Open Heart SurgeryBy
Sarah Lewis, PharmD
What is open heart surgery?
Open heart surgery is any surgery in which the surgeon cuts open the chest to operate on the heart. Open heart surgery can treat a variety of diseases and conditions of the heart. Conditions commonly treated with open heart surgery include heart valve disease, birth defects of the heart, and coronary artery disease. Coronary artery disease is the leading cause of heart attack.
Your heart is made of specialized muscle tissue (myocardium) that pumps blood through your body. Blood moves through the four chambers of the heart in a precise manner controlled by electrical signals. Valves help coordinate the movement of blood through the heart. The coronary arteries are blood vessels that supply your heart muscle with blood.
Open heart surgery is a common but major surgery with significant risks and potential complications. You may have less invasive treatment options. Consider getting a second opinion about all your treatment choices before having open heart surgery.
Types of open heart surgery
The types of open heart surgery procedures include:
On-pump surgery uses a heart-lung machine (cardiopulmonary bypass). This machine temporarily takes over the heart’s job of pumping oxygen-rich blood to the organs and tissues. This is the traditional type of open heart surgery. It allows your surgeon to operate on a heart that is not beating and has no blood traveling through it.
Beating heart or off-pump surgery does not use a heart-lung machine and your surgeon operates on an actively beating heart. However, your surgeon will slow your heart rate with medication or a device. This type of open heart surgery is limited to a few specific procedures.
Robot-assisted surgery allows your surgeon to use a special computer to control robotic arms that perform the surgery. The surgeon sees a three-dimensional view of the surgery on the computer. This type of surgery is very precise. However, it also is limited to a few specific procedures.
Why is open heart surgery performed?
Your doctor may recommend open heart surgery to treat a variety of diseases and conditions of the heart. Your doctor may only consider open heart surgery for you if other treatment options that involve less risk of complications have been ineffective. Ask your doctor about all of your treatment options and consider getting a second opinion before deciding on open heart surgery.
Your doctor may recommend open heart surgery for:
Congenital defect repair, which is done to correct a variety of heart problems that are present at birth
Coronary artery bypass graft (CABG), commonly called heart bypass surgery. CABG provides a new route around diseased coronary arteries with healthy vessels taken from other places in your body. This is the most common heart surgery in adults.
Heart transplant to remove a severely damaged heart and replace it with a donor heart
Heart valve repair or replacement when a heart valve does not function properly. Heart valves control the flow of blood into and out of the heart.
Implantation of medical devices to help control your heartbeat or support proper heart function
Transmyocardial laser revascularization when coronary artery bypass is not an option. The surgeon uses lasers to make channels directly in the heart muscle to supply it with blood.
Maze procedure, which is the creation of scar tissue to block irregular electrical signals through the heart. The Maze procedure is used to treat atrial fibrillation or an irregular heartbeat that is not amenable to medications or less invasive methods. It is often performed with another procedure, such as CABG or valve repair.
Who performs open heart surgery?
The following specialists perform open heart surgery:
Cardiac surgeons specialize in the surgical treatment of conditions of the heart and its blood vessels. Cardiac surgeons may also be known as cardiothoracic surgeons.
Congenital cardiac surgeons specialize in the surgical treatment of heart defects present at birth.
Thoracic surgeons specialize in the surgical treatment of diseases of the chest, including the blood vessels, heart, lungs and esophagus. Thoracic surgeons may also be known as cardiothoracic surgeons.
How is open heart surgery performed?
Your open heart surgery will be performed in a hospital. It requires a large incision in your chest and through your breastbone (sternum). Open surgery allows your surgeon to directly view and access the surgical area.
If you are having on-pump surgery, your surgical team will stop your heart with medicine and the heart-lung machine will pump blood to the body. Your surgeon will take your heart off the machine when the surgery is complete.
Some heart surgeries can now be performed at certain medical centers using minimally invasive techniques. These surgeries include coronary artery bypass surgery and heart valve repair and replacement.
