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.
According to the National Heart,
Lung, and Blood Institute (NHLBI), coronary artery bypass grafting
(CABG) is the most common type of heart surgery done on adults. During
this surgery, a healthy artery or vein is grafted (attached)
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.
is open-heart surgery needed?
Open-heart surgery may be done to perform a CABG. A coronary
artery bypass graft may be necessary for people with coronary heart
Coronary heart disease occurs when the blood vessels that
provide blood and oxygen for 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 (heart transplantation)
is open-heart surgery performed?
According to the National Institutes of Health, a CABG takes
from four to six hours. It is generally done following these basic steps:
- The patient is given general
anesthesia. This ensures that the patient 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 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
Sometimes sternal plating is done for people
at high-risk, such as people of advanced age or people who have had multiple
surgeries. This is when the breastbone is rejoined with small titanium plates after
are the risks of open-heart surgery?
Risks for open-heart surgery include:
According to the University of Chicago Medicine, the
heart-lung bypass machine is associated with increased risks. These risks
include stroke and memory problems.
How to prepare for open-heart surgery
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
In the two weeks before the 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 surgery. If you typically have three or
more drinks a day and stop right before you go into 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 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 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 surgery.
happens after open-heart surgery?
When you wake up after surgery, you will have two or three
tubes in your chest. These are to help drain fluid from the area around your
heart. You may have intravenous (IV) lines in you, supplying
you with fluids. You may have a catheter (thin tube) in your
bladder to remove urine.
You will also be attached to machines that monitor your
heart. Nurses will be nearby to help you if something should arise.
You will usually spend your first night in the intensive
care unit (ICU). You will then be moved to a regular care room for the
next three to seven days.
up, and what to expect
Taking care of yourself at home immediately after the
surgery is an essential part of your recovery.
Incision care is extremely important. Keep your incision
site warm and dry, and wash your hands before and after touching it. If your
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 (not hot) water. You
should ensure that the incision site isn’t hit directly by the water. It’s also
important to regularly inspect your incision sites for signs of infection,
- increased drainage, oozing, or opening from the
- redness around the incision
- warmth along the incision line
Pain management 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.
Get enough 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
While some believe that people may experience declines in
mental functioning as a result of open-heart surgery, most recent research has
found that not to be the case. Though some patients may have open-heart surgery
and mental decline later on, it’s thought that they
are more likely to be the natural effects of aging.
Some people do experience depression or anxiety after open-heart
surgery. A therapist or psychologist can help you manage these effects.
Most people who’ve had a CABG 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
for open-heart surgery
Expect a gradual recovery. It may take up to six weeks
before you start feeling better, and up to six months to feel the full benefits
of the surgery. However, the outlook is good for many people, and the grafts
can work for many years.
Nevertheless, surgery does not prevent artery blockage from
happening again. You can help improve your heart health by:
- eating a healthy diet
- cutting back on foods high in
salt, fat, and sugar
- leading a more active
- not smoking
- controlling high
blood pressure and high cholesterol