Cardiothoracic surgery is the

field Field may refer to: Expanses of open ground * Field (agriculture), an area of land used for agricultural purposes * Airfield, an aerodrome that lacks the infrastructure of an airport * Battlefield * Lawn, an area of mowed grass * Meadow, a grass ...

of medicine involved in surgical treatment of organs inside the thoracic cavity — generally treatment of conditions of the

heart The heart is a muscular organ in most animals. This organ pumps blood through the blood vessels of the circulatory system. The pumped blood carries oxygen and nutrients to the body, while carrying metabolic waste such as carbon dioxide to ...

(

heart disease Cardiovascular disease (CVD) is a class of diseases that involve the heart or blood vessels. CVD includes coronary artery diseases (CAD) such as angina and myocardial infarction (commonly known as a heart attack). Other CVDs include stroke, h ...

), lungs (

lung disease The lungs are the primary organs of the respiratory system in humans and most other animals, including some snails and a small number of fish. In mammals and most other vertebrates, two lungs are located near the backbone on either side of ...

), and other

pleural The pleural cavity, pleural space, or interpleural space is the potential space between the pleurae of the pleural sac that surrounds each lung. A small amount of serous pleural fluid is maintained in the pleural cavity to enable lubrication be ...

mediastinal The mediastinum (from ) is the central compartment of the thoracic cavity. Surrounded by loose connective tissue, it is an undelineated region that contains a group of structures within the thorax, namely the heart and its vessels, the esophagu ...

structures. In most countries, cardiothoracic surgery is further subspecialized into cardiac surgery (involving the heart and the

great vessels Great vessels are the large vessels that bring blood to and from the heart. These are: *Superior vena cava * Inferior vena cava * Pulmonary arteries *Pulmonary veins *Aorta Transposition of the great vessels is a group of congenital A birt ...

) and thoracic surgery (involving the lungs, esophagus, thymus, etc.); the exceptions are the United States, Australia, New Zealand, the United Kingdom, and some European Union countries such as Portugal.

Training

A cardiac surgery

residency Residency may refer to: * Domicile (law), the act of establishing or maintaining a residence in a given place ** Permanent residency, indefinite residence within a country despite not having citizenship * Residency (medicine), a stage of postgrad ...

typically comprises anywhere from four to six years (or longer) of training to become a fully qualified surgeon. Cardiac surgery training may be combined with thoracic surgery and / or vascular surgery and called cardiovascular (CV) / cardiothoracic (CT) / cardiovascular thoracic (CVT) surgery. Cardiac surgeons may enter a cardiac surgery residency directly from medical school, or first complete a

general surgery General surgery is a surgical specialty that focuses on alimentary canal and abdominal contents including the esophagus, stomach, small intestine, large intestine, liver, pancreas, gallbladder, appendix and bile ducts, and often the thy ...

residency followed by a

fellowship A fellow is a concept whose exact meaning depends on context. In learned or professional societies, it refers to a privileged member who is specially elected in recognition of their work and achievements. Within the context of higher educatio ...

. Cardiac surgeons may further sub-specialize cardiac surgery by doing a fellowship in a variety of topics including:

pediatric Pediatrics ( also spelled ''paediatrics'' or ''pædiatrics'') is the branch of medicine that involves the medical care of infants, children, adolescents, and young adults. In the United Kingdom, paediatrics covers many of their youth until the ...

cardiac surgery, cardiac transplantation, adult acquired heart disease, weak heart issues, and many more problems in the heart.

Australia and New Zealand

The highly competitive Surgical Education and Training (SET) program in Cardiothoracic Surgery is six years in duration, usually commencing several years after completing medical school. Training is administered and supervised via a bi-national (Australia and New Zealand) training program. Multiple examinations take place throughout the course of training, culminating in a final fellowship exam in the final year of training. Upon completion of training, surgeons are awarded a Fellowship of the Royal Australasian College of Surgeons (FRACS), denoting that they are qualified specialists. Trainees having completed a training program in General Surgery and have obtained their FRACS will have the option to complete fellowship training in Cardiothoracic Surgery of four year in duration, subject to college approval. It takes around eight to ten years minimum of post-graduate (post-medical school) training to qualify as a cardiothoracic surgeon. Competition for training places and for public (teaching) hospital places is very high currently, leading to concerns regarding

workforce planning The workforce or labour force is a concept referring to the pool of human beings either in employment or in unemployment. It is generally used to describe those working for a single company or industry, but can also apply to a geographic re ...

in Australia.

