Perspectives on the Historical Leadership, Prep, Recovery, and Long-Term Care in Cardiothoracic Transplant Surgery
John A. Macoviak provides an overview of the surgery, including what to expect before, during, and after the operation. Aseptic technique is of paramount importance, especially for heart transplant surgery.
About the Author
John A. Macoviak MD was trained at Stanford by Norman E Shumway MD Ph.D the original creator of the first in-man successful heart transplantation techniques.
Dr. Macoviak was Assistant Professor of Surgery and Director of Heart Transplantation at Georgetown University Hospital. Performed the first 30 heart transplants in Washington DC while on faculty at Georgetown University School of Medicine 1986 to 1990. Recruited to Harvard School of Medicine as Associate Professor in Heart Transplantation in 1990. Established the Heart Transplantation Program with Jack Sternlieb MD at Eisenhower Medical Center in 1992. Retired from Surgery at Mayo Clinic in 2009 in Rochester MN. Remains as a US Executive 2009 through 2024 in two of the world’s 50 largest operating International Healthcare Companies.
Cardiothoracic Surgery Explained
Cardiothoracic surgery is a field of medicine that deals with the surgical treatment of conditions affecting the heart, lungs, and esophagus. It is a specialized form of surgery and is seen as highly invasive. Before patients go under the scalpel, they must be prepared both physically and mentally. This includes a pre-operative evaluation by the surgeon, which will assess the patient’s overall health and fitness for surgery.
The patient will also be asked to stop taking certain medications and fast for some time before the operation. Following the procedure, the patient will go through a recovery period and may face long-term care.
Cardiothoracic surgery is a specialized form of surgery that relies on both pulmonary and cardiovascular procedures to diagnose and treat diseases of the lungs, heart, and esophagus. Surgeries are usually prepared for and performed by a team of professionals, including nurses, scrub techs, cardiothoracic surgeons, anesthesiologists, cardiologists, and pulmonologists.
The most common type of cardiothoracic surgery is a coronary artery bypass graft (CABG), which is used to treat coronary heart disease. Other common procedures include valve replacement surgeries, lung resections, and heart transplants. These procedures require a deep understanding of how the body’s vascular and pulmonary systems work and can be highly risky if not performed properly.
Preparation for Cardiothoracic Surgeries
Cardiothoracic surgery is considered to be highly invasive, and as such, patients should be in a relatively stable condition before being considered for the procedure. The surgeon will conduct a pre-operative evaluation to assess the patient’s overall health and fitness for surgery. During the evaluation, the surgeon will take a medical history, perform a physical examination, and order tests, such as blood work, X-rays, and cardiac imaging.
The purpose of the evaluation is to identify any potential risks or complications that could occur during or after the surgery to prevent injury or death. Once the surgeon has determined that the patient is a good candidate for surgery, the next step is to prepare for the procedure.
The patient will be asked to stop taking certain medications, such as blood thinners and non-steroidal anti-inflammatory drugs (NSAIDs), and to fast for a while, usually 12-24 hours before the operation. The surgeon will also provide the patient with specific instructions on how to prepare for surgery, such as showering with antibacterial soap and shaving the surgical site.
What to Expect During Cardiothoracic Surgery
Before the procedure begins, an anesthesiologist will administer a general anesthetic through an IV to bring the patient to an unconscious state for the duration of the procedure. The surgeon will then make an incision in the chest to access the heart, lungs, or esophagus. The type of incision will depend on the type of surgery being performed.
For example, a heart transplant or a CABG surgery requires a long incision down the center of the chest, while a valve replacement surgery may only require a smaller incision if done robotically assisted. During the CABG or transplant procedure, surgeons will work with the other team members to repair or replace the affected organ. This may include grafting a section of a healthy artery from another part of the body, bypassing blockages, or implanting new tissues.
Recovery and Long-Term Care Following a Cardiothoracic Surgery
After surgery, the patient will be taken to a recovery room where they will be closely monitored. The recovery period can last for several hours or days, depending on the type of surgery that was performed. During this time, the patient may experience some pain and will be given medication to help manage it, as well as a breathing tube to help them breathe.
Once the patient is stable, they will be transferred to a regular hospital room. Most patients may need to stay in the hospital for a week or more after surgery. During this time, the patient will be closely monitored and will gradually be able to increase their activity level.
The patient will also be given instructions on how to care for their incisions and will be given a list of warning signs to watch for, such as fever, chest pain, or shortness of breath. Once the patient is discharged from the hospital, they will need to take it easy for several weeks as their body heals.
The patient may need to take new medications, such as blood thinners, and will need to avoid strenuous activity initially. The patient will also need to follow up with their surgeon for regular checkups. In some cases, the patient may need long-term care, such as physical therapy, to help them recover fully.
Conclusion
Cardiothoracic surgery is a lifesaving but highly invasive procedure. Although patients can expect several weeks or even months of post-op recovery and physical therapy, without the advanced and specialized knowledge it takes to perform these surgeries, many more people would suffer from cardiovascular, lung. esophagus and thoracic diseases.