Annals of Cardiothoracic Surgery - Annals of Cardiothoracic Surgery

Welcome to Art of Operative Techniques

Art of Operative Techniques is a featured section that publishes illustrated articles, describing the operative procedures in a step-by-step format.

You are welcome to provide commentary and discuss any of the published illustrated articles, via the Your Comments section. The Your Comments section will be available for general public viewing. If you wish to comment on an article in the Art of Operative Techniques, please locate the illustrated article, click on the Your Comments tab and email your letter directly to the Editor-in-Chief. The authors of the original publication will be given the opportunity to respond to your comments. Please note that letters submitted in the Your Comments section are limited to 500 words. Join in the discussion today! All accepted letters will be published online within 48 hours and selected letters will be published in the print journal.

Vol 9, No 6 (November 27, 2020): Transcatheter Aortic Valve Replacement

A step-by-step guide to trans-axillary transcatheter aortic valve replacement

Morgan T. Harloff, Edward D. Percy, Sameer A. Hirji, Farhang Yazdchi, Hunbo Shim, Muntasir Chowdhury, Alexandra A. Malarczyk, Piotr S. Sobieszczyk, Ashraf A. Sabe, Pinak B. Shah, Tsuyoshi Kaneko

Full Text (6779) | PDF | Open Access

Vol 9, No 5 (September 30, 2020): Sutureless and Rapid Deployment Aortic Valve Replacement II

Sutureless and rapid deployment valves: implantation technique from A to Z—the INTUITY Elite valve

Mattia Glauber, Antonio Miceli, Lorenzo Di Bacco

Full Text (5204) | PDF | Open Access

Vol 9, No 4 (July 28, 2020): Sutureless and Rapid Deployment Aortic Valve Replacement I

Sutureless and rapid deployment valves: implantation technique from A to Z—the Perceval valve

Mattia Glauber, Antonio Miceli, Lorenzo di Bacco

Full Text (13432) | PDF | Open Access

Vol 9, No 3 (May 29, 2020): Frozen Elephant Trunk

Mini-access branch-first total arch replacement and frozen elephant trunk procedure

Adam Chakos, Tristan D. Yan

Full Text (6460) | PDF | Open Access

Vol 9, No 2 (March 30, 2020): Total Artificial Heart

Insertion of the total artificial heart in the Fontan circulation

Robert D. B. Jaquiss, Ronald K. Woods

Full Text (3738) | PDF | Open Access

Vol 9, No 1 (January 29, 2020): Lung Transplantation

Sternotomy versus thoracotomy lung transplantation: key tips and contemporary results

Gita N. Mody, Anthony Coppolino, Steve K. Singh, Hari R. Mallidi

Full Text (5929) | PDF | Open Access

Vol 8, No 6 (November 29, 2019): Endocarditis

The “UFO” procedure

Martin Misfeld, Piroze M. Davierwala, Michael A. Borger, Farhad Bakhtiary

Full Text (17765) | PDF | Open Access

Vol 8, No 5 (September 24, 2019): Type A Intramural Hematoma

Cannulation strategies, circulation management and neuroprotection for type A intramural hematoma: tips and tricks

Bradley G. Leshnower

Full Text (7163) | PDF | Open Access

Vol 8, No 4 (July 01, 2019): Type B Intramural Hematoma and Descending Penetrating Aortic Ulcer

Art of operative techniques: treatment options in arch penetrating aortic ulcer

Chiara Lomazzi, Viviana Grassi, Maurizio Domanin, Carlo De Vincentiis, Gabriele Piffaretti, Santi Trimarchi

Full Text (5450) | PDF | Open Access

Vol 8, No 3 (May 01, 2019): Advanced Techniques in Aortic Valve Repair

Bicuspid aortic valve repair adapted to aortic phenotype

Mustafa Zakkar, Pouya Youssefi, Christophe Acar, Nizar Khelil, Mathieu Debauchez, Emmanuel Lansac

Full Text (Video) (8201) | PDF | Open Access

Vol 8, No 2 (March 30, 2019): Robotic Thoracic Surgery

Right robotic-assisted thoracoscopic lower lobectomy

Sasha Stamenkovic, Franca Melfi

Full Text (6156) | PDF | Open Access

Vol 8, No 1 (January 01, 2019): Extracorporeal Life Support in Refractory Heart Failure

Double, triple and quadruple cannulation for veno-arterial extracorporeal membrane oxygenation support: is there a limit?