Canada

Historically, cardiac surgeons in Canada completed general surgery followed by a fellowship in CV / CT / CVT. During the 1990s, the Canadian cardiac surgery training programs changed to six-year "direct-entry" programs following medical school. The direct-entry format provides residents with experience related to cardiac surgery they would not receive in a general surgery program (e.g.

echocardiography An echocardiography, echocardiogram, cardiac echo or simply an echo, is an ultrasound of the heart. It is a type of medical imaging of the heart, using standard ultrasound or Doppler ultrasound. Echocardiography has become routinely used in th ...

coronary care unit A coronary care unit (CCU) or cardiac intensive care unit (CICU) is a hospital ward specialized in the care of patients with heart attacks, unstable angina, cardiac dysrhythmia and (in practice) various other cardiac conditions that require conti ...

, cardiac catheterization etc.). Residents in this program will also spend time training in thoracic and vascular surgery. Typically, this is followed by a fellowship in either Adult Cardiac Surgery, Heart Failure/Transplant, Minimally Invasive Cardiac Surgery, Aortic Surgery, Thoracic Surgery, Pediatric Cardiac Surgery or Cardiac ICU. Contemporary Canadian candidates completing general surgery and wishing to pursue cardiac surgery often complete a cardiothoracic surgery fellowship in the United States. The Royal College of Physicians and Surgeons of Canada also provides a three-year cardiac surgery fellowship for qualified general surgeons that is offered at several training sites including the

University of Alberta The University of Alberta, also known as U of A or UAlberta, is a public research university located in Edmonton, Alberta, Canada. It was founded in 1908 by Alexander Cameron Rutherford,"A Gentleman of Strathcona – Alexander Cameron Rutherf ...

, the University of British Columbia and the University of Toronto. Thoracic surgery is its own separate 2–3 year fellowship of general or cardiac surgery in Canada. Cardiac surgery programs in Canada: *

– 1 position * University of British Columbia – 1 position * University of Calgary – 1 position *

Dalhousie University Dalhousie University (commonly known as Dal) is a large public research university in Nova Scotia, Canada, with three campuses in Halifax, a fourth in Bible Hill, and a second medical school campus in Saint John, New Brunswick. Dalhousie offe ...

– 1 position every other year * Université Laval – 1 position every three years * University of Manitoba – 1 position * McGill University – 1 position every three years * McMaster University – 1 position every other year * Université de Montréal – 1 position every three years * University of Ottawa – 1 position * University of Toronto – 1 position * Western University – 1 position

United Kingdom

In the United Kingdom, cardiac surgeons are trained by direct specialty training or through core surgical training. Through the core surgical training route, trainees can apply on their third year for specific training in cardiothoracic surgery. Thereafter, they may choose to subspecialise in areas such as aortic surgery, adult cardiac surgery, thoracic surgery, paediatric cardiothoracic surgery, and adult congenital surgery.

United States

Surgeon operating, Fitzsimons Army Medical Center, circa 1990

Cardiac surgery training in the United States is combined with general thoracic surgery and called cardiothoracic surgery or thoracic surgery. A cardiothoracic surgeon in the U.S. is a physician (

M.D. Doctor of Medicine (abbreviated M.D., from the Latin ''Medicinae Doctor'') is a medical degree, the meaning of which varies between different jurisdictions. In the United States, and some other countries, the M.D. denotes a professional degree. T ...

D.O. Doctor of Osteopathic Medicine (DO or D.O., or in Australia DO USA) is a medical degree conferred by the 38 osteopathic medical schools in the United States. DO and Doctor of Medicine (MD) degrees are equivalent: a DO graduate may become licens ...

