Heart Surgery

What is heart surgery?

Heart surgery is any surgery that involves your heart or the blood vessels connected to your heart. Heart surgery is complex and requires the specialized expertise of cardiac surgeons. It’s a major event that can improve heart function and circulation and give you a whole new lease on life.

Heart surgery can correct issues you were born with (congenital heart disease). It can also repair issues that develop later in life. The type of heart surgery you have depends on the underlying problem or combination of problems.

Other names for heart surgery are:

• Cardiac surgery.
• Cardiovascular surgery.

When is heart surgery needed?

People need heart surgery when they have heart problems like:

• Blockages in their arteries that carry blood to their heart.
• Heart valves that aren’t working right.
• Abnormal heart rhythms.
• Heart failure.

Usually, your provider plans heart surgery in advance. This happens when your provider (usually your cardiologist) diagnoses a problem with your heart, and surgery is the best or only way to fix it.

Other times, heart surgery is an emergency treatment that comes up when you don’t expect it. This can happen if you have a heart attack or if a provider finds severe blockages that put you in immediate danger.

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 would face higher risks if they had surgery.

What conditions are treated with heart surgery?

Heart surgery treats a range of conditions that affect your heart and the blood vessels connected to your heart. It can treat these conditions:

• Aneurysms (bulges in your artery walls or heart muscle).
• Arrhythmias (an abnormal heartbeat that’s too fast, too slow or just irregular).
• Congenital (present at birth) heart disease.
• Coronary artery disease (CAD) (a narrowing of your coronary arteries).
• Heart failure (your heart can’t pump blood as well as it should).
• Heart valve disease (issues with any of your four heart valves).

What are the different types of heart surgery?

There are many types of heart surgery. The type of heart surgery you receive depends on the condition you have. Types of heart surgery include:

• Coronary artery bypass grafting or CABG treats coronary artery disease (CAD) in one or more of your coronary arteries. Providers also call this a double, triple or quadruple bypass, depending on how many coronary arteries they need to bypass. CABG uses a healthy blood vessel from somewhere else in your body to create a new path for blood to reach your heart.
• Heart valve surgery repairs or replaces a valve (a “door” that manages your blood flow) that isn’t working as it should. This surgery allows your valve to open more widely or close more tightly so blood can flow in the right direction.
• Aneurysm repair surgery treats aortic aneurysms in your belly and chest. This surgery replaces the damaged part of your aorta with a graft (an artificial artery made of a special type of cloth). The graft offers a new, safe path for your blood. Left ventricular reconstructive surgery treats aneurysms that form in your heart muscle, usually after a heart attack. Surgery removes the aneurysm and any scar tissue around it. This reduces symptoms and allows your heart to pump better.
• Septal myectomy helps people who have hypertrophic cardiomyopathy. This disease causes your heart muscle to become too thick. It usually happens in your septum (the muscular wall that separates the left and right sides of your heart). The surgery removes a small part of your septum. This allows more blood to flow from your left ventricle to your aorta and helps relieve symptoms.
• A surgeon can use the maze procedure to treat atrial fibrillation (AFib) during the same operation for another issue. During a maze procedure, a surgeon creates scar tissue in your heart to block the abnormal electrical signals that cause AFib. Your heart can then get back to a normal rhythm. People with AFib who don’t need any other heart repairs can have a minimally invasive maze procedure.
• Surgery to insert a cardiac device can help people who have arrhythmias or heart failure. Several kinds of devices treat specific problems, like restoring a normal heart rhythm or helping your heart function better. Devices may include a permanent pacemaker, an implantable cardioverter defibrillator (ICD), a left ventricular assist device (LVAD) or a total artificial heart (TAH).
• Heart transplant surgery is a last resort treatment for people who have end-stage heart failure. It involves replacing your heart with a donor’s heart. This is a rare surgery because it’s hard to find a donor heart. Plus, the procedure is very complex. Only 150 out of over 6,000 hospitals in the U.S. can perform a heart transplant.

How common are heart surgeries?

The number of heart surgeries can vary by year. In 2018, nearly half a million people in the U.S. had heart surgery. Looking at the two most common heart surgeries, surgeons performed:

• About 200,000 coronary artery bypass grafting (CABG) procedures in the U.S. in 2018.
• About 110,000 valve surgeries in the U.S. in 2018. This number doesn’t include repair methods that don’t require open surgery.

The COVID-19 pandemic affected how many people had heart surgery. The monthly average dropped by 50% in April 2020. The number continued to be lower than normal through the rest of 2020. Although hospitals needed to postpone elective care, many people also chose to delay care even if they had symptoms.

If you’ve been putting off getting care, call your healthcare provider and make an appointment. Keep in mind that untreated heart problems can get worse and lead to more serious issues down the road.

What happens before heart surgery?

Preparation for your surgery can take weeks or months. Before scheduling your heart surgery, your medical care team will evaluate your condition. Your care team will likely include your primary care provider and cardiologist. You’ll also consult with a cardiothoracic surgeon (a cardiac surgeon who operates on organs and tissues in the chest).

