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.
* This article is presented and copyrighted by The 'Lectric Law Library
and Dr. Steven E. Lerner & Associates (www.drlerner.com)