Left-handed cardiac surgery has been a rising topic. Training necessities pertaining to left-handed cardiac surgery education and mentorship are crucial to this group of surgeons. Through initiatives of experienced left-handed cardiac surgeons in association with the EACTS, a left-handed learning lab at the EACTS annual meeting was developed. This skills lab training is dedicated to offering left-handed surgeons a space which offers both technical development and career networking. In this short communication, we detail lessons learned and future insights into left-handed cardiac surgery education through hands-on training.

Journal Article Left-handed cardiac surgery simulation training: making things right Get access Eric E Vinck, Eric E Vinck Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht University, Maastricht, NetherlandsDepartment of Cardiac Surgery, Colsubsidio Cardiovascular Clinic, Bogota, ColombiaDivision of Cardiac Surgery, Country Clinic, Bogota, Colombia Corresponding author. Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht University, P. Debyelaan 25, 6229 HX Maastricht, Netherlands. Tel: +57-3016135455; e-mail: [email protected] (E.E. Vinck). https://orcid.org/0000-0002-9728-3910 Search for other works by this author on: Oxford Academic PubMed Google Scholar Mona Bickel-Dabadghao, Mona Bickel-Dabadghao Department of Medicine, University of Lübeck, Lübeck, Germany Search for other works by this author on: Oxford Academic PubMed Google Scholar Roberto V P Ribeiro, Roberto V P Ribeiro Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht University, Maastricht, Netherlands Search for other works by this author on: Oxford Academic PubMed Google Scholar Darío Andrade, Darío Andrade Department of Cardiac Surgery, Colsubsidio Cardiovascular Clinic, Bogota, ColombiaDivision of Cardiac Surgery, Country Clinic, Bogota, Colombia Search for other works by this author on: Oxford Academic PubMed Google Scholar Peyman Sardari Nia Peyman Sardari Nia Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht University, Maastricht, Netherlands Search for other works by this author on: Oxford Academic PubMed Google Scholar European Journal of Cardio-Thoracic Surgery, Volume 67, Issue 2, February 2025, ezaf011, https://doi.org/10.1093/ejcts/ezaf011 Published: 06 February 2025 Article history Received: 20 November 2024 Revision received: 11 December 2024 Accepted: 22 January 2025 Published: 06 February 2025

Background: Robot-assisted surgery (RAS) is expanding rapidly across surgical specialities, yet adoption across the globe remains variable. There is growing recognition to expand RAS across all healthcare settings, to ensure equity of access and improve clinical outcomes for all patients. Facilitating the expansion of RAS requires the development of high-quality, durable and sustainable RAS programmes. The aim of the RoboDev study was to develop a universal, globally applicable guideline to aid development and expansion of RAS programmes. Methods: The RoboDev study was conducted as an international, multistakeholder Delphi process consisting of four phases: (1) scoping review and item generation, (2) questionnaire design and pre-testing, (3) accelerated two-round Delphi survey, and (4) consensus meetings. Participants were stratified by World Bank income classification. Recommendations achieving ≥80% agreement were retained. A subset of participants subsequently evaluated the final recommendations using the APEASE criteria (Acceptability, Practicability, Effectiveness, Affordability, Spill-over effects, and Equity). Results: A total of 1,000 participants completed Round 1 and 812 completed Round 2 of the Delphi, representing HIC (59.5%), UMIC (16.6%), LMIC (18.7%), and LIC (1.6%) stakeholders. From 245 initial statements across eight domains, 194 recommendations achieved global consensus. Tailored adaptations were added for each income group, resulting in 197 recommendations for HICs, 207 for UMICs, 206 for LMICs, and 216 for LICs. Training, infrastructure readiness, and multidisciplinary engagement showed the greatest variation across settings. APEASE evaluation confirmed overall acceptability, practicality, and equity, with LIC participants reporting the highest spill-over and equity benefits. Conclusion: The RoboDev study has developed the first global, evidence-based, and context-sensitive guidelines for building and expanding robot-assisted surgical programmes. By combining universal principles with context-specific adaptations, these recommendations provide a roadmap for equitable and sustainable expansion of robotic surgery worldwide. Adoption of these guidelines has the potential to improve patient outcomes, strengthen surgical systems and ensure that the benefits of robotic innovation are shared equitably across all global contexts.

