PAs play an integral role in the global management of cardiothoracic surgery patients- including all aspects of per-operative care. In addition to performing histories and physical exams, daily patient rounds (including the CVICU), patient education and discharge summaries - CT PAs frequently perform invasive procedures such as thoracenteses, chest tube insertions, placement of central venous, dialysis and Swan-Ganz catheters, arterial lines and intra-aortic balloon pumps.

Cardiothoracic Physician Assistants have a significant amount of autonomy in the operating room and perform a separate but critical operation on their own. The expedient and careful retrieval of vascular tissue, including greater and lesser saphenous veins and/or radial arteries, for use as a bypass conduit is an essential component of almost every coronary bypass procedure. In addition, methods focused on endoscopic retrieval of these vessels have placed PAs at the forefront of this rapidly evolving technology. Currently, many PAs are involved in the industrial aspect of EVH.

Many PAs also fill the role as first assistant on all adult and pediatric cardiac cases, thoracic and major/minor vascular cases. The PA is the ideal first assistant in these settings as we are trained specifically to meet the needs of the attending surgeon. It is not unusual for a single PA to assist a number of surgeons in a single practice and it is vital that the first assistant have exacting knowledge of each surgeon's idiosyncrasies in order to expedite the procedure and limit the patient's morbidity and mortality. Surgical PAs are trained in the medical model, and this adds to the synergistic relationship between physician and PA.

Although the role of a cardiac surgical PA may differ from practice to practice, most work 50-60 hours each week, providing patient care expertise in the postoperative acute care units, step-down units, and regular floors. These PA must have extensive knowledge of the pharmacologic effects of vasoactive / cardiotonic drugs, ventilator management, and artificial cardiac devices. In addition, these specialty PAs must also assume the role of primary care PAs and be well versed in the management of other disease entities frequently encountered in the cardiac population, namely hypertension, diabetes, COPD, asthma, hypothyroidism and others.

These highly technical and demanding skills are mastered only through years of experience and often with the benefit of a post-graduate surgical residency. As the specialty of cardiothoracic surgery continues to evolve, the flexible and adaptable nature of the surgical PA will be an essential element for every successful practice.

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