Aortic valve surgery is usually performed for either narrowing of the valve (stenosis) or regurgitation. In some cases the dysfunction of the valve is due to a congenital abnormality called bicuspid valve disease. This is present from birth although it can take many decades before the valve actually requires replacement. A small proportion of patients require surgery for infection of the valve (endocarditis.)
Aortic valve replacement is performed using a sternotomy incision and cardiopulmonary bypass. The procedure takes 2-3 hours and provided that there are no major co-existing medical conditions it is a very safe procedure with an operative risk of only 1-2%
Recently patients who are unable to receive a surgical valve replacement have been offered a catheter delivered valve (TAVI)
Valves may be mechanical (carbon + metal) which require lifelong warfarin therapy, or tissue (usually from a pig.)
Mitral valve disease is either degenerative, due to infection, or rheumatic in origin. Rheumatic disease is now rare in the UK and the majority of patients undergoing mitral valve surgery have valve regurgitation due to prolapse of the valve. This can often be repaired without the need to replace the whole valve. This avoids the need for warfarin therapy.
If the valve is not repairable then either tissue or mechanical valves offer an excellent durable option to correct the valve pathology.
The risk of mitral valve surgery varies from 1-5% depending on the complexity of the problem and the presence of other health issues.
Coronary Artery Bypass Surgery (CABG) is the commonest cardiac operation performed in the UK. While patients with limited coronary artery disease can have effective treatment with stents, more extensive disease, especially if it affects the main coronary vessels, or in patients with diabetes is better treated by surgical therapy.
A combination of internal mammary arteries, radial arteries and veins are used to bypass diseased coronary vessels.
The use of multiple arterial grafts where suitable can improve the long term outcome and your surgeon will discuss the options with you.
Spontaneous pneumothorax is caused by rupture of blebs or cysts on the surface of the lung. This causes air to leak into the pleural cavity collapsing the lung. Common symptoms include pain and shortness of breath. It is a common condition usually presenting in young adults. The underlying lungs are usually normal. Surgery is advised after a 2nd episode as the recurrence rate is very high, after bilateral pneumothoraces or after any complicated episode (for example when the lung remains collapsed despite treatment.) Rarely the lung collapses and pressure builds up inside the chest (tension). This can be life-threatening and surgery is always advised after such an episode.
Surgery consists of a minimally invasive (VATS) operation to remove the cysts, and attach the lung to the chest wall, preventing further collapse. While pleuradhesis (abrading the pleura, or instilling a foreign material such as talc to create adhesions) is often performed, I advise a pleurectomy, carefully stripping the pleura, as this has the lowest recurrence rate (<5%)
Secondary pneumothorax occurs in older patients and is associated with an underlying lung condition such as emphysema. the treatment is similar although talc powder pleuradhesis is often appropriate in such cases.
Surgery for lung cancer is performed after extensive diagnostic and staging investigations. These may include chest Xray, Bronchoscopy and biopsy, CT scanning (plus biopsy) and PET scanning. In some cases an Endoscopic Bronchoscopy (EBUS) or mediastinoscopy (a small surgical lymph node biopsy) may also be needed.
If after these tests there is no evidence of spread, then surgery offers the best outcome. usually only 1 lobe needs to be removed (Lobectomy) although in more advanced cases the whole lung (pneumonectomy) is resected.
More than 80% of my patients receive minimally invasive (VATS) surgery resulting in shorter hospitalisation and enhanced recovery. Patients can go home as soon as 24 hours after surgery although more commonly a stay of 2-4 days is required (this compares to up to 10 days with open surgery.)
I work closely with Respiratory Physicians, Radiologists, Pathologists and Oncologists to provide a comprehensive service for lung cancer patients.
Lung biopsy is a valuable tool often recommended to establish a diagnosis in fibrotic and inflammatory lung conditions. your respiratory physician will refer you for a biopsy if they feel it is important to pin point a diagnosis to help decide on a treatment plan.
Lung biopsy is done via VATS, usually as a day case.
Surgery for mediastinal masses is usually performed either via a small sternotomy or by a VATS approach. The commonest form of tumour is a thymoma. Surgery is usually curative, although with very large or invasive tumours radiotherapy is sometimes necessary as an additional safeguard.
Diagnostic biopsy procedures can be performed minimally invasively as a day case procedure in most cases.
VATS or Video Assisted thoracic Surgery is a technique of operating inside the chest using small incisions and endoscopic instruments. It results in less pain, better cosmetic results and a quicker return to normality.
Whilst not all thoracic procedures can be performed by VATS, the list is extensive and includes:
lung cancer resections
treatment of pneumothorax
drainage of pleural infections (empyema0
mediastinal cysts and biopsies
Endoscopic radial artery and vein harvesting for CABG minimises scarring, reduces wound infection and is leads to quicker mobilisation.