Table of ContentsView AllTable of ContentsWhat It IsPurposeRisksPreparationPre-Op Lifestyle ChangesWhat to ExpectRecovery
Table of ContentsView All
View All
Table of Contents
What It Is
Purpose
Risks
Preparation
Pre-Op Lifestyle Changes
What to Expect
Recovery
Cardiothoracic surgery is a field of surgery focused on organs in thethorax(chest), including the heart, lungs, and esophagus. It may be used to treat a wide range of issues, fromheart failuretopulmonary embolismtoesophagealcancer.
Thierry Dosogne / Getty Images
What Is Cardiothoracic Surgery?
These surgeries are used to diagnose and treat diseases and traumatic injuries of the heart and lungs, but also structures including:
Depending on the procedure being performed, cardiothoracic surgery may be:
Endoscopic and robotic surgeries are minimally invasive procedures with typically shorter recovery times than invasive surgeries. Most areinpatient procedures(requiring a hospital stay).
Some diagnostic procedures (like alung biopsy), however, may be performed as an outpatient procedure.
Cardiothoracic surgery is most commonly performed in the operating room of a hospital. It is standardly equipped with an ECG machine, anesthesia machine,mechanical ventilator, and “crash cart” to use in a cardiac emergency. Video-assisted surgeries involve a narrow fiber-optic scope, called an endoscope, that is inserted into a small incision to view the surgical site on a video monitor.
Observation, Outpatient, or Inpatient Status Explained
Why Someone Would Need Cardiothoracic Surgery
Cardiothoracic surgeries are used to diagnose and treat a vast range of lung and heart conditions, as well as gastrointestinal problems affecting the esophagus. They are indicated during a major heart attack, traumatic chest injury, or other emergency. With some diseases, like lung cancer, cardiovascular surgery is considered a standard of care.
Cardiothoracic surgery can be performed on adults, children, and infants, and may even be completed using specialized in-utero procedures for fetal surgeries.The following chart presents various cardiothoracic surgeries and why they may be needed.
Cardiothoracic Surgery and Risk
All surgeries pose risks, but those involving theheartand lungs are especially concerning given the vital functions they carry out and the fact they are tied to those of the kidneys, liver, brain, and other organs. Weighing the risks and benefits is especially important if:
However, since cardiothoracic surgery tends to be limited to advanced cardiovascular and pulmonary diseases, the benefits of surgery as a “last option” tend to outweigh the risks.
Beyond thegeneral risks of surgery(including post-operative bleeding,post-operative infection, and therisks of anesthesia), there are specific risks and complications associated with cardiovascular or pulmonary surgery.
Arrhythmia(abnormal heart rhythm)
Thrombosis(venous blood clots)
Heart failure
Stroke
Myocardial infarction(heart attack)
Cardiac tamponade(caused when blood fills the lining of the heart)
Acute kidney failure
Pulmonary RisksAtelectasis(collapsed lung due to deflation of the air sacs of the lungs)Pneumothorax(collapsed lung due to a leak in the lungs)Respiratory failurePulmonary embolism(blood clot in the lungs)Empyema(a pocket of pus in the chest cavity)Pleural effusion(fluid in the membranes surrounding the lungs)Deep vein thrombosisAtrial fibrillation(chaotic heart rate)Pneumonia
Atelectasis(collapsed lung due to deflation of the air sacs of the lungs)
Pneumothorax(collapsed lung due to a leak in the lungs)
Respiratory failure
Pulmonary embolism(blood clot in the lungs)
Empyema(a pocket of pus in the chest cavity)
Pleural effusion(fluid in the membranes surrounding the lungs)
Deep vein thrombosis
Atrial fibrillation(chaotic heart rate)
Pneumonia
Preparation Before Cardiothoracic Surgery
If cardiothoracic surgery is indicated, pre-operative tests will be performed to confirm that you are a candidate for surgery and to help direct the course of the procedure, including the type of anesthesia used.
Diagnostic Workup
There are different assessment tools used to determine an individual’s risks for surgery, including EuroSCORE II, Parsonnet score, and Society of Thoracic Surgeons (STS) score. These can establish whether a person is at low, intermediate, or high risk of death following cardiothoracic surgery.
