Open heart surgery is any surgery where the chest is opened and surgery is performed on the heart. The term "open" refers to the chest, not the heart itself.
What Is Open Heart Surgery?
Open heart surgery is a general term referring to procedures in which the chest is cut open to access the heart. The type of heart problem corrected during open heart surgery can include the heart muscle, arteries, valves and other structures. Depending on the type of surgery, the heart may or may not be opened.
Traditional Open Heart Surgery
In traditional open heart surgery, your heart is stopped. You are placed on a heart-lung bypass machine while a procedure is performed on the heart. The heart-lung machine is often referred to as the "pump" or cardiopulmonary bypass (CPB). It does the work of the heart and lungs during the operation.
Minimally Invasive or Off-Pump Heart Surgery
Newer, less-invasive methods of heart surgery have eliminated the need to use heart-lung machines for some procedures, although the surgery may still be considered open heart surgery.
If your surgeon uses an off-pump coronary artery bypass (OPCAB) procedure, you may be able to avoid being put on a heart-lung machine. During OPCAB, the breastbone is still split, but your doctor sews bypass grafts in place while your heart continues to beat.
Minimally invasive direct coronary artery bypass (MIDCAB) also allows grafts to be placed without using a heart-lung machine. This procedure is performed through a small incision in the sternum, eliminating the need to split the breastbone. MIDCAB can only be used if only one or two arteries need to be bypassed. Robotic-assisted coronary artery bypass (RACAB) allows surgery to be performed using a surgical robot, which your surgeon guides from a computer console.
Why Have Open Heart Surgery?
Open heart surgery is major surgery. Physicians at The Ohio State University Wexner Medical Center strive to use less invasive procedures whenever possible, but some conditions can only be treated with open heart surgery. If you have certain problems involving the heart muscle, arteries, valves and other structures, open heart surgery may be recommended.
What to Expect During Open Heart Surgery
Preparing for Your Procedure
Prior to your open heart surgery, you’ll meet with your doctor to discuss your medical history, the medicines you take and any questions you have about the procedure.
Typically, you cannot eat or drink after midnight the day of surgery. Before surgery, you use a special soap on your chest and legs and your body hair is shaved to prevent infection after surgery.
During Your Procedure
In traditional open heart surgery, your surgeon makes an incision in the center of the chest and spreads apart the breastbone in order to reach the heart. You may have small drainage tubes placed beneath your breastbone to drain fluid around your heart, and a chest tube beneath your rib cage to drain fluid from the chest cavity.
The heart is stopped and you are placed on a heart-lung machine so your surgeon can work on the heart while it is not beating. You are connected to other machines to monitor your vital signs and perform other functions.
A tube is inserted in your mouth that reaches your trachea (windpipe). This endotracheal tube attaches to a ventilator that breathes for you during surgery. Another tube is inserted in your nose that goes through the back of your throat to reach your stomach. This nasogastric tube keeps the stomach free from excess fluids during surgery. A urinary catheter is put in place to collect your urine.
Two small wires are placed on either side of your incision. They are attached to a pacemaker to regulate your heart rate. The wires are removed within a few days.
After the procedure is completed, the heart is restarted. Surgery must be completed in less than six hours, as it is not safe for the body to remain on the heart-lung machine any longer.
After Your Procedure
The hours following open heart surgery are considered critical. You will be closely monitored to make sure your heart is functioning normally. Pain medication is usually prescribed to help ease the pain from the cut in your chest.
Tubes placed in the chest for drainage are removed several days after surgery. Your health care team may instruct you in using a device to exercise your lungs. This is important to prevent fluid from accumulating in your lungs after surgery.
Becoming active soon after surgery also is vital to your recovery. As soon as you are able, your health care team helps you get up, move around and walk in the hallways. Activity helps to prevent pneumonia and blood clots.
You remain in the hospital for four to six days and sometimes longer. The duration of your hospital stay depends on your particular heart condition, the type of procedure performed and the healing process.
Before going home, you are given instructions on how to care for yourself during the first phase of recovery, which lasts about six to eight weeks. If you had minimally invasive surgery, your recovery time may be shorter.