Overview
Open Heart Surgery is any type of surgery where the chest is cut open and surgery is performed on the muscles, valves, or arteries of the heart.
According to the National Heart, Lung, and Blood Institute (NHLBI), coronary artery bypass grafting (CABG) is the most common type of heart surgery done on adults.

During this surgery, a healthy artery or vein is grafted (attached) to a blocked coronary artery. This allows the grafted artery to “bypass” the blocked artery and bring fresh blood to the heart.
Open-heart surgery is sometimes called Traditional Heart Surgery.
Learn More: Heart Bypass Surgery

When is Open Heart Surgery needed?
Open-heart surgery may be done to perform a CABG. A coronary artery bypass graft may be necessary for people with coronary heart disease.
Coronary heart disease occurs when the blood vessels that provide blood and oxygen for the heart muscle become narrow and hard. This is often called “hardening of the arteries.”
Hardening occurs when fatty material forms a plaque on the walls of the coronary arteries. This plaque narrows the arteries, making it difficult for blood to get through.
When blood can’t flow properly to the heart, a heart attack may occur.
Open-heart surgery is also done to:

• repair or replace heart valves, which allow blood to travel through the heart.
• repair damaged or abnormal areas of the heart.
• implant medical devices that help the heart beat properly.
• replace a damaged heart with a donated heart (heart transplantation).

Learn More: Coronary Bypass Surgery and Alternative Treatments

How is Open Heart Surgery performed?
According to the National Institutes of Health, a CABG takes from four to six hours. It is generally done following these basic steps:

• The patient is given general anesthesia. This ensures that the patient will be asleep and pain free through the whole surgery.
• The surgeon makes an 8- to 10-inch cut in the chest.
• The surgeon cuts through all or part of the patient’s breastbone to expose the heart.
• Once the heart is visible, the patient may be connected to a heart-lung bypass machine. The machine moves blood away from the heart so that the surgeon can operate. Some newer procedures do not use this machine.
• The surgeon uses a healthy vein or artery to make a new path around the blocked artery.
• The surgeon closes the breastbone with wire, leaving the wire inside the body.
• The original cut is stitched up.

Sometimes sternal plating is done for people at high-risk, such as people of advanced age or people who have had multiple surgeries.
This is when the breastbone is rejoined with small titanium plates after the surgery.

What are the risks of Open Heart Surgery?
Risks for open-heart surgery include:

• chest wound infection (more common in patients with obesity or diabetes, or those who have had a CABG before)
• heart attack or stroke
• irregular heartbeat
• lung or kidney failure
• chest pain and low fever
• memory loss or “fuzziness”
• blood clot
• blood loss
• breathing difficulty
• pneumonia

According to the University of Chicago Medicine, the heart-lung bypass machine is associated with increased risks.
These risks include stroke and memory problems.
Learn More: Surgery for Atrial Fibrillation: Types, Risks, and More

How to prepare for Open Heart Surgery
Tell your doctor about any drugs you are taking, even over-the-counter medications, vitamins, and herbs. Inform them of any illnesses you have, including herpes outbreak, cold, flu, or fever.
In the two weeks before the surgery, your doctor may ask you to quit smoking and stop taking blood-thinning medications, such as aspirin, ibuprofen, or naproxen.

It’s important to talk to your doctor about your alcohol consumption before you prepare for the surgery. If you typically have three or more drinks a day and stop right before you go into surgery, you may go into alcohol withdrawal. This may cause life-threatening complications after open-heart surgery, including seizures or tremors.
Your doctor can help you with alcohol withdrawal to reduce the likelihood of these complications.

The day before the surgery, you may be asked to wash yourself with a special soap. This soap is used to kill bacteria on your skin and will lessen the chance of an infection after surgery. You may also be asked not to eat or drink anything after midnight.
Your healthcare provider will give you more detailed instructions when you arrive at the hospital for surgery.

What happens after Open Heart Surgery?
When you wake up after surgery, you will have two or three tubes in your chest. These are to help drain fluid from the area around your heart.
You may have intravenous (IV) lines in you, supplying you with fluids.
You may have a catheter (thin tube) in your bladder to remove urine.

You will also be attached to machines that monitor your heart. Nurses will be nearby to help you if something should arise.
You will usually spend your first night in the intensive care unit (ICU).
You will then be moved to a regular care room for the next three to seven days.

Recovery, follow up, and what to expect
Taking care of yourself at home immediately after the surgery is an essential part of your recovery.

Incision Care
Incision care is extremely important. Keep your incision site warm and dry, and wash your hands before and after touching it. If your incision is healing properly and there is no drainage, you can take a shower. The shower shouldn’t be more than 10 minutes with warm (not hot) water. You should ensure that the incision site isn’t hit directly by the water.
It’s also important to regularly inspect your incision sites for signs of infection, which include:

• increased drainage, oozing, or opening from the incision site
• redness around the incision
• warmth along the incision line
• fever

Pain management
Pain management is also incredibly important, as it can increase recovery speed and decrease the likelihood of complications like blood clots or pneumonia. You may feel muscle pain, throat pain, pain at incision sites, or pain from chest tubes.
Your doctor will likely prescribe pain medication that you can take at home. It’s important that you take it as prescribed. Some doctors recommend taking the pain medication both before physical activity and before you sleep.

Get enough sleep
Some patients experience trouble sleeping after open-heart surgery, but it’s important to get as much rest as possible.
To get better sleep, you can:

• take your pain medication a half hour before bed
• arrange pillows to decrease muscle strain
• avoid caffeine, especially in the evenings

While some believe that people may experience declines in mental functioning as a result of open-heart surgery, most recent research has found that not to be the case.
Though some patients may have open-heart surgery and mental decline later on, it’s thought that they are more likely to be the natural effects of aging.
Some people do experience depression or anxiety after open-heart surgery. A therapist or psychologist can help you manage these effects.