) who first completes a

residency (typically 5–7 years), followed by a cardiothoracic surgery fellowship (typically 2–3 years). The cardiothoracic surgery fellowship typically spans two or three years, but certification is based on the number of surgeries performed as the operating surgeon, not the time spent in the program, in addition to passing rigorous board certification tests. Two other pathways to shorten the duration of training have been developed: (1) a combined general-thoracic surgery residency consisting of four years of general surgery training and three years of cardiothoracic training at the same institution and (2) an integrated six-year cardiothoracic residency (in place of the general surgery residency plus cardiothoracic residency), which have each been established at many programs (over 20). Applicants match into the integrated six-year (I-6) programs directly out of medical school, and the application process has been extremely competitive for these positions as there were approximately 160 applicants for 10 spots in the U.S. in 2010. As of May 2013, there are 20 approved programs, which include the following: Integrated six-year Cardiothoracic Surgery programs in the United States: * Medical College of Wisconsin * Stanford University – two positions * University of North Carolina at Chapel Hill * University of Virginia * Columbia University – two positions * University of Pennsylvania * University of Pittsburgh – two positions *

University of Washington The University of Washington (UW, simply Washington, or informally U-Dub) is a public research university in Seattle, Washington. Founded in 1861, Washington is one of the oldest universities on the West Coast; it was established in Seattle ...

* Northwestern University *

Mount Sinai Hospital, New York Mount Sinai Hospital, founded in 1852, is one of the oldest and largest teaching hospitals in the United States. It is located in East Harlem in the New York City borough of Manhattan, on the eastern border of Central Park stretching along Ma ...

* University of Maryland * University of California, Los Angeles

UCLA The University of California, Los Angeles (UCLA) is a public land-grant research university in Los Angeles, California. UCLA's academic roots were established in 1881 as a teachers college then known as the southern branch of the California St ...

– two resident positions, one Transplant Fellowship; one Congenital resident position * University of Texas Health Science Center at San Antonio * Medical University of South Carolina * University of Southern California – two positions *

University of Rochester The University of Rochester (U of R, UR, or U of Rochester) is a private research university in Rochester, New York. The university grants undergraduate and graduate degrees, including doctoral and professional degrees. The University of Roc ...

University of California, Davis The University of California, Davis (UC Davis, UCD, or Davis) is a public land-grant research university near Davis, California. Named a Public Ivy, it is the northernmost of the ten campuses of the University of California system. The institu ...

Indiana University Indiana University (IU) is a system of public universities in the U.S. state of Indiana. Campuses Indiana University has two core campuses, five regional campuses, and two regional centers under the administration of IUPUI. *Indiana Universit ...

* University of Kentucky *

Emory University Emory University is a private research university in Atlanta, Georgia. Founded in 1836 as "Emory College" by the Methodist Episcopal Church and named in honor of Methodist bishop John Emory, Emory is the second-oldest private institution of h ...

* University of Michigan The

American Board of Thoracic Surgery The American Board of Thoracic Surgery is an American surgical organization devoted to surgery of the chest.pericardium (the sac that surrounds the heart) took place in the 19th century and were performed by

Francisco Romero Francisco Romero may refer to: * Francisco García Romero (1559–1630s), Spanish military officer * Francisco Romero (bishop) (died 1635), served as archbishop in Italy *Francisco Romero (bullfighter) (1700–1763), Spanish matador *Francisco Rome ...

(1801) Dominique Jean Larrey,

Henry Dalton Henry Clay Dalton (May 7, 1847 – November 3, 1911) was superintendent of the St. Louis City Hospital, Missouri, United States, from 1886 to 1892, and later a professor of abdominal and clinical surgery at Marion Sims College of Medicine (now par ...

, and

Daniel Hale Williams Daniel Hale Williams (January 18, 1856 – August 4, 1931) was an African-American surgeon, who in 1893 performed what is referred to as "the first successful heart surgery". It was performed at Chicago's Provident Hospital, which he founded in ...

