Cardiothoracic Surgery

Cardiothoracic surgery, a specialized field of medicine, otherwise referred as thoracic surgery, represent an intricate branch of the healing arts, delving into the identification, remediation, and oversight of maladies afflicting the cardiac, respiratory, and thoracic cavity components and is performed by cardiothoracic surgeons. The operative spectrum encompasses minimally intrusive techniques to elaborate open-cardiac maneuvers, contingent on individual requisites. (1) (2)

Afflictions such as arteriosclerotic cardiac complications, cardiac valvular dysfunctions, pulmonary carcinomas, and thoracic aortic dilations fall within its purview. The repertoire of procedures comprises cardiac shunts, valvular mending or substitution, pulmonary excision, and cardiac or pulmonary engraftments. Finally, The Society of Thoracic Surgeons (STS) National Database materialized in 1989 as a pioneering endeavor to enhance quality and fortify patient security within the realm of cardiothoracic surgical procedures. (3) (4) (5)

Definition and Overview

Cardiothoracic surgery is a branch of surgery consisting of a combination of cardiovascular (heart and blood vessel) surgery and pulmonary (lung) surgery. This branch diagnoses and treats diseases and traumatic injuries of the heart, lungs and other related structures such as the trachea (windpipe), esophagus (feeding tube), and diaphragm.

Cardiothoracic surgeons work closely with cardiologists, oncologists, and anesthesiologists. These surgeons work in collaboration with other non-medical personnel such as perfusionists (who operate heart-lung bypass machines), intensive care personnel, and operating room personnel during all treatment processes of the patient.

Cardiothoracic surgery is performed by a cardiothoracic surgeon. To become a cardiothoracic surgeon, one must first be trained in medical school as a general surgeon. Afterwards, a four-year postgraduate degree in medicine must be successfully completed.

The cardiothoracic surgeon meets with the patient to review pre-operative test results and discuss what the surgery entails, including pre-operative preparations and post-operative recovery. IIt is important for the patient to ask as many questions as they need to fully understand the benefits and risks of surgery. It may reassure the patient to ask how often the surgeon performs the surgery and why this procedure is preferred over others. (6,7)

Procedures

Cardiothoracic surgery is a subspecialty in surgery that focuses on the heart and chest or rib cage. Surgeries and procedures involving these parts of the human body and their diseases are performed by cardiothoracic surgeons. The most common procedures are as follows.

• Aortic Aneurysm Repair

The aorta acts as the main artery of the body. When it expands and bulges outward, it is called an aortic aneurysm. A cardiologist places a stent in the aorta to treat patients living with an aortic aneurysm. The purpose of this procedure is to shrink the enlarged area of the aorta around the stent.

• Aortic Valve Surgery

This procedure can be used to replace the aorta if you experience aortic regurgitation, a condition that occurs when the aortic valve does not close completely, allowing blood to leak back into the heart. Surgery may also be required if the patient has aortic stenosis, a condition that occurs when the aortic valve does not fully open and reduces blood flow to the heart.

• Complex Reoperations

Patients who have had heart surgery in the past may need another surgery in the future. Complications from the initial surgery, new disease, and valve replacement failure are some of the conditions that may require a cardiac surgeon to operate again.

• Coronary Artery Bypass Surgery

A cardiologist may choose to perform coronary artery bypass surgery on patients with coronary artery disease who have blocked or narrowed arteries. This procedure creates an alternative route by taking a vein from another part of the body and connecting it directly to the coronary artery for blood that needs to flow to the heart.

• Heart Valve Surgery

Heart valve surgery can be used to repair or replace diseased heart valves, usually the aortic or mitral valve. This procedure can be performed through open heart surgery or minimally invasive valve surgery such as percutaneous surgery or robot-assisted surgery.

• Transcatheter Procedures (TAVR)

Chest pain, fatigue, and shortness of breath caused by aortic stenosis can be treated using transaortic valve repair or TAVR. In this procedure, the damaged valve is repaired by placing a new replacement valve inside. (8)

Candidates

Depending on the particular procedure and the medical history of the patient, the surgeon may treat the patients with,

• coronary artery disease or blockages of the arteries in the heart
• blockages in the heart valve(s)
• aneurysms or abnormal enlargement of the great arteries in the chest
• leaking heart valve(s)
• lung cancer
• atrial fibrillation
• hiatal hernias
• swallowing disorders such as achalasia
• other thoracic conditions (9)

Risks and Side Effects

All surgeries carry risks, but surgeries involving the heart and lungs can be particularly worrisome given vital functions. Therefore, complications from cardiothoracic surgery can adversely affect these and other vital organ systems.

Beyond the general risks of surgery such as post-operative bleeding, post-operative infection and anesthesia, there are specific risks and side effects associated with cardiovascular surgery. These include

• Arrhythmia (abnormal heart rhythm)
• Heart failure
• Stroke
• Cardiac tamponade
• Thrombosis (venous blood clots)
• Ischemic heart damage
• Myocardial infarction (heart attack)
• Acute kidney failure
• Intestinal ischemia (10)

Post-Procedure and Follow-up

To ensure that complications do not occur or to determine whether a response has been achieved, the length of hospital stay may vary by surgery and may require a short stay for observation purposes or a long stay in hospital for recovery and rehabilitation. Follow-up visits are scheduled to ensure the patient is recovering properly. In order for patients to maintain a healthy recovery process, it is important not to interrupt their visits. (11)

Recovery

There is always a recovery period following cardiothoracic surgery, as well as frequently a formal rehabilitation program. Typically, a physical therapist with expertise in cardiopulmonary conditions is in charge of this program. Some of the procedures are carried out in the office, while others are often performed at home.

Results

The purpose of cardiothoracic surgery and procedures is to solve patients' thorax (chest), including the heart and lungs problems. Operations result in getting healthy by going with regular follow-ups and following the instructions given by the doctor.