Open Heart Surgery: What to Know

Approximately 2 million people around the world undergo open heart surgeries each year. An open heart surgery involves cutting open the chest wall and performing surgery directly on the heart muscle, arteries, or valves. In traditional heart surgery, the heart is stopped and connected to a heart-lung machine that pumps blood throughout the body for the duration of the procedure. Off-pump coronary artery bypass surgery is done on a beating heart. Please continue reading to find out more.

What is open heart surgery usually for?

An open heart surgery is done for many different reasons, such as:

To improve blood flow to the heart muscle in people with coronary artery disease (narrowed or blocked arteries). This procedure is called a coronary artery bypass graft. It is sometimes done as an emergency surgery after a heart attack if other treatments do not work.
To perform heart valve repair or replacement in people with heart valve disease.
To repair congenital heart defects that are present from birth, for example, an atrial septal defect (hole in the heart).
To repair aneurysms, for example, an aortic aneurysm (a balloon-like bulge in the aorta, which is the main artery that carries blood away from the heart).
To treat an abnormal heart rhythm, for example, a maze procedure for atrial fibrillation.
To place medical devices in the heart, such as a ventricular assist device (VAD) for heart failure.
To perform a heart transplant whereby a damaged or diseased heart is replaced with a healthy heart from a donor.

Some heart problems can be treated with minimally invasive heart surgery, such as catheter-based procedures or robot-assisted heart surgery to repair heart valves. Minimally invasive surgery is associated with fewer complications, less pain, a shorter hospital stay, and faster recovery. However, how your surgeon chooses to perform heart surgery will depend on many factors. A minimally invasive procedure may not be right for everyone.

What is the difference between bypass surgery and open heart surgery?

Coronary artery bypass surgery is the most common type of open heart surgery. It is performed to improve blood flow to the heart in people with coronary artery disease, where the coronary arteries that supply blood to the heart muscle become narrowed or blocked.

Coronary artery bypass grafting is of two types - on-pump and off-pump. During a traditional heart surgery (on-pump bypass surgery), the surgeon opens up your chest wall, stops your heart, and places you on a heart-lung machine that acts like an artificial heart while they repair the blood vessels (remove and replace a blocked artery with a healthy blood vessel to restore blood flow).

Off-pump heart surgery, also called beating heart surgery, is done without stopping the heart or placing you on a heart-lung bypass machine. Your heart continues to pump blood while the surgeon works on it. This is a newer type of heart surgery that is associated with fewer postoperative risks. However, not everyone is a candidate for off-pump or beating heart surgery.

How do surgeons perform open heart surgery?

The main steps during an open heart surgery are as follows:

You are put under general anesthesia and remain asleep during the procedure.
The surgeon makes a 6- to 8-inch long incision (cut) over your breastbone down the center of your chest.
They then spread your ribcage apart to gain access to your heart.
Your heart is connected to a heart-lung bypass machine for an on-pump heart surgery. The anesthesiologist uses IV medication to stop your heart from beating. They put a breathing tube in your throat and connect it to a ventilator to help you breathe.
The surgeon then performs the surgery on your heart.
Once the surgery is finished, they get blood flowing to your heart again. The heart usually starts beating on its own, but sometimes a mild electrical shock is needed to restart the heart.
You are disconnected from the heart-lung bypass machine and taken off the ventilator.
The surgeon closes the incision with wires and stitches.

How serious is open heart surgery?

An open heart procedure is a major operation that requires close monitoring and medical care in an intensive care unit (ICU) after the procedure, as well as a hospital stay for a few days. Your health care team will give you a more definite timeline, depending on the condition being treated and your overall health status.

How long does open heart surgery last?

Open heart surgery is a major surgery that can last 6 hours or more, depending on the type of heart surgery. During your pre-surgical consultations, your surgeon will give you an estimate of how long it will take to complete the surgical treatment.

What are the potential complications of open heart bypass surgery?

Possible complications of open heart surgery include allergic reactions to medications used for anesthesia, irregular heartbeat, bleeding, infection, damage to the surrounding organs, and stroke. Risk factors for complications include pre-existing health conditions such as obesity, diabetes, or lung disease.

How long is recovery from open heart surgery?

Open heart procedures usually require a hospital stay of 5-7 days, including initial care in the hospital intensive care unit for 2-3 days. After discharge from the hospital, recovery from open heart surgery usually takes 6-8 weeks. You can start resuming some of your normal activities after 1-2 weeks, many of your daily activities at home after about 4 weeks, and driving usually after 6 weeks. However, you should allow up to 12 weeks for proper healing and complete recovery.

Participating in a medically supervised program for cardiac rehabilitation can help you recover faster and optimize your heart health. In addition to cardiac rehab, you should take all the medications your doctor prescribes, for example, medications to keep you pain-free during recovery, blood pressure medications, or blood thinners to prevent blood clots.

When to see the doctor after open heart surgery?

Your surgeon will call you for several follow-up appointments at the medical center after your open heart surgery. During these appointments, they will remove the surgical tubes left in place to drain fluid from your chest cavity. They will also make sure the incision site is healing well, and your recovery is on track by performing a physical exam, ordering blood tests, and requesting other tests such as a chest X-ray or electrocardiogram (ECG).

Keep all your appointments, and in addition, call your doctor if you develop fever, chest pain, shortness of breath, nausea, vomiting, oozing or redness at the surgical incision site, or signs of stroke (numbness or weakness on one side of the body).

What is the survival rate for open heart surgery?

Studies have shown that the risk of death is higher in patients after coronary bypass (CABG) surgery (3.2% compared to 0.2% in the general population), especially in the first 30 days after open heart surgery. Research has also shown a survival rate of 96%, 94%, and 92% after 3, 5, and 10 years, respectively, after open heart surgery in adults with congenital heart disease. The survival of patients with heart valve disease following open heart surgery for valve repair or replacement is excellent and similar to the general population.

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