Heart Surgery

Heart surgery (cardiac surgery) is an umbrella term for operations that treat problems with your heart or the blood vessels connected to it. You might have surgery to restore blood flow to your heart, fix valve issues or receive a new device that helps your heart beat as it should. Cardiac surgeons can perform heart surgery using many different methods, like making one cut (incision) or several smaller cuts. The exact method depends on the issue they’re treating.

For most people, heart surgery is a planned event. This means your cardiologist has diagnosed a problem with your heart, and surgery is the best or only way to fix it. In some cases, though, heart surgery is an emergency treatment. This can happen if you have a heart attack or your healthcare provider finds an issue that puts you in immediate danger.

When is it needed?

You may need heart surgery if you have:

• Aortic aneurysm: A bulge in the wall of the artery that sends oxygen-rich blood out of your heart
• Arrhythmia: A heartbeat that’s too fast, too slow or has an irregular rhythm
• Congenital heart disease: A problem with your heart’s structure that’s present at birth
• Coronary artery disease: Narrowing or blockages in one or more of the arteries that supply blood to your heart muscle (which can lead to a heart attack)
• Heart failure: A condition in which your heart can’t pump blood well enough to meet your body’s needs
• Heart valve disease: An issue with any of your heart’s “doors,” which control blood flow between different areas of your heart
• Structural disease: An issue with any structure of your heart that affects heart function

Types of this procedure

There are many types of heart surgery. Some are minimally invasive, while others involve larger cuts (open-heart). Examples include:

• Aneurysm surgery: Replaces the damaged part of your aorta with a graft (an artificial artery made of a special type of fabric). The graft offers a new, safe path for your blood to flow.
• Coronary artery bypass grafting (CABG): Treats coronary artery disease. Your surgeon creates a new route for blood to detour around blocked arteries and reach your heart vessels.
• Heart transplant surgery: One of many treatments for end-stage heart failure. Your surgeon replaces your heart with a donor heart. Some people have surgery to receive an artificial heart as they wait for a transplant.
• Heart valve surgery: Repairs or replaces a valve that isn’t working as it should — most commonly your aortic valve or mitral valve.
• Implantable cardiac defibrillator (ICD) placement: Treats life-threatening arrhythmias. The device sends an electrical shock to your heart to restore a normal rhythm.
• Left ventricular assist device (LVAD) placement: Helps your heart pump blood better when you have end-stage heart failure. Your surgeon places the device at the bottom of your heart to support its main pumping chambers.
• Ablation procedure: Treats a common arrhythmia called atrial fibrillation (AFib). Your surgeon creates scar tissue in your heart to block the abnormal electrical signals that cause AFib.
• Pacemaker placement: Treats arrhythmias. Your surgeon places a small device in your chest that sends electrical impulses to control your heart rhythm. But unlike an ICD, a pacemaker doesn’t deliver a shock.

Depending on the problem, you may not need surgery. Technology is providing us with innovative ways to manage heart disease. For example, methods like percutaneous coronary intervention (PCI) and endovascular aneurysm repair (EVAR) reduce your time in the hospital and make recovery easier. They’re especially helpful for people who’d face higher risks if they had surgery. Your care team will talk with you about the options in your situation.

What happens before heart surgery?

Before scheduling your heart surgery, your care team will give you a medical evaluation and perform testing. All this information helps your surgeon decide the best type of surgery for you — and the best method of performing it.

You can expect your care team to:

• Talk with you about your symptoms and how long they’ve been going on
• Ask about your medical history and your biological family’s medical history
• Run some tests to get a detailed picture of your heart function and overall health

Tests you may need (commonly called “pre-op testing”) include:

Blood tests

• Cardiac CT scan
• Heart MRI
• Chest X-ray
• Coronary angiogram
• Echocardiogram (echo)
• Electrocardiogram (EKG/ECG)
• Stress test

How should I prepare?

Once your surgery is scheduled, your care team will tell you what you should do to prepare. For example, they’ll explain when to:

• Stop smoking, using tobacco products or drinking alcohol to lower your risk of surgical complications
• Stop taking any medications
• Start fasting (not eating or drinking anything) the day before your surgery

Be sure to ask any questions you have, even if they seem small or you think you asked them already. It’s better to double-check to make sure you’re as prepared as possible for your surgery.

What to expect on your surgery day

The hospital might admit you the day before surgery, but this is often not necessary. Once you’re in the hospital, you’ll spend some time getting settled and talking with your care team. You might also have:

• Tests like an EKG or chest X-ray
• Hair shaved from the spot where you’ll have your incision
• Blood tests

What happens during heart surgery?

A healthcare provider will give you medicine to help you relax. They’ll take you to the operating room on a rolling bed. In the operating room, you’ll receive anesthesia to put you to sleep so you won’t feel anything and won’t remember anything from your surgery.

