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Thoracic Surgery

Thoracic surgery is any surgery performed in the chest (thorax).

The purpose of thoracic surgery is to treat diseased or injured organs in the thorax, including the esophagus (muscular tube that passes food to the stomach), trachea (windpipe that branches to form the right bronchus and the left bronchus), pleura (membranes that cover and protect the lung), mediastinum (area separating the left and right lungs), chest wall, diaphragm, heart, and lungs.

General thoracic surgery is a field that specializes in diseases of the lungs and esophagus. The field also encompasses accidents and injuries to the chest, esophageal disorders (esophageal cancer or esophagitis), lung cancer, lung transplantation, and surgery for emphysema. The most common diseases requiring thoracic surgery include lung cancer, chest trauma, esophageal cancer, emphysema, and lung transplantation.

Cardiac Surgery

Any surgical procedure involving the heart, performed to correct acquired or congenital defects, replace diseased valves, open or bypass blocked vessels, or graft a prosthesis or a transplant is considered cardiac surgery. There are two major types of heart surgery: closed and open. The closed technique is done through a small incision, without use of the heart-lung machine. In the open technique the heart chambers are open and fully visible, and blood is detoured around the surgical field by the heart-lung machine.

Coronary Artery Bypass

Coronary artery bypass surgery reroutes the blood supply around a blocked section of the artery. During this procedure, surgeons remove healthy blood vessels from another part of the body, such as a leg or the chest wall. They then surgically attach the vessels to the diseased artery in such a way that the blood can flow around the blocked section.

After a bypass operation, it's especially important for you to watch your diet and reduce the amount of fat and cholesterol you eat, since these substances cause the arteries to clog. We also recommend following a routine of increased physical activity to strengthen the heart muscles.

Vascular Procedures

The vascular system is the network of blood vessels that circulate blood to and from the heart and lungs. The circulatory system (made up of the heart, arteries, veins, capillaries, and the circulating blood) provides nourishment to the body's cells and removes their waste. When these systems are blocked or damaged, vascular surgery may be called for. Corrective procedures include balloon angioplasty and/or stenting, aortic and peripheral vascular endovascular stent/graft placement, thrombolysis, and other adjuncts for vascular reconstruction.

Transplants & Devices

Heart Transplants

Some people have severe, progressive heart failure that can't be helped by medications and dietary and lifestyle changes. In such cases a heart transplant may be the only effective treatment option. We replace the damaged heart with a healthy one taken from a donor who has been declared brain dead. It can take several months to find a donor heart that closely matches the tissues of the person receiving the transplant. But this matching process increases the likelihood that the recipient's body will accept the heart. In some cases we will implant a left ventricular assist device to help the heart function during this waiting period.

This mechanical pump helps the left ventricle (lower left chamber) to pump. During a transplant procedure, our surgeons connect the patient to a heart-lung machine, which takes over the functions of the heart and lungs. We then remove the diseased heart and replace it with the donor heart. Finally, the major blood vessels are reconnected and the new heart is ready to work. The outlook for people with heart transplants is good during the first few years after the transplant. In fact, over 85 percent of patients live for more than a year after their operations. However, the number of patients who receive heart transplants is still relatively low (around 2,200 each year).

Devices

Valve Replacement

Heart failure is sometimes caused by a defective or diseased heart valve. Heart valves regulate the flow of blood inside the heart. When they don't work properly, this puts extra strain on the heart and can lead to heart failure. Correcting the problem surgically can often improve or resolve the condition.

A variety of different replacement valves can be used: a mechanical valve made from metal and plastic, one made from human or animal tissue. During the surgery, the patient is connected to a heart-lung machine that supplies blood to the brain and body. The bad valve is removed and replaced.

After the operation and depending on the type of replacement heart valve used, patients may take medicines to prevent blood clots from forming around the new heart valve. This treatment is often long-term to ensure the new valve works properly. Most heart valve surgeries are a success, but the operation is only considered as an option when a defective or diseased valve threatens someone's life.

Defibrillator Implantation

Some people who have severe heart failure or serious arrhythmias (irregular heartbeats) are candidates for implantable defibrillators. These devices are surgically placed and deliver pacing, or an electric countershock, to the heart when a life-threatening abnormal rhythm is detected.

Left Ventricular Assist Device (LVAD)

The left ventricle is the large, muscular chamber of the heart that pumps blood out to the body. A left ventricular assist device (LVAD) is a battery-operated, mechanical pump-type device that's surgically implanted. It helps maintain the pumping ability of a heart that can't effectively work on its own.

This device is sometimes called a "bridge to transplant," but is now used in long-term therapy. People awaiting a heart transplant often must wait a long time before a suitable heart becomes available. During this wait, the patient's already-weakened heart may deteriorate and become unable to pump enough blood to sustain life. An LVAD can help a weak heart and "buy time" for the patient or eliminate the need for a heart transplant. Most recently, LVADs are being used longer-term as 'destination therapy' in end-stage heart failure patients when heart transplantation is not an option.

A common type of LVAD has a tube that pulls blood from the left ventricle into a pump. The pump then sends blood into the aorta (the large blood vessel leaving the left ventricle). This effectively helps the weakened ventricle. The pump is placed in the upper part of the abdomen. Another tube attached to the pump is brought out of the abdominal wall to the outside of the body and attached to the pump's battery and control system. LVADs are now portable and are often used for weeks to months. Patients with LVADs can be discharged from the hospital and have an acceptable quality of life while waiting for a donor heart to become available.

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