CARDIOVASCULAR AND THORACIC SURGERY
Cardiovascular and thoracic surgery is the specialty which encompasses cardiac surgery, peripheral vascular surgery and general thoracic surgery. This includes the performance of coronary bypass grafting, valve replacement, repair of aortic dissections and trauma, pulmonary surgery, esophageal surgery, pericardial surgery and the entire field of peripheral vascular surgery covering carotid endarterectomy and abdominal aneurysm repair. Physicians who practice this specialty are generally board-certified in cardiovascular and thoracic surgery (American Board of Thoracic Surgery) which requires prior certification by the American Board of Surgery (general surgery). Individuals who are board-certified in cardiovascular and thoracic surgery
have completed a general surgery residency and have had an additional two to three years fellowship in cardiovascular and thoracic surgery. There is some overlap in general thoracic surgery and peripheral vascular surgery with general surgeons and others who have taken non-board eligible fellowships in peripheral vascular surgery.
Cardiovascular and thoracic surgeons see patients with a variety of problems and complications that can be grouped into several common areas.
Common problems seen with cardiac surgery include questions concerning the necessity for the performance of coronary bypass grafting, complications related to coronary bypass grafting including infection, strokes and early death related to cardiac failure. Additionally in the performance of repairs upon the thoracic aorta, complications such as paraplegia, renal failure, massive bleeding requiring reoperation and early death are encountered.
In the field of thoracic surgery complications such as early death, chronic ventilator support necessity, wound infections and serious bleeding are seen. Additionally, despite the surgeon's best efforts, local recurrences can occur from primary pulmonary malignancies. In the field of esophageal surgery, esophageal leaks are common which may produce empyema, sepsis and early death. Recurrences locally are common and the cure rate for esophageal carcinoma is probably less than 30%.
Peripheral Vascular Surgery:
A variety of complications are seen in the field of peripheral vascular surgery and range from stroke and cranial nerve injury related to carotid endarterectomy, massive bleeding and infection association with aneurysm resection to early occlusion of bypass grafts in peripheral vascular reconstruction. Additionally there are rare incidences of paraplegia associated with abdominal aortic resection and renal failure. Sexual impotence is seen with various forms of aortic surgery particularly in middle aged men who are heavy smokers. This can be associated with dissection of tissues around the aortic bifurcation but may also occur as a result of vascular occlusion to the genitals.
Informed consent is a complicated and largely inclusive duty of the cardiovascular surgery. Due to the complexity of many of these surgical procedures informing the patient of all potential complications is often impossible and potentially injurious to the patient as they may decline surgery when overwhelmed by the possible number of complications. It is important that the patient's and their families be informed of the major complications known with some frequency and also be advised of certain imponderables which can occur with any surgery.