Definition and Overview

An open-heart surgery refers to all types of surgical procedures where the heart is exposed. The surgery may involve any part of the heart, from the arteries, valves, to the muscles. It is most commonly done for the treatment of severe coronary heart disease or CHD. Nowadays, this type of surgery is also known as “traditional heart surgery” to distinguish it from newer, more advanced heart surgeries that require only small cuts so that the heart is no longer exposed. These procedures have been developed mainly due to the risks that have been associated with open-heart surgery.

Who Should Undergo and Expected Results

Open-heart surgery is typically performed in the following situations:

  • For the treatment of coronary heart disease – Coronary heart disease is the most common reason why an open-heart surgery becomes necessary. The condition develops when the blood vessels in the heart harden and become narrow due to the plaque that accumulates on their walls. This plaque is due to fatty food that the patient consumes. This disease may lead to obstructed blood flow to the heart, raising the person’s risk of suffering a heart attack. The surgery to treat CHD is also called coronary artery bypass grafting or CABG.

  • Heart valve repair – Some valves of the heart may become damaged, but some surgical techniques can be used to repair them.

  • Heart valve replacement – If valves are severely damaged, they need to be replaced instead of repaired. This can also be done through open-heart surgery.

  • Pacemaker implantation – A pacemaker is a medical device used to treat arrhythmias or conditions that affect the electrical rhythms that control the beating of the heart.

  • Heart transplant – If a person’s heart becomes damaged, it is possible to replace it with a donated heart.

  • Congenital heart defect corrective surgery – This is a procedure performed on a person, sometimes on an infant, who is born with a congenital heart defect.

  • Thoracic aortic procedures – These refer to the surgical treatment of thoracic aortic heart conditions.

Open-heart surgery is usually the last line of treatment for several heart diseases. It is expected to resolve the problem and prolong the life of a person suffering from chronic heart disease for many years. However, since it is a major procedure, patients may take a long time recovering from it. It may take up to six weeks for the patient to feel an improvement in his condition, and the full effects of the procedure may not be felt for at least six months after the procedure.

Also, open-heart surgery does not guarantee against recurrences. For example, if a coronary artery blockage is resolved with surgery, there is still a possibility that the repaired artery will become blocked again. To prevent this from happening, patients need to make certain adjustments to their diet and lifestyle habits.

How Does the Procedure Work?

An open-heart surgery begins with the surgeon making a 2 to 5-inch incision on the chest wall and dividing the muscles that are in the way to gain access to the heart.

Before the actual surgery is performed, the patient is attached to a heart-lung bypass machine. This allows the surgeon to work on the patient’s heart while the machine takes on its role of pumping blood to the other organs in the body.

At this point, the surgeon can perform the repair, replacement, or transplant that is needed. After the surgery, the patient will be brought to an intensive care unit, where he will stay for the first night after the surgery. He will typically have tubes attached to the chest in order to drain out excess fluid from around the heart. The patient will also have an IV line to supply the body with necessary fluids as well as a catheter connected to the bladder to remove waste products from the body. The heart will also be continuously monitored by the machine. After the first night, the patient will be transferred to a regular room but will need to stay in the hospital for up to seven days.

Nowadays, open-heart surgeries are becoming less common, thanks to other surgical techniques such as endoscopic heart surgery, where surgeons only need to make four small cuts in the chest and performs the surgery while being guided by a camera. Another modern heart surgery method is robot-assisted valve surgery, which uses robotic arms that are controlled by a computer; this technique is known for its precision and has so far yielded better results than traditional open-heart surgery. These less invasive procedures also do not require the patient to be on a heart-lung bypass machine, making the entire procedure less complex.

Possible Risks and Complications

Open-heart surgery is a major surgical procedure that comes with certain risks. These include:

  • BleedingChest wound infection, causing fever and inflammation
  • Heart attack, often caused by a blood clot breaking loose after the procedure
  • Stroke
  • Organ damage affecting the heart, kidneys, lungs, or liver
  • Blood loss
  • Difficulty breathing
  • Blood clot
  • Memory loss, which often resolves without treatment within six months to a year
  • Fuzziness or confusion
  • Chest pain
  • Low fever
  • Allergic reactions to medications used during the surgery


There is also a risk of the patient needing additional or repeat surgery, although the need may arise after several years.

There is also a small risk to the patient’s life. Thus, doctors first weigh its risks and benefits, taking into consideration the patient’s general health condition before they even recommend the procedure.

The risk of complications occurring is typically higher in surgeries that are performed in emergency situations, such as in response to a heart attack, or in cases wherein the patient is suffering from other serious diseases.

References:

  • Recommendations for preparing children and adolescents for invasive cardiac procedures: A statement from the American Heart Association Pediatric Nursing Subcommittee of the Council on Cardiovascular Nursing in collaboration with the Council on Cardiovascular Diseases of the Young. Circulation. 2003;108:2250-2564. PMID: 14623793 www.ncbi.nlm.nih.gov/pubmed/14623793.

  • Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA, et al. ACC/AHA 2008 Guidelines for the Management of Adults with Congenital Heart Disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to develop guidelines on the management of adults with congenital heart disease). Circulation. 2008;118:e714-e833. PMID: 18997169 www.ncbi.nlm.nih.gov/pubmed/18997169.

  • Webb GD, Smallhorn JF, Therrien J, Redington AN. Congenital heart disease. In: Mann DL, Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 62.

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