Cardiothoracic surgery is the field of medicine involved in surgical treatment of organs inside the thorax —generally treatment of conditions of the heart and lungs. Cardiac surgery, or cardiovascular surgery, is surgery on the heart or great vessels performed by cardiac surgeons.
It is often used to treat complications of ischemic heart disease (for example, with coronary artery bypass grafting); to correct congenital heart disease; or to treat valvular heart disease from various causes, including endocarditis, rheumatic heart disease, and atherosclerosis. It also includes heart transplantation.
The earliest operations on the pericardium (the sac that surrounds the heart) took place in the 19th century and were performed by Francisco Romero (1801), Dominique Jean Larrey (1810), Henry Dalton (1891), and Daniel Hale Williams (1893).
The first surgery on the heart itself was performed by Axel Cappelen on 4 September 1895 at Rikshospitalet in Kristiania, now Oslo. Cappelen ligated a bleeding coronary artery in a 24-year-old man who had been stabbed in the left axilla and was in deep shock upon arrival.
Access was through a left thoracotomy. The patient awoke and seemed fine for 24 hours, but became ill with a fever and died three days after the surgery from mediastinitis.
The first successful surgery on the heart, without any complications, was performed by Dr. Ludwig Rehn of Frankfurt, Germany, who repaired a stab wound to the right ventricle on 7 September 1896.
Types of cardiac surgery
Open heart surgery
Open-heart surgery is any kind of surgery in which a surgeon makes a large incision (cut) in the chest to open the rib cage and operate on the heart. “Open” refers to the chest, not the heart. Depending on the type of surgery, the surgeon also may open the heart
Modern beating-heart surgery
In the early 1990s, surgeons began to perform off-pump coronary artery bypass, done without cardiopulmonary bypass. In these operations, the heart continues beating during surgery, but is stabilized to provide an almost still work area in which to connect a conduit vessel that bypasses a blockage using a technique known as endoscopic vessel harvesting (EVH).
In 1945, the Soviet pathologist Nikolai Sinitsyn successfully transplanted a heart from one frog to another frog and from one dog to another dog.
Norman Shumway is widely regarded as the father of human heart transplantation, although the world’s first adult heart transplant was performed by a South African cardiac surgeon, Christiaan Barnard, using techniques developed by Shumway and Richard Lower.
Barnard performed the first transplant on Louis Washkansky on 3 December 1967 at Groote Schuur Hospital in Cape Town. Adrian Kantrowitz performed the first pediatric heart transplant on 6 December 1967 at Maimonides Hospital (now Maimonides Medical Center) in Brooklyn, New York, barely three days later. Shumway performed the first adult heart transplant in the United States on 6 January 1968 at Stanford University Hospital.
Coronary artery bypass grafting
Coronary artery bypass grafting, also called revascularization, is a common surgical procedure to create an alternative path to deliver blood supply to the heart and body, with the goal of preventing clot formation.
This can be done in many ways, and the arteries used can be taken from several areas of the body. Arteries are typically harvested from the chest, arm, or wrist and then attached to a portion of the coronary artery, relieving pressure and limiting clotting factors in that area of the heart.
The procedure is typically performed because of coronary artery disease (CAD), in which a plaque-like substance builds up in the coronary artery, the main pathway carrying oxygen-rich blood to the heart. This can cause a blockage and/or a rupture, which can lead to a heart attack.
Minimally invasive surgery
As an alternative to open heart surgery, which involves a five- to eight-inch incision in the chest wall, a surgeon may perform an endoscopic procedure by making very small incisions through which a camera and specialized tools are inserted.
In robot-assisted heart surgery, a machine controlled by a cardiac surgeon is used to perform a procedure. The main advantage to this is the size of the incision required: three small holes instead of an incision big enough for the surgeon’s hands.