Open Heart Surgery

What is open heart surgery?

Open heart surgery is a surgical procedure usually performed under general anesthesia.

The procedure involves opening up your heart muscles, arteries, and valves.

Some of the heart conditions treated through open-heart surgery include:

• Congenital heart defects

• Coronary artery disease

• Heart failure

To access the heart during surgery, the surgeon makes an eight to ten-inch incision through the breastbone and exposes the heart.

Open-heart surgery is highly reliable in treating various heart conditions. It may also include the following procedures:

• Heart transplant

• Replacing or repairing a faulty heart valve

• Repair damaged areas of your heart

• Installing a pacemaker or other heart devices

• Not all patients can tolerate open heart surgery

• Your surgeon needs to first assess your ability to withstand this procedure

• Other less invasive procedures for open heart surgery are available, including robotic surgery and minimally invasive procedures

Who needs open-heart surgery?

Surgeons have traditionally preferred open-heart surgery performing a coronary artery bypass graft (CABG) surgery.

This procedure is essential in treating coronary heart disease (CAD).

This condition occurs due to the narrowing and hardening of blood vessels that supply oxygen and blood to your heart muscles.

Plaque formation hardens the walls of your arteries. This causes narrowed arteries and affects the flow of blood. Plaque formation might trigger a heart attack.

Open-heart surgery is also useful in treating the following conditions:

• Thoracic aortic aneurysm

• Arrhythmia (irregular heartbeat)

• Congenital heart defects

• Heart valve disease

Types of open-heart surgery  

There are two main types of open-heart surgery:  

Off-pump 

This form of open-heart surgery is popular with the CABG procedure. It is done with the heat beating unaided.   

On pump

Here, your heart is connected by a bypass machine that temporarily assumes the role of the lungs and heart. 

During the procedure, there is no blood flow into your heart and no heartbeat either.

Once the procedure is completed, the surgical team disconnects the bypass machine, and the heart resumes its work. 

It may be necessary to restart the heart by passing a mild electric shock through it.  

Preparing for open-heart surgery

Before the open-heart procedure, your surgeon will have advised you on what to do to ensure the surgery is as successful as possible.

Some recommendations that your surgeon is likely to share with you include:

• Medication – If you are on certain medications, your surgeon may advise you to stop taking them a week or two before the procedure.
• Some of the medications that you may have to stop taking include nonsteroidal anti-inflammatory drugs (NSAIDs) and blood thinners to prevent blood clots.
• Nutrition – Open-heart surgery is administered under general anesthesia. The procedure works best on an empty stomach. You are advised to fast several hours before surgery, possibly after midnight on the day of surgery.
• Smoking – If you are a smoker, you will be advised to quit the habit as it might exacerbate post-surgical complications.
• Alcohol – Alcohol might interfere with the healing process after an open-heart surgery. You need to quit or cut back on your consumption.

The following tests are also important before open-heart surgery to assist your surgeon prepare for the procedure:

• Electrocardiogram (EKG)

• Urinalysis

• Blood tests

• Chest X-ray

If you have a hairy chest, it will be shaved to facilitate the procedure.

The surgical team uses an antibacterial soap to sterilize the surgical area.

The cardiothoracic anesthesiologist will administer medication and fluid via an intravenous line in your arm.

During surgery

The duration of open-heart surgery varies from one patient to another. The surgery may be determined by several factors:

• Age of the patient

• Presence of other pre-existing medical conditions

• Overall health

Typically, the procedure takes between 4 and 6 hours.

The surgeon makes an incision of 6 to 8 inches down your chest.

To reach the heart, your surgeon cuts the breastbone open. This spreads your ribcage.

If you are undergoing an on-pump procedure, the surgeon your heart gets connected to a heart-lung bypass machine.

The anesthesiologist administers IV medication that stops the heart from pumping.

The anesthesiologist remains alert throughout the procedure to monitor your vitals.

Once the surgeon has repaired the heart, blood flow is restored.

Typically, the heart begins to pump unaided. If this does not happen, it may be necessary to restart the heart using a mild electrical shock.

Once the heart has resumed its pumping action, the surgical team will disconnect the bypass machine.

The surgeon uses sutures to close your breastbone. The skin incision also gets stitched in place.

In the case of an elderly patient or one who has undergone multiple surgeries, such a patient is considered high risk.

For high-risk patients, the surgeon may recommend sternal plating. it entails rejoining the breastbone with minute titanium plates once the procedure is completed.

After the procedure

After surgery, you will wake up to find several tubes attached to your chest.

The tubes help to drain fluid around the heart.

The catheter attached to your bladder helps with the draining of urine, while IV lines in the arms aid in fluid supply.

Your heart needs close monitoring and for this reason, there are machines attached to it.

The surgical nurses will be on standby to attend to any issues that might arise while in the ICU.

Most patients remain in the ICU for about 24 hours after undergoing open-heart surgery, barring any serious complications during the procedure.

The surgical team will subject such a patient to close monitoring to minimize post-surgical risk and/or complications.

The patient is taken to the general ward where they will continue with recuperation.

You may experience the following symptoms after surgery:

• Depression

• Insomnia

• Constipation

• Loss of appetite

• Memory lapse

• Pain around the incision site

Your surgeon will recommend medication to manage these symptoms which should improve as you progress towards full recovery.

Benefits of open-heart surgery

Some benefits of an open-heart surgery procedure include:

• Reduced risk of stroke

• Improved oxygen and blood supply to the heart

• Reduced symptoms, including shortness of breath and chest pain

• The risk of a heart attack is reduced drastically

• Improved overall quality of life

As you continue with your recovery in the general ward, your care team will encourage you to move about to increase breathing and blood flow.

