What is Cardiothoracic and Vascular Surgery (CTVS)?
Cardiothoracic and Vascular Surgery (CTVS) focuses on treating conditions that affect the heart, lungs, and blood vessels through specialised surgical procedures. These surgeries are often necessary when non-surgical treatments are not sufficient to manage serious or life-threatening conditions.
The Field of CTVS Includes:
- Heart Surgeries (Cardiac Surgery): Procedures like coronary artery bypass grafting (CABG) to improve blood flow, heart valve repairs, and surgeries to correct congenital heart defects.
- Lung and Chest Surgeries (Thoracic Surgery): Surgeries to treat lung cancer, infections, and collapsed lungs, including procedures like lobectomy or thoracotomy.
- Blood Vessel Surgeries (Vascular Surgery): Treatments for conditions such as aneurysms, blocked arteries, or damaged blood vessels through procedures like vascular bypass and aneurysm repair.
- Beating Heart Surgery (Off-Pump CABG): A technique where surgeons perform bypass surgery while the heart continues to beat naturally. Unlike traditional methods, it does not require a heart-lung machine. Instead, special stabilizing devices are used to keep a small area of the heart steady, allowing surgeons to attach grafts, such as the internal mammary artery, to reroute blood flow around blocked coronary arteries.
What are the Symptoms & Warning Signs Of CTVS Surgery?
Recognising warning signs is critical for early diagnosis and successful treatment. Seek immediate medical attention if you experience any of the following symptoms:
Chest Pain or Discomfort
- Pressure, squeezing, or heaviness in the chest
- Pain radiating to arms, neck, jaw, or back
- Pain triggered by exertion or stress
Shortness of Breath
- Difficulty breathing during minimal activity or at rest
- Worsening breathlessness when lying flat
- Fatigue and weakness
Heart-Related Symptoms
Vascular Symptoms
- Leg pain or cramping, especially during walking (claudication)
- Coldness or numbness in limbs
- Discoloration or swelling in legs or feet
When to Seek Emergency Care?
- Severe chest pain lasting more than a few minutes
- Sudden severe shortness of breath
- Loss of consciousness or fainting
- Sudden severe pain in chest, abdomen, or back
When is Cardiothoracic and Vascular Surgery Recommended?
Common conditions affect critical areas like the heart, lungs, and major blood vessels, often requiring expert surgical care when medications aren't enough. Here's an overview of when CTVS is recommended:
- Coronary Artery Disease (CAD): Coronary Artery Disease occurs when cholesterol and plaque build up in the heart's blood vessels, restricting blood flow to heart muscle. This causes chest pain (angina) and increases risk of heart attack. When medication fails to control symptoms, surgical intervention (CABG) becomes necessary.
- Heart Valve Disease: Heart valves may become stenotic (narrowed, reducing blood flow) or regurgitant (leaky, allowing backflow). Valve disease progressively damages the heart and can lead to heart failure, requiring surgical repair or replacement.
- Aortic Aneurysm: An aortic aneurysm is a weakened, bulging section of the aorta (main artery leaving the heart). Large aneurysms are at high risk of rupture, which is immediately life-threatening and requires emergency surgical repair.
- Peripheral Artery Disease (PAD): PAD involves blocked arteries in the legs and other limbs, causing pain during walking (claudication) and risk of tissue loss. Severe cases require vascular bypass surgery to restore blood flow and save limbs.
- Lung Cancer & Thoracic Conditions: Lung cancer, infections, and collapsed lungs often require surgical removal (lobectomy) or other thoracic procedures. Early surgical intervention improves survival outcomes significantly.
What to Expect Before CTVS Surgery?
