What is Open Heart Surgery? - Procedure, Types, Survival Rate

Open Heart Surgery is a type of surgery performed to treat heart problems. It involves opening the chest wall, including the breastbone, for the surgeon to access the heart. The surgery is performed on the heart’s muscles, arteries, or valves. Since this surgery has been performed for decades, it is also known as traditional heart surgery. 

Anatomy and Physiology of the Heart

The heart is a fist-size organ that pumps blood throughout the body. It is located at the centre of the chest, slightly pointing towards the left. It consists of the following parts:

Chambers

The heart is divided into two upper (atria) and two lower (ventricles) chambers:

1. Right atrium: It pumps deoxygenated blood to the right ventricle. 
2. Right ventricle: Deoxygenated blood is carried by the pulmonary artery from the right ventricle to the lungs, where the blood is reloaded with oxygen.
3. Left atrium: The oxygenated blood is carried from the lungs to the left atrium through pulmonary veins. The left atrium then delivers oxygenated blood to the left ventricle. 
4. Left ventricle: It pumps oxygen-rich blood to the body. 

Valves

1. Heart valves open and close to allow the flow of blood. 
2. The atrioventricular valves open between the upper and lower heart chambers. 
3. The semilunar valves open when blood flows out of the ventricles. 

Blood Vessels

The heart pumps blood through three blood vessels:

1. Arteries (carry oxygenated blood from the heart to the body)
2. Veins (carry deoxygenated blood to the heart)
3. Capillaries (small blood vessels where the body exchanges oxygenated and deoxygenated blood)

A doctor may suggest open heart surgery to treat the following heart conditions:

1. Arrhythmias (irregular heartbeat)
2. Coronary artery disease (narrowing or blockage of the coronary arteries due to plaque buildup)
3. Hereditary heart defects (such as underdeveloped heart structures or a hole in the heart)
4. Heart valve disease (damaged or diseased valve in the heart)
5. Heart failure (heart does not pump enough blood)
6. Thoracic aortic aneurysm (a weakened area in the aorta wall)

An open heart surgery is ideal for patients who need the following:

1. Repair or replace their heart valves
2. Repair the damaged or abnormal heart areas
3. Heart transplantation
4. Medical device implantation for proper heartbeats

A person is an ideal candidate for open heart surgery if they:

1. Are in a good physical condition
2. Follow post-operative instructions
3. Do not smoke

Open heart surgery is a complex surgery that may take four hours or longer. The steps involved in the surgery may vary depending on the procedure. Some general steps for the surgery include:

Preparation for the Open Heart Surgery

1. In the OT, the patient will lie in a supine position (lying horizontally on the back with the face pointing up) on the operating table. 
2. The anesthesiologist will start an IV line in the patient’s arms or hands for fluids and medications. 
3. They will administer general anaesthesia to make the patient sleep throughout the procedure. 
4. The team will insert a breathing tube down the patient’s windpipe. 
5. The nursing team will clean the surgical site with antimicrobial soap. 
6. The anaesthesiologist will monitor the patient’s vitals, like heart rate, blood pressure, and breathing, throughout the procedure. 

The Final Surgery

1. The surgeon will make a six- to eight-inch-long incision in the middle of the chest. 
2. They will cut the patient’s breastbone and spread the ribcage apart to expose the heart. 
3. Once the heart is visible, the surgeon will connect it to a heart-lung bypass machine in case of an on-pump surgery. The machine takes over the heart’s pumping action and diverts blood from the heart through tubes. 
4. The anaesthesiologist will inject IV medication to stop the patient’s heart from beating, allowing the surgeon to operate. 
5. The surgeon will restore blood flow to the heart and disconnect the heart-lung bypass machine. 
6. The surgeon will close the breastbone with sutures and wires left inside the body. 
7. Finally, the skin incision will be closed using stitches. 

