Cardiothoracic surgery, also known as thoracic surgery, is the area of surgery for the organs of the chest (thorax), including the heart and lungs. It can be used to treat a wide range of problems, from heart failure to pulmonary embolism and esophageal cancer.
Cardiothoracic surgeries are varied, including coronary artery bypass surgery, lung resection, stenting, and many other procedures. In addition, there are many medical disciplines in thoracic surgery, including pediatrics , oncology , and neurology .
What is Cardiothoracic Surgery?
Cardiothoracic surgery consists of cardiovascular surgery (heart and blood vessels) and lung surgery (lung). It is used to diagnose and treat diseases and injuries of the heart, lungs, and other related structures, such as the trachea (windpipe), esophagus (feeding tube), and diaphragm .
Cardiothoracic surgery is performed by a cardiothoracic surgeon, a healthcare provider trained as a general surgeon before embarking on an additional two- to three-year fellowship and certification from the American Board of Thoracic Surgeons. Some cardiothoracic surgeons specialize in complex procedures such as heart and lung transplants.
Depending on the procedure performed, cardiothoracic surgery can be:
Open surgery is generally used if the pathology is difficult to access, the injury is severe or complex, or if a large amount of tissue is removed.
In contrast, endoscopic and robotic surgeries are minimally invasive and generally prefer open surgery whenever possible. Because they involve one or more smaller incisions, recovery times are usually shorter.
Most of these are inpatient procedures that require hospitalization; Because the incision is large and other structures (including the ribs and sternum ) can be affected, open surgery generally requires a longer hospital stay and recovery time.
However, some diagnostic procedures (such as a lung biopsy) can be performed on an outpatient basis , allowing you to return home afterward.
Cardiothoracic surgery is believed to have been started in 1896 by the German surgeon Ludwig Wren, who successfully cured the bleeding right ventricle of a man who was stabbed in the chest.
Since then, the practice of cardiothoracic surgery has grown to the point that open heart surgery is now commonplace, and other less invasive surgical techniques have become household names.
Contraindications to cardiothoracic surgery can vary depending on the type of procedure being performed. However, there are several absolute contraindications to cardiothoracic surgery beyond those related to surgery in general .
A cardiothoracic procedure cannot be performed if it is unlikely to prolong life or put the person at undue risk of harm due to extreme weakness , concomitant infection or illness, inability to withstand general anesthesia, or for other reasons.
However, because cardiothoracic surgery is generally limited to severe cardiovascular and pulmonary diseases, the benefits of 'last resort' surgery tend to outweigh the risks .
A careful individual evaluation is required before proceeding.
All surgeries carry risks, but heart and lung surgeries are of particular concern given the vital functions they perform and the fact that they are related to the functions of the kidneys, liver, brain, and other organs. Therefore, complications derived from cardiothoracic surgery can adversely affect these and other vital organ systems.
In addition to the general risks of surgery (including postoperative bleeding , postoperative infection, and risks of anesthesia ), there are certain risks and complications associated with cardiovascular or pulmonary surgery.
Appointment of cardiothoracic surgery.
Cardiothoracic surgeries are used to diagnose and treat a wide range of pulmonary and cardiovascular diseases and disorders, as well as gastrointestinal diseases that affect the esophagus.
It is indicated in emergencies (such as a serious heart attack or chest injury) or in planned procedures (when non-surgical options are exhausted or deemed inappropriate). For some conditions, such as lung cancer, cardiovascular surgery is considered the standard of care .
Cardiothoracic surgery can be performed on adults, children, and infants, and it can also be performed on unborn babies using specialized intrauterine procedures .
Below is an extensive list of cardiothoracic surgeries and when they can be performed:
If cardiothoracic surgery is indicated, preoperative tests will be performed to confirm that you are a candidate for surgery and to help guide the procedure, including the type of anesthesia used.
There are several assessment tools used to determine an individual's risk of surgery, including the EuroSCORE II, the Parsonnet assessment, and the Society of Thoracic Surgeons (STS) assessment. They can determine whether a person is at low, medium, or high risk of dying after cardiothoracic surgery .
Additionally, a cardiothoracic surgeon will perform a variety of tests and procedures to help plan surgery and identify vulnerabilities that could affect a person's response to anesthesia, risk of complications, or recovery.
