Cardiothoracic surgery is a medical specialty focused on surgical interventions within the chest cavity, also known as the thorax. The name combines “cardio” (heart) and “thoracic” (chest). This field provides surgical treatment for diseases affecting the heart, lungs, and other structures in this space, addressing conditions that require a mechanical or structural fix to restore proper function.
The Anatomical Scope of the Specialty
This surgical discipline is defined by the physical boundaries of the thoracic cavity, which houses multiple organ systems. The “cardio” component encompasses the heart and the great vessels, such as the aorta and the vena cavae. The “thoracic” component covers all other organs and structures within the chest wall.
These structures include the lungs, the trachea (windpipe), the esophagus, and the diaphragm. The specialty also addresses issues within the mediastinum, the central compartment containing the heart, major blood vessels, and lymph nodes. Surgeons must navigate the delicate relationships between the heart, lungs, and major airways to perform corrective procedures safely.
Surgical Treatment of Cardiac Conditions
Cardiothoracic surgeons address structural and circulatory problems that cannot be managed solely with medication. Coronary artery disease is frequently treated with Coronary Artery Bypass Grafting (CABG), where the surgeon reroutes blood flow around blocked arteries. This bypass uses a healthy blood vessel, often taken from the patient’s leg or chest wall, to restore adequate blood supply to the heart muscle.
Another major area is heart valve disorders, where valves may be too narrow (stenosis) or leak blood backward (regurgitation). Surgeons perform valve repair or replacement using mechanical or biological tissue valves to ensure unidirectional blood flow. Heart rhythm disorders, like atrial fibrillation, can be treated surgically using the Maze procedure to block abnormal electrical signals. For end-stage heart failure, surgeons implant devices like Left Ventricular Assist Devices (LVADs) or perform heart transplantation. They also repair congenital heart defects, structural abnormalities present from birth.
Surgical Treatment of Pulmonary and Thoracic Conditions
The thoracic side of the specialty focuses on surgical management of the lungs, esophagus, and other non-cardiac structures within the chest. Lung cancer represents a significant portion of this work, requiring procedures that remove cancerous tissue while preserving healthy lung function. Procedures include a lobectomy (removing an entire lobe) or a pneumonectomy (removing an entire lung, reserved for extensive disease). Smaller resections, like a segmentectomy or wedge resection, remove only a portion of a lobe.
These procedures are increasingly performed using minimally invasive techniques, such as Video-Assisted Thoracoscopic Surgery (VATS), which uses small incisions and a camera. Disorders of the esophagus, such as cancer or motility issues, may require an esophagectomy (surgical removal of part or all of the esophagus). The specialty also handles lung transplantation for conditions like severe emphysema or pulmonary fibrosis. Surgeons address trauma to the chest wall and conditions affecting the mediastinum, such as the removal of thymic tumors or the repair of a collapsed lung.
Cardiothoracic Surgery Versus Cardiology
A cardiologist is a physician specializing in the diagnosis, medical management, and prevention of heart disease. They primarily use medications and non-surgical procedures, such as placing stents in coronary arteries or performing cardiac catheterizations.
The cardiothoracic surgeon, by contrast, is a surgical specialist whose expertise is performing operations to mechanically fix structural problems in the heart and chest. They are responsible for procedures that involve making an incision to access the affected organ directly, such as bypass surgery or a valve replacement. A patient typically sees a cardiologist first for diagnosis and ongoing medical treatment, and is then referred to a cardiothoracic surgeon only if a mechanical or structural intervention is necessary. Both specialists must work collaboratively, with the cardiologist often managing the patient’s long-term care after the surgeon has completed the post-operative recovery phase.