Cardiothoracic Surgery (Heart Surgery)

Today, there are more adults living with congenital heart disease than children. Unfortunately, however, it is common for people born with congenital heart disease to “get lost in the healthcare system” after age 25.

Weill Cornell Medicine answers the need

An aortic aneurysm is an enlargement or dilatation of the aorta, the body’s major blood vessel responsible for carrying blood to the entire body. Aortic aneurysms tend to grow slowly. If the aorta becomes too large, it may be at higher risk for rupturing (bursting) or tearing (aortic dissection), requiring surgery to repair it.

Aortic aneurysms are frequently detected during routine medical exams, as well as a chest X-ray or an ultrasound of the heart or abdomen. Once an aneurysm has been identified, the condition is assessed to determine if surgery is necessary. If not, the condition is closely monitored.

Surgical expertise at Weill Cornell Medicine

The heart surgeons at Weill Cornell Medicine have extraordinary expertise and experience in repairing aortic aneurysms. In fact, we have one of the largest aortic surgery centers in the region and country.

We have extensive experience repairing aneurysms of the entire aorta, including:

●      Aortic root

●   Ascending aorta

●   Aortic arch

●   Descending thoracic aorta

●   Thoracoabdominal aorta

●   Abdominal aorta

Weill Cornell Medicine is unique in that it successfully performs all of these types of surgery on a routine basis. We have some of the lowest complication rates in the world.

While most hospitals perform less than 20 thoracic aortic aneurysm repairs per year, our team typically repairs 140 per year. This places us between the 98 and 99th percentile nationally for the number of procedures performed annually.

Minimally invasive surgical options

We offer minimally invasive, endovascular stent grafting (TEVAR) for aneurysm repair. This is an excellent alternative to traditional, open-heart surgery to repair many aneurysms of the thoracic aorta.

Our surgeons thread a catheter into the aorta through an artery in the groin. A stent is guided through the catheter and placed at the site of the aneurysm, where it is opened and excludes the aneurysm from the rest of the aorta. Learn more about minimally invasive heart surgery at Weill Cornell Medicine.

Aortic valve-sparing aneurysm repair: Our surgeons perform a large number of aortic valve-sparing aneurysm repairs, a procedure that allows patients to keep their own valve instead of replacing it with a prosthetic valve. This can provide a durable, life-long solution to aortic valve problems that helps avoid future operations or treatment with blood thinners.

We have had a 0% mortality associated with this operation for over 15 years and 99% of those repaired using our current technique have not needed additional aortic valve surgery.

Why choose us?

●   Our record of excellent outcomes—among the best in the nation—with very low rate of complications

●   Expertise in operating on patients with other health problems (such as diabetes, kidney problems, or others) and those who are elderly

●   Collaboration with other specialists (such as interventional radiologists and anesthesiologists) to provide seamless, high-quality care

●   Access to world-class diagnostic imaging

●   We focus on treating the patient as a whole, employing a comprehensive approach

Heart valve disorders

Heart valves are flaps of tissue that ensure that blood entering or leaving the heart moves in the right direction, with no backflow. The aortic valve is the main heart valve that controls blood flow between the heart and the rest of the body.

A heart valve can become dysfunctional in two ways: stenosis or insufficiency.

Valve stenosis is due to the inability of the heart valve to open properly. As this tightening of the heart valve becomes increasingly severe, it prevents the heart from being able to pump enough blood through the valve.

This condition can occur in the aortic valve; this is called aortic stenosis.

Valve insufficiency, or regurgitation, is due to ineffective closure of the valve that leads to blood being pumped backwards instead of forward.

Aortic insufficiency is often caused by degeneration of the aortic valve tissue or damage to the valve from other causes. Patients with aortic aneurysms may have excessive stretching of the valve, which causes insufficiency.

Weill Cornell Medicine surgical expertise

At Weill Cornell Medicine, our cardiothoracic surgeons have exceptional experience and expertise in the surgical techniques for repairing and replacing aortic valves.

Minimally invasive aortic valve replacement: Our surgeons are experiences and successful in performing traditional, open-heart surgery to replace aortic valves. Our team has also led the development of less invasive techniques, including percutaneous transcatheter valve replacement technology (TAVR and TMVR). Our team plays a leading role in the clinical trials assessing the latest percutaneous mitral and aortic valve replacement approaches, giving us more experience than most centers in these emerging new techniques.

