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The phrase open-heart surgery is often used interchangeably with “bypass surgery,” which is technically “coronary artery bypass grafting,” or CABG. But open-heart surgery can actually refer to any of several operations that require surgeons to open up the chest cavity and work directly on the heart.
Other procedures requiring open-heart surgery include valve repair or replacement, arrhythmia (abnormal heart rhythm) treatment, aneurysm (bulge in artery wall) repair, or, of course, a heart transplant.
Medical technology advancements in recent years are allowing doctors to perform some of these procedures with a catheter or through several small incisions that do not require the one large incision associated with open surgery. But open-heart surgery remains an important treatment option for patients facing a variety of cardiac problems.
Regardless of what type of open-heart surgery you have, there are some important facts you should understand if you or a loved one ever faces this major operation.
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When Is Surgery Needed?
CABG is the most common type of heart surgery. It’s done to maintain blood flow when the heart has a blocked artery. Symptoms such as angina (chest pain), shortness of breath, and weakness or pain in the limbs are among the first signs of heart disease and the possible need for CABG or other procedures.
Arteries in the heart, called coronary arteries, can narrow due to a buildup of cholesterol, fats, and other substances. This buildup is called plaque, and if it narrows your coronary arteries too much, or ruptures and forms a clot that blocks blood flow in the artery, the result can be a heart attack.
CABG is meant to prevent a heart attack, though sometimes it is done to treat someone after a heart attack has already happened.
Depending on the extent and location of the blockage, CABG may or may not be required. You may be able to relieve those blocked artery symptoms with a stent—a thin, mesh tube that is placed with a catheter inside to expand the affected blood vessel.
If you have coronary artery blockage, be sure to discuss with your doctor whether CABG or stenting is the right option for you.
The repair or replacement of diseased heart valves is another area where newer catheter procedures are able to do the job that once required open-heart surgery. But there are still plenty of cases of valve treatment where a surgeon needs to open a patient up to operate on the heart. If valve repair or replacement is in your future, ask your doctor about your treatment options.
What to Expect
If traditional open-heart surgery is needed, you may need to be hooked up to a heart-lung machine that helps you breathe and takes over the heart’s pumping action. It helps move blood away from the heart to make it easier for the doctors and nurses to do their jobs. There are some types of CABG that can be done without a heart-lung machine. These are called “off-pump” procedures and use machines that allow the heart to keep beating, but stabilize the part of the heart being worked on.
“Off-pump CABG carries its own risks, and requires substantial training to learn and perform comfortably,” says Artyom Sedrakyan, MD, PhD, a cardiothoracic surgeon and health services researcher at the Agency for Healthcare Research and Quality.
If you do use a heart-lung machine, it will be turned off as soon as the surgery is completed. Your heart will probably start beating again on its own, but it may take a mild electric shock to get it going. A breathing tube will remain in place, providing you with oxygen until you’re able to breathe on your own.
You’ll also be given medicine to help keep your blood from clotting..
To reach your heart, the surgeon must cut through your breastbone. It will be reattached with wire sutures after the operation. These wire sutures will stay in you for the rest of your life. More traditional stitches or staples will be used to close up the skin.
After Open-Heart Surgery
Immediately after surgery, you’ll go to the intensive care unit (ICU) for recovery.
Assuming all goes well, you’ll be discharged from the hospital within a few days. Because this is such an invasive procedure, the recovery after open-heart surgery is lengthy; it may be six- to eight-weeks before you’re driving again and engaging in your normal activities. It could be longer, depending on the nature of your surgery and your overall health. One of the great advantages of catheter and minimally invasive procedures is the shorter recovery time.
Your to-do list during your recovery will include participation in cardiac rehabilitation, a program of supervised exercise and education about diet, medication use and how to live a heart-healthy lifestyle.
The medication aspect of your post-surgery life is extremely important. Your regimen may include antiplatelets (to prevent clotting), blood pressure-lowering drugs, cholesterol-lowering drugs, as well as any medications you may take for diabetes or other conditions.
Taking your medications as prescribed by your doctor and adopting other necessary heart-healthy behaviors are just as important to living a longer life as your surgery, explains Michael P. Savage, MD, the Ralph J. Roberts Professor of Cardiology at the Sidney Kimmel Medical Collage at Thomas Jefferson University. “It is important for patients to understand that bypass surgery is a second chance, not a cure for their disease,” he says.
If you have family and friends nearby, enlist their help in getting you through surgery and the recovery period that follows. That means arranging for rides, grocery shopping and other errands, because you won’t be able to drive for a while. You’ll also need extra help around your home, at least for a while. Be willing to ask for help and accept help when it’s offered. This is a temporary situation.
You should also expect some emotional ups and downs following open-heart surgery. It’s quite normal to have feelings of depression or anxiety as a heart patient. Share those feelings with your loved ones and with your doctor. You may benefit from some talk therapy with a counselor or psychologist with a background in helping heart patients.
Open-heart surgery is a major ordeal. But it can often restore your health and energy, and give you a new outlook on life. Focus on the possibilities and pay attention to your doctor’s advice. You may be surprised just how much your quality of life improves.
Originally published in June 2016 and updated.