Cardiothoracic Surgery — Find Specialists & Top Hospitals Worldwide | MyMedicPlus

Cardiothoracic surgery is a highly specialised surgical discipline encompassing operations on the heart, great vessels, lungs, oesophagus, trachea, and other structures within the chest cavity. It represents one of the most technically demanding fields in all of medicine, requiring mastery of complex anatomy, perfusion physiology, and microsurgical technique. Cardiothoracic surgeons are the last line of treatment for many life-threatening conditions when catheter-based interventions and medical therapy have been exhausted or are not feasible.

The specialty is typically divided into two major domains. Cardiac surgery focuses on the heart and great vessels — including coronary artery bypass grafting, valve repair and replacement, aortic surgery, congenital heart defect repair, and heart transplantation. Thoracic surgery (sometimes practised as a separate specialty) addresses the lungs, oesophagus, mediastinum, chest wall, and pleura — including lung resections for cancer, oesophagectomy, and mediastinal tumour removal.

Cardiothoracic surgery differs from interventional cardiology in that it involves open or minimally invasive incisions rather than catheter-based access alone, often requiring cardiopulmonary bypass (heart-lung machine) to temporarily take over the function of the heart and lungs during the operation. The field has evolved dramatically with robot-assisted surgery, minimally invasive valve repair, and extracorporeal membrane oxygenation (ECMO) for patients in cardiogenic shock or respiratory failure.

Cardiothoracic surgeons manage conditions across two broad domains — cardiac (heart and great vessels) and thoracic (chest organs):

• Coronary artery disease requiring bypass: Severe multi-vessel or left main coronary artery disease not suitable for stenting, where bypass grafting is superior to percutaneous intervention.
• Aortic and mitral valve disease: Stenosis (narrowing) or regurgitation (leakage) of the aortic or mitral valves causing symptomatic heart failure, requiring repair or replacement when medical management is insufficient.
• Aortic aneurysm and dissection: Dangerous dilation or tearing of the aorta requiring emergency or elective surgical reconstruction to prevent rupture.
• Congenital heart defects: Structural heart abnormalities present from birth, including atrial and ventricular septal defects, tetralogy of Fallot, and transposition of the great arteries, requiring repair in childhood or adulthood.
• End-stage heart failure: Patients with irreversible ventricular dysfunction who are candidates for ventricular assist device (VAD) implantation as a bridge to transplant or destination therapy.
• Heart transplantation: Orthotopic heart transplant for patients with end-stage cardiomyopathy or congenital heart disease refractory to all other treatments.
• Lung cancer: Primary lung malignancies (non-small cell lung cancer stages I–III) requiring lobectomy, segmentectomy, or pneumonectomy for curative intent.
• Pleural disease: Empyema, malignant pleural effusion, pleural mesothelioma, and spontaneous pneumothorax requiring surgical drainage or pleurectomy.
• Oesophageal cancer: Oesophagectomy for resectable oesophageal or gastro-oesophageal junction cancer.
• Lung transplantation: Single or bilateral lung transplant for end-stage pulmonary fibrosis, COPD, or pulmonary hypertension.

Cardiothoracic surgeons perform some of the most complex operations in medicine:

• Coronary artery bypass grafting (CABG): Uses a healthy blood vessel — typically the internal mammary artery from the chest wall or the saphenous vein from the leg — to bypass blocked coronary arteries and restore blood flow to the heart muscle. The heart is often stopped and cardiopulmonary bypass used.
• Aortic valve replacement (AVR) and repair: Replacement of a diseased aortic valve with a mechanical or biological prosthesis, or repair of the native valve to eliminate regurgitation. TAVR (transcatheter approach) is increasingly used for high-risk surgical patients.
• Mitral valve repair: Preferred over replacement where possible; techniques include annuloplasty ring placement, leaflet repair, and artificial chordal reconstruction to restore competent valve closure.
• Aortic root replacement: Reconstruction of the aortic root and ascending aorta using a composite graft or valve-sparing techniques (David procedure) for aneurysmal dilation.
• Lobectomy and segmentectomy: Removal of a lung lobe or anatomical segment for primary lung cancer, performed via thoracotomy or video-assisted thoracoscopic surgery (VATS).
• Video-assisted thoracoscopic surgery (VATS): Minimally invasive approach using a thoracoscope and small port incisions for lung resection, pleural procedures, and mediastinal operations, reducing recovery time significantly.
• Oesophagectomy: Removal of all or part of the oesophagus for cancer, with reconstruction using the stomach or colon as a conduit.
• Ventricular assist device (VAD) implantation: Mechanical pump placed to support a failing left or right ventricle, used as a bridge to transplant or long-term destination therapy.
• Heart transplantation: Orthotopic replacement of the native heart with a donor organ under cardiopulmonary bypass; requires lifelong immunosuppression.

