“Open-heart” surgery refers to a variety of surgical treatments performed on different areas of the heart, such as its valves and surrounding blood vessels, through an incision that “opens” the chest. Advances in cardiovascular surgery have made it possible to perform some procedures through smaller incisions. The type of incision used, and procedure performed depends on a variety of factors, such as each individual’s condition, anatomy and medical history.
These surgeries occur in specialized cardiovascular operating rooms designed specifically for heart surgeries and require the use of general anesthesia. In most open-heart surgeries, the surgeon accesses the heart and its blood vessels through a large incision in the patient's sternum (breastbone) to open the chest. Special surgical equipment is used to keep the chest open. In most cases, a cardiopulmonary bypass machine (CPB) is used to take over the functions of the heart and lungs while the surgeon works on the heart. Once the surgeon(s) finish the needed procedure and confirm the heart is working properly, the CPB machine is turned off and removed and surgeons close the chest.
The most common form of open-heart surgery is done to improve blood flow to the heart by redirecting blood flow around the coronary arteries. It’s important to note that CABG surgery does not treat the underlying cause of the blocked blood vessels, which are often a result of coronary artery disease (CAD). During CABG Surgery, the surgeon uses a healthy blood vessel, also known as a graft, from a patient’s chest, arm or leg and attaches one end of the graft above the blockage and the other end below the blockage. Blood is then able to “bypass” the blocked or narrowed artery by going through the new graft to reach the heart muscle. For some, robotic-assisted CABG may be an option. In this procedure, a cardiovascular surgeon uses robotic technology to bypass blocked arteries through small incisions often between the ribs to access the heart.
This surgery is used to treat atrial fibrillation (AFib). The surgeon makes small incisions with a scalpel and then uses cryoablation (applying cold) or radiofrequency device (applying heat) in the upper chambers of the heart. These incisions are made in a certain pattern, like a maze, that will then heal and form scar tissue. Scar tissue is unable to carry abnormal electrical impulses that cause AFib.
This procedure is needed when an area of the aorta is weak and starts to bulge, known as a thoracic aortic aneurysm (TAA). If your TAA is large and growing quickly, then your doctor may recommend surgical treatment to prevent it from bursting. During this surgery, a surgeon will replace the weakened area of the aorta with a fabric tube, also called a graft. The graft makes the aorta stronger and in return allows blood to pass through it without causing a bulge.
This procedure helps treat end-stage heart failure where the heart muscle is too weak to pump blood. A VAD is a device implanted below the heart to assist the ventricles, which pump blood through the body. It is attached to both a ventricle and the ascending aorta, allowing blood to flow through your left ventricle into the VAD, which then pushes the blood into your aorta and the rest of your body. A VAD doesn’t replace your heart.
Once you and your cardiac surgeon have decided open-heart surgery is right for you or a loved one, your surgeon and their office staff will begin going over key information leading up to your surgery:
Education:
Your surgeon and office staff will share a variety of information around your condition, the surgery being recommended, and the team members that will participate in your care. They may also discuss what an advance directive is and if you have one.
Pre-admission Testing (PAT):
Seven to fourteen days prior to your scheduled surgery, you’ll have a preadmission testing appointment at your BayCare hospital. During this appointment you’ll complete the hospital registration process, receive education materials and complete any additional testing needed before surgery. This testing may include, but isn’t limited to:
At PAT, you’ll also be given preoperative instructions on medications you can and can’t take before your surgery, food and drinks to avoid, and any necessary bathing/shaving instructions.
Preparing Yourself and Your Home:
Your surgeon and care team will help you understand what services or medical equipment you may need at home after your surgery, such as home health care. They will also provide tips on how to ready your home for an easier recovery process, things to consider if you live alone, what to pack for your trip to the hospital and what to leave at home.
The day before your surgery a team member from the hospital will call you to give you the time of arrival and where you’ll check in at the hospital.
