With the flood of tricuspid endocarditis over the last few years, pacemaker implantation in these patients is undesirable post TV replacement. Here’s a nice trick @APolancoMD showed me which avoids conduction complications
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Stephen Spindel MD
170 posts
Stephen Spindel MD
@StephenSpindel
Cardiac surgeon at Montefiore Medical Center, Mount Sinai trained, Air Force veteran, exercise fanatic
New York
Joined October 2022
- Grateful to have performed my final Ross procedure at Ochsner a few days ago. I’ve worked with an amazing team these past 6 years and am thrilled to join Montefiore next week, continuing my love of aortic surgery, heart and lung transplant, but now in New York!
- What is your favored method for aortic arch debranching? Side biting clamp on the aorta with sequential grafting (Y graft), off pump, is my preference. As seen here in this 61 y.o. male with rapidly enlarging chronic type B dissection involving distal arch
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00:00 - This 38 y.o. with bicuspid AV was found to have aortic and mitral endocarditis, plus 4.6cm aortic root. Intraop, a large vegetation on MV with perf meant MV replacement. What would be your strategy? I chose Ross plus mechanical MVR, an odd combo
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00:00 - Interesting how many 3.8cm ascending aorta referrals we see but somehow the really big ones slip through the cracks. Did a 3rd time sternotomy, hemi arch, root replacement on this 7.2cm ascending aorta patient (prior BAV). What other large ones have you guys seen?
00:00 - Although Commando is usually for endocarditis, the approach is helpful for combined aortic/mitral stenosis with MAC, such as radiation heart disease. It can make a significant difference in decreasing the technical difficulty when dealing w severely calcified aortomitral curtains
00:00 - Destruction of the aortomitral curtain may seem like a big undertaking to rebuild it, yet it is not as complicated as some may think. This video we put together provides the basic steps for reconstruction which may help out some folks in tricky situations
- What is your post cardiopulmary bypass method for tackling low EF mitral regurgitation patients? @APolancoMD joined me for direct insertion impella for this mitral and tricuspid repair patient which assured a postop course on minimal vasoactive drips, no end organ dysfunction
- Loving the teaching opportunities at my first wet lab with @MontefioreCTS residents, practicing coronary anastomoses this time. 1st of 4 wet labs this fall, excited for the next ones!
- Our first wet lab of 2023: mitral repair. Plenty of fun and great teaching moments with the residents, fellows, and @APolancoMD
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- What’s your favored less invasive technique for mitral surgery? 8cm incision with full sternotomy is my preference. I accredit restricting the degree of chest retraction to limiting the pain, and decreasing LOS. Complex MV repair on this 80 year old male, home on POD 4.
- TAVR is used often lately in small aortic annuli in sexagenarians. I prefer extended Nick’s in this population to allow for future valve in valve TAVRs. 19mm valve up to 25mm valve, 5mmHg MG on TEE in this 63 year old
- Surprisingly, there aren’t many technical videos out there focused on aortic arch debranching. Here is a step-by-step video for off pump arch debranching which is simplistic and easy to duplicate, via @ctsnetorg
- It’s uncommon to operate solely for myocardial bridge over the LAD, but this 47 y.o. with recurrent angina had a rather impressive degree of dynamic LAD stenosis. Pretty straightforward operation to expose the intramyocardial LAD and great postop relief of symptoms
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