Open-Heart Surgery

Open-heart surgery is a complex surgical procedure that necessitates the use of a heart-lung machine. During the procedure, surgeons make a lengthy midline vertical incision on the chest, cut through the breastbone, and spread it apart to access the heart, allowing them to connect the patient to the heart-lung machine, stop the heart beats, and control blood flow while performing various operative procedures. These procedures can include coronary artery bypass grafting, aortic dissection, or aneurysm surgery, as well as repairing defects within the heart chambers like heart valve repair or replacement and congenital heart defect repair.

Indications for Open-Heart Surgery

Patients requiring open-heart surgery have the following typical conditions:

• Congenital heart defects (e.g., septal defects, heart valve regurgitation, stenosis, or heart chamber anomalies)
• Heart valve regurgitation or stenosis
• Coronary artery disease
• Aortic aneurysm and dissection
• Heart tumor
• Heart transplant

Open-heart surgical procedure

Pre-Procedure Preparation

Your doctor will conduct physical examination and diagnostic tests, including electrocardiography, chest X-rays, echocardiogram, and coronary angiography, evaluate for other medical conditions, such as diabetes, hypertension, hyperlipidemia, and stroke, perform blood coagulation time and lung function tests.

• Lifestyle adjustments to reduce risk include smoking cessation, alcohol avoidance, and weight loss.
• Discontinuation of specific medications, such as blood thinners and nonsteroidal anti-inflammatory drugs.
• Fasting for 8 hours before surgery reduces the risk of aspiration during anesthesia.
• Administration of fluids and medications through an intravenous line.
• Shaving of the chest, groin, and legs by the operating room nursing staff.

During the Procedure

Open-heart surgery typically lasts at least four hours, during which the patient is under anesthesia.

• Surgeons make a 6- to 8-inch-long incision down the chest center, cut the breastbone, and spread the chest.
• The heart and circulatory system are connected to a heart-lung machine, and heartbeats are temporarily stopped using medication.
• The necessary heart procedure is performed, such as coronary artery bypass, heart valve repair or replacement, congenital heart defect repairs, or aneurysm repair.
• Once the repair is completed, the heart is stimulated to resume its regular beating to restore blood circulation, and the heart-lung machine is disconnected.
• The breastbone and incision are closed using wire or sutures.

Post-Procedure Recovery

The patient is closely monitored in the Critical Care Unit (CCU) and subsequently transferred to a regular ward.

• Healthcare personnel assist with activities like coughing, standing up, walking within and outside the room, and navigating stairs.
• Post-surgery effects can include incisional pain, frequent cough, muscle aches, bruising, wound swelling, digestive issues, constipation, mood swings, loss of appetite, and insomnia.

Risks and Complications

Potential surgical risks and complications encompass allergies to anesthetic agents, abnormal bleeding, irregular heartbeat, damage to other organs (e.g., pneumonia or pulmonary edema), bloating, constipation, infections, and stroke. Complications are more likely in patients with obesity, lung disorders like emphysema, a history of smoking, preexisting health conditions, or older age.

Alternative Surgical Procedures

Due to advances in surgical technologies, surgeons can use minimally invasive heart surgery options instead of traditional open-heart surgery, including transcatheter aortic valve replacement (TAVR), coronary angioplasty and stenting, transcatheter septal defect closure, catheter ablation of cardiac arrhythmias, pacemaker implantation, aortic dissection or aneurysm stenting, and robotically assisted heart surgery.

Recovery

Recovery time varies but typically takes around one month, depending on individual health, the type of surgery, and any complications. Most patients can resume work or exercise one month post-surgery. During the first six weeks, it is advisable to refrain from driving and lifting heavy objects. Patients usually achieve a full recovery within three months.

Incision Care

• Proper hand hygiene before and after touching the incision site is crucial.
• Avoid prolonged immersion in a bathtub and direct spray of water on the incision site during showers.
• Keep the incision dry and regularly check for signs of infection, such as redness, warmth, drainage, or fever.

Pain Management

Pain relievers prescribed by the doctor are essential for well-managed pain, which can expedite recovery and reduce the risk of complications like pneumonia or blood clots.

Sleep Issues

Adequate sleep is essential for recovery; some patients may benefit from sleep medication. Tips to improve sleep include -- avoiding caffeinated beverages, using pillows for support, taking pain relievers before bedtime, and seeking help from a psychologist or medications if experiencing anxiety or depression.

When to see the doctor

Patients should promptly consult their doctor if they experience abnormal symptoms, high fever, nausea, vomiting, shortness of breath, redness or drainage from the surgical site, or chest pain.

Note from MedPark’s Doctors

Open-heart surgery is a complex major procedure with inherent risks, necessitating postoperative recovery time. Preoperative preparation, such as weight loss, smoking cessation, and exercise, can be beneficial. Patients are encouraged to discuss any questions or concerns about their surgery or conditions with their doctor.