Rehabilitation
Most people who’ve had a CABG benefit from participating in a structured, comprehensive rehabilitation program. This is usually done outpatient with visits several times a week.
The components to the program include exercise, reducing risk factors, and dealing with stress, anxiety, and depression.

Long-term outlook for Open Heart Surgery
Expect a gradual recovery. It may take up to six weeks before you start feeling better, and up to six months to feel the full benefits of the surgery. However, the outlook is good for many people, and the grafts can work for many years.
Nevertheless, surgery does not prevent artery blockage from happening again. You can help improve your heart health by:

• eating a healthy diet
• cutting back on foods high in salt, fat, and sugar
• leading a more active lifestyle
• not smoking
• controlling high blood pressure and high cholesterol

Learn More: Lower Your Blood Pressure Fast With These Tips

Source: Healthline

Questions & Answers About Coronary Artery Bypass Surgery

Source: Medtronic
1 Why has my doctor recommended coronary artery bypass surgery?
2. What do I need to know about CABG surgery?
3. What are the main differences between a conventional CABG surgery procedure, a beating heart CABG surgery procedure, and a MICS CABG surgery procedure
4. What are tissue stablilizers?
5. How soon after beating heart CABG surgery can I expect to see results?
6. How soon after surgery can I resume normal activity?
7. Will I need to take medications after my surgery?
8. What are the risk of CABG Surgery?
9. How do I prepare for CABG Surgery?
10. What are the alternatives to CABG Surgery?
11. What happens after CABG Surgery?
12. What should I know about recovery from CABG Surgery?

1. Why has my doctor recommended coronary artery bypass surgery?
Your doctor may have recommended coronary artery bypass grafting (CABG) surgery for the following reasons:

• You have significant narrowing or blockages in your coronary arteries.
• Your coronary artery disease has progressed beyond the point where it can be safely treated by medications.
• Your arteries have renarrowed after stents or angioplasty therapy,

Unfortunately, you may not have any symptoms in early coronary artery disease, yet the disease will continue to progress until there’s enough artery blockage to cause symptoms and problems.
If the blood supply to your heart muscle continues to decrease as a result of increasing blockage of a coronary artery, you may have a heart attack. If the blood flow can’t be restored to the particular area of the heart muscle affected, the tissue dies.

2. What do I need to know about CABG surgery?
CABG surgery is a major surgical procedure that reroutes blood flow to the portion of the heart beyond the blockage in the coronary artery.
The surgeon creates a graft using portions of another artery or vein taken from somewhere else in your body. One part of the graft is connected to an artery above the blockage, and the other section is connected below the blockage. This will reestablish blood flow to the affected area of the heart.

3. What are the main differences between a conventional CABG surgery procedure, a beating heart CABG surgery procedure, and a MICS CABG surgery procedure?
During conventional CABG surgery, your heart is stopped so that the surgeon can more easily operate on it. You are placed on the heart-lung machine.
The heart-lung machine does the work of the heart and lungs, providing blood flow to the entire body during the procedure.

Beating heart CABG surgery allows the heart to continue beating while the surgery is performed. The heart does not need to be stopped. To make it easier to work on a moving/beating heart, the surgeon will use a device called a "tissue stabilizer" which immobilizes the small section of the heart that needs the bypass graft, while the rest of the heart beats.
A "heart positioner" is typically used to position the heart for access to the blocked coronary artery. MICS CABG is performed in a similar manner to beating heart CABG, but the surgeon uses only a small incision to access the heart, rather than a full sternotomy.

Heart-Lung Machine
The heart-lung machine collects the blood. Special filters remove the carbon dioxide and other waste products. The oxygenator adds oxygen, the oxygenator's heat exchanger warms (or cools) the blood. The blood is gently circulated back through the body. Medtronic markets a heart-lung machine and many of the other important medical products used during conventional CABG surgery.

4. What are tissue stablilizers?
Tissue stabilizers like the Medtronic Octopus Tissue Stabilizer are used by thousands of surgeons worldwide to stabilize the heart while they perform the beating heart CABG surgery.
The Octopus device uses small suction pods that gently grip the heart to steady it while the surgeon works.
Medtronic Octopus Tissue Stabilizers, along with Starfish and Urchin Heart Positioners, have helped to make beating heart surgeries safe and effective.

5. How soon after beating heart CABG surgery can I expect to see results?
Results vary from person to person. Many people experience relief from symptoms right away. For others, it may take awhile (a few weeks) to notice a change.
Your doctor will help you evaluate the progress of your condition after surgery.

6. How soon after surgery can I resume normal activity?
Typically, recovery takes from 4 to 6 weeks. During this time, you’ll gradually regain your energy and will be able to return to your normal routine. Of course, how quickly you recover depends on several things including your overall health prior to surgery, the kind of surgery you have, and how well your incision is healing.
A good cardiac rehabilitation program helps you regain your energy and overall good health.

7. Will I need to take medications after my surgery?
You may have to take medications after your surgery. It depends on your overall health and the particular nature of your coronary artery disease.
Your doctor will prescribe the medicines you need.