Going through a CTVS surgery can feel overwhelming, but knowing the preparation steps brings clarity and calm. Here's what to expect before CTVS surgery:
Initial Consultation
- Detailed medical history assessment
- Physical examination and symptom review
- Discussion of surgical options and risks
Diagnostic Tests
- Electrocardiogram (ECG): Records heart electrical activity
- Echocardiogram: Ultrasound showing heart structure and function
- Cardiac CT/MRI: Detailed imaging of heart and vessels
- Cardiac Catheterization: Visualises coronary arteries
- Stress Testing: Evaluates heart function under exertion
- Blood Work: Complete metabolic panel, clotting studies
Pre-Operative Workup
- Chest X-ray: Baseline lung assessment
- Pulmonary function tests: Evaluates breathing capacity
- Anaesthesia pre-evaluation: Ensures safe anaesthesia
- Infection screening: COVID-19, TB testing
Pre-Operative Instructions
- Fasting: Usually NPO (nothing by mouth) 6-8 hours before surgery
- Medication adjustments: Some medications stopped; others continued
- Skin preparation: Shower with antiseptic soap night before
- Arrival timing: Typically, 2 hours before scheduled surgery
- What to bring: Insurance card, ID, medical records, list of medications
What Happens During CTVS Surgery?
Understanding what happens during surgery reduces anxiety and gives patients knowledge and confidence. Here are the typical steps that were taken during the procedure; this is how the patient can know what to expect every step.
- You're transferred to the operating room
- Sterile draping and positioning on the operating table
- Monitoring equipment attached (heart monitors, blood pressure cuff, oxygen saturation)
- Cardiac anaesthesiologist administers general anaesthesia intravenously
- Breathing tube (endotracheal tube) placed
- Continuous monitoring of vital signs throughout surgery
- Median sternotomy (6-8 inch vertical chest incision) for open CABG
- Mini-thoracotomy (2-3 inch) for minimally invasive procedures
- Vessels and tissues carefully exposed
- In most open-heart surgeries, patient is connected to heart-lung machine
- This machine oxygenates blood and pumps it while heart is stopped
- Allows surgeon to work on stationary heart safely
- For CABG: Harvesting graft vessel (leg, arm, or chest artery), then creating bypass grafts
- For Valve Surgery: Replacing or repairing damaged valve
- For Aneurysm Repair: Removing aneurysmal segment and replacing with synthetic graft
- Procedure duration: 2-6 hours depending on complexity
- Heart gradually restarted on bypass
- Pacing wires placed for post-operative monitoring
- Chest tubes placed to drain fluid
- Surgical incision closed in layers
- Transfer to intensive care unit for recovery
What to Expect After CTVS Surgery?
After the surgery, as the effects of anesthesia gently fade, the patient slowly awakens in the recovery room. Next, a carefully guided journey begins through essential post-operative steps designed to ensure safety, comfort, and a smooth transition to healing.
Immediate Post-Operative Period (First 24 Hours in ICU)
- Intensive monitoring of heart rhythm, blood pressure, oxygen
- Mechanical ventilation (breathing tube) for 4-24 hours
- Sedation provided for comfort
- Pain management with intravenous medications
- Chest tubes and catheters present for fluid drainage
- NPO (nothing by mouth) until breathing tube removed
Hospital Stay Duration
- Open-heart surgery: 5-7 days typically
- Minimally invasive: 2-4 days
- Robotic-assisted: 1-3 days
Pain Management
- Expect incisional pain and chest discomfort
- Medications (opioids, acetaminophen) provided regularly
- Pain improves significantly by week 2-3
Early Mobilization
- Day 1-2: Sitting in chair
- Day 3-4: Short walks with assistance
- Week 2+: Gradual increase in activity
- Walking is most important exercise: prevents clots and pneumonia
Wound Care
- Incision kept clean and dry
- Dressings changed as instructed
- Stitches or staples removed at 2-3 weeks
- Avoid heavy lifting, straining for 6-8 weeks
Driving & Activity Restrictions
- Avoid driving for 4-6 weeks post-surgery
- Sexual activity: Resume cautiously after 4-6 weeks
- Heavy exercise: Restart gradually after 8-12 weeks
- Return to work: Typically 6-8 weeks for office jobs; longer for physical labour
Prognosis After CTVS Surgery: Recovery and Care
Recovery doesn't end with hospital discharge. Long-term lifestyle changes prevent disease progression and future surgeries.