Minimally invasive cardiac surgery has progressed from small thoracotomies to endoscopic and robotic surgeries. Here we present a periareolar approach in patients with breast implants. This technique involves both cardiac and plastic surgeons in response to a more cosmetically conscious population along with the benefits of avoiding the sternum. In elective cases, myxoma removals, atrial septal defect closures, and mitral valve surgeries can be performed in patients with previous breast prosthesis using a periareolar technique.

Cardiac tumors, whether primary (mostly benign) or secondary (metastatic), are extremely rare, and very few cases of retiniform hemangioendothelioma have been documented since its initial diagnosis in 1994. We present a 67-year-old male who presented with pericarditis, recurrent pericardial and pleural effusions. On computed axial tomography, an oval lesion located on the superior aspect of the left pulmonary pericardial recess within the transverse sinus, adjacent to the trunk of the pulmonary artery. In the operating room, after dissection and resection of the mass, the histopathological diagnosis of retiniform hemangioendothelioma was confirmed.

INTRODUCTION:With the introduction of minimally invasive cardiac surgery, more commonly cases of lung herniation are starting to appear. Acquired lung hernias are classified as postoperative, traumatic, pathologic, and spontaneous. Up to 83% of lung hernias are intercostal. Herein, we describe patients presenting with intercostal lung hernias following minimally invasive cardiac surgery at a single center in Medellín, Colombia. METHODS:We conducted a retrospective search of all patients presenting with intercostal lung hernias secondary to minimally invasive cardiac surgery at our clinic in Medellín since the beginning of our program, from 2010 to 2022. Mini-sternotomies were excluded from our study. We reviewed the incision type and other possible factors leading to intercostal lung hernia development. We also describe the approach taken for these patients. RESULTS:From 2010 up until 2022, 803 adult patients underwent minimally invasive cardiac surgeries through a mini-thoracotomy. At the time of data retrieval, nine patients presented with intercostal lung hernias at the previous incision site. Five hernias (55%) were from right 2nd intercostal parasternal mini-thoracotomies for aortic valve surgeries. Four hernias (45%) were from right 4th intercostal lateral mini-thoracotomies for mitral valve surgeries. Our preferred repair technique is a video-assisted thoracoscopic mesh approach. CONCLUSION:Minimally invasive cardiac surgical approaches are becoming more routine. Proper wound closure is critical in preventing lung hernias. Additionally, timely diagnosis and opportune hernia surgery using video-assisted thoracoscopic mesh repair can prevent further complications.

Minimally invasive cardiac surgery (MICS) has demonstrated its efficacy in diminishing postoperative pain, accelerating early recovery, and facilitating a prompt return to daily activities. Notably, the periareolar incision has gained prominence owing to its superior cosmesis. This article elucidates the procedural details for implementing periareolar incision access in MICS and providing insights into its technique and applications.

Objective: Cardiovascular disease is the leading cause of death globally, responsible for 17.5 million deaths each year, 80% of which occur in low- and middle-income countries, including countries in Africa. Cardiothoracic surgery, with its heavy financial outlay, is unavailable in many African countries. Many African healthcare givers are under the erroneous impression that the cardiovascular surgical landscape of Africa is blank. This review aims at describing the cardiothoracic surgery practice in Africa, the different training programs in the region, and its future prospects. Method: Through a literature review, the authors elaborate on key points, such as healthcare and cardiothoracic surgery in Africa, African cardiothoracic practice and training, and the future of cardiothoracic surgery in Africa. Results: African countries with established cardiothoracic surgery capacity and training programs still face several challenges across multiple levels, including a persistent low enrollment rate in residency programs, insufficient local expertise, a lack of financial resources, an inadequate health infrastructure, and a skewed health insurance reimbursement system. Thus, there is still a growing burden of surgically correctable cardiovascular disease in these countries. Conclusions: Cardiothoracic surgery in Africa has faced great challenges due to resource constraints, but it has demonstrated resilience and growth through diverse models and initiatives. The burden of cardiovascular diseases in Africa remains high, yet the capacity to provide cardiothoracic surgery is limited. With investment, support, and the implementation of comprehensive healthcare policies, cardiothoracic surgery practice can improve in this region and this can make a significant impact on the health and well-being of its population.

