Cardiothoracic surgery (also known as thoracic surgery) is a field of medicine involved in surgical treatment of organs in the thorax (chest) - generally treatment of heart conditions (heart disease) and lung (lung disease) lung). In most countries, heart surgery (involving the heart and large blood vessels) and general thoracic surgery (involving the lungs, esophagus, thymus, etc.) is a separate surgical specialty; the exceptions are the United States, Australia, New Zealand and some EU countries, such as Britain and Portugal.
Video Cardiothoracic surgery
Training
The heart surgery residence usually consists of 4 to 16 years (or more) of training to become a qualified surgeon. Heart surgery exercises can be combined with thoracic and/or vascular surgery and are called cardiovascular (CV)/cardiothoracic (CT)/cardiovascular thoracic (CVT) surgery. The cardiac surgeon may enter the heart surgery site directly from the medical school, or first complete a general surgical residence followed by fellowship. Heart surgeons can further sub-specialty cardiac surgery by conducting fellowships on various topics including: pediatric heart surgery, heart transplant, adult heart disease, weak heart problems, and more heart problems.
Australia and New Zealand
The highly competitive Surgery Education and Training (SED) Program in Cardiac Surgery is six years old, usually starting a few years after completing medical school. Training is managed and supervised through a two-state training program (Australia and New Zealand). Several exams are conducted throughout the training, culminating in the final exam of the scholarship in the final year of training. After completing the training, the surgeon was awarded a Fellowship from Royal Australasian College of Surgeons (FRACS), which showed that they were qualified specialists. Trainees who have completed training programs in General Surgery and have obtained FRACS they will have the option to complete fellowship training in Cardiothoracic Surgery for four years, depending on college approval. It takes approximately eight to ten years of minimum post-graduate training (post-medical school) to qualify as a cardiothoracic surgeon. The competition for training venues and public places (teaching) of hospitals is very high right now, causing concerns about manpower planning in Australia.
Canada
Historically, cardiac surgeons in Canada completed general surgery followed by an alliance in CV/CT/CVT. During the 1990s, Canada's cardiac surgery training program turned into a "straightforward" program six years after medical school. The live entry format gives residents experience related to heart surgery that they will not receive in general surgery programs (eg echocardiography, coronary care units, cardiology pathology, etc.). Typically, this is followed by a good fellowship of Adult Heart Surgery, Heart Failure/Transplant, Minimally Invasive Surgery, Aortic Surgery, Thoracic Surgery, Cardiac ICU Surgery. Contemporary Canadian candidates who complete general surgery and wish to perform cardiac surgery often complete the cardiothoracic surgery partnership in the United States. The Royal College of Physicians and Surgeons of Canada also provide a three-year heart surgery partnership for eligible general surgeons offered at several training venues including the University of Alberta, the University of British Columbia and the University of Toronto.
Thoracic surgery itself separates 2-3 years of common surgical or heart surgery in Canada.
Heart surgery program in Canada:
- University of Alberta - 1 position
- University of British Columbia - 1 position
- University of Calgary - 1st position
- Dalhousie University - 1 position every other year
- Università © 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
- Università ©  © de MontrÃÆ'  © al - 1 position every three years
- University of Ottawa - 1st position
- University of Toronto - 1 position
- Western University - 1 position
United Kingdom
In the United Kingdom, you have to practice for MBBS (or MBChB), usually for 5 years. You can interconnect BSc degrees for a total of 6 year undergraduate education, but this is not necessary. After you apply for a special place, or core surgical training (which is less competitive than direct to specialization). If you go for core surgical training, you can apply it in the third year for cardiothoracic surgery, which at that time is much less competitive. Once you have undergone training for specialization, you may choose to provide subspecies as possible: aortic surgery; adult heart surgery; thoracic surgery; pediatric cardiothoracic surgery; adult congenital operation. It is a technically useful and technically challenging specialty, similar to interventional cardiology in some aspects.