Your care team will give you a medical evaluation. This includes:

• Talking about your symptoms and how long they’ve been going on.
• Talking about your medical history and your biological family’s medical history.
• Blood tests to check your cholesterol and other important numbers.

Your team will also run some diagnostic tests. These tests provide a detailed picture of your heart function and any problems. They also help you and your care team decide if you need surgery and what type you need.

• Cardiac computed tomography scan (cardiac CT).
• Cardiac magnetic resonance imaging (heart MRI).
• Chest X-ray.
• Coronary angiography.
• Echocardiogram (echo).
• Electrocardiogram (ECG/EKG).
• Stress test.

If you need surgery, your care team will tell you exactly how to prepare and what to expect. It’s important to follow their recommendations about:

• When to stop taking any medications.
• When to begin fasting (not eating or drinking anything) the day before your surgery.
• Quitting smoking or tobacco use and reducing alcohol consumption to lower your risk of complications.

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 after you’re admitted to the hospital

The hospital might admit you the day before surgery, but this is often not necessary. If 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.

You’ll need to stop eating and drinking (usually at midnight). It’s a good idea to give personal items to a family member or friend the night before your surgery or early in the morning. These include:

• Glasses and contact lenses.
• Dentures.
• Jewelry.
• Wristwatch.
• Phone.

A provider will give you medicine to help you relax, and 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 heart surgery?

What happens during your surgery depends on the type you’re having. It also depends on the method your surgeon uses for the operation.

Surgeons use different methods for operating on your heart. These include open-heart surgery, off-pump bypass surgery and minimally invasive heart surgery. Your care team will discuss which method is best for you — and why.

Open-heart surgery

Open-heart surgery is what most people think of when they hear someone say “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 won’t be beating during the surgery.

Off-pump bypass surgery

Off-pump bypass surgery or “beating heart” surgery is like traditional open-heart surgery. But you won’t be on a heart-lung bypass machine. Providers can only use this method for CABG surgery. And it’s best for bypassing only one or two coronary arteries.

Minimally invasive surgery

Minimally invasive heart surgery or “keyhole surgery” uses smaller incisions to access your heart.

A partial sternotomy involves a 3- to 4-inch incision through part of your sternum (breastbone). A mini-thoracotomy avoids your breastbone and instead uses small cuts between your ribs.

Minimally invasive surgery sometimes uses robotics. Don’t worry — a surgeon is still in charge. But the surgeon uses computer and imaging equipment to guide robotic arms. These arms are the size of a pencil, and they hold surgical tools. The robotic arms can make complex, precise movements. This incredible, innovative approach can cut down on your surgery time and recovery time. It also needs smaller incisions than other approaches.

How long does heart surgery take?

The length of traditional open-heart surgery varies based on what the surgeon is fixing. CABG surgery (the most common type) takes about three to six hours.

What happens after heart surgery?

After your heart surgery, a 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. Each person’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.

What are the advantages of heart surgery?

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

What are the risks or complications of heart surgery?

Heart surgery has excellent outcomes overall. But there are still risks, as with any other surgery. Possible risks and complications 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 body mass index (BMI) greater than 25.
• Peripheral artery disease.

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

What is the recovery timeline for heart surgery?

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 people need even more time.

As you recover, you may feel:

• A clicking sensation in your chest. This 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. You may even feel nauseated around food for a couple of weeks. This is normal and common.
• Pain or tightness in your shoulders and upper back.
• Sad, depressed or moody.

These are normal responses to surgery. But that doesn’t mean you have to face them alone. Tell your family or friends how you’re feeling. If the pain feels severe or medication doesn’t help, call your care team.

What is the survival rate of heart surgery?

Heart surgery survival rates vary based on the type of surgery and how many issues your surgeon is repairing during the operation. Survival rates are:

• Mitral valve repair for mitral valve prolapse: 99%.
• Aortic valve replacement: 98.1%.
• Coronary artery bypass surgery (CABG): 97.8%.

Heart surgery is generally riskier for people who are very ill or have other medical conditions.

How long can you live after heart surgery?

You can live for many years or decades after heart surgery. Many factors affect how long you live, including other health conditions and risk factors. Heart surgery can make you healthier and stronger. But it’s important to keep doing whatever you can to lower your risks for future problems. Things you can do include:

• Make lifestyle changes your healthcare provider recommends.
• Take your medications as prescribed.
• Keep all of your medical appointments and follow-ups.

Heart surgery is like a bicycle that can carry you down a long road when you’re tired of walking, but you still have to push the pedals.

How can I take care of myself after heart surgery?

Follow your care team’s instructions on when you can drive, go back to work, lift heavy objects or do other activities. They’ll also offer advice on how to care for your incision. It’s important to take things slow and give your body time to heal.

General guidelines after heart surgery include:

• Wait one month to drive.
• Avoid lifting or moving more than 10 pounds for six weeks after surgery.
• Watch for redness or swelling at your incision site.
• Avoid soaking in bathtubs or other water.
• Take walks several times a day, but don’t push yourself too much.

When should I see my healthcare provider?

Call your doctor 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 by your incision, like oozing or redness.
• Slurred speech or other signs of a stroke.

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.