Cardiothoracic surgery

Dr Max Codispoti
SpR in Cardiothoracic Surgery
Royal Infirmary of Edinburgh

Cardiothoracic Surgery is one of the most demanding and challenging disciplines available to a doctor who has decided to pursue a surgical career. The specialty has always been at the forefront of surgical innovation, reaching formidable results in a relatively short period of time. Even though the reform of the SHO grade will probably lead to a reduction in the length of training across surgical specialties, a newly qualified doctor currently wishing to pursue a career in this field should allow 10-15 years of training, including 6 years of higher specialist training (HST). After obtaining the MRCS, competition for HST posts is high (applicant to post ratio averages 20:1), and successful cardiothoracic candidates must be equipped with determination, perseverance, technical skills, sound clinical judgement, and the ability to communicate and work effectively in a team.

The increasing age of the general population, growing complexity of clinical problems, availability of sophisticated diagnostic techniques and the rapid introduction of new technologies have led to a demonstrable trend towards sub-specialisation into the areas of adult cardiac, general thoracic and congenital cardiac surgery. A smaller aspect of the specialty deals with intrathoracic organ transplantation, performed in only eight centres across the UK.

Adult Cardiac Surgery

The encouraging short-term results of drug-eluting stents and advances in the prevention of atherosclerotic coronary artery disease have led some to fear the decline and eventual disappearance of coronary surgery - currently accounting for 75-80% of adult cardiac surgical practice. However, the specialty has survived similar "scares" in the recent past, and the reality is that increasingly complex cases will continue to require surgical attention. Many technological advances have been recently introduced to improve results while decreasing the amount of surgical trauma in the treatment of coronary, valvular and aortic diseases, arrhythmia and end-stage heart failure. Arguably, the single most important quality for future cardiac surgeons will be their ability to not become entrenched in their established practices but to venture outside the operating room and seek cross-fertilisation of ideas with ancillary specialties.

General Thoracic Surgery

The introduction and rapid development of minimally invasive, video- and robotic- assisted techniques has reduced iatrogenic trauma, whilst safeguarding sound oncological principles. The NHS however, is afflicted by a critical underprovision of general thoracic surgery, leading to it having the unenviable record of one of the lowest resection and 5-year survival rates for lung cancer in Europe. To tackle this issue, the UK Government and Training Authorities are taking robust remedial actions, which include a major expansion of national training posts, probably with new entry pathways for candidates wanting to specialise in general thoracic surgery from the outset.

Congenital Cardiac Surgery

It is 50 years since the first corrective cardiac procedure was successfully performed in an infant. Surgical advances, coupled with a finer understanding of cardiac anatomy, neonatal and paediatric pathophysiology have led to many successes. Corrective congenital cardiac procedures are among the few operations which can give a near-normal life expectancy and quality of life to a child who would otherwise be surely condemned to a premature death, and the professional and personal gratification associated with such achievements is enormous. Subspecialty training in congenital cardiac surgery currently occupies two years towards the end of higher surgical training in cardiothoracic surgery.

Interested candidates can contact their local department or seek further information at: www.scts.org or www.jchst.org