What Is Open Heart Surgery?

  • Nurah Ekhlaque Masters in Biotechnology, Guru Ghasidas University, India

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Introduction

Open heart surgery refers to any surgical procedure that involves opening the chest to operate on the heart or its major blood vessels. This intricate procedure allows surgeons to access the heart to repair damaged areas, correct heart defects, or improve overall heart function.¹ This comprehensive guide aims to provide insights into the world of open heart surgery, covering its various aspects to equip you with a better understanding of this critical medical procedure.

Here's a breakdown of what this surgery typically involves:

  • Preparation: Before the surgery, extensive tests and evaluations are conducted to ensure the patient is fit for the procedure. This might include blood tests, imaging scans, and discussions about the surgical process
  • Anaesthesia: Once in the operating room, the patient is given anaesthesia to induce sleep and prevent any pain or discomfort during the surgery
  • Incision: A large incision is made in the chest to access the heart. Sometimes, the breastbone is divided to reach the heart, which is why it's often called "open chest" surgery
  • Heart-Lung Bypass: The heart-lung bypass machine takes over the heart's pumping action and the lungs' oxygenation function, allowing the surgeon to work on the heart while it's not actively pumping blood
  • Surgery: The surgeon performs the necessary repairs or procedures, which can range from coronary artery bypass grafting (CABG), valve repair or replacement, to repairing heart defects or treating heart aneurysms
  • Closure: After completing the surgery, the chest is closed with wires, and the incision is stitched or stapled back together¹

Read on

Understanding the nuances of open heart surgery can provide valuable insights into the intricacies of this procedure. From the reasons it's performed to the recovery process, there's more to explore that can help you grasp the full scope of this critical medical intervention.

Reasons for open heart surgery

Types of open heart surgery

Coronary artery bypass grafting (CABG)

  • Purpose: To improve blood flow to the heart by bypassing blocked or narrowed arteries
  • Procedure: Involves using blood vessels from other parts of the body to create detours around the blocked arteries, restoring proper blood flow to the heart
  • Conditions treated: Severe coronary artery disease (CAD) or heart attack²

Valve repair or replacement surgery

  • Purpose: To repair damaged heart valves or replace them with mechanical or biological substitutes
  • Procedure: Surgeons repair the valve or replace it entirely to restore proper blood flow through the heart
  • Conditions treated: Valve stenosis (narrowing) or regurgitation (leakage) due to various causes, including age-related wear or congenital defects³

Heart transplant surgery

  • Purpose: To replace a failing or diseased heart with a healthy donor heart.
  • Procedure: Involves removing the patient's damaged heart and transplanting a donor’s heart, usually from a deceased organ donor.
  • Conditions treated: End-stage heart failure when other treatments have been unsuccessful.⁴

Aneurysm repair surgery

  • Purpose: To repair weakened or bulging areas in the aorta, reducing the risk of rupture
  • Procedure: Involves reinforcing or replacing the weakened section of the aorta to prevent any potential life-threatening complications
  • Conditions treated: Aortic aneurysms, which can develop due to various factors, including genetic predisposition or atherosclerosis⁵

Congenital heart defect repair

  • Purpose: Correcting structural abnormalities present at birth that affect the heart's structure or function
  • Procedure: Surgeons repair defects such as holes in the heart walls, abnormal heart valves, or misplaced blood vessels to improve heart function
  • Conditions treated: Various congenital heart defects affect individuals from birth⁴

Each type of open heart surgery addresses specific heart conditions and aims to restore optimal heart function or mitigate life-threatening complications associated with heart diseases or abnormalities. The choice of surgery depends on the patient's condition, overall health, and the expertise of the medical team involved in the treatment.

Preparation for surgery

Prior to surgery, patients undergo comprehensive medical evaluations, medication adjustments, and various pre-surgical tests like blood work and imaging to ensure readiness for the procedure.

Comprehensive medical evaluation

  • Patient assessment: A thorough examination by the healthcare team, including cardiologists, surgeons, anesthesiologists, and other specialists, to evaluate the patient's overall health status and determine their suitability for surgery
  • Medical history review: Detailed assessment of the patient's medical history, including past surgeries, medications, allergies, and any pre-existing health conditions

Medication management

Medication Adjustment: Review and adjustment of current medications. Some medications might need to be adjusted, stopped, or substituted before surgery to minimise risks such as bleeding or interaction with anaesthesia.

Pre-surgical tests

  • Blood work: Comprehensive blood tests to assess blood cell counts, clotting factors, electrolyte levels, and overall organ function
  • Imaging studies: Various imaging techniques like X-rays, echocardiograms, CT scans, or MRIs to obtain detailed images of the heart and surrounding structures, aiding surgeons in planning the surgical approach
  • Electrocardiogram (ECG/EKG): Recording of the heart's electrical activity to assess heart rhythm and detect any abnormalities
  • Other diagnostic tests: Additional tests based on the patient's specific condition, such as stress tests or angiograms, to provide further insights into cardiac function and blood flow

Cardiac rehabilitation and education

  • Pre-surgery education: Patient and family education sessions to understand the procedure, risks, expectations, and post-operative care. This helps alleviate anxiety and ensures informed decision-making
  • Cardiac rehabilitation: For some patients, especially those with pre-existing heart conditions, participation in cardiac rehabilitation programs before surgery to optimise cardiovascular fitness and overall health