8. What are the risk of CABG Surgery?
Possible risks of coronary artery bypass graft surgery (CABG) include:

• Bleeding during or after the surgery
• Blood clots that can cause heart attack, stroke, or lung problems
• Infection at the incision site
• Pneumonia
• Breathing problems
• Pancreatitis
• Kidney failure
• Abnormal heart rhythms
• Failure of the graft
• Death

There may be other risks depending on your specific medical condition. The exact risks are specific to you and differ for every person.
Be sure to discuss any concerns with your doctor and/or surgeon before the procedure.

9. How do I prepare for CABG Surgery?
Your surgeon will discuss with you what will happen before, during and after your procedure, and any pain you might have.
This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure.
Preparations may include:

• Your doctor will explain the procedure and you can ask questions.
• You will be asked to sign a consent form that gives your permission to do the test. Read the form carefully and ask questions if anything is unclear.
• Along with a review of your medical history, your doctor may do a complete physical exam to ensure you are in otherwise good health before undergoing the procedure. You may need blood tests or other diagnostic tests.
• You will be asked to fast (not eat or drink) for 8 hours before the procedure, generally after midnight.
• You may be asked to shower with an antiseptic soap the night before and the morning of surgery.
• If you are pregnant or think you could be, tell your doctor.
• Tell your doctor if you are sensitive to or are allergic to any medicines, iodine, latex, tape, or anesthetic agents (local and general).
• Tell your doctor about all medicines (prescription and over-the-counter), vitamins, herbs, and supplements that you are taking.
• Tell your doctor if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medicines, aspirin, or other medicines that affect blood clotting. You may be told to stop some of these medicines before the procedure.
• Your doctor may do blood tests before the procedure to determine how long it takes your blood to clot.
• Tell your doctor if you have a pacemaker or any other implanted cardiac device.
• If you smoke, stop smoking as soon as possible. This may improve your chances for a successful recovery from surgery and benefit your overall health.
• Based on your medical condition, your doctor may request other specific preparation.
  

10. What are the alternatives to CABG Surgery?
There are several alternative treatments available. Some examples are listed below.

• Medicines, such as calcium channel blockers, beta-blockers, statins and anti-platelets may improve your symptoms or prevent your condition from getting worse.
• Coronary angioplasty – a plastic tube called a catheter is inserted into a blood vessel (either in your groin or your wrist) and used to open up the narrowed arteries so that blood flows more easily to the heart muscle.
  A stent (a small metal tube) may be used to help keep the artery open.

Your treatment will depend on the condition of your coronary arteries.
Your surgeon will advise you which treatment is most suitable for you.

11. What happens after CABG Surgery?
In the hospital
After the surgery, you may be taken to the recovery room and then the intensive care unit (ICU) to be closely monitored. Machines will constantly display your electrocardiogram (ECG) tracing, blood pressure, other pressure readings, breathing rate, and your oxygen level.
Coronary artery bypass surgery (CABG) requires an in-hospital stay of at least several days.

You will most likely have a tube in your throat to help with breathing through a ventilator (breathing machine) until you are stable enough to breathe on your own. As you continue to wake up from the anesthesia and start to breathe on your own, your doctor can adjust the breathing machine to allow you to take over more of the breathing.
When you are awake enough to breathe completely on your own and you are able to cough, your doctor will remove the breathing tube. In most cases, the breathing tube is removed soon after the operation, usually the same day or by early the next morning. Your doctor will also remove the stomach tube at this time.

After the breathing tube is out, a nurse will help you cough and take deep breaths every couple of hours. This will be uncomfortable due to soreness, but it is very important that you do this to keep mucus from collecting in your lungs and possibly causing pneumonia. Your nurse will show you how to hug a pillow tightly against your chest while coughing to help ease the discomfort.
The surgical incision may be tender or sore for several days after a CABG procedure. Take a pain reliever for soreness as recommended by your doctor. Aspirin or certain other pain medicines may increase the chance of bleeding. Be sure to take only recommended medicines.
Your doctor may delivery medicines through the IV to help your blood pressure and your heart, and to control any problems with bleeding. As your condition stabilizes, he or she will gradually decrease and then stop these medicines.

Once your doctor removes the breathing and stomach tubes and you are stable, you may start to drink liquids. You can gradually include more solid foods as you can handle them.
When your doctor determines that you are ready, you will be moved from the ICU to a post-surgical nursing unit. Your recovery will continue there. You can gradually increase your activity as you get out of bed and walk around for longer periods. You can eat solid foods as soon as you can tolerate them.
A member of your care team will arrange for you to go home and schedule a follow-up visit with your doctor.

At home
Once you are home, it will be important to keep the surgical area clean and dry. Your doctor will give you specific bathing instructions. Your doctor will remove the sutures or surgical staples during a follow-up office visit, if they were not removed before leaving the hospital.
Do not drive until your doctor tells you it's OK. You may have other activity restrictions.
Tell your doctor if you have any of the following:

• Fever of 100.4°F (38°C) or higher, or chills
• Redness, swelling, or bleeding or other drainage from any of the incision sites
• Increase in pain around any of the incision sites
• Trouble breathing
• Rapid or irregular pulse
• Swelling in the legs
• Numbness in the arms and legs
• Persistent nausea or vomiting

Your doctor may give you other instructions after the procedure, depending on your situation.

12. What should I know about recovery from CABG Surgery?
If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice.

Your breastbone should take about six to eight weeks to heal but it can take up to three months to recover fully. Don’t lift heavy objects or do any strenuous activity until the breastbone has fully healed. Your surgeon will give you advice about how soon you can return to work.

Follow your surgeon’s advice about driving. You shouldn’t drive until you’re confident that you could perform an emergency stop without discomfort. If you drive a lorry or a bus you need to notify the DVLA about your operation and you will be disqualified from driving for three months. You will need to take an exercise test before you are allowed to drive again.

