Episode Details

CardioNerds (Drs. Rawan Amir, Tripti Gupta, and Alysha Joseph) discuss the fundamentals of adult congenital heart disease (ACHD) surgery with Dr. Elizabeth Stephens.  Audio editing by CardioNerds academy intern, Grace Qiu. 

Using a case of a young adult undergoing a Ross procedure, the episode walks through what happens in the operating room—from induction and intraoperative transesophageal echocardiography (TEE) to cardiopulmonary bypass (CPB), myocardial protection, and surgical repair. The discussion highlights key concepts including cardioplegia, cross-clamp and bypass times, hypothermic circulatory arrest, and the complexity of redo sternotomy. This episode provides learners with a practical framework to interpret operative reports, anticipate postoperative physiology, and better collaborate with surgical teams.

This episode was produced by the CardioNerds ACHD Council and planned by Dr. Rawan Amir. 

CardioNerds Adult Congenital Heart Disease Page
CardioNerds Episode Page

Pearls

1. “LV distension kills patients.”
   Preventing left ventricular distension with appropriate venting and awareness of aortic insufficiency is critical to intraoperative safety. 
2. TEE can change the surgical plan in real time.
   Findings such as underestimated aortic regurgitation, mitral pathology, or a PFO may directly alter cannulation and cardioplegia strategy. 
3. Cross-clamp time = myocardial ischemic time; bypass time = systemic stress.
   Both are key predictors of postoperative complications including renal injury, bleeding, and ventricular dysfunction. 
4. Redo sternotomy risk is driven by anatomy, not just number.
   Aorta adherent to the sternum, conduit position, and chamber pressurization define risk more than the number of prior surgeries. 
5. Think longitudinally—ACHD surgery is lifetime planning.
   Surgical materials and strategies must account for future interventions, especially in younger patients.

Notes:

Notes drafted by Dr. Alysha Joseph, aided by generative artificial intelligence.

1. What are the key steps in congenital cardiac surgery from incision to closur