Cardiothoracic Surgery Services at City Hospital Mediclinic

The surgeons in Mediclinic’s Heart & Vascular Centre provide optimal and carefully tailored care to every patient within a comprehensive setting by working as a team across all cardiovascular disciplines. We discuss treatment plans of our complex patients in a multidisciplinary team meeting on a weekly basis and we have a daily systematic surgical review of coronary angiographies. Our surgical team works jointly and collaboratively, delivering enhanced outcomes for our patients.

Our surgical team is highly skilled and provides the full spectrum of surgical treatments for patients with advanced cardiac diseases: coronary artery bypass graft surgery (CABG), heart valve repair and replacement, mechanical circulatory support/ ventricular assist devices (VADs), extra-corporeal membrane oxygenation support (ECMO). Our surgeons are also trained in heart and lung transplantation.

Surgical treatments provided

• Surgical Coronary Revascularisation
• Heart Valve Surgery (repair and replacement)
• Surgery of Aorta
• Heart Failure Surgical Services
• Minimally Invasive Cardiac Surgery
• Emergency Cardiac Surgery

Surgical Coronary Revascularisation

Surgical coronary revascularisation or coronary artery bypass graft (CABG) surgery, is a surgical procedure that re-establishes blood flow across a blockage in a coronary artery to maintain a good blood supply to the muscle of the heart. The cardiac surgical team provides comprehensive coronary revascularisation services to patients who require heart bypass surgery. Our team specialises in both beating heart (off-pump) and on-pump coronary angioplasty graft (CABG) procedures. Our cardiac surgical team uses arterial grafts to perform these surgeries. The team is proficient in tailoring surgical revascularisation to the needs of our patients and performing simultaneous coronary surgery to treat other structural disorders of the heart such as valve disease with repair and replacement.

Heart Valve Surgery

Heart valves maintain blood flow in the correct direction through the heart and the circulation. In the event of valve dysfunction, they may need to be repaired or replaced. Heart valve assessment is important and valve dysfunction should be carefully analyzed as most patients may not get symptoms initially. The presence of symptoms such as chest pain (angina), syncope (loss of consciousness) and dyspnoea (difficulty in breathing) indicates declining life expectancy and requires surgical intervention.

The heart and vascular surgical team at Mediclinic City Hospital can repair heart valves (in particular the mitral and tricuspid valves) and replace them as well, with CE and FDA approved implants, according to the best international standards and guidelines.

Surgery of Aorta

The aorta is the main artery of the body. The various parts of the aorta may require surgical treatment in certain diseases, usually by replacement with synthetic grafts. The aorta in the chest may be affected by expansion or dilatation, aneurysms, aortic dissection, inflammation or rupture. Our cardiac surgeons are experts in the evaluation and surgical treatment of patients with aortic diseases, with excellent results and low complication rates.

• Aortic Root Surgery: Aortic root surgery is required when there is aortic root aneurysm, aortic valve calcification or stenosis, aortic root abscesses or dissection.  Our surgical team is experienced in aortic root surgery, while preserving the native aortic valve, in carefully selected cases. This is a technically challenging surgery, requiring replacement of this part of the aorta with a synthetic graft and re-implantation of the coronary arteries and usually replacement of the aortic valve.
  
• Ascending Aorta/ Arch. Ascending aorta and aorta arch surgery involves their replacement. This is usually performed where the aorta is dilated or has formed an aneurysm or if it ruptures. The cardiac surgeons at Mediclinic City hospital are experts and they use a number of techniques to deliver better outcomes. This is challenging surgery, as this zone of aorta supplies blood to the brain, head and neck and upper body.  
• Descending Thoracic Aorta: This part of the aorta may be replaced with grafts or treated with stents placed by our vascular surgeons for a variety of conditions such as aneurysms, dissections or rupture.
• Surgery for Acute Aortic Dissection. Acute aortic dissection is a medical emergency with a high mortality if untreated. It can affect other organs of the body such as the brain, lungs, arms and legs. It is caused by a localised tear in the wall of the aorta which may split it from the inside. Emergency aortic surgery may include replacing the aortic valve and replacing the aortic root, ascending aorta and the arch, and the head and neck vessels.

Heart Failure Surgical Services

Heart failure is due to impaired cardiac function. Our team works in a multidisciplinary manner to evaluate comprehensively our patients with heart failure and treat them with appropriate medical and surgical therapies. Surgical treatment of heart failure includes coronary artery surgery, valve replacement and repair, repair and remodeling of the damaged heart muscle (surgical ventricular restoration) are routinely performed by our surgical team. Our surgical team can provide other methods of supporting the heart including electrically driven blood pumps and temporary mechanical circulatory support in case of recovery or bridging to organ transplantation.

• Surgical Ventricular Restoration. Patients with failing hearts usually have enlarged cardiac chambers and pump inefficiently. The heart may be remodeled by an operation to alter its geometry and make it contract and relax in a more efficient manner. Our cardiac surgeons have also reshaped the heart affected by aneurysmal dilation to improve its function.
  
• Mitral and Tricuspid Repair. Repairing heart valves is a very effective technique to improve the pumping efficiency of the heart. In heart failure, the annulus upon which the valves in the center of the heart are seated may cause them to leak. Our cardiac surgeons are experts in valve repair in the setting of heart failure.
• Mechanical Circulatory Support (MCS). Our cardiac surgeons can surgically implant miniaturized electrically driven pumps called continuous flow VADs in patients with severe heart failure. These can support the patient until recovery, until a heart transplant is available or implanted permanently for long term support. In emergencies cases technology called extracorporeal membrane oxygenator support (ECMO) is also available to treat critically ill patients with severe heart and lung failure.
• Surgery for Atrial Fibrillation (isolated and concomitant surgical treatment). Atrial fibrillation is a type of irregular heart rhythm. Our cardiac surgeons and cardiologists can treat patients with proven treatment options.
• Coronary Artery Bypass Surgery. Our cardiac surgeons can operate on patients with reduced ejection fraction and coronary artery disease. The benefits of this surgery is especially evident in patients with impaired heart function.

Minimally Invasive Cardiac Surgery

The cardiac surgeons in our Heart and Vascular Centre are proficient in using smaller incisions and minimal access approaches to surgical operations for the full range of surgical services that we offer.

Emergency Cardiac Surgery

It may be necessary to perform emergency surgery for a range of cardiac and aortic conditions. Mediclinic City Hospital is a fully equipped tertiary care hospital to treat such emergency patients. Our cardiac surgical team is supported with a state of the art intensive care unit and our surgical and medical team is available 24/7.