Lifestyle modifications

  • Dietary guidance: Recommendations for dietary adjustments, especially regarding specific foods or fluids to consume or avoid before surgery
  • Smoking and alcohol: Strong emphasis on quitting smoking and limiting alcohol consumption before surgery to reduce risks and aid in better post-operative recovery

Preparation for hospital stay

  • Logistics and support: Arrangements for transportation to and from the hospital, planning for post-operative care at home, and addressing any logistical concerns
  • Pre-surgery instructions: Specific instructions regarding fasting before surgery, medications that can be taken on the day of surgery, and other guidelines to follow prior to admission

The pre-surgery phase is critical, ensuring that patients are physically and mentally prepared for the upcoming procedure. It involves a collaborative effort between healthcare professionals, patients, and their families to optimise conditions for a successful surgical outcome and smooth recovery.

Procedure details

Under general anaesthesia, a surgical incision is made in the chest, allowing access to the heart. Specific procedures are then performed depending on the heart condition, following which the chest is carefully closed.⁶

Recovery process and aftercare

Patients are closely monitored in the intensive care unit initially and typically stay in the hospital for around 4 to 7 days. Post-surgery, a structured rehabilitation program, prescribed medications, and gradual physical activity to help recovery.

Risks and complications

Potential risks include infections, bleeding, blood clots, stroke, and irregular heartbeats, emphasising the need for careful post-operative monitoring.

Lifestyle changes post-surgery

Post-surgery, lifestyle modifications like dietary changes, regular exercise, adherence to prescribed medications, and quitting smoking play pivotal roles in ensuring a successful recovery and long-term heart health.

In conclusion, open heart surgery, while a complex and serious procedure, offers hope and treatment for various critical heart conditions. Individual patient circumstances and care plans may vary, making personalised medical advice and guidance essential for optimal outcomes.⁷

Summary

Open heart surgery is a complex procedure involving the opening of the chest to access the heart for various repairs or corrections. It's performed for a range of reasons, from treating heart disease to addressing congenital defects. Understanding the process, risks, and recovery involved is crucial for patients and their families facing this procedure.

FAQs

What conditions might require open heart surgery?

Conditions like coronary artery disease, heart valve problems, congenital heart defects, and aneurysms might necessitate open heart surgery.

How long does the recovery from open heart surgery take?

Recovery varies for each individual, but typically patients spend several days in the hospital and take weeks to months for a full recovery.

Are there alternative procedures to open heart surgery?

Some conditions can be treated with minimally invasive procedures or medications, but open heart surgery remains necessary for certain complex heart conditions.

References:

  1. Heart Surgery - Conditions Treated by Heart Surgery | NHLBI, NIH. 1 June 2022, https://www.nhlbi.nih.gov/health/heart-surgery/conditions.
  2. ‘Coronary Artery Bypass Graft (CABG)’. Nhs.Uk, 24 Oct. 2017, https://www.nhs.uk/conditions/coronary-artery-bypass-graft-cabg/.
  3. CDC. ‘Valvular Heart Disease | Cdc.Gov’. Centers for Disease Control and Prevention, 9 Dec. 2019, https://www.cdc.gov/heartdisease/valvular_disease.htm.
  4. Criteria, Institute of Medicine (US) Committee on Social Security Cardiovascular Disability. ‘Congenital Heart Disease’. Cardiovascular Disability: Updating the Social Security Listings, National Academies Press (US), 2010. www.ncbi.nlm.nih.gov, https://www.ncbi.nlm.nih.gov/books/NBK209965/.
  5. Shaw, Palma M., et al. ‘Abdominal Aortic Aneurysm’. StatPearls, StatPearls Publishing, 2023. PubMed, http://www.ncbi.nlm.nih.gov/books/NBK470237/.
  6. Senst, Benjamin, et al. ‘Cardiac Surgery’. StatPearls, StatPearls Publishing, 2023. PubMed, http://www.ncbi.nlm.nih.gov/books/NBK532935/.
  7. DiMarco, Ross F. ‘Postoperative Care of the Cardiac Surgical Patient’. Surgical Intensive Care Medicine, 2010, pp. 535–66. PubMed Central, https://doi.org/10.1007/978-0-387-77893-8_47.

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Nurah Ekhlaque

Masters in Biotechnology, Guru Ghasidas University

I'm a highly motivated and skilled biotechnology professional, known for my strong background in research and laboratory work. My proficiency extends to cryosectioning, immunohistochemistry, confocal imaging, and various molecular biology techniques. I am detail-oriented and dedicated to consistently producing high-quality results.

My educational journey led me to a Master's degree in Biotechnology from Guru Ghasidas Vishwavidyalaya, India. This academic foundation, combined with my practical experience, fuels my commitment to advancing scientific research and improving human health.

My practical experience includes roles as a Research Assistant at Saarland University in Germany and as an Internship Research Trainee at the All India Institute of Medical Sciences. In these positions, I mastered the use of cryosectioning, immunohistochemistry, and various laboratory techniques, consistently delivering high-quality data for scientific research.

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