Cardiac surgery, also known as cardiovascular or heart surgery, encompasses a range of surgical procedures designed to treat diseases and conditions affecting the heart and surrounding blood vessels. Dr Aliya Shair Muhammad Lecturer: Bolan University Medical and Health sciences, Quetta

1. THORACIC SURGERY PART .2
cardiac surgery
Dr Aliya Shair Muhammad
Lec: BUMHS , QUETTA

2. Indications:
 Ischemic Heart Disease
 Coronary Artery Bypass Grafting (CABG)
 Congenital Heart Defects
 Heart Valve Disease
 Valve Repair or Replacement
 Heart Failure
 Arrhythmias
 Aortic Aneurysms and Dissections
 Heart Tumors
 Heart Transplantation
 Infective Endocarditis

3. Indication of cardiothoracic surgery:
 Ischemic Heart Disease:
This includes coronary artery disease, where blockages in the arteries restrict blood flow to the heart, leading to angina or
heart attacks.
 Coronary Artery Bypass Grafting (CABG): A common procedure where a healthy blood vessel is grafted to bypass the
blocked artery, restoring blood flow.
 Congenital Heart Defects:
These are structural problems present at birth, such as septal defects, valve abnormalities, or
abnormal heart chambers.
 Heart Valve Disease:
Damaged or diseased heart valves can cause stenosis (narrowing) or regurgitation (leakage), affecting
blood flow.
 Valve Repair or Replacement:
Surgical procedures to fix or replace faulty valves, restoring proper blood flow.
 Heart Failure:
When the heart cannot pump enough blood to meet the body's needs, surgery may be needed to address the
underlying cause or improve heart function.
 Arrhythmias:
Irregular heartbeats, such as atrial fibrillation, can sometimes be treated with surgery to correct the
electrical pathways causing the arrhythmia.
 Aortic Aneurysms and Dissections:
These involve abnormal bulges or tears in the aorta, the main artery carrying blood from
the heart.

4.  Heart Tumors:
Tumors in or around the heart can require surgical removal.
 Heart Transplantation:
In severe cases of heart failure, transplantation may be necessary when
other treatments are not effective.
 Infective Endocarditis:
Surgical intervention may be needed to treat severe infections of the
heart valves or inner lining, especially if there are complications like embolisms or persistent sepsis,
according to the National Institutes of Health (NIH).

5. Special Investigation Procedure In C.S:
 Cardiovascular diseases are diagnosed using an array of laboratory tests and imaging
studies. The primary part of diagnosis is medical and family histories of the patient,
risk factors, physical examination and coordination of these findings with the results
from tests and procedures
Some of the common tests used to diagnose cardiovascular diseases include:
 1. Blood test
 2. Chest X-ray
 3. ECG
 4. Stress testing
 5. ECHO
 6. CT
 7. MRI
Cardiac Investigations
│
├── Invasive
│ └── Angiogram / Cardiac Catheterization
│
└── Non-Invasive
├── Chest X-ray
├── Echocardiography (Echo)
├── Exercise Stress Test
├── CT / Nuclear Stress Test
└── ECG (Electrocardiogram)

6. • Invasive:
 Angiogram / Cardiac Catheterization:
A procedure where a catheter is inserted into blood
vessels to check for blockages in the heart arteries using contrast dye.
• Non-Invasive:
 Chest X-ray
A simple imaging test to view the size, shape, and position of the heart and lungs.
 Echocardiography (Echo)
An ultrasound of the heart that shows its structure and checks how well it’s pumping.
 Exercise Stress Test
Evaluates heart function under physical stress using a treadmill or stationary bike.
 CT / Nuclear Stress Test
Advanced imaging that shows blood flow to the heart muscle, often using a radioactive tracer.
 ECG (Electrocardiogram)
Records the electrical activity of the heart to detect arrhythmias or signs of heart damage.

