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.
According to the National Heart Lung and Blood Institute (NHLBI), coronary artery bypass grafting (CABG) is the most common type of heart surgery done on adults. During this surgery, a healthy artery or vein is grafted (attached) to a blocked coronary (heart) artery. This allows the grafted artery to “bypass” the blocked artery and bring fresh blood to the heart (NHLBI).
Open heart surgery is sometimes called traditional heart surgery. Today, many new heart procedures can be performed with only small incisions (cuts), not wide openings. Therefore, the term “open heart surgery” can sometimes be misleading.
Open heart surgery may be done to perform a CABG. A CABG may be necessary for patients with coronary heart disease (CHD).
CHD occurs when the blood vessels that provide blood and oxygen for the heart 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.
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
- put in medical devices that help the heart to beat properly
- replace a damaged heart with a donated heart (heart transplantation)
According to the National Institutes of Health, a CABG takes between four to six hours. It is generally done following these basic steps:
- The patient is given general anesthesia. This ensures the patient will be asleep and pain-free through the whole surgery.
- The surgeon makes an eight to 10-inch cut in the chest.
- The surgeon cuts through all or part of the patient’s breastbone to expose the heart.
- Once the heart is visible, the patient may be connected to a heart-lung bypass machine. The machine moves blood away from the heart so that the surgeon can operate. Some newer procedures do not use this machine.
- The surgeon uses a healthy vein or artery to make a new path around the blocked artery.
- The surgeon closes the breastbone with wire, leaving the wire inside the body.
- The original cut is stitched up. (NIH)
Sometimes sternal plating is done for high-risk patients, such as patients of advanced age or patients who have had multiple surgeries. This is when the breastbone is rejoined after the surgery with small titanium plates.
Risks for a CABG include:
- chest wound infection (more common in patients with obesity or diabetes, or those who have had a CABG before)
- heart attack or stroke
- irregular heart beat
- lung or kidney failure
- chest pain and low fever
- memory loss or “fuzziness”
- blood clot
- blood loss
- breathing difficulty
According to the University of Chicago Medicine (UCM), the heart-lung bypass machine is associated with increased risks. These risks include stroke and memory problems (UCM).
Tell your healthcare provider about any drugs you are taking, even over-the-counter medications, vitamins, and herbs. Inform them also of any illnesses, including herpes outbreak, cold, flu, or fever.
In the two weeks before the surgery, your healthcare provider may ask you to quit smoking and to stop taking blood-thinning medications, such as aspirin, ibuprofen, or naproxen.
The day before the surgery, you may be asked to wash yourself with a special soap. This soap is used to kill bacteria on your skin and will lessen the chance of an infection after surgery. You may also be asked not to eat or drink anything after midnight.
Your healthcare provider will give you any other detailed instructions when you arrive at the hospital for surgery.
When you wake up after surgery, you will have two to three tubes in your chest. These are to help drain fluid from the area around your heart.
You may have intravenous (IV) tubes in you, supplying you with fluids.
You may have a catheter (thin tube) in your bladder to remove urine.
You will also be attached to machines that monitor your heart. Nurses will be nearby to help you if you need it.
You will usually spend your first night in the intensive care unit (ICU). You will then be moved to a regular care room for the next three to seven days.
Expect a gradual recovery. It may take up to six weeks before you start feeling better, and up to six months to feel the full benefits of the surgery. However, the outlook is good for many people, and the grafts can work for many years.
Nevertheless, surgery does not prevent artery blockage from happening again. You can help improve your heart health by:
- eating a healthy diet
- cutting back on foods high in salt, fat, and sugar
- leading a more active lifestyle
- not smoking
- controlling high blood pressure and high cholesterol