. The first surgery on the heart itself was performed by Norwegian surgeon

Axel Cappelen Axel Hermansen Cappelen (20 July 1858 – 13 November 1919) was a Norwegian surgeon. He was born in Selje as a son of district physician Johan Nicolay Cappelen (1818–1890) and Elisabeth Brunchorst Ravn (1825–1906). His brother Christian was ...

on 4 September 1895 at Rikshospitalet in Kristiania, now Oslo. He ligated a bleeding

coronary artery The coronary arteries are the arterial blood vessels of coronary circulation, which transport oxygenated blood to the heart muscle. The heart requires a continuous supply of oxygen to function and survive, much like any other tissue or organ o ...

in a 24-year-old man who had been stabbed in the left

axilla The axilla (also, armpit, underarm or oxter) is the area on the human body directly under the shoulder joint. It includes the axillary space, an anatomical space within the shoulder girdle between the arm and the thoracic cage, bounded super ...

and was in deep

shock Shock may refer to: Common uses Collective noun *Shock, a historic commercial term for a group of 60, see English numerals#Special names * Stook, or shock of grain, stacked sheaves Healthcare * Shock (circulatory), circulatory medical emerge ...

upon arrival. Access was through a left

thoracotomy A thoracotomy is a surgical procedure to gain access into the pleural space of the chest. It is performed by surgeons (emergency physicians or paramedics under certain circumstances) to gain access to the thoracic organs, most commonly the he ...

. The patient awoke and seemed fine for 24 hours, but became ill with increasing temperature and he ultimately died from what the

post mortem An autopsy (post-mortem examination, obduction, necropsy, or autopsia cadaverum) is a surgical procedure that consists of a thorough examination of a corpse by dissection to determine the cause, mode, and manner of death or to evaluate any d ...

proved to be mediastinitis on the third postoperative day. The first successful surgery of the heart, performed without any complications, was by Ludwig Rehn of Frankfurt, Germany, who repaired a stab wound to the right ventricle on September 7, 1896. Surgery in

(

aortic coarctation Coarctation of the aorta (CoA or CoAo), also called aortic narrowing, is a congenital condition whereby the aorta is narrow, usually in the area where the ductus arteriosus (ligamentum arteriosum after regression) inserts. The word ''coarctation' ...

repair, Blalock-Taussig shunt creation, closure of

patent ductus arteriosus ''Patent ductus arteriosus'' (PDA) is a medical condition in which the ''ductus arteriosus'' fails to close after birth: this allows a portion of oxygenated blood from the left heart to flow back to the lungs by flowing from the aorta, which has ...

) became common after the turn of the century and falls in the domain of cardiac surgery, but technically cannot be considered heart surgery. One of the more commonly known cardiac surgery procedures is the coronary artery bypass graft (CABG), also known as "bypass surgery." In this procedure, vessels from elsewhere in the patient's body are harvested, and grafted to the coronary arteries to bypass blockages and improve the blood supply to the heart muscle.

Early approaches to heart malformations

In 1925 operations on the heart valves were unknown.

Henry Souttar Sir Henry Sessions Souttar (14 December 1875 – 12 November 1964) was a British surgeon with a wide breadth of interests. He trained first as a mathematician and engineer. His engineer’s training enabled him to design and make new types of s ...

operated successfully on a young woman with

mitral stenosis Mitral stenosis is a valvular heart disease characterized by the narrowing of the opening of the mitral valve of the heart. It is almost always caused by rheumatic valvular heart disease. Normally, the mitral valve is about 5 cm2 during d ...

. He made an opening in the appendage of the left atrium and inserted a finger into this chamber in order to palpate and explore the damaged mitral valve. The patient survived for several years but Souttar's physician colleagues at that time decided the procedure was not justified and he could not continue.Lawrence H Cohn (2007), Cardiac Surgery in the Adult, page 6+ Cardiac surgery changed significantly after World War II. In 1948 four surgeons carried out successful operations for

resulting from rheumatic fever. Horace Smithy (1914–1948) of

Charlotte Charlotte ( ) is the most populous city in the U.S. state of North Carolina. Located in the Piedmont region, it is the county seat of Mecklenburg County. The population was 874,579 at the 2020 census, making Charlotte the 16th-most populo ...

