Cardiothoracic Surgery

surgery cardiothoracic

Sections & Subspecialties

  • Adult Cardiac Surgery
  • Heart Transplant Program
  • Lung Transplant Program
  • VAD Program
  • Thoracic and Foregut Surgery
  • Congenital Heart Surgery  

Adult Cardiac Surgery

The majority of procedures performed by the cardiothoracic surgical fellows at University of Minnesota Medical Center, division of Fairview and affiliated hospitals are in the field of adult cardiac surgery. Operations to revascularize the myocardium are the single most common procedure performed during the fellowship. While the American Board of Thoracic Surgery requires far fewer revascularization cases than the number completed during our program, the general consensus is that a far larger amount of experience is required to become competent and proficient at performing such surgeries.

This field is changing constantly; multiple arterial revascularization is becoming routine, and surgeons are expanding their search for long-lasting conduits (internal mammary artery, radial artery, gastroepiploic artery). Minnesota surgeons are in the forefront of innovations in these areas. Thus, the relatively large number of myocardial revascularization procedures performed by the fellow as the operating surgeon constitutes the basis for the transition between fellowship and independent clinical practice.

Operations for valvular heart disease and diseases of the great arteries comprise a large proportion (about 25%) of the fellow's experience. A significant amount of time during didactic lectures and conferences is devoted to this subject. Our diverse faculty have expertise in different areas, but repair of mitral regurgitation and stenosis, as well as mitral chordal preservation during mitral valve replacement, have become common practice. We have vast experience with homograft replacement of the aortic valve and proximal aortic root. Many patients are undergoing aortic valve sparing and ascending aortic aneurysm resection.

The recently organized TAVR and endovascular programs are an integral part of our world-renowned cardiovascular and thoracic surgery program. Teaming with faculty in Vascular Surgery, Cardiology, and Radiology, this multidisciplinary staff specializes in the diagnosis, treatment, and surgery for diseases and disorders of the aorta, aortic valve, great arteries, and major blood vessels.

Valve repair for aortic and mitral valve pathology is commonly performed by our surgeons, employing innovative techniques of leaflet excision, chordal replacement, annuloplasty, and valve resuspension. Valve sparing aortic root replacement, as well as homograft replacement of the aortic valve and root, are also frequently performed. Thoracic aortic aneurysm repair is also an area of great interest.

Mechanical assist devices are being used with increasing frequency as a bridge to transplantation in patients with intractable heart failure. We were one of the leading centers in REMATCH trial (Randomized Evaluation of Mechanical Assistance for the Treatment of Chronic Heart Failure). Surgery for hypertrophic cardiomyopathy has also expanded at our institution.

Heart Transplant Program

The University of Minnesota's heart transplant program began in 1978. We are one of the largest and most successful programs in the United States. To date, 774 heart transplants have been performed here. Our patient survival rates at one year, three years and five years are all above the national average. We had the longest-living heart transplant survivor in the world at over 27 years. We performed the first heart transplant and the first heart-lung transplant in the upper Midwest region. Being the most active program in the upper Midwest region, we constantly draw transplant referrals from the nearby five states. We have gained a reputation for taking on challenging patients who were turned down at other centers and still achieve excellent survival rates. Our program has been recognized as the regional Center of Excellence in Heart Transplant by the third party payers. Currently, we perform about 30 heart transplants annually. This places our program among the top 10-15% in the nation. Our medical center is committed to a 20% annual increase in our heart transplant volume in the next few years.

Cardiac surgeons and transplant cardiologists at our program work closely to provide state-of-art care for heart transplant patients. A multidisciplinary team approach to care is provided in patient screening, pre-operative monitoring, donor procurement, immediate postoperative care, immunosuppression, and rejection monitoring. We have a vast experience that allows us to perform complex heart transplants. The majority of our transplant recipients had previous open heart surgeries and over 30% of our recipients had a left ventricular assist device as a bridge to transplant. We also have the expertise to perform heart-kidney transplant and redo heart transplants. We apply innovative surgical techniques to the modern era of heart transplant. We apply advanced multi-modalities to treat post transplant right heart failure and pulmonary hypertension including early administration of Nitric Oxide and insertion of right ventricular assist device.

We have an active surgical practice built around our successful heart transplant program including high risk CABG, valve repair/replacement, redo surgery and LV reconstruction with various ventricular assist device backup. We participate in multiple heart transplant clinical trials. The attending surgeons in our program are fully committed to training the fellows to become a UNOS certified transplant surgeon. Our fellows enjoy a complete transplant experience from being independent during donor procurement, operating as a co-surgeon in the OR and to making critical decisions in the ICU management. One of the unique features in our program is that most of our fellows graduate with their full complement of required cases for UNOS certification of primary surgeon or 1st assist on 20 or more heart and/or heart/lung transplants and primary surgeon or 1st assistant on 10 or more heart or heart/lung procurements.

