Cardiothoracic Surgery

Cardiothoracic surgeons address a range of conditions including aortic injury from trauma, atrial fibrillation, congestive heart failure (heart attack), esophageal cancer, left ventricular aneurysm, lung cancers, mediastinal tumors, thoracic aortic aneurysm, tracheal stenosis, valvular insufficiency, and valvular stenosis.

Symptoms of a heart attack can vary based on the specific condition but may involve:

• Chest Pain or Discomfort
  Persistent or severe chest pain, often indicative of coronary artery disease or heart attack.
• Shortness of Breath
  Difficulty breathing, especially during physical activity or when lying down, may signal heart failure or valve issues.
• Palpitations
  Irregular or rapid heartbeats, which could suggest arrhythmias needing surgical correction.
• Dizziness or Fainting
  Frequent episodes of dizziness or fainting might point to severe arrhythmias or heart valve problems.
• Swelling (Edema)
  Fluid buildup in the legs, ankles, or feet can be a sign of heart failure.
• Fatigue
  Unexplained, persistent fatigue that affects daily activities could be related to heart conditions requiring surgical treatment.
• Nausea or Vomiting
  Feeling sick to the stomach or vomiting, often associated with heart attack symptoms.
• Sweating
  Excessive sweating, especially cold sweats, can be a sign of a heart attack.
• Pain in other areas of the body
  Pain that radiates to the shoulders, arms, back, neck, jaw, or stomach, often associated with heart attacks.

If you are experiencing these symptoms, consulting a cardiac surgeon at Northern Heart Hospital is essential as they specialise in managing heart-related diagnoses and surgeries and ensuring patient safety during these complex procedures.

At Northern Heart Hospital, our dedicated team of Cardiothoracic Surgeons perform a range of heart surgeries including:

Aortic Surgery

• Aortic Dissection Repair and Replacement
• Aortic Aneurysm Repair and Replacement (Aortic Root, Ascending Aorta, Aortic Arch and Descending Aorta Replacement)
• Personalised External Aortic Root Support (PEARS)
• Thoracic Endovascular Aortic Repair
• Transcatheter Aortic Valve Replacement (TAVR)

Cardiac Bypass Surgery

• Coronary Artery Bypass Grafting (CABG) (Bypass Surgery)
• Minimally Invasive Coronary Artery Bypass Grafting Surgery (MICS)
• Aortic Valve Replacement (AVR)
• Transcatheter Aortic Valve Replacement (TAVR)
• itral Valve Repair and Replacement (MVR)
• Transcatheter Mitral Valve Repair (TMVR)
• Tricuspid Valve Annuloplasty (Repair and Replacement) (TAP)
• Atrial Fibrillation Ablation
• Radiofrequency Ablation
• Left Atrial Appendage Closure
• Cardiac Tumour Removal
• Atrial Septal Defect (ASD) and Patent Foramen Ovale (PFO) Closure
• Ventricular Septal Defect Closure (VSD)
• Pericardiectomy
• Double valve replacement
• Coronary Artery Bypass Grafting & Mitral Valve Replacement/Repair
• Coronary Artery Bypass Grafting & Aortic Valve Replacement/repair
• MIS Mitral entValve Replacement
• MIS Mitral Calve Repair
• MIS Aortic Valve Replacement
• MIS Tricuspid Valve Replacement
• Off pump Coronary Artery Bypass Grafting
• MIDCAB (Minimally Invasive Direct Coronary Artery Bypass)
• Bentall procedure
• Left Atrial Myxoma Excision
• Frozen Elephant Trunk procedure
• Redo Coronary Artery Bypass Grafting
• Redo Mitral Valve Repair and Replacement (MVR)
• Redo Aortic Valve Replacement (AVR)

Thoracic Surgery

• Bronchoscopy
• Mediastinoscopy, Mediastinotomy
• Lung Cancer Resection – Lobectomy, Pneumonectomy
• Lung Tumour Resection
• Thymectomy for Myasthenia Gravis
• Mediastinal Tumour Excision
• Chest Wall Tumour Excision
• Sympathectomy for Hyperhidrosis (Sweaty Hands)
• Pneumothorax Surgery (Bullectomy, Pleurectomy, Pleural Abrasion, Pleurodesis)
• Pleural Effusion Surgery (Pleurodesis)
• Empyema Drainage and Decortication
• Video-Assisted Thoracoscopic (VATS) Surgery
• Non Open Heart surgery
• Chest Reopen Thymectomy
• Sternal Wound Debridement
• Sternal Wire Removal
• Wound debridement limb
• Thoracotomy & decortication
• VATS, Bullectomy and Pleurodesis kiv thoracotomy
• VATS, Decorticationkiv thoracotomy

The main areas of specialisation include cardiac, thoracic, and congenital surgery, each possessing distinct features. While some surgeons may have a combined practice covering thoracic and adult cardiac surgeries, the majority focus on one specific area. Adult cardiac surgery primarily addresses coronary heart disease, although there’s a growing demand for valve surgeries due to an aging population. Thoracic surgery deals with lung, chest wall, esophagus, and diaphragm conditions, often concentrating on the treatment of malignant diseases. Congenital surgery, the most challenging subset, is performed by a select group of highly skilled and specialised surgeons.