Daniele Camboni, Alois Philip, Christof Schmid, Antonio Loforte

Full Text (19882) | PDF | Open Access

Vol 7, No 6 (November 30, 2018): Emerging Technologies in Mitral Valve Surgery

Transapical NeoChord mitral valve repair

Andrea Colli, David Adams, Alessandro Fiocco, Nicola Pradegan, Lorenzo Longinotti, Matteo Nadali, Dimosthenis Pandis, Gino Gerosa

Full Text (8837) | PDF | Open Access

Vol 7, No 5 (September 30, 2018): Coronary Revascularisation—Surgical Developments and Future Prospects

How I deploy arterial grafts

David P. Taggart

Full Text (13118) | PDF | Open Access

Vol 7, No 4 (July 31, 2018): Coronary Revascularisation—Cardiology for the Surgeon

Dual inflow, total-arterial, anaortic, off-pump coronary artery bypass grafting: how to do it

Fabio Ramponi, Michael Seco, James B. Edelman, Andrew G. Sherrah, Paul G. Bannon, R. John L. Brereton, Michael K. Wilson, Michael P. Vallely

Full Text (12073) | PDF | Open Access

Vol 7, No 3 (May 31, 2018): Complex Aortic Arch Surgery

Hybrid three-stage repair of mega aorta with Lupiae technique: tips and tricks

Giampiero Esposito, Antonio Pignatelli, Gaetano Contegiacomo, Giangiuseppe Cappabianca, Cesare Beghi, Carlo Lafranceschina, Fabio Tiecco, Francesco Bartolomucci, Matteo Miccoli, Massimiliano Conte

Full Text (7235) | PDF | Open Access

Vol 7, No 2 (March 31, 2018): Tracheal Surgery

Idiopathic subglottic stenosis: techniques and results

Andrea L. Axtell, Douglas J. Mathisen

Full Text (10611) | PDF | Open Access

Vol 7, No 1 (January 31, 2018): Heart Transplantation

Pre-transplant ventricular assist device explant

Espeed Khoshbin, Stephan Schueler

Full Text (Video) (8283) | PDF | Open Access

Vol 6, No 6 (November 30, 2017): Marfan Syndrome

Aortic valve sparing root surgery for Marfan syndrome

George Matalanis, Nisal K. Perera

Full Text (10813) | PDF | Open Access

Vol 6, No 5 (September 30, 2017): Transcatheter Aortic Valve Implantation

Technical pitfalls and tips for the valve-in-valve procedure

Vinayak Bapat

Full Text (17619) | PDF | Open Access

Vol 6, No 4 (July 01, 2017): Hypertrophic Obstructive Cardiomyopathy

Transaortic septal myectomy: techniques and pitfalls

Anthony Ralph-Edwards, Rachel D. Vanderlaan, Pietro Bajona

Full Text (Video) (24582) | PDF | Open Access

Vol 6, No 3 (May 31, 2017): Tricuspid Valve Surgery

Surgical management of tricuspid stenosis

Marisa Cevasco, Prem S. Shekar

Full Text (12595) | PDF | Open Access

Vol 6, No 1 (January 20, 2017): Robotic Heart Surgery (II)

Robotic trans-atrial and trans-mitral ventricular septal resection

W. Randolph Chitwood Jr

Full Text (Video) (8499) | PDF | Open Access

Vol 5, No 6 (November 25, 2016): Robotic Heart Surgery (I)

Technical aspects of robotic posterior mitral valve leaflet repair

Hoda Javadikasgari, Rakesh M. Suri, Tomislav Mihaljevic, Stephanie Mick, A. Marc Gillinov

Full Text (7353) | PDF | Open Access

Vol 5, No 5 (September 01, 2016): Pectus Excavatum

Short Nuss bar procedure

Hans Kristian Pilegaard

Full Text (13233) | PDF | Open Access

Vol 5, No 4 (July 01, 2016): Type A Aortic Dissection (II)

Thoracic endovascular repair for acute type A aortic dissection: operative technique

Aamir Shah, Ali Khoynezhad

Full Text (15357) | PDF | Open Access

Vol 5, No 3 (May 01, 2016): Type A Aortic Dissection (I)

Surgical management of acute type A aortic dissection: branch-first arch replacement with total aortic repair

Sean D. Galvin, Nisal K. Perera, George Matalanis

Full Text (18585) | PDF | Open Access

Vol 5, No 2 (March 01, 2016): Uniportal Video-Assisted Thoracoscopic Lobectomy

Uniportal video-assisted thoracic (VATS) lobectomy

Alan D. L. Sihoe

Full Text (17732) | PDF | Open Access

Vol 5, No 1 (January 01, 2016): Minimally Invasive Mediastinal Surgery (II)

