Cardiothoracic Surgery Subspecialties

Adult Cardiac Surgery
Heart Transplant Program
Lung Transplant Program
VAD Program
General Thoracic Surgery
Pediatric Surgery
Esophageal Atresia Tracheoesophageal Fistula (opens new window)
Minimally Invasive Thoracic Surgery (opens new window)

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 Aortic Disease Program is 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, 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.

We have a particular interest in using retrograde cerebral blood flow to protect the central nervous system during operations on the transverse aortic arch under profound hypothermia and circulatory arrest. Techniques employing deep hypothermia, circulatory arrest, and either antegrade or retrograde cerebral perfusion for central nervous system protection are utilized on a routine basis.

Mechanical assist devices are being used with increasing frequency as a bridge to transplantation in patients with intractable heart failure. We are 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.

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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, 637 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 have the longest-living heart transplant survivor in the world (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 40 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 the 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 the 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 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 our fellows graduate with their full complement of required cases for UNOS certification.  

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

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Lung Transplant Program

The University of Minnesota's lung transplant program began in 1988. Since that time, over 450 lung transplants have been performed here. The number has been steadily growing over the years. During 2002, we performed 35 lung transplants. We average between 30 and 40 lung transplants yearly. Our patient survival and satisfaction rates have been well above the national average, reflecting 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. The database has also helped in production of many scientific manuscripts that have set the standard in the field of lung transplantation. Upon completion of their fellowship, our fellows easily exceed the UNOS qualification for lung transplant surgeons.

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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, Ken Liao, Sarah Shumway, and the director Lyle Joyce.  The team has performed in excess of 350 VAD implants since its beginning in 1995.  The faculty has a combined experience of over 60 years of research and clinical use of total artificial hearts and ventricular assist devices.  The director worked in Dr. Michael E. DeBakey’s lab in 1968, developing the very first total artificial heart ever implanted in a human.  He was the co-surgeon in the Barney Clark Jarvik total artificial heart permanent implant in 1982.  He is a founder of the total artificial heart and transplant program at the Minneapolis Heart Institute where he implanted the first Jarvik 7-70 pump in a human (who was also the first female implant in the world), and implanted the youngest child to ever have a total artificial heart. 

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.  Members of the team are serving as national principal investigators for the Ventracor LVAD FDA study.  The University is a national training site for teams that wish to be trained in the techniques of implanting Thoratec and Ventracor devices. 

Devices implanted include the Thoratec VADs, HeartMate XVE, HeartMate II, DeBakey VAD, Levitronix and ABIOMED temporary devices, Tandem Heart, and the VentrAssist centrifugal flow VAD.

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General Thoracic Surgery

The Thoracic and Foregut Surgery division 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. The varied case levels far exceed board requirements, offering exposure to complete procedures.

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Pediatric 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.

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.

In pediatric thoracic surgery, our most innovative approaches concern the spectrum of esophageal atresia, a condition in infants where the esophagus is not connected to the stomach or is improperly attached to the trachea. We are now able to achieve a true primary repair without circular myotomies or disruption of the gastroenterologic junction in all infants, even those missing virtually the entire intrathoracic esophagus. Patients from all over the world have come to the University of Minnesota for this specialized procedure. The undeniable advantages of using the child's own esophagus and our success with true primary esophageal repairs for even the longest gaps are the reason for presenting this option. By doing this, we have avoided less satisfactory esophageal substitutes that are commonly offered to parents.

For additional information, please see our esophageal atresia website.

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