Heart-Healthy Diet
- Reduce saturated fats (< 7% of daily calories)
- Eliminate trans fats completely
- Increase fibre (oats, beans, vegetables, fruits)
- Choose lean proteins (fish, chicken, legumes)
- Limit sodium to < 2000mg daily
- Include omega-3 fatty acids (fish, nuts, seeds)
Exercise & Activity
- Aim for 150 minutes of moderate-intensity aerobic activity weekly
- Add resistance training 2 days per week (light to moderate)
- Flexibility exercises (yoga, stretching) for mobility
- Always clear exercise plans with your cardiologist
Weight Management
- Maintain BMI 18.5-24.9 (healthy weight range)
- 5-10% weight loss significantly improves heart health
- Consult nutritionist for personalised diet plan
Smoking Cessation
- Quit smoking completely (no exceptions)
- Avoid second-hand smoke
- Use nicotine replacement therapy or counseling if needed
Stress Management
- Practice relaxation techniques: meditation, deep breathing, yoga
- Counseling for depression/anxiety (common post-surgery)
- Maintain healthy sleep (7-9 hours nightly)
Blood Pressure & Cholesterol Control
- Target: BP < 130/80 mmHg
- LDL cholesterol < 70 mg/dL (especially post-cardiac surgery)
- Regular monitoring and medication adherence essential
What is the Difference Between Minimally Invasive and Open Heart Surgery?
Patients get two options to proceed with the surgery; minimally invasive means there will be no big cuts and scars. Another option is open surgery, in which a big incision is made to treat the condition. Here we have differentiated the two, so the patient can learn what are the benefits of each and how we approach each surgery based on patient condition and risk factors.
Factor | Open Surgery | Minimally Invasive |
Incision Size | 6-8 inches | 1-3 inches |
Pain Level | Moderate | Mild to moderate |
Hospital Stay | 5-7 days | 2-3 days |
Return to Work | 6-8 weeks | 3-4 weeks |
Scarring | Vertical scar | Minimal scarring |
Blood Loss | Moderate (may need transfusion) | Minimal |
Cost | Standard rate | 15-20% higher |
Success Rate | 95-98% | 95-98% |
Note: Not all patients are candidates for minimally invasive surgery. Complex anatomy, previous cardiac surgery, or technical factors may necessitate open surgery. Our surgeon will discuss the best approach for your specific condition.
What is Robotic-Assisted CTVS Surgery?
Robotic systems represent the cutting edge of cardiac surgery, combining surgeon expertise with advanced technology for unprecedented precision and safety.
How Robotic Surgery Works?
- Surgeon sits at control console away from operating table
- Robotic arms with surgical instruments perform procedures
- 3D high-definition visualization of surgical field
- Surgeon controls all movements with enhanced dexterity and precision
What are the Advantages?
- 3D high-definition vs. 2D
- Robotic wrists provide 360-degree movement
- Enables to perform complex minimally invasive procedures
Which Procedures are Performed Robotically?
- Robotic CABG (especially LIMA-LAD bypass)
- Robotic valve repair and replacement
- Robotic atrial septal defect (ASD) closure
- Robotic lung cancer resection
What is the Outcome of Robotic Surgery?
- Success rates: 98-99% (slightly higher than conventional techniques)
- Complications: Lower rates of bleeding, infection
- Hospital stay: 1-2 days (shortest recovery)
- Return to activity: 2-3 weeks (fastest recovery)
Why Choose Artemis Hospitals For CTVS?
Our highly experienced surgeons specialise in treating complex heart, lung, and vascular conditions. With years of expertise and training, they are skilled in performing both traditional and minimally invasive procedures.
Each surgeon at Artemis Hospitals follows evidence-based practices, ensuring precision and safety in every surgery. We offer state-of-the-art operating rooms and cardiac care units equipped with the latest technology, ensuring precise and safe surgeries.
Our facilities include dedicated Cardiac ICUs for post-surgical monitoring and care, providing 24/7 support for patients recovering from complex procedures. To reduce recovery time and minimise pain, our surgeons use minimally invasive techniques and robotic-assisted surgeries.
To book an appointment with us, book your slot by calling +91 98004 00498.
Article by Dr. Surendra Nath Khanna
Chairperson - Adult Cardiac Surgery & Heart - Lung Transplant
Artemis Hospitals
