Mission Statement
The Cardiothoracic Surgery Service at Naval Medical Center San Diego offers state-of-the-art surgical procedures for the comprehensive treatment of chest diseases for active and retired members of the military and their families.
Surgeons Alfredo Ramirez, MD, Theodore Pratt, MD, and Joshua Kindelan, MD, lead several large multi-specialty teams dedicated to the treatment of diseases affecting specific body organ systems.
We are proud to offer a one-call service to answer any questions about thoracic, cardiovascular, or esophageal disease. Call (619) 532-9140 to get answers from our clinic staff and physicians.
Overview of Services
Cardiothoracic surgery is a comprehensive specialty treating diseases of the chest, including cardiac, lung, or esophageal disease. At Naval Medical Center San Diego, our surgeons collaborate on a daily basis with the non-surgical physicians specializing in diseases of the chest.
For the treatment of heart disease, we have employed a Heart Team approach since 1987. According to the Heart Team concept, a multidisciplinary team of cardiac surgeons, cardiologists, and radiologists reviews each patient’s case to determine the optimal approach to treating that unique person’s cardiac disease. This approach has recently been given the highest level of recommendation by the American Heart Association and American College of Cardiology for adoption as the nationwide standard.
Our Center for Aortic Disease is a systematic program involving multiple medical specialists dedicated to the diagnosis and treatment of life-threatening aortic disease. . The foundation of this Center is our world-class aortic radiographic imaging capabilities Long-term surveillance and treatment is provided by our vascular surgeons, interventional cardiologists, cardiac surgeons, and cardiovascular radiologists. Treatment options include open and minimally invasive aortic valve repair or replacement, and surgical or stent replacement of the thoracic or abdominal aorta.
We offer a robust screening program for lung cancer backed up by a multi-disciplinary team of pulmonologists, oncologists , thoracic surgeons, radiation oncologist, and pathologists. The individualized diagnostic evaluation or treatment of patients with lung nodules or lung cancer is thoroughly discussed by this team to ensure excellence in their evaluation and treatment.
Some of the cutting-edge procedures we perform are valve-sparing aortic root replacement, minimally-invasive aortic valve replacement, complex mitral valve repair, atrial fibrillation (AFib) surgery, aortic stenting, minimally-invasive lobectomy for lung cancer, and minimally-invasive surgery for achalasia and hiatal hernias.
FOR MORE INFORMATION ON CARDIOTHORACIC SURGERY SERVICES, PLEASE CONTACT 619-532-9140 TO SPEAK TO A HEALTH CARE PROFESSIONAL.
Heart Valve Surgery
The heart contains four valves that allow it to work as a pump. Various diseases affect the function of these valves, and due to the variation in demands our bodies place on each of these valves the optimal treatment of each valve is different. Some valves are best treated by replacement while others by repair of the native valve. Our surgeons and cardiologist are well-versed in the criteria favoring either option and can help patients decide what treatment is right for them.
AORTIC VALVE
Diseases affecting the aortic valve frequently require the valve to be replaced. Fortunately, there are many excellent replacement valve options that are exceptionally durable and require no long-term anticoagulation. Repair of a person’s native aortic valve is occasionally possible in certain circumstances. Minimally-invasive options are available resulting in a very small, or no, surgical scar.
MITRAL VALVE
The mitral valve has a complex shape and function. Numerous studies have demonstrated that in most cases this valve should be repaired for the best possible patient outcomes, rather than undergo replacement. The most common method of repair is to remove the diseased portion of the valve, repair the defect, and prevent future expansion of the valve orifice by implanting a titanium ring. Long-term anticoagulation is not required in most cases.
TRICUSPID VALVE
Diseases of the tricuspid valve rarely affect that valve alone. Instead, repair is usually performed in conjunction with another heart procedure. Repair, versus replacement, is the norm for tricuspid disease. While uncommon, replacement of the tricuspid valve is sometimes required, and occasionally necessitates simultaneous implantation of a cardiac pacemaker. This is due to the close proximity of the heart’s natural pacemaker to the tricuspid valve.
PULMONARY VALVE
As the gateway valve for blood traveling to the lungs (a less demanding circulation task), the pulmonary valve is rarely so diseased that it cannot perform its function. The exception is patients who have undergone heart surgery as a child, in particular those who have undergone correction of Tetralogy of Fallot.
FOR MORE INFORMATION ON HEART VALVE SURGERY, PLEASE CONTACT 619-532-9140 TO SPEAK TO A HEALTH CARE PROFESSIONAL.