Types of Heart Surgery and Procedures
Source: National Heart, Lung, and Blood Institute
Coronary Artery Bypass Grafting (CABG)
Coronary artery bypass grafting (CABG) is the most common type of heart surgery. CABG improves blood flow to the heart. Surgeons use CABG to treat people who have severe coronary heart disease (CHD).
CHD is a disease in which a waxy substance called plaque (plak) builds up inside the coronary arteries. These arteries supply oxygen-rich blood to your heart.
Over time, plaque can harden or rupture (break open). Hardened plaque narrows the coronary arteries and reduces the flow of oxygen-rich blood to the heart. This can cause chest pain or discomfort called angina (an-JI-nuh or AN-juh-nuh).
If the plaque ruptures, a blood clot can form on its surface. A large blood clot can mostly or completely block blood flow through a coronary artery. This is the most common cause of a heart attack. Over time, ruptured plaque also hardens and narrows the coronary arteries.

During CABG, a healthy artery or vein from the body is connected, or grafted, to the blocked coronary artery. The grafted artery or vein bypasses (that is, goes around) the blocked portion of the coronary artery. This creates a new path for oxygen-rich blood to flow to the heart muscle.
Surgeons can bypass multiple blocked coronary arteries during one surgery.

Percutaneous Coronary Intervention (PCI)
CABG isn't the only treatment for CHD. A nonsurgical procedure that opens blocked or narrow coronary arteries is percutaneous coronary intervention (PCI), also known as Coronary Angioplasty.
During PCI, a thin, flexible tube with a balloon at its tip is threaded through a blood vessel to the narrow or blocked coronary artery. Once in place, the balloon is inflated to push the plaque against the artery wall. This restores blood flow through the artery.

During PCI, a stent might be placed in the coronary artery to help keep it open. A stent is a small mesh tube that supports the inner artery wall.
If both CABG and PCI are options, your doctor can help you decide which treatment is right for you.

Transmyocardial Laser Revascularization (TMR)
Transmyocardial (tranz-mi-o-KAR-de-al) laser revascularization (re-VAS-kyu-lar-ih-ZA-shun), or TMR, is surgery used to treat angina.
TMR is most often used when no other treatments work. For example, if you've already had one CABG procedure and can't have another one, TMR might be an option. For some people, TMR is combined with CABG.

If TMR is done alone, the procedure may be performed through a small opening in the chest.
During TMR, a surgeon uses lasers to make small channels through the heart muscle and into the heart's lower left chamber (the left ventricle).
It isn't fully known how TMR relieves angina. The surgery may help the heart grow tiny new blood vessels. Oxygen-rich blood may flow through these vessels into the heart muscle, which could relieve angina.

Heart Valve Repair or Replacement
For the heart to work well, blood must flow in only one direction. The heart's valves make this possible. Healthy valves open and close in a precise way as the heart pumps blood.
Each valve has a set of flaps called leaflets. The leaflets open to allow blood to pass from one heart chamber into another or into the arteries. Then the leaflets close tightly to stop blood from flowing backward.
Heart surgery is used to fix leaflets that don't open as wide as they should. This can happen if they become thick or stiff or fuse together. As a result, not enough blood flows through the valve.

Heart surgery also is used to fix leaflets that don't close tightly. This problem can cause blood to leak back into the heart chambers, rather than only moving forward into the arteries as it should.
To fix these problems, surgeons either repair the valve or replace it with a man-made or biological valve. Biological valves are made from pig, cow, or human heart tissue and may have man-made parts as well.

To repair a mitral (MI-trul) or pulmonary (PULL-mun-ary) valve that's too narrow, a cardiologist (heart specialist) will insert a catheter (a thin, flexible tube) through a large blood vessel and guide it to the heart.
The cardiologist will place the end of the catheter inside the narrow valve. He or she will inflate and deflate a small balloon at the tip of the catheter. This widens the valve, allowing more blood to flow through it. This approach is less invasive than open-heart surgery.

Researchers also are testing new ways to use catheters in other types of valve surgeries. For example, catheters might be used to place clips on the mitral valve leaflets to hold them in place.
Catheters also might be used to replace faulty aortic valves. For this procedure, the catheter usually is inserted into an artery in the groin (upper thigh) and threaded to the heart.
In some cases, surgeons might make a small cut in the chest and left ventricle (the lower left heart chamber). They will thread the catheter into the heart through the small opening.
The catheter has a deflated balloon at its tip with a folded replacement valve around it. The balloon is used to expand the new valve so it fits securely within the old valve.
Currently, surgery to replace the valve is the traditional treatment for reasonably healthy people. However, catheter procedures might be a safer option for patients who have conditions that make open-heart surgery very risky.

Arrhythmia Treatment
An arrhythmia (ah-RITH-me-ah) is a problem with the rate or rhythm of the heartbeat. During an arrhythmia, the heart can beat too fast, too slow, or with an irregular rhythm.
Many arrhythmias are harmless, but some can be serious or even life threatening. If the heart rate is abnormal, the heart may not be able to pump enough blood to the body. Lack of blood flow can damage the brain, heart, and other organs.
Medicine usually is the first line of treatment for arrhythmias. If medicine doesn't work well, your doctor may recommend surgery. For example, surgery may be used to implant a pacemaker or an implantable cardioverter defibrillator (ICD).
A pacemaker is a small device that's placed under the skin of your chest or abdomen. Wires connect the pacemaker to your heart chambers. The device uses low-energy electrical pulses to control your heart rhythm. Most pacemakers have a sensor that starts the device only if your heart rhythm is abnormal.