Our heart transplant surgeons are Ranjit John, MD, Gabe Loor, MD, Sara Shumway, MD and Kenneth Liao, MD (Surgical Director).

Lung Transplant Program

The University of Minnesota’s Lung Transplant Program began in 1986. Since that time, over 700 lung transplants have been performed here. The number has been steadily growing over the years. During 2011, we performed 22 lung transplants. We average between 20 and 30 lung transplants on an annual basis. Our patient survival and satisfaction rates have been well above the national average. This reflects the dedication and determination of each and every member of our team to provide the best possible care. We maintain a detailed database, the key to systematic review and subsequent modifications of surgical and medical treatments. Protocols are reviewed yearly. The database has also helped in the production of many scientific manuscripts that have set the standard in the field of lung transplantation. Upon completion of their fellowship, majority of our fellows meet the UNOS qualification for lung transplant surgical certification of primary surgeon or first assistant on 15 or more lung and/or heart/lung transplant procedures and primary surgeon or first assistant on 10 or more lung procurement procedures.

Our lung transplant surgeons are Gabe Loor, MD, Sara Shumway, MD, and Rosemary Kelly, MD, who serve as co-directors of this service

VAD Program

Our division has established itself as one of the leading cardiac Ventricular Assist Programs in the country with 50 – 60 implants performed each year. The experience with ventricular assist devices has brought with it the various other surgical treatments for congestive heart failure as well.

The faculty consists of Drs. Ranjit John (Surgical Director), Ken Liao, and Sara Shumway. The team has performed in excess of 660 VAD implants since its beginning in 1995.

The University was a lead the enrollment in the landmark REMATCH trial that demonstrated the efficacy of using left ventricular assist devices as permanent (destination) therapy rather than as a bridge to transplant. Our program has been a leader in clinical evaluation of several second and third generation continuous flow pumps. The University is a national training site for teams that wish to be trained in the techniques of implanting Thoratec devices.

Devices implanted include the Thoratec VADs, HeartMate II, Levitronix, HeartWare, Berlin Heart (pediatric), SynCardia, and the Tandem Heart.

General Thoracic Surgery

The Division of Thoracic and Foregut Surgery, under the direction of Dr. Rafael Andrade, specializes in comprehensive diagnostic, surgical and therapeutic training with pulmonary, tracheal, and esophageal disorders. Our primary focus is on minimally invasive pulmonary and esophageal treatment, with a full range of thoracoscopic, diagnostic procedures for our fellows.

The varied case levels far exceed board requirements, offering exposure to complete procedures. In reviewing case volume for the calendar year of 2012, the expected procedures include 92 lung resections, 14 esophagectomies, 51 Nissen, and 168 miscellaneous cases. Clinical interests of the faculty include esophageal surgery, minimally invasive thoracic surgery, interventional airway and foregut endoscopy, endobronchial ultrasound, endoscopy ultrasound, diaphragm paralysis and hyperhidrosis treatment.

Congenital Heart Surgery

The pediatric cardiovascular program began at the University of Minnesota with the pioneering work of C. Walton Lillehei in 1953. This program provides an unusually wide exposure to pediatric cardiothoracic disease including the full range of operations. This includes complete repair for AV canal, Tetralogy of Fallot, transposition of the great arteries, heart transplantation, the Norwood procedure, and procedures for adult congenital repair. Recent innovations include use of the Berlin heart in appropriate candidates as a bridge to transplantation or recovery.

Current surgical innovations in the management and repair of children born with functional single ventricle are strong at the University of Minnesota. This includes efforts for biventricular repair in patients in which hypoplastic ventricles are induced to grow, the Norwood procedure, and heart transplantation as well. Currently, our greatest success in inducing hypoplastic ventricles to grow has been in individuals with pulmonary atresia and intact septum or unbalanced AV canal defects.


Fellowship

Our division provides the ideal environment to facilitate training cardiovascular and thoracic surgery residents, general surgery residents, and medical students in the discipline of cardiovascular and thoracic surgical sciences. Read about our Cardiothoracic Surgery Fellowship program.

C. Walton & Richard C. Lillehei Surgical Society

In 1986, the Lillehei Surgical Society was founded to honor and perpetuate the contributions of the three Lillehei brothers, C. Walton, Richard, and James, to the field of cardiovascular care. In 1987, The Lillehei Surgical Society created and funded the Land Grant Chair at the University of Minnesota.

