Open-Heart Surgery

What is open-heart surgery?

Open-heart surgery is a type of heart surgery that involves opening your chest wall so a surgeon can reach your heart more easily. It’s a way surgeons can reach your heart directly and treat the heart issue you have.

To access your heart, surgeons cut through your sternum (breastbone) and spread your ribs. Sometimes, people call this cracking your chest. Your surgeon may recommend an open procedure if you’re strong enough to tolerate it.

If open-heart surgery isn’t right for you, your surgeon can do many kinds of heart surgery through smaller, less invasive incisions. This includes small incisions between the ribs on the right side of your chest.

Every year, about 2 million people worldwide have open-heart surgery.

What procedures do surgeons perform during open-heart surgery?

Surgeons need direct access to your heart and surrounding blood vessels for certain procedures. Sometimes, surgeons can use less invasive techniques for these procedures. Your surgeon will assess your health to choose the best treatment approach.

These procedures may take place during open-heart surgery:

• Aneurysm repair.
• Repairs of congenital heart disease, like atrial septal defect (hole in your heart) or hypoplastic left heart syndrome (underdeveloped heart structures).
• Coronary artery bypass grafting (CABG or bypass surgery) to treat coronary artery disease.
• Heart transplant for heart failure.
• Heart valve replacement or repair to treat heart valve disease.
• Left ventricular assist device (LVAD) or total artificial heart placement to treat heart failure.

Sometimes, surgeons place pacemakers or implantable cardioverter defibrillators (ICDs) during open-heart surgery while performing other procedures. They may also perform ablation procedures to treat arrhythmias in the same procedure.

How should I prepare for open-heart surgery?

To prepare for open-heart surgery, you should follow your healthcare provider’s recommendations about:

• Medications: A week or two before surgery, you may need to stop taking certain medicines that can increase your risk of bleeding. These may include blood thinners (aspirin, warfarin or other medicines that prevent blood clots and strokes) and nonsteroidal anti-inflammatory drugs (NSAIDs).
• Food and drink: Your healthcare team will ask you to fast (not eat or drink) before your surgery. Anesthesia is safer on an empty stomach.
• Smoking and alcohol: Cut back on alcohol and quit smoking. Both can slow your healing after surgery and increase your risk of complications.
• Illness: Stay away from people who are sick in the two weeks before your surgery. This helps you avoid coming down with a cold or another illness when it’s time for your surgery.

What happens before open-heart surgery?

Before open-heart surgery, you can expect a provider to:

• Perform chest X-rays, an electrocardiogram (EKG) or other tests to help your surgeon plan your procedure.
• Shave your chest.
• Sterilize the surgical area with antimicrobial (bacteria-killing) soap.
• Place an intravenous line (IV) in your arm to provide fluids and medications.

What are the types of open-heart surgery?

There are two ways to perform open-heart surgery:

• On-pump: A heart-lung bypass machine connects to your heart and temporarily takes over for your heart and lungs. The machine circulates blood through your body while moving blood away from your heart. The surgeon then operates on a heart that isn’t beating and doesn’t have blood flow. After surgery, the surgeon disconnects the device and your heart starts to work again.
• Off-pump: Off-pump bypass surgery takes place on a heart that continues to beat on its own. This approach only works for coronary artery bypass grafting (CABG). Your surgeon may call this beating-heart surgery.

What happens during open-heart surgery?

Heart surgery is complex. Surgery steps vary depending on your heart condition and the procedure you’re having. In general, your surgeon:

1. Makes a 6- to 8-inch long incision (cut) down the middle of your chest.
2. Cuts your breastbone and spreads your ribcage apart to reach your heart.
3. Connects your heart to a heart-lung bypass machine if you’re having an on-pump surgery. An anesthesiologist gives you medication to stop your heart from beating and monitors you during your surgery.
4. Repairs your heart.
5. Restores blood flow to your heart. Usually, your heart starts beating on its own. Sometimes, the heart needs a mild electrical shock to restart it.
6. Disconnects the heart-lung bypass machine.
7. Closes your breastbone or other incision with wires or sutures that remain in your body.
8. Uses stitches to close your skin incision.

How long does open-heart surgery take?

The time it takes for open-heart surgery depends on which procedure you’re having. Some surgeries may take six hours or longer. You’ll receive anesthesia and be asleep during the procedure.

What happens after open-heart surgery?

Depending on the procedure, you may stay in the hospital intensive care unit (ICU) for a day or longer. When you’re ready, you’ll move to a regular hospital room.

