Dr. Sam Zeraatian

  Conceptual Framework: Bilateral Pneumonectomy + Lung Transplant with Dynamic ECMO Support (DREAM-style strategy) 1. Clinical Context & Rationale This scenario typically applies to: * End-stage bilateral lung malignancy confined to thorax (selected cases only) * No viable native lung preservation strategy * Need for complete cardiopulmonary support during en..

    The reversed valved Potts shunt is an advanced surgical strategy for patients with severe Pulmonary Hypertension, designed to create a controlled extracardiac communication between the left pulmonary artery and descending aorta using a unidirectional valved conduit. Its mechanism relies on suprasystemic pulmonary artery pressures, which drive right-to-left shunting..

  1. Preoperative Planning & Coordination •Multidisciplinary alignment (cardiac surgery, transplant hepatology, anesthesia, perfusion) •Donor organ assessment and synchronized timing of procurement •Hemodynamic optimization and coagulation planning •blood products (massive transfusion readiness)   ⸻   2. Surgical Exposure •Median sternotomy + laparotomy (simultaneous or staged) •Establish invasive monitoring (TEE, PA..

      Dr.Sam Zeraatian Nejad Davani, Cardiovascular and Transplant surgeon. Advanced Fellow of Thoracic Organs Transplantation Chicago Illinois.                                    

  Heterotopic heart transplantation, also known as the “piggyback” or “double heart” transplant, involves implanting a donor heart alongside the recipient’s native heart rather than replacing it. This technique is particularly useful in patients with high pulmonary vascular resistance or when donor-recipient size mismatch is a concern. Donor heart procurement..

    Perfusion Management – Technical Notes   Core Perfusion Strategy   •Full CPB with bicaval cannulation •Target DHCA at 18–20°C •Ensure excellent venous drainage •Maintain uniform cooling (ΔT <10°C)   ⸻   Cooling Phase   •Duration: 30–45 min •Strategy: Alpha-stat •Monitor: •NIRS (cerebral saturation) •Core vs peripheral temp gradient..

    Technical Challenges & Surgical Strategy Background •Aorto–pulmonary fistula is a rare but life-threatening complication •Common in redo cardiac surgery •Frequently associated with: •Prior aortic valve/root procedures •Infective endocarditis •Pseudoaneurysm rupture •Leads to: •Continuous left-to-right shunt •Pulmonary overcirculation •Progressive LV & RV dysfunction   ⸻    Objective   To..

    Heart Procurement and Placement on OCS – Stepwise Approach   I. Preoperative Preparation   1.Team Preparation •Confirm donor consent and organ allocation. •Communicate with recipient surgical team and perfusion/OCS team. •Confirm availability of all equipment: OCS device, cannulas, prime solutions, perfusate. 2.Donor Assessment •Review hemodynamic stability, echocardiography, coronary..

      1. Donor Identification •Identify a potential DCD donor (Maastricht category III or II in some systems). •Patient has devastating neurologic or systemic injury but does not meet brain death criteria. •Decision for withdrawal of life-sustaining therapy (WLST) is made independently of the transplant team.   ⸻  ..

A redo Bentall operation for right coronary artery (RCA) ostial insufficiency represents one of the most technically demanding scenarios in complex aortic root surgery. This condition typically arises from progressive ostial stenosis, kinking, pseudoaneurysm formation, or patch dehiscence following a prior composite valve–graft root replacement, leading to myocardial ischemia, ventricular..