Open-Heart Surgery Risks, Procedure, and Preparation

Overview 

Open-heart surgery is any surgery in which the chest is opened, and surgery on the heart’s muscles, valves, or arteries is done.

The most typical form of adult heart surgery is coronary artery bypass grafting (CABG). A healthy vein or artery is grafted to an obstructed coronary artery during this procedure. This enables the transplanted artery to bypass the blocked artery and supply the heart with new blood.

Traditional heart surgery is also known as an open-heart surgery. Many modern heart operations can now be carried out using only tiny incisions rather than large openings. Therefore, it may be inaccurate to refer to open heart surgery as such.

What is open-heart surgery? 

Treatment for heart problems includes heart surgery. One method for surgeons to access the heart is through open-heart surgery.

The chest wall must be opened to access the heart more easily during open-heart surgery. Surgeons spread the ribcage and cut through the sternum (breastbone) to gain access to the heart. Sometimes, it is referred to as chest cracking.

The most dependable method for surgeons to conduct heart surgery is open-heart surgery. If you are healthy enough to endure an open procedure, your doctor might advise it.

Smaller, less invasive incisions, such as those on the right side of the chest, between the ribs, can be used to conduct a variety of heart surgeries.

Types of open-heart surgery 

Open heart surgery can be carried out in one of two ways:

On-pump

A heart-lung bypass system attached to the heart temporarily replaces the heart and lungs. Blood is circulated throughout the body while being moved away from the heart. The physician then operates on a heart that isn’t pumping blood or beating. After the procedure, the surgeon disconnects the device, and the heart starts beating again.

Off-pump

Off-pump bypass surgery is performed on a heart that is still beating normally. Only the coronary artery bypass grafting (CABG) procedure suits this method. (bypass surgery). The surgeon may use the phrase beating-heart surgery.

What does open-heart surgery treat? 

You might need open-heart surgery if you have one of the following heart conditions.

• Arrhythmias, including atrial fibrillation.
• Congenital heart defects, like hypoplastic left heart syndrome (underdeveloped heart structures) or atrial septal defect (hole in the heart).
• Heart valve disease.
• Thoracic aortic aneurysm.
• Coronary artery disease.
• Heart failure.

When is open-heart surgery needed? 

A CABG procedure may involve open-heart surgery. People with coronary heart disease may require a coronary artery bypass transplant.

Coronary heart disease develops when the blood vessels that carry oxygen and blood to the heart muscle constrict and harden. Hardening of the arteries is a common name for this.

When fatty material deposits a plaque on the heart artery walls, it results in hardening. Blood flow is hampered by the vessel’s narrowing caused by this plaque. A heart attack could happen if the heart’s blood supply is compromised.

Preparation for open-heart surgery 

To prepare for open-heart surgery, you should follow your healthcare provider’s recommendations about

Medications

Some medications must be stopped a week or two before the operation. Nonsteroidal anti-inflammatory medications (NSAIDs) and blood thinners (such as aspirin, warfarin, or other drugs that prevent blood clots and strokes) are frequently stopped by patients. (NSAIDs). These medications may make bleeding more likely.

Food and beverage

On an empty stomach, anaesthesia is more secure, so you will be asked to fast (i.e., not consume or drink) before your surgery.

Alcohol and smoking

Reduce alcohol consumption and stop smoking. Both can slow postsurgical healing and raise the risk of complications.

Procedure 

Before open heart surgery

Before having open heart surgery, you should have: 

• An electrocardiogram (EKG), chest X-rays, or other procedures to aid the surgeon in planning the surgery.
• Cleaning the surgical site with antimicrobial soap to eliminate bacteria.
• An IV in your arm that will deliver fluids and medicine.

During open-heart surgery 

Heart operation is complex. Some operations could go on for six hours or longer. Having received anaesthesia, you will be unconscious throughout the process.

Different surgical procedures are used depending on the procedure and heart condition. Typically, your doctor:

• Cuts down in the centre of your chest that is 6 to 8 inches long.
• Stretches your ribs apart and cuts through your breastbone to reach your heart.
• If you have an on-pump procedure, the doctor might connect the heart to a heart-lung bypass machine. An anesthesiologist watches you throughout the procedure and administers IV medication to stop your heart from beating.
• Helps in repairing your heart.
• Restores your heart’s blood supply. Your heart typically begins to pulse on its own. The heart occasionally requires a slight electrical shock to restart.
• The heart-lung bypass equipment is disconnected. The doctor closes the breastbone or other wounds with internal wires or sutures.
• The skin incision is stitched shut.

After open-heart surgery 

Depending on the procedure, your stay in the hospital’s critical care unit (ICU) could last a day or longer. You’ll transfer to a standard medical room when you’re prepared.