These preoperative tests, also known as diagnostic tests, are done long before surgery. These include blood tests to assess how well the organs are working, including liver function tests (LFTs) , kidney function tests , complete blood count (CBC) , and blood clotting tests . Imaging studies can help map the surgical approach and determine which surgical procedure is the most appropriate.
A diagnostic test for cardiovascular surgery may include:
Diagnostic tests for lung surgery may include:
Diagnostic tests for esophagus surgery may include:
How to prepare
The surgeon will meet with you to review the results of your preoperative tests and discuss what the surgery entails, including preoperative preparation and postoperative recovery.
Ask as many questions as you need to fully understand the benefits and risks of surgery. This includes the question of how often the surgeon performed the operation and why this procedure was preferred over others (for example, open surgery or video surgery).
Cardiothoracic surgeries are most often performed in a hospital operating room. It is equipped as standard with an ECG machine, an anesthesia machine, a mechanical ventilator and an "emergency cart" for use in urgent cases of heart failure. Video-assisted surgery involves a narrow fiberoptic scope called an endoscope, which is inserted into a small incision to view the surgical site on a video monitor.
Most of these operations require hospitalization, even a relatively minor one.
You will need to arrange for someone to drive you home after your hospital stay. Most hospitals don't discharge patients unless a friend or family member drives them home (or at least a car service).
Food and drink
Cardiothoracic surgery usually includes general anesthesia , regional block with intravenous sedation , or local anesthesia with intravenous sedation. In all three cases, there are food and drink restrictions.
Food and drink restrictions are designed to prevent accidental ingestion of food or liquid into the lungs during surgery. They are applied regardless of whether the operation is minor or major.
In most cases, you will need to stop eating something after midnight before surgery. The next morning, you will be allowed a few sips of water to take any medications that your healthcare provider has approved. For four hours after surgery, do not eat anything, including water, ice cubes, gum, or breath lozenges.
Your surgeon will give you a list of medications to stop before your cardiothoracic surgery. These include drugs that promote bleeding, worsen blood clotting, affect blood sugar levels, or increase the effect of anesthesia.
The following medications are most commonly affected:
Always inform your surgeon of any medications you are taking, whether they are prescription, over-the-counter, dietary, herbal, or recreational.
To be admitted to the hospital, you will need to show government-issued photo identification (such as a driver's license), your insurance card, and an approved form of payment if an up-front copayment or coinsurance costs are required.
Since most cardiothoracic surgeries are performed in a hospital setting, you will need to pack the appropriate items for the duration of your stay and bring appropriate clothing for your procedure. For instance:
- You may want to wear button-down blouses instead of sweaters to prevent them from going over your head or disturbing seams, seams, or surgical drains .
- Women may find it helpful to purchase a front closure postoperative bra that is easier to put on and does not put pressure on surgical wounds.
- Nightgowns and gowns will be easier to wear if a postoperative urinary catheter is required.
Don't forget essential toiletries, a change of underwear and socks, a bathrobe and slippers, and things to read and have fun. Don't do unnecessary things, as you won't have a lot of storage space. Leave valuables at home.
You will also need to bring an adequate supply of chronic medical conditions that the nursing staff can take when you arrive, without any other medications prescribed by your surgeon.
Lifestyle changes before surgery
Cigarette smoke causes long-term vasoconstriction (narrowing of the blood vessels), which can inhibit healing by reducing the amount of blood and oxygen that enters surgical wounds. Smoking is also associated with an increased risk of wound dehiscence when the incision is not closed properly.
Because of this, most cardiothoracic surgeons recommend quitting smoking at least five days before and five days after surgery, regardless of the reason it is being performed.
However, people with heart or lung disease are often advised to quit smoking completely to prevent disease progression. If cardiothoracic surgery is indicated, there is no more compelling reason to permanently quit smoking.
To reduce your cravings for nicotine and increase your chances of quitting, ask your doctor about prescription smoking cessation medications, many of which are fully covered by the Affordable Care Act .
What to Expect the Day of Surgery
On the day of surgery, you will be asked to wash thoroughly with an antimicrobial surgical shower product such as Hibiclens and to avoid applying lotion, ointment, fragrance, or makeup to your skin.
