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A cardiothoracic surgeon is a sub-specialist who deals with the surgical management of conditions of the heart, lungs and their great vessels. This article will discuss the conditions these specialists manage as well as their daily schedules.

Cardiothoracic surgeons are specialists who focus on the diagnosis and management of conditions that affect the heart, its coronary arteries, the thoracic aorta, the lungs, the respiratory passageways and the pulmonary veins and arteries. These specialists manage these conditions through surgical means, and any medical conditions affecting these organs are managed by cardiologists and pulmonologists.

Training

Cardiothoracic surgeons first need to qualify as medical doctors and to do this they have to complete a 5-6 year medical and surgical undergraduate degree. This is followed by a 1-2 year internship period where the doctor familiarizes themselves with the various medical and surgical disciplines.

The doctor in now able to specialise and can do this in two ways: either complete a 6 year residency in cardiothoracic surgery, or complete a 5 year general surgery residency programme and then take part in a 2 year cardiothoracic fellowship. The latter is the more preferred route for cardiothoracic surgeons presently.

Conditions managed by Cardiothoracic Surgeons 

  • Congestive heart failure.
  • Coronary artery disease.
  • Valvular stenosis.
  • Valvular insufficiency.
  • Thoracic aorta aneurysm.
  • Myocardial infarction.
  • Aortic dissection.
  • Atrial fibrillation.
  • Left ventricular aneurysm.
  • Transecting aorta.
  • Mediastinal tumours.
  • Lung cancer.
  • Tracheal stenosis.
  • Tracheobronchial cancer.

Procedures performed by Cardiothoracic Surgeons 

Coronary artery bypass graft (CABG)

This is a procedure where veins or arteries from other parts of the body are used to bypass the coronary arteries to decrease the patient's mortality risk due to coronary artery disease. This procedure bypasses the blocked or narrowed arteries so that blood flow to the heart muscle is improved.

Surgical treatment of aortic aneurysms and dissections

Patients with aortic aneurysms or dissections have these damaged areas surgically repaired with a graft/stent of special woven material. Nowadays, elective repairs of aneurysms and dissections can be done endoscopically, thereby avoiding open surgery.

Mitral and aortic valve repair or replacement

Tissue (from human donors) or mechanical prostheses are used to replace badly damaged valves that can't be otherwise repaired. These replacements can be done by performing minimally-invasive procedures nowadays. 

Left ventricle restoration

Scarred tissue is removed from the left ventricle of the heart to improve its ability to pump blood to the body. This is done to manage issues such as heart attacks and congestive heart failure, and is often performed together with valve repairs or coronary bypass surgery.

Lung resection

Surgical removal of damaged lung tissue is performed when these parts of the lung are affected by benign or malignant diseases. 

Cardiac Support Devices

Cardiothoracic surgeons implant devices that offer temporary support of cardiac function before or after surgery.

Radiofrequency ablation for atrial fibrillation 

Atrial fibrillation (AF) is a common arrhythmia that causes rapid, irregular heartbeats. If this condition isn't managed properly, then it can lead to clot formations in the heart which can break off, lodge in the cerebral arteries and cause a stroke.

AF can be managed medically but in cases where medical therapy fails, then radiofrequency ablation is performed where the surface of the heart is exposed to modified electrical waves that create scar lines to block the erratic electrical impulses causing the AF.

Management of mediastinal tumors

Mediastinal tumours are benign or malignant tumours that grow in the chest cavity between the lungs. These tumors are removed by accessing the chest via procedures such as a thoracotomy, thoracoscopy or mediastinoscopy.

Heart and lung transplantation

Cardiothoracic surgeons are responsible for performing heart and/or lung transplantation in patients with conditions such as heart failure with a poor ejection fraction and cystic fibrosis.

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