Introduction An infrequent yet known complication of ECMO is abdominal compartment syndrome requiring emergency laparotomy. Also, the need for prolonged enteral nutrition while on ECMO may require endoscopic gastrostomy to maintain adequate nutritional status. Here we describe our experience with emergency laparotomy and endoscopic gastrostomy in patients on ECMO support. Methods We retrieved patient histories from our clinical archives and performed a retrospective description of all patients taken to an emergency laparotomy or endoscopic gastrostomy while on ECMO support at our cardiovascular referral center from July 2019 through June 2024. Results During the research period of 5 years a total of 401 patients were placed on ECMO support for either cardiogenic shock or respiratory failure. A total of 27 (7%) patients required an abdominal intervention while on ECMO. 14 (3.5%) patients required emergency laparotomy and 13 (3.2%) of patients required endoscopic gastrostomy tube placement. Overall 30-day mortality of all patients requiring a general surgery procedure while on ECMO support was 33%. Conclusion ECMO support can result in many complications despite its many benefits. Patients who require emergency laparotomy while on ECMO have lower survival-to-discharge and higher mortality at 30 days. Endoscopic gastrostomy however, can be safely performed on ECMO with little to no bleeding complications despite anticoagulation.

The first successful lung transplant in Colombia was performed on October 28, 1997 in Medellín by Alberto Villegas Hernández at the "Clínica Cardiovascular Santa María" today called the Cardio VID Clinic. Here we present both survival outcomes and characteristics of the oldest and most experienced lung transplant program in Colombia. We conducted a retrospective study of all patients taken to lung transplantation at the Cardio VID Clinic in Medellín, Colombia from October 1997 to October 2022. Patient information from our institutional database and transplant archives were retrieved and reviewed. From October 1997 to October 2022, a total of 153 patients underwent orthotopic lung transplantation at our institution in Medellín, Colombia. Mean recipient age was 48 ± 13 years, the youngest patient was 15 years old and the oldest patient was 73 years old at the time of transplant. Seventy-four (48.4%) patients were men and seventy-nine (51.6%) were women. Uncensored lung transplant survival in Medellin at 1 month, 1 year, 5 years, and 10 years were 68%, 50%, 31%, and 12%, respectively. Although health care coverage in Colombia reaches nearly 100%, socioeconomic hurdles during post-transplant care, nonreturning patients, infections, and traumatic donor deaths lead to high mortality rates. Due to these factors, establishing successful and sustainable lung transplant programs in these settings is challenging.

Cardiovascular diseases are the leading cause of morbidity and mortality worldwide, costing the lives of 18 million people annually, with up to one-third being attributable to cardiac surgical conditions. Approximately 6 billion people do not have access to safe, timely, and affordable cardiac surgery, predominantly affecting populations living in low-middle income countries. Cardiac surgical care is costly, resulting in few centers in variable-resource contexts operating continuously or with the resources observed in higher-resource environments. As a result, innovations may be formally developed or informally adopted to bypass resource constraints and ensure care delivery. Innovations have been observed across the cardiac surgical care continuum and across settings, potentially benefiting both high-income countries, where growing health care costs are becoming unsustainable, and low- and middle-income countries, where competing health agendas may limit investments into cardiac surgery. This narrative review attempts to address the costs associated with cardiac surgery, placing an emphasis on frugal innovations in the perioperative and postoperative care spectrum.