An ICD is another small device that's placed under the skin of your chest or abdomen. This device also is connected to your heart with wires. An ICD checks your heartbeat for dangerous arrhythmias. If the device senses one, it sends an electric shock to your heart to restore a normal heart rhythm.

Another arrhythmia treatment is called maze surgery. For this surgery, the surgeon makes new paths for the heart's electrical signals to travel through. This type of surgery is used to treat atrial fibrillation, the most common type of serious arrhythmia.
Simpler, less invasive procedures also are used to treat atrial fibrillation. These procedures use high heat or intense cold to prevent abnormal electrical signals from moving through the heart.

Aneurysm Repair
An aneurysm (AN-u-rism) is a balloon-like bulge in the wall of an artery or the heart muscle. This bulge can occur if the artery wall weakens. Pressure from blood moving through the artery or heart causes the weak area to bulge.
Over time, an aneurysm can grow and burst, causing dangerous, often fatal bleeding inside the body. Aneurysms also can develop a split in one or more layers of the artery wall. The split causes bleeding into and along the layers of the artery wall.
Aneurysms in the heart most often occur in the heart's lower left chamber (the left ventricle). Repairing an aneurysm involves surgery to replace the weak section of the artery or heart wall with a patch or graft.

Heart Transplant
A heart transplant is surgery to remove a person's diseased heart and replace it with a healthy heart from a deceased donor. Most heart transplants are done on patients who have end-stage heart failure.
Heart failure is a condition in which the heart is damaged or weak. As a result, it can't pump enough blood to meet the body's needs. "End-stage" means the condition is so severe that all treatments, other than heart transplant, have failed.
Patients on the waiting list for a donor heart receive ongoing treatment for heart failure and other medical conditions. Ventricular assist devices (VADs) or total artificial hearts (TAHs) might be used to treat these patients.

Surgery To Place Ventricular Assist Devices or Total Artificial Hearts
A VAD is a mechanical pump that is used to support heart function and blood flow in people who have weak hearts.
Your doctor may recommend a VAD if you have heart failure that isn't responding to treatment or if you're waiting for a heart transplant. You can use a VAD for a short time or for months or years, depending on your situation.
A TAH is a device that replaces the two lower chambers of the heart (the ventricles). You may benefit from a TAH if both of your ventricles don't work well due to end-stage heart failure.
Placing either device requires open-heart surgery.

Surgical Approaches
Surgeons can use different approaches to operate on the heart, including open-heart surgery, off-pump heart surgery, and minimally invasive heart surgery.
The surgical approach will depend on the patient's heart problem, general health, and other factors.

Open-Heart Surgery
Open-heart surgery is any kind of surgery in which a surgeon makes a large incision (cut) in the chest to open the rib cage and operate on the heart. "Open" refers to the chest, not the heart. Depending on the type of surgery, the surgeon also may open the heart.

Once the heart is exposed, the patient is connected to a heart-lung bypass machine. The machine takes over the heart's pumping action and moves blood away from the heart. This allows the surgeon to operate on a heart that isn't beating and that doesn't have blood flowing through it.
Open-heart surgery is used to do CABG, repair or replace heart valves, treat atrial fibrillation, do heart transplants, and place VADs and TAHs.

Off-Pump Heart Surgery
Surgeons also use off-pump, or Beating Heart Surgery to do CABG. This approach is like traditional open-heart surgery because the chest bone is opened to access the heart. However, the heart isn't stopped, and a heart-lung bypass machine isn't used.
Off-pump heart surgery isn't right for all patients. Work with your doctor to decide whether this type of surgery is an option for you. Your doctor will carefully consider your heart problem, age, overall health, and other factors that may affect the surgery.

Minimally Invasive Heart Surgery
For minimally invasive heart surgery, a surgeon makes small incisions (cuts) in the side of the chest between the ribs. This type of surgery may or may not use a heart-lung bypass machine.
Minimally invasive heart surgery is used to do some bypass and maze surgeries. It's also used to repair or replace heart valves, insert pacemakers or ICDs, or take a vein or artery from the body to use as a bypass graft for CABG.

One type of minimally invasive heart surgery that is becoming more common is robotic-assisted surgery. For this surgery, a surgeon uses a computer to control surgical tools on thin robotic arms.
The tools are inserted through small incisions in the chest. This allows the surgeon to do complex and highly precise surgery. The surgeon always is in total control of the robotic arms; they don't move on their own.

Open Heart Surgery – Incredible Animated Picture Guide!
Source: MyHeart.net (Dr. Mustafa Ahmed)
What is Open Heart Surgery?
Traditionally, open heart surgery meant the breastbone being cracked open, providing direct access to the heart, allowing heart surgeons to fix heart problems while the patient is placed on a heart lung machine. Open heart surgery is probably the most widely known and feared of all operations, but in the right hands open heart surgery can be remarkably safe and effective, associated with excellent outcomes for patients. Read here to learn about Robotic Heart Surgery.

See Throughout This Article For Incredible Open Heart Surgery Moving Pictures.
Modern approaches mean that open heart surgery has been revolutionized and is now an entirely different prospect compared to what it used to be. In expert centers, particularly for valve surgery, there is now the routine use of minimally invasive techniques meaning incisions are getting smaller and smaller.
Certain heart surgery cases may even be done using robot assistance where the entire case is done without any major incisions at all.



Excitingly, the rapidly expanding field of Structural Heart Disease is realizing the dream of repairing heart defects without the need for any chest incisions whatsoever meaning that the future of open heart surgery may be no open-heart whatsoever!