, revived an operation due to Dr

Dwight Harken Dwight Emary Harken (1910–1993) was an American surgeon. He was an innovator in heart surgery and introduced the concept of the intensive care unit. Life Dwight Harken was born in Osceola, Iowa. He received his Bachelor's and Medical degrees fr ...

of the Peter Bent Brigham Hospital using a punch to remove a portion of the mitral valve. Charles Bailey (1910–1993) at the Hahnemann Hospital, Philadelphia,

Boston Boston (), officially the City of Boston, is the state capital and most populous city of the Commonwealth of Massachusetts, as well as the cultural and financial center of the New England region of the United States. It is the 24th- most p ...

and Russell Brock at

Guy's Hospital Guy's Hospital is an NHS hospital in the borough of Southwark in central London. It is part of Guy's and St Thomas' NHS Foundation Trust and one of the institutions that comprise the King's Health Partners, an academic health science centre. ...

all adopted Souttar's method. All these men started work independently of each other, within a few months. This time Souttar's technique was widely adopted although there were modifications. In 1947 Thomas Holmes Sellors (1902–1987) of the

Middlesex Hospital Middlesex Hospital was a teaching hospital located in the Fitzrovia area of London, England. First opened as the Middlesex Infirmary in 1745 on Windmill Street, it was moved in 1757 to Mortimer Street where it remained until it was finally clo ...

operated on a Fallot's Tetralogy patient with

pulmonary stenosis Pulmonic stenosis, is a dynamic or fixed obstruction of flow from the right ventricle of the heart to the pulmonary artery. It is usually first diagnosed in childhood. Signs and symptoms Cause Pulmonic stenosis is usually due to isolated valvula ...

and successfully divided the stenosed pulmonary valve. In 1948, Russell Brock, probably unaware of Sellor's work, used a specially designed dilator in three cases of

. Later in 1948 he designed a punch to resect the infundibular muscle stenosis which is often associated with Fallot's Tetralogy. Many thousands of these "blind" operations were performed until the introduction of heart bypass made direct surgery on valves possible.Harold Ellis (2000) A History of Surgery, page 223+

Open heart surgery

Open heart surgery is a procedure in which the patient's heart is opened and surgery is performed on the internal structures of the heart. It was discovered by Wilfred G. Bigelow of the University of Toronto that the repair of intracardiac pathologies was better done with a bloodless and motionless environment, which means that the heart should be stopped and drained of blood. The first successful intracardiac correction of a congenital heart defect using hypothermia was performed by

C. Walton Lillehei Clarence Walton Lillehei (October 23, 1918 – July 5, 1999), was an American surgeon who pioneered open-heart surgery, as well as numerous techniques, equipment and prostheses for cardiothoracic surgery. Background Clarence (often called " ...

and

F. John Lewis Floyd John Lewis (1916 – September 20, 1993) was an American surgeon who performed the first successful open heart operation, closing an atrial septal defect in a 5-year-old girl, on 2 September 1952. For the next 3 years, Lewis and colleagues ...

at the University of Minnesota on September 2, 1952. The following year,

Soviet The Soviet Union,. officially the Union of Soviet Socialist Republics. (USSR),. was a transcontinental country that spanned much of Eurasia from 1922 to 1991. A flagship communist state, it was nominally a federal union of fifteen nationa ...

surgeon Aleksandr Aleksandrovich Vishnevskiy conducted the first cardiac surgery under local anesthesia. Surgeons realized the limitations of hypothermia – complex intracardiac repairs take more time and the patient needs blood flow to the body, particularly to the brain. The patient needs the function of the heart and lungs provided by an artificial method, hence the term

cardiopulmonary bypass Cardiopulmonary bypass (CPB) is a technique in which a machine temporarily takes over the function of the heart and lungs during surgery, maintaining the circulation of blood and oxygen to the body. The CPB pump itself is often referred to as a he ...

John Heysham Gibbon John Heysham Gibbon (September 29, 1903 – February 5, 1973) was an American surgeon best known for inventing the heart–lung machine and performing subsequent open-heart surgeries which revolutionized heart surgery in the twentieth ...

at Jefferson Medical School in Philadelphia reported in 1953 the first successful use of extracorporeal circulation by means of an oxygenator, but he abandoned the method, disappointed by subsequent failures. In 1954 Lillehei realized a successful series of operations with the controlled cross-circulation technique in which the patient's mother or father was used as a '

heart-lung machine Cardiopulmonary bypass (CPB) is a technique in which a machine temporarily takes over the function of the heart and lungs during surgery, maintaining the circulation of blood and oxygen to the body. The CPB pump itself is often referred to as a he ...