We have achieved superior outcomes using these innovative approaches, which make valve replacement possible for many patients who otherwise would not be good candidates for conventional heart surgery.

Our physicians participated as investigators in two pivotal clinical trials, which established the effectiveness of percutaneous (transcatheter) valve surgery:

2.  The EVEREST II trial, which evaluated the percutaneous implantation of a clip that grasps and approximates the edges of the mitral valve leaflets. The percutaneous approach was associated with superior safety and similar improvements in clinical outcomes compared with conventional surgery.

View current clinical trials

Our patients benefit from:

●   Our record of excellent outcomes—among the best in the nation

●   Our surgical team works with each patient to develop an individualized, comprehensive treatment plan

●   Access to world-class imaging technology for the most accurate diagnosis possible

●   Collaboration with other specialists (such as cardiologists and anesthesiologists) to provide seamless, high-quality care

●    The research being conducted at Weill Cornell Medicine that is improving treatment techniques and care throughout the world

Cardiac (heart) tumors are most often benign or noncancerous. They have the potential, however, to become cancerous, and their presence may interfere with normal heart function and possibly cause a stroke. A cardiac tumor requires immediate and careful treatment.

Imaging and surgical expertise at Weill Cornell Medicine

The Weill Cornell Medicine Department of Cardiothoracic Surgery has exceptional experience detecting and treating benign and cancerous cardiac tumors.

Benign tumors: Our surgeons are experienced in removing benign tumors of the heart, such as myxomas and fibroelastomas. The most common benign heart tumor is a myxoma, an abnormal growth of neoplastic tissue, which can block valves or cause a stroke.

Malignant (cancerous) tumors: Malignant heart tumors—typically sarcomas—are less common and require careful consideration. Our heart surgeons are experienced in removing resectable tumors of the great vessels and the heart.

Our surgeons will review your findings with you and help guide you toward the proper treatment. Careful analysis of the imaging is required to ensure that we can perform a complete resection of the tumor.

Why choose Weill Cornell Medicine?

●   Our record of excellent outcomes—among the best in the nation—with very low rate of complications

●   Our surgical team works with each patient to develop an individualized, comprehensive treatment plan

●   Access to world-class imaging technology for the most accurate diagnosis possible

●   Collaboration with our Department of Oncology, as well as our partner hospital, Memorial Sloan Kettering Cancer Center

Coronary artery disease afflicts a large number of Americans. When cholesterol and calcium build up in the arteries (the vessels that pump blood from the heart throughout the body), this can cause blockages or “hardening” of one or more arteries. If left untreated, the blockages can cause a heart attack.

The most common surgical treatment for coronary artery disease is coronary artery bypass graft (CABG). This procedure has proven to lower the risk of future heart attack and the need for additional procedures. It has also proven to result in less chest pain (often referred to as “angina”) and a longer life expectancy.

Why choose Weill Cornell Medicine for CABG surgery?

Our outcomes are consistently among the best in New York State and routinely exceed the national average. The most current mortality rate for CABG surgery at Weill Cornell Medicine is only 0.085%.

Our patients also benefit from our:

●   Expertise in performing CABG for elderly patients (age 80 and older)

●   Expertise in performing CABG for patients with other medical conditions

●   Range of CABG surgical approaches—including traditional, open-heart surgery and minimally invasive techniques—to treat all patients

●   Access to world-class imaging technology for the most accurate diagnosis possible

●   Commitment to individualized care

CABG procedure

Before surgery, our surgical team carefully analyzes the coronary angiograms and performs ultrasound testing to determine the best approach.

During CABG surgery, the surgeon takes a blood vessel from the chest, arms, or legs and uses it to route blood around blockages in the coronary arteries in order to restore adequate blood circulation to the heart.

Our surgeons take a modernized approach to coronary bypass surgery in order to maximize the durability of this operation for our patients. Research shows that using arteries instead of veins to perform the bypass improves the durability of the bypass grafts. Many patients are candidates for CABG using multiple arterial grafts

In select cases, coronary artery bypass grafting can be performed without the use of the heart-lung machine. In this "beating heart" (also called off-pump) technique, a small vertical incision is made in the chest, and a mechanical stabilizing device is used to restrict movement of the heart so that the surgeon can perform surgery while the heart is beating. The heart maintains its own rhythm without the assistance of the heart-lung machine.

