Cardiothoracic Surgery Overview

Cardiothoracic Surgery involves the surgical treatment of diseases affecting organs inside the thorax generally treatment of conditions of the heart and lungs. Cardiothoracic surgeons will also undertake training in the management of chest wall and oesophageal pathologies. Cardiothoracic surgery in Ireland is currently delivered in 6 public hospitals and 4 private hospitals.

Cardiothoracic training is undertaken in a 6 year Specialty Training Programme (ST3 – ST8). During this time an appointed trainee will be expected to spend some time in each of the approved public cardiothoracic surgical units to acquire a rounded knowledge of the specialty. At a minimum Specialist trainee’s will spend three years doing adult cardiac surgery, six months doing thoracic surgery and six months in Paediatric cardiothoracic surgery.

Specialty trainees then have the option of focusing their training on a sub-specialty in cardiothoracic surgery i.e. adult cardiac, adult thoracic, transplantation or congenital cardiothoracic surgery. At the current time there are no subspecialty divisions on the Irish Medical Council cardiothoracic register, however in other jurisdictions such as the United Kingdom trainees can train towards sub-specialist recognition i.e. congenital or thoracic. In Ireland at present most consultant cardiothoracic surgeons have a specialist interest (adult cardiac, adult thoracic, congenital or transplantation) and they may practice across the sub-specialties. However in recent years some consultants have been appointed into single sub-specialty clinical practice i.e. thoracic surgery.

Cardiothoracic sub-specialty training:

• Adult cardiac specialist are expected to do a minimum of 4 years of adult cardiac surgery training and will frequently undertake specialist training in areas such as mitral repair, aortic root surgery, minimal invasive surgery or hybrid procedures (TAVI, TEVR).
• Thoracic specialist is expected to do a minimum of 2 years of adult thoracic training, which may include oesophageal surgery. They will frequently do specialist training in thoracic oncology, VATS surgery or robotics.
• Transplantation specialist is expected to do a minimum of one year in thoracic organ transplantation and they may focus on heart or lung transplantation depending on their other area of interest (thoracic or cardiac surgery).
• Congenital cardiothoracic trainees are expected to spend a minimum of three years doing congenital cardiothoracic training. Often 1-2 of these years is done post Higher Surgical Training as a fellow.

Adult cardiothoracic surgery is performed at the Mater Misericordiae University Hospital, St James’s Hospital, St Vincent’s Hospital (Thoracic), Cork University Hospital and Galway University Hospital. The Heart and Lung transplantation Program and the ventricular assist program are delivered in the Mater Misericordiae University Hospital. All Paediatric cardiothoracic surgery is performed in Our Lady’s Children’s Hospital, Crumlin. The various programmes report their results to the society of cardiothoracic surgery of Great Britain and Ireland and NICOR, which allows the results to be compared with international units. The results are published annually and online.