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Open Heart Surgery

Open heart surgery is a medical procedure in which a large incision is made on the chest and different surgical techniques are applied on the heart muscle, the valves or the arteries supplying blood to the heart. Open heart surgery is also known as traditional and it is often used for more complicated medical problems. One of the most common procedures that can be performed is the bypass grafting of the coronary artery. During this procedure, the surgeon will attach a healthy artery to a blocked coronary artery that commonly supplied the heart with blood. What happens is that the newly attached artery will actually bypass the artery that is blocked and it will bring the much needed supply of blood to the heart.

Coronary artery bypass grafting is the kind of open heart surgery recommended for patients who have been diagnosed with coronary heart disease. In this medical situation, the blood vessels that commonly supply the heart with oxygenated blood are narrowed and they also harden, making it difficult for the blood to pass. Open heart surgery is recommended for a wide range of other medical problems, including when arteries are narrowed because of the excessive atheroma plaque built inside their walls. When this problem arises, blood cannot go through the artery and the patient is at risk to develop a heart attack. Other recommendations for open heart surgery include valve repairs or replacements, repairing heart defects, pacemaker installations and heart transplants.

Procedure

open heart surgeryThe general procedure for open heart surgery is as it follows:

  • General anesthesia is administered to the patient
  • A large incision is made on the central line of the body, in the chest
  • The surgeon will use a retractor for the ribs and also to have better exposure to the area of the heart
  • In order to reduce the potential risks and complications and also for the surgeon to be able to work on the heart, the patient is connected to what is known as a bypass machine. Using this machine, the blood supply to the heart is temporarily cut off and the open heart surgery can be performed.
  • The actual procedure is performed:
    • If the problem is a blocked artery, then a new one will be attached in order bring fresh blood to the heart
  • The cut sternum will be reattached with special wires
    • In elderly patients or in those who have had to go through more than one heart surgery, the sternum will be reattached with the help of small plates made from titanium
  • The initial incision will be stitched and a dressing will be applied to the wound

How long does Open Heart Surgery last?

The duration of the open heart surgery depends on the actual procedure that is being performed. On average, the duration of this kind of surgery is around three or four hours. Besides the actual procedure, at least one hour before and one hour after the surgery will be necessary. The hour before will be used in order to prep the surgical field, administer the anesthesia and other things like that. The hour after the surgery is necessary for post-operative initial care. The duration of the surgery might increase if there are complications with the surgery.

Recovery time

After the surgery, you will be brought down to the intensive care unit. Depending on the hospital in which the open heart surgery was performed, you might be taken to what is known as the cardiac intensive care unit. In general, the patient is moved to a regular hospital room a day after the surgery, provided everything goes well and no further complications arise. If the patient has been intubated, then the breathing tube will be removed as soon as the patient is able to breathe on his own and the vital signs are stable.

The patient has to stay on the hospital somewhere around four to six days. Depending on the procedure, the patient might be even released earlier but it is common sense that the period is prolonged in case of complications or high-risk patients. The patient is going to be released at home and it will take several weeks before the patient does not feel so weak anymore. Small walks are recommended to be taken inside the house during the first weeks of recovery. The amount of physical movement and activity should be increased according to the prescription made by the doctor.

The doctor will also make recommendations when it comes to the other activities that the patient can resume. Driving a car is generally recommended three weeks after the surgery has been performed. Also, there are certain activities that should be performed only after a couple of months from the surgery, such as lifting weights and other strenuous physical activity. This is mainly necessary because the sternum needs time to heal and you don’t want to run the risk of it not healing properly. In general, the recovery time for open heart surgery is of a couple of months and physical therapy is one of the most recommended methods that can guarantee a proper recovery.

What to expect after an Open Heart Surgery?

In the initial period after the surgery, the patient will have a tube (or several) coming from the recently operated area, in order to drain the excessive fluid. The post-operative care measures involve the administration of intravenous fluids in order to prevent dehydration, a catheter for urine and the connection to a machine to monitor the patient’s vital signs. After the patient is moved to a regular hospital room, treatment will be administered in order to prevent blood clots. After the release from the hospital, the recovery period will start at home and the patient will be instructed to take things slowly and not to rush anything.

After the open heart surgery, the doctor will give the patient a set of recommendations that are meant to protect the recently operated area. The patient should have a healthy diet, with plenty of fresh fruits and vegetables. It is recommended that foods with a high salt content, those that are spicy or excessively greasy should be avoided. The patient will be encouraged to perform regular physical exercise (adapted to his or her condition), to quit smoking and drinking alcohol and to take the recommended treatment for the control of the blood pressure and cholesterol.

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Cost

The cost of the open heart surgery depends on a lot of factors, including the geographical area, the actual hospital or clinic in which the surgery is performed and the actual surgeon performing the operation. When discussing to your doctor about the open heart surgery, you might want to discover about the additional fees that might arise. There are costs related to the anesthesia that you will have to handle, the fees of the physician and other medical staff. Also, if complications arise during the heart surgery and additional care measures are necessary, the overall cost of the procedure might increase. In such situations, it is for the best to check our insurance policy before the actual procedure and see for certain how much of the actual procedure is covered.

