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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.

3 operations in depth5 interactive cases

Backdrop: A cardiac surgery operating room · Pfree2014 · CC BY-SA 4.0

Inside the OR

OR & Periop

Shared operative foundations, the room, the instruments, the anaesthetic.

Shared operative foundations taught once, the room they happen in, the instruments on the tray, and the anaesthetic that makes it possible.

  • Cardiopulmonary bypass

    Most cardiac operations need a still, empty heart. The bypass circuit takes over the circulation so the heart can be stopped: taught once here, referenced by every operation that uses it.

    1. 01Venous drainage. Blood leaves the right atrium (or both cavae) by gravity into the venous reservoir.
    2. 02Oxygenator. A membrane does the lungs' work: oxygen in, carbon dioxide out.
    3. 03Pump. A roller or centrifugal head returns the blood at a set flow, the circulation now a dialled number.
    4. 04Arterial return. Oxygenated blood re-enters at the ascending aorta (or an alternative site the CT chose).
    5. 05Anticoagulation. Full heparinisation before cannulation, monitored by ACT, reversed with protamine at the end.
    6. 06Weaning. Warm, de-air, restore rhythm, fill, and hand the circulation back gradually while the TEE and the pressures judge the result.
    Used byCoronary artery bypass graftingAortic valve replacementMitral valve repair

  • Cardioplegia & myocardial protection

    A stopped heart must also be a protected heart. Cardioplegia is how the myocardium survives the cross-clamp.

    1. 01Purpose. Cold, potassium-rich solution arrests the heart in diastole and drops its oxygen demand to a fraction of beating.
    2. 02The cross-clamp. The aorta is clamped between the heart and the arterial return, isolating the coronaries so cardioplegia, not blood, perfuses them.
    3. 03Delivery. Antegrade down the coronaries via the aortic root, retrograde via the coronary sinus, or both: redosed on a timer.
    4. 04The stakes. Every clamp minute is borrowed; protection is what makes the borrowing safe, and poor protection is a ventricle that will not come back.
    Used byCoronary artery bypass graftingAortic valve replacementMitral valve repair
Educational illustration
Medical illustration of one typical way a heart-lung machine is connected to the veins and arteries near the heart
Cardiopulmonary bypass · one typical way the circuit is connected to the great vessels
Operative photo
Operating room during cardiac surgery with the cardiopulmonary bypass machine, its reservoir and tubing in the foreground and the surgical team at the table behind
Inside the OR · the bypass circuit connected to the patient during a cardiac operation
Operative photo
A perfusionist in scrubs adjusting the heart-lung machine, with the oxygenator, reservoir and pump console in view
Inside the OR · a perfusionist operating the heart-lung machine
Operative photo
Operative photograph through a sternotomy: gloved hands hold fine forceps and a swab over the surface of the heart while a bypass line runs across the lower field
Operative photograph · coronary artery bypass grafting on cardiopulmonary bypass, the grafts being sewn on the surface of the heart
Clinical photo
Photograph of an adult chest from below the neck to the navel showing a healing vertical midline sternotomy incision and three small drain-site sutures below it
Post-operative · a median sternotomy incision and the drain sites beneath it, healing
Operative photo
A cardiac surgery operating room with the team, perfusion equipment and monitors in view
Inside the cardiac OR · surgeon, perfusion console and the bypass circuit

On the tray

No instruments are tagged to this specialty’s operations yet.

Anaesthesia

The airway, the depth, the haemodynamics and the analgesia: the head of the bed has its own rooms.

Enter anaesthesia

Watch and learn

When an operation is best understood in motion

  • Cardiopulmonary bypass: the role of the circuit

    Why the operation needs a machine at all: a still, bloodless heart with the body still perfused.

    Watch for

    • What bypass takes over, and what it does not
    • Why the heart can be stopped safely once the circuit runs
    • Who in the room owns the machine
    Source: CTSNet · Watch on YouTube

  • Cardiopulmonary bypass: the circuit

    The path blood takes from the venous cannula through the reservoir, oxygenator and pump back into the aorta.

    Watch for

    • Venous drainage into the reservoir
    • The oxygenator and where gas exchange happens
    • The arterial line and the cannula it returns to
    Source: CTSNet · Watch on YouTube

  • Cardiopulmonary bypass: circuit components

    Each part of the circuit named and explained: cannulae, reservoir, pump heads, oxygenator, filters and suckers.

    Watch for

    • Roller versus centrifugal pump
    • Where the cardiotomy suckers return blood
    • What the arterial filter is protecting
    Source: CTSNet · Watch on YouTube

  • Cardiopulmonary bypass: pathophysiology

    What non-pulsatile flow, haemodilution, hypothermia and the foreign circuit do to the body, and why the ICU course follows.

    Watch for

    • The inflammatory response to the circuit
    • Haemodilution and why haematocrit falls
    • Why kidneys and brain are the organs the team watches
    Source: CTSNet · Watch on YouTube

  • Cardiopulmonary bypass: conduct and weaning

    Going on, running the pump, and the choreography of coming off: rewarming, rhythm, filling and the cannulae out.

    Watch for

    • The checklist before going on bypass
    • What the perfusionist reports and how often
    • Weaning: heart filled, rhythm restored, flow handed back
    Source: CTSNet · Watch on YouTube

  • Cardiopulmonary bypass: emergency scenarios

    What goes wrong on the pump and what the team does in the first minute: air, dissection at the cannula, pump failure, oxygenator failure.

    Watch for

    • Massive air embolism and the immediate response
    • Aortic dissection at cannulation
    • Oxygenator or pump failure and the backup plan
    Source: CTSNet · Watch on YouTube

  • Coronary artery bypass surgery

    Sternotomy, conduit, bypass and the grafts, in the words of the centre that does the most of them.

    Watch for

    • Where the internal mammary artery goes and why
    • Vein grafts from the leg
    • Coming off bypass
    Source: Cleveland Clinic · Watch on YouTube

  • Aortic valve surgery

    Replacing the aortic valve: the aortotomy, excising the leaflets and seating the prosthesis.

    Watch for

    • Cardioplegia and the still heart
    • Decalcifying the annulus without perforating it
    • Mechanical versus tissue valve
    Source: Cleveland Clinic · Watch on YouTube

  • Demystifying mitral valve repair

    Why repair beats replacement for degenerative disease, and what the surgeon does to the leaflet.

    Watch for

    • The prolapsing segment
    • Resection or neochords
    • The annuloplasty ring
    Source: Cleveland Clinic · Watch on YouTube

  • Creating the chordae system for anterior leaflet mitral repair

    Operative footage of artificial chordae for the anterior leaflet.

    Source: CTSNet · Watch on YouTube

Watch for

Coronary artery bypass grafting

  • Sternotomy and conduit harvest
  • Cannulation, bypass, arrest
  • The anastomoses
  • Weaning and closure
Find candidates on YouTube

Watch for

Aortic valve replacement

  • Bypass and aortotomy
  • Excising the valve
  • Sizing and implanting
  • Closing and weaning
Find candidates on YouTube

Watch for

Mitral valve repair

  • Bypass and exposure
  • Valve analysis
  • Reconstruction
  • Testing and weaning
Find candidates on YouTube

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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.