Video-assisted thoracoscopic thymectomy using 5-mm ports and carbon dioxide insufflation

René Horsleben Petersen

Full Text (10863) | PDF | Open Access

Vol 4, No 6 (November 30, 2015): Minimally Invasive Mediastinal Surgery (I)

Video-assisted thoracoscopic microthymectomy

Joel Dunning

Full Text (8865) | PDF | Open Access

Vol 4, No 5 (September 25, 2015): Mitral Valve Repair (III)

Alternative approaches for mitral valve repair

Andrew B. Goldstone, Y. Joseph Woo

Full Text (13696) | PDF | Open Access

Vol 4, No 4 (July 13, 2015): Mitral Valve Repair (II)

The butterfly technique

Tohru Asai

Full Text (9923) | PDF | Open Access

Vol 4, No 3 (May 28, 2015): Mitral Valve Repair (I)

Mitral valve repair for ischemic mitral regurgitation

Jahan Mohebali, Frederick Y. Chen

Full Text (12628) | PDF | Open Access

Vol 4, No 2 (March 29, 2015): Minimally Invasive Aortic Valve Surgery (II)

Mini-Bentall procedure

Tristan D. Yan

Full Text (15117) | PDF | Open Access

Vol 4, No 1 (January 20, 2015): Minimally Invasive Aortic Valve Surgery (I)

Minimally invasive aortic valve replacement: the “Miami Method”

Joseph Lamelas

Full Text (16261) | PDF | Open Access

Vol 3, No 6 (November 30, 2014): Mechanical Circulatory Support (II)

SynCardia: the total artificial heart

Gianluca Torregrossa, Anelechi Anyanwu, Fabio Zucchetta, Gino Gerosa

Full Text (11406) | PDF | Open Access

Vol 3, No 5 (September 26, 2014): Mechanical Circulatory Support (I)

The Jarvik-2000 ventricular assist device implantation: how we do it

Fabio Zucchetta, Vincenzo Tarzia, Tomaso Bottio, Gino Gerosa

Full Text (12742) | PDF | Open Access

Vol 3, No 4 (July 25, 2014): Type B Aortic Dissection (II)

Open fenestration for complicated acute aortic B dissection

Santi Trimarchi, Sara Segreti, Viviana Grassi, Chiara Lomazzi, Marta Cova, Gabriele Piffaretti, Vincenzo Rampoldi

Full Text (18318) | PDF | Open Access

Vol 3, No 3 (May 31, 2014): Type B Aortic Dissection (I)

Emergent treatment of aortic rupture in acute type B dissection

Santi Trimarchi, Sara Segreti, Viviana Grassi, Chiara Lomazzi, Carlo de Vincentiis, Vincenzo Rampoldi

Full Text (12086) | PDF | Open Access

Vol 3, No 2 (March 31, 2014): Sublobar Resection

Surgical atlas of thoracoscopic lobectomy and segmentectomy

Tristan D. Yan

Full Text (22736) | PDF | Open Access

Vol 3, No 1 (January 28, 2014): Atrial fibrillation surgery

Illustrated techniques for performing the Cox-Maze IV procedure through a right mini-thoracotomy

Jason O. Robertson, Lindsey L. Saint, Jeremy Leidenfrost, Ralph J. Damiano Jr

Full text | PDF | Open Access

Vol 2, No 6 (November 29, 2013): Minimally invasive mitral valve surgery

Minimally invasive valve sparing mitral valve repair—the loop technique—how we do it

Stephan Jacobs, Simon H. Sündermann

Full text | PDF | Open Access

Vol 2, No 5 (September 01, 2013): Frozen Elephant Trunk

Sun’s procedure for complex aortic arch repair: total arch replacement using a tetrafurcate graft with stented elephant trunk implantation

Wei-Guo Ma, Jun-Ming Zhu, Jun Zheng, Yong-Min Liu, Bulat A. Ziganshin, John A. Elefteriades, Li-Zhong Sun

Full Text (15729) | PDF | Open Access

Vol 2, No 4 (July 30, 2013): Total arterial revascularization

Harvesting the radial artery

Arie Blitz, Robert M. Osterday, Richard F. Brodman

Full Text (68103) | PDF | Open Access

The art of arterial revascularization—total arterial revascularization in patients with triple vessel coronary artery disease

Brian F. Buxton, Philip A. Hayward

Full Text (38976) | PDF | Open Access

Vol 2, No 3 (May 30, 2013): Aortic arch surgery (II)

Total aortic arch replacement: current approach using the trifurcated graft technique