OBJECTIVES:There is a lack of guidance and scant learning resources for left-handed (LH) cardiac surgery residents and surgeons. No objective data exists to evaluate the reality of the training experience of LH cardiac surgeons and residents. METHODS:A 32-question survey was designed for LH cardiac surgeons and residents. The survey questions were aimed towards understanding the experiences of LH cardiac surgeons and residents in order to identify and determine where the challenges of LH in cardiac surgery lie. The survey was disseminated by the European Association for Cardio-thoracic Surgery (EACTS) through online platforms, social media and the EACTS website. RESULTS:74 total responses were gathered from the survey; 73% were true LH operators. During residency, 78.1% of LH cardiac surgery residents had no access to LH faculty. Of those with LH mentors, only 53.3% were supportive and helped teach LH techniques. As trainees, 49.3% considered coronary artery bypass grafting anastomosis to be the most difficult portion of LH technique. Upon initiating independent practice, LH cardiac surgeons consider being LH an advantage in comparison to residency. CONCLUSIONS:In LH cardiac surgery, there is a lack of tailored surgical exposure, training guidance, standardization, learning tools and teaching resources. Training resources for LH cardiac surgeons and residents should be developed.

Cardiovascular surgery in Panama has depended on constant contributions and support from other developed countries. Although cardiac surgery has reached important milestones, cardiac surgery training is still evolving. Here, we provide a look into both the development and training of cardiac surgery in the Republic of Panama and the importance of international training.

Introduction: Data on extra-corporeal membrane oxygenation (ECMO) therapy for pregnant patients with Coronavirus 2019 (COVID-19) infection are limited. Here we report a case of an emergency cesarean section performed while the COVID-19 positive mother was on ECMO support. Case report: A 36-year-old COVID-19 positive patient at 26 weeks gestational age presented with respiratory failure requiring extra-corporeal membrane oxygenation therapy. Nine days later fetal distress demanded an emergency C-section. After 5 weeks on ECMO, the patient was weaned off. Both mother and child were discharged. Discussion: The decision to perform an urgent C-section is one that requires meticulous thought from the attending team. Pulmonary maturation is key as pregnancy may need to be terminated at any time during ECMO. Conclusion: Data on ECMO support for pregnant patients with COVID-19 infection are scarce. Best results can be achieved ensuring adequate anticoagulation, meticulous choice of cannulas, continued fetal monitoring, early lung maturation, and precision timing of delivery.

MitraClip implantation has been reported in severe mitral regurgitation following ischemic papillary muscle rupture in surgically high-risk patients with cardiogenic shock. Here we present a case of a 68-year-old female patient who suffered an ischemic papillary muscle rupture resulting in severe mitral prolapse and had a MitraClip implanted. Three months later, due to progressive symptoms, she was taken to surgery and had an elective minimally invasive mitral valve replacement. Informed consent was given and ethics board approval was obtained.

Background Destination left ventricular assist device placement is increasing as a result of donor shortages and changing patient attitudes. As organ shortages become critical, LVAD programs become fundamental even in more remote regions of the world including island states. Here, we provide a look into the current state and availability of LVAD programs in island states. Main body A narrative review was performed using the World Health Organization Global Index Medicus and PubMed/MEDLINE databases to identify articles describing the island states having reported LVAD placements and programs. Additionally, INTERMACS reports were used. Data were retrieved and a review is presented describing the current state of LVADs in island states. The Caribbean region as a whole has a heart failure (HF) prevalence of 814 per 100,000 and Oceania 667 per 100,000 people. We estimate that over 3000 people in these islands need either a heart transplant or an LVAD. Short conclusion For HF patients living in island regions, special attention should be paid to the inability of having access to specialized mainland medical care. The continuous quest for a solution to HF in island regions should include the establishing of high-quality LVAD programs in a transfer-network centralized/regionalized system to care for those patients not candidates for long-distance air-bridging.

Evolution of cardiac surgical training Surgical training and education began in 1890 at The Johns Hopkins Hospital. Here, the Halstedian training structure became the cornerstone for surgical education up to this day1.