CARDIAC SURGEONS

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    Cardiothoracic surgery


    Cardiothoracic Surgeon
    Ijn surgeon.JPG
    Cardiothoracic surgeon performs an operation.
    Occupation
    Names
    • Physician
    • Surgeon
    Occupation type Specialty
    Activity sectors Medicine, Surgery
    Description
    Education required

    Cardiothoracic surgery is the field of medicine involved in surgical treatment of diseases affecting organs inside the thorax (the chest)—generally treatment of conditions of the heart (heart disease) and lungs (lung disease). Cardiac surgery (involving the heart and great vessels) and thoracic surgery (involving the lungs) are separate surgical specialties, except in the USA, Australia, New Zealand and in some EU countries, such as the UK and Portugal.[1]


    Cardiac surgeons Training


    A cardiac surgery residency typically comprises anywhere from six to nine 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 residency followed by a fellowship. Cardiac surgeons may further sub-specialize cardiac surgery by doing a fellowship in a variety of topics including: pediatric cardiac surgery, cardiac transplantation, adult acquired heart disease, weak heart issues and many more problems in the heart.


    Cardiac surgeons Australia and New Zealand

    The integrated advanced training program in Cardiothoracic Surgery is six years in duration with two of these years being devoted to experience in General Surgery, preferably during the first three years. 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.


    Cardiac surgeons 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, coronary care unit, cardiac pathology, etc.). Contemporary Canadian candidates completing general surgery and wishing to pursue cardiac surgery often complete a cardiothoracic surgery fellowship in the United States. However, the Royal College of Physicians and Surgeons of Canada affords 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 British Columbia and the University of Toronto.


    Cardiac surgeons United States

    Surgeon operating.

    Cardiac surgery training in the United States is combined with thoracic surgery and called cardiothoracic surgery. Cardiothoracic surgeons in the U.S. is a physician (D.O. or M.D.) who first completes a general surgery 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. Recently, however, options for an integrated 6-year cardiothoracic residency (in place of the general surgery residency plus cardiothoracic residency) have been established at several programs. Applicants match into these 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 now 20 approved programs, which include the following:

    The American Board of Thoracic Surgery offers a special pathway certificate in congenital heart surgery which typically requires an additional year of fellowship. This formal certificate is unique because pediatric cardiac surgeons in other countries do not have formal evaluation and recognition of pediatric training by a licensing body.


    Cardiac surgeons Cardiac surgery


    Cardiac surgery
    Intervention
    Coronary artery bypass surgery Image 657B-PH.jpg
    Two cardiac surgeons performing a cardiac surgery known as coronary artery bypass surgery. Note the use of a steel retractor to forcefully maintain the exposure of the patient's heart.
    ICD-9-CM 35-37
    MeSH D006348
    OPS-301 code: 5-35...5-37

    The earliest operations on the pericardium (the sac that surrounds the heart) took place in the 19th century and were performed by Francisco Romero[2] Dominique Jean Larrey, Henry Dalton, and Daniel Hale Williams.[3] The first surgery on the heart itself was performed by Norwegian surgeon Axel Cappelen on the 4th of September 1895 at Rikshospitalet in Kristiania, now Oslo. He ligated a bleeding coronary artery in a 24 year old man who had been stabbed in the left axillae 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 increasing temperature and he ultimately died from what the post mortem proved to be mediastinitis on the third postoperative day.[4][5] The first successful surgery of the heart, performed without any complications, was by Dr. Ludwig Rehn of Frankfurt, Germany, who repaired a stab wound to the right ventricle on September 7, 1896.[6][7]

    Surgery in great vessels (aortic coarctation repair, Blalock-Taussig shunt creation, closure of patent ductus arteriosus), 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 most commonly harvested using a procedure known as EVH, and grafted to the coronary arteries to bypass blockages and improve the blood supply to the heart muscle.


