Cardiothoracic Surgery

What is Cardiothoracic Surgery?

Cardiothoracic surgery is the surgical specialty dedicated to treating diseases and injuries affecting the organs within the chest cavity — principally the heart, the lungs, and the oesophagus, along with the major blood vessels and surrounding structures. It is one of the most technically demanding areas of surgery, working on organs that must, in most cases, continue functioning for as long as possible during and immediately after the operation.

Cardiothoracic surgeons perform operations for both diagnosed disease — such as coronary artery disease, heart valve disorders, and lung cancer — and for trauma resulting from accidents or injury. Given the complexity and significance of the organs involved, cardiothoracic surgery is typically only recommended once other treatment options have been carefully considered, and it is almost always delivered as part of a coordinated, multidisciplinary care plan.

Understanding the Chest Cavity and its Organs

The chest, or thoracic cavity, houses several vital organs, each susceptible to its own specific diseases and each requiring highly specialised surgical techniques. The heart sits at the centre of the chest, encased by the pericardium, and is responsible for pumping blood throughout the body. On either side, the lungs fill most of the remaining chest cavity, drawing in oxygen and expelling carbon dioxide with every breath, and are lined by a thin membrane called the pleura.

The oesophagus runs through the chest on its way from the throat to the stomach, while the mediastinum — the central compartment of the chest between the two lungs — contains the heart, major blood vessels, and other important structures such as the trachea and lymph nodes. The chest wall itself, made up of the ribs, sternum, and surrounding muscle, protects these organs but can also be the site of its own structural conditions. Because these organs sit so close together and share the same protected space, procedures on one often require careful consideration of the others, which is part of why cardiothoracic surgery developed as a distinct, highly specialised field.

Two Main Branches: Cardiac Surgery & Thoracic Surgery

Although often referred to as a single specialty, cardiothoracic surgery is generally understood in terms of two closely related branches, distinguished by which organs they primarily treat:

• Cardiac Surgery: Concerned specifically with surgical treatment of the heart and the major blood vessels closest to it, including procedures to restore blood flow, repair or replace heart valves, and correct problems with the aorta.
• Thoracic Surgery: Concerned with surgical treatment of the lungs, oesophagus, chest wall, and other structures within the chest cavity outside of the heart itself, including surgery for cancer, infection, and structural abnormalities.

Common Cardiac Surgical Procedures

• Coronary Artery Bypass Grafting (CABG): Restores blood flow to the heart muscle by using a grafted blood vessel to bypass a blocked or narrowed coronary artery, most commonly performed for advanced coronary artery disease.
• Heart Valve Surgery: Repairs or replaces a damaged heart valve — most often the aortic, mitral, tricuspid, or pulmonary valve — to restore proper one-way blood flow through the heart.
• Aortic Surgery: Repairs or replaces a section of the aorta that has become abnormally enlarged (an aneurysm) or damaged, reducing the risk of a life-threatening rupture.
• Heart Transplant: Replaces a heart that is failing beyond the point of benefit from other treatments with a healthy donor heart, reserved for select patients with end-stage heart failure.
• Minimally Invasive Cardiac Surgery (MICS): Performs selected cardiac procedures through smaller incisions than traditional open-heart surgery, often resulting in less post-operative pain and a faster return to daily activities.

Common Thoracic Surgical Procedures

• Lung Cancer Surgery: Removes cancerous tumours from the lung, with the specific extent of surgery depending on the size, location, and stage of the cancer.
• Lobectomy: Removes one lobe (section) of the lung, commonly performed for localised lung cancer while preserving as much healthy lung tissue as possible.
• Pneumonectomy: Removes an entire lung, typically reserved for cases where a tumour or extensive disease cannot be adequately treated by removing a smaller portion of lung tissue.
• Pleural Surgery: Treats conditions affecting the pleura, the thin membrane surrounding the lungs, including drainage or removal of fluid, air, or diseased tissue from the pleural space.
• Oesophageal Surgery: Treats conditions affecting the oesophagus, including oesophageal cancer and severe, treatment-resistant acid reflux disease.
• Mediastinal Surgery: Treats tumours, cysts, or other abnormalities located in the mediastinum, the central compartment of the chest between the two lungs.
• Chest Wall Surgery: Corrects structural deformities or abnormalities of the chest wall, which can affect breathing, physical appearance, or both.

