Welcome to East Tennessee Cardiovascular Surgery Group

Aortic surgery refers to surgery involving the aorta – the large artery that leaves the heart and provides oxygen-rich blood throughout the body. Many diseases and conditions can cause the aorta to dilate (widen) or can cause aortic dissection (tear).

Aortic Aneurysm

Aortic aneurysms can occur as a result of atherosclerotic disease, infection, degenerative change or an inherited condition such as Marfan’s Syndrome. These abnormal dilations or enlargement in the wall of the aorta (the main blood vessel leading away from the heart) are progressive and develop the risk of rupture over time. Treatment involves aggressive control of hypertension and eventual surgical management with graft replacement or repair.

Aortic Dissection

Occasionally as a result of atherosclerotic, degenerative, or genetic predisposition (Marfan’s Syndrome), the layers of the aortic wall will become thin and fragile and then tear and separate resulting in a disease process known as aortic dissection. The management of acute aortic dissection involves urgent graft replacement of the diseased segment as above. Occasionally patients may have long-standing separation of layers known as chronic dissection and under certain circumstances will also require resection and replacement of the diseased aorta to prevent complications of end organ failure and rupture.

Aortic Valve Replacement

Aortic valve replacement is either an open heart procedure or a minimally invasive procedure. In an aortic valve replacement surgery, the damaged valve is removed and replaced with an artificial valve (mechanical or tissue). Several different types of replacement valves are available. Aortic valve replacement is performed by cardithoracic surgeons for treatment of narrowing (stenosis) or leakage (regurgitation) of the aortic valve.

Arch Reconstruction

The great vessels which include branches of the arch of the aorta may become closed up with atherosclerosis resulting in shortages of blood supply to the brain, spinal cord and upper extremities. These difficulties are frequently managed by surgical correction involving replacement or repair of one or more branches of the aortic arch.

The MAZE procedure is performed on the left and right atrium for the treatment of atrial fibrillation.

Atrial fibrillation is an abnormality of the electrical system of the heart. Normally, the heartbeat is triggered by an electrical impulse which starts in a node in the right atrium of the heart – this is the normal “pacemaker” of the heart.

Atrial fibrillation occurs when this electrical impulse no longer travels in the normal manner. Instead, the impulse is “side-tracked” and the atrium is no longer triggered evenly and in synchrony, but is triggered one small region at a time. The atrium no longer contracts in a coordinated manner, but instead it fibrillates irregularly. The electrical signal is therefore irregular and so the heartbeat is irregular, too.

CABG surgery is advised for selected groups of patients with significant narrowing and blockage in the heart’s arteries (coronary artery disease). CABG surgery creates new routes around narrowed and blocked arteries, allowing sufficient blood flow to deliver oxygen and nutrients to the heart muscle.

Mitral valve repair is an open heart procedure to treat stenosis (narrowing) or regurgitation (leakage) of the mitral valve.

The mitral valve is the “inflow valve” for the left side of the heart. Blood flows from the lungs, where it picks up oxygen, and into the heart through the mitral valve. When it opens, the mitral valve allows blood to flow into the heart’s main pumping chamber called the left ventricle. It then closes to keep blood from leaking back into the lungs when the ventricle contracts (squeezes) to push blood out to the body.

OPCAB is a coronary artery bypass graft (CABG) done without putting the patient on the heart-lung machine. Off-pump CABG permits surgery on multiple vessels within the heart by mechanically stabilizing it.

Off-pump surgery is minimally invasive, as compared to surgery on the heart-lung machine. The potential benefits include shorter hospital stay, less bleeding, less chance for infection, less risk of irregular heartbeats (arrhythmia), less trauma, shorter recovery time, and greater cost effectiveness.

The Ross operation is an open heart procedure performed with the assistance of the heart-lung machine. After the patient is hooked up onto the machine and the heart stopped, the pulmonary valve is harvested.