Some patients experience a sudden deterioration in heart or lung function so that the heart can no longer pump enough blood to the vital organs or the lungs cannot properly add oxygen to the blood. This serious condition may be caused by:

●   Massive heart attack

●   Viral and bacterial infection of the heart muscle (cardiomyopathy)

●   Inflammatory disorder

Weill Cornell Medicine’s state-of-the-art surgical treatment options

The surgeons at Weill Cornell Medicine’s Department of Cardiothoracic Surgery offer exceptional care to patients with advanced heart or lung deterioration.

The extracorporeal membrane oxygenation (ECMO) is a group of devices that provide extracorporeal life support to the entire body so that the heart and lungs can heal and strengthen.

These devices help take the oxygen-poor blood form the venous system of the body, infuse the blood with oxygen, and pump the oxygenated blood to the body and vital organs. The heart and lungs are kept in a resting state.

The ECMO devices (circuit) consists of a:

●   Pump that powers the circuit by pulling blood from the venous side and pushing it into the patient’s arterial circulation.

●   Tubing that connects the pump to the body. One tube carries the dark venous blood from the veins to the pump. A second tube carries the bright red oxygenated blood back to the body.

●   Oxygenator that saturates the blood with oxygen molecules, which are needed for the body to function properly.

●   Electronic control system that allows specialists to monitor and adjust the speed of the pump and the amount of blood flowing through it.

Weill Cornell Medicine’s ECMO patients benefit from:

●   Our record of excellent outcomes

●   Our surgical team works with each patient to develop an individualized, comprehensive treatment plan

●   Access to world-class imaging technology for the most accurate diagnosis possible

●   Collaboration among a wide range of specialists, which ensures the best possible recovery

Many cardiothoracic surgery centers will not operate on patients over age 80, considering them to be at high risk for complications. At Weill Cornell Medicine, we frequently treat patients over 80 with complex cases—and have garnered a reputation as experts in doing so.

Weill Cornell Medicine’s unique approach

As with all patients, the care of older patients requires a team approach. Elderly patients often have other medical conditions that need to be considered and addressed.

One of the most common complications of heart surgery for elderly patients is stroke. Our surgeons have conducted pioneering research to minimize this risk with proper blood pressure management during surgery. With this approach, we dramatically lower the potential for a stroke.

Elderly patients who require valve replacement and repair may benefit from minimally invasive percutaneous approaches that obviate the need for conventional surgery. Weill Cornell played a leading role in pivotal clinical trials establishing the effectiveness of this approach, and therefore has more expertise in this technique than many other New York-area hospitals.

Our elderly patients benefit from:

●   Our collaborative approach to patient care, which brings together a team of specialists—including cardiologists, anesthesiologists, neurologists, and others—to provide comprehensive treatment

●   Access to the entire care team at one convenient location

●   Highly communicative care team, who ensure that everyone is up to date on the care and treatment plan

●   Dedicated tam of nurses with exceptional experience caring for elderly heart surgery patients

●   Rehabilitation, nutritional guidance, social support, and other services to ensure the most successful recovery possible

Less invasive surgical techniques have transformed surgery in many fields, including cardiothoracic surgery. Smaller incisions mean less blood loss, less discomfort, a shorter hospital stay, and a faster recovery.

Weill Cornell Medicine’s Department of Cardiothoracic Surgery specializes in many minimally invasive surgical techniques. In fact, our surgeons have pioneered many of these approaches.

Our surgeons specialize in:

Transcatheter aortic valve replacement (TAVR): This minimally invasive approach repairs or replaces a diseased heart valve by threading a catheter up to the heart through a blood vessel in the groin.

Weill Cornell surgeons were leaders in the clinical trials that established this technique’s effectiveness.

Mini-sternotomy or partial sternotomy: Many procedures, such as aortic valve replacement, mitral valve repair/replacement, and aneurysm repair can be performed through a small incision and partial sternotomy. This is an alternative to traditional, “open-heart” surgery. 

Endovascular stent-graft placement for aortic aneurysms (TEVAR and EVAR): Some patients needing an aneurysm repair may be good candidates for this type of minimally invasive surgery.

