WHAT IS A THORACIC SURGEON?

Thoracic surgery is defined as the medical specialty that encompasses the treatment (preoperative, operative and postoperative procedures and care, including critical care) of diseases of the thorax (chest). A thoracic surgeon is a medical doctor whose treatment includes the heart, lungs, esophagus, and other organs in the chest. Thoracic surgeons can be called cardiac surgeons, cardiothoracic surgeons, cardiovascular surgeons, general thoracic surgeons, and congenital heart surgeons, depending on the emphasis of their practice.

WHAT ARE THE SPECIAL TRAINING AND SKILLS OF BOARD-CERTIFIED THORACIC SURGEON?

In their training, and in preparation for certification, Board Diplomates acquire in-depth knowledge of the diagnosis, surgical treatment, and management of disease and conditions of the checst, including diseases of the heart, lung, and esophagus. Board-certified thoracic surgeons have extensive knowledge of the anatomy and physiology of the organs contained in the chest wall and are skilled in the use of state-of-the-art diagnostic procedures, including x-ray, computed tomography (CT), and magnetic resonance imaging (MRI). They are also trained to perform invasive diagnostic procedures such as bronchoscopy, endoscopy, mediastinoscopy, and fineneedle asporation; andto evaluate sophisticated laboratory studies used in diagnosis. Transplantation of the heart and lungs is within the domain of the board-certified thoracic surgeon. Board-certified thoracic surgeons are trained in oncology and have extensive knowledge of the diagnosis and management of tumors occurring in the chest including cancer of the lung, esophagus, and thymus. In addition to their surgical skills, Board Diplomates have specialized knowledge of chemotherapy and radiation therapy as well as immunotherapy and other innovative therapies that may be required to treat thoracic diseases. Board Diplomates also have experience and skill in the management of irregular heart rhythms that require the use of drugs, pacemakers, defibrillators, and cardiac assist devices. They also have expertise in the use of respiratory support systems and cadiopulmonary bypass equipment and procedures.

WHAT KIND OF TRAINING IS REQUIRED TO BECOME A THORACIC SURGEON?

Thoracic surgeons must graduate from medical school and most commonly will complete a five-year general surgery residency, although there are some other residency training pathways. After residency training, they must successfully complete an approved thoracic surgery residency training program (sometimes called ‘fellowship’) for either two or three years. Some thoracic surgeons choose to do further additional training in a sub-specialized area, but this training is largely optional, except for congenital heart surgery for which additional approved training is required.

ARE THERE DIFFERENT KINDS OF THORACIC SURGEONS? WHAT IS THE DIFFERENCE BETWEEN A THORACIC SURGEON AND A CARDIOLOGIST?

All thoracic surgeons have the same basic training and are certified by the same ABTS specialty Board, except for congenital heart surgeons who have additional training and a sub-specialty certificate in addition to the ABTS certification. Some surgeons choose to focus their training and clinical practice in certain areas of thoracic surgery and can be referred to differently. A cardiac or cardiovascular surgeon will usually focus on the heart and great vessels, while general thoracic surgeons often treat diseases of the lungs, esophagus, chest wall, and mediastinum. Congenital heart surgeons operate on infants and children with heart defects or disease. “Cardiothoracic surgeon” is the most inclusive term used to describe the specialty, irrespective of a particular surgeon’s area of focus and expertise, and can be used interchangeably with the term “thoracic surgeon.”  Regardless of the practice description (cardiac, cardiothoracic, cardiovascular etc), the American Board of Thoracic Surgery is the only certifying agency.

A cardiologist will diagnosis disorders of the heart and treat them with medication. Cardiologist may also perform interventions on the arteries in the heart working through puncture wounds in the groin, but they do not do open surgery. A immunologist will diagnosis disorders of the lung and treat them with medication. Some pulmonologist will also perform interventions through the airway such as bronchoscopy to diagnose some disorders, but again, they do not perform open surgery.

DO THORACIC SURGEONS DO PROCEDURES OTHER THAN OPEN OPERATIONS?

Yes. Many cardiac surgeons also perform percutaneous (through punctures in the groin) interventions to treat aneurysms of the large vessels in the chest.  Most general thoracic surgeons also perform bronchoscopy and/or esophagoscopy, drain fluid or air.  Thoracic surgeons are qualified to follow patients in the surgical intensive care units of the hospital.

WHEN SHOULD I SEE A THORACIC SURGEON?

Your primary care physician, cardiologist, pulmonologist, or gastroenterologist may refer you to a thoracic surgeon if he/she feels that you could benefit from an operation to treat a condition involving the heart, lungs, esophagus, mediastinum, or chest wall.

WHAT CAN I EXPECT ON MY FIRST VISIT?

You will be interviewed and examined by the Thoracic Surgeon, and if you have had any test, echocardiograms, X-rays or CT scans done, your Thoracic Surgeon will review the images and reports. Then, he/she will make a recommendation for the next step in your evaluation and treatment. This includes possible surgery, additional testing, or observing your condition over time.

Diagnosis and management of diseases and conditions of the heart

*Surgery for heart disease

• coronary arteries
• heart valves
• irregular heart beats

*Surgery for injuries to the heart

*Surgery for congenital heart disease

*Surgery for thoracic vascular disease including aneurysms, traumatic injury, and blocked arteries

*Heart and heart-lung transplantation

*Implantation of temporary and permanent artificial assist devices (artificial hearts, pacemakers, defibrillators, and other devices)

Diagnosis and management of diseases and conditions of the respiratory system and esophagus

*Diagnosis and management of pulmonary disease

*Diagnosis and management of cancer, including cancer of the lung and esophagus

*Diagnosis and management of diseases of the mediastinum and chest

*Diagnosis and management of diseases of the esophagus and gastroesophageal junction/p>

*Pediatric general thoracic surgery

*Video-assisted thoracic surgery

*Use of temporary devices, including extracoproreal membrane oxygenators (ECMO) and intravenous oxygenators

*Diagnosis and management of end-stage pulmonary disease

*Lung transplantation for advanced lung disease, including pulmonary fibrosis, emphysema, cystic fibrosis, and pulmonary hypertension