You can expect to spend several days of recovery time in the hospital after open-heart surgery. During this time, providers may perform tests like the ones you had before surgery. They’ll want to see how well your heart is working. They’ll also encourage you to walk around your room and hallway to help you heal.

Your heart care team will explain how to care for your incision. You may have a special firm pillow to protect your chest when you cough, sneeze or get out of bed.

After surgery, you may experience:

• Constipation (a common side effect of strong pain relievers).
• Depression or mood swings.
• Insomnia (difficulty sleeping).
• Loss of appetite.
• Memory problems.
• Muscle pain in your chest area.
• Pain, bruising and minor swelling at the incision site.
• Tiredness.

What are the benefits of open-heart surgery?

Open-heart surgery is a traditional, reliable approach to heart surgery. It can be a life-saving operation for some. For others, open-heart surgery improves their symptoms, making it easier for them to do everyday tasks. This can give them a better quality of life.

What are the risks or complications of open-heart surgery?

Open-heart surgery risks include:

• Allergic reaction to anesthesia.
• Arrhythmias (irregular heartbeat).
• Bleeding.
• Damage to surrounding blood vessels or organs like your lungs or kidneys.
• Infections.
• Blood clots.
• Stroke.

The risk of complications is greater if you have emergency surgery or if you have health issues like:

• Diabetes.
• Obesity.
• Chronic obstructive pulmonary disease (COPD) or other lung issues.
• Kidney disease.
• Peripheral artery disease.

People who smoke or use tobacco products are more likely to have surgical and postsurgical issues.

You may be able to make your recovery easier by improving your health before surgery. This includes being physically active, losing weight and quitting smoking.

What are the long-term side effects of open-heart surgery?

Usually, people don’t have long-term pain after open-heart surgery. But anxiety and depression can continue. Talk to your provider if your depression lasts more than one or two months. Rarely, people can have numbness, tingling or pain in their hands or arms from a stretched or pinched nerve. This often goes away in three to six months.

How serious is open-heart surgery?

Open-heart surgery is a major surgery. It’s serious because you rely on your heart to keep blood moving through your body all the time. This is why it’s important to choose a surgeon who has a lot of experience performing open-heart surgery. Knowing that cardiac surgeons do this type of surgery regularly can provide peace of mind.

What is the recovery time?

Open-heart surgery recovery time varies depending on the surgery type, complications and your overall health before surgery. It can take six to 12 weeks (and sometimes longer) for open-heart surgery recovery.

Recovery after open-heart surgery

You’ll probably need pain medication for a few days after surgery. Some people need to take blood thinners for a few months after heart surgery to prevent blood clots. Your healthcare provider may also recommend cardiac rehab. This medically supervised program can help you regain strength and stamina and improve your overall heart health.

A couple of weeks after surgery, you’ll have a follow-up appointment with your provider. They’ll check to see how well you’re healing and how well your heart is working.

When can I go back to work?

Your surgeon will let you know when you can return to work and other activities. Typically, you shouldn’t drive or lift anything heavy for the first six weeks after surgery.

When should I call my healthcare provider?

You should call your healthcare provider if you experience:

• Chest pain other than normal discomfort at the incision.
• Fever.
• Nausea and vomiting.
• Shortness of breath.
• Signs of infection at the surgical site (like oozing and redness).
• Slurred speech or other signs of stroke.

Are there alternatives to standard open-heart surgery?

Yes. Thanks to medical advances, surgeons can now use minimally invasive heart surgery or small incisions to perform many procedures that once required them to open your chest. The surgeon sometimes still needs to cut through part of your breastbone.

Depending on your situation, your surgeon may be able to use these methods:

• Catheter-based: Your surgeon threads a catheter (thin, hollow tube) to your heart. Then they insert surgical instruments, balloons or stents through the catheter to perform a procedure. Catheter-based procedures include transcatheter aortic valve replacement (TAVR) and coronary angioplasty and stenting.
• Video-assisted thoracic surgery (VATS): Your surgeon performs VATS by inserting a tiny video camera (thoracoscope) and surgical instruments into several small chest incisions. They may use VATS to place a pacemaker, repair heart valves or treat an arrhythmia.
• Robotically assisted: Certain people with heart valve disease, cardiac tumors, atrial fibrillation and septal defects (holes in the heart) may be candidates for this minimally invasive approach. A surgeon controls the robotic arms that perform the surgery.

A note from Cleveland Clinic

It’s normal to have concerns before having major surgery like open-heart surgery. But your surgeon has a plan and a team of people to help them carry it out. Don’t hesitate to share questions and concerns with your healthcare provider. They want you to understand how you can prepare and make this experience the best it can be for yourself.