The heart operations needed in children are mainly due to problems that infants are born with. In adults, operations are done to treat the following:
- problems with the valves in the heart
- blocked arteries supplying the heart
- problems with bulges in the main vessel near the heart
This article will focus on open heart surgery for adults.
What is open heart surgery?
Open heart surgery is an operation to repair a fault or damage in the heart. The surgeon opens the chest to get access to the heart.
In open heart surgery, the surgeon opens up the chest to gain access to the heart.
The procedure most commonly done by open heart surgery is coronary artery bypass surgery. This replaces the role of the coronary arteries in supplying the heart with blood. This surgery may be needed if the coronary arteries become narrower because of heart disease. Such narrowing increases the risk of heart attack.
An artery is grafted in place of the blocked one. This is taken from elsewhere in the chest or from a leg.
Another procedure done by open heart surgery is replacing a faulty valve. Valves in the heart are needed to stop blood flowing back into parts of the heart after being pumped out of them.
A problem called an aneurysm can also be repaired by open heart surgery. This is when there is a bulge in the main artery leaving the heart.
The total hospital stay needed for open heart surgery is around 7 to 10 days. This includes a day or more in the intensive care unit immediately after the operation.
Preparing for the surgery
Preparation for open heart surgery starts the night before. Patients should eat an evening meal as normal but take no food or drink at all after midnight.
Antibacterial soap may be given for washing the upper body during a bath or shower. The chest may also be prepared before anesthetic is given, including possible shaving.
Patients should wear whatever clothes are most comfortable. Loose clothing helps to make the time easier after the surgery when movement is restricted.
General anesthetic is used to put the patient to sleep during open heart surgery.
It is helpful to have all personal medical information ready for the hospital team. This might include a list of medications, recent illness, and insurance information.
It is normal for people to have raised levels of anxiety before an anesthetic. Patients should not hesitate to ask the healthcare team any questions they may have.
The doctors may need to run tests before the surgery, such as heart monitoring or taking blood samples. The team may place a line into a vein for fluids and drugs to be delivered.
A tablet may be given on the ward, prescribed by the anesthesiologist to make the patient drowsy. General anesthetic is then used to put the patient to sleep by injection.
During the operation
The amount of time needed for open heart surgery varies by the particular procedure and the patient. As a guide, the National Heart, Lung, and Blood Institute say that a coronary artery bypass takes 3 to 6 hours.
The surgeons reach the heart by opening up the chest. A cut of 6 to 8 inches is made with a blade along the middle of the chest and through the breastbone.
A heart-lung bypass machine may be used during the surgery. This means using a drug to stop the heart from beating while the surgeon operates on it. In place of the heart's pumping action, a machine is used to take blood down tubes from the heart. Carbon dioxide is removed from the blood, oxygen is added, and the blood is returned to the body.
Although it is usually done "on-pump" in this way, open-heart surgery may also be completed "off-pump." The heart is allowed to keep beating and is held in place with a device to assist the surgeon.
There is not much evidence to decide whether it is better to have on- or off-pump open heart surgery. Survival rates 1 year after either form of open heart surgery are similar at nearly nearly 100 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 lead surgeon is a heart surgeon who may direct others surgeons giving assistance
- The anesthesiologist is in charge of giving and monitoring anesthesia and vital signs
- The pump team - people called perfusionists operate the heart-lung machine and other technical equipment used during open heart surgery
- Nurses and technicians assist the surgical team and prepare the operating theater
Open heart surgery is a major operation that needs close monitoring and support immediately afterward.
It is normal to be cared for and remain in the intensive care unit (ICU). This is usually for a couple of days after the procedure.
A breathing tube remains in place after waking up to assist with breathing. A line into the vein also remains to give pain relief. Monitoring equipment is also in place.
It is normal for patients to remain in the hospital after leaving the ICU. Recovery at home after leaving the hospital will then take a number of weeks. The rest period is often 4 to 6 weeks.
Rehabilitation will be guided by the healthcare team, including advice about medications and physical activity. Activities will need to be light at first.
- Tiredness and some pain are normal
- Being alert to the possibility of infection is important
Open heart surgery is a major operation requiring close monitoring and support afterward.
Patients should follow the medical team's advice on wound care and look out for signs of infection around the chest wound such as redness or discharge.
Specialist support for activities and other aspects of recovery may be offered in a specific cardiac rehabilitation program
Aftercare varies by individual but may include follow-up tests such as blood tests, heart scans, and stress tests, which is heart monitoring during a treadmill exercise. Medication may include blood-thinning drugs.
Recovery and long-term outlook depend on the patient and the particular procedure.
After recovery from a graft operation, there should be improvement in symptoms such as breathlessness and chest pain.
The risk of heart attack is also reduced by the surgery. Open heart surgeries are not necessarily a cure, however. Disease in the coronary arteries can still progress after a graft, for example.
Alternatives to opening up the chest are now available. These can include the use of endoscope cameras and robots.
The treatment of narrowed coronary arteries can be done by minimally invasive cuts to the skin and the use of the da Vinci robot. This alternative is known as endoscopic coronary artery bypass surgery.
No advantage has been found in terms of effectiveness or safety across patients choosing open surgery over these alternatives. Both types of surgery still require similar time in hospital and care. The main difference is that less invasive surgery has a shorter recovery.
All forms of heart surgery come with risks. These risks include being under anesthetic, and chances of infection, organ damage, and stroke. Risks depend on the person, such as being higher in people who are less well.
Alternatives to open heart surgery include:
- Angioplasty - this places a stent inside the narrowed artery to widen it out
- Transcatheter aortic valve replacement - the new valve is inserted via a catheter and opens out once in place
- Aortic valve balloon valvuloplasty - a balloon is used to widen a valve