With the diagnostic workup, pre-operative tests are ordered well in advance of surgery. They include blood tests to assess how well organs are functioning, includingliver function tests (LFTs),kidney function tests,complete blood count (CBC), andblood coagulationtests. Imaging studies can help map the surgical approach and determine which surgical procedure is most appropriate.
The diagnostic workup for cardiovascular surgery may include:
The diagnostic workup for pulmonary surgery may include:
The diagnostic workup for esophageal surgery may include:
The surgeon will meet with you to review your pre-operative test results and discuss what is involved with the surgery, including pre-operative preparations and post-operative recovery.
Ask as many questionsas you need to fully understand the benefits and risks of surgery. This includes asking how often the surgeon has performed the surgery and why this procedure was chosen over others (such as open vs. video-assisted surgery).
An Overview of Surgery
What to Do Ahead of Surgery
There are things you need to do and know before your surgery. They include understanding the kind of facility you’ll be in, whether or not you’re planning an inpatient stay or need a driver to take you home, and other factors. These factors include the following:
Common Medications Before, During, and After Surgery
Cigarette smoke causes prolonged vasoconstriction (the narrowing of blood vessels), which reduces the blood and oxygen supply that reaches surgical wounds. Smoking is associated with increased complications and slower healing times, including the risk ofwounddehiscencein which an incision fails to close properly.
Most cardiothoracic surgeons recommend smokingcessation(stopping) before and after surgery. The American Society of Anesthesiologists recommends at least one week before surgery, while other studies recommend up to four weeks of being smoke-free.
Surgery and Smoking
What to Expect on the Day of Surgery
Once you have checked in at hospital admissions, you will need to fill out a medical information sheet and a consent form stating that you understand the aims and risks of the surgery. Depending on the surgery, you are led either to a pre-operative procedure room or directly admitted to a hospital room where you will be prepped for surgery.
Before the Surgery
There are standard procedures a patient will undergo before cardiothoracic surgery. Once you have changed into a hospital gown, a nurse will:
A healthcare provider also will record your weight and height. It is used to calculate yourbody mass index (BMI)so that the correct dosage of medications, including anesthesia, can be prescribed.
BMI is a dated, flawed measure. It does not take into account factors such asbody composition, ethnicity, sex, race, and age. Even though it is a biased measure, BMI is still widely used in the medical community because it’s an inexpensive and quick way to analyze a person’s potential health status and outcomes.
During the Surgery
A cardiothoracic surgery can take a few or many hours, depending on how extensive the procedure is. What happens next depends on the exact surgery you are having done and the technique being used to perform it.
For example, surgery fortracheal stenosis(narrowing) will involve the placement of a stent to keep the airway open, while a lobectomy will involve surgically removing a lobe of the lung. Some surgeries require the placement of a temporarychest tubeto help drain accumulated fluids from the chest cavity and/or help reinflate the lungs after lung surgery.
After Surgery
You will either be taken to thepost-anesthesia care unit (PACU)where you will be monitored until you are fully recovered from anesthesia, or directly to theintensive care unit (ICU)if major surgery is performed.
Cardiothoracic surgery invariably involves a period of recovery and, more often than not, a structured rehabilitation program.
In addition, you will need to see your surgeon for scheduled visits to ensure that you are healing properly, as well as yourcardiologist,pulmonologist,gastroenterologist, oroncologistto ensure ongoing management of the treated condition.
Recovery from cardiothoracic surgery can improve significantly with the support of family and friends, as well as online or in-person support groups. Counseling and therapy may also be involved.
Summary
A cardiothoracic surgeon is trained to perform procedures used to diagnose and treat conditions affecting the heart, lungs, and other organs in the chest, such as the esophagus. Some of these surgeries may be complex, involving inpatient hospital stays and longer recovery times. Others may be minimally invasive procedures completed on an outpatient basis.
Some of the preparation steps are similar. You’ll likely need to stop eating and taking certain medications before your procedure. If you’re a smoker, you may need to stop before the surgery can move forward. Your healthcare team will ensure you have the instructions for your situation.
Talk to your healthcare provider about your recovery time, too. You will likely have an extended recovery following major cardiothoracic surgery.