At the moment, the heart transplant is considered as one of the most expensive open heart surgeries, costing on average $800.000. This is a complicated procedure and it carries a lot of risks but these are not the main reasons why this procedure is so expensive. As it turns out, the actual procurement of a healthy heart for the transplant is what adds to the costs.

Risks

These are the most common risks associated with open heart surgery:

  • Infection at the site of the surgery
    • Increased risk for infection is present in overweight patients, those who suffer from diabetes or those who have gone through multiples open heart surgeries
    • The infection can be accompanied by the swelling of the tissues
    • Sepsis can occur because of:
      • Infection of the respiratory tract
      • Infection of the central catheter line
      • Infection at the site of the surgery
      • Urinary catheter infection
      • Viral infection in different parts of the body
      • Requires emergency medical treatment because of the potential life-threatening symptoms
  • Myocardial infarct
    • This may happen because of a blood clot that has detached from its place immediately after the surgery
  • Stroke – may cause temporary or permanent damage
  • Abnormal heart rhythm
    • Arrhythmias
      • Narrow complex tachyarrhythmia
        • Sinus tachycardia
        • Supraventricular tachycardia
        • Junctional ectopic tachycardia
        • Atrial flutter/fibrillation
      • Broad complex tachyarrhythmia
        • Ventricular tachycardia
        • Ventricular fibrillation
      • Bradyarrhythmia
        • Sinus bradycardia
  • Internal organ failure
    • Most commonly – lungs or kidneys
  • Pain in the chest
  • Fever (low grade)
  • If a heart-lung bypass machine was used during the procedure, then the patient might wake up experiencing the following symptoms:
    • Loss of memory
    • Confusion
  • Blood clots
    • These may form in the legs and travel to the lungs, causing serious problems
  • Excessive loss of blood
    • Surgical bleeding
    • Medical bleeding
      • Platelet dysfunction
      • Thrombocytopenia
  • Difficult breathing
  • Allergic reaction to the anesthesia administered during the surgery
  • Brain damage
  • Increased blood pressure
    • Can appear in open heart surgery where the coarctation of the aorta was repaired
    • Pain and fluid over-load can also lead to such medical problems
    • Can lead to heart failure or other acute hemorrhagic complications

Complications

These are the most common complications associated with open heart surgery:

Cardiac tamponade

  • This is a life-threatening complication of the open heart surgery
  • The pericardium, which is the sac that surrounds the heart, fills with blood
  • If that happens, then the heart is unable to function and cardiac arrest might happen

Other cardiac complications include:

  • Mechanical complications
  • Physiologic complications
    • The preload is not adequate
    • The after-load is excessive

Hematologic complications

  • Bleeding
  • Thrombosis
  • Capillary leak syndrome
    • Neonates and infants who have undergone open heart surgery
    • Prolonged cardiopulmonary bypass
    • Circulatory arrest during the procedure

Internal organ complications

  • Pulmonary
    • Chylothorax – milky pleural effusion
    • Pulmonary hypertension – potentially fatal complication in neonates and infants undergoing this kind of procedure
  • Renal
    • Renal dysfunction – reduced urine output
  • Central nervous system (neurologic complications)
    • Seizures (sudden or late onset)
    • Acquired brain injury in neonates with congenital heart disease who have undergone open heart surgery
      • Pre-operative
      • Intra-operative
      • Post-operative

Diaphragmatic palsy

  • Cause – damage to the phrenic nerve
  • May require a second surgical intervention for the surgical plication of the diaphragm

Hyperkalemia

  • May be a sign that the cardiac output is declining
  • Administration of potassium should be immediately stopped and the exact cause that leads to increased levels of potassium should be identified

Hypokalemia

  • Appears as a post-operative complication
  • Especially in patients who were on heart-lung bypass during the open heart surgery
  • It can also appear after diuretics have been administered to the patient

Hypocalcaemia

  • The right amount of calcium is necessary in the body in order to improve the contractility of the heart muscle
  • May be accompanied by decreased levels of magnesium

Metabolic and lactic acidosis

  • Metabolic acidosis
  • Lactic acidosis

Death

  • Increased mortality rates are present in patients who have reached a certain age or those who have suffered for prolonged periods of time of heart disease
  • If the heart has stopped during the procedure, there is a reduced chance for resuscitation to function.

Open Heart Surgery Scar

Given the fact that open heart surgery requires a large incision to be made to the chest, you should take all the necessary measures to protect the incision and make sure that the wound heals properly. Maintaining excellent hygiene is essential, so as to prevent infection and guarantee that you have a clean scar in the end. Avoid soaking the incision in hot water until the wound heals but be sure to take regular showers and keep the area clean. If the scar looks infected, then be sure to contact the doctor and see what treatment options are available.

Video

Watch this Live Open Heart Surgery Video to know more about the procedure…


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