Definition and Overview
Cardiothoracic surgery, which involves the heart, blood vessels, throat and lungs, is often a complex and risky procedure. As such, patients who are scheduled to undergo this type of surgery are required to consult their surgeon so they will better understand the procedure, its risk and complications, how it will be performed, and possible outcomes, among others.
Due to the various serious complications that are linked to this type of surgery, cardiothoracic surgeons require intensive educational training, experience, and expertise. After completing four years of medical school, they proceed by completing their five-year surgical residency followed by fellowship on cardiothoracic for another 2 to 3 years. All cardiothoracic surgeons are board certified, although the requirements, eligibility, and rules can differ among countries.
Cardiothoracic surgeons can further subspecialize. For example, they may focus on children (pediatric) or older people (geriatric) or specialize in treating congenital defects or in organ transplantation.
As the field continues to grow and develop, cardiothoracic surgeons are expected to continue with their education and training. This way, they can offer advanced surgical options, give sound advice, and know how to extend the right amount and quality of care to patients, including during consultations.
Who Should Undergo and Expected Results
Cardiothoracic surgery is recommended to patients if:
- The medications or other initial treatments are no longer working. It could be because the patient is allergic to them, the condition doesn’t simply respond, or the side effects are serious.
- The condition is congenital
- The disease has already progressed or has become more severe
- The condition threatens the patient’s life such as when a blood vessel is clogged due to plaque deposit buildup, putting the patient at risk of myocardial infarction or heart attack
- All non-surgical treatment has already been tried but none has worked
- The technology to make the surgical procedure much safer, more reliable, and faster is already available (such as in the case of robotic-assisted surgery)
A cardiothoracic surgery consultation is also for patients who seek a second opinion. Faced with serious dangers associated with surgery, it’s normal for patients to confirm the first surgeon’s recommendation by scheduling another consultation with another surgeon.
The objectives of the consultation are:
- To assess if the patient is eligible for surgery
- To determine whether other treatment options have been considered and/or exhausted before surgery is considered
- To plan the surgery, including helping the patient choose the most ideal procedure
- To establish a relationship with the patient
- To prepare the patient for surgery
- To counsel the patient’s family and caregivers on pre- and post-surgical care
How Does the Procedure Work?
A patient sees a cardiothoracic surgeon through a referral from his attending physician. For example, a patient with a stenotic or a narrowed vessel in the heart may be checked first by a cardiologist. If the doctor believes surgery is the best option, he will refer the patient to the cardiothoracic surgeon.
During the consultation, the cardiothoracic surgeon goes over the patient’s medical data and asks for the reason for referral. He then determines whether the referral is correct by:
- Performing a comprehensive interview to obtain information related to the patient’s family and personal medical history, lifestyle, medications and supplementations taken, existing diseases, and inherited disorders, among others
Requesting for diagnostic tests such as cardiac angiography, stress test, and Holter monitor.
If the surgeon thinks the patient indeed requires surgery, he will proceed by planning the procedure. Details that the surgeon will discuss include:
Time and place of surgery
- Actual surgical technique to be used
- Risks and complications
- Surgical team like the anesthesiologist
- Recovery period
- Surgical management
- Cost, insurance, and financing
A cardiothoracic surgery consultation is usually done within 30 minutes. Patients are encouraged to express their concerns or ask questions during the visit.
Possible Risks and Complications
In an effort to determine the patient’s overall health and eligibility for surgery, the patient may be forced to undergo certain tests that will prove to be unnecessary later on. Also, there are cases wherein both the surgeon and the patient fail to establish a good relationship, which is crucial. Without this, the patient may feel uncomfortable to ask questions or voice concerns, which may spell the difference between his survival and loss.
- Gopaldas RR, Chu, D, Bakaeen FG, et al. Acquired heart disease: coronary insufficiency. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 60.