Definition and Overview
Cardiothoracic surgery is a subspecialty of surgery that deals with the chest (thorax) and the heart (cardiac). To a certain extent, it also includes the esophagus. In other countries, cardiac and thoracic surgeries are treated separately.
A person who specializes in this procedure is called a cardiothoracic surgeon, although he or she may also be referred to as cardiac surgeon, thoracic surgeon, or cardiovascular surgeon.
Due to the needed technical skills and expertise, doctors who want to specialize in cardiothoracic surgery have to fulfill many years of education and training. They spend four years in pre-med then another four years in medical school. After, they enter into residency training, where they spend around six years assisting and performing general surgeries. Once they have completed this stage, they proceed to complete at least two years of fellowship training for specialization. Subsequently, they take the board certification.
Because of the length of study, many medical students are taking advantage of comprehensive residency programs that take only about six years rather than seven or even nine years. However, the application process is rigorous and only a small percentage of the candidates are accepted every year.
Who Should Undergo and Expected Results
Different types of health conditions and diseases can affect the chest area, particularly the lungs, and the heart. Cardiovascular disease is the leading cause of preventable death in the world. Lung cancer, meanwhile, is the number one cause of death in the world. The risk of dying from the disease is equal for both men and women.
Surgery is usually performed when an issue affecting these major organs prevents them from functioning properly, endangering the life of the patient in the process. For example, a narrowing or blockage of the artery (stenosis) will slow down or even cut off the blood supply to different parts of the body, especially the brain. When the brain is starved of oxygen and nutrients, tissues will die, resulting in loss of body function.
A lung disease, on the other hand, such as a growth of a tumour, will significantly reduce the amount of oxygen that goes into the body, not to mention decrease the person’s ability to breathe. Surgery may also be needed when the cause is a congenital defect or malformation, usually due to genetic mutation during conception.
The broad objective of cardiothoracic surgery is to help patients achieve better quality of life. This could mean that the procedure may help extend the life of the patient, relieve symptoms that limit function and motion, or eventually treat and cure the disease. For instance, an installed pacemaker can help regulate the beating of the heart.
How Does the Procedure Work?
A cardiothoracic surgeon can perform a wide variety of procedures, including the following:
Angioplasty – This is the standard procedure for a person who has stenosis of the artery. A catheter with a balloon at the tip is inserted into a major artery found either in the groin or wrist. It is then guided into the heart where the blockage can be found. Once in position, the balloon is inflated and deflated multiple times until the plaque buildup that is causing the blockage is pushed toward the arterial walls. In many cases, angioplasty is accompanied by stenting. A stent looks like a mesh structure that is typically used to keep the arteries open.
Coronary bypass surgery – This procedure is carried out when the regular blood route has been badly damaged that angioplasty and other forms of intervention cannot reverse the damage. The surgeon uses a graft, which is usually a healthy vein obtained from another part of the body, to serve as a new route for the blood.
Cardiomyoplasty – The heart is a large muscular organ that should pump blood at all times. There are times, however, when the muscle tissues become damaged or weakened. Cardiomyoplasty is a process of reinforcing these muscles by wrapping them with muscles obtained from the abdomen or the back.
Transplantation – Transplantation becomes necessary when vital organs such as the heart and the lungs have failed and can never be revived to a much better condition. The transplanted organs are obtained from deceased persons who are a match to the patient.
Minimally invasive surgeries – More cardiothoracic surgeons are specializing in minimally invasive surgeries, where only small incisions are needed. A robot-assisted procedure such as a Da Vinci system can also fall into this category.
Possible Risks and Complications
Surgeries are always riskier than other types of procedures. There’s always the threat of infection and excessive bleeding, although these two can be minimized through minimally invasive surgeries.
In the case of transplantation, the greatest risk or complication is rejection. When this happens, the body can attack the new organ until it also fails. Thus, doctors provide medications that should be taken regularly to decrease the chances of the body rejecting the new organ.