    Cardiac surgeons Early approaches to heart malformations

    In 1925 operations on the heart valves were unknown. Henry Souttar operated successfully on a young woman with mitral stenosis. 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[8] but Souttar’s physician colleagues at that time decided the procedure was not justified and he could not continue.[9][10]

    Cardiac surgery changed significantly after [10]

    In 1947 Thomas Holmes Sellors (1902–1987) of the Middlesex Hospital operated on a Fallot’s Tetralogy patient with pulmonary stenosis 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 pulmonary stenosis. 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.[9]


    Cardiac surgeons Open heart surgery

    Open heart surgery is a surgery in which the patient's heart is opened and surgery is performed on the internal structures of the heart. It was soon discovered by Dr. local anesthesia. This surgery is during which the heart is exposed and the blood made to bypass it.

    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. Dr. John Heysham Gibbon 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 Dr. 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'. Dr. John W. Kirklin at the Mayo Clinic 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.

    [12]


    Cardiac surgeons Modern beating-heart surgery

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

    Some researchers believe that the off-pump approach results in fewer post-operative complications, such as postperfusion syndrome, and better overall results. Study results are controversial as of 2007, the surgeon's preference and hospital results still play a major role.


    Cardiac surgeons 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.


    Cardiac surgeons Pediatric cardiovascular surgery

    Pediatric cardiovascular surgery is surgery of the heart of children.The first operations to repair heart defects in children were performed by Clarence Crafoord in Sweden when he repaired coarctation of the aorta in a 12 year old boy.[16]


    Cardiac surgeons 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.[17][18] A major concern with cardiac surgery is the incidence of neurological damage. Stroke occurs in 5% of all people undergoing cardiac surgery, and is higher in patients at risk for stroke.[19] A more subtle constellation of neurocognitive deficits attributed to cardiopulmonary bypass is known as postperfusion syndrome, sometimes called "pumphead". The symptoms of postperfusion syndrome were initially felt to be permanent,[20] but were shown to be transient with no permanent neurological impairment.[21]

    In order to assess the performance of surgical units and individual surgeons, a popular risk model has been created called the EuroSCORE. 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.[22] The precise methodology used has however not been published to date nor has the raw data on which the results are based.


