The Daily Schedule Of A Cardiothoracic Surgeon

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.

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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.

The Daily Schedule Of A Cardiothoracic Surgeon

The cardiothoracic surgeon will consult with their hospital and ICU patients on a daily basis until they are ready to be discharged home. Post-operative cardiothoracic patients are initially managed in an ICU, before being transferred to a general ward, since they need to be monitored closely after their procedure.

The cardiothoracic surgeons' rooms are located on the hospital grounds so that these specialists can get to their ward and ICU patients, as well as casualty department patients that need to be consulted, on an emergency basis. Other specialists, especially cardiologists and pulmonologists, will consult with these specialists for surgical intervention on patients where medical therapy is unsuccessful or not indicated.

Cardiothoracic surgeons provide on call services for the hospital they work at over after hour and weekend periods. These specialists will manage patients in emergency situations such as severe coronary artery disease needing a bypass graft, severe atrial fibrillation resistant to medical therapy needing radiofrequency ablation or patients with severe left ventricular dysfunction needing implantation of cardiac support devices.

Monday

Cardiothoracic surgeons use the first half on the morning to deal with clinical and non-clinical administrative issues of the office. The specialist will also be attending staff and hospital management meetings and meetings with surgical representatives.

The surgeon will begin to consult with patients once these aspects have been dealt with. The specialist will see patients consulting them for the first time as well as those who are coming for a follow up visit after their procedure. First time patients will be examined accordingly and have appropriate special investigations performed which will aid the surgeon in making a diagnosis.

The patients may then be managed conservatively, be scheduled for an elective procedure at a later date or be admitted to the hospital for further investigations to be performed and management to be initiated or be prepared for emergency surgery. 

Tuesday

The cardiothoracic surgeon will spend this day operating on patients in theatre. The procedures that are performed on this day would be time consuming and complex ones such as heart and/or lung transplantation and coronary artery bypass grafts. These procedures take a very long time to complete and these surgeons usually find themselves operating well into the night.

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Wednesday

Patients will be consulted and managed in the morning. The afternoon will be used for performing operations and filling in of reports, motivation letters to medical aid companies and doing research for their own academic purposes.

Thursday

The cardiothoracic surgeon will spend the day operating in theatre again. If they are involved with the academic programme of the local medical school, then they may offer training to undergraduate medical students and postgraduate residents and fellows.

Friday

The cardiothoracic surgeon will consult with and manage patients in the morning and finalise the week's administrative issues that still need to be resolved. The surgical lists for the following week are confirmed and the work week can conclude.