Department of Cardiothoracic Surgery

urgeons of the Department of Cardiothoracic Surgery offer expertise in every major area of cardiothoracic surgery, performing procedures designed to correct a wide variety of congenital and acquired cardiac abnormalities in adult and pediatric patients. Cardiac transplantation, mechanical assist devices, and aortic aneurysm surgery are among the many fields in which our staff are intensively involved. While many cardiothoracic programs excel in one or more of these technologies, expertise in such a broad range of therapies is unusual even among academic health science centers. Teams of our cardiothoracic surgeons travel the world to perform cardiac surgery in children, bringing advanced technological developments to nations like Russia and the People's Republic of China as part of the academic exchange of information.

Surgical procedures for adult patients include operations for coronary disease and valve pathology. In addition, as The Mount Sinai Hospital is a tertiary referral center with a reputation for handling difficult problems, complex ischemic and valve cases are routine. The development of valve salvage techniques has allowed many valves to be repaired rather than replaced. In fact, for patients with mitral insufficiency resulting from an isolated defect in the posterior leaflet, repair can be achieved in over 90 percent of cases.

Many procedures, including aortic valve replacement, mitral valve replacement, and mitral valve repair, are now performed using "minimally invasive" approaches with small incisions. A rapidly growing part of this effort is off-pump coronary artery bypass (OPCAB) procedures for patients with suitable coronary anatomy. These less invasive procedures have reduced hospital costs and shortened length of stay and offer patients more rapid and less painful recovery.

For two decades, surgery of complex thoracic aortic and thoracoabdominal aneurysms has been a special interest of cardiothoracic surgeons at Mount Sinai. Some 150 thoracic aortic procedures are carried out here each year, more than in any other center in the northeastern United States. In addition, the Department maintains the world's largest database of thoracic aortic aneurysms that do not yet require surgery, allowing careful follow-up to determine the natural history of aneurysms and the optimum timing of surgical intervention. Through studying data and trends, we have developed an equation to calculate the probability of rupture, allowing surgery to be carried out on a timely basis. Over the past several years, substantial advances in techniques of cerebral and spinal cord protection have reduced the risk associated with major aortic surgery. Patients with acute and chronic forms of aortic aneurysmal disease have an improved outlook because of advances in clinical care arising from clinical research supplemented by an active laboratory research program supported by the National Institutes of Health.

Our surgeons also have vast experience with various surgical options to improve life expectancy and quality of life for patients with intractable congestive heart failure (CHF). Despite severe ventricular dysfunction, patients with CHF who have a substantial amount of viable myocardium may benefit from coronary bypass surgery, and when mitral valve disease is the primary cause of cardiac failure, valve replacement or repair operations may bring about symptomatic and functional improvement. Cardiac replacement, either by transplantation or with a mechanical ventricular assist device, is an alternative for select patients with end-stage heart failure when there are no other reasonable options.

Over 200 cardiac transplant procedures have been performed at Mount Sinai, about 25 - 30 each year, with a survival rate that is among the best in the nation. When appropriate, the Novacor® left ventricular assist device can provide a crucial "bridge" to transplantation. This portable electronic device may also be a long-term solution for patients who are not otherwise suitable candidates for transplantation.

As a referral center for complex cardiac disease, our Department encounters the entire spectrum of congenital cardiac pathology. While repair of atrial and ventricular septal defects is routinely accomplished using modified small sternotomy incisions, more complex anatomical defects may require staged operations. In these cases, transfusion is often avoided, even in small children, and modern techniques allow a shorter length of stay and a speedier recovery. An active fetal monitoring program enhances the coordination between pediatric cardiologists and cardiac surgeons to ensure comprehensive care for newborns with congenital heart disease that may entail surgical intervention shortly after birth. The program is one of just two centers in the state of New York to offer pediatric cardiac transplantation. Extracorporeal membrane oxygenator support is available as an adjunct to other forms of ventricular assist.

Even the most skillful surgeons cannot act alone. Ours rely on an outstanding team of cardiovascular anesthesiologists, specialized cardiothoracic surgical intensivists, nurses, and a large support staff of biomedical engineers, perfusionists, and technologists. These individuals are integrated into the Cardiac Care Center, Mount Sinai's "heart hospital within a hospital" that "brings it all together" for patients with diverse needs with the full array of cardiovascular technologies.

For more information about the training, research, and patient care programs of the Department of Cardiothoracic Surgery, to discuss a patient with one of our attending cardiac surgeons, or to schedule an operation, contact 212-241-8181.