AORTIC SURGERY
The aorta is the largest artery in the body originating at the heart and extending into the pelvis where it branches off into smaller divisions.
Diseases of the aorta can result in aneurysms and dissections. Aneurysms are an enlargement in the aorta, while dissections are a separation of the wall of the aorta. These manifestations frequently occur together and can be life-threatening. Some people are born with an increased risk of developing aortic disease, for example, those with Marfan’s Syndrome or who have an aortic valve with two leaflets instead of the usual three.
Optimal management of aortic disease requires a coordinated multi-specialty approach. Patients who have certain risk factors should be tested for the presence of disease. Those who are known to have disease need at least annual surveillance studies to ensure that their disease has not progressed to a stage that they are at risk of life-threatening complications. Fortunately, there are well-established guidelines for when to treat aortic disease to avoid the possibility of catastrophic complications.
Treatment of aortic disease has evolved dramatically, resulting in much safer procedures which halt the progression of disease and protect from complications. Many of the available procedures require only the placement of metal stents through a tiny incision in the leg.
The Center for Aortic Disease at Naval Medical Center San Diego is a multidisciplinary team of specialists dedicated to ensuring that aortic disease is recognized early and treated at the earliest sign that it presents a risk to the well-being of our patients. The backbone of the Center is our world-class Radiology Department that provides our cardiovascular radiologists and cardiac surgeons unparalleled imaging capabilities.
FOR MORE INFORMATION ON AORTIC DISEASE OR THE CENTER FOR AORTIC DISEASE PROGRAMS, PLEASE CONTACT 619-532-9140 TO SPEAK TO A HEALTH CARE PROFESSIONAL.
CORONARY ARTERY SURGERY
The coronary arteries supply blood directly to the heart. Atherosclerosis is the disease that results in blockages of these arteries that produces chest pain, heart attacks, and heart failure. Coronary artery disease (CAD) is the most common heart disease in the world.
There are many treatment options for CAD, ranging from cholesterol and blood pressure control, to stents and surgical bypasses. Stents are typically inserted through a puncture of a leg or arm artery. These procedures are performed by interventional cardiologists in a specialized Cardiac Catheterization Lab. Coronary Artery Bypass Graft (CABG) is performed by cardiac surgeons for more severe CAD. These operations can be performed with or without the assistance of the heart-lung machine (cardiopulmonary bypass) depending on the specific nature of the CAD. Combined approaches, where the interventional cardiologists and cardiac surgeons collaborate to stent certain blockages and surgically bypass others, is sometimes an excellent option for patients and is performed in our highly specialized Hybrid Operating Room.
FOR MORE INFORMATION ON CORONARY ARTERY DISEASE (CAD), PLEASE CONTACT 619-532-9140 TO SPEAK TO A HEALTH CARE PROFESSIONAL.
ATRIAL FIBRILLATION SURGERY
Atrial Fibrillation (AFib) affects more than 2 million people in America. It is an abnormal heart rhythm that results in a fast and irregular heartbeat. If not treated it can result in strokes, pulmonary embolism, and cardiac ischemia (a condition related to a heart attack). Fortunately, most of the complications of AFib can be prevented by treatment with combinations of medication that includes blood thinners.
For some patients, medications do not adequately control their symptoms, or they are unable to take blood thinners due to bleeding risks or the desire to become pregnant. For other people, the lifestyle restrictions required when taking blood thinners are too burdensome. For these patients, a procedure to stop AFib may be more appropriate than long-term medical therapy.
Several excellent surgical options have been developed that offer the possibility of curing AFib. The choice of procedure is tailored to the individual needs of each person evaluated by our team of cardiac surgeons and electrophysiologists (cardiologists who specialize is heart rhythms).
Among the procedures we offer to treat Afib is the Totally Thorascopic Maze. This is a minimally-invasive surgery performed through tiny incisions on the sides of the chest with the aid of high-definition video scopes. This is a new approach to a traditional surgery offered throughout the country only at specialized centers. The results have been excellent with a majority of patients being able to stop taking blood-thinners such as Coumadin.
FOR MORE INFORMATION ON ATRIAL FIBRILLATION (AFIB) OR THE TOTALLY THORASCOPIC MAZE PROCEDURE, PLEASE CONTACT 619-532-9140 TO SPEAK TO A HEALTH CARE PROFESSIONAL.