Conditions That May Require Cardiothoracic Surgery

A wide range of cardiac and thoracic conditions may ultimately require surgical treatment, particularly once they progress beyond what medication or less invasive procedures can adequately manage:

• Coronary artery disease: When arteries supplying the heart become severely narrowed by plaque build-up and are not well suited to catheter-based treatment, bypass surgery may be needed to restore adequate blood flow to the heart muscle.
• Heart valve disease: When a heart valve becomes too narrowed or leaks too severely to be managed with medication alone, surgical repair or replacement may be required to prevent long-term strain on the heart.
• Aortic aneurysm: An abnormally enlarged section of the aorta carries a risk of rupture that increases as it grows, and surgery is often recommended once an aneurysm reaches a size where this risk becomes significant.
• Advanced heart failure: When heart failure progresses despite optimal medical treatment, surgical options ranging from device implantation to heart transplantation may be considered for carefully selected patients.
• Lung cancer: Surgical removal of a tumor, when detected at an early enough stage and when the patient's overall lung function allows it, offers the best chance of long-term cure for many forms of lung cancer.
• Emphysema and severe lung disease: In select cases of advanced lung disease, surgery to remove damaged lung tissue can improve breathing function and quality of life.
• Pleural effusion or infection: A build-up of fluid or infection around the lungs that does not resolve with drainage alone may require surgical intervention to fully clear the pleural space and allow the lung to re-expand.
• Chest wall deformities: Structural abnormalities of the chest wall, whether present from birth or acquired later, can sometimes affect breathing or heart function significantly enough to warrant surgical correction.
• Chest trauma: Serious injury to the chest from an accident can damage the heart, lungs, or major blood vessels, sometimes requiring urgent surgical repair to control bleeding or restore normal function.

Minimally Invasive and Robotic-Assisted Approaches

Cardiothoracic surgery has evolved considerably from the large, open incisions once required for almost every procedure. Where clinically appropriate, many operations can now be performed using smaller incisions and specialised instruments, offering meaningful benefits for suitable patients.

• Video-assisted thoracoscopic surgery (VATS): A minimally invasive technique using a small camera and instruments inserted through several small incisions in the chest wall, commonly used for certain lung resections and pleural procedures.
• Robotic-assisted surgery: Uses a robotic surgical system, controlled directly by the surgeon, to perform selected cardiac and thoracic procedures with enhanced precision and dexterity through very small incisions.
• Minimally invasive cardiac surgery: Applies smaller-incision techniques to selected heart procedures, such as certain valve repairs, reducing surgical trauma while still achieving the same underlying repair as open surgery.

Not every patient or every condition is suited to a minimally invasive approach — factors such as the complexity of the disease, prior surgeries, and overall anatomy all influence whether it is an appropriate option, a decision made individually by the surgical team.

Preparing for Cardiothoracic Surgery

Because cardiothoracic procedures place significant demands on the body, thorough preparation plays an important role in achieving the best possible outcome.

• Comprehensive pre-operative assessment: A detailed evaluation of heart and lung function, alongside overall fitness for surgery, helps the surgical team anticipate and plan for any individual risk factors ahead of time.
• Lung function testing: For thoracic procedures in particular, tests that measure how well the lungs are working help determine how much lung tissue can be safely removed, if applicable, without compromising future breathing.
• Smoking cessation: Stopping smoking well ahead of surgery, where relevant, meaningfully reduces the risk of breathing complications after the operation and supports better wound healing.
• Medication review: Certain medications, particularly blood thinners, may need to be adjusted or temporarily stopped ahead of surgery, under the guidance of the surgical team, to manage bleeding risk appropriately.
• Physical conditioning: Where time allows, improving overall physical fitness ahead of a planned procedure, sometimes through a structured pre-surgical exercise programme, can support a smoother recovery afterward.

Our dedicated teams of experienced multidisciplnary specialists and healthcare professionals work together to provde treatment plans tailored to the needs of our patients on their recovery journey.

Speak to our Specialists today.