Cardiac Surgery
Cardiac surgery encompasses coronary artery bypass grafting (CABG), valve repair/replacement, congenital heart defect correction, and aortic procedures. CSTs manage cardiopulmonary bypass circuits, cardioplegia delivery systems, specialized cardiac retractors, and precise vascular instrumentation. Cases demand meticulous anticoagulation management, temperature control, and coordination between surgical, perfusion, and anesthesia teams.
Role of CSTs
- Prepare cardiopulmonary bypass circuits and cardioplegia delivery systems
- Manage specialized cardiac retractors and valve exposure instruments
- Support vascular anastomosis with fine instrumentation and tying platforms
- Coordinate anticoagulation protocols and ACT monitoring equipment
- Handle grafts, patches, and prosthetic valve materials
- Maintain sterile technique during on-pump and off-pump procedures
- Assist with pacing wires, chest tubes, and mediastinal drainage systems
Essential Skills
- Proficiency with cardiac retractors and valve exposure systems
- Knowledge of cardiopulmonary bypass components and priming sequences
- Understanding of cardioplegia solutions and myocardial protection
- Safe handling of grafts and prosthetic valve materials
- Coordination of anticoagulation monitoring and reversal agents
- Familiarity with pacing wire placement and temporary cardiac pacing
- Management of temperature control during hypothermic procedures
Common Procedures
- Coronary artery bypass grafting (CABG) – on-pump and off-pump
- Aortic valve replacement
- Mitral valve repair/replacement
- Tricuspid valve repair
- Aortic root replacement
- Mitral valve annuloplasty
- ASD/VSD closure
- Left ventricular assist device (LVAD) implantation
Instruments & Equipment
Instruments
- Cardiac retractors (Cooley, Favaloro, Delicate)
- Valve retractors and annulus sizers
- DeBakey vascular forceps and scissors
- 6-0, 7-0 polypropylene suture materials
- Coronary probe and shunt instruments
- Tying platforms and Castroviejo needle drivers
- Skin hooks and fine tissue forceps
- Argon beam coagulator with cardiac tips
Equipment
- Cardiopulmonary bypass machine and oxygenator
- Cardioplegia delivery system
- Intra-aortic balloon pump (IABP)
- Transesophageal echocardiography (TEE) probes
- Temporary pacing wire generators
- Cell saver and rapid infusion systems
- Temperature probes (nasopharyngeal, bladder, rectal)
- ACT (activated clotting time) monitoring devices
Workflow & Case Progress
- Prepare bypass circuit, cardioplegia system, and specialized cardiac instruments
- Support sternotomy and pericardiotomy with appropriate retractors
- Assist with aortic cannulation and venous return line placement
- Manage cardioplegia delivery and myocardial protection during aortic cross-clamp
- Support coronary anastomosis or valve procedures with fine instrumentation
- Coordinate weaning from bypass and aortic cross-clamp removal
- Place pacing wires, chest tubes, and mediastinal drains
- Support chest closure with sternal wiring and layered reconstruction
Sterile Technique Considerations
- Bypass circuits require dedicated sterile preparation zones
- Cardioplegia lines must maintain sterile integrity during connection
- Grafts demand glove change before handling and placement
- Multiple access sites increase cross-contamination risk between teams
- Perfusion equipment creates condensation—manage drape protection
- Extended pump times require fresh sterile supplies and glove changes
Career Pathways
- Cross-training in Vascular Surgery and Thoracic Surgery
- Certification in perfusion technology assistance
- Specialization in adult congenital heart surgery
- Leadership roles in cardiac OR teams
- Education and precepting for cardiac surgical programs
- Research involvement in minimally invasive cardiac techniques
How to Prepare
- Study cardiopulmonary bypass principles and circuit components
- Practice cardiac retractor systems and valve exposure techniques
- Learn cardioplegia delivery and myocardial protection protocols
- Review graft preparation and vascular anastomosis workflows
- Familiarize with pacing wire placement and temporary cardiac pacing
- Build knowledge of anticoagulation monitoring and ACT management