LUNG SURGERY
Lung surgery is performed for many reasons; however, the most common is to biopsy and treat lung cancer. Lung cancer is the leading cause of cancer death in America. It is almost always found in people who have a history of tobacco smoking. In the past, lung cancer was usually not detected until it caused symptoms, at which point it was at an advanced stage where it was often incurable. When detected at an early stage, lung cancer can often be completely cured by surgery with or without the addition of chemotherapy and radiation therapy.
A very large study of lung cancer screening performed across the United States found that screening people at risk for lung cancer with a C.T. scan can substantially reduce the number of deaths from lung cancer. Our world-class chest radiology department has spearheaded Naval Medical Center San Diego’s adoption of these screening standards allowing us to detect many cancers when they are still at an early stage.
Evaluation and treatment of our patients with lung cancer and other pulmonary diseases is planned at our weekly conference of lung specialists, including pulmonologists, thoracic surgeons, oncologists, radiation oncologists, radiologists, and pathologists. Our mission is not only state-of-the-art treatment, but also rapid detection and diagnosis.
The overwhelming majority of our lung surgery is performed minimally-invasively aided by high-definition scope technology (VATS). This results in less pain and faster recovery for our patients.
FOR MORE INFORMATION ON LUNG SURGERY OR LUNG CANCER, PLEASE CONTACT 619-532-9140 TO SPEAK TO A HEALTH CARE PROFESSIONAL.
ESOPHAGEAL SURGERY
The esophagus is the portion of the gastrointestinal tract located in the chest that connects the mouth to the stomach. There are several major diseases that affect the esophagus, including esophageal cancer, motility disorders such as Achalasia, hiatal hernias, and gastroesophageal reflux disease (GERD). Esophageal surgery is unlike any other gastrointestinal tract surgery due to its unique microanatomy and position in the chest.
Esophageal cancer is increasing in frequency and is associated with gastroesophageal reflux disease (GERD). It is frequently discovered at an advanced stage, and because of this long-term survival has been disappointing. Fortunately, a multifaceted treatment approach has been developed that has resulted in significant improvements in survival rates. Our team of esophageal cancer specialists, including gastroenterologists, thoracic surgeons, oncologists, radiation oncologists, radiologists, and pathologists, combine to plan optimal treatment programs for our patients.
Motility disorders of the esophagus result in swallowing problems. Evaluation of these disorders requires specialized tests. Some types of motility problems are best treated with medications, but for many others, in particular Achalasia, excellent results have been obtained from minimally-invasive corrective surgery.
Minimally-invasive surgeries for GERD and hiatal hernias are available and have shown excellent results.
FOR MORE INFORMATION ON ESOPHAGEAL SURGERY OR LUNG CANCER, PLEASE CONTACT 619-532-9140 TO SPEAK TO A HEALTH CARE PROFESSIONAL.
THYMIC SURGERY
The thymus gland is an organ of the immune system. Once people reach adulthood, it is believed to no longer to serve any useful function and it usually shrinks or disappears altogether. Diseases involving the thymus gland include cancer, enlargement, and Myasthenia Gravis.
Myasthenia Gravis (MG) is a neurologic disease resulting in muscle weakness. The exact role of the thymus gland in this disease is not known but surgical removal of the thymus can result in significant improvement of symptoms in patients with Myasthenia Gravis.
Thymic cancer and enlargement causing symptoms are best treated by surgery. Minimally-invasive thymectomy (removal of the thymus) is almost always possible for MG and enlargement, while a conventional approach is a believed to result in better long-term survival in patients with cancer.
FOR MORE INFORMATION ON THYMIC SURGERY, PLEASE CONTACT 619-532-9140 TO SPEAK TO A HEALTH CARE PROFESSIONAL.
MINIMALLY-INVASIVE SURGERY
Many of the operations performed by our surgeons are done in a minimally-invasive fashion. The goals of this approach is to reduce pain and decrease the recovery time, while providing an equally high-quality of surgery as a conventional approach. Atrial fibrillation (AFib) surgery, lung surgery, and many esophageal surgeries can routinely be performed through very small incisions aided by high-definition scope technology. For some surgeries, scope technology is not applicable but smaller incisions are feasible. Less invasive approaches are always considered when we plan treatment with our patients.
FOR MORE INFORMATION ON MINIMALLY-INVASIVE SURGERY, PLEASE CONTACT 619-532-9140 TO SPEAK TO A HEALTH CARE PROFESSIONAL.