The diseased aortic valve is then excised, and the harvested pulmonary valve is implanted in a manner very similar to the aortic homograft implantation. The right ventricle outflow tract (from which the pulmonary valve was removed) is now reconstructed using a biologic tissue valve or human homograft valve.

If the disease is more extensive and involves a part of the aortic root too, the operation can be modified to excise the damaged portion of the aortic valve and use the pulmonary valve and artery to replace it.

Since the Ross procedure involves removing the native pulmonary valve, a replacement must be put back in place. Choices include 1) using a bioprosthetic valve, 2) an aortic homograft (the aortic valve harvested from a human cadaver), or 3) a pulmonary homograft. The pulmonary homograft is often preferred because it is nearly identical to the valve that it replaces.

Download Our Ross Procedure Packet

TMR is a surgical procedure aimed at improving blood flow to areas of the heart that were not treated by angioplasty or surgery.

A specialized laser is used to create small channels in the heart muscle, improving blood flow in the heart. The procedure is performed through a small left chest incision or through a midline incision. TMR can also be performed using a robotic approach. Frequently, TMR is performed with coronary artery bypass surgery, but occasionally it is performed independently.

Download our TMR Information Packet

During coronary artery bypass graft surgery (CABG), a segment of a healthy blood vessel (an artery or vein) is taken from another part of the body and used to create a detour or bypass around the blocked portion of the coronary artery. That process is called vein harvesting.

Traditionally, vein harvesting is accomplished through a lengthy surgical incision in the leg. However, a less invasive method called endoscopic vein harvesting (EVH) is the preferred method of vein harvesting among centers that are properly equipped.

Traditional vein harvesting requires an incision to remove the blood vessel being used for the bypass graft, leaving the patient with a long scar. By contrast, EVH requires one to three small incisions, each less than one inch in length.

In addition to avoiding scar tissue, patients undergoing EVH are also less likely to experience complications and usually have shorter recovery times. Because of these advantages, more bypass procedures are being performed using endoscopic vein harvesting. Most people who require a bypass operation are candidates for EVH.

Endovascular surgery is a form of minimally invasive surgery that was designed to access many regions of the body via major blood vessels and to treat diseases of the thoracic aorta, most often an aortic aneurysm.

Aortic aneurysms can occur as a result of atherosclerotic disease, infection, degenerative change or an inherited condition such as Marfan’s Syndrome. These abnormal dilations, or enlargement in the wall of the aorta (the main blood vessel leading away from the heart), are progressive and develop the risk of rupture over time.

Treatment involves aggressive control of hypertension and eventual surgical management. Endovascular surgical repair involves the delivery of a covered stent within the diseased aorta through a small incision in the groin. Aneurysms of the aorta in the chest can be treated in this manner in appropriate candidates.

MIDCAB is a surgical treatment for coronary heart disease that is a less invasive method of coronary artery bypass surgery (CABG). MIDCAB gains surgical access to the heart with a smaller incision than other types of CABG.

MIDCAB is a form of off-pump coronary artery bypass surgery (OPCAB), performed “off-pump” (without the use of cardiopulmonary bypass machine). MIDCAB differs from OPCAB in the type of incision used for the surgery; with traditional CABG and OPCAB a median sternotomy (dividing the breastbone) provides access to the heart; with MIDCAB, the surgeon enters the chest cavity through a mini-thoracotomy (a two to three inch incision between the ribs).

Minimally invasive mitral valve repair surgery is performed through a small incision, often using specialized surgical instruments. The incision is two to four inches instead of an eight inch incision required for traditional surgery.

The benefits of minimally invasive mitral valve surgery may include: reduced pain, reduced blood loss, reduced risk of infection, shorter hospital stay, faster recovery, faster return to work, less scarring and improved post-surgery appearance.

Robotically-assisted mitral valve surgery is a type of minimally invasive surgery during which we use a specially-designed computer console to control surgical instruments on thin robotic arms. The robotic arms are introduced through a one inch incision in the right side of the chest.

