Open Heart Surgery, Procedure, Risk, Preparation and Recovery
Open-heart surgery is any type of surgery where the chest is cut open and surgery is performed on the muscles, valves, or arteries of the heart. Open-heart surgery is the most common type of heart surgery done on adults. During open-heart surgery, a healthy artery or vein is grafted to a blocked coronary artery. This allows the grafted artery to “bypass” the blocked artery and bring fresh blood to the heart.
Open-heart surgery is sometimes called traditional heart surgery. Today, many new heart procedures can be performed with only small incisions, not wide openings. Therefore, the term “open-heart surgery” can be misleading.
When is open-heart surgery needed?
Open-heart surgery is one treatment option if you have a blocked artery to your heart. You and your doctor might consider open-heart surgery if:
You have severe chest pain caused by narrowing of several arteries that supply your heart muscle, leaving the muscle short of blood during even light exercise or at rest.
You have more than one diseased coronary artery, and the heart's main pumping chamber — the left ventricle — isn't functioning well.
Your left main coronary artery is severely narrowed or blocked. This artery supplies most of the blood to the left ventricle.
You have an artery blockage that can't be treated with a procedure that involves temporarily inserting and inflating a tiny balloon to widen the artery.
You've had a previous angioplasty or placement of a small wire mesh tube to hold the artery open that hasn't been successful. Or you've had a stent placement, but the artery has narrowed again.
Open-heart surgery might also be performed in emergency situations, such as a heart attack, if you're not responding to other treatments.
Even with open-heart surgery, you'll need to make lifestyle changes after open-heart surgery. Medications are prescribed routinely after open-heart surgery to lower your blood cholesterol, reduce the risk of developing a blood clot and help your heart work as well as possible.
Open-heart surgery may be done to perform a coronary artery bypass grafting. A coronary artery bypass graft may be necessary for people with coronary heart disease. Coronary heart disease occurs when the blood vessels that provide blood and oxygen to the heart muscle become narrow and hard. This is often called “hardening of the arteries.” Hardening occurs when fatty material forms a plaque on the walls of the coronary arteries. This plaque narrows the arteries, making it difficult for blood to get through. When blood can’t flow properly to the heart, a heart attack may occur.
Open-heart surgery is also done to:
- Repair or replace heart valves, which allow blood to travel through the heart
- Repair damaged or abnormal areas of the heart
- Implant medical devices that help the heart beat properly
- Replace a damaged heart with a donated heart
How is open-heart surgery performed?
An open-heart surgery takes from three to six hours. It’s generally done following these basic steps:
- The open-heart surgery patient is given general anesthesia. This ensures that they will be asleep and pain free through the whole surgery.
- The surgeon makes an 8- to 10-inch cut in the chest.
- The surgeon cuts through all or part of the patient’s breastbone to expose the heart.
- Once the heart is visible, the open-heart surgery patient may be connected to a heart-lung bypass machine. The machine moves blood away from the heart so that the surgeon can operate. Some newer procedures do not use this machine.
- The surgeon uses a healthy vein or artery to make a new path around the blocked artery.
- The surgeon closes the breastbone with wire, leaving the wire inside the body.
- The original cut is stitched up.
- Sometimes sternal plating is done for open-heart surgery patients at high risk, such as those who’ve had multiple open-heart surgeries or people of advanced age. Sternal plating is when the breastbone is rejoined with small titanium plates after the open-heart surgery.
What are the risks of open-heart surgery?
Risks for open-heart surgery include:
- Chest wound infection (more common in open-heart surgery patients with obesity or diabetes, or those who’ve had an open-heart surgery before)
- Heart attack or stroke
- Irregular heartbeat
- Lung or kidney failure
- Chest pain and low fever
- Memory loss or “fuzziness”
- Blood clot
- Blood loss
- Breathing difficulty
- The heart-lung bypass machine is associated with increased risks. These risks include stroke and neurological problems.
How you prepare for open-heart surgery:
Your doctor will give you specific instructions about activity restrictions and changes in your diet or medications that you should make before open-heart surgery.
Make arrangements for assistance after your open-heart surgery. It will take about four to six weeks for you to recover to the point where you can resume driving, return to work and perform daily chores.
Tell your doctor about any drugs you are taking, even over-the-counter medications, vitamins, and herbs. Inform them of any illnesses you have, including herpes outbreak, cold, flu, or fever.
In the two weeks before the open-heart surgery, your doctor may ask you to quit smoking and stop taking blood-thinning medications, such as aspirin, ibuprofen, or naproxen.
It’s important to talk to your doctor about your alcohol consumption before you prepare for the open-heart surgery. If you typically have three or more drinks a day and stop right before you go into open-heart surgery, you may go into alcohol withdrawal. This may cause life-threatening complications after open-heart surgery, including seizures or tremors. Your doctor can help you with alcohol withdrawal to reduce the likelihood of these complications.
The day before the open-heart surgery, you may be asked to wash yourself with a special soap. This soap is used to kill bacteria on your skin and will lessen the chance of an infection after open-heart surgery. You may also be asked not to eat or drink anything after midnight.
Your healthcare provider will give you more detailed instructions when you arrive at the hospital for open-heart surgery.
Recovery of open-heart surgery:
Taking care of yourself at home immediately after the open-heart surgery is an essential part of your recovery after open-heart surgery.
- Incision care after open-heart surgery:
Incision care after open-heart surgery is extremely important. Keep your incision site warm and dry, and wash your hands before and after touching it. If your open-heart surgery incision is healing properly and there is no drainage, you can take a shower. The shower shouldn’t be more than 10 minutes with warm water. You should ensure that the open-heart surgery incision site isn’t hit directly by the water. It’s also important to regularly inspect your open-heart surgery incision sites for signs of infection, which include:
- Increased drainage, oozing, or opening from the open-heart surgery incision site
- Redness around the open-heart surgery incision
- Warmth along the open-heart surgery incision line
Pain management after open-heart surgery is also incredibly important, as it can increase recovery speed and decrease the likelihood of complications like blood clots or pneumonia. You may feel muscle pain, throat pain, pain at incision sites, or pain from chest tubes. Your doctor will likely prescribe pain medication that you can take at home. It’s important that you take it as prescribed. Some doctors recommend taking the pain medication both before physical activity and before you sleep.
Some patients experience trouble sleeping after open-heart surgery, but it’s important to get as much rest as possible. To get better sleep, you can:
- Take your pain medication a half hour before bed
- Arrange pillows to decrease muscle strain
- Avoid caffeine, especially in the evenings
In the past, some have argued that open-heart surgery leads to a decline in mental functioning. However, most recent research has found that not to be the case. Though some open-heart surgery patients may have open-heart surgery and experience mental decline later on, it’s thought that this is most likely due to the natural effects of aging.
Some open-heart surgery patients do experience depression or anxiety after open-heart surgery. A therapist or psychologist can help you manage these effects.
Most open-heart surgery patients who’ve had a open-heart surgery benefit from participating in a structured, comprehensive rehabilitation program. This is usually done outpatient with visits several times a week. The components to the program include exercise, reducing risk factors, and dealing with stress, anxiety, and depression.
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