United States
The heart surgery training in the United States is combined with a general thoracic surgery and is called cardiothoracic surgery or thoracic surgery. A cardiothoracic surgeon in the US is a physician (D.O. or M.D.) who first completes a general surgical residence (usually 5-7 years), followed by a cardiothoracic surgery alliance (usually 2-3 years). Cardiothoracic surgery operations usually last two or three years, but certification is based on the number of surgeries performed as surgical surgeons, not the time spent in the program, in addition to passing a rigorous board certification test. Recently, however, the choice for 6 years of integrated residence kardiotoraks (in place of general surgical residency plus cardiothoracic residency) has been established in many programs (more than 20). Applicants fit into this I-6 program directly from medical schools, and the application process is very competitive for this position as there are about 160 applicants for 10 places in the US by 2010. In May 2013, there are now 20 approved programs, which include the following :
Cardiothoracic Surgery Program in USA:
- Medical College of Wisconsin
- Stanford University - 2 positions
- University of North Carolina at Chapel Hill
- The University of Virginia
- Columbia University - 2 positions
- University of Pennsylvania
- University of Pittsburgh - 2 positions
- University of Washington
- Northwestern University
- Mount Sinai Hospital, New York
- University of Maryland
- University of California, Los Angeles UCLA - 2 resident positions, 1 Transplant Fellowship; 1 The congenital resident position
- University of Texas Medical Center in San Antonio
- Medical University of South Carolina
- University of Southern California - 2 positions
- University of Rochester
- University of California, Davis
- Indiana University
- The University of Kentucky
- Emory University
- University of Michigan
The American Board of Thoracic Surgery offers a special path certificate in congenital heart surgery that usually requires an additional year of fellowship. This official certificate is unique because child's cardiac surgeons in other countries have no formal evaluation and recognition of pediatric training by the licensing body.
Maps Cardiothoracic surgery
Heart Surgery
The earliest surgery on the pericardium (sac surrounding the heart) occurred in the 19th century and was done by Francisco Romero (1801) Dominique Jean Larrey, Henry Dalton, and Daniel Hale Williams. The first operation of the heart itself was performed by Norwegian surgeon Axel Cappelen on 4 September 1895 at Rikshospitalet in Kristiania, now Oslo. He binds a bleeding coronary artery to a 24-year-old man stabbed in the left armpit and is shocked when it arrives. Access is through the left thoracotomy. The patient woke up and looked fine for 24 hours, but became ill with an increase in temperature and he eventually died from what post mortem proved to be mediastinitis on the third postoperative day. The first successful heart surgery, performed without any complications, was by Ludwig Rehn of Frankfurt, Germany, who repaired a stab wound into the right ventricle on September 7, 1896.
Surgery in large blood vessels (aortic coartite repair, blalock-Taussig shunt creation, patent ductus arteriosus closure) became common after the turn of the century and fell into the heart surgery domain, but technically it can not be considered a heart surgery. One of the more commonly known procedures of cardiac surgery is coronary artery bypass (CABG), also known as "bypass surgery." In this procedure, the vessels from elsewhere in the patient's body are taken, and grafted into the coronary arteries to bypass the blockage and increase the blood supply to the heart muscle.
The early approach to heart malformation
In 1925 surgery on the heart valve was unknown. Henry Souttar operated successfully on a young woman with mitral stenosis. He makes an opening in the additional portion of the left atrium and inserts a finger into this room to feel and explore the damaged mitral valve. The patient survived for several years but co-physician Souttar at the time decided the procedure was not justified and he could not continue.
Cardiac surgery changed significantly after World War II. In 1948, four surgeons performed successful surgery for mitral stenosis due to rheumatic fever. Horace Smithy (1914-1948) from Charlotte, revived the operation because Dr. Dwight Harken from Peter Bent Brigham Hospital used a blow to lift a portion of the mitral valve. Charles Bailey (1910-1993) at Hahnemann Hospital, Philadelphia, Dwight Harken in Boston and Russell Brock at Guy Hospital all adopted the Souttar method. All these men start working independently of each other, within a few months. Souttar's technique was widely adopted despite modifications.
In 1947 Thomas Holmes Sellors (1902-1987) of Middlesex Hospital operated on the Tetralogy of Fallot patients with pulmonary stenosis and successfully divided the pulmonary valve stenosis. In 1948, Russell Brock, probably unaware of Sellor's work, used a specially designed dilator in three cases of pulmonary stenosis. Then in 1948 he designed a blow to resolve the infundibular muscle stenosis that is often associated with Tetralogy of Fallot. Many thousands of "blind" operations are performed until the introduction of the heart bypass makes direct operation on the valves possible.