Minimally invasive procedures use smaller incisions instead of the larger incision made in open surgery. The surgeon uses special instruments with an attached camera to see the surgical area on a video screen. Minimally invasive surgery, as compared to an open procedure, generally has a faster recovery time, less pain, and a lower risk of some complications, such as infection.
Your surgeon will advise you on which procedure is best for you and how long you need to stay in the hospital based on your diagnosis, age, medical history, general health, and possibly your personal preference. Learn about the different procedures and ask why your surgeon will use a particular type for you.
Types of anesthesia that may be used
Your surgeon will perform open heart surgery using either general anesthesia or regional anesthesia.
General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the procedure and will not feel any pain. You may also have a peripheral nerve block infusion in addition to general anesthesia. A peripheral nerve block infusion is an injection or continuous drip of liquid anesthetic. The anesthetic flows through a tiny tube inserted near your surgical site to control pain during and after surgery.
Regional anesthesia is also known as a nerve block. It involves injecting an anesthetic around certain nerves to numb a large area of the body. To numb a smaller area, your doctor injects the anesthetic in the skin and tissues around the procedure area (local anesthesia). You will likely have sedation with regional anesthesia to keep you relaxed and comfortable.
What to expect the day of your open heart surgery
Your surgeon may admit you to the hospital the day before your open heart surgery. The day of your surgery you can generally expect to:
Remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member. Your care team will give you blankets for modesty and warmth.
Talk with members of your surgical care team, including your surgeon, cardiologist and nurse. This is a good time to ask any questions that you may have forgotten during your preoperative office appointments. You will also talk with your anesthesiologist about your medical history and the type of anesthesia you will have.
A care team member will start an IV.
The day of your surgery, you will receive medication to help you rest comfortably about an hour before your surgery begins.
The anesthesiologist will start your anesthesia.
A tube will be placed in your windpipe to protect and control breathing during general anesthesia. You will not feel or remember this or the surgery as they happen.
A team member will insert a urinary catheter.
The care team will monitor your vital signs throughout the procedure and during your recovery until you are alert, breathing effectively, and all vital signs are stable.
What are the risks and potential complications of open heart surgery?
As with all surgeries, open heart surgery involves risks and possible complications. Complications may become serious and life threatening in some cases. Complications can develop during surgery or recovery.
General risks of surgery
The general risks of surgery include:
Anesthesia reaction, such as an allergic reaction and problems with breathing
Bleeding or heavy bleeding (hemorrhage), which can lead to shock
Blood clot, in particular a deep vein thrombosis that develops in the leg or pelvis and which can travel to your lungs, heart or brain and cause a pulmonary embolism, heart attack, or stroke
Infection and septicemia, which is the spread of a local infection to the blood
Potential complications of open heart surgery
Complications of open heart surgery include:
Heart arrhythmias or problems with heart rhythm
Post-pericardiotomy syndrome, which is a low-grade fever and chest pain for up to six months following open heart surgery. A pericardiotomy is a surgical incision of the sac that surrounds the heart.
Reducing your risk of complications
You can reduce the risk of certain complications by following your treatment plan and:
Following activity, dietary and lifestyle restrictions and recommendations before surgery and during recovery
Informing your doctor or radiologist if you are nursing or if there is any possibility of pregnancy
Notifying your doctor immediately of any concerns, such as bleeding, fever, increase in pain, or wound redness, swelling or drainage
Taking your medications exactly as directed
Telling all members of your care team if you have any allergies
How do I prepare for my open heart surgery?
You are an important member of your own health care team. The steps you take before surgery can help improve your comfort and outcome.
You can prepare for open heart surgery by:
Answering all questions about your medical history and medications. This includes prescribed medications, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.
Getting preoperative testing as directed. Testing will vary depending on your age, health, and specific procedure. Preoperative testing may include a chest X-ray, EKG (electrocardiogram), blood tests, and other tests as needed.