The surgeon threads a catheter into the aorta through a blood vessel in the patient's groin. A stent (metal or plastic tube) is guided through the catheter and placed at the site of the aneurysm, where it opens up and acts as a scaffold to support the walls of the aorta.

Weill Cornell was chosen as one of only two centers in the New York metropolitan area to use a new, FDA-approved device, which allows for more rapid recovery.

Robotic mitral valve surgery: The mitral valve can be repaired or replaced with the assistance of a robotic system. This procedure is done through a small incision in the skin

Coronary artery bypass graft (CABG): The surgeon performs this procedure through a two- or three-inch incision between the ribs. Our surgeons conduct this operation using a specialized surgical robot and heart stabilizer developed by Weill Cornell surgeons. Some patients may have "off-pump" beating heart surgery that can be accomplished without the need for a heart-lung machine.

Percutaneous valve surgery: Percutaneous valve repair or replacement is a minimally

invasive approach that uses a catheter to repair or replace a diseased valve by threading a catheter up to the heart through a blood vessel in the groin. We are able to use this approach to replace mitral and aortic valves. 

Weill Cornell surgeons were leaders in the clinical trials that established percutaneous valve surgery’s effectiveness.

Mitral valve disorders

Heart valves are flaps of tissue that ensure that blood entering or leaving the heart moves in the right direction, with no backflow. A heart valve can become dysfunctional in two ways: stenosis or insufficiency.

The mitral valve controls blood flow between the heart and the lungs. If the mitral valve dysfunctions, the lungs can become congested with blood. Excess fluid in and around the lungs causes shortness of breath, and backed up fluid causes swelling throughout the body.

●   Mitral valve stenosis occurs when the mitral valve does not open properly. Over time, the mitral valve and supporting structures become stiffer, shorter, and tighter. This makes it harder for the valve to open and the heart to pump blood throughout the body. This disorder is most often caused by rheumatic fever and rheumatic heart disease.

●   Mitral valve insufficiency, or regurgitation, occurs when the valve does not close effectively. This can cause blood to be pumped backwards instead of forward, leaking blood into the lungs. This leads to increased fluid in the lungs and can cause high pressures in the arteries of the lungs (pulmonary arteries). If mitral regurgitation is left untreated, the heart becomes weakened, which may lead to heart failure.

Surgical options at Weill Cornell Medicine

Mitral valves can be repaired with surgery. At Weill Cornell Medicine’s Department of Cardiothoracic Surgery, our surgeons are experienced in using a variety of techniques to repair and replace all heart valves, including the mitral valve.

Mitral valve repair: Our surgeons have extensive training and experience, which enables them to repair a large percentage of mitral valves, instead of replacing them with prosthetic valves. We specialize in:

●   Repairing the mitral valve using an annuloplasty ring, which shrinks the valve to the normal size and shape. This technique reverses the stretching caused by mitral regurgitation.

●   Removing excess tissue in the mitral valve caused by mitral regurgitation and repairing the normal tissue using small sutures (stitches).

●   Repairing the mitral valve using a neochordae, a set of synthetic threads connecting the mitral valve to the surrounding structures.

Mitral valve replacement: In some cases, the mitral valve is too damaged to repair. Our surgeons offer state-of-the-art replacement options. We specialize in:

Why choose Weill Cornell Medicine for mitral valve surgery?

●   Access to state-of-the-art imaging technology that allows our surgeons to obtain three-dimensional images of the patient’s heart, which is used to determine the best surgical technique and guides the surgery

●   Our record of excellent outcomes

●   Our surgical team works with each patient to develop an individualized, comprehensive treatment plan

●   Collaboration among a wide range of specialists, which ensures the best possible recovery

Excellence in pediatric cardiac surgery

NewYork-Presbyterian Hospital/Weill Cornell Medicine has an international reputation for excellence in heart surgery for children.

Our program – in partnership with NewYork-Presbyterian, the #1 hospital in New York for 17 years running – is among the best in the nation, according to U.S. News & World Report. It was ranked #10 in the country by the publication’s 2017-2018 survey.

We offer children the best

Children with heart disorders often have multiple health problems. They also have complex needs and require immense support. At Weill Cornell Medicine, we offer highly specialized surgical options, comprehensive care, and support for the children and their families.