Open heart operation
Open heart surgery is a procedure in which the patient's heart is opened and surgery is performed on the internal structure of the heart. It was discovered by Wilfred G. Bigelow of the University of Toronto that improvements in intracardiac pathology are better done with a bloodless and immobile environment, meaning that the heart must be stopped and drained of blood. The first successful intracardiac correction of congenital heart defects using hypothermia was performed by C. Walton Lillehei and F. John Lewis at the University of Minnesota on 2 September 1952. The following year, the Soviet surgeon Aleksandr Aleksandrovich Vishnevskiy performed the first heart surgery under local anesthesia.
Surgeons are aware of the limitations of hypothermia - complex intracardiac repair takes more time and the patient needs blood flow to the body, especially to the brain. Patients need heart and lung function provided by an artificial method, hence the term cardiopulmonary bypass. John Heysham Gibbon at Jefferson Medical School in Philadelphia reported in 1953 the successful first use of extracorporeal circulation by using oxygenator, but he abandoned the method, disappointed with his subsequent failure. In 1954 Lillehei realized a successful series of operations with controlled circulation techniques in which the mother or father of the patient was used as a 'heart-lung machine'. John W. Kirklin at the Mayo Clinic in Rochester, Minnesota began using the Gibbon-type oxygenator pump in a series of successful operations, and was soon followed by surgeons around the world.
Nazih Zuhdi undertook a total open-heart operation of intentional hemodilution 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 an open heart surgery on a child, aged 1 >/ 2 , using a deliberate total hemodilution engine. In 1985 Zuhdi performed the first successful heart transplant in Oklahoma at Nancy Rogers at Baptist Hospital. The transplant was successful, but Rogers, a cancer patient, died from an infection 54 days after surgery.
Modern heart beating operations
Since the 1990s, surgeons began performing "off-pump bypass surgery" - coronary artery bypass surgery without the previously mentioned cardiopulmonary bypass. In this operation, the heart beats during operation, but is stabilized to provide an almost fixed area of ​​work in which to connect the passage through the blockage; in the US, most of the vessels are harvested endoscopically, using a technique known as endoscopic vessel retrieval (EVH).
Some researchers believe that the off-pump approach results in fewer postoperative complications, such as postperfusion syndrome, and better overall outcomes. The results of a controversial study in 2007, surgeon preference and hospital outcomes still play a major role.
Minimally invasive surgery
A new form of heart surgery that is increasingly popular is heart surgery with the help of robots. This is where the machine is used to perform the operation while controlled by the cardiac surgeon. The main advantage for this is the size of the incision made in the patient. Instead of an incision that is at least large enough for the surgeon to put his hand inside, it does not have to be larger than 3 small holes for a much smaller "hand" robot to pass through.
pediatric cardiovascular surgery
Pediatric cardiovascular surgery is a cardiac surgery of children. The first surgery to repair a heart defect in children was done by Clarence Crafoord in Sweden when he corrected the aortic coarctation in a 12-year-old boy. The first attempt to relieve congenital heart disease was done by Alfred Blalock with the help of William Longmire, Denton Cooley, and experienced Blalock technician Vivien Thomas in 1944 at Johns Hopkins Hospital. Techniques for improving congenital heart defects without using a bypass engine were developed in the late 1940s and early 1950s. Among them are an open repair of atrial septal defect using hypothermia, inflow occlusion and direct vision in 5-year-old children conducted in 1952 by Lewis and Tauffe. C. Walter Lillihei used cross circulation between his son and father to maintain perfusion when performing direct repair of the ventricular septal defect in a 4-year-old boy in 1954. He continued to use cross circulation and make the first corrections of tetratology. Fallot and presented the results in 1955 at the American Surgical Association. In the long run, pediatric cardiovascular surgery will depend on cardiopulmonary shortcuts developed by Gibbon and Lillehei as mentioned above.