Prior to cardiothoracic surgery, patients will undergo screenings at Northern Heart Hospital to accurately diagnose and treat your condition. Several diagnostic tests and screenings are employed to identify and assess cardiothoracic conditions affecting the heart and lungs.

Heart:

• Electrocardiogram (ECG)
• Echocardiogram (Echo)
• Chest X-ray
• MRI
• Holter monitor
• CT Coronary Angiography (CTCA)
• Blood tests including Cardiac Enzymes, Troponin I, Lipid Profile

Lungs:

• Full blood count
• Blood tests including C-reactive protein (CRP) & Erythrocyte sedimentation rate (ESR)
• Tumour Markers
• Chest X-ray
• CT Thorax
• PET Scan

Food and Drink
Food and beverage guidelines are crucial in cardiothoracic surgery, where patients typically undergo general anesthesia, regional blocks with intravenous sedation, or local anesthesia with intravenous sedation. These restrictions aim to prevent inadvertent aspiration of food or liquids into the lungs during the procedure, applicable regardless of its complexity. Generally, patients are instructed to refrain from eating after midnight prior to surgery and are permitted only a few sips of water to take approved medications on the morning of the procedure. Within four hours of surgery, oral intake, including water, ice chips, gum, or breath mints, should be avoided.

Medications
Your cardiac surgeon will furnish you with a list of medications to discontinue before undergoing cardiothoracic surgery. These medications typically include those that increase bleeding risk, hinder blood clotting, influence blood sugar levels, or potentiate anesthesia effects. Commonly affected drugs encompass:

• Anticoagulants: Typically ceased three to five days pre-surgery, including Coumadin (warfarin) and Plavix (clopidogrel).
• Aspirin: Usually halted five days before surgery.
• Beta-blockers: Generally discontinued two to three days prior to surgery, such as Lopressor (metoprolol) and Inderal (propranolol).
• Diabetes medications: Often stopped on the day of surgery, including insulin.
• Nonsteroidal anti-inflammatory drugs (NSAIDs): Typically paused five to seven days pre-surgery and resumed within four days post-surgery, like Advil (ibuprofen), Aleve (naproxen), and Celebrex (celecoxib).
• Additionally, high-dose vitamin E and oral corticosteroids like prednisone may require cessation before and after surgery due to their impact on wound healing.

It’s crucial to inform your surgeon about all medications you take, whether prescribed, over-the-counter, nutritional, herbal, or recreational, to ensure optimal surgical preparation and outcomes.

Lifestyle Changes
Cigarette smoke induces prolonged vasoconstriction, narrowing blood vessels and hindering healing by diminishing blood and oxygen supply to surgical wounds. Additionally, smoking heightens the risk of wound dehiscence, where incisions fail to close properly. As a result, most cardiothoracic surgeons advocate for smoking cessation at least five days before and after surgery, irrespective of the procedure’s purpose. Moreover, individuals with heart or lung ailments are routinely advised to quit smoking altogether to halt disease progression. Given the potential implications for cardiothoracic surgery, there is a compelling rationale to cease smoking permanently in such cases.

After cardiothoracic surgery, your postoperative destination depends on the procedure’s complexity. You’ll be transferred to the intensive care unit (ICU) for comprehensive monitoring until anesthesia effects wear off. Hospitalisation duration varies, ranging from short stays for observation to extended in-hospital recovery and rehabilitation periods tailored to individual needs.

Recovery typically involves a structured rehabilitation program, often supervised by a specialised physical therapist. These efforts encompass a range of activities, including progressive aerobic and strength training, breathing exercises to enhance lung function, and addressing potential weight loss under the guidance of a certified dietitian.

Cardiac rehabilitation typically unfolds in four phases: acute (hospital-based), subacute (outpatient), intensive outpatient, and independent ongoing conditioning. Alongside physical therapy, regular follow-up visits with your surgeon, cardiologist, pulmonologist, gastroenterologist, or oncologist are crucial to ensure proper healing and ongoing management of your condition.