'. John W. Kirklin at the

Mayo Clinic The Mayo Clinic () is a nonprofit American academic medical center focused on integrated health care, education, and research. It employs over 4,500 physicians and scientists, along with another 58,400 administrative and allied health staff, ...

in Rochester, Minnesota started using a Gibbon type pump-oxygenator in a series of successful operations, and was soon followed by surgeons in various parts of the world. Nazih Zuhdi performed the first total intentional hemodilution open heart surgery on Terry Gene Nix, age 7, on February 25, 1960, at Mercy Hospital, Oklahoma City, OK. The operation was a success; however, Nix died three years later in 1963. In March, 1961, Zuhdi, Carey, and Greer, performed open heart surgery on a child, age , using the total intentional hemodilution machine. In 1985 Zuhdi performed Oklahoma's first successful heart transplant on Nancy Rogers at Baptist Hospital. The transplant was successful, but Rogers, who had cancer, died from an infection 54 days after surgery.

Modern beating-heart surgery

Since the 1990s, surgeons have begun to perform " off-pump bypass surgery" – coronary artery bypass surgery without the aforementioned

. In these operations, the heart is beating during surgery, but is stabilized to provide an almost still work area in which to connect the conduit vessel that bypasses the blockage; in the U.S., most conduit vessels are harvested endoscopically, using a technique known as

endoscopic vessel harvesting Endoscopic vessel harvesting (EVH) is a surgical technique that may be used in conjunction with coronary artery bypass surgery (commonly called a "bypass"). For patients with coronary artery disease, a physician may recommend a bypass to reroute b ...

(EVH). Some researchers believe that the off-pump approach results in fewer post-operative complications, such as

postperfusion syndrome Postperfusion syndrome, also known as "pumphead", is a constellation of neurocognitive impairments attributed to cardiopulmonary bypass (CPB) during cardiac surgery. Symptoms of postperfusion syndrome are subtle and include defects associated wit ...

, and better overall results. Study results are controversial as of 2007, the surgeon's preference and hospital results still play a major role.

Minimally invasive surgery

A new form of heart surgery that has grown in popularity is robot-assisted heart surgery. This is where a machine is used to perform surgery while being controlled by the heart surgeon. The main advantage to this is the size of the incision made in the patient. Instead of an incision being at least big enough for the surgeon to put his hands inside, it does not have to be bigger than 3 small holes for the robot's much smaller "hands" to get through.

Pediatric cardiovascular surgery

Pediatric cardiovascular surgery is surgery of the heart of children. The first operations to repair cardio-vascular defects in children were performed by Clarence Crafoord in Sweden when he repaired coarctation of the aorta in a 12-year-old boy. The first attempts to palliate congenital heart disease were performed by Alfred Blalock with the assistance of William Longmire, Denton Cooley, and Blalock's experienced technician, Vivien Thomas in 1944 at Johns Hopkins Hospital. Techniques for repair of congenital heart defects without the use of a bypass machine were developed in the late 1940s and early 1950s. Among them was an open repair of an atrial septal defect using hypothermia, inflow occlusion and direct vision in a 5-year-old child performed in 1952 by Lewis and Tauffe. C. Walter Lillihei used cross-circulation between a boy and his father to maintain perfusion while performing a direct repair of a ventricular septal defect in a 4-year-old child in 1954. He continued to use cross-circulation and performed the first corrections of tetratology of Fallot and presented those results in 1955 at the American Surgical Association. In the long-run, pediatric cardiovascular surgery would rely on the cardiopulmonary bypass machine developed by Gibbon and Lillehei as noted above.

Risks of cardiac surgery

The development of cardiac surgery and cardiopulmonary bypass techniques has reduced the mortality rates of these surgeries to relatively low ranks. For instance, repairs of congenital heart defects are currently estimated to have 4–6% mortality rates. A major concern with cardiac surgery is the incidence of

neurological Neurology (from el, νεῦρον (neûron), "string, nerve" and the suffix -logia, "study of") is the branch of medicine dealing with the diagnosis and treatment of all categories of conditions and disease involving the brain, the spinal c ...

damage. Stroke occurs in 5% of all people undergoing cardiac surgery, and is higher in patients at risk for stroke. A more subtle constellation of

neurocognitive deficit Neurocognitive functions are cognitive functions closely linked to the function of particular areas, neural pathways, or cortical networks in the brain, ultimately served by the substrate of the brain's neurological matrix (i.e. at the cellular a ...

s attributed to

is known as

, sometimes called "pumphead". The symptoms of postperfusion syndrome were initially felt to be permanent, but were shown to be transient with no permanent neurological impairment. In order to assess the performance of surgical units and individual surgeons, a popular risk model has been created called the

EuroSCORE EuroSCORE (European System for Cardiac Operative Risk Evaluation) is a risk model which allows the calculation of the risk of death after a heart operation. The model asks for 17 items of information about the patient, the state of the heart and t ...