Types of Open Heart Surgery

The various types of open heart surgery include:

1. Coronary Artery Bypass Grafting (CABG): Also known as heart bypass or coronary bypass surgery, it is the most common open heart surgery performed today for patients suffering from coronary heart disease and atherosclerosis. In this procedure, the surgeon uses a healthy vein or artery from another body part and creates a new path around the blocked artery.
2. Heart valve repair or replacement: To replace a damaged heart valve, the surgeon may replace the natural valve with an artificial one. For a valve repair, the procedure depends on the type of valve problem. For instance, the surgeon may insert a catheter into a blood vessel and inflate a balloon to reshape the valve and ensure better function. 
3. Heart transplant: It is a surgery in which the surgeon replaces a failing heart with a healthier donor heart. The procedure is usually reserved for patients whose condition does not improve with medication and other surgeries. 
4. Inserting an implantable cardioverter-defibrillator (ICD) or a pacemaker: ICDs and pacemakers are implanted in the patient’s chest to monitor and control irregular heartbeats. 

Please note: The procedure selection is based on the patient’s condition and the surgeon’s opinion.

Before open heart surgery

The patient will meet the doctor to perform some tests and discuss the do's and don’ts for surgery preparation. Here’s what the patient can expect before the surgery:

Consultation and Evaluation

1. The patient will have a Pre-Anaesthetic Check Up (PAC) with an anesthesiologist.
2. The doctor will evaluate the patient’s medical history and perform tests such as chest X-rays and electrocardiogram (EKG) to plan the surgery. 
3. Based on the surgery and the PAC results, the anaesthesiologist will decide the type of anaesthesia to be administered. 
4. The patient must inform the doctor about any illnesses they have, such as cold, flu, fever, or herpes outbreak. 
5. Furthermore, they should inform the doctor about their medications, including over-the-counter, prescribed medicines, supplements, and herbs. 
6. After receiving clearance, the doctor will appoint a date for the surgery. 
7. The doctor will briefly explain the duration, hospital stay, estimated cost, and insurance formalities. 

Restrictions

1. The patient will be asked to quit smoking and limit alcohol consumption several weeks before the surgery. 
2. The patient will be asked to stop taking certain blood thinners and nonsteroidal anti-inflammatory drugs (NSAIDs) a week or two before surgery. 
3. The doctor will ask him/her not to drink or eat anything after midnight. 

On the Day of Open Heart Surgery

The following is what the patient can expect on the day of the procedure:

1. The hospital team will ask the patient to sign consent formalities before the procedure. 
2. The patient must change into the hospital gown and remove all jewellery pieces. 
3. The nursing team will shave the excess hair on the patient’s chest. 
4. The doctor will record the patient’s last meal and give medicine to be taken with a sip of water. 
5. The anaesthesiologist will monitor the patient’s vital signs, such as heart rate, breathing, and blood pressure. 
6. The team will shift the patient to the OT room. 

After the Open Heart Surgery

The patient will stay in the hospital for several days. Here’s what they can expect in the hospital after the procedure:

1. The team will shift the patient to the recovery room, where the anaesthesiologist will monitor the vitals and anaesthesia effect. 
2. Once the patient’s vitals stabilise, they will be moved to the Intensive Care Unit (ICU) for a day or longer. 
3. After a day or two, the patient will be moved to a general ward or hospital room for three to seven days.
4. The patient will get discharged from the hospital once their condition stabilises. 
5. The doctor will offer several home care and follow-up instructions. 

Open Heart Surgery Recovery at Home

The initial recovery from open heart surgery can take six to eight weeks. Home care instructions after open heart surgery include:

Incision Care

1. The bandages and strips should be left on for the first two days unless the wound oozes. 
2. Keep the incision dry and clean.
3. Wash hands before and after touching the incision. 
4. Wash the incision gently with mild soap and pat it dry.
5. Regularly check the incision for signs of infection, such as redness, warmth, fever, and increased drainage from the incision site. 
6. Ensure protection of the open heart surgery scar from direct sunlight for up to a year after surgery. 