    Cardiac surgeons See also



    Cardiac surgeons References


    1. ^ "Portuguese Ordem dos Médicos - Medical specialties" (in Portuguese). 
    2. ^ Aris A. Francisco Romero, the first heart surgeon. Ann Thorac Surg 1997 Sep;64(3):870-1. PMID 9307502
    3. ^ http://www.nlm.nih.gov/exhibition/aframsurgeons/pioneers.html Pioneers in Academic Surgery, , U.S. National Library of Medicine
    4. ^ Landmarks in Cardiac Surgery by Stephen Westaby, Cecil Bosher, ISBN 1-899066-54-3
    5. ^ http://www.tidsskriftet.no/?seks_id=659174
    6. ^ Absolon KB, Naficy MA (2002). First successful cardiac operation in a human, 1896: a documentation: the life, the times, and the work of Ludwig Rehn (1849-1930). Rockville, MD : Kabel, 2002
    7. ^ Johnson SL (1970). History of Cardiac Surgery, 1896-1955. Baltimore: Johns Hopkins Press. p. 5.
    8. ^ Dictionary of National Biography – Henry Souttar (2004–08)
    9. ^ a b c Harold Ellis (2000) A History of Surgery, page 223+
    10. ^ a b Lawrence H Cohn (2007), Cardiac Surgery in the Adult, page 6+
    11. ^ Warren, Cliff, Dr. Nazih Zuhdi – His Scientific Work Made All Paths Lead to Oklahoma City, in Distinctly Oklahoma, November, 2007, p. 30-33
    12. ^ http://ndepth.newsok.com/zuhdi Dr. Nazih Zuhdi, the Legendary Heart Surgeon, The Oklahoman, Jan 2010
    13. ^ Crafoord C, Nyhlin G. Congenital coarctation of the aorta and its surgical management J Thorac Surg 1945;14:347-361.
    14. ^ Blalock A, Taussig HB. The surgical treatment of malformations of the heart in which there is pulmonary stenosis or pulmonary atresia. JAMA 1948; 128: 189-202.
    15. ^ Lillehei CW, Cohen M, Warden HE, et al. The results of direct vision closure of ventricular septal defects in eight patients by means of controlled cross circulation. Surgery, Gynecology, and Obstetrics 1955; October: 447-66.
    16. ^ "Pediatric heart surgery" in MedlinePlus
    17. ^ Stark J, Gallivan S, Lovegrove J, Hamilton JR, Monro JL, Pollock JC, Watterson KG. Mortality rates after surgery for congenital heart defects in children and surgeons' performance. Lancet 2000 March 18;355(9208):1004-7. PMID 10768449
    18. ^ Klitzner TS, Lee M, Rodriguez S, Chang RR. Sex-related Disparity in Surgical Mortality among Pediatric Patients. Congenital Heart Disease 2006 May;1(3):77. Abstract
    19. ^ Jan Bucerius, Jan F. Gummert, Michael A. Borger,Thomas Walther, Nicolas Doll, Jorg F. Onnasch,Sebastian Metz, Volkmar Falk, Friedrich W. Mohr (2003). "Stroke after cardiac surgery: a risk factor analysis of 16,184 consecutive adult patients". The Annals of Thoracic Surgery 75 (2): 472–478. doi:10.1016/S0003-4975(02)04370-9. 
    20. ^ Newman M, Kirchner J, Phillips-Bute B, Gaver V, Grocott H, Jones R, Mark D, Reves J, Blumenthal J (2001). "Longitudinal assessment of neurocognitive function after coronary-artery bypass surgery". N Engl J Med 344 (6): 395–402. doi:10.1056/NEJM200102083440601. PMID 11172175. 
    21. ^ Van Dijk D, Jansen E, Hijman R, Nierich A, Diephuis J, Moons K, Lahpor J, Borst C, Keizer A, Nathoe H, Grobbee D, De Jaegere P, Kalkman C (2002). "Cognitive outcome after off-pump and on-pump coronary artery bypass graft surgery: a randomized trial". JAMA 287 (11): 1405–12. doi:10.1001/jama.287.11.1405. PMID 11903027. 
    22. ^ http://heartsurgery.cqc.org.uk/ CQC website for heart surgery outcomes in the UK for 3 years ending March 2009

    Cardiac surgeons External links




    Top Cardiac Surgeons Information On Cardiac Surgeons Cardiovascular Surgeon Cardiovascular Surgeons Names Heart Surgeons Cardiac Surgeon Education Requirements Cardiac Surgeon Education Cardiac Surgeon Pay

    | Top Cardiac Surgeons | Information On Cardiac Surgeons | Cardiovascular Surgeon | Cardiovascular Surgeons Names | Heart Surgeons | Cardiac Surgeon Education Requirements | Cardiac Surgeon Education | Cardiac Surgeon Pay | Cardiac_surgeons | Cardiac_surgery | Richard_Lee_(Cardiac_Surgeon) | Duke_Cameron | Mitral_valve_repair | Zbigniew_Religa | A._Marc_Gillinov | John_Callaghan | William_Thornton_Mustard | Ramakanta_Panda | Claude_Beck | David_H._Adams | Harry_Windsor_(surgeon) | Hamilton_Naki | Marian_Ionescu | Bruce_Reitz | Juan_Giambruno | Marko_Turina | Amit_Patel | Senning_procedure | Lars_Georg_Svensson | William_Glenn | Arthur_Vineberg | Terence_English | Cardiology | Gilles_Dreyfus | Robert_Poston | Gopal_Bhatnagar | Fabian_Udekwu | Albert_Pacifico | Devi_Prasad | Randas_Batista | Giancarlo_Rastelli | John_Callaghan_(disambiguation) | Revishvili | Tirone_E._David | Cardiac_transplantation | Perfusionist | Marius_Barnard_(surgeon) | Patrick_M._McCarthy_(surgeon) | Adrian_Kantrowitz | Victor_Chang | Jatene_procedure | Multan_Institute_of_Cardiology | Christiaan_Barnard | Devi_Shetty | A._G._K._Gokhale

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