Cardiothoracic surgery is the specialty that involves surgical
management of conditions of the heart and thorax. Around 60 per cent
of adult cardiac surgery involves coronary artery bypass grafting,
with most of the remainder comprising valve operations and aortic
surgery. Thoracic surgery includes removal of lung cancers,
mediastinal tumours, pleurodesis for pneumothorax and decortication
for empyema. Some minimally invasive surgery is performed e.g.
thoracoscopic procedures and endovascular aortic stenting. The
specialty also encompasses heart and lung transplantation.
In paediatric patients, surgery largely involves repair of
congenital heart defects, the majority of which are corrected in the
first year of life. Acquired valve defects are also dealt with in
older children and teenagers.
Cardiothoracic surgery is increasingly semi-elective (inpatients
needing surgery) rather than elective (patients from home). There
are also some emergency operations (e.g. acute aortic dissection)
when on-call. Surgeons also need to be available to re-operate after
hours on their own patients (e.g. bleeding after cardiac surgery).
All these factors influence lifestyle.
The main difference compared with other surgical specialties is that
cardiothoracic surgery usually involves more operating (2 to 3 full
days in theatre), longer operations (typically 4-5 hours), and a
higher mortality and morbidity rate (about 1 in 25 patients die
after cardiac surgery). The specialty requires a high degree of
technical skill, mental stamina, and emotional strength.