Choosing a Cardiac Surgeon

The first step in choosing a cardiac surgeon is to determine if you need a cardiac surgeon in the first place. A cardiac surgeon or cardiothoracic surgeon as they are generally called is capable of performing all surgeries that require the heart or blood vessels in the chest to be modified in some way. “Open heart surgery,” that is, a surgery that involves opening the chest to gain access to the heart, would be completed by a cardiac surgeon. One of the major surgeries performed by a cardiac surgeon is the placement of a coronary artery bypass graft or CABG. You may hear this procedure referred to as a “cabbage.” A CABG involves taking a blood vessel from another part of the body, either an artery or vein, and bypassing the normal coronary artery that supplies blood to the heart. This type of surgery is usually done because the coronary arteries are blocked by atherosclerotic disease. You should be choosing a cardiac surgeon if you have a disease that affects the valves of the heart. The valves of the heart separate the heart into its four chambers and may be surgically fixed or replaced. Certain valves are replaced with artificial valves while others are simply restructured depending on which valve is affected and by what disease. There are also a variety of heart malformations that require a cardiac surgeon to repair. These heart malformations are usually present at birth and require a pediatric cardiac surgeon.  Some malformations, however, may only create problems later in life such as a patent foramen ovale or “hole” between the two atria of the heart.

 

 

It used to be the case that any intervention that required direct manipulation of the heart was the responsibility of a cardiac surgeon. However, a simple device called a stent has changed all of that. A stent is a small mesh tube that can be expanded with the help of a tiny balloon and left inside a patient’s coronary artery. The stent is snaked through an artery in the patient’s leg, all the way up to the heart and placed within a blocked coronary artery. More and more these procedures are being performed by interventional radiologists and interventional cardiologists, not cardiac surgeons. Interventionalists, as they are called, are not trained in surgery but have cornered the market on these procedures. In fact, most atherosclerotic disease of the coronary arteries is corrected by stent rather than CABG. The decision of whether to use a stent or CABG is a complex, but is usually based on the degree of disease. If there is a single blockage in a large coronary, a stent will likely be used. If there are multiple areas of disease in several coronary arteries, bypass surgery is indicated. Be aware though the complications of stent placement may arise that will require the urgent need of a cardiac surgeon. If you are having a stent placed by an interventionalist, make sure a cardiac surgeon is on staff and available in case something goes awry.