The question of whether a cardiologist performs surgery often stems from confusion between the medical specialty of cardiology and the surgical specialty of cardiac surgery. Cardiology is the branch of internal medicine focused on the diagnosis, treatment, and prevention of diseases affecting the heart and blood vessels. The short answer is generally no, as the most invasive procedures are performed by cardiac surgeons. However, the field includes distinct subspecialties, and one group of cardiologists performs highly technical, procedure-based interventions often confused with traditional surgery. This distinction lies in the approach, ranging from medical management to minimally invasive catheter-based techniques.
Defining the Medical Cardiologist
The traditional medical cardiologist, often called a general cardiologist, focuses primarily on the non-procedural aspects of heart health. Their expertise lies in the long-term management of chronic conditions and the use of diagnostic tools to assess cardiovascular function. They spend years of training after medical school learning to manage complex conditions such as chronic heart failure, hypertension, and arrhythmias through medication and lifestyle modifications.
A major part of their work involves interpreting non-invasive diagnostic tests to accurately identify issues within the cardiovascular system. These tests include the electrocardiogram (EKG), which records the heart’s electrical activity, and the echocardiogram, which uses sound waves to create moving images of the heart’s structure and function.
This specialist manages patient risk factors, which often involves prescribing specific pharmaceutical agents to control blood pressure and lower cholesterol levels. By guiding patients toward healthier diets and appropriate exercise routines, they work to slow the progression of existing heart disease and prevent future cardiac events. When a patient requires a procedure beyond medical management, the general cardiologist determines the appropriate subspecialist referral, whether to an interventional cardiologist or a cardiac surgeon.
Procedures Performed by Interventional Cardiologists
The subspecialty of interventional cardiology represents the primary area where a cardiologist performs hands-on procedures. An interventional cardiologist uses thin, flexible tubes called catheters to access the heart and blood vessels through small punctures, typically in the wrist or groin artery. This minimally invasive approach allows for the repair of structural issues without the need for large incisions.
One of the most common procedures is coronary angioplasty, where a catheter is guided to a narrowed coronary artery. A small balloon is inflated to compress the plaque against the vessel wall, which is almost always followed by the placement of a stent. The stent is a small mesh tube that acts as a scaffold to keep the newly opened artery patent.
Interventional cardiologists also implant permanent electronic devices, such as pacemakers and implantable cardioverter-defibrillators (ICDs), to manage abnormal heart rhythms. More advanced catheter-based interventions include transcatheter valve replacement procedures, like Transcatheter Aortic Valve Replacement (TAVR). TAVR allows a new valve to be implanted without removing the old one, utilizing specialized delivery systems through the catheter. Because these techniques avoid opening the chest, patients experience faster recovery times and shorter hospital stays compared to traditional surgical methods.
The Role of the Cardiac Surgeon
The cardiac surgeon, formally a cardiothoracic surgeon, is the specialist who performs traditional, highly invasive operations on the heart, great vessels, and lungs. Unlike cardiologists, surgeons are trained to operate directly on the internal structures of the heart, often requiring a sternotomy. A sternotomy involves dividing the breastbone to access the thoracic cavity, preparing them for complex reconstruction and repair that cannot be accomplished with catheter-based techniques.
The most widely known procedure performed by this specialist is Coronary Artery Bypass Grafting (CABG). This involves harvesting a healthy artery or vein from another part of the body to create a new path for blood flow around a blocked coronary artery. Cardiac surgeons also perform intricate heart valve repair and replacement procedures for valves that are too diseased or damaged to function correctly.
These operations may involve replacing a patient’s native valve with a mechanical or tissue prosthesis. The cardiac surgeon is also responsible for highly specialized procedures, including heart transplantation and the implantation of Ventricular Assist Devices (VADs). These operations involve extensive surgical expertise and often require the use of a heart-lung machine to temporarily take over the function of the heart and lungs. The division between the cardiologist and the cardiac surgeon is defined by the level of invasiveness and the need for open access to the heart anatomy.