Showering

1. The patient can shower if the incision is healing properly and there is no drainage. 
2. The shower with warm water should be at most ten minutes. 
3. The incision site should not be directly hit with water. 

Pain Management

1. It is common to experience throat pain, muscle pain, pain from chest tubes, or pain at the incision site after the procedure. 
2. To manage pain, the doctor may prescribe over-the-counter pain medications like acetaminophen and NSAIDs. 

Sleep

1. It is important to get enough rest after open heart surgery. 
2. To get better sleep, the patient can take pain medication half an hour before bed and use a firm pillow to protect the chest and decrease muscle strain. 

Diet

1. Eat nutritious meals with proteins, whole grains, vegetables, and fruits to support healing. 
2. Avoid foods rich in sodium and saturated fat. 
3. Avoid caffeine, especially in the evening. 

Activities

1. Unless the surgeon says otherwise, the patient can return to activities like walking, cooking, climbing stairs, light cleaning, and washing dishes. 
2. The patient can return to work six to eight weeks after the surgery unless the job is physically strenuous. 

Restrictions

1. Avoid driving for four weeks after the surgery. 
2. Avoid lifting anything heavier than 4.5 kg for about six weeks. 

Rehabilitation

1. These outpatient visits include exercise, reducing risk factors, and dealing with anxiety, stress and depression. 
2. The patient will need to participate in such a rehabilitation program several times a week. 

First Follow-Up Appointment

1. The first follow-up appointment after an open heart surgery is scheduled within three to seven days, where the healthcare provider checks for signs of infection and other vitals like blood pressure and heart rate. 
2. An additional follow-up will be required after six to eight weeks, where the doctor will monitor how well the patient’s heart is working. They will also provide further instructions for activities that can be performed safely. 

There are several benefits of open heart surgery, especially for patients suffering from serious cardiovascular disease:

1. It can save the lives of patients suffering from a heart attack or those at a high risk of having one. 
2. It can help reduce discomfort caused by shortness of breath and ongoing angina due to diseased heart arteries. 
3. After recovery from the surgery, patients will feel stronger, healthier, and ready to do things they love. 

Since open heart surgery is a major operation that even requires stopping the heart in several cases, it carries certain risks and complications. The common side effects of open heart surgery include:

1. Allergic reaction to anaesthesia
2. Bleeding
3. Blood clots
4. Infections in the incision or inside the chest (more common in patients with diabetes, obesity, and chronic kidney disease)
5. Pneumonia

Complications specific to open heart surgery include:

1. Heart attack or stroke
2. Arrhythmia
3. Lung or kidney failure
4. Chest pain
5. Memory loss
6. Breathing difficulty

Sequelae of complications, if not treated in time, include:

1. A heart attack, if not treated promptly, can cause permanent heart damage or even death. 

When to Consult a Doctor?

The patient should call the healthcare professional if they experience the following:

1. A fever of more than 101℉
2. Nausea and vomiting
3. Chest pain 
4. Shortness of breath
5. Signs of infection, such as redness and oozing from the incision
6. Signs of stroke, such as trouble speaking, numbness, or loss of balance

An open heart surgery may produce the best results only when done at the right time. Unnecessarily delaying the procedure can increase the chances of permanent heart weakness, making the surgery riskier and less effective. 

Being a major operation, the average open heart surgery cost can be extremely high. The cost of the procedure can range from Rs. 1,80,000 to Rs. 2,50,000, depending on various factors, such as:

1. Type of hospital (Government, private, or trust)
2. Type of city (the cost is higher in metro cities)
3. The kind of technology used
4. The type of surgery
5. Surgeon’s experience and qualifications
6. The general health and fitness of patients
7. The type of room selected
8. The reputation of the hospital

The Average Cost of the Most Common Open Heart Procedures