Cardiac Surgery

Disease, decision, operation, recovery: the surgical heart.

• Cardiac surgery treats structural disease of the heart and the proximal aorta: blocked coronaries, failing valves, and an aorta about to give way.
• Cardiology diagnoses and manages medically or through catheters; cardiac surgery opens the chest. Most patients pass through both, which is why the heart team exists.
• Almost every case shares one machine and two ideas: cardiopulmonary bypass to take over the circulation, and cardioplegia to protect a still heart. Learn those once and every operation gets simpler.
• The rhythm of the specialty is clinic, OR, ICU: a decision made in a meeting, an operation measured in clamp minutes, and a recovery measured in drain output and rhythm strips.

Operative photo

• Chest pain with known coronary disease

  “Cardiology refers a 68-year-old with three-vessel disease and ongoing angina despite medical therapy.”

  • Is this medical therapy, PCI, or CABG? The anatomy decides more than the symptoms: left main and proximal LAD disease pull toward surgery.
  • How good is the ventricle? Ejection fraction changes both the benefit and the risk.
  • Is the patient diabetic? Multivessel disease in diabetes classically favours surgical revascularisation.

  Live it as a case Coronary artery bypass grafting

• Severe aortic stenosis

  “Syncope on the stairs, an ejection systolic murmur, and an echo showing a valve area of 0.8 cm².”

  • Symptoms are the trigger: angina, syncope or failure in severe AS is an indication to intervene, not observe.
  • The echo carries the decision: gradient, valve area, and what the ventricle has done about years of pressure load.
  • Surgical valve or transcatheter valve is a heart-team decision built on age, anatomy and operative risk.

  Live it as a case Aortic valve replacement

• Mitral regurgitation

  “A patient with a pansystolic murmur, worsening breathlessness, and a dilating left ventricle on serial echoes.”

  • Primary MR (the valve is broken) is a surgical disease; secondary MR (the ventricle is broken) is first a ventricle problem.
  • Repair beats replacement when the valve allows it, which is why the mechanism on echo matters more than the murmur.
  • Timing is the art: operate before the ventricle is damaged, not after the symptoms are undeniable.

  Mitral valve repair

• Acute aortic syndrome

  “Tearing chest pain radiating to the back, a blood pressure difference between arms, and a widened mediastinum.”

  • The first fork is Stanford type: A (ascending involved) is an emergency operation, B is usually medical first.
  • CT angiography makes the diagnosis; the clock started at symptom onset, and mortality climbs by the hour in type A.
  • While theatre is readied, control the pressure and the pulse: the tear propagates with every hypertensive beat.

  Live it as a case

• The deteriorating post-cardiotomy patient

  “POD 0 after CABG: pressures drifting down, filling pressures up, drains suspiciously quiet.”

  • The short list is short: bleeding, tamponade, low cardiac output, arrhythmia, and the ventilator.
  • A drain that suddenly stops is more frightening than one that keeps draining: blood may be accumulating where you cannot see it.
  • Tamponade after cardiac surgery is a surgical diagnosis: if the physiology says tamponade, the answer is reopening, not another echo delay.

  Live it as a case Coronary artery bypass grafting