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 artery. This allows the grafted artery to “bypass” the blocked artery and bring fresh blood to the heart.
Open-heart surgery is sometimes called traditional heart surgery. Today, many new heart procedures can be performed with only small incisions, not wide openings. Therefore, the term “open-heart surgery” can be misleading.
When it’s needed
Open-heart surgery may be done to perform a CABG. A coronary artery bypass graft may be necessary for people with coronary heart disease.
Coronary heart disease occurs when the blood vessels that provide blood and oxygen for the heart muscle 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.
Open-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
- implant medical devices that help the heart beat properly
- replace a damaged heart with a donated heart (heart transplantation)
According to the National Institutes of Health, a CABG takes from four to six hours. It is generally done following these basic steps:
- The patient is given general anesthesia. This ensures that the patient will be asleep and pain free through the whole surgery.
- The surgeon makes an 8- 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.
Sometimes sternal plating is done for people at high-risk, such as people of advanced age or people who have had multiple surgeries. This is when the breastbone is rejoined with small titanium plates after the surgery.
Risks for open-heart surgery 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 heartbeat
- 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, the heart-lung bypass machine is associated with increased risks. These risks include stroke and memory problems.
Tell your doctor about any drugs you are taking, even over-the-counter medications, vitamins, and herbs. Inform them of any illnesses you have, including herpes outbreak, cold, flu, or fever.
In the two weeks before the surgery, your doctor may ask you to quit smoking and stop taking blood-thinning medications, such as aspirin, ibuprofen, or naproxen.
It’s important to talk to your doctor about your alcohol consumption before you prepare for the surgery. If you typically have three or more drinks a day and stop right before you go into surgery, you may go into alcohol withdrawal. This may cause life-threatening complications after open-heart surgery, including seizures or tremors. Your doctor can help you with alcohol withdrawal to reduce the likelihood of these complications.
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 more detailed instructions when you arrive at the hospital for surgery.
When you wake up after surgery, you will have two or three tubes in your chest. These are to help drain fluid from the area around your heart. You may have intravenous (IV) lines 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 something should arise.
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.
Taking care of yourself at home immediately after the surgery is an essential part of your recovery.
Incision care is extremely important. Keep your incision site warm and dry, and wash your hands before and after touching it. If your incision is healing properly and there is no drainage, you can take a shower. The shower shouldn’t be more than 10 minutes with warm (not hot) water. You should ensure that the incision site isn’t hit directly by the water. It’s also important to regularly inspect your incision sites for signs of infection, which include:
- increased drainage, oozing, or opening from the incision site
- redness around the incision
- warmth along the incision line
Pain management is also incredibly important, as it can increase recovery speed and decrease the likelihood of complications like blood clots or pneumonia. You may feel muscle pain, throat pain, pain at incision sites, or pain from chest tubes. Your doctor will likely prescribe pain medication that you can take at home. It’s important that you take it as prescribed. Some doctors recommend taking the pain medication both before physical activity and before you sleep.
Get enough sleep
Some patients experience trouble sleeping after open-heart surgery, but it’s important to get as much rest as possible. To get better sleep, you can:
- take your pain medication a half hour before bed
- arrange pillows to decrease muscle strain
- avoid caffeine, especially in the evenings
While some believe that people may experience declines in mental functioning as a result of open-heart surgery, most recent research has found that not to be the case. Though some patients may have open-heart surgery and mental decline later on, it’s thought that they are more likely to be the natural effects of aging.
Some people do experience depression or anxiety after open-heart surgery. A therapist or psychologist can help you manage these effects.
Most people who’ve had a CABG benefit from participating in a structured, comprehensive rehabilitation program. This is usually done outpatient with visits several times a week. The components to the program include exercise, reducing risk factors, and dealing with stress, anxiety, and depression.
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