What To Expect During Open Heart Surgery

Open heart surgery is a medical procedure where a heart surgeon cuts your chest open to easily access the heart and fix any problems with it. About 2 million people undergo open heart surgery yearly for different heart conditions, including coronary artery disease, atrial fibrillation, or heart failure.

What's the Purpose?

Open heart surgery allows your surgeon to make a large incision (cut) in your chest to access your heart. It helps the surgeon to reach and operate on your heart directly. Your healthcare provider may recommend open heart surgery if you have been diagnosed with one of the following heart conditions:

• Coronary heart disease: Causes the coronary arteries (blood vessels in your heart) to narrow, limiting blood flow to the heart
• Heart valve disease: Occurs when your heart valves don't open or close properly
• Atrial fibrillation: When the upper chambers of the heart (known as the atria) beat irregularly, leading to improper blood flow to the lower chambers (known as the ventricles)
• Heart failure: Develops when the heart cannot pump enough blood to meet the body's needs

These heart conditions can cause several symptoms, including chest pain, fatigue, shortness of breath, palpitations, and dizziness. Your provider may recommend open heart surgery or an alternative procedure to help relieve these symptoms and improve your overall heart health.

Types of Open Heart Surgery

There are two main types of open heart surgery:

• On-pump surgery: Uses a heart-lung bypass machine to help pump blood throughout the body during the surgery while the heart is not beating
• Off-pump surgery: Allows the heart to keep beating during the surgery, and no machine is involved

How To Prepare for Surgery

Undergoing open heart surgery can make you feel anxious. Talk to your healthcare provider about questions or concerns to help reduce any worry and ensure the surgery goes smoothly. The surgery takes place at a hospital while you are under anesthesia and unconscious to prevent you from feeling any pain or discomfort during the procedure.

Your healthcare team—including surgeons, cardiologists, nurses, and anesthesiologists—may recommend you undergo certain blood tests to assess your heart function alongside exams such as an electrocardiogram (EKG) or chest X-ray. These tests can give your healthcare team a baseline of your overall health.

Knowing how to prepare for the procedure ahead of time can help ensure it goes smoothly. Consider these tips:

• Wear comfortable clothes to the hospital
• Leave jewelry, watches, and other accessories or valuables at home
• Avoid eating or drinking anything before the surgery
• Inform your healthcare provider about any ongoing medications and ask if you need to stop taking them before the surgery
• Bring your photo identification and insurance card
• Ask a loved one to accompany you to the hospital or pick up and drop you off, as you won't be able to drive after being under anesthesia
• Talk to your insurance provider about any out-of-pocket costs you might have to pay for the surgery

How Does It Work?

During open heart surgery, your surgeon makes a cut in your chest to access the heart more easily. The surgery takes place in a hospital under anesthesia. You may have to stay at the hospital for a few days after the surgery to recover. Depending on your cardiologist's recommendation, the surgery can be on-pump or off-pump.

During the Procedure

Before your surgeon cuts into your chest, your healthcare team will shave the area of the chest where the cut will happen. They will then wash the area with an antiseptic soap to reduce the risk of infections. You can expect your team to place an intravenous (IV) line into a blood vessel in your arm, which allows you to receive fluids and medicine during surgery.

Here's what you can expect after you've been prepped for surgery. Your healthcare team will:

1. Administer anesthesia to ensure you're asleep during the surgery
2. Make a cut in your chest (6-8 inches, but might be smaller or larger)
3. Cut through your breastbone to reach your heart
4. Connect your heart to a heart-lung bypass machine if you are having an on-pump surgery
5. Repair your heart condition
6. Restore blood flow back to the heart
7. Electrically shock the heart to restart it, if necessary
8. Closes the breastbone with wires
9. Stitch up your chest to close the incision

The procedure's length will depend on your exact condition and the complexity of the surgery you're undergoing. You can generally expect the surgery to last anywhere from 3-5 hours.

After the Procedure

You will stay in an intensive care unit (ICU) for one or more days following the surgery, depending on the type of surgery you had. During this time, your healthcare team may:

• Apply bandages on your chest
• Monitor your heart rhythm
• Drain fluids from your chest
• Maintain proper blood flow through your body to prevent blood clots
• Give you extra oxygen through face masks or specialized nasal tubes
• Monitor your vitals, such as your heart rate, blood pressure, and breathing

After leaving the ICU, you may need to stay at the hospital for a few more days for further monitoring before you can go home. Once you are discharged from the hospital, your healthcare team will provide you (and your caregiver) specific instructions on managing your recovery at home. You'll likely also need to come in for follow-up appointments so your provider can determine the success of the surgery and adjust any other treatments you may be receiving.

Risks and Precautions

Open heart surgery also has certain risks, just like any other surgery. The risks vary based on your heart condition, overall health, and surgery type. The most common risks of open heart surgery include:

• Arrhythmia (irregular heartbeat)
• Damage to heart, lung, kidney, or liver tissues
• Formation of blood clots that can eventually lead to stroke
• Bleeding
• Infection or swelling at the incision site
• Fever
• Loss of memory or difficulty thinking clearly
• Pneumonia

The risks are usually higher if the surgery takes place in an emergency situation, such as a heart attack. The risk is also higher if you have other underlying health conditions, including diabetes, kidney disease, or lung conditions. Tell your healthcare team immediately if you experience any side effects after your procedure so they can monitor you and prevent the risk of complications.

Recovery

It may take 4-6 weeks to start feeling better, but the recovery time for open heart surgery varies by person. To ensure a healthy recovery, you may need to:

• Schedule regular check-ups with your cardiologist or surgeon and undergo tests to ensure your heart is working properly
• Take prescribed medications
• Regularly check for signs of infection at your incision site
• Undergo cardiac rehabilitation, which includes getting exercise, reducing stress, following a heart-healthy meal plan, and learning more about taking care of your overall heart health

Open heart surgery does not prevent future heart conditions. That's why following a healthy lifestyle is essential to maintaining cardiovascular health and lowering the risk of future concerns. Your healthcare provider may recommend these lifestyle changes:

• Eat a heart-healthy diet
• Manage stress
• Exercise or stay physically active
• Get good quality sleep
• Avoid or quit smoking
• Reduce alcohol intake

A Quick Review

Open heart surgery allows your heart surgeon to cut open your chest to reach your heart directly and repair any damage. You may need open heart surgery if you're living with severe or advanced symptoms of heart conditions like heart failure or coronary artery disease.

This procedure is a major surgery, and recovery can take several weeks. After your surgery is complete, you will need to meet with your healthcare team regularly, undergo cardiac rehabilitation, and make lifestyle changes that improve your heart health and lower your risk of future heart concerns.