Built for cardiothoracic surgeons, trainees, advanced-practice clinicians, and perioperative teams, this handbook connects cardiopulmonary anatomy, operative physiology, imaging, and disease mechanism to the decisions that define modern thoracic and cardiac care. It moves from lung resection, pleural disease, esophageal surgery, coronary revascularization, valve repair, aortic reconstruction, and congenital pathways into robotic access, structural-heart intervention, ECMO, mechanical support, hybrid procedures, and reoperation rescue.

The Operative Decision Arc System turns each domain into a repeatable planning language: indication trigger, preoperative gate, approach pivot, technical anchor, complication trap, and follow-up lockpoint.

• Stage and plan thoracic oncology operations — translate imaging, nodal disease, pulmonary reserve, margins, and lymphadenectomy into safe resection strategy.
• Manage airway, mediastinal, pleural, diaphragm, chest wall, and foregut procedures — connect anatomy and failure modes to operative exposure, reconstruction, and source control.
• Build coronary and valve plans — select CABG, mitral repair, tricuspid repair, SAVR, TAVR, annular enlargement, or hybrid treatment based on durability and future access.
• Navigate aortic root and thoracic aortic reconstruction — compare valve-sparing repair, Bentall procedure, arch reconstruction, dissection rescue, and staged endovascular pathways.
• Apply structural-heart and mechanical-support logic — plan transcatheter repair, valve-in-valve therapy, VA-ECMO, VV-ECMO, LVAD pathways, and transplant-adjacent decisions.
• Treat congenital and pediatric surgery as staged circulation design — evaluate ductal dependence, shunts, arch obstruction, complex repairs, Norwood, Glenn, Fontan, and adult congenital follow-up.
• Use robotic, minimally invasive, and hybrid access safely — match approach to exposure, team readiness, conversion threshold, and complication rescue.

Open it before the next case conference, operation, or postoperative rescue decision — and make every approach choice serve the patient’s anatomy, physiology, and future care.