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Luis J Castro MD @LuisCastroMD

Heart Surgery-MarinHealth, CA. Tips/Techniques to facilitate heart surgery. All my opinions based on personal experience. Yolopactli/ticitl

Joined August 2012
  • Tweets 1,491
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  • Followers 2,302
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50 y.o woman treated for “HTN & chronic headaches” for decades. Thought weak legs after walking was normal. Finally got a CT chest; revealed the real problem. Simple surgical fix: 24Fr Ao‑to‑Ao bypass. She feels like a new person. Reminder to keep differential wide.
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Love this device.
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72 yo w h/o bicuspid AS S/P TAVR 5yrs ago, now severe stenosis of implant. Explant revealed massive calcification & dense pannus. Hard to imagine Tavr in Tavr. Standard root enlargement enabled safe implantation of a 29 mm Epic. @DrZeigler1 @JCoselli_MD @Abedeanda @tomcnguyen
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Use of an Intraoperative Head, Neck, and Back Support... : Annals of Surgery journals.lww.com/annalsofsur…

Use of an Intraoperative Head, Neck, and Back Support... : Annals of Surgery

ion to support surgeons’ body parts and alleviate strain and discomfort. Methods: The NekSpine (a passive neck exoskeleton) was trialed on 12 surgeons (7 males and 5 females) across 6 specialties....

journals.lww.com
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Not all aortic valves come out clean. This one was heavily calcified... had to be cut out in several pieces. Mean gradient 74mmHg. Conduction system intact, annulus fully debrided, and a 29 mm prosthesis seated smoothly in a super athletic man.
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I'm a big fan... of the ⁦@NekSpine⁩
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80 y/o w infected #TAVR (#Sapien). SAVR Asc aorta replacement via mini-sternotomy. Sapien removed cleanly, no root injury. A standard elevator tool makes separation of native leaflets & frame relatively easy. TAVR explantation is often simpler than it’s made out to be.
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Excising an aortic valve as a single piece is a skill set developed when learning to properly detach leaflets at the annular insertion. No need to "tear & pluck" at leaflets & calcium. Almost no annular debridement required. SAVR, w 29mm Abbott Epic valve via mini sternotomy.
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Luis J Castro MD retweeted
Mike Posner
@MikePosner
14 Feb 2024
on my 26th birthday, i wrote I Took A Pill in Ibiza…10 years ago. The song became popular several years after i wrote it. Yesterday i celebrated my 36th birthday. i feel proud to look at the song lyrics and know that NONE of them are true anymore. I’ve grown into a completely new man…one that i’m proud of. check this out… 🧵
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85 yo 👱🏼‍♂️, TAVR 3 years ago, now with endocarditis. Ugly, calcified root with obstructed prosthesis, required SAVR & partial aortic wall endarterectomy. Challenging to say the least. 25 mm tissue valve implanted via mini sternotomy. Clamp time 45 minutes.
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I use a surgical elevator to intelligently separate native smashed-up aortic leaflets from outer frame with counter-traction by grabbing the top of frame using a grasping tool. Start with the right, non, then left cusp. In 3-5 minutes, it "pops" out. It's not a "sardine can".
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Great day! Cardiac surgery is alive & thriving. 3 cases. 1st case, partial anomalous right pulmonary vein into SVC, patch baffled into LA via fossa septostomy. 2nd, AVR/replacement Ascending aorta. 3rd, TAVR explant for endocarditis requiring surgical AVR. All extubated...
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A classic rheumatic" fish-mouthed " aortic valve excised this AM. 50-year-old man with 2 prior mitral valve operations, the last one 20 years ago with a mechanical heart valve. Aortic valve replaced with a 23 St Jude Regent valve.
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This device that I wear every day has been a game changer for my practice. After a two or three case day, I leave the OR knowing that the NekSpine device is going to extend my career. Happy to chat with anybody about this.
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Tough case today. Young 👩🏻, 2 prior heart valve operations, last op w 25 OnX mitral & 19 OnX aortic root 7 yrs ago, now with severe double valve stenoses. Required 3rd time operation, w Commando Root and MVR to safely negotiate disaster. Pictures are worth 1000 words... haha!
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On-x-ly??? ha
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Constructed St Jude Regent valve with Hemashield tube conduit to create a 1 cm proximal cuff, creating space above underlying St Jude mechanical heart valve... read previous post. 3rd time reoperation today ...@StephenSpindel @DrZeigler1 @tomcnguyen @AspiringCTS @stanfordctsurg
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Tough redo, previous AVR, Left and Right coronaries 2mm above prosthetic annulus. Endocarditis & Severe MR with massive posterior annular calcification. Near impossible exposure. Without understanding Commando "de-" and "re-"construction, cases like these are inoperable.
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Mastering root enlargement is essential, it's the foundation. Leverage the dome of the LA; it's a vital ally for exposure & orientation. Success in LVOT surgery hinges on a deep understanding of anatomic relationships. Commando isn’t just advanced, it’s root enlargement 2.0
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