At Weill Cornell Medicine, we offer our patients a team-based, specialized approach to care. This means that each child receives assessment and care from a wide range of experts—all in the same convenient location. These experts may include:

●   Pediatric cardiologists

●   Pediatric gastroenterologists

●   Pediatric neurologists

●   Pediatric hematologists

●   Pediatric surgeons

●   Pediatric neurosurgeons

●   Pediatric urologists

●   Pediatric anesthesiologists

●   Intensive care specialists

Our patients also benefit from our:

●   World-class facilities

●   K-12 school within the hospital

●   Support services, including nutritionists and psychologists, to ensure that patients thrive after surgery

●   State-of-the-art imaging technology to ensure the best possible diagnosis

●   Breadth and depth of experience treating pediatric patients of all ages, from newborns to adolescents

●   Commitment to comprehensive, personalized care

Surgical options

The pediatric cardiothoracic surgeons at Weill Cornell Medicine offer the most advanced surgical options.

Conditions we treat:

●   Anomalous left coronary from the pulmonary artery (ALCAPA)

●   Aortic and subaortic stenosis and regurgitation

●   Aortopulmonary window

●   Atrial and ventricular septal defects

●   Atrioventricular canal

●   Coarctation of the aorta

●   Cor triatriatum

●   Coronary artery anomalies/coronary fistulas

●   Double outlet right ventricle

●   Ebstein's anomaly and tricuspid valve disease

●   Failing Fontan surgery

●   Heart tumors

●   Hypoplastic left heart syndrome

●   Mitral valve stenosis and regurgitation

●   Patent ductus arteriosus

●   Pulmonary atresia

●   Pulmonary stenosis

●   Pulmonary valve stenosis and regurgitation

●   Single ventricle disease

●   Tetralogy of Fallot

●   Total anomalous pulmonary venous return/pulmonary vein stenosis vascular rings

●   Transposition of the great arteries

●   Tricuspid atresia

●   Truncus arteriosus

●   Valve repair

The pericardium is a thin sac that surrounds the heart, separating it from the lungs and other organs in the chest. It is composed of two layers—an inner and outer layer—that hold fluid in between.

There are several types pericardia diseases, all of which require specialized, comprehensive care.

Pericarditis

This condition is caused by the pericardium becoming inflamed. Pericarditis can cause chest pain, changes in the heart’s rhythm (referred to as “EKG changes”), or the accumulation of fluid around the heart (pericardial effusion or pericardia tamponade).

Fluid around the heart must be drained. Weill Cornell Medicine’s Department of Cardiothoracic Surgery offers state-of-the-art techniques for draining the pericardium, including percutaneous drainage—a minimally invasive technique that uses advanced imaging technology.

Constrictive pericarditis

Chronic inflammation may lead to severe thickening of the pericardium, which restricts the heart. To treat constrictive pericarditis, cardiac surgeons at Weill Cornell Medicine perform a pericardiectomy, commonly referred to as “pericardial stripping” to maximize relief and prevent future recurrence.

Pericardial cysts

Pericardial cysts are sacs of fluid surrounded by a fibrous layer of tissue. A skilled surgeon can safely remove them, often using minimally invasive techniques.

●   Access to state-of-the-art imaging technology for the most accurate diagnosis possible

●   Our record of excellent outcomes

●   Our surgical team works with each patient to develop an individualized, comprehensive treatment plan

●   Expertise in minimally invasive cardiac surgery

●   Collaboration among a wide range of specialists, which ensures the best possible recovery

Weill Cornell Medicine is at the forefront of minimally invasive heart surgery techniques, including robotic cardiac surgery.

Endoscopic robotic heart surgery

This is a type of minimally invasive surgery that uses robotic instruments and very small incisions to operate on the heart. This is an alternative to traditional, “open heart” surgery (sternotomy).

The ability to perform surgery through tiny incisions can improve both the outcome of surgery and recovery time. Smaller incisions mean less blood loss, less post-operative discomfort, a faster recovery, and a lower risk of infection. In many cases—including mitral valve repair—the success rates using robotic surgical techniques are higher than when traditional surgery is used.

Robotic heart surgery at Weill Cornell Medicine

The Weill Cornell Medicine Department of Cardiothoracic Surgery offers endoscopic robotic surgery to patients who are good candidates for these procedures.