7. Basic techniques in cardiac surgery
•Median Sternotomy:
A vertical incision through the breastbone to provide access to the heart.
•Cardiopulmonary Bypass (Heart-Lung Machine)
A machine temporarily takes over heart and lung function during surgery.
•Cardioplegia:
A technique to stop the heart safely using a cold, high-potassium solution during surgery.
•Heparinization:
Administration of heparin to prevent blood clotting during bypass.
•Aortic Cross-Clamping:
A clamp is placed on the aorta to stop blood flow during certain procedures.
•Anastomosis:
Surgical connection between blood vessels or grafts.
•De-airing Techniques:
Removal of air from the heart chambers to prevent air embolism after surgery.
•Weaning from Bypass:
Gradual transition from the heart-lung machine back to natural heart function.

8. Types of incisions:
1. Median Sternotomy
A vertical incision through the sternum; most common for cardiac
surgeries.

9. 2.Thoracotomy
Incision through the chest wall, used for lung and esophageal surgeries. Types include:
Posterolateral Thoracotomy – Along the back and side of the chest.
Anterolateral Thoracotomy – Along the front and side of the chest.
Axillary Thoracotomy
- Made under the arm; minimally invasive and cosmetically better.

10. 3 .Clamshell Incision:
A bilateral transverse thoracotomy, giving
wide access to both lungs and mediastinum.

11. 4. Subxiphoid Incision:
Below the sternum; used for minimally invasive cardiac
procedures.

12. 5 . Video-Assisted Thoracoscopic Surgery (VATS) Ports:
Small incisions for inserting a camera and instruments for minimally invasive thoracic
surgery.

13. Types of operations
I. OPEN HEART SURGERY.
II. MODERN BEATING HEART SURGERY.
III. CABG.
IV. MINIMALLY INVASIVE SURGERY.
V. HEART TRANSPLANT.
VI. ROBOT ASSISTED SURGERY.

14. Conti…
I. Open Heart Surgery
 Traditional method where the chest is opened.
 Heart is stopped and supported by a heart-lung machine.
 Used for valve repair, CABG, or congenital defect correction.
II. Modern Beating Heart Surgery
 Performed while the heart is still beating.
 No heart-lung machine needed.
 Reduces complications and recovery time.
III . CABG (Coronary Artery Bypass Grafting)
 Treats blocked coronary arteries.
 Uses a graft (usually from leg or chest) to bypass blockage.
 Improves blood flow to the heart.

15. Conti…
IV. Minimally Invasive Surgery
 Small incisions, no need to open the entire chest.
 Less pain, faster recovery, fewer complications.
 Often used for valve repair or small tumors.
V. Heart Transplant
 Replaces a failing heart with a donor heart.
 Option for end-stage heart failure.
 Requires lifelong immunosuppressive therapy.
VI. Robot-Assisted Surgery
 Surgeon controls robotic arms for precision.
 Minimally invasive with enhanced accuracy.
 Used in valve surgery and some bypass procedures.

16. Complications:
Depending on the procedure after care is given.
 Excessive bleeding
 Infection
 A negative reaction to anesthesia.
 Other complications include: the development of kidney failure, heart
arrhythmias, heart attack, blood clot formation, and stroke during or soon
after the procedure. Death is possible and occurs in about 3% of patients who
have cardiac bypass surgery and valve replacement surgery.

17. Lines , tubes and drains:
 Intravascular Lines
 Central Venous Line (CVP):
Monitors central venous pressure and gives
medications/fluids.
 Arterial Line (A-Line):
Continuous blood pressure monitoring and blood sampling.
 Pulmonary Artery (Swan-Ganz) Catheter:
Measures heart pressures and cardiac output (used in
complex cases).

18. 2. Tubes
 Endotracheal Tube:
For mechanical ventilation during and after surgery.
 Nasogastric (NG) Tube:
Decompresses the stomach and prevents aspiration.
 Urinary Catheter (Foley):
Monitors urine output, which reflects kidney and
heart function.

19. Drains
 Chest Tubes:
Remove blood, fluid, or air from around the heart and lungs
post-surgery.
 Mediastinal Drains:
Specifically drain fluid from the central chest cavity near
the heart.
 Pleural Drains:
Used if pleural spaces are entered; remove fluid/air from
lungs.

