About Open Heart Surgery

Each year more than 500,000 people in the United States are told that they must have heart surgery, with many of them undergoing open heart surgery. While the idea of undergoing this type of operation is daunting, surgeons have been performing open heart surgery for many years and are skilled at performing the procedure without significant complications.

Identification

• During open heart surgery, the chest cavity is opened to allow access to the heart. Depending on the type of surgery, the heart may or may not be opened. In traditional open heart surgery, the patient is placed on a heart-lung bypass machine while a procedure is performed on the heart. The machine pumps blood throughout the body, provides oxygen, removes carbon dioxide from the bloodstream and circulates anesthetic drugs. Advances in surgical procedures have eliminated the need to use heart-lung machines for some procedures, although the surgery may still be considered open heart surgery.

Types

• Open heart surgery is used to perform a large number of cardiac procedures. These include repair of defects, replacement of valves, angioplasty, heart transplants, bypass surgery, surgery to repair congenital heart defects in infants and procedures to clear arterial blockages.

Procedure

• During traditional open heart surgery, the surgeon makes an incision in the center of the chest and spreads apart the breastbone in order to reach the heart. The heart is stopped and the patient placed on a heart-lung machine so that the surgeon can work on the heart while it is not beating. After the procedure is completed, the heart is restarted. The surgery must be completed in under six hours, as it isn't safe for the body to remain on the heart-lung machine any longer.

  After leaving the recovery unit, patients spend at least a few hours in the Intensive Care Unit to make sure that the heart is functioning normally. The total hospital stay will probably last slightly less than a week. Tubes may have been placed in the chest for drainage and these will be removed several days after surgery. Although doctors advise patients to gradually resume normal activities, it may take a month or more until they return to feeling normal.

Alternate Methods

• Newer, less-invasive methods of heart surgery are constantly being perfected. If you need bypass surgery and your surgeon is skilled in using the off-pump coronary artery bypass (OPCAB) procedure, you may be able to avoid being put on a heart-lung machine. During OPCAB, the breastbone is still split, but your doctor will sew bypass grafts in place while your heart continues to beat. Minimally invasive direct coronary artery (MIDCAB) also allows grafts to be placed without using a heart-lung machine, but this procedure is performed through a small incision in the sternum, eliminating the need to split the breastbone. MIDCAB can only be used if only one or two arteries need to be bypassed. Robotic assisted coronary artery bypass (RACAB) allows surgery to be performed using a robotic device, which the surgeon guides from another room.

Considerations

• If you will be having traditional open heart surgery, you can expect that you will have a poor appetite for a few weeks following surgery and may find it difficult to sleep at night. Many people experience some memory loss after being hooked up to a heart-lung machine and it may seem that your brain doesn't react quite as quickly as it did before surgery. If you had a bypass performed and the graft was taken from your leg, you can expect that your leg will be sore and swollen. You will be advised not to drive for at least a month. Other types of less-invasive surgery will have a shortened recovery period, but these procedures may not be appropriate for every patient or every situation.