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 (ICU) immediately after surgery.

A surgeon may operate on the heart to treat problems with the valves, arteries supplying the heart, or to replace the heart entirely with a transplant. These procedures involve opening the chest to gain access to the heart under general anesthetic.

This article will focus on the preparation, procedure, and recovery for open heart surgery in adults.

A person under blue sheets having open heart surgery, with the hands of surgeons working above the incision.Share on Pinterest
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Open heart surgery involves opening the chest to access the heart. There are several procedures surgeons perform this way, including:

Coronary artery bypass graft (CABG)

CABG is one of the most common types of open heart surgery. The coronary arteries supply the heart with blood. If the arteries become blocked or narrowed due to heart disease, a person may be at risk of a heart attack.

The operation involves taking a healthy blood vessel from another part of the body and using it to bypass the blocked arteries.

Heart valve repair or replacement

Another open heart procedure involves repairing or replacing a malfunctioning heart valve. Heart valves control the flow of blood in and out of the heart. When valves do not open and close as they should, it can put extra strain on the heart to pump more blood, which can result in heart failure.

Valve repair involves strengthening the existing valves. Replacement involves removing them and implanting a mechanical valve, or one that comes from another human or animal.

Heart transplant

Heart transplants involve removing a heart that is no longer functioning well enough, and replacing it with a heart from a healthy donor. Doctors use this procedure to treat severe heart failure that does not improve with any other treatment.

It can take months to find a donor for heart transplants, and as a result, the procedure is relatively uncommon.

The timeline for open heart surgery will depend on the procedure a person is having and how they respond to it. Here is what to expect before, during, and after.

Preparing for the surgery

Depending on the procedure a person is undergoing, preparation for open heart surgery may begin months in advance, or in a matter of hours.

Those with long-term conditions who are candidates for a heart transplant may try numerous other treatments before they begin waiting for a donor. In contrast, people who have heart attacks may need open heart surgery as an emergency measure.

Before the procedure, a doctor may explain:

  • when a person should stop eating or drinking before the surgery
  • how to bathe before surgery, which may involve using antibacterial soap
  • what medical information to bring
  • which medications to take before and after

The doctors may also need to run tests before surgery, such as monitoring the heart or taking blood samples.

If possible, it is a good idea to bring loose, comfortable clothing to assist with restricted movement following surgery.

People can feel anxious before anesthetic. People should not hesitate to seek reassurance from the healthcare team.

Before the surgery begins, a member of the healthcare team may shave the person’s chest area. They may 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, CABG can take 3–6 hours, while heart transplants take 4–6 hours.

To access the heart, the surgeon makes a 6–8 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.

What happens next depends on the surgery. Afterward the procedure is complete, the surgeon will close with wound with stitches, and health professionals will dress the wound with bandages.

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 may include:

  • the lead surgeon, who will direct others surgeons who will assist during the operation
  • the anesthesiologist, who is in charge of giving anesthesia and monitoring vital signs
  • the pump team, also known as perfusionists, who operate the heart-lung machine and other technical equipment
  • 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 postoperative support. It is typical for a person to remain in the ICU for a day or more after the procedure to receive further care. The healthcare team may:

  • provide oxygen to help with breathing
  • use an IV line to administer pain medication
  • use a tube to drain urine
  • attach an electrocardiogram to monitor heart rhythm
  • change a person’s bandages
  • give medications
  • provide compression stockings to prevent blood clots

The person may feel tired, groggy, or nauseous when they wake up from anesthesia. They may also experience some pain or side effects from pain medications.

When a person is ready to go home, the healthcare team will guide rehabilitation, advise on medications, and any restrictions on physical activity.

It takes many time 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 cardiac rehabilitation program, which helps people get fitter and implement heart-healthy changes.

Most insurance plans cover cardiac rehabilitation for up to 12 weeks. Other follow-up appointments might include blood tests, heart scans, and stress tests to monitor progress. A stress test involves monitoring the heart during a treadmill exercise.

During recovery from open heart surgery, it is typical to feel fatigue and experience some pain and itchiness as wounds heal. Some people can also experience:

A doctor can provide advice on how to manage the effects. For example, medications may help with constipation. It is also important to seek help for mental health symptoms, such as depression, if they occur.

Complications of open heart surgery

Open heart surgery has a risk other complications. These include:

  • infection
  • irregular heart rhythm, or arrhythmia
  • bleeding
  • clots
  • organ or tissue damage
  • memory loss or difficulty thinking, which often improve within 1 year after surgery
  • pneumonia
  • graft dysfunction or rejection, if a person received a transplant

In general, the risk of complications in higher when the surgery is an emergency procedure, or the person has other health problems.

The medical team will advise on ways to reduce some of these risks, which may involve taking medications, as well as making diet or lifestyle changes.

Seek immediate medical attention if a person develops:

  • pus or inflammation around the wound, fever, or feeling unwell
  • bleeding around the wound that will not stop after applying pressure
  • torn stitches
  • difficulty breathing
  • sudden muscle paralysis or weakness
  • chest pain or pressure
  • pain in the arm, neck, or jaw
  • a persistent fast or irregular heartbeat

There are now some alternatives to opening the chest to perform heart surgery, including the use of endoscope cameras and robots.

Some people who need bypass surgery may be able to have minimally-invasive heart surgery. This involves making small cuts to the skin and using instruments or a robot to perform the surgery inside the body. The healthcare team views the inside of the chest on a monitor.

The main advantage of this option is that the recovery time is shorter than those who have open heart surgery. Other catheter-based options 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, or very thin tube.
  • Aortic valve balloon valvuloplasty: This procedure involves inserting a balloon to enlarge a heart valve. Doctors can do this via catheter instead of making a large incision.

The long-term outlook of open heart surgery depends on the overall health of the person and the particular procedure they had.

However, the procedure may restore function, reduce symptoms, and the risk of complications if the condition goes untreated, such as future heart attacks or worsening heart failure.

Open heart surgeries are not necessarily a cure in all situations, though. Disease in the coronary arteries can still progress even after a bypass, for example. People still need to take care of their heart health to prevent this.

Open heart surgery survival rates

It is difficult to estimate the average survival rate for all type of open heart surgery. There are numerous types of open heart surgery that doctors use in different situations, for people with conditions of varying severity.

For example, a 2021 study on adults with congenital heart defects recorded a 5 year survival rate of 94.3%. But another study on adults undergoing CABG surgery recorded a slightly lower 5 year survival rate of 82.9%.

Many factors, such as age, coexisting conditions, and overall health status influence the prognosis.

Open heart surgery refers to any procedure that involves opening up the chest to gain access to the heart. Surgeons can use this approach to help treat heart valve problems, heart failure, and blocked arteries leading in or out of the heart.

Open heart procedures are major surgeries that take time to recover from, and may involve ongoing treatment with medications, diet or lifestyle changes, and follow-up appointments afterwards.

Many types have a good outlook, but they also have risks. A doctor can discuss the benefits and risks with a person so they can make an informed decision.