. This takes a number of health factors from a patient and using precalculated logistic regression coefficients attempts to give a percentage chance of survival to discharge. Within the UK this EuroSCORE was used to give a breakdown of all the centres for cardiothoracic surgery and to give some indication of whether the units and their individuals surgeons performed within an acceptable range. The results are available on the CQC website. The precise methodology used has however not been published to date nor has the raw data on which the results are based. Infection represents the primary non-cardiac complication from cardiothoracic surgery. Infections can include mediastinitis, infectious myo- or pericarditis, endocarditis, cardiac device infection, pneumonia, empyema, and bloodstream infections. ''Clostridium difficile'' colitis can also develop when prophylactic or post-operative antibiotics are used. Post operative patients of cardiothoracic surgery are at risk of nausea, vomiting, dysphagia and aspiration pneumonia.

Thoracic surgery

A pleurectomy is a surgical procedure in which part of the pleura is removed. It is sometimes used in the treatment of pneumothorax and mesothelioma.

Lung volume reduction surgery

Lung volume reduction surgery, or LVRS, can improve the quality of life for certain COPD and emphysema patients. Parts of the lung that are particularly damaged by emphysema are removed, allowing the remaining, relatively good lung to expand and work more efficiently. The beneficial effects are correlated with the achieved reduction in residual volume. Conventional LVRS involves resection of the most severely affected areas of emphysematous, non-

bullous A skin condition, also known as cutaneous condition, is any medical condition that affects the integumentary system—the organ system that encloses the body and includes skin, nails, and related muscle and glands. The major function of thi ...

lung (aim is for 20–30%). This is a surgical option involving a mini-thoracotomy for patients in end stage COPD due to underlying emphysema, and can improve lung

elastic recoil Elastic recoil means the rebound of the lungs after having been stretched by inhalation,Sherwood, L. (2007). ''Human Physiology: From Cells to Systems'', 6th ed, Thomson Brooks/Cole, Belmont, CA. or rather, the ease with which the lung rebounds. Wi ...

as well as diaphragmatic function. The National Emphysema Treatment Trial (NETT) was a large multicentre study (N = 1218) comparing LVRS with non-surgical treatment. Results suggested that there was no overall survival advantage in the LVRS group, except for mainly upper-lobe emphysema + poor exercise capacity, and significant improvements were seen in exercise capacity in the LVRS group. Later studies have shown a wider scope of treatment with better outcomes. Possible complications of LVRS include prolonged air leak (mean duration post surgery until all

chest tube A chest tube (also chest drain, thoracic catheter, tube thoracostomy or intercostal drain) is a surgical drain that is inserted through the chest wall and into the pleural space or the mediastinum in order to remove clinically undesired substance ...

s removed is 10.9 ± 8.0 days. In people who have a predominantly upper lobe emphysema, lung volume reduction surgery could result in better health status and lung function, though it also increases the risk of early mortality and adverse events. LVRS is used widely in Europe, though its application in the United States is mostly experimental. A less invasive treatment is available as a

bronchoscopic lung volume reduction Bronchoscopic lung volume reduction (BLVR) is a procedure to reduce the volume of air within the lungs. BLVR was initially developed in the early 2000s as a minimally invasive treatment for severe COPD that is primarily caused by emphysema. BLVR ev ...

procedure.

Lung cancer surgery

Not all lung cancers are suitable for surgery. The

stage Stage or stages may refer to: Acting * Stage (theatre), a space for the performance of theatrical productions * Theatre, a branch of the performing arts, often referred to as "the stage" * ''The Stage'', a weekly British theatre newspaper * St ...