What happens during your surgery depends on the type you’re having. It also depends on the method your surgeon uses. Your care team will explain to you which of the following methods they’re using and why:

• Open-heart surgery: Your surgeon makes a 6- to 8-inch-long incision in the middle of your chest and spreads your ribcage to reach your heart. A provider will connect you to a heart-lung bypass machine, so your heart will be supported during the surgery.
• Off-pump bypass surgery: This is like traditional open-heart surgery, but you won’t be on a heart-lung bypass machine. That’s why it’s also called “beating heart” surgery. It’s most commonly used for bypassing only one or two coronary arteries in CABG.
• Minimally invasive heart surgery: Also called “keyhole surgery,” this method uses smaller incisions to access your heart. For example, a partial sternotomy uses a 3- to 4-inch cut through part of your breastbone. A mini-thoracotomy uses small cuts between your ribs.
• Robotic heart surgery: This is a type of minimally invasive surgery. It lets your surgeon operate with smaller incisions. Your surgeon controls thin robotic arms that can make precise movements.

How long does heart surgery take?

It depends on the type of surgery. The most common type, CABG, takes about three to six hours.

What are the benefits and risks of this procedure?

Heart surgery can save — and change — your life. After you recover, you’ll likely feel healthier, stronger and ready to get back to the things you love doing.

Possible risks include:

• Allergic reaction to anesthesia
• Arrhythmias
• Bleeding
• Confusion or trouble thinking clearly
• Damage to nearby blood vessels or organs
• Infection in your incision or inside your chest
• Stroke

The risks are higher if you have health conditions like:

• Diabetes
• Chronic obstructive pulmonary disease (COPD)
• Kidney disease
• A higher body mass index (BMI)
• Peripheral artery disease

Smoking and tobacco use also raise the risk of complications during and after surgery.

What is the survival rate?

Survival rates vary based on the type of heart surgery and the hospital where you receive care. It’s a good idea to know your surgeon, the institution and their level of expertise. Your chances of survival also depend on the severity of your heart issue and your overall health. Heart surgery is generally riskier if you’re very ill or have other significant medical conditions. 

What happens after heart surgery?

A healthcare provider will move you to the intensive care unit (ICU). You’ll recover in the ICU for at least one day. You’ll then move to a regular hospital room for continued rest and care.

How long you stay in the hospital depends on the surgery you had and how your body responds to it. Everyone’s recovery is different. Your hospital team will keep a close eye on you and make sure you’re healing as you should. They’re also prepared to notice and respond to any issues that come up.

As you recover, you may feel the following normal responses to surgery:

• A clicking sensation in your chest that should go away after a week or two (if it doesn’t, call your surgeon)
• Bruising or minor swelling at your incision site
• Constipation
• Like it’s hard to fall asleep or stay asleep
• Less hungry or even nauseated when around food for a couple weeks
• Pain or tightness in your shoulders and upper back (if it’s severe, call your surgeon)
• Sad, depressed or moody

Just because these are expected doesn’t mean you have to manage them alone. Talk to your care team about how to feel better as your body heals.

What is the recovery time?

Recovery depends on the type of surgery and other factors, like your overall health. Most people need six to 12 weeks to recover from open-heart surgery. Some need more time. Taking part in cardiac rehab can help you recover and regain your strength. Your care team will also tell you which kinds of pain medication are safe for you to take.

How can I take care of myself after heart surgery?

Take things slow and give your body time to heal. Your care team will tell you how long you should wait to:

• Return to work
• Drive
• Lift heavy objects
• Take baths or swim

Your care team will also advise you on the amount of physical activity that’s safe — and helpful — for you.

Heart surgery can make you healthier and stronger. But it’s important to keep doing whatever you can to lower your risks of future problems. For example:

• Quit smoking or tobacco use
• Limit or avoid alcohol
• Eat heart-healthy foods
• Take your medications as prescribed
• Exercise regularly (based on your provider’s advice)
• Keep all your follow-up appointments

How long can you live after heart surgery?

Some people live for many years or decades after heart surgery. Your life expectancy depends on many things, including other health conditions. Your care team can tell you more about what to expect.

When should I call my healthcare provider?

Call your surgeon if you have signs of complications as you recover. It’s normal to feel some discomfort. Pain medication will help. But it’s not normal to have the following:

• Chest pain that’s not getting better over time
• Fever
• Nausea and vomiting
• Shortness of breath
• Signs of infection near your incision, like oozing or redness

It may be hard to know when a symptom is just a part of recovery or when it’s a sign of a complication. When in doubt, pick up the phone and call your care team. It’s better to get checked out and learn nothing’s wrong than to ignore an issue that needs medical care.

Call 911 or your local emergency services number if you have signs of a stroke:

• Balance problems
• Vision changes
• Drooping on one side of your face
• Weak arm or leg
• Trouble speaking or understanding others