Risk of heart surgery
The development of cardiac surgery and cardiopulmonary bypass techniques has reduced mortality rates from these operations into relatively low ratings. For example, improvements in congenital heart defects are currently estimated to have mortality rates of 4-6%. The main concern with heart surgery is the incidence of neurological damage. Stroke occurs in 5% of all people who undergo heart surgery, and is higher in patients at risk for stroke. A finer constellation of neurocognitive deficits associated with a cardiopulmonary bypass is known as postperfusion syndrome, sometimes called a "pumphead". Symptoms of postperfusion syndrome are initially perceived as permanent, but proven temporarily without permanent neurological disorders.
To assess the performance of individual surgical and surgeon units, a popular risk model has been created called EuroSCORE. This takes a number of health factors from a patient and uses calculated logistic regression coefficients trying to give a survival percentage chance to be discarded. In the UK, this EuroSCORE is used to provide details of all cardiothoracic surgical centers and to provide an indication of whether individual units and surgeons are performed within an acceptable range. The results are available on the CQC website. The exact methodology used has not been published to date nor does it have the raw data on which the results are based.
Infection is a major non-cardiac complication of cardiothoracic surgery. Infection may include mediastinitis, myo- or pericarditis infections, endocarditis, cardiac device infections, pneumonia, empyema, and bloodstream infections. Clostridum difficile colitis may also develop when prophylactic or post-operative antibiotics are used.
Chest surgery
Pleurectomy is a surgical procedure in which the pleural part is removed. Sometimes used in the treatment of pneumothorax and mesothelioma.
Lung volume reduction operation
Pulmonary volume reduction, or LVRS, can improve the quality of life of COPD patients and certain emphysema. Parts of the lung that are damaged mainly by emphysema are removed, allowing the lungs to remain, relatively good for developing and working more efficiently. Conventional LVRS involves resection of the most severe areas exposed to emphysematous, non-bullous lungs (the goal is for 20-30%). This is a surgical option involving a mini thoracotomy for patients suffering from late stage COPD due to underlying emphysema, and can improve lung elastic recovery as well as diaphragm function.
The National Emphysema Treatment Trial is a large multicenter study (N = 1218) comparing LVRS with non-surgical treatment. The results show that there is no overall survival benefit in the LVRS group, except for emphysema of the lobe over poor exercise capacity, and significant improvements seen in exercise capacity in the LVRS group.
Possible LVRS complications include prolonged air leakage (average duration of postoperative until all chest tubes removed were 10.9 ± 8.0 days.
In people who have upper lobe emphysema, pulmonary volume reduction surgery can result in better health status and lung function, although it also increases the risk of premature death and adverse events.
LVRS is widely used in Europe, although its application in the United States is largely experimental.
Surgery for lung cancer
Not all lung cancers are suitable for surgery. Stage, location, and cell type are important limiting factors. In addition, people who are very sick with poor performance status or who have inadequate lung reserves will not be likely to survive. Even with careful selection, the overall operating mortality rate is around 4.4%.
In non-small cell lung staging, stage IA, IB, IIA, and IIB are suitable for surgical resection.
Pulmonary reserves are measured by spirometry. If there is no evidence of improper breath or diffuse pulmonary parenchymal disease, and FEV 1 exceeds 2 liters or 80% of prediction, the person is eligible for pneumonectomy. If FEV 1 exceeds 1.5 liters, the patient is suitable for lobectomy.
Type
- Lobectomy (removal of the lung lobe)
- Sublobar resection (partial removal of the lung lobes)
- Segmentectomy (removal of anatomical cleavage of certain lung lobes)
- Pneumonectomy (removal of the entire lung)
- Resection wedge
- Sleeve/bronchoplastic resection (removal of associated tubular portions of the associated main bronchus during lobectomy with subsequent bronchial reconstruction)
- VATS lobectomy (minimally invasive approach to lobectomy that allows for pain relief, faster return to full activity, and reduced hospital costs)
See also
- Journal of Cardiothoracic Surgery
References
External links
- Cardiothoracic Surgery Network
- The Torch Surgeons Association
- The American Association for Thoracic Surgery
- The International Society for Minimally Invasive Cardiothoracic Surgery
Source of the article : Wikipedia
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