Cardio-thoracic surgery procedures

Aortic dissection is when the aorta, the largest artery connecting the heart to the whole body, tears. This is a life threatening situation and requires an emergency operation. The operation involves replacing the dissected aorta with a graft. This may also necessitate aortic valve replacement and aortic arch replacement.

The aorta is the largest artery in the human body, carrying blood from the heart to the whole body. A diseased aorta can dilate or enlarge (aneurysm) or dissect and rupture. Aortic surgery replaces the aorta with prosthetic grafts. Aortic replacement involves using a cardiopulmonary bypass (heart-lung machine). Sometimes, deep hypothermia and circulatory arrest is needed and there is a higher procedural risk with operations requiring this surgical technique. Long term surveillance is required after any aortic operation.

Atrial fibrillation is an abnormal heart rhythm that may cause sluggish blood flow through the heart. Surgery to treat atrial fibrillation is performed in combination with valve and/or coronary surgery or as a standalone procedure. The surgery aims to restore normal rhythm and is an alternative treatment option to taking medications such as anticoagulants (blood thinners). If you have been diagnosed with atrial fibrillation, speak with your surgeon about this procedure

Coronary artery bypass grafting is the surgical treatment for coronary artery disease. It restores the flow of blood to the heart by bypassing the blockages in the heart blood vessels using arterial/ venous conduits. The operation can be performed with or without the aid of a bypass machine. An uncomplicated coronary operation involves a hospital stay of 1 day before surgery and 5 to 7 days post-surgery. It remains the only modality of revascularisation with proven longevity to the patient.

Minimally invasive surgery is performed with the use of video assisted technology and small operating ports through the chest wall. It minimises trauma, surgical and deep sternal wound infections and is better from a cosmetic and pain point of view. Some heart valve operations can be performed via minimally invasive surgery. Ask your doctor if you are a candidate for a minimally invasive operation.

Valve surgery repairs or replaces diseased heart valves. You can ask your surgeon if your valve is repairable or needs replacement. If it needs replacement, you may be able to choose between a tissue valve and mechanical valve. Tissue valves are either porcine or bovine and do not need long term warfarin (blood thinner) therapy. However, they are subject to degeneration in 10 to 20 years and may need reoperation. Mechanical valves normally last a person’s lifetime but need long term warfarin therapy. Warfarin may have an impact on your lifestyle including your diet and participation in contact sports/adventure activities. You can discuss these issues with your treating team. This is still the gold standard of care for patients with diseased heart valves.

Lung volume reduction surgery is offered to a selected group of patients with emphysema. Emphysema is a chronic lung disease that causes shortness of breath. The surgery involves removing grossly emphysematous (diseased lung tissue) portions of the lung to optimise the efficiency of the remaining lung tissue. It is generally performed via video assisted surgery.

Treatable lung cancers can be operated on with minor resections or major resections. A resection is the surgical removal of all or part of an organ, tissue or structure to remove a tumour. These procedures can be performed by open surgery or keyhole surgery. The treatment is often combined with radiotherapy and/or chemotherapy depending on the stage of cancer. In some cases, you may undergo chemotherapy before surgery.

Benign lung tumours and mediastinal tumours that develop in the mediastinum (the area in the middle of the chest) sometimes need surgical resections. These may be performed via a thoracotomy (surgical incision in the chest wall), sternotomy (surgical incision in the centre of the chest) or by video assisted thoracotomy (see below).

Chest wall deformities including pectus excavatum, a condition characterised by an abnormal development of the breastbone and rib cage, can be treated surgically. The thoracic unit offers Nuss procedures to correct pectus excavatum.

Recurrent pneumothorax and pleural effusions (the build-up of air or fluid around the lungs inside chest) are treated by a pleurodesis procedure. This procedure permanently removes space between the membranes in the chest to prevent air/fluid build-up. This is generally performed via video assisted surgery.

Video assisted sympathectomy is surgical treatment for hyperhidrosis, a condition characterised by excessive sweating. The procedure involves removing the responsible segment of the sympathetic ganglia, which is located in the chest. It is a successful procedure to treat uncontrollable symptoms of hyperhidrosis.

Many surgeries involving the lung, chest wall and mediastinum are performed via video assisted thoracoscopic surgery. The procedure involves operating inside the chest using instruments under video guidance. Commonly performed operations by this technique include lobectomies, surgery for recurrent pleural effusions and pneumothorax, mediastinal surgeries and chest wall and lung biopsies. Advantages include faster recovery time, lower pain and wound issues and improved cosmesis.