open heart surgery
Alternative Namesintracardiac surgery
Definition
Open heart surgery describes any surgery that requires the heart to be cut open.
In addition, although the heart is not technically cut open for most coronary artery bypass procedures, many experts classify a coronary artery bypass surgery as open heart surgery as well.
Who is a candidate for the procedure?
This type of surgery may be necessary for any of these conditions:
- physical defects of the heart present at birth, known as congenital heart disease
- damaged or diseased heart valves
- severe heart disease requiring heart transplant
- severe blockages of the arteries of the heart requiring heart bypass surgery.
A person must be healthy enough to withstand the stress of major surgery.
How is the procedure performed?
Open heart surgery is done with general anesthesia. This means that the person is put to sleep with medications and feels no pain during the surgery. He or she is put on an artificial breathing machine, a ventilator, during the first part of the surgery. The chest area is cleaned with an antibacterial soap.
Next, an incision is made into the chest. Usually, the incision is made through the breastbone (sternum) into the middle of the chest, exposing the heart. At this point, the heart is stopped, the lungs are deflated, the ventilator is turned off, and the person is placed on a heart-lung bypass machine. This device keeps the blood circulating through the body at the correct pressure and full of oxygen.
The surgeon can then fix the heart problem. This may involve repairing or replacing a valve, sewing a defect closed, or bypassing blocked arteries. When the repair is complete, the person is taken off the heart-lung machine, the heart is restarted with an electric pulse, and the ventilator is reconnected.
Once the surgeon verifies that the person's heart is working again to pump the blood, the chest incision can be closed. The person is taken off anesthesia and sent to the surgery recovery room.
What happens right after the procedure?
After the surgery, the person will be taken either to the intensive care unit or to a specialized cardiac recovery room to be monitored while anesthesia wears off. Once a person can breathe on his or her own, her or she is taken off the ventilator. The person then must stay in the hospital at least a few days to recover.
Pain medications are given to relieve pain. The person will be assisted out of bed for increasingly longer periods, beginning 24-48 hours after surgery. This early activity helps to prevent post operative problems such as deep venous thrombosis and pneumonia.
What happens later at home?
Full recovery may take months because this is a major operation. People are usually be told to:
- increase activity gradually as tolerated
- take pain medication
as needed to manage pain
Other care depends on the procedure that was performed.
What are the potential complications after the procedure?
Like any surgery, an open heart procedure can be complicated by bleeding, infection, or a reaction to the anesthetic. Each of these can be more serious than usual because of the extent of this kind of surgery. Additionally, a person may have irregular heart beats (arrhythmias) during recovery.
Occasionally, a person can die from complications during surgery or recovery. A fatal outcome is more likely if the underlying heart condition that required the surgery had reached a critical stage.
Chest pain may persist for months. Some numbness in the skin near the incision may also occur, but often gets better with time. Specific risks depend on the procedure that is performed and should be discussed with the surgeon.
Author:Adam Brochert, MD
Date Written:04/22/00
Medical Review:Daniel VanHamersveld, MD
Date Written:9/21/2006
Reviewer:Reginald Finger, MD
Date Reviewed:10/26/2006
Contributors
Potential conflict of interest information for reviewers available on request
