Cardiothoracic surgery

Coronary artery bypass surgery

Surgeon operating, Fitzsimons Army Medical Center circa 1990

Surgery of suprasternal epidermoid cyst

In the realm of medicine, cardiothoracic surgery delves into the realm of surgical interventions targeting diseases that afflict organs nestled within the thorax or chest. This broadly encompasses conditions plaguing the heart (known as cardiovascular disease) and the lungs (often referred to as lung disease). Cardiothoracic surgery is acknowledged as a distinct surgical specialty with a rich history of groundbreaking achievements and critical procedures.

Thoracic Surgery

Thoracic surgery is a branch of cardiothoracic surgery that primarily focuses on surgical treatments of chest ailments, excluding heart-related issues. While general surgeons may possess expertise or show a keen interest in thoracic surgery, cardiothoracic surgeons specialize in procedures involving both the heart and lungs.

Role of a Cardiothoracic Surgeon

Cardiothoracic surgeons wield the expertise to execute a plethora of complex surgical procedures, including but not limited to:

• Coronary Artery Bypass Graft (CABG): This procedure involves rerouting blood flow around blocked coronary arteries to improve blood supply to the heart muscle.
• Heart valve surgeries: Repair or replacement of heart valves affected by conditions like valvular stenosis or regurgitation.
• Lung volume reduction surgeries: Surgical reduction of damaged lung tissue to improve lung function in conditions such as emphysema.
• Heart and/or lung transplantation procedures: Transplantation of hearts, lungs, or both, often the last resort for patients with end-stage heart or lung diseases.
• Arrhythmia surgeries: Procedures like atrial fibrillation ablation to correct abnormal heart rhythms.
• Thoracic aorta repairs: Repairing aortic dissections, a life-threatening condition involving the aorta's tearing.

History

The history of cardiothoracic surgery is decorated with momentous events and breakthroughs that have revolutionized medical practice. Pioneering animal experiments conducted by stalwarts like Vladimir Demikhov and Dominique Metras during the 1940s and 1950s bore evidence to the technical feasibility of such procedures.

In 1963, Hardy etched history by accomplishing the first human lung transplantation. The patient, after receiving a left lung transplant, managed to survive for 18 days. The period between 1963 and 1978 witnessed numerous endeavors to perfect lung transplantation, with challenges such as rejection and issues with bronchial healing impeding consistent success.

The epoch-making event of the first human-to-human heart transplantation was spearheaded by Dr. Barnard in South Africa on December 3, 1967. This monumental achievement had its seeds sown in 1905 when a puppy's heart was transplanted into a dog's neck. In the contemporary medical landscape, this surgery is predominantly reserved for individuals grappling with terminal congestive heart failure (CHF) and those beyond the aid of conventional medical interventions.

Procedures

Cardiothoracic surgery covers a wide spectrum of procedures, divided into the following categories:

• Heart Procedures
  • Coronary artery bypass surgery: Redirects blood flow around blocked coronary arteries to restore blood supply to the heart.
  • Valve replacement: Repairs or replaces heart valves affected by stenosis or regurgitation.
  • Congenital heart disease: Corrects structural heart defects present at birth.
  • Ventricular assist device: Implants mechanical devices to assist heart function.
  • Heart transplantation: Replaces a failing heart with a healthy donor heart.

• Lung Procedures
  • Mediastinoscopy: A diagnostic procedure to examine the mediastinum, an area between the lungs.
  • Video-assisted thoracoscopy (VATS): Minimally invasive surgery for lung and chest conditions.
  • Lobectomy: Removal of a lobe of the lung, often recommended for lung cancer.
  • Bullectomy: Surgical treatment for a bulla in emphysema.
  • Lung transplantation: Replaces one or both lungs in patients with end-stage lung disease.

• Vascular Procedures
  • Aortic aneurysm: Repairs or replaces a weakened or enlarged aortic wall.
  • Aortic dissection: Surgical repair of an aortic dissection, a life-threatening condition.

Glossary of Cardiothoracic Surgery Terms

This glossary provides an overview of key terms and concepts related to cardiothoracic surgery, a specialized field of surgery focusing on the heart, lungs, and chest.

A

• Aneurysm: A localized, abnormal dilation of a blood vessel, often involving the aorta.
• Aortic dissection: A life-threatening condition where there is a tear in the inner layer of the aorta's wall, causing blood to flow between the layers.
• Arrhythmia: An irregular heart rhythm that can be corrected through surgical procedures.
• Atrial fibrillation ablation: A procedure to treat irregular heartbeats by targeting and isolating abnormal electrical pathways in the heart's atria.
• Atrial septal defect (ASD): A congenital heart defect involving an abnormal opening in the atrial septum (the wall between the heart's upper chambers).

