Kayatta, MD
Emory University
Aortic Root Replacement (Endocarditis)
Mark J. Kerns, MD
St. Paul’s Hospital
Biatrial Cox-Maze Ablation for Atrial Fibrillation
Kemp Kernstine, MD, PhD
University of Texas Southwestern
Pleural Decortication (Open/Thoracoscopic), Pleural Biopsy (Open/Thoracoscopic)
Zarrish S. Khan, MD
New York Presbyterian –Weill Cornell Medical Center
Thoracoabdominal Aneurysm Repair, Open Modified McKeown Esophagectomy
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