What are Some Types of Open Heart Surgery?
The most well known open heart surgery is Bypass Surgery, often known as CABG (Coronary Artery Bypass Surgery). That is done to bypass Heart Blockages. Other well known open-heart surgeries include Heart Valve Repair and Replacement, surgery on the aorta , surgery for holes in the heart and heart transplant surgeries
.
Artificial heart pumps (known as VAD short for ventricular assist devices) are also often placed by means of open heart surgery. In children and adults that have been born with major abnormalities (known as Congenital Heart Disease) multiple open heart surgeries may be required over a life time.
These different types of open heart surgery will be discussed in more detail below.



Who Performs Open Heart Surgery?
Open Heart Surgery is performed by heart surgeons, also known as Cardiac Surgeons. To become a cardiac surgeon a significant amount of training is required. After medical school, there is 5 years of residency training then 2 years of training in cardiac surgery.
Often an extra year will be done to super specialize in certain areas or to develop extra skills. It often takes many years before surgeons become experienced enough to perform independent, highly complex open heart operations.

The History of Open Heart Surgery
Prior to the 1950’s adult heart surgery was limited to procedures that were performed for rheumatic mitral valve disease. These procedures, although working on heart valves, did not need the heart lung machine and were relatively simple. The reason that more complex operations were not done is because in order to perform complex heart surgery, the heart would need to be stopped and a heart lung machine would need to take over

This was not developed until the 1950’s. In 1952, after spending 20 years developing the heart lung machine, Dr John Gibbon performed what is considered the first successful open heart operation for a large hole in the heart. Since that time the field has advanced incredibly to where we stand today.

Descriptions of Different Open Heart Surgery Operations
Bypass Surgery
Coronary Bypass Surgery is performed to treat blockages in heart arteries. It is the most common open heart surgery. In this operation arteries and/or veins are used to bypass the blockage and improve the blood supply to the heart. The arteries can be taken either from inside the chest wall, or the arm. The veins are typically taken from the leg. In most cases the patient is placed on the heart lung bypass machine and the heart stopped.

There are some surgeons who prefer to perform the operation with the heart beating and therefore no need for the heart lung machine. The best approach is controversial and depends on the center used. The mini videos throughout this post are taken from a bypass operation.




Heart Valve Surgery
There are four valves in the heart. These are called the Mitral Valve, Aortic Valve, Tricuspid Valve and pulmonic valve. These are described in more detail in this linked article. Heart valve repair and replacement is conventionally performed with the use of the heart lung machine
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In valve repair, the diseased valve is fixed by making adjustments to the existing valve. In valve replacement the valve is simply cut out and a new either tissue or metallic valve is sewn in. In many cases, in patients with artery blockages, bypass surgery can be performed at the same time as valve surgery.

Aortic Surgery
The aorta is the large blood vessel that leaves the heart and supplies the body with blood. Surgery can be required for aortic aneurysms or more emergently for aortic dissections. Heart surgeons operate on the aorta when it is in the chest.
Vascular surgeons operate on the aorta once it is in the abdomen. Aortic surgery needs to be done by experts and very carefully as the vessels that leave the aorta supply the brain and spine.

Heart Transplant Surgery
In heart transplant surgery, the diseased heart is literally removed and a new heart sewn in to place. The new heart of course needs to be attached carefully to the blood vessels of the body. Dedicated heart transplant surgeons who are also responsible for retrieving the donor hearts perform transplant surgery
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Transplant surgeons are also responsible for placement of artificial heart pumps known as VAD’s short for ventricular assist devices. VAD’s can do the work of the heart when the heart fails. Progress continues to be made in what is known as the Total Artificial Heart.

Other Heart Surgery
Myomectomy: A procedure known as myomectomy is performed for a condition called HOCM that stands for hypertrophic obstructive cardiomyopathy. In that condition thick heart muscle gets in the way of blood trying to leave the heart. In the operation the thick tissue is cut out.
Septal Defect Repair: Holes in the upper and lower chambers of the heart known as Atrial s Septal Defects and ventricular septal defects are often repaired by means of open heart surgery. Often patches are placed over these holes to cover them.
Pulmonary Embolectomy and Endarterectomy: Clots known as Echocardiograms, CT scans, and a Heart Catheterization. Once the diagnosis and the need for open heart surgery have been determined then the patient is referred to a cardiac surgeon for an evaluation.

Meeting the Surgeon: Surgeons will often be suggested by the cardiologist depending on their referral patterns however often patients will select their own surgeons based on other recommendations or their own research. Once this is decided the patient will go and meet the surgeon in clinic. Here the surgeon will talk with the patient and review the testing. Based on this meeting a surgical recommendation can be made and operative risk and suitability can be determined. In many cases the surgeon may ask for further testing to be performed.

Meeting the Anesthesiologist: When undergoing open heart surgery patients will be put to sleep, which is known as being under general anesthesia. Of course this is so patients will not feel anything or be aware of what’s happening. Before the surgery the anesthesiologist will meet the patient, take a careful history and determine the risk of anesthesia and the best method of delivering it. In some places there are special clinics known as pre-op clinics that patients attend. In other places the patient will meet the anesthesiologists the night before, or the morning of surgery.

Getting Ready for the Operation: Patients will be dressed in a gown and taken to the operating room there they will lay on the operating table. Here the patient will be prepared for open heart surgery with meticulous detail using sterile techniques to prevent infection. The chest will be shaved in the case of men. The chest will then be cleansed with disinfectant and a thin wrap be placed over the chest. The anesthesiologists will place IV lines and arterial lines to be used for pressure monitoring and drug delivery during the case. A breathing tube will then be placed in the patient, and the ventilator machine will take over breathing until the patient wakes back up.

