9 Videos for a Strong Cardiothoracic Surgical Foundation

CTSNet’s Step-By-Step series uses diagrams and surgical videos to illustrate key technical elements of nine basic cardiothoracic surgical procedures. The authors also provide further reading for elaboration on each procedure. The series provides essential knowledge for trainees and beginning surgeons, and is helpful for those at any point in their career.

1. CTSNet Step-by-Step Series: Pacing Wires
By Caryl Richards, Shruti Jayakumar, Leanne Harling (Ashrafian), Jason Varzaly, James Edwards
Pacing wires may be required in the acute postoperative period for cardiac surgery patients who are at risk for conductive abnormalities such as postoperative block or atrial fibrillation. This most popular video in the series gives a detailed explanation of how pacing wires work, along with their placement, installment, and removal. 

2. CTSNet Step-by-Step Series: Chest Drains
By Caryl Richards, Shruti Jayakumar, Leanne Harling (Ashrafian), Jason Varzaly, James Edwards
After a cardiac procedure, chest tubes are placed in the mediastinal space to monitor blood loss and allow undesirable blood, fluids, and air to evacuate the space. Their insertion, management, and removal are procedures that every cardiothoracic surgeon should understand. This article and video give a detailed breakdown of chest drain insertion, including incision, stitching, and removal technique.

3. CTSNet Step-by-Step Series: Posterolateral Thoracotomy
By Shruti Jayakumar, Pavlos Papoulidis, Marco Nardini, Leanne Harling (Ashrafian), Joel Dunning, Ian Paul
The posterolateral thoracotomy is a popular incision used in procedures on the lung or posterior mediastinum. This video shows a muscle-sparing approach to the incision, preserving the serratus anterior while allowing for clear access to the surgical field.

4. CTSNet Step-by-Step Series: Central Cannulation
By Andrel Yoong, Omar Jarral, Shruti Jayakumar, Jason Varzaly, Leanne Harling (Ashrafian), James Edwards
Central cannulation is essential knowledge for every cardiothoracic surgeon to have. This video and its detailed description break down each step in the procedure, including explanations of complications that may arise and how to avoid them. 

5. CTSNet Step-by-Step Series: Midline Sternotomy
By Shruti Jayakumar, Leanne Harling (Ashrafian), Joel Dunning, Jason Varzaly, James Edwards
A midline sternotomy is the starting point for many cardiac and thoracic procedures, even with the increasing prevalence of minimally invasive surgery. This quick video demonstrates the technique using helpful diagrams and surgical footage.

6. CTSNet Step-by-Step Series: Proximal Anastomosis
By Christopher Chen, Manraj Sandhu, Shruti Jayakumar, Jason Varzaly, Leanne Harling (Ashrafian), James Edwards
In a CABG procedure, proximal anastomosis is a key step to ensure success. In this video, the authors break proximal anastomosis down into five parts: preparation, creating the aortic hole, cutting the graft, parachuting the graft onto the aorta, and completing the anastomosis. 

7. CTSNet Step-by-Step Series: Tricuspid Annuloplasty
By K N, Omar Jarral, Shruti Jayakumar, Jason Varzaly, Leanne Harling (Ashrafian), James Edwards
Using the cannulation method demonstrated previously in the series, this video shows each step in a tricuspid annuloplasty. The procedure uses an annuloplasty ring to reinforce the annulus and correct valve dysfunction. The author makes sure to include complications that may arise and how to avoid them.

8. CTSNet Step-by-Step Series: Sternal Closure Using Stainless Steel Wires
By Edward Lau, Leanne Harling (Ashrafian), Shruti Jayakumar, Jason Varzaly, James Edwards
Once a procedure requiring a median sternotomy is complete, there are a few different materials that can be used for closure. This video demonstrates the use of stainless-steel wires to close a sternotomy, including different stitches and closure methods.

9. CTSNet Step-by-Step Series: AVR Valve Excision and Debridement
By Tinrui Toh, Michael Ghosh-Dastidar, Shruti Jayakumar, Leanne Harling (Ashrafian), Jason Varzaly, James Edwards
The final video in the step-by-step series uses anatomical diagrams and video footage to guide the viewer through the initial steps of aortic valve replacement. As one of the most common cardiac procedures, it is essential to any cardiac surgeon’s repertoire.

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