Numerous days in the infirmary are to be anticipated. Your heart care staff will go over aftercare instructions with you. You might have a unique firm pillow to shield your chest when you sneeze, cough, or get out of bed.

After surgery, you might experience

• Constipation 
• Memory problems
• Depression or mood swings
• Loss of appetite
• Insomnia or difficulty sleeping
• Muscle pain in the chest area
• Pain and minor swelling at the incision site

How is open-heart surgery performed? 

According to the National Institutes of Health, a CABG takes three to six hours. It’s generally done following these basic steps.

• Anesthesia is given to a patient. This guarantees they will sleep off and be pain-free throughout the procedure.
• The surgeon makes an 8 to 10-inch incision in the chest.
• The physician makes a full or partial cut through the breastbone to access the patient’s heart.
• Once the heart is revealed, the patient might be connected to a heart-lung bypass machine. For the physician to perform surgery, the device moves blood away from the heart. Some more recent treatments don’t employ this device.
• The surgeon creates a new path around the blocked artery using a healthy vein or artery.
• The wire is left inside the body after the physician uses it to close the breastbone.
• The original cut is stitched up.
• For those at high risk, such as those who have undergone numerous surgeries or are elderly, sternal plating may occasionally be necessary. After the operation, the breastbone is repaired with tiny titanium plates known as sternal plating.

Risks of open-heart surgery 

Risks of open-heart surgery include

• Heart attack or stroke
• Chest wound infection 
• Chest pain and low fever
• Blood clot
• Memory loss or fuzziness
• Lung or kidney failure
• Blood loss
• Breathing difficulty
• Irregular heartbeat
• Pneumonia

Recovery, follow-up, and what to expect 

Caring for yourself at home is essential to your recovery in the first few days after the operation.

Incision care

It’s essential to take care of your incisions. Wash your hands before and after handling the incision site, and keep them warm and dry. You can shower if your incision is healing correctly and there is no drainage. 

Warm (not hot) water in the bathtub should be used for at most 10 minutes. Make sure that water doesn’t immediately hit the incision site. Additionally, it’s essential to routinely check your incision locations for infection symptoms, such as

• Increased drainage, oozing, or opening from the incision site
• Redness around the incision
• Warmth along the incision line
• Fever

Pain management

Pain management is also necessary to speed up healing and reduce the risk of complications like blood clots or pneumonia. You might experience discomfort in your muscles, throat, at the sites of your incisions, or from chest tubes. You’ll most likely be given painkillers to take home by your doctor.

You must consume it precisely as directed. Some medical professionals advise taking painkillers both before exercise and before bed. 

Get enough sleep

After open-heart surgery, some patients have difficulty falling asleep, but getting as much rest as possible is essential. To sleep better, you can

Take your painkillers 30 minutes before going to bed.

• Organize your pillows to reduce muscular tension
• Do not consume caffeine, particularly at night.
• Some have previously asserted that open heart surgery causes a decrease in mental capacity. But the majority of recent studies have discovered that’s not the case.
• After open heart surgery, some patients suffer from anxiety or depression. You can handle these effects with the aid of a therapist or psychologist.

Rehabilitation

An organized, thorough rehabilitation programme is beneficial for the majority of CABG patients. Exercise, lowering risk factors, and addressing tension, anxiety, and depression are among the programme’s components.

Alternatives to standard open-heart surgery? 

Many treatments that once required chest opening can now be performed through small incisions or minimally invasive heart surgery due to medical breakthroughs. Sometimes, the physician must still cut through a portion of the breastbone. (partial sternotomy).

Depending on the situation, your physician can apply the following techniques.

Catheter-based

A catheter (a narrow, hollow tube) is threaded into the heart by your surgeon. The surgeon then inserts surgical tools, balloons, or stents through the catheter. Transcatheter aortic valve replacement (TAVR), stenting and coronary angioplasty are two examples of catheter-based treatments.

Video-assisted thoracic surgery (VATS) 

Your doctor will conduct VATS by making several tiny incisions in your chest and inserting a small video camera (thoracoscope) and surgical tools. To implant a pacemaker, replace damaged cardiac valves, or handle arrhythmias, your surgeon might use VATS.

Robotically assisted

This minimally invasive procedure may be appropriate for some individuals with valvular heart disease, cardiac tumours, septal defects (holes in the heart) and atrial fibrillation.

When to see a doctor?

You should call your healthcare provider if you experience

• Chest pain other than normal discomfort at the incision
• Fever
• Signs of infection at the surgical site, such as oozing and redness
• Slurred speech or other signs of stroke
• Nausea and vomiting
• Shortness of breath

Summary 

Surgery does not, however, stop artery blockage from occurring again. Your heart’s wellness can be enhanced by consuming a balanced meal, reducing consumption of foods rich in salt, fat, and sugar and leading a more active lifestyle.

FAQ’s