Our surgeons use robotic techniques to perform many types of heart surgeries, including:

●   Mitral valve repair or replacement (mostly repair)

●   Atrial septal defect closures

●   Removal of cardiac tumors (atrial myxomas for example)

●   Septal Myectomy for Hypertrophic Cardiomyopathy

●   Tricuspid valve repair or replacement

●   Coronary artery bypass (for blocked arteries to the heart)

●   Pacemaker lead placement (for heart failure)

Our patients benefit from: 

●   Our record of excellent outcomes

●   Our surgical team works with each patient to develop an individualized, comprehensive treatment plan

●   Access to world-class imaging technology for the most accurate diagnosis possible

●   Collaboration with other specialists (such as cardiologists and anesthesiologists) to provide seamless, high-quality care

●   The research being conducted at Weill Cornell Medicine that is pioneering minimally invasive and robotic surgical techniques

Atrial fibrillation is a type of arrhythmia (irregular heart rhythms) caused by irregular electrical transmissions through the heart. With atrial fibrillation, the atria (the two small upper chambers of the heart) beat chaotically, which can cause blood to pool and clots to form.

Atrial fibrillation increases the risk of:

• Stroke

• Cardiomyopathy (the inability of the heart to pump blood around the body)

• Congestive heart failure.

NewYork-Presbyterian/Weill Cornell Medical Center is a leader in diagnosing and managing arrhythmias in both adults and children.

Weill Cornell Medicine's surgical treatment options

The cardiac surgeons at Weill Cornell Medicine offer CryoMAZE—a surgical procedure for patients with atrial fibrillation who are also having an open-heart procedure.

The CryoMAZE surgery can interrupt the path of aberrant electrical impulses that cause the arrhythmia. The area around the pulmonary veins— the site where irregularities in the electrical impulses most likely form — is treated with freezing temperatures. This treatment forms a barrier that disrupts the pathway of abnormal electrical impulses, thereby curing the arrhythmia.

At Weill Cornell Medicine, our success rate for CryoMAZE is 90 percent.

Our patients also benefit from:

• Our unique post-CryoMAZE procedure follow-up program: For two years after surgery, all patients receive a heart rhythm-monitoring devise at three- to six-month intervals. The devise is worn for five consecutive days to collect data and create detailed records of the heart rhythm. This guides long-term medication management strategies.

• Our surgical team works with each patient to develop an individualized, comprehensive treatment plan

• Access to world-class imaging technology for the most accurate diagnosis possible

• Collaboration with other specialists (such as cardiologists and anesthesiologists) to provide seamless, high-quality care

Weill Cornell Medicine: Pioneers in transcatheter valve replacement surgery

TAVR is a minimally invasive approach in which a surgeon threads a catheter (thin tube) up to the heart through a blood vessel in the groin to replace the damage valve. This technique makes valve replacement possible for patients who would not tolerate conventional heart surgery.

Weill Cornell Medicine and NewYork-Presbyterian are leaders in the development this surgical technique—both for mitral and aortic valve replacement. In fact, our physicians participated as investigators in two pivotal clinical trials that established the effectiveness of percutaneous (transcatheter) valve surgery:

• The PARTNER Trial, which in 2011 demonstrated that transcatheter aortic valve implantation (TAVI) was as effective as conventional open-heart surgery for reducing mortality among high-risk patients with aortic stenosis. In 2010, PARTNER Trial investigators reported that patients who were not candidates for surgery fared much better with TAVI than patients who were treated medically. Currently, our team is conducting a new trial assessing the safety and efficacy of the SAPIEN 3 transcatheter heart valve in low-risk patients.

• The EVEREST II trial evaluated the percutaneous implantation of a clip that grasps and approximates the edges of the mitral valve leaflets. The percutaneous approach was associated with superior safety and similar improvements in clinical outcomes compared with conventional surgery.

Our physicians continue to play a leading role in the clinical trials assessing the latest percutaneous mitral and aortic valve replacement approaches, giving us more experience than most centers in these emerging new techniques.

Our TAVR patients also benefit from:

• Our superior record of excellent surgical outcomes

• Our surgeons works with each patient to develop an individualized, comprehensive treatment plan

• Collaboration with other specialists (such as cardiologists and anesthesiologists) to provide seamless, high-quality care