Referral to a cardiothoracic surgeon is typically made by a cardiologist, pulmonologist, oncologist, or gastroenterologist once non-surgical or catheter-based options have been considered and surgical intervention is judged most appropriate.

Cardiac indications for referral include coronary artery disease with left main stem stenosis of 50% or greater, three-vessel disease with reduced ejection fraction (EF below 35%), aortic valve stenosis with a mean gradient above 40 mmHg or valve area below 1 cm², symptomatic severe mitral regurgitation, and aortic aneurysm reaching 5.5 cm diameter in the ascending aorta (or 4.5 cm in patients with bicuspid valve or connective tissue disease). Emergency surgical referral is required for acute aortic dissection (Stanford Type A) and post-infarction mechanical complications such as ventricular septal defect or acute mitral regurgitation.

Thoracic indications include a lung nodule or mass with imaging characteristics suspicious for malignancy, resectable non-small cell lung cancer on staging CT-PET, resectable oesophageal cancer, recurrent spontaneous pneumothorax, and suspected mediastinal tumour such as thymoma. Referral to a high-volume centre is strongly recommended as outcomes for complex cardiac surgery correlate significantly with annual surgical volume.

Cardiothoracic surgery has one of the longest and most rigorous training pathways in medicine. The traditional route begins with a 4-year medical degree (MD or DO), followed by a 5-year general surgery residency leading to ABS board certification. After proving general surgical competence, the surgeon enters a 2–3 year cardiothoracic surgery fellowship, during which they perform high volumes of cardiac and thoracic cases under close supervision.

An alternative pathway, available at select programmes in the USA, is the integrated 6-year cardiothoracic surgery residency, which accepts medical graduates directly and provides dedicated cardiothoracic training without a separate general surgery residency. This pathway is designed to produce surgeons who begin subspecialty training earlier.

Board certification is granted by the American Board of Thoracic Surgery (ABTS), which requires completion of an accredited training programme, a qualifying examination, and an oral examination assessing operative decision-making and complication management. Surgeons may seek additional certification in congenital cardiac surgery or adult cardiac surgery as separate credentials. In the UK, the equivalent qualification is the Certificate of Completion of Training (CCT) in Cardiothoracic Surgery under the Joint Committee on Surgical Training (JCST).

Referral to a cardiothoracic surgeon almost always comes through a cardiologist, oncologist, or pulmonologist who has determined that surgical intervention is the most appropriate treatment. When seeking a surgeon, outcome data is critical: hospital surgical volume is one of the strongest predictors of outcomes for major cardiac and thoracic procedures.

In the USA, the Society of Thoracic Surgeons (STS) publishes quality ratings for cardiac surgery programs based on risk-adjusted outcomes data — seek centres with STS 3-star ratings for the relevant procedure. Ask your referring cardiologist about the surgeon's annual operative volume for your specific procedure. For your pre-operative consultation, bring all cardiac imaging (echocardiogram, coronary angiogram, CT), pulmonary function tests, and oncology staging results as applicable. Expect a thorough anaesthetic risk assessment, discussion of surgical versus non-surgical alternatives, informed consent regarding mortality and complication risks, and a detailed plan for post-operative rehabilitation and follow-up.