Browsing by Author "Nellis, Joseph R"
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Item Open Access Borrowing from Adult Cardiac Surgeons-Bringing Congenital Heart Surgery Up to Speed in the Minimally Invasive Era.(Innovations (Philadelphia, Pa.), 2020-03) Alsarraj, Mohammed K; Nellis, Joseph R; Vekstein, Andrew M; Andersen, Nicholas D; Turek, Joseph WThe majority of congenital and adult cardiac surgery is performed through a median sternotomy. For surgeons, this incision provides excellent exposure; however, for patients, a median sternotomy confers a poorer cosmetic outcome and the possibility of postoperative respiratory dysfunction, chronic pain, and deep sternal wound infections. Despite the advances in adult cardiac surgery, the use of minimally invasive techniques in pediatric patients is largely limited to small case series and less complex repairs. In this article, we review the risks, benefits, and limitations of the minimally invasive congenital cardiac approaches being performed today. The interest in these approaches continues to grow as more data supporting reduced morbidity, decreased length of stay, and faster recovery are published. In the future, as the technology and surgical familiarity improve, these alternative approaches will become more common, and may someday become the standard of care.Item Open Access Left Anterior Mini-Incision for Pulmonary Valve Replacement Following Tetralogy of Fallot Repair.(Innovations (Philadelphia, Pa.), 2020-03) Nellis, Joseph R; Vekstein, Andrew M; Meza, James M; Andersen, Nicholas D; Haney, John C; Turek, Joseph WPulmonary insufficiency is a known complication following Tetralogy of Fallot repair. With over 90% of patients now surviving to adulthood, surgeons are once again faced with the question of when, and more importantly, how to reintervene. We developed a novel approach to pulmonary valve replacement in this population through a 5-cm left anterior mini-incision. The incision is optimized for exposing and operating on the right ventricular outflow tract and the main pulmonary artery in patients with a history of median sternotomy. Early outcomes are reassuring, and we believe our approach is a safe and reliable alternative to median sternotomy within this patient population, with the ability to quickly convert intraoperatively when needed.Item Open Access Left Anterior Mini-Incision for Pulmonary Valve Replacement in a 12-Year-Old.(Innovations (Philadelphia, Pa.), 2020-03) Vekstein, Andrew M; Nellis, Joseph R; Meza, James M; Andersen, Nicholas D; Haney, John C; Turek, Joseph WA 12-year-old, 32 kg male with history of Tetralogy of Fallot status post repair at 8 days of life presented with progressive pulmonary insufficiency and left pulmonary artery stenosis. Surgical options were discussed, and the patient and his family elected to pursue minimally invasive pulmonary valve replacement with left pulmonary artery augmentation through a 5-cm left anterior mini-incision. The procedure was performed without complication, and he was discharged on postoperative day 3. At the time of his last follow-up, the patient was recovering well without evidence of pulmonary stenosis or insufficiency.Item Open Access Minimally Invasive Pulmonary Fibroelastoma Resection.(Innovations (Philadelphia, Pa.), 2019-11-19) Nellis, Joseph R; Wojnarski, Charles M; Fitch, Zachary W; Andersen, Nicholas A; Turek, Joseph WPulmonary fibroelastomas are a rare primary cardiac tumor with less than 50 cases reported in the literature to date. We performed a minimally invasive valve-sparing tumor resection through a left anterior mini-incision (LAMI). The procedure was performed without cardiac arrest or aortic cross clamp, expediting postoperative recovery and allowing for an uncomplicated discharge on postoperative day 5. LAMI is a safe and reliable alternative to median sternotomy for patients requiring interventions on the right ventricular outflow tract and main pulmonary artery, including pulmonary fibroelastoma resection and pulmonary valve replacement when needed.