Browsing by Author "Vekstein, Andrew M"

Now showing 1 - 4 of 4

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 W
The 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.
Open Access
Commentary: Mechanical aortic graft injury after thoracoabdominal aortic aneurysm repair: A reminder that even the little details matter.
(JTCVS techniques, 2021-08) Vekstein, Andrew M; Andersen, Nicholas D; Hughes, G Chad
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 W
Pulmonary 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.
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 W
A 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.