What is open heart surgery?

Open-heart surgery is any type of surgery where the chest is cut open and surgery is performed on the muscles, valves, or arteries of the heart. The procedure most commonly done by open heart surgery is coronary artery bypass surgery. This replaces the role of the coronary arteries in supplying the heart with blood. This surgery may be needed if the coronary arteries become narrower because of heart disease. Such narrowing increases the risk of heart attack.

An artery is grafted in place of the blocked one. This is taken from elsewhere in the chest or from a leg. Another procedure done by open heart surgery is replacing a faulty valve. Valves in the heart are needed to stop blood flowing back into parts of the heart after being pumped out of them.

A problem called an aneurysm can also be repaired by open heart surgery. This is when there is a bulge in the main artery leaving the heart.

When is open-heart surgery needed?

Open-heart surgery may be done to perform a CABG. A coronary artery bypass graft may be necessary for people with coronary heart disease.

Coronary heart disease occurs when the blood vessels that provide blood and oxygen for the heart muscle become narrow and hard. This is often called “hardening of the arteries.”

Hardening occurs when fatty material forms a plaque on the walls of the coronary arteries. This plaque narrows the arteries, making it difficult for blood to get through. When blood can’t flow properly to the heart, a heart attack may occur.

Open-heart surgery is also done to:

  • repair or replace heart valves, which allow blood to travel through the heart
  • repair damaged or abnormal areas of the heart
  • implant medical devices that help the heart beat properly
  • replace a damaged heart with a donated heart (heart transplantation)

How a heart surgery is performed?

General anesthesia is given to the patient before the start of the surgery. There are several types of cardiac surgeries and one of them involves the surgeon making an 8 to 10 inches long incision in the chest to expose the heart. The heart is stopped temporarily and a heart-lung machine is attached to the patient, which does the work of the heart by pumping oxygenated blood into the body so that the surgeon can perform the surgery. After the procedure is done, the incision is stitched up.

A new type of heart surgery does not require an eight-inch cut. It can be done with a small cut using a camera and endoscopic tool. In 1990 surgeons started to do surgeries without using the cardiopulmonary bypass or the heart-lung machine. The heart continues to beat during the surgery and instead of stopping the heart, it is stabilized for the surgery. Another popular type of heart surgery is the robot-assisted heart surgery. The surgery is performed by a machine, which is controlled by a surgeon. As the robot has a much smaller hand, three small holes are required for the surgery instead of a big incision.

Recovery from open heart surgery

  • Open heart surgery is a major operation that needs close monitoring and support immediately afterward.
  • It is normal to be cared for and remain in the intensive care unit (ICU). This is usually for a couple of days after the procedure.
  • A breathing tube remains in place after waking up to assist with breathing. A line into the vein also remains to give pain relief. Monitoring equipment is also in place.
  • It is normal for patients to remain in the hospital after leaving the ICU. Recovery at home after leaving the hospital will then take a number of weeks. The rest period is often 4 to 6 weeks.
  • Rehabilitation will be guided by the healthcare team, including advice about medications and physical activity. Activities will need to be light at first.

During recovery

  • Tiredness and some pain are normal
  • Being alert to the possibility of infection is important
  • Open heart surgery is a major operation requiring close monitoring and support afterward.
  • Patients should follow the medical team’s advice on wound care and look out for signs of infection around the chest wound such as redness or discharge.

It is important for patients to seek urgent care for any potentially serious symptoms such as difficulty breathing, fever, and excessive sweating.

Specialist support for activities and other aspects of recovery may be offered in a specific cardiac rehabilitation program

Aftercare varies by individual but may include follow-up tests such as blood tests, heart scans, and stress tests, which is heart monitoring during a treadmill exercise. Medication may include blood-thinning drugs.

Alternatives to open heart surgery

Alternatives to opening up the chest are now available. These can include the use of endoscope cameras and robots.

The treatment of narrowed coronary arteries can be done by minimally invasive cuts to the skin and the use of the da Vinci robot. This alternative is known as endoscopic coronary artery bypass surgery.

No advantage has been found in terms of effectiveness or safety across patients choosing open surgery over these alternatives. Both types of surgery still require similar time in hospital and care. The main difference is that less invasive surgery has a shorter recovery.

All forms of heart surgery come with risks. These risks include being under anesthetic, and chances of infection, organ damage, and stroke. Risks depend on the person, such as being higher in people who are less well.

Alternatives to open heart surgery include:

  • Angioplasty – this places a stent inside the narrowed artery to widen it out
  • Transcatheter aortic valve replacement – the new valve is inserted via a catheter and opens out once in place
  • Aortic valve balloon valvuloplasty – a balloon is used to widen a valve

What to expect after the surgery?

Taking care of the patient is the most important part of the recovery. The incision site should be kept clean and dry. Keep it infection free by washing your hands before and after touching it. Utmost care should be taken if you plan to take a shower. Your shower should not extend more than 10 minutes and warm water should be used for the shower. Always check the site of incision for any sign of infection like redness, warmth, oozing from the site etc.

You may experience pain in the chest region, at the incision site, throat pain or muscle pain. Discuss with your doctor about pain management. Pain medication will be prescribed by your doctor to you. It is essential to follow the prescribed medication. You also need to relax and get enough sleep.