The surgeon’s hands control the movement and placement of the endoscopic instruments to open the pericardium (thin sac that surrounds the heart) and to perform the procedure. Robotically-assisted mitral valve surgery provides us with an undistorted, three-dimensional view of the mitral valve, leaflets and subvalvular structures with the use of special camera. This approach enables us to perform complex repairs without the need for division of the breast bone (sternum) or spreading of the ribs, in most cases.

OPCAB is a coronary artery bypass graft (CABG) done without putting the patient on the heart-lung machine. Off-pump CABG permits surgery on multiple vessels within the heart by mechanically stabilizing it.

Off-pump surgery is minimally invasive, as compared to surgery on the heart-lung machine. The potential benefits include shorter hospital stay, less bleeding, less chance for infection, less risk of irregular heartbeats (arrhythmia), less trauma, shorter recovery time, and greater cost effectiveness.

TMR is a surgical procedure aimed at improving blood flow to areas of the heart that were not treated by angioplasty or surgery.

A specialized laser is used to create small channels in the heart muscle, improving blood flow in the heart. The procedure is performed through a small left chest incision or through a midline incision. TMR can also be performed using a robotic approach. Frequently, TMR is performed with coronary artery bypass surgery, but occasionally it is performed independently.

Download our TMR Information Packet

Bronchoscopy is a technique of visualizing the inside of the airways in the lungs. A bronchoscope is inserted into the airways, usually through the nose or mouth, or occasionally through a tracheostomy. This allows us to examine the patient’s airways for abnormalities such as foreign bodies, bleeding, tumors, or inflammation.

Specimens may be taken from inside the lungs, such as biopsies, fluid (bronchoalveolar lavage), or endobronchial brushing.

The main types of lung cancer are small cell lung carcinoma and non-small cell lung carcinoma. This distinction is important because the treatment varies; non-small cell lung carcinoma (NSCLC) is sometimes treated with surgery, while small cell lung carcinoma (SCLC) usually responds better to chemotherapy and radiation.

Mediastinoscopy is a surgical procedure to examine the inside of the upper chest between and in front of the lungs.

During the surgery, a small incision is made in the neck just above the breastbone or on the left side of the chest next to the breastbone. Then a thin scope is inserted through the opening. A tissue sample (biopsy) can be collected and examined under a microscope for lung problems, such as infection, inflammation, or cancer.

• Esophageal cancer
• Lung cancer
• Paralyzed diaphragm
• Thymus tumors
• Other mediastinal tumors

Esophageal cysts are rare congenital malformations that occur in the esophagus.

Esophagectomy is a surgical procedure to remove some or all of the esophagus and then reconstruct it using part of another organ, usually the stomach.

Esophagectomy is a common treatment for advanced esophageal cancer and is used occasionally for Barrett’s Esophagus if aggressive precancerous cells are present. This procedure may also be recommended for noncancerous conditions when prior attempts to save the esophagus have failed.

Diaphragm plication is a surgical procedure to treat damage or paralysis of the diaphragm. The procedure involves repositioning and/or reshaping the diaphragm to expand lung capacity and improve breathing difficulties caused by these conditions.

Lung resection is a surgical procedure performed to remove all or part of the lung. It is typically performed to treat an infection or disease of the lungs such as cancer, emphysema, or bronchiectasis.

Types of resections include:

• Pulmonary Lobectomy – a surgical operation where a lobe is removed to remove a portion of diseased lung, such as early stage lung cancer. In addition to cancer, a lobectomy can also help to treat a fungal infection, emphysema and tuberculosis
• Segmentectomy – surgery to remove part of an organ or gland. It may also be used to remove a tumor and normal tissue around it
• Wedge – removal of a triangle-shaped slice of tissue of the lung to remove a localized portion of diseased lung, such as early stage lung cancer

Mediastinal tumors include thymomas, lymphomas, germ cell tumors and cysts that appear in the space between your lungs, called the mediastinum. These tumors may be malignant (cancerous), but they’re usually benign (noncancerous). Surgery is the most common treatment.