Your occupational and physical therapist will give you specific exercises and movement goals during your stay in the facility.

You may need to perform coughing and deep breathing exercises to clear your lungs.

Having a respiratory specialist as part of your care team helps with this.

Risks

Like any other surgery, open-heart surgery carries several risks. Some of the risks include:

• Stroke or heart attack

• Blood clots

• Kidney or lung failure

• Arrhythmia (irregular heartbeat)

• Pneumonia

• Allergy to anesthesia

• Bleeding

• Infection

• Difficulty in breathing

• Low fever and chest pain

• Blood loss

• Memory loss

Using the heart-lung bypass machine during open-heart surgery also comes with a few risks. Examples include neurological problems and stroke.

If you experience anxiety and depression following open-heart surgery, consult a psychologist or therapist to manage the symptoms.

Alternatives to open-heart surgery  

Open-heat surgery is the standard heart procedure that has proven effective in treating various heart conditions. 

Thanks to advancements in medical research, we now have other more efficient and effective procedures that may be used in place of open-heart surgery. These include: 

Minimally invasive heart surgery 

A minimally invasive heart surgery is a surgical procedure where the surgeon makes small cuts in your chest to reach the heat. 

The procedure avoids cutting through your breastbone, unlike in open-heart surgery, and is less painful. 

Many people recover more quickly in comparison with those who have undergone open-heart surgery. 

Video-assisted thoracic surgery (VATS) 

The surgeon makes a few small incisions on your chest that help with inserting surgical instruments and a thoracoscope. 

A thoracoscope is a tiny video camera that allows the surgeon to view the inside of your heart while performing the surgery. 

The VATS assists the surgeon in treating arrhythmia or placing a pacemaker. It is also useful in repairing a malfunctioning heart valve. 

Catheter-based procedures 

This procedure involved inserting a thin, hollow tube (catheter) into your heart.  

Stents and other surgical instruments are inserted via the catheter as the surgeon performs this surgery. Stenting and coronary angioplasty are some examples of catheter-based procedures. 

Robotic-assisted surgery 

The procedure is suitable for patients with cardiac tumors or valvular heart diseases.  

The reason is that robotically assisted surgery is a minimally invasive procedure and is hence safer for such high-risk patients. 

Recovery and follow-up

Recovery time after open-heart surgery depends on:

• Type of surgery (that is, open on-pump or off-pump)

• Patient’s overall health before the procedure

• Whether there are any complications involved

Patients typically take between 6 and 12 weeks to recover after an open-heart surgery.

Your surgeon will inform you of the most appropriate time to resume physical activity or get back to work.

During the first six weeks after surgery, make sure you do not engage in any strenuous physical activities such as lifting heavy objects or driving.

Taking care of yourself following open-heart surgery plays a vital role in your overall recovery.

Cease from engaging in physical activity if you experience the following symptoms:

• Dizziness

• Chest pain

• Shortness of breath

• Arrhythmia 

Incision care

Make sure the site of the incision remains dry and warm at all times Start taking a shower only if there is no drainage from your incision.

Use warm water to shower for 10 minutes or fewer.

Check for infections in your incision site such as:

• Fever

• An opening or drainage from the incision

• If the incision line feels warm

Pain management

You will likely feel pain in multiple areas after open-heart surgery. This includes the site muscles, chest, and throat.

Make sure you are in regular communication with the surgical team regarding the level of pain that you might be experiencing.

Managing this kind of pain is essential in reducing the risk of such complications as pneumonia or blood clots. It also increases your rate of recovery after surgery.

Your surgeon will recommend medication to manage this pain as you continue with your recovery at home.

Ensure you get sufficient sleep after open-heart surgery. Some patients may, however, experience insomnia.

The following will help you to get better sleep:

• Arranging your pillow properly to minimize muscle strain

• Do not take caffeinated drinks, and more so in the evening

• Make sure you have taken your pain medication as prescribed, preferably 30 minutes before you retire to bed  

Cost of open-heart surgery in India

The cost of open-heart surgery in India ranges between Rs. 1,50,000 and Rs. 5,50,000 but is determined by a number of factors:

• City – If you choose to have your open-heart surgery in a metro city such as Bangalore, Mumbai, or Chennai, the cost is higher

• Type of hospital – Public or trust hospitals charge relatively less for open-heart surgery than private hospitals

• Health insurance – If you do not have any insurance cover, you will pay more for one-heart surgery

• Diagnosis & extent of surgery – The cost of open-heart surgery may increase if there are many diagnostic tests involved, or the anticipated procedure is complex

• Surgeon’s qualifications – Surgeons who are with higher qualifications or expertise will usually charge more for the procedure

• Nature of technology – If the hospital has invested in advanced technology for open-heart surgery, this might increase the overall cost of such a procedure

• Room category – If you opt for a deluxe room or premium deluxe, you will pay more compared to a person opting for a twin-sharing room

• Hospital reputation – medical institutes or healthcare facilities that have gained a reputation for performing open-heart surgery in India are likely to charge more than general healthcare facilities

Long-term outlook

Open-heart surgery can be a lifesaver. Like all other major surgeries, it takes longer to recover from the procedure.

You might take up to six weeks or months to fully recover. The outlook remains good for the majority of the people.

Surgery is not a guarantee that you will the blockage will recur. Doing the following will assist you to improve your heart health:

• Aim for a healthy diet with limited fat intake and more fruit and vegetables

• Reduce your intake of sugar and salt

• Engage in more physical activities such as brisk walking or gardening

• If you are a smoker, consider quitting the habit

• Take medication combined with diet and exercise to lose weight and gain control over high cholesterol and high blood pressure

• If you have any concerns or queries about open-heart surgery, contact your healthcare provider

References

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