Currently, the membership includes more than 200 first, second, and third generation Lillehei trained cardiovascular and thoracic surgeons, as well as principals in the biomedical product and service industry. The Society offers an annual membership meeting and social function. Also, on a bi-annual basis, a Scientific Symposium is held to interact first hand with leaders in the international cardiovascular and thoracic community. These events are held to coincide with the date and location of the annual Society of Thoracic Surgeons meeting.

For information regarding membership requirements, please contact:

Kira Lillehei
Executive Director
1660 South Highway 100, Suite 500
St. Louis Park, MN 55416
Phone: (952) 641-1575
Email: Kira@lilleheisurgicalsociety.org
www.lilleheisurgicalsociety.org

History

Rarely, if ever, does a large specialty arise at a single institution to the extent that cardiac surgery did at the University of Minnesota. The specialty's history began long before the university's Division of Cardiovascular and Thoracic Surgery, or even the national Thoracic Surgery Boards were established. Up to 1950, the only operations done in this area were extra-cardiac procedures, such as ligation of patent ductus arteriosus, repair of coarctation of the aorta, or placement of systemic pulmonary artery (Blalock-Taussig) shunts. At the University of Minnesota, however, several surgeons not only dreamed about operating inside the heart, but set about making it a reality.

The obvious stumbling block to intra-cardiac repairs was the ability to support the patient while the heart and lungs were isolated from the circulation. Drs. Clarence Dennis and Richard Varco developed a cardiopulmonary support device; the first two patients placed on bypass were operated on in 1951. Unfortunately, from the combination of lack of accurate preoperative diagnosis and an easily avoidable technical failure on the part of the bypass machine technician (a surgery resident), neither patient survived, so such operations were put on hold.

The world's first successful open-heart procedure was carried out by Dr. F. John Lewis at the University of Minnesota in 1952. Using the technique of hypothermia and inflow occlusion, he did open repairs of secundum-type atrial septal defects without severe complications in about 20 patients from 1952 to 1953. Without an effective means of supporting the patients' circulation, however, only very simple defects could be repaired.

In Philadelphia, Dr. John Gibbon continued to work on a cardiopulmonary bypass system. In 1953 he was the first to successfully repair an atrial septal defect on support. Unfortunately, he was not able to repeat this feat, leaving mechanical cardiopulmonary bypass still unproven. The apparent difficulties in achieving reliable, safe cardiopulmonary bypass led a team of Minnesota surgeons (including Drs. C. Walton Lillehei, Richard L. Varco, Morley Cohen, and Herbert Warden) to use cross-circulation to provide support. With this technique, a blood-matched donor served as the heart-lung machine for the patient. Cross-circulation proved very effective and enabled a string of firsts in repair of lesions. The first closure of a ventricular septal defect, the first repair of an atrioventricular canal, and the first correction of tetralogy of Fallot were all accomplished in 1954. Although some of these patients died, the difficulties lay in the cardiac repair rather than in the means of support.

The cross-circulation operations proved that complex intra-cardiac repairs could be carried out. Efforts continued to develop a perfusion system. The first clinically reliable bubble oxygenator, developed by Drs. Richard DeWall and C. Walton Lillehei in 1955, provided the next breakthrough in cardiac surgery. Now the field was wide open, and many lesions could be repaired. Not only were a number of intra-cardiac lesions first corrected at the University of Minnesota, but the wherewithal was developed to accomplish this elsewhere.

Other major technological advances began at the University of Minnesota. An occasional consequence of open-heart repairs was, and is, the creation of temporary or permanent heart block. The first clinically usable pacemaker was designed by Earl Bakken while working with the cardiac surgeons at the University of Minnesota. The success of this original pacemaker led Bakken to found Medtronic, the number one pacing corporation in the world today. Subsequently, "Medical Alley" was formed as other companies have spun off locally as new technological advances were made.

Although heart transplantation did not begin at the University of Minnesota, the two pioneers received their cardiac surgery education here at our institution. Dr. Christiaan Barnard accomplished the world's first heart transplant in Capetown, South Africa, while Dr. Norman Shumway, from Stanford University, performed the first heart transplant in the United States and made it a clinically useful procedure.

When cardiac surgery became routine at countless hospitals, major breakthroughs were more difficult to come by. Nevertheless, more advances occurred at the University of Minnesota. Improvements in heart valves were made. The tilting disc valve prosthesis (Lillehei-Kaster) was developed here and proved to be a significant advance over the older poppet-style valves. The first bi-leaflet mechanical valve (St. Jude) was designed by a Minnesota engineer and first evaluated experimentally and clinically at the University of Minnesota.