Journal of Biomedical Engineering and Medical Devices
Open Access

Perspective on Cardiothoracic Surgery

Sangeeta Pradhan^{* *}Correspondence: Sangeeta Pradhan, Department of Microbiology, Utkal University, Bhubaneswar, Odisha, India, Email:

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Perspective

Cardiothoracic surgery is a branch of medicine that focuses on the surgical treatment of organs located within the thoracic cavity, such as the heart (heart illness), the lungs (lung disease), and other pleural or mediastinal structures. Cardiothoracic surgery is divided into two subspecialties in most countries: cardiac surgery (which deals with the heart and major vessels) and thoracic surgery (which deals with the lungs, oesophagus, and thymus, among other things). A cardiac surgery residency usually lasts four to six years (or longer) and prepares you to be a fully trained surgeon. Cardiovascular (CV) / cardiothoracic (CT) / cardiovascular thoracic (CVT) surgery is when cardiac surgery is coupled with thoracic surgery and/or vascular surgery. Cardiac surgeons can enter a cardiac surgery residency straight out of medical school, or they can first finish a general surgery residency and then a fellowship. Cardiac surgeons can specialise further by completing a fellowship in a range of fields such as paediatric cardiac surgery, cardiac transplantation, adult acquired heart disease, weak heart concerns, and a variety of other heart disorders. Surgical Education and Training (SET) in Cardiothoracic Surgery is a six-year curriculum that typically begins several years after medical school graduation. A bi-national training programme (Australia and New Zealand) is used to administer and supervise training. Francisco Romero (1801), Dominique Jean Larrey, Henry Dalton, and Daniel Hale Williams performed the first procedures on the pericardium (the sac that surrounds the heart) in the 19th century. On September 4, 1895, Norwegian surgeon Axel Cappelen performed the first surgery on the heart itself at Rikshospitalet in Kristiania, now Oslo. He ligated a bleeding coronary artery in a 24-year-old guy who was stabbed in the left axilla and was in critical condition when he arrived. A left thoracotomy was used to get access. The patient awoke feeling great for the first 24 hours, but then grew ill with a rising temperature, and on the third postoperative day, he died of mediastinitis, as determined by a postmortem. Ludwig Rehn of Frankfurt, Germany, performed the first successful heart surgery with no problems on September 7, 1896, when he treated a knife wound to the right ventricle. Great vessel surgery (aortic coarctation repair, BlalockTaussig shunt formation, patent ductus arteriosus closure) became prevalent after the turn of the century and falls under the category of cardiac surgery, but it is not strictly termed heart surgery. The coronary artery bypass graft (CABG), also known as "bypass surgery," is one of the most well-known cardiac surgery procedures. In this procedure, vessels from other parts of the patient's body are harvested and grafted to the coronary arteries to bypass blockages and improve blood supply to the heart muscle. In 1925, heart valve procedures were unheard of. A young woman with mitral stenosis was successfully operated on by Henry Souttar.

An open heart surgery procedure involves opening the patient's heart and doing surgery on the heart's interior parts. Wilfred G. Bigelow of the University of Toronto discovered that repairing intracardiac diseases was easier in a bloodless and immobile environment, which meant stopping the heart and draining the blood. Hypothermia has limitations, according to surgeons: intricate intracardiac repairs take longer, and the patient need blood flow to the body, notably the brain. Because the patient requires artificial heart and lung function, the term cardiopulmonary bypass was coined. Surgeons have been doing "off-pump bypass surgery" – coronary artery bypass surgery without the cardiopulmonary bypass – since the 1990s. The heart is still beating during these operations, but it is stabilised to provide a nearly still work area in which to connect the conduit vessel that bypasses the blockage; in the United States, most conduit vessels are harvested endoscopically, using a technique called endoscopic vessel harvesting (EVH). According to some researchers, the off-pump technique leads to less post-operative problems, such as postperfusion syndrome, and better overall outcomes. As of 2007, the surgeon's preference and hospital performance still have a key effect in the study results. Robot-assisted heart surgery is a novel type of heart surgery that is gaining popularity. This is when a machine is utilised to do surgery while the heart surgeon is in control. The size of the incision created in the patient is the key benefit. Instead of requiring at least three small holes for the robot's considerably smaller "hands" to pass through, an incision just needs to be large enough for the surgeon to insert his hands inside. Pediatric cardiothoracic surgery is cardiac surgery for children. Clarence Crafoord performed the first procedures to repair cardio-vascular abnormalities in youngsters when he corrected coarctation of the aorta in a 12-yearold boy in Sweden.

The dangers of cardiac surgery

The advancement of heart surgery and cardiopulmonary bypass techniques has resulted in remarkably low death rates for these procedures. Repairs of congenital cardiac abnormalities, for example, are currently predicted to have a mortality rate of 4–6%. The risk of neurological impairment after heart surgery is a big worry. Stroke happens in 5% of all people undergoing heart surgery, and it is more common in stroke patients. Postperfusion syndrome, also known as "pumphead," is a more modest constellation of neuropsychological abnormalities caused by cardiopulmonary bypass. The symptoms of postperfusion syndrome were thought to be permanent at first, but they were later discovered to be temporary, with no long-term neurological consequences. Certain COPD and emphysema patients may benefit from lung volume reduction surgery, or LVRS. Emphysema-affected parts of the lungs are removed, allowing the remaining, relatively healthy lung to expand and work more efficiently. The positive effects are proportional to the amount of residual volume that is reduced.