Cardiothoracic Surgery

CMHVI Offers Many Testing and Treatment Services

Cardiothoracic Surgery

Coronary Aartery Bypass Surgery

Someone with one or more blocked coronary arteries may not be getting enough blood and oxygen to their heart. In some cases, a cardiologist may recommend bypass surgery to create new pathways for blood to reach the heart. Bypass surgery – also called coronary artery bypass graft, or CABG (pronounced "cabbage") -- is open-heart surgery requiring general anesthesia.

Conventional bypass surgery is done through an incision in the breastbone (sternum) on a still heart. Medications are used to stop the patient's heart. A heart-lung machine adds oxygen to the blood and pumps the blood throughout the body.

The cardiac surgeon sews the healthy graft to one end of the blood vessel just below the blocked artery. The other end of the graft is sewn above the blocked artery. Blood can then flow around the blocked area. After bypass surgery, blood flows more freely through the coronary arteries, lowering the risk of heart attack.

During bypass surgery the surgeon removes a piece of a healthy blood vessel, from the leg, arm or chest wall, to use as a graft to create a new path for blood flow around the blocked artery. The surgeon chooses the healthy vessel(s) based on the size and location of the blocked artery. Pieces of blood vessels can be safely removed for bypass because other vessels take over for them. Surgeons more often choose arteries for grafts because they are less likely to clog.

Most bypass surgery patients are out of the hospital within a week. Patients may experience pain at the incision site for a few weeks, but medication eases this discomfort. Recovery at home takes four to six weeks.

After bypass surgery, a patient's doctor may recommend cardiac rehabilitation.

Esophagectomy

An esophagectomy is a surgical procedure where the esophagus – the tubular structure connecting the mouth and stomach – is partially or completely removed. The procedure may be necessary due to cancer, trauma, ingestion of caustic substances, and spontaneous rupture of the esophagus (usually due to severe vomiting).

An esophagectomy is a major operation, performed under general anesthesia, that usually lasts 4 to 8 hours. Usually the esophagus is replaced with a portion of the stomach or colon. In some instances, the surgery can be performed in a minimally invasive or laparoscopic/thoracoscopic procedure.

Patients generally are hospitalized for one to two weeks and may have dietary restrictions following surgery. Complete recovery may take three to 12 months.

Heart Valve Replacement and Repair

Valve disease can weaken the heart muscle. A damaged heart valve can affect the heart's left ventricle. Early treatment of this condition helps prevent further damage to the heart. But a cardiologist may first monitor valve disease to see if it is getting worse. Heart valve replacement or repair may be recommended if the valve disease becomes significant.

There are no medications designed to directly treat valve disease. In some cases, medication may be used to treat valve disease symptoms but not the problem itself.

During valve surgery, the heart patient's heart is stopped with medication and its functions are assumed by a heart-lung machine that adds oxygen to the blood and pumps the blood throughout the body. The cardiac surgeon removes the damaged valve and sews a new valve in place. The replacement valve may come from an organ donor, but more often a mechanical valve, made of plastic and metal, is used.

Sometimes diseased valves can be repaired. Repair may be done if: calcium deposits can be removed from the valve, allowing it to close correctly; the valve can be surgically reshaped, allowing it to close more effectively; if the valve opening is too big, it sometimes can be tightened with stitches.

Your breast bone takes about 6-8 weeks to heal, but it may be 2-3 months before you feel completely back to normal.

Thoracic & Lung Surgery

A range of thoracic and lung surgical procedures are offered by Central Maine Cardiovascular Surgery. The surgeons at CMCS work closely with pulmonologists, gastroenterologists, oncologists and primary physicians in the region.

Among the procedures provided are:

• pulmonary resection – removal of part of the lung

• mediastinal tumors – thymoma, teratoma, nerve tumors

• esophagectomy – removal of the esophagus

• tracheal and bronchial surgery – removal of part of the trachea or bronchus

• video assisted thoracic surgery (VATS) – also known as endoscopic thoracic surgery or minimally invasive thoracic surgery (thoracoscopy)

Many thoracic surgical procedures are performed using small incisions and advanced video-assisted techniques, which reduces post-operative discomfort, decreases length of hospitalization and returns people to normal activities sooner.

Medical issues often treated using these techniques are:

• pleural effusion – fluid around the lungs lung biopsy – for disease diagnosis

• lobectomy for cancer of the lung – early lung cancers can often be removed using minimally invasive techniques

• mediastinal tumors – some tumors and cysts can be removed endoscopically

• pneumothorax (lung collapse) – removal of the leaky area of the lung and pleurodesis can usually be done endoscopically

• hyperhidrosis treatment – stops excessive sweating, by removing part of the sympathetic nerve system. This procedure is also effective for patients with other upper extremity problems, including reflex sympathetic dystrophy and Raynaud's disease.

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