Details of the Operation
Making the Incision: In the case of classic open heart surgery, the breast bone will be split open using a saw. Alternative approaches may use incisions to the side of the bone between the ribs or through some of the ribs on the side. In robotic heart approaches, no large incisions are made, and small tubes are inserted through which the operation is performed, sometimes called keyhole surgery.

Cardiopulmonary bypass: This is also known as going on the heart lung machine. The machine takes over the work of the heart and the lungs, while the heart is stopped using a technique known as hypothermic cardioplegia, which is essentially infusion of a cold solution into the coronary circulation to stop the electro-mechanical activity of the heart. Tubes known as cannulas are placed in the heart and the great vessels of the body and the blood is drained through and pumped back in to the body through these tubes. In some cases the heart lung machine is not used, these are called off-pump cases. In those cases the operation is performed on the beating heart.

The Operation Itself: In bypass surgery, one by one the blocked arteries will be bypassed using vein or artery taken from elsewhere; these are sewed into place delicately. In the case of valve replacement the old valve is cut out and a new valve sewn in. In Valve Repair, different techniques are used to repair the existing valve.



Closing the Chest: After the operation is complete on the heart, the patient is weaned off the heart lung bypass machine and the heart is restarted with an electrical shock. Then the chest incisions are sewn together. In the case of the breastbone, wires known as sternal wires are placed to hold it together until it heals.



Transport to the ICU: After the operation is complete, the breathing tube will be left in place and the patient transported to the intensive care unit. There will be several drains in place from around the heart and the chest to allow blood to drain. The breathing tube is typically taken out a few hours after the operation and the drains taken out over the next few days.

Post-operative Recovery: A lot of this depends on the patient. Of course a sick 85 year old will in general have a tougher time than a relatively healthy 45 year old. Early sitting in a chair and walking is encouraged and physical therapists will often work with patients to ensure a timely recovery. Patients are expected to walk up and down the halls easily prior to being discharged. Breathing exercises are encouraged to allow the lungs to return to normal functioning.

Discharge: Most patients are discharged within the week of an open-heart operation. Patients who are not well enough to return home may be discharged to a rehab facility for a short while to enhance their recovery.




Return Visit: Most patients will come back and see the heart surgeon 1-2 weeks after the operation. Remaining stitches can be removed and any issues discussed. Patients will usually see their cardiologist a month after any procedure also.

Open Heart Surgery - Patient Risk
The risk of open heart surgery to any patient is very dependent on the patient themselves and how sick they are. Of course a healthy 45 year old is going to have a lower risk than an 85 year old. Several risk factors have been found to be important when determining the risk for any given patient.
Age: Older patients are in general at higher risk than younger patients.
Sex: In general female patients have higher risk than make patients.
Obesity: Obese patients are at higher risk.
Heart Function: Pumping function of the heart is important; those with impaired heart pumping function are at higher risk.
Kidney Function: Patients with Impaired Kidney function have higher risk; the worse the kidney function the higher the risk
Heart Attack: Those that have had a heart attack are at higher risk, particularly if the heart attack is around the time of surgery or if there are active symptoms of chest pain at the time of surgery.
Lung Disease: Those with known lung disease, such as COPD, are at higher risk; the worse the lung disease the higher the risk.
Emergency Surgery: Surgery that needs to be performed emergently due to active symptoms, or instability carries a much higher risk than elective planned surgery.
Presence of Multiple Problems: The more issues that need fixing, the higher the risk; for example someone needing a simple bypass operation is lower risk than someone needing a bypass and 2 valves fixed at the same time.
Number of Previous Surgeries: The more surgeries someone has had, the higher the risk. This is due to build up of scar tissue and other issues that arise with each open heart surgery operation.

Open Heart Surgery in Children Source: CincinnatiChildrens.org
Open-heart surgery refers to operations performed on the heart that require a patient being placed on the heart-lung bypass machine.
The heart-lung bypass machine takes over the function of the heart and lungs to provide oxygenated blood to the body.
The heart can be stopped with a solution called "cardioplegia." Cardioplegia is a cold, high-potassium solution. It also protects the heart muscle while it is stopped.

The heart itself can then be opened and repair can be accomplished in a bloodless, still environment. In some situations, when on the cardiopulmonary bypass machine, the heart can be operated upon while still beating, but emptied.
This usually occurs when the repair is on the right side and there are no holes between the left and right sides of the heart.

Open-Heart Surgery Use
The repair of many cardiac defects such as atrial septal defects, ventricular septal defects, AV canals, transposition of the great arteries, tetralogy of Fallot and other complex anomalies requires the use of cardiopulmonary bypass, stopping the heart, and opening the heart.
Most pediatric heart procedures are open-heart procedures.

Description of Open Heart Surgery
To get access to the heart, the surgeon has to open the chest. To do so, he or she has to cut through the breast bone (sternum). This is referred to as the sternotomy.
The skin incision is generally smaller in size than the length of the breast bone, since the skin can be stretched to some extent.
For repeat incisions (a redo-sternotomy) often the length is a little longer than the previous scar.

For many parents, the concept of a sternotomy raises much concern. Most parents are surprised to hear that a sternotomy is one of the safest and more comfortable incisions performed during surgery.
Performing a sternotomy is nothing but an artificial fracture; at the end of the operation the two edges of the breast bone are put back together with steel wires. This usually does not lead to any deformities of the chest wall, even as a child grows.
At the same time, performing a sternotomy does not prevent the progression of already existing chest wall deformities (e.g., "pigeon chest").