When You Can’t Get a Diagnosis
18 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Summa Health.Cardiothoracic Surgery.
Gonzalez-Rivas D, Manolache V, Bosinceanu ML, Gallego-Poveda J, Garcia-Perez A, de la Torre M,et al.Uniportal pure robotic-assisted thoracic surgery-technical aspects, tips and tricks.Ann Transl Med. 2023 Aug 30;11(10):362. doi: 10.21037/atm-22-1866.
American Board of Thoracic Surgery.Training and initial certification.
Lemjabbar-Alaoui H, Hassan OU, Yang YW, Buchanan P.Lung cancer: Biology and treatment options.Biochim Biophys Acta. 2015;1856(2):189-210. doi:10.1016/j.bbcan.2015.08.002
Benlamkaddem S, Berdai A, Labib S, Harandou M.A history case of cardiac surgery in pregnancy.Case Rep Obstet Gynecol.2016;2016:7518697. doi:10.1155/2016/7518697
Castro ML, Alves M, Papoila AL, Botelho A, Fragata J.One-Year Survival after Cardiac Surgery in Frail Older People-Social Support Matters: A Prospective Cohort Study.J Clin Med. 2023 Jul 15;12(14):4702. doi: 10.3390/jcm12144702.
Garcia-Valentin A, Mestres CA, Bernabeu E, et al.EuroSCORE and EuroSCORE II in the Spanish cardiac surgical population: a prospective, multicentre study.Eur J Cardio-Thoracic Surg.2016 Feb;49(2):399-405. doi:10.1093/ejcts/ezv090
Roy PM.Preoperative pulmonary evaluation for lung resection.J Anaesthesiol Clin Pharmacol. 2018 Jul-Sep;34(3):296-300. doi:10.4103/joacp.JOACP_89_17
Seo HS, Choi M, Son SY, Kim MG, Han DS, Lee HH.Evidence-based practice guideline for surgical treatment of gastroesophageal reflux disease 2018.J Gastric Cancer.2018;18(4):313-27. doi:10.5230/jgc.2018.18.e41
Sousa-Uva M, Head SJ, Milojevic M, et al.2017 EACTS guidelines on perioperative medication in adult cardiac surgery.Eur J Cardiothorac Surg. 2018;53(1):5-33. doi:10.1093/ejcts/ezx314
Yang L, Liao Z.Effect of Smoking on Cancer Surgery Outcomes and Recommendations for Perioperative Smoking Cessation Intervention.Sichuan Da Xue Xue Bao Yi Xue Ban. 2023 Nov 20; 54(6):1312-1316. Chinese. doi: 10.12182/20231160605.
United Nations.Smokers who quit one month before surgery reap benefits: UN health agency.
American Society of Anesthesiologists.Smoking.
Chakravarthy M.Regional analgesia in cardiothoracic surgery: A changing paradigm toward opioid-free anesthesia?.Ann Card Anaesth. 2018;21(3):225-7. doi:10.4103/aca.ACA_56_18
Bayly J, Fettes L, Douglas E, et al.Short-term integrated rehabilitation for people with newly diagnosed thoracic cancer: a multi-centre randomized controlled feasibility trial.Clin Rehabil. 2020;34(2):205-19. doi:10.1177/0269215519888794
McMahon SR, Ades PA, Thompson PD.The role of cardiac rehabilitation in patients with heart disease.Trends Cardiovasc Med. 2017;27(6):420-5. doi:10.1016/j.tcm.2017.02.005
Meet Our Medical Expert Board
Share Feedback
Was this page helpful?Thanks for your feedback!What is your feedback?OtherHelpfulReport an ErrorSubmit
Was this page helpful?
Thanks for your feedback!
What is your feedback?OtherHelpfulReport an ErrorSubmit
What is your feedback?
By clicking “Accept All Cookies”, you agree to the storing of cookies on your device to enhance site navigation, analyze site usage, and assist in our marketing efforts.Cookies SettingsAccept All Cookies
By clicking “Accept All Cookies”, you agree to the storing of cookies on your device to enhance site navigation, analyze site usage, and assist in our marketing efforts.
Cookies SettingsAccept All Cookies