Upon check-in to your BayCare hospital, you’ll be taken to the preoperative unit and given a hospital gown. You’ll be asked to confirm medical history and preparation requirements. An IV will be started and certain medications ordered by your surgeon will be given to you. Your family or loved ones will be directed to the surgery waiting room, where the nurse can give them updates throughout the procedure. You’ll speak to the anesthesia team and will be evaluated by the operating room team. When you’re moved to the operating room, your team will make sure you’re comfortable and calm. Once you’re asleep, the anesthesiologist will place a breathing tube and additional IVs as needed. This process usually takes one hour. Then the team will be ready to start your surgery.
Immediately after surgery, your cardiac surgeon will speak to your primary contact. You will be moved to a recovery area called the cardiovascular surgery intensive care unit (CVICU) where hospital staff watch you closely monitoring your progress and vital signs. Sometimes medications or temporary pacing wires may be used to stabilize the heart. Usually within two hours, the nurse will notify your family and/or friends that they may briefly visit and receive an update on your progress. When you’re ready to leave the ICU, you may go to a coronary care unit (CCU) for more special care, or you may go to a regular hospital room.
Your cardiac surgeon will share when you’re ready to go home. Before leaving the hospital, you will be given recovery instructions such as how to care for your incisions, taking medicines, being active, and any special items or instructions you may need. You’ll also be given dates and time for follow-up appointments with your surgeon, cardiologist, and primary care doctor.
Your doctor may also recommend cardiac rehabilitation after surgery. Cardiac rehabilitation is a medically supervised exercise and education program to help with recovery. This procedure helps treat end-stage heart failure where the heart muscle is too weak to pump blood. A VAD is a device implanted below the heart to assist the ventricles, which pump blood through the body. It is attached to both a ventricle and the ascending aorta, allowing blood to flow through your left ventricle into the VAD, which then pushes the blood into your aorta and the rest of your body. VAD doesn’t replace your heart.
The program is designed to help you regain stamina and strength, improve activity level, reduce the risk of future cardiac events, decrease pain and shortness of breath, and lessen the physical and emotional effects of heart disease.
At BayCare, we have three outstanding, high-quality cardiovascular surgery programs. Our programs and surgeons are all members of The Society of Thoracic Surgeons (STS), the leading organization dedicated to ensuring the best possible outcomes for cardiothoracic surgeries of the heart, lung, and esophagus, as well as other surgical procedures within the chest.
STS has developed a comprehensive rating system that allows for comparisons regarding the quality of cardiac surgery among hospitals across the country. Approximately 10% of hospitals receive the “3-star” rating, which denotes the highest category of quality. BayCare’s programs have once again been awarded the highest quality 3-star rating in multiple areas of open-heart surgery, placing us within the top 10% of hospitals, including coronary artery bypass grafting (CABG), isolated aortic valve replacement and in combination with CABG, and mitral valve repair and replacement.
The length of an open-heart surgery is directly related to the type of procedure being performed. On average, most open-heart surgeries can last anywhere from 3 to 6 hours.
Recovery from open-heart surgery can take weeks to months and is dependent on a variety of factors. Patients typically spend several days in the hospital before going home. Full recovery, including regaining strength and returning to normal activities, may take 6 to 12 weeks or longer depending on how well you are healing and the complexity of surgery and your underlying condition.
The primary benefit of having an open-heart surgery is improving your heart’s function and your quality of life by treating conditions that affect blood flow or your heart’s structure. For example, CABG surgery can restore blood flow to the heart, reducing the risk of heart attack and improving overall heart health.
In some cases, minimally invasive heart surgery procedures may be alternatives to traditional open-heart surgery, particularly for certain types of heart valve problems or coronary artery blockages. The decision usually depends on the patient's health, the specific condition, and the cardiovascular or cardiothoracic surgeon's evaluation.
The risk of complications should be discussed with your cardiac surgeon and your care team before surgery as a variety of things can impact the risk for complications. In general, complications can include infection at the incision site or in the chest, bleeding or blood clots, heart rhythm problems (arrhythmias), stroke, lung problems (such as pneumonia), and kidney issues.
For a referral to a cardiovascular or cardiothoracic surgeon, call us at (855) 233-0888 for a physician referral or fill out the form to request a referral.
