SurgSpace / Specialties / Cardiac Surgery
Cardiac Surgery
The heart and great vessels: bypass grafting built on the coronary map, valve repair and replacement stitched millimetres from the conduction system, and the physiology of cardiopulmonary bypass, the machine that lends the patient a heart and lungs for an hour.
Backdrop: A cardiac surgery operating room · Pfree2014 · CC BY-SA 4.0
Apply it
Cases & Practice
Patients to decide on, images to interpret, and the first day on the rotation.
Patients to decide on, images to interpret, and the briefing for the first day on the rotation.
Decisions, one patient at a time
Cases
Imaging practice
Read the image, then decide
Surgical decision-making
Does this patient need surgery?
68-year-old, three-vessel disease including a proximal LAD lesion, diabetic, EF 45%, symptoms despite two antianginals.
Optimise medical therapy
Always part of the answer, rarely all of it at this anatomy.
PCI
Treats lesions one by one; less complete revascularisation in diffuse three-vessel disease.
CABG
Bypasses territories rather than lesions; the classical answer to diabetic multivessel disease with a usable ventricle.
More information
Frailty, conduit quality and the patient's own goals can still move this either way.
The learner's job is not to memorise the answer but to see what moves it: anatomy first (left main, proximal LAD, number of territories), then diabetes, ventricular function, operative risk, and the patient's goals. That list is the heart-team meeting in miniature.
82-year-old with severe symptomatic AS, frail, small calcified annulus, good femoral access.
Surgical AVR
The durable reference operation, at the price of a sternotomy and bypass in a frail patient.
Transcatheter valve
No sternotomy, faster recovery; anatomy and access permitting, often the answer at this age and frailty.
Continue surveillance
Severe AND symptomatic means surveillance is the one clearly wrong answer.
Symptomatic severe AS gets intervention; the real question is which route. Age, frailty, anatomy and access decide between SAVR and TAVR, and that decision belongs to the heart team, not to either specialty alone.
Type A dissection confirmed on CT, patient hypertensive and in pain, nearest cardiac theatre 40 minutes away.
Theatre, now
Type A is a surgical emergency; every hour adds mortality.
Stabilise first
Pressure and pulse control happen on the way to theatre, not instead of it.
More imaging
The CT already answered the operative question; more pictures cost time the aorta does not have.
For type A the decision is made the moment the ascending aorta is involved. Everything else, pressure control, analgesia, transfer, is choreography executed in parallel with getting to a cardiac theatre.
The rotation
Your first day here
- The morning starts in the ICU, not the ward: overnight patients are reviewed drain by drain, wire by wire.
- Before a CABG, know the angiogram: which vessels are diseased and which conduits are planned. That is the question you will be asked.
- Before a valve, know the echo: the lesion, the severity, and what the ventricle has done about it.
- Learn the furniture: mediastinal drains, pacing wires, arterial and central lines. The ward round reads them before it reads the patient's face.
- Bypass and cardioplegia are the two concepts that unlock every case: read the shared modules before your first OR day.
- In theatre, stand where perfusion is visible: half the operation's drama is on that console.
Hub shaped by the Surgical Specialties Lead with the Cardiac surgery reviewer (open seat). Images and videos carry their source; educational use for supervised learning, not clinical guidance.