Open-Heart Surgery

Open-Heart Surgery is a major operation in which the surgery is performed by a surgeon on the muscles, valves or arteries of the heart by cut opening the chest.

Some facts about Open-Heart Surgery

• The problems with the valves, arteries supplying the heart, and aneurysms in the main vessel leaving the heart can be treated by an open-heart surgery.
• Coronary artery bypass grafting (CABG) is the most common type of heart surgery done on adults according to the National Heart, Lung, and Blood Institute (NHLBI).
• A healthy artery or vein is attached to a blocked coronary artery which allows the attached artery to bypass the blocked artery and bring fresh blood to the heart during this surgery.
• Open-heart surgery is required for people with coronary heart disease when there is hardening of the arteries in which the blood vessels that provide blood and oxygen to the heart muscle become narrow and hard.
• Hardening occurs when a plaque is formed on the walls of the coronary arteries because of deposition of fatty material. The arteries becomes narrow because of formation o palque, making it difficult for blood to get through and increasing the risk of a heart attack as the blood can't flow properly to the heart.
• Open-heart surgery can 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 and replace a damaged heart with a donated heart which is called as heart transplantation.

Preparation before the Open-Heart Surgery

• A person undergoing open heart surgery will need to stay 7 to 10 days in the hospital including at least a day in the intensive care unit immediately after the operation.
• Preparation starts the night before the open heart surgery.
• The person undergoing open heart surgery should eat an evening meal as usual but is not allowed to consume any food or drink after midnight.
• Comfortable clothing should be worn to assist with restricted movement following surgery.
• All personal medical information including a list of medications, recent illness and insurance information should be there on hand.
• The upper body should be washed with antibacterial soap and a member of the healthcare team may help the person to shave his chest area before they can have the anesthetic.
• Some tests such as monitoring the heart or taking blood samples are done by the doctor before surgery.
• A line into a vein is placed by a doctor or nurse to enable the delivery of fluids.
• The anesthesiologist will administer general anesthesia after completion of the preliminary tasks by the medical team.

Procedure for Open-Heart Surgery

• A coronary artery bypass usually takes 3 to 6 hours according to the National Heart, Lung, and Blood Institute (NHLBI). However, the duration of open heart surgery depends on the type of procedure and the needs of the individual.
• The surgeon makes a 6 to 8 inch incision along the middle of the chest which will go through the breastbone to access the heart.
• A heart-lung bypass machine may be used by the medical team during the surgery which involves stopping the heart from beating. The pumping action of heart is taken over by the bypass machine and removes blood from the heart through tubes. Carbon dioxide is removed from the blood, oxygen is added and the blood is returned to the body. This procedure is called 'on-pump' surgery.
• A bypass machine is not in use and heart of the person keeps beating in case of a 'off-pump' surgery. A device is used by a member of the surgical team to steady the heart while the surgeon performs the procedure.
• All or part of the breastbone of the patient is cut by the surgeon to expose the heart.
• The patient may be connected to a heart-lung bypass machine once the heart is visible. The blood is moved away from the heart by the bypass machine so that the surgeon can operate.
• A healthy vein or artery can be used by the surgeon to make a new path around the blocked artery.
• The breastbone will then be closed by the surgeon with wire, leaving the wire inside the body and the original cut is stitched up.
• Sometimes sternal plating is done for people at high risk in which the breastbone is rejoined with small titanium plates after the surgery. This can be done in people who have had multiple surgeries or people of advanced age.

• Chest wound infection is a common risk in patients with obesity or diabetes or those who have had a CABG before.
• Heart attack or stroke, irregular heartbeat, lung or kidney failure, chest pain and low fever, memory loss, blood clot, blood loss, breathing difficulty and pneumonia are some risk that can occur during an open heart surgery.
• The heart-lung bypass machine is associated with increased risks which include stroke and neurological problems.

• Close monitoring and immediate post-operative support is required for an open heart surgery as it is a major operation.
• The patient will remain in the intensive care unit (ICU) for a couple of days after the procedure to receive further care.
• A breathing tube will remain in place for a period to assist with breathing after the operation.
• Pain relief can be administered by a line that stays in the vein.
• A variety of other monitoring equipment are also attached to the patient in ICU.
• The patient will probably stay in the hospital for about a week after leaving ICU.
• Usually it takes between 4 to 6 weeks for recovery at home after leaving the hospital.
• rehabilitation and advise on medications and restrictions on physical activity will be guided by the healthcare team.
• It is normal to experience tiredness and some pain during recovery.
• The advice of the medical team on wound care should be followed, and signs of infection around the chest wound, such as redness or discharge should be look out.
• Seek urgent care for any potentially serious symptoms of infection such as difficulty breathing, fever, and excessive sweating.
• It may takes many weeks or months to return to usual levels of activity.
• Specialist support for daily activities and other aspects of recovery can be offered by some doctor as part of a specific cardiac rehabilitation program.
• Aftercare varies for each individual depending on their personal need which might include blood tests, heart scans, and stress tests.
• Blood-thinning drugs can be included as medication.