Scott A. LeMaire, Scott A. Weldon, Joseph S. Coselli

Full Text (41035) | PDF | Open Access

Vol 2, No 2 (March 18, 2013): Aortic Arch Surgery (I)

Surgical techniques of total arch replacement using selective antegrade cerebral perfusion

Yutaka Okita, Kenji Okada, Atsushi Omura, Hiroya Kano, Hitoshi Minami, Takeshi Inoue, Toshihito Sakamoto, Shunsuke Miyahara, Tomonori Shirasaka, Katsuhiro Yamanaka, Taimi Ohara, Yoshikatsu Nomura, Hidekazu Nakai

Full Text (18449) | PDF | Open Access

Vol 2, No 1 (January 28, 2013): Aortic Valve Repair

How to perform valve sparing reimplantation in a tricuspid aortic valve

Laurent de Kerchove, Zahra Mosala Nezhad, Munir Boodhwani, Gébrine El Khoury

Full Text (22311) | PDF | Open Access

Vol 14, No 2 (March 31, 2025): TAVR Explant

Transcatheter aortic valve replacement explant various techniques

Alexander A. Brescia, Puja Kachroo, Tsuyoshi Kaneko; the Washington University Collaborative for Aortic Research (WashU-CAR)

Full Text (1815) | PDF | Open Access

Vol 13, No 6 (November 30, 2024): Heart Transplantation In Controlled Donation After Circulatory Death I

Surgical techniques for cardiac allograft procurement and perfusion in controlled donation after circulatory death

Antonio Loforte, Matteo Marro, Erika Simonato, Andrea Costamagna, Marco Ellena, Anna Chiara Trompeo, Marinella Zanierato, Luca Brazzi, Mauro Rinaldi, Massimo Boffini

Full Text (1140) | PDF | Open Access

Vol 13, No 5 (September 29, 2024): Robotic Coronary Artery Bypass Grafting II

Step-by-step technique of robotic-assisted minimally invasive direct coronary artery bypass

MaryAnn C. Wertan, Serge Sicouri, Yoshiyuki Yamashita, Massimo Baudo, Trisha A. Senss, Danielle Spragan, Gianluca Torregrossa, Francis P. Sutter

Full Text (3330) | PDF | Open Access

Vol 13, No 3 (May 31, 2024): Aortic Annular Enlargement

Aortic annular enlargement with Y-incision/rectangular patch

Bo Yang

Full Text (12542) | PDF | Open Access

Vol 13, No 1 (January 30, 2024): Atrial Fibrillation Management I

Concomitant atrial fibrillation ablation in minimally invasive cardiac surgery

Andrew Tjon Joek Tjien, Ferdi Akca, Kayan Lam, Jules Olsthoorn, Lukas Dekker, Pepijn van der Voort, Niels Verberkmoes, Thomas J. van Brakel

Full Text (3716) | PDF | Open Access

Vol 12, No 6 (November 27, 2023): Aortic Disease in Women

Minimally invasive surgical coronary artery bypass in women

Cynthia L. Miller, Brittany A. Zwischenberger

Full Text (4009) | PDF | Open Access

Vol 12, No 5 (September 28, 2023): Spinal Cord Protection

Minimally invasive staged segmental artery coil embolization (MIS²ACE) for spinal cord protection

Josephina Haunschild, Tilo Köbel, Martin Misfeld, Christian D. Etz

Full Text (2672) | PDF | Open Access

Vol 12, No 4 (July 31, 2023): Three Decades of Aortic Valve-Sparing Operations II

Aortic root remodeling

Christian Giebels, Tristan Ehrlich, Hans-Joachim Schäfers

Full Text (3152) | PDF | Open Access

Vol 12, No 3 (May 31, 2023): Three Decades of Aortic Valve-Sparing Operations I

Valve-sparing root replacement—reimplantation technique

Jennifer L. Perri, Edward P. Chen

Full Text (4129) | PDF | Open Access

Vol 12, No 1 (January 31, 2023): Uniportal Robotic-Assisted Thoracic Surgery I

Uniportal fully robotic-assisted major pulmonary resections

Diego Gonzalez-Rivas, Mugurel Bosinceanu, Veronica Manolache, Javier Gallego-Poveda, Alejandro Garcia, Marina Paradela, Joel Dunning, Manjunath Bale, Natalia Motas

Full Text (3804) | PDF | Open Access

Vol 11, No 6 (November 29, 2022): Robotic Mitral Valve Surgery II

Robotically assisted mitral valve repair—the string, ruler, and bulldog technique

Matheus Guimaraes Carelli, Martin Misfeld, Ashley R. Wilson-Smith, Tristan D. Yan

