Cardiac Surgery

with Frank X. Downey, M.D., Cardiothoracic Surgeon, Columbia St. Mary’s

Posted: Feb. 1, 2005

Cardiac surgeons today are faced with operating on patients of advanced age, many of whom have more than one medical condition. Thanks to advancements in surgical techniques and support staff, few patients are turned away regardless of age or medical conditions.

In addition to coronary artery disease and valvular heart disease, congestive heart failure has become prevalent in an aging population. Fully five percent of the adult population over the age of 65 has been diagnosed with congestive heart failure. Five percent of these patients will not respond to medical therapy and may be candidates for newer techniques in the surgical treatment of heart failure.

Frank X. Downey, M.D., Cardiothoracic Surgeon, Columbia St. Mary’s "It’s never just one person or one physician that determines the patient’s outcome. With cardiac surgery, it is truly the team approach."

Despite the advancements that have been made in cardiac surgery, including the use of robotics and mechanical pumps, Frank Downey, M.D., a cardiothoracic surgeon with Columbia St. Mary’s, said the most important advancements in cardiac care have to do with the medical team that supports the cardiac surgeon.

This highly trained and experienced team makes it possible to treat patients with complicated cardiac illnesses. Just a decade or two ago, these patients would have likely died of heart disease.

“The major change in cardiac surgery in the last ten years is that we are now able to operate on older, sicker patients,” Dr. Downey said. “Many of our patients have multiple medical conditions, including high blood pressure, diabetes mellitus and peripheral vascular disease. Many have had previous cardiac procedures.”

Cardiac surgery team’s roles
Dr. Downey spotlighted the anesthesiologist as being critical to the success of any cardiac surgical procedure. Patients with heart disease have cardiovascular complications from general anesthesia and surgery more often and more severely than patients without heart disease. The specialty of cardiac anesthesia has developed and grown in the past decade. Many area hospitals have specialists in cardiac anesthesia that are vital to patient survival.

Dr. Downey also highlighted the role of the clinical perfusionist as an example of a part of the surgical team who has taken on a much greater role in the last decade. Perfusionists operate the heart/lung machine that supports the patient during many cardiac operations. They monitor circulatory and physiologic processes during surgery and take action if problems arise. They are also involved in blood conservation. Many perfusionists have Master’s degrees in Biomedical Engineering.

“These men and women are real thinkers in the operating room,” Dr. Downey said.

Another prominent advancement in the care of cardiac surgical patients is in nursing. The specialty of cardiovascular surgical nursing has developed, advanced and improved the care of patients after the operation.

“With heart surgery, you don’t just do the surgery and send the patient home,” Dr. Downey said.

The experience of the cardiovascular surgical nurse is critical to the ultimate recovery of the patient. The survival of the patient may be determined in the intensive care unit after surgery and may depend on the experience and training of the cardiac surgical nurse.

Intensive care unit
In the past, the intensive care unit a heart patient would go to after surgery would have patients with many different kinds of illnesses. Now, most large hospitals have an intensive care unit dedicated to cardiovascular surgery patients. Because nurses in these units work exclusively with heart patients, almost no complication from surgery is unfamiliar to them.
With these improvements in the team surrounding the cardiac surgeon, older, sicker patients have a better chance of survival through cardiac surgery.

“It’s never just one person or one physician that determines the patient’s outcome. With cardiac surgery, it is truly the team approach,” Dr. Downey said.

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