Open heart surgery is a major operation that requires a hospital stay of a week or more. An individual will often spend time in the intensive care unit immediately after surgery.
In adults, a surgeon will operate on the heart to treat problems with the valves, arteries supplying the heart, and aneurysms in the main vessel leaving the heart.
While it is an intensive surgery, the risk of mortality is very low. One 2013 study showed an in-hospital mortality rate of 2.94 percent.
This article will focus on the preparation, procedure, and recovery for open heart surgery in adults.
Open heart surgery is an operation to repair a fault or damage in the heart. The operation requires the surgeon to open the chest to access the heart.
The most common type of open heart surgery is a coronary artery bypass.
The operation involves taking a healthy blood vessel from another part of the body and using it to bypass the blocked arteries.
Another open-heart procedure involves replacing a faulty aortic valve. The aortic heart valve prevents blood from flowing back into parts of the heart after the heart has pumped it out.
Surgeons also perform open-heart surgery to repair aneurysms, which are bulges in the main artery leaving the heart.
A person undergoing open heart surgery will need to stay in the hospital for 7 – 10 days. This includes at least a day in the intensive care unit immediately after the operation.
Preparing for the surgery
Preparation for open heart surgery starts the night before. A person should eat an evening meal as usual but must not consume any food or drink after midnight.
It is a good idea to wear loose, comfortable clothing to assist with restricted movement following surgery, but wear whatever is comfortable.
Be sure to have all personal medical information on hand. This might include a list of medications, recent illness, and insurance information.
It is normal to feel anxious before an anesthetic, and people should not hesitate to seek reassurance from the healthcare team.
The doctor may request that the person washes their upper body with antibacterial soap. A member of the healthcare team may need to shave the person's chest area before they can have the anesthetic.
The doctors may also need to run tests before surgery, such as monitoring the heart or taking blood samples. A doctor or nurse might place a line into a vein to enable the delivery of fluids.
After the medical team has completed the preliminary tasks, the anesthesiologist will administer general anesthesia.
During the operation
The length of time it takes to carry out open heart surgery depends on the type of procedure and the needs of the individual. As a guide, the National Heart, Lung, and Blood Institute (NHLBI) state that a coronary artery bypass takes 3 to 6 hours.
To access the heart, the surgeon makes a 6-to-8-inch incision along the middle of the chest. The cut will go through the breastbone.
The medical team might use a heart-lung bypass machine during the surgery. This involves stopping the heart from beating. The bypass machine takes over the heart's pumping action and removes blood from the heart via tubes. The machine then removes carbon dioxide from the blood, adds oxygen, and returns the blood to the body. This surgery is called "on-pump" surgery.
Sometimes, a surgeon might work "off-pump." When a bypass machine is not in use, the person's heart keeps beating. A member of the surgical team uses a device to steady the heart while the surgeon performs the procedure.
There is insufficient evidence to confirm whether on-pump open heart surgery is safer than off-pump surgery. However, according to the National Institute for Health and Clinical Excellence (NICE), survival rates 1 year after either form of open-heart surgery are similar at about 96–97 percent.
Who is in theater for open heart surgery?
A team of doctors and other health professionals work together in the operating theater during open heart surgery.
The team is likely to include:
- the lead surgeon who will direct others surgeons who will assist during the operation
- the anesthesiologist, who is in charge of giving and anesthesia and monitoring vital signs
- the pump team, also known as perfusionists, operate the heart-lung machine and other technical equipment that supports open heart surgery
- nurses and technicians, who assist the surgical team and prepare the operating theater for surgery
Open heart surgery is a major operation that requires close monitoring and immediate post-operative support.
It is normal for a person to remain in the intensive care unit (ICU) for a couple of days after the procedure to receive further care.
After the operation, a breathing tube will remain in place for a period to assist with breathing. A line also stays in the vein to administer pain relief. A person may find themselves attached to a variety of other monitoring equipment.
After leaving ICU, a person will probably stay in the hospital for about a week. Recovery at home after leaving the hospital usually takes between 4 to 6 weeks.
The healthcare team will guide rehabilitation and advise on medications and restrictions on physical activity.
- It is perfectly normal to experience tiredness and some pain.
- Follow the advice of the medical team on wound care, and look out for signs of infection around the chest wound, such as redness or discharge.
- Seek urgent care for any potentially serious symptoms of infection. Symptoms include difficulty breathing, fever, and excessive sweating.
Be patient and take your time. It takes many weeks or months to return to usual levels of activity. Some doctors might offer specialist support for daily activities and other aspects of recovery as part of a specific cardiac rehabilitation program.
Aftercare varies for each individual but might include blood tests, heart scans, and stress tests. A stress test involves monitoring the heart during a treadmill exercise.
Medication might include blood-thinning drugs.
There are now some alternatives to opening the chest to perform heart surgery, including the use of endoscope cameras and robots.
Sometimes, surgeons can treat narrowed coronary arteries by making minimally invasive cuts to the skin and using the da Vinci robot to perform the surgery. The Da Vinci is a multi-limbed, robotic surgical tool, which the surgeon controls remotely.
The procedure is called endoscopic coronary artery bypass surgery.
This procedure has no advantages in terms of effectiveness or safety over open-heart surgery. Both types of surgery require a similar length of stay and care plan in the hospital.
The main difference is that people who have undergone this less invasive surgery recover in less time than those who have had more traditional surgery.
Other alternatives to open heart surgery include:
- Angioplasty: During this procedure, a surgeon places a stent inside the narrowed artery to widen it.
- Transcatheter aortic valve replacement: This involves inserting a new valve via a catheter. This opens out once in place, expanding the blood vessel.
- Aortic valve balloon valvuloplasty: This procedure involves inserting a balloon to enlarge a valve.
All forms of heart surgery come with risks. These risks include:
- being under anesthesia
- organ damage
The severity of these risks depends on the individual. People with a more advanced heart condition face a higher risk of complications during and after surgery.
Recovery and long-term outlook depend on the overall health of the person and the particular procedure they need.
After recovery from a bypass operation, people should see an improvement in symptoms, such as chest pain and breathlessness.
The surgery also reduces the risk of heart attack. Open heart surgeries are not necessarily a cure, however. Disease in the coronary arteries can still progress even after a bypass.
Open heart surgery can be a daunting prospect for a newly-diagnosed person, but its success rate is high and experienced professionals will make the procedure as comfortable as possible.
Should I be scared about open heart surgery?
It is normal to feel anxious before open heart surgery. Getting as much information as possible from your heart surgeon can help ease your anxiety.
Also, be reassured by the fact that surgeons perform open heart surgeries every day with a fantastic survival rate. In addition to getting information on what to expect, you can also try relaxation techniques to help decrease your anxiety, such as meditation and breathing exercises.Gerhard Whitworth, RN Answers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.