Open Heart Surgery

Open Heart Surgery

Open heart surgery is also known as traditional cardiac surgery. It is a procedure in which the chest wall is opened to perform surgery on the heart muscles, valves, or arteries. The surgeon makes an incision in the sternum (breastbone) or its upper part. Once the heart is reached, a heart-lung machine is used to replace the function of the heart by pumping blood throughout the body. This allows the surgeon to operate on a non-beating heart without blood flowing through it.

Nowadays, the procedure can also be performed through small incisions between the ribs instead of the large incision in the sternum, known as minimally invasive surgery. In some cases, the heart-lung machine may or may not be used, so the term “open heart surgery” may not always be completely accurate.

Doctors decide to perform open heart surgery when other treatments such as medications and lifestyle changes are no longer effective. The cardiologist evaluates the patient’s condition, conducts necessary tests, and discusses the procedure in detail with the patient, including its complexity, risks, and expected outcomes. After surgery, the patient requires a recovery period to regain health and strength.

Reasons for Open Heart Surgery

Doctors may recommend open heart surgery for the following reasons:

  • Repair damaged parts of the heart
  • Replace or repair faulty heart valves
  • Perform a heart transplant using a donor heart
  • Implant medical devices to regulate heart rhythm and blood flow
  • Treat heart failure and coronary artery disease

Types of Open Heart Surgery

Coronary Artery Bypass Grafting (CABG)

This is the most common type of open heart surgery. It improves blood flow to the heart by treating coronary artery disease, which is caused by the buildup of fatty plaques (cholesterol) inside the coronary arteries, leading to narrowing and reduced blood flow.

This can cause chest pain (angina) and, if plaques rupture, may lead to blood clots that block blood flow completely (heart attack). During this surgery, a healthy artery or vein is grafted to bypass the blocked coronary artery, restoring blood and oxygen supply to the heart muscle. This can be done for more than one artery in the same procedure.

Heart Valve Repair or Replacement

Heart valves ensure that blood flows in one direction. If a valve is damaged (either narrowed or leaking), surgery is performed to repair or replace it with an artificial or biological valve (from a human or animal source).

Atrial Fibrillation Treatment

Atrial fibrillation is a common heart rhythm disorder where the atria beat irregularly or rapidly. A procedure called “maze surgery” creates new pathways for electrical signals to regulate heart rhythm.

Heart Transplant

This involves removing a diseased heart and replacing it with a healthy donor heart. It is usually performed in end-stage heart failure when all other treatments have failed.

Ventricular Assist Device (VAD)

A mechanical device used to support heart function and regulate blood flow in patients with weakened heart muscles or heart failure, or while waiting for a heart transplant.

Total Artificial Heart (TAH)

A device that temporarily replaces the ventricles in patients with severe heart failure, usually as a bridge to heart transplantation.

Medical Evaluation and Diagnostic Tests

The doctor evaluates:

  • The type of heart problem and symptoms
  • Previous treatments and surgeries
  • Family history of heart disease
  • Other health conditions (e.g., diabetes, hypertension)
  • Age and overall health

Tests may include:

  • Blood tests (e.g., complete blood count, cholesterol)
  • Electrocardiogram (ECG)
  • Stress test
  • Echocardiogram (ultrasound of the heart)
  • Coronary angiography (cardiac catheterization)
  • Chest X-ray
  • Cardiac MRI

Preparation for Surgery

The patient is admitted days before surgery for monitoring and testing. Preparation includes:

  • Special antiseptic washing to reduce infection risk
  • Shaving chest area
  • Receiving medications via IV
  • General anesthesia before entering the operating room

During Open Heart Surgery

  • The patient’s heart rate, blood pressure, oxygen levels, and breathing are monitored
  • A breathing tube is inserted and connected to a ventilator
  • The chest is opened (6–8 inches), and the sternum is divided
  • A heart-lung machine takes over circulation
  • The surgery is performed
  • Blood flow is restored, and the heart may restart naturally or with mild electrical shocks
  • The machine is removed
  • The sternum is closed with wires, and the skin is sutured

After Surgery

  • The patient stays in intensive care for one or more days
  • Gradual introduction of fluids via IV
  • Oxygen support as needed
  • Then transferred to a regular hospital room for several days

Vital signs such as heart rate, blood pressure, and breathing are continuously monitored.

Recovery is gradual, and visits are limited during the first week to reduce infection risk.

Recovery and Lifestyle

Patients recover at different rates depending on their condition and procedure. Doctors provide guidance on wound care, signs of infection, and managing side effects.

Lifestyle changes may be required:

  • Quit smoking
  • Follow a healthy diet
  • Exercise regularly
  • Reduce stress

Post-Surgery Symptoms

Patients may experience:

  • Muscle and chest pain
  • Swelling in the legs (especially after CABG)
  • Depression or mood changes
  • Anxiety and sleep problems
  • Loss of appetite
  • Constipation or urinary retention

These symptoms are usually temporary and improve gradually.

Risks and Complications

Despite successful outcomes, risks may include:

  • Bleeding
  • Infection
  • Side effects of anesthesia
  • Irregular heartbeat
  • Damage to heart, lungs, kidneys, or liver
  • Stroke
  • Death (especially in severe or emergency cases)
  • Memory loss (in some patients)

Risks are higher in elderly patients, women, and those with chronic conditions like diabetes, kidney disease, or lung disease.

Final Note

A strong patient mindset and understanding of the procedure play a major role in recovery. Many patients return to normal life and daily activities after surgery, often with significantly improved health compared to before.