Full Text (Video) (2969) | PDF | Open Access

Vol 11, No 4 (July 29, 2022): Bicuspid Aortic Valve

Bicuspid aortic valve repair: the 180°-Reimplantation technique

Jama Jahanyar, Laurent de Kerchove, Gebrine El Khoury

Full Text (Video) (5790) | PDF | Open Access

Vol 11, No 3 (May 31, 2022): Surgical & Non-Surgical Management of Mechanical Complications of AMI

Operative strategies for acute mitral regurgitation as a mechanical complication of myocardial infarction

Giulio Massimi, Matteo Matteucci, Mariusz Kowalewski, Daniele Ronco, Giovanni Chiarini, Maria Elena De Piero, Valeria Lo Coco, Jos G. Maessen, Cesare Beghi, Roberto Lorusso

Full Text (3369) | PDF | Open Access

Vol 11, No 2 (March 31, 2022): PTE in Chronic Thromboembolic Pulmonary Hypertension and Disease

Pulmonary endarterectomy: technique and pitfalls

Stefan Guth, Eckhard Mayer, Diethard Prüfer, Christoph B. Wiedenroth

Full Text (3794) | PDF | Open Access

Vol 10, No 6 (November 28, 2021): Thoracic Aortic Endovascular Solutions I

Endovascular repair of acute type B thoracic aortic dissection

Alice Le Huu, Ourania Preventza

Full Text (5716) | PDF | Open Access

Vol 10, No 5 (September 29, 2021): Transcatheter Valve-in-Valve

Safeguards and pitfalls for Bioprosthetic or Native Aortic Scallop Intentional Laceration to Prevent Iatrogenic Coronary Artery Obstruction during transcatheter aortic valve replacement—the BASILICA technique

Christopher G. Bruce, Adam B. Greenbaum, Vasilis C. Babaliaros, Toby Rogers, Robert J. Lederman, Jaffar M. Khan

Full Text (3004) | PDF | Open Access

Vol 10, No 4 (July 30, 2021): Ross Procedure

The Ross-Konno procedure for congenital aortic stenosis

Sameh M. Said

Full Text (Video) (12585) | PDF | Open Access

Vol 10, No 2 (March 31, 2021): Continuous-Flow MCS in End-Stage Heart Failure I

Conventional and alternative sites for left ventricular assist device inflow and outflow cannula placement

Antonio Loforte, Tomaso Bottio, Matteo Attisani, Sofia Martin Suarez, Vincenzo Tarzia, Marco Pocar, Luca Botta, Gino Gerosa, Mauro Rinaldi, Davide Pacini

Full Text (4675) | PDF | Open Access

Vol 10, No 1 (January 29, 2021): Transcatheter Mitral Valve Replacement

LAMPOON techniques to prevent or manage left ventricular outflow tract obstruction in transcatheter mitral valve replacement

Brian C. Case, John C. Lisko, Vasilis C. Babaliaros, Adam B. Greenbaum, Lowell Satler, Itsik Ben-Dor, Brian J. Forrestal, Charan Yerasi, Norihiko Kamioka, Toby Rogers, Ron Waksman, Robert J. Lederman, Jaffar M. Khan

Full Text (11562) | PDF | Open Access

Vol 1, No 4 (November 29, 2012): Malignant Pleural Mesothelioma

Extrapleural pneumonectomy and extended pleurectomy/decortication for malignant pleural mesothelioma: the Memorial Sloan-Kettering Cancer Center approach

Valerie W. Rusch

Full Text (17956) | PDF | Open Access

Vol 1, No 3 (September 26, 2012): Thoracoabdominal Aortic Aneurysm Repair

Open reconstruction of thoracoabdominal aortic aneurysms

Yutaka Okita, Atsushi Omura, Katsuaki Yamanaka, Takeshi Inoue, Hiroya Kano, Rei Tanioka, Hitoshi Minami, Toshihito Sakamoto, Shunsuke Miyahara, Tomonori Shirasaka, Taimi Ohara, Hidekazu Nakai, Kenji Okada

Full Text (14584) | PDF | Open Access

Thoracoabdominal aortic aneurysm repair with a branched graft

Kim I. de la Cruz, Scott A. LeMaire, Scott A. Weldon, Joseph S. Coselli

Full Text (30914) | PDF | Open Access

Vol 1, No 2 (July 26, 2012): Transapical Aortic Valve Implantation

Illustrated techniques for transapical aortic valve implantation

Anson Cheung, Kevin M. Lichtenstein

Full Text (58589) | PDF | Open Access