Balloon aortic valvuloplasty (BAV) is a treatment for high risk patients with severe aortic valve stenosis (AS). Rapid pacing is needed to reduce cardiac output when dilating the balloon, but it may cause cardiac ischemia or lethal arrhythmia. In this case report, percutaneous cardiopulmonary support (PCPS) was used to prevent these complications with BAV. We achieved adequate blood pressure and cardiac output during BAV without using rapid pacing by drawing a certain amount of blood into the reservoir equipped with the PCPS circuit. When performing BAV, PCPS may be a useful option for the patients who have high risks of circulatory failure.

Along with clinical practice and education, research is among the most important activities for medical doctors. The same is true in cardiovascular surgery: Young cardiovascular surgeons are expected to improve their surgical techniques and prioritize their clinical practice. However, their perspective on the role of research in their field of expertise is unknown. Therefore, we conducted a survey of and discussion with young cardiovascular surgeons to clarify their thoughts and concerns about performing research. Here we review and report the survey and discussion results.

Basic procedures that cardiovascular surgeons routinely perform are rarely discussed, despite the great variability among facilities. We conducted a questionnaire survey on Extracorporeal Membrane Oxygenation (ECMO) targeting under-forty cardiovascular surgeons and obtained responses from 53 surgeons. We report the questionnaire results.

We conducted a questionnaire survey on shift and on-call system targeting under-forty cardiovascular surgeons and obtained responses from 35 surgeons. We report the questionnaire results.

The importance of off the job training in surgical education are widely recognized. The Japanese Board of Cardiovascular Surgery has required a board candidate to do at least 30 hours of off the job training from 2017. U-40 Basic Lecture Course are held annually for young cardiovascular surgeon to learn about basic surgical skills. U-40 Advanced Lecture Course was started to provide opportunity to have more advanced hands-on lecture for young cardiovascular surgeon. However, after the COVID-19 pandemic, the opportunity to hold hands-on seminars are highly limited. In such circumstances, we held a hybrid hands-on seminar. We report details about the hybrid hands-on seminar.

Background : Endoscopic vessel harvesting (EVH) is one of the less-invasive graft harvesting techniques for CABG. On the other hand, it needs certain amount of a learning curve to acquire sufficient technique. Inappropriate manipulation will cause damage of the vein, decrease the patency and affect the patient's long-term survival. Off-the-job training has the potential to shorten the length of the learning curve. In this study we evaluated the effectiveness of a newly developed saphenous vein harvesting model provided by EBM corporation. Purpose : To evaluate the effectiveness of concentrated training with the EVH simulator. Objective and Methods : One novice trainee doctor was recruited for this study. After 20 procedures using the simulator training clinical device, EVH was performed under supervision. This procedure was compared with the last case before the training in terms of setup for the EVH, visualization by endoscope, dissection, division of branches, duration of the procedure, and number required for repair. Results : The duration required to train with the simulator showed a stable average of 10 cases. All the elements in terms of EVH procedure were improved after the simulator training. Discussion : It is important to prepare an appropriate simulator, trainer, and clear purpose for effective training. It was beneficial to enhance the clinical level with the concentrated simulator training. Conclusions : The newly developed EVH model is an effective simulator before performing the initial clinical case.

An 83-year-old woman (BSA 1.36 m2) who had undergone aortic valve replacement (Magna ease 19 mm), mitral valve replacement (Epic mitral 25 mm), tricuspid annuloplasty (De Vega technique), and pulmonary vein isolation eight years earlier was referred to our hospital due to her heart failure symptoms. Ultrasound cardiography revealed severe mitral regurgitation due to perforation of bioprosthetic valve, severe mitral valve stenosis (mean pressure gradient 7.8 mmHg) due to bioprosthetic deterioration, and subsequent pulmonary hypertension (mean pulmonary artery pressure 49 mmHg, tricuspid regurgitation pressure gradient 85.5 mmHg). We performed a redo aortic valve (Inspiris 23 mm) and mitral valve (Epic mitral 29 mm) replacement using the Manouguian technique. The postoperative course was uneventful and pulmonary hypertension improved (tricuspid regurgitation pressure gradient 39.6 mmHg).