Open heart surgery

Overview

Open-heart surgery is a surgical approach used to access the heart by making an incision through the breastbone and spreading the ribcage. This procedure is employed to address various heart-related issues, including heart failure, congenital heart defects, aneurysms, coronary artery disease, and arrhythmias.

Open-heart surgery is a reliable method for performing various cardiac procedures, which may include treatments like coronary artery bypass grafting (CABG), heart transplants, and valve replacements. In certain situations, less invasive techniques that involve smaller incisions, such as those made between the ribs on the right side of the chest, can also be considered.

It’s important to note that open-heart surgery is a significant surgical intervention, and like any surgical procedure, it comes with potential risks. The decision to opt for an open approach is made by healthcare providers after evaluating the overall health and condition of the patient to ensure that they are suitable candidates for such a procedure.

Types

Open-heart surgery can be done using two approaches:

• On-pump: In this method, the healthcare provider operates on a non-beating heart with no blood flow. A machine known as the heart-lung bypass machine is connected to the heart and temporarily takes on the functions of both the heart and lungs. It maintains blood circulation throughout the body while diverting blood away from the heart. Once the surgery is complete, the device is disconnected, and the heart resumes its normal operation.
• Off-pump: Also known as the beating-heart surgery, is exclusively applicable to coronary artery bypass grafting (CABG) surgery. This surgery is performed on a heart that maintains its natural beating rhythm.

Reasons for undergoing the procedure

Open-heart surgery may be necessary to address various heart conditions, including arrhythmias like atrial fibrillation, congenital heart defects such as atrial septal defect and hypoplastic left heart syndrome, thoracic aortic aneurysms, coronary artery disease, heart valve issues, and heart failure.

Risk

Open-heart surgery risks encompass potential complications such as allergic reactions to anesthesia, irregular heartbeats, bleeding, damage to adjacent blood vessels or organs like the lungs or kidneys, infections, and the risk of a stroke.

People who smoke are at a higher susceptibility to both surgical and post-surgical problems. Complications increase with underlying health issues such as diabetes or obesity and lung conditions like chronic obstructive pulmonary disease (COPD).

Procedure

The healthcare provider will determine the most suitable treatment approach for each patient. During open-heart surgery, various procedures necessitate direct access to the heart and the adjacent blood vessels can be performed. The procedures including aneurysm repair, repair of congenital heart defects, coronary artery bypass surgery (CABG) for coronary artery disease, heart transplantation to address heart failure, replacement or repair of heart valves for heart valve conditions, and left ventricular assist device (LVAD) or total artificial heart placement for heart failure treatment.

In some cases, pacemakers, or implantable cardioverter defibrillators (ICDs) may be inserted as part of open-heart surgery while simultaneously conducting other interventions. Ablation procedures for addressing arrhythmias may also be integrated into the same surgical process.

In certain cases, these procedures can be performed using minimally invasive methods.

Before the procedure

Prior to undergoing open-heart surgery, the preoperative preparations typically involve diagnostic tests such as chest X-rays and electrocardiograms (EKG) to assist in surgical planning.

Other preparations may include:

• Medications: Medicines that can amplify the risk of bleeding such as nonsteroidal anti-inflammatory drugs (NSAIDs) are discontinued prior the surgery. Individuals may be recommended to temporarily stop the intake of blood-thinning medications including aspirin, warfarin, or other drugs to prevent blood clots and strokes. One to two weeks is usually required to halt the usage of certain medications.
• Eating and drinking: Since anesthesia is more secure when administered to individuals with empty stomachs, one may be requested to refrain from eating or drinking prior to the surgery.
• Consumption of cigarettes and alcohol: The risk of complications increases, and the recovery becomes slower with smoking and drinking alcohol. Stopping both behaviors can have a significant impact on one’s overall health.

An intravenous line (IV) will be inserted into the arm to facilitate the administration of fluids and medications during the procedure. It is also generally advised that the surgical site is sterilized with antimicrobial soap, and the chest is shaved prior to the surgery.

During the procedure

Heart surgery is a complex procedure that can last for six hours or more, with patients under anesthesia.

In open-heart surgery, the specific steps vary depending on the heart condition and procedure.

The procedure includes:

• Making a sizable chest incision
• Opening the ribcage to access the heart
• Typically, the on-pump surgery involves administering medication to stop the heart from beating and connecting the heart to a heart-lung bypass machine. The patient’s condition is also monitored throughout the surgery.
• Repairing the heart.
• After heart surgery, the healthcare provider typically restores blood flow to the heart, often with the heart restarting on its own but occasionally requiring a mild electrical shock.
• The heart-lung bypass machine is disconnected
• The breastbone or other incisions are closed using wires or sutures that stay in the body.
• The skin incision is closed with stitches.

After the procedure

Individuals who have undergone open-heart surgery may experience constipation due to potent pain relievers, and minor pain, bruising, and swelling at the incision site.
Others may feel:

• Mood changes, like depression
• Memory issues
• Muscle discomfort in the chest region
• Difficulty sleeping
• Loss of appetite

The length of the hospital stay following open-heart surgery varies depending on the specific procedure, but it typically involves spending at least a day in the intensive care unit (ICU) before moving to a standard hospital room.

Patients are given a specialized firm pillow to protect their chest when they cough, sneeze, or get out of bed. They will also receive guidance on how to appropriately care for their incision.

Outcome

After undergoing heart surgery, it is crucial to closely monitor your condition. If you experience any of the following signs and symptoms, it’s important to seek immediate medical attention:

• Fever
• Difficulty breathing
• Chest pain that goes beyond the typical discomfort around the incision
• Nausea or vomiting
• Signs of infection at the surgical site
• Slurred speech or other indications of a stroke

The duration of your recovery varies depending on factors such as the type of surgery, any complications that may arise, and your overall health before the surgery. For open-heart surgery, the recovery period typically ranges from 6 to 12 weeks, with the possibility of it taking even longer in some cases.

Your healthcare provider will provide guidance on when you can safely resume work and other activities. It’s common to be advised to avoid driving and heavy lifting for the first six weeks

In some cases, cardiac rehabilitation may be recommended to improve your strength and heart health. Your healthcare provider might also prescribe blood thinners to prevent blood clots.