What is Cardiothoracic Surgery?
Cardiothoracic Surgery is a medical specialty that deals with the management of conditions affecting organs within the thorax (the chest), mainly the esophagus, lungs, and heart. A cardiothoracic surgeon is a specialist who diagnoses conditions affecting these organs and offers treatment including surgery.
Cardiothoracic surgery is one of the most challenging and demanding areas of surgery since disorders of the chest are a significant cause of health problems and death all over the world. Cardiothoracic surgeons is an inclusive term that includes:
- Cardiac or cardiovascular surgeons
- General thoracic surgeons
- Congenital heart surgeons
Conditions Treated by Cardiothoracic Surgery
Listed below are some examples of conditions treated by cardiothoracic surgeons.
Some of the conditions a cardiac or cardiovascular surgeon can treat include:
- Coronary Artery Disease (CAD): CAD is the most common of all heart diseases, and a leading cause of death. It usually occurs when cholesterol and plaque accumulate inside the coronary arteries (blood vessels supplying oxygen-rich blood to heart muscles) and block the flow of oxygen-rich blood to the heart muscles.
- Heart Failure: It is a condition where the heart fails to pump blood in order to maintain the metabolic needs of the body.
- Atrial Fibrillation: It is a heart condition characterized by an irregular and rapid heartbeat that hampers blood supply to the body.
- Aortic Aneurysm: It is a condition characterized by an abnormal ballooning or bulging of a section of the aorta due to weakness in the wall of the blood vessel. The aorta is the main blood vessel that carries oxygenated blood from the heart to the different parts of the body.
Some of the conditions a general thoracic surgeon can treat include:
- Lung Cancer: Cancer is a disease that results from abnormal growth and division of cells that make up the body's tissues and organs. Lung cancer is the growth of abnormal cells inside the lung. It is one of the leading causes of death in both men and women.
- Emphysema: It is a chronic lung condition that causes shortness of breath. In individuals with emphysema, the air sacs in the lungs (alveoli) weaken and rupture, decreasing the amount of oxygen your body receives.
- Gastroesophageal Reflux Disease (GERD): It is a condition where the stomach acid leaks into your food pipe (esophagus) causing a burning sensation in your chest and other associated symptoms.
- Hiatal Hernia: It is a condition characterized by a protrusion of the upper part of the stomach through the diaphragm, mostly as a result of weakening of the diaphragm muscles.
- Swallowing Disorders such as Achalasia: Achalasia, also known as esophageal achalasia, is a condition in which the esophagus (a tube that carries food from the mouth to the stomach) is unable to move the food into the stomach.
Some of the conditions a congenital heart surgeon can treat include:
- Atrial and Ventricular Septal Defects: An atrial septal defect (ASD) is the condition of a defective muscular wall (septum) that separates the two upper chambers of the heart. A ventricular septal defect (VSD) is a condition of the defective septum that separates the lower chambers of the heart. The hole or defect in the septum allows the mixing of blood in the right and left chambers of the heart.
- Coarctation of the Aorta: Coarctation of the aorta is a common congenital heart defect caused by narrowing of the aorta at one site or along the portion of its length. This results in restricted blood flow through the aorta.
- Patent Ductus Arteriosus: It is a heart defect in which there is an abnormal connection between the aorta and the pulmonary artery that is present at birth.
- Bicuspid Aortic Valve Disease: It is a disease in which there are only two leaflets in the aortic valve instead of three. This results in a stiff, leaky valve that does not open or close properly.
- Tetralogy of Fallot: This is a rare, congenital heart defect which is a group of four heart defects including large ventricular septal defect, pulmonary stenosis, right ventricular hypertrophy, and an overriding aorta.
Procedures and Surgeries Performed by Cardiothoracic Surgery
Some of the common cardiothoracic surgeries and procedures include:
- Coronary Artery Bypass Grafting (CABG): CABG is a surgical procedure to bypass a blocked artery of the heart. It involves incising a small part of a blood vessel (most commonly a vein from the leg) and using it as a graft (a piece of living tissue that is transplanted surgically). The procedure is indicated for the treatment of narrowing and blockages in the coronary arteries, which can lead to serious complications if left untreated.
- Heart Valve Repair or Replacement: If the heart valves have been diseased or damaged, they may fail to close and open properly. This puts additional stress on the heart muscle. In such instances, your cardiothoracic surgeon may advise open-heart surgery to replace or repair your heart valve(s).
- Pacemaker Implantation: The heart is a muscular organ that pumps blood throughout the body. The rhythmic beating of the heart is triggered by electrical signals. A change or interruption in these signals can cause a change in the rhythm of the heart. A pacemaker is a small device inserted into the chest cavity to correct and stabilize the heart rhythm.
- Implantable Cardioverter-Defibrillator (ICD): An ICD is a device similar to a pacemaker. It is a small electronic device that is implanted in the chest or abdomen to control abnormal heart rhythm and prevent sudden cardiac arrest. The ICD detects abnormal heart rhythms and restores normal heart rhythm by delivering electrical impulses to the heart muscle.
- Coronary Angioplasty: Also called percutaneous coronary intervention (PCI) is a minimally invasive procedure in which a thin flexible tube called a catheter is used to place a stent inside the blocked coronary arteries in your heart to clear the blockage from plaque deposition and improve blood flow.
- Stent Placement: A stent is a tiny, metal, or plastic mesh tube that is placed permanently inside a blood vessel to relieve an obstruction. The procedure of inserting and placing the stent within your arterial wall through a small tube (catheter) is known as stenting.
- Heart Transplant: This is a major surgery and is only considered for late-stage heart failure when all other treatment alternatives have failed. A heart transplant involves the replacement of a severely damaged or diseased heart with a new heart from a human organ donor.
In general, postoperative/post-procedure care instructions and recovery may involve the following steps:
- Take all medications recommended by your physician. These may include blood-thinners to prevent blood clots, antibiotics for risk of surgery-related infection, and pain medicines for the management of pain.
- Consume soft foods to aid in easy swallowing and digestion during recovery.
- Apply ice packs on the operated area and use pillows while lying down to limit pain and swelling.
- Avoid strenuous activities and lifting heavy objects for a specified period of time.
- Instructions on surgical site care management and bathing will be provided.
- Refrain from driving until you receive your physician’s consent.
- Keep your periodic follow-up appointments to monitor your progress.
Benefits of Cardiothoracic Surgery
Cardiothoracic surgeries can assist in the opening up of coronary arteries blocked or narrowed by the accumulation of fatty deposits (plaque), repair heart defects or heart muscles that have been weakened, or correct problems pertaining to heart rhythm.
Risks and Complications of Cardiothoracic Surgery
Cardiothoracic surgeries are relatively safe procedures. However, as with any surgery, some risks and complications may occur such as:
- Heart attack
- Blood clots
- Seizures, stroke, or brain damage (rarely)
- Re-accumulation of plaques in arteries
- Adverse reactions to the anesthesia used during surgery