Pain is sensed by the nerve endings in the affected tissues. In the bone, pain arises from movement at the site of a fracture. Infants don't have much chest wall muscle mass to move the sternal edges and develop pain. For that reason, not surprisingly, most infants are discharged home on just ibuprofen and Tylenol.
After the chest is opened, a part (or all) of the thymus gland is removed. The thymus gland is involved in the immune system; however, its removal has not been shown to lead to any immune compromise. The removal of the thymus is necessary to allow the surgeon to see and operate on the heart.

The heart sits in a thin, leather like sac called the pericardium. To get access to the heart, the pericardial sac has to be opened. The surgeon often removes a small portion of the pericardium, to be used later to patch holes in the heart or patch vessels to make them bigger.
Often the removed piece is treated with a chemical called glutaraldehyde to increase the stiffness of the pericardium, making it easier to work with during surgery
The removed pericardial piece is used during the operation as patch material for a variety of holes or defects within the heart. The removed piece of pericardium does not need to be replaced.

Preparing Your Child for Open-Heart Surgery
Patients requiring open-heart surgery will have had a complete evaluation by their cardiologist and cardiac surgeon.
The evaluation usually includes blood work, chest X-ray, an electrocardiogram, an echocardiogram and possibly a cardiac catheterization. All of this information helps guide the surgery and peri-operative care.​
Blood is crossmatched to be available in the operating room or to prime the bypass machine if necessary.

Decision to Perform Open-Heart Surgery
When a patient's cardiologist feels surgery may be indicated, the patient is discussed at Cincinnati Children's Heart Institute's weekly combined Cardiology-Cardiothoracic Surgery Case Management Conference.
The patient's medical history, physical exam findings and all studies that have been performed are reviewed. The group then discusses your child’s case and decides on a treatment plan for your child. If surgery or alternate procedure (e.g., cath intervention) is recommended, the timing and type of procedure are then decided.

Often, the operation needed is clear-cut. However, more complex defects may have different possible approaches for either correction or palliation. Such cases benefit greatly from the input of many experts. Also, regardless of how good the pre-operative assessment, the anatomy is never really known until the surgeon is looking at the heart.
Therefore, sometimes the operation done may change because of intra-operative findings.

Open-Heart Surgery Complications & Risks
All open-heart procedures carry risks related to the use of cardiopulmonary bypass. The safety of cardiopulmonary bypass has improved significantly over the years.
Major complications are now exceedingly rare. Bypass times up to four to eight hours are well tolerated.
The risks of bypass itself include inadequate perfusion of organs or tissues, activation of a systemic inflammatory response, and embolization of air or particles.
Especially concerning is the potential of embolization to the brain, but this risk should be quite low – less than 1 percent in most cases.

“Inadequate perfusion of organs and tissues” means that the bypass machine is not as efficient of a pump as your own heart, so some organs and tissues get a little less blood flow during surgery than they would normally. These organs protect themselves by slowing down. However, this is rare during modern cardiopulmonary bypass.
“Activation of a systemic inflammatory response” means that the heart-lung machine activates the body to release chemicals and cells that cause inflammation. This is why children after cardiopulmonary bypass can be somewhat swollen and their lungs can become “wet.”
Lasix (a medicine that helps your child get rid of fluid by urinating) is usually given after surgery.
“Embolization” occurs when a particle breaks loose and travels from one location in the body to another. Both air and clots can break lose and embolize, and can cause a potentially dangerous event (such as stroke).
A potentially significant, yet rare, complication of cardiopulmonary bypass is neurologic injury resulting in stroke or seizures.

Bleeding is also a risk after open heart surgery. Due to the use of Heparin (a blood thinner) during bypass, bleeding sometimes occurs where we have placed sutures.
Usually the bleeding is minimal and easily controlled with medications and bandages. The need for re-operation for bleeding following open-heart operations is low, about 2 percent.
In addition to the risks of bypass, the heart itself can be affected. First, the heart undergoes a period of cold ischemia (no blood flow) during most open-heart operations.
Myocardial function may be compromised by this period of ischemia despite efforts to protect the heart muscle using cardioplegia and cooling. Second, the heart’s function may be decreased or “depressed” after surgery.
The heart needs time to adapt to new anatomy and physiology after repair. Last, the heart rhythm may also be affected by open-heart procedures. Some patients require temporary or even permanent pacing (stimulation of the heart to assure a normal rhythm).

Incidence of Open-Heart Surgery in Children
At Cincinnati Children's Hospital Medical Center, more than 300 open-heart operations are performed each year.
In the United States, approximately 22,000 pediatric open heart procedures are performed each year. These procedures are done safely in younger children.
Currently nearly 25 percent of children undergoing open heart surgery are under a month of age, and nearly 70 percent are under 1 year of age.

Open-Heart Surgery Success
Success of open-heart surgery is highly dependent on the particular defect being operated upon.
Corrective procedures such as atrial septal defect and ventricular septal defect closures are highly successful with a near-zero percent mortality (or death rate).
Somewhat more complex lesions -- yet ones that are performed often, such as AV canal defects, transposition of the great vessels and tetralogy of Fallot -- carry a risk less than 5 percent.
More complex lesions, such as single ventricle defects, may carry a higher risk in the range of 15 to 20 percent, because one of the ventricles or valves is hypoplastic (underdeveloped).
Other factors can affect these results. For instance, a prematurely delivered newborn suffering from low birth weight and end-organ injury (i.e., kidney failure or liver injury) is at increased risk from open heart surgery.