C

• Cardiopulmonary bypass: A technique that temporarily takes over the function of the heart and lungs during surgery, allowing the surgeon to operate on a still and bloodless heart.
• Congenital heart disease: Structural heart defects present at birth, often requiring surgical correction.
• Coronary artery bypass graft (CABG): A surgical procedure to reroute blood flow around blocked coronary arteries to improve blood supply to the heart muscle.
• Cardiotomy: A surgical procedure involving an incision into the heart.
• Cardioplegia: The temporary cessation of the heart's activity during surgery.

D

• Decellularized homografts: Biological grafts that have had their cells removed, often used in cardiac surgery.
• Dor procedure: A surgical procedure used to treat left ventricular aneurysms.
• Damus–Kaye–Stansel procedure: A surgical procedure used in the treatment of congenital heart defects.

E

• Endoscopic vessel harvesting: A minimally invasive technique for harvesting blood vessels for coronary artery bypass surgery.
• External support: Surgical techniques involving external support structures for the heart or blood vessels.

F

• Fontan procedure: A surgical procedure used to redirect blood flow in individuals with certain congenital heart defects.
• Balloon septostomy: A procedure involving the use of a balloon to enlarge an atrial septal defect.
• Heart valve repair: Surgical procedures aimed at repairing heart valves.
• Heart valve replacement: Surgical procedures involving the replacement of damaged or malfunctioning heart valves.

H

• Henry Opitek: A pioneering figure in cardiothoracic surgery.
• Hyperhidrosis: Excessive sweating, sometimes treated with surgical procedures.

K

• Kawashima procedure: A surgical procedure used to reroute blood flow in certain congenital heart conditions.

L

• LeCompte maneuver: A surgical technique used in certain congenital heart surgeries.
• Lung surgery: Surgical procedures involving the lungs, often used to treat lung cancer or other conditions.

M

• Mitral valve repair: Surgical repair of the mitral valve to correct issues like regurgitation or prolapse.
• Mitral valve replacement: Surgical replacement of the mitral valve.
• Mustard procedure: A surgical procedure used in the treatment of congenital heart defects.

P

• Pericardiectomy: Surgical removal of the pericardium (the sac around the heart).
• Perfusionist: A healthcare professional who operates the heart-lung machine during cardiac surgery.
• Postperfusion syndrome: A condition characterized by cognitive changes after cardiopulmonary bypass surgery.

R

• Rib removal: Surgical removal of ribs, sometimes performed in thoracic surgery.
• Ross procedure: A surgical procedure used to treat aortic valve disease.

S

• Sano shunt: A surgical procedure used in congenital heart surgery.
• Senning procedure: A surgical procedure used in the treatment of certain congenital heart defects.
• Valve-sparing aortic root replacement: A surgical procedure to replace the aortic root while preserving the aortic valve.

T

• Totally endoscopic coronary artery bypass surgery: Minimally invasive coronary artery bypass surgery performed through small incisions.
• Transposition of the great arteries: A congenital heart condition often treated with surgery.
• Vasoplegic syndrome: A condition characterized by low blood pressure after cardiac surgery.

V

• Valvulotomy: Surgical procedure involving the incision or removal of a valve.
• Ventriculectomy: Surgical removal of a portion of the heart's ventricle.
• Video-assisted thoracoscopy (VATS): A minimally invasive surgical technique for examining and treating chest conditions.

List of Cardithoraci Surgeons (USA)

• Alabama
• Alaska
• Arizona
• Arkansas
• California
• Colorado
• Connecticut
• Delaware
• Florida
• Georgia
• Hawaii
• Idaho
• Illinois
• Indiana
• Iowa
• Kansas
• Kentucky
• Louisiana
• Maine
• Maryland
• Massachusetts
• Michigan
• Minnesota
• Mississippi
• Missouri
• Montana
• Nebraska
• Nevada
• New Hampshire
• New Jersey
• New Mexico
• New York
• North Carolina
• North Dakota
• Ohio
• Oklahoma
• Oregon
• Pennsylvania
• Rhode Island
• South Carolina
• South Dakota
• Tennessee
• Texas
• Utah
• Vermont
• Virginia
• Washington
• West Virginia
• Wisconsin
• Wyoming

US territories

• American Samoa
• Guam
• Northern Mariana Islands
• Puerto Rico
• U.S. Virgin Islands
• District of Columbia

See Also

• Classification of aortic dissection

References

• Cardiac Surgery in the Adult
• Extended Cervical Mediastinoscopy
• [http://www.tmc.edu/thi/mcst

External Links

• American Association for Thoracic Surgery
• Advances in Cardiovascular Surgery and Cardiothoracic Surgical Procedures
• Cardiothoracic Surgery Notes

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