After registering for hospital admission, you will need to complete a medical information sheet and consent form confirming that you understand the goals and risks of the surgery.
Depending on the operation, you will be taken to the preoperative treatment room or directly to the hospital room where you will be prepared for the operation.
Before the surgery
There are standard procedures that a patient will need to undergo prior to cardiothoracic surgery. As soon as you put on your hospital gown, the nurse:
- Record your weight and height – This is used to calculate your body mass index (BMI) so that the correct dose of medication can be prescribed, including anesthesia.
- It measures vital signs: temperature, blood pressure and heart rate.
- Blood sampling for blood tests – Includes complete blood count, complete metabolic panel (CMP) , and arterial blood gases (ABG) to assess blood chemistry.
- ECG monitoring setup: Attach the electrodes to your chest so that you can monitor your heart rate during surgery.
- Pulse Oximetry Setup – Use a device attached to your finger to monitor blood oxygen saturation during surgery.
- IV catheter placement: Insertion of a flexible tube called an intravenous (IV) catheter into a vein in your arm to give medications and fluids, including sedatives and antibiotics.
Your body may also need to be shaved at the surgery site. This is done by the nurse just before the operation. You don't have to do it yourself.
The anesthesiologist selects and administers anesthesia so that the operation is safe and comfortable with minimal risk. Possible options include the following, and the procedure that follows primarily determines what to use:
- Local anesthesia: involves one or more injections at the surgical site and is usually followed by controlled anesthesia (MAC) , a form of intravenous sedation used to induce twilight sleep.
- Regional anesthesia: A form of anesthesia that blocks nerve pain signals (such as thoracic or spinal epidural anesthesia ), used with or without MAC .
- General anesthesia: generally used for more complex or prolonged surgeries to completely fall asleep.
After anesthesia, the operation can begin. What happens next depends on the specific operation you are performing and the technique used to perform it. There are many possibilities since a cardiothoracic surgeon is qualified to perform a variety of procedures.
For example, surgery for tracheal stenosis (narrowing) will involve the placement of a stent to keep the airway open, while a lobectomy will involve the surgical removal of a lobe of the lung.
Some surgeries require the insertion of a temporary chest tube to help drain accumulated fluid from the chest cavity and / or to help fill the lungs after lung surgery.
Cardiothoracic surgery can last several hours or many hours, depending on the extent of the procedure.
After the operation
Length of hospital stay may vary by operation and may include a short stay for observation purposes (i.e. to make sure no complications arise or to determine if a response has been achieved) or a long stay in the hospital. hospital for recovery and rehabilitation.
Cardiothoracic surgery invariably includes a recovery period and, more often, a structured rehabilitation program.
Rehabilitation activities are usually supervised by a physical therapist who specializes in cardiopulmonary diseases. Some procedures are done in the office, others at home, often on an ongoing basis.
- Pulmonary rehabilitation generally involves progressive aerobic and strength training combined with breathing exercises to increase the volume and force of the inhale and exhale. Additionally, under the guidance of a board certified nutritionist , efforts are being made to correct the weight loss that often occurs after major lung surgery.
- Cardiac rehabilitation is generally performed in four phases in people who have undergone major cardiac surgery, including an acute phase (performed in a hospital), a subacute phase (performed on an outpatient basis), an intensive outpatient phase (outpatient and at-home). ), and an independent continuous conditioning phase.
In addition, you will need to visit your surgeon for scheduled visits to ensure that you are recovering properly, as well as your cardiologist , pulmonologist , gastroenterologist , or oncologist to ensure that continued treatment of the condition has healed.
Recovery from cardiothoracic surgery can be greatly improved with the support of family and friends, as well as online or in-person support groups. Consultations and therapy may also be involved.
Get the word of drug information
A referral to a cardiothoracic surgeon does not mean that your condition is necessarily serious. It simply means that you will benefit from the skills of a surgeon specially trained in the structure, function, and disease of the heart, lungs, and other organs of the chest.
If cardiothoracic surgery is recommended, ask as many questions as you need to make an informed decision. If you do not get the answers you want, feel free to ask another doctor for an opinion , as long as the delay in treatment does not harm your health.