Open Heart Surgery

About the Procedure

Open Heart Surgery refers to any procedure where the chest is opened and surgery is performed on the internal structures of the heart, such as muscles, valves, or arteries. Coronary artery bypass surgery, congenital heart disease, valve prolapse, mitral valve stenosis, as well as heart transplants are all open heart surgeries. There are three major surgical techniques used for this procedure. In a Traditional technique, the chest wall is cut with a two to five inch incision and the patient is attached to a heart-lung machine. In an alternate version of this technique, "off-pump heart surgery", the patient is not attached to an external machine and surgery is performed while the heart is beating. The Endoscopic technique is performed via one to four small holes in the chest and may be done on a beating heart which is slowed with either drugs or mechanical device. Robot-assisted surgery is a new technique whereby the surgeon sits at a computer performing the motions of the surgery with the benefit of 3-D while robotic arms do the actual operation through two to four tiny cuts.

Open heart procedures are performed by a cardiac surgeon in a hospital and takes from two to five hours. Patients are put under general anesthesia and an endotracheal tube is inserted. In some disorders for which this operation is performed, the expected degree of severity may change once the surgeon is inside the heart. A valve repair can end up as a replacement, a pacemaker may be necessary, or a non-traditional procedure becomes an open surgery. Therefore, the operating time, risks, hospital stays, and short and long term recovery periods are dependent on numerous factors.

What to Know Before the Procedure

Because of the serious nature of open heart surgery, limiting risks and complications is of critical importance and selecting the best option for reducing risks and enhancing outcomes should be discussed with the surgeon. Possible risks associated with open heart surgery are: heart attack, stroke, heart rhythm problems, incision infection, infection of the new valve, kidney failure, and neurocognitive impairment involving memory loss and loss of mental clarity thought to result from "mini-strokes". In valve replacement surgery, longevity and the potential for blot clots around the valve, are of concern. Occasionally, the heart rate becomes too slow after the procedure and a temporary pacemaker may be required.

In preparing for surgery, it is likely that the patient or their family will be able to donate blood which can be used for transfusions during and after surgery. Discuss this with the physician or hospital personnel a few weeks prior to surgery. Pre-admission testing, such as a complete assay of blood tests, X-rays, and EKG are done the week before the procedure. The surgeon will advise the patient regarding all medications, prescribed and over-the-counter to avoid conflicts with surgery and blood-clotting issues. Plan for a driver upon discharge as driving is discouraged for several weeks and assistance at your intended location is advised due to pain and restricted mobility.

What to Know After the Procedure

The first night following surgery will be spent in ICU where the tubes attached during surgery will remain until no longer required, frequently one to three days after surgery. The endotracheal tube will be removed during the first twenty four hours. Expect to spend 5 to 7 days in the hospital after surgery. Initial recovery from open heart surgery takes up to two months, with less time for minimally invasive techniques, and a complete recovery can take six months. During the initial period of recovery normal activities are gradually increased. Light housework, at the patient's comfort level, is acceptable; lifting or pushing heavy objects is prohibited; climbing stairs should be kept to an absolute minimum and completely avoided for the first couple of days. The doctor will advise regarding daily exercise as well as a cardiac rehabilitation program.

If you Need to Travel Outside of your Local Hospital

The serious nature of open heart surgery makes the choice of surgeon and facility crucial for reducing risks and for successful long-term outcomes. There may be considerable cost savings in travelling for this surgery, with many qualified and experienced surgeons around the world. Since the initial recuperation period is lengthy and the patient's mobility is limited, return travel would need to be delayed until given approval by the doctor. With significant advanced planning and a discussion with the doctor regarding a patient’s individual risks, surgery can be performed successfully abroad. In cases where the decision is made to have the procedure done internationally a patient must be sure to discuss with the doctor how much time will be required for a proper recovery, as well as what steps need to be taken for rehabilitation back in their home country.