Losing excess weight before the surgery through a healthy diet and exercise plan
Not eating or drinking before surgery as directed. Your surgery may be cancelled if you eat or drink too close to the start of surgery because you can choke on stomach contents during anesthesia.
Stopping smoking as soon as possible. Even quitting for just a few days can be beneficial and help the healing process.
Taking or stopping medications exactly as directed. This may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners. Your doctor will give you instructions for taking your specific medications and supplements.
Questions to ask your doctor
Facing surgery can be stressful. It is common for patients to forget some of their questions during their doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before surgery and between appointments.
It is also a good idea to bring a list of questions to your appointments. Questions can include:
Why do I need open heart surgery? Are there any other options for treating my condition?
What type of open heart surgery procedure will I need?
How long will the surgery take? When can I go home?
What restrictions will I have after the surgery? When can I return to work and other activities?
What kind of assistance will I need at home?
What medications will I need before and after the surgery? How should I take my usual medications?
How will you treat my pain?
When should I follow up with you?
How should I contact you? Ask for numbers to call during and after regular hours.
What can I expect after my open heart surgery?
Knowing what to expect can help make your road to recovery after open heart surgery as smooth as possible.
How long will it take to recover?
You will stay in the recovery room after surgery until you are alert, breathing effectively, and your vital signs are stable. Your care team will then move you to an intensive care unit (ICU). ICUs provide 24-hour specialized monitoring and care.
It may take a few hours until the major effects of anesthesia wear off and you are alert. You may have a breathing tube in your mouth and tubes and wires attached to your body when you wake up. These allow your team to monitor your vital signs, drain bodily fluids, take blood, and give medications and fluids.
You will not be able to talk if you have a breathing tube. However, the care team usually removes it within 24 hours. You may have a sore throat from the tube. This is usually temporary, but tell your care team if you are uncomfortable.
You may move to a hospital room outside the ICU as you recover. This room will have the equipment to monitor your heart rhythm and vital signs. Typically, hospital stays after open heart surgery are five to seven days.
Recovery after surgery is a gradual process. Recovery time varies depending on the procedure, type of anesthesia, your general health, age, and other factors. Your doctor will likely refer you to a cardiac rehabilitation program to help you recover. Full recovery takes a few weeks to a few months.
Will I feel pain?
Pain control is important for healing and a smooth recovery. There will be discomfort after open heart surgery. Your doctor will treat your pain so you are comfortable and can get the rest you need. Tell your doctor or care team if your pain gets worse or changes because it may be a sign of a complication.
When should I call my doctor?
It is important to keep your follow-up appointments after open heart surgery. Contact your doctor for questions and concerns between appointments. Call your doctor right away or seek immediate medical care if you have:
Breathing problems, such as shortness of breath, difficulty breathing, labored breathing, or wheezing
Change in alertness, such as passing out, unresponsiveness, or confusion
Chest pain, chest tightness, chest pressure, or palpitations
Fever. A low-grade fever (lower than 101degrees Fahrenheit) is common for a couple of days after surgery and not necessarily a sign of a surgical infection. However, you should follow your doctor's specific instructions about when to call for a fever.
Inability to urinate or have a bowel movement
Leg pain, redness or swelling, especially in the calf, which may indicate a blood clot
Pain that is not controlled by your pain medication
Unexpected drainage, pus, redness or swelling of your incision
Weight gain of more than five pounds. This could indicate that you are retaining fluids, which can be serious.
How might open heart surgery affect my everyday life?
Open heart surgery may cure your condition or reduce your symptoms so you can lead an active, normal life. For example, coronary artery bypass graft (CABG) surgery should relieve chest pain and reduce your risk of heart attack.
Open heart surgery will not prevent heart disease from coming back. You can make changes to your everyday life that may help prevent or delay recurrence of heart disease, such as:
Eating a heart-healthy diet
Getting regular exercise
Maintaining a healthy weight
Practicing stress management techniques
Treating other related conditions, including high blood pressure, high cholesterol, and diabetes
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