20. Congenital heart disease
 Congenital heart disease is a defect in the structure of the heart and great vessels that is
present at birth.
Two main categories
1.Palliative Procedures
•Temporary measures to improve oxygenation or blood flow.
•Do not fully correct the defect.
•Example: Blalock–Taussig shunt.
2.Complete repair:
•Definitive surgery to correct the structural abnormality.
•Often done in infancy or early childhood.
•Example: Closure of septal defects, arterial switch operation.

21. Acquired heart diseases:
 Acquired heart diseases are conditions affecting the heart and its associated blood vessels that develop during
a person's lifetime, in contrast to congenital heart diseases, which are present at birth.
Causes:
 Rheumatic Fever:
Post-streptococcal inflammatory disease; may cause valve damage.
 Kawasaki Disease:
Acute vasculitis in children; can lead to coronary artery aneurysms.
 Infective Endocarditis:
Infection of heart valves or lining, often after congenital heart disease or surgery.
 Pericarditis:
Inflammation of the heart lining; causes chest pain and fluid buildup.
 Myocarditis:
Viral infection of the heart muscle; may result in heart failure.
 Cardiomyopathy:
Abnormal heart muscle function; leads to heart enlargement or failure.
Cardiac Arrhythmias: Heart failure + HR > 200 bpm = suspect
The commonest arrhythmia in children is SVT (Supraventricular Tachycardia)

22. Pericardium disorders:
 Acute Pericarditis:
Inflammation of the pericardium; causes
sharp chest pain, often relieved by sitting forward.
 Constrictive Pericarditis:
Thickened, stiff pericardium restricts
heart filling; leads to signs of right heart failure.
 Pericardial Effusion:
Accumulation of fluid in the pericardial sac;
may be asymptomatic or cause pressure on the heart.
 Cardiac Tamponade:
Emergency condition where fluid
compresses the heart, impairing function; requires urgent
drainage.

23. Indication of cardiac transplant:
•Refractory Cardiogenic Shock:
Requires mechanical support (e.g., IABP or LVAD)
due to severe heart failure.
•Inotropic-Dependent Cardiogenic Shock:
Needs continuous IV drugs (e.g.,
dobutamine, milrinone) to maintain cardiac output.
•Low Exercise Capacity:
Peak VO < 10 mL/kg/min indicates severely impaired cardiac function.
₂
•Advanced Heart Failure (NYHA III–IV) :
Persistent symptoms despite optimal medical
and device therapy.
•Recurrent Life-Threatening Arrhythmias:
Not controlled by ICD (Implantable
Cardioverter-Defibrillator), meds, or ablation.
•End-Stage Congenital Heart Failure:
No pulmonary hypertension; not amenable to
other surgical options.
•Refractory Angina:
Severe chest pain not responsive to medications or bypass surgery.

24. Post op complications of transplant:
•Rejection:
Immune system attacks the new heart; requires close monitoring and
immunosuppressants.
•Infection:
Due to immunosuppressive therapy; increased risk of bacterial, viral,
and fungal infections.
•Graft Vasculopathy:
Chronic rejection causing narrowing of coronary arteries in the
transplanted heart.
•Kidney Dysfunction:
Caused by long-term use of immunosuppressive drugs like
calcineurin inhibitors.
•Malignancy:
Higher risk of cancers (e.g., lymphoma, skin cancers) due to immune
suppression.
•Arrhythmias:
Irregular heartbeats can occur post-transplant, especially early on.

25. Post-op precaution of heart transplant:
 Lifelong Immunosuppressive Therapy:
Strict medication adherence is critical to prevent
rejection.
 Regular Follow-Up & Biopsies:
Routine monitoring for early detection of rejection and
graft function.
 Infection Prevention:
Maintain hygiene, avoid crowds, and get vaccinations as advised.
 Physiotherapy and Healthy Lifestyle:
Balanced diet, no smoking, and regular physical
activity.
 Medication Monitoring:
Watch for drug side effects and maintain therapeutic levels.
 Psychological Support:
Mental health care and counseling may be needed post-surgery.