, location and cell type are important limiting factors. In addition, people who are very ill with a poor

performance status In medicine (oncology and other fields), performance status is an attempt to quantify cancer patients' general well-being and activities of daily life. This measure is used to determine whether they can receive chemotherapy, whether dose adjustment ...

or who have inadequate pulmonary reserve would be unlikely to survive. Even with careful selection, the overall operative death rate is about 4.4%. In non-small cell lung cancer staging, stages IA, IB, IIA, and IIB are suitable for surgical resection. Pulmonary reserve is measured by

spirometry Spirometry (meaning ''the measuring of breath'') is the most common of the pulmonary function tests (PFTs). It measures lung function, specifically the amount (volume) and/or speed (flow) of air that can be inhaled and exhaled. Spirometry is he ...

. If there is no evidence of undue shortness of breath or

diffuse parenchymal lung disease Interstitial lung disease (ILD), or diffuse parenchymal lung disease (DPLD), is a group of respiratory diseases affecting the interstitium (the tissue and space around the alveoli (air sacs)) of the lungs. It concerns alveolar epithelium, pulmo ...

, and the FEV₁ exceeds 2 litres or 80% of predicted, the person is fit for

pneumonectomy A pneumonectomy (or pneumectomy) is a surgical procedure to remove a lung first successfully done in 1933 by Dr. Evarts Graham. This is not to be confused with a lobectomy or segmentectomy, which only removes one part of the lung. There are two ...

. If the FEV₁ exceeds 1.5 litres, the patient is fit for lobectomy. There is weak evidence to indicate that participation in exercise programs before lung cancer surgery may reduce the risk of complications after surgery.

Complications

A prolonged air leak (PAL) can occur in 8–25% of people following lung cancer surgery. This complication delays chest tube removal and is associated with an increased length of hospital stay following a lung resection (lung cancer surgery). The use of surgical sealants may reduce the incidence of prolonged air leaks, however, this intervention alone has not been shown to results in a decreased length of hospital stay following lung cancer surgery. There is no strong evidence to support using non-invasive positive pressure ventilation following lung cancer surgery to reduce pulmonary complications.

Types

Lobectomy Lobectomy means ''surgical excision of a lobe''. This may refer to a lobe of the lung (also simply called a lobectomy), a lobe of the thyroid ( hemithyroidectomy), a lobe of the brain (as in anterior temporal lobectomy), or a lobe of the liver ...

(removal of a lobe of the lung) * Sublobar resection (removal of part of lobe of the lung) * Segmentectomy (removal of an anatomic division of a particular lobe of the lung) *

Pneumonectomy A pneumonectomy (or pneumectomy) is a surgical procedure to remove a lung first successfully done in 1933 by Dr. Evarts Graham. This is not to be confused with a lobectomy or segmentectomy, which only removes one part of the lung. There are two ...

(removal of an entire lung) *

Wedge resection Wedge resection is a surgical procedure to remove a triangle-shaped slice of tissue. It may be used to remove a tumor A neoplasm () is a type of abnormal and excessive growth of tissue. The process that occurs to form or produce a neoplasm ...

* Sleeve/bronchoplastic resection (removal of an associated tubular section of the associated main bronchial passage during lobectomy with subsequent reconstruction of the bronchial passage) *

VATS lobectomy Video-assisted thoracoscopic surgery (VATS) lobectomy is an approach to lung cancer surgery. Traditional approach to lung cancer surgery: thoracotomy Anatomic lung resection, i.e. pulmonary lobectomy or pneumonectomy, in conjunction with re ...

(minimally invasive approach to lobectomy that may allow for diminished pain, quicker return to full activity, and diminished hospital costs) *

esophagectomy Esophagectomy or oesophagectomy is the surgical removal of all or parts of the esophagus. Medical uses The principal objective is to remove the esophagus, a part of the gastrointestinal tract. This procedure is usually done for patients with esoph ...

(removal of the esophagus)

References

External links

The Cardiothoracic Surgery Network

The Society of Thoracic Surgeons

American Association for Thoracic Surgery

International Society for Minimally Invasive Cardiothoracic Surgery
{{Thoracic surgery Surgical specialties Cardiac surgery Thoracic surgery Pulmonary thoracic surgery