Why or When An Open-Heart Surgery is Required

By Dr. Vishal Khullar in Heart Institute , Invasive Interventional Cardiology Unit

Apr 24 , 2023 | 4 min read

Open-heart surgery treats clogged/blocked coronary arteries or coronary artery diseases (CAD). The coronary artery bypass graft surgery establishes a new blood route to the heart muscle, facilitating a smoother blood flow through the heart.

What is Open-Heart Surgery?

Open-heart surgery treats critical heart conditions. Surgeons open the ribs and cut the sternum to reach the heart. Doctors call this procedure cracking the chest.

If the patient is physically fit, the surgeon might advise open-heart surgery. Smaller and less invasive incisions in the space between the ribs on the right side of the chest help doctors perform many types of heart surgery.

Why and when is open heart surgery necessary

Heart disease patients require a CABG, which demands open-heart surgery. Coronary heart disease occurs when blood and oxygen-supplying arteries harden and constrict due to fatty plaque. This plaque obstructs blood circulation through the arteries. If blood cannot reach the heart properly, it causes a heart attack.

Additionally, doctors perform open-heart surgery to:

Repair or replace heart valves to enable blood to flow through the heart.
Repair the heart's damaged or abnormal areas.
Place implants that promote a normal heartbeat.
Replace a damaged heart.

What are the types of open-heart surgery?

Following are the types of open-heart surgery:

On-pump: During a heart-lung bypass procedure, a machine temporarily replaces the heart and lungs functions. It moves blood away from the heart while circulating it elsewhere in the body. The surgeon operates on a non-beating, non-blood-flowing heart. The surgeon removes the device after the surgery, and the heart pumps normally.

Off-pump: Off-pump CABG restores coronary blood flow. The surgeon removes one artery or vein and bypasses the blocked artery to restore normal heart blood flow.

What does open-heart surgery treat?

Open-heart surgery treats heart defects or damage. The surgeon must make an incision in the chest to reach the heart.

Heart surgery can take up to six hours or more in some cases. During heart surgery, doctors will put the patient to sleep with anaesthesia.

The heart condition and procedure determine surgical steps. The surgeon will:

Create a 6- to 8-inch cut across the centre of the chest.
Spread the ribs and cut through the breastbone to get to the heart.
Connect the heart to a heart-lung bypass machine during on-pump surgery.
During heart surgery, an anesthesiologist stops the heartbeat and monitors the patient closely.
Boosts heart health
Restart heart blood flow. The heartbeat usually starts by itself. Mild electrical shocks may help restart the heart.
Disconnect the heart-lung bypass machine.
Use wires or sutures inside the body to close any incisions around the breastbone or other body parts.
The surgeon uses stitches to close the incision on the skin.

How should I prepare for open-heart surgery?

Inform the doctor of all the medications and supplements. The doctor may recommend stopping blood-thinning medications and smoking two weeks before surgery.
Before the surgery, talk to the doctor regarding alcohol consumption. Seizures or tremors may be deadly after open-heart surgery. Before surgery, the doctor may instruct the patient to use an antibacterial soap, which reduces post-heart-surgery infection risk.

Also Read About Best Heart Hospital in Mumbai

What happens during open-heart surgery?

Doctors will insert a breathing tube into the lungs via the throat.
The surgeon will create a chest wall incision.
The surgeon will remove a vein from the chest or leg for heart bypass grafts.
Doctors connect the heart to a heart-lung bypass machine. During surgery, a machine will pump and oxygenate the heart's blood.
The doctors will take the heart-lung bypass machine away after the surgeon has successfully restored blood flow to the heart.
The surgeon will use wires to close the breastbone.

What happens after open-heart surgery?

Patients may stay a day or more in the ICU after surgery, depending on the conditions. They are moved to a normal room when ready.
The hospital stay is likely to last several days. The cardiac team will discuss incision care. Patients may use a firm pillow while sneezing, coughing, or getting out of bed.

Following surgery, patients may experience the following:

Constipation
Depression
Bruising
Insomnia
Loss of appetite
Memory loss
Chest area muscle pain

What is recovery like after open-heart surgery?

It will take some time to get back into a routine after heart surgery because of the effects of the anaesthesia, medications, and reduced activity. Healing will take 2-3 months.
Patients may feel anxious, tired, irritable, or depressed for weeks. It takes much mental strength to face the worries and pressures that arise after surgery. Talking to family and friends can help patients deal with emotions after a heart operation.

Frequently Asked Questions

1. What are the dos and don'ts after open-heart surgery?
Dos:

Shower daily with light soap and dry carefully with a towel.
After seven days at home, remove any white tape from the incision.
If the incisions are puffy, red, leaking, or opening, notify the surgeon.

Don'ts

Do not drive unless approved by the doctor.
Don't lift, carry, push, or drag more than 5-10 pounds.
Do not vacuum, mop, scrape, mow, rake, dig, or cut wood.

2. What are some common complications after open-heart surgery?

Infection of the chest wound (more common in patients with diabetes, obesity, or prior CABG surgery)
Stroke /heart attack or abnormal heartbeat
Kidney or lung failure
Continual pain in the chest and a mild fever
Memory loss or fuzziness
Blood clotting
Loss of blood
Difficulty in breathing
Pneumonia

3. How long does it take to recover from open-heart surgery fully?

Recovery from an open-heart operation typically takes between 6 and 12 weeks. The surgeon will determine when the patient may return to work. In most cases, patients shouldn't drive or lift heavy items for the first six weeks after surgery.

4. Does open-heart surgery shorten your life?

The prognosis after a heart operation has improved over three decades. Bypass patients have a similar survival rate to the general population. However, mortality rates rise by 60-80% in the 8-10 years following a heart bypass operation.

5. How painful is open-heart surgery?

In the operating room, the doctor will use anaesthesia to put the patient to sleep for the duration of the procedure. Patients won't experience any pain or even remember it during the procedure. Depending on the complexity, a heart operation can take 3 to 6 hours.