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.
open heart surgery cutting through the chest
open heart surgery cutting deeper on chest wall
open heart surgery sawing the breastbone
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!
sternotomy vs. mini incision open heart surgery
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.
open heart surgery retracting the breastbone
open heart surgery approaches scars
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.
open heart surgery harvesting the leg vein
open heart surgery preparing vein for bypass
open heart surgery sewing the bypass on
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. 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. 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 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 pulmonary embolism can form in the lung and lead to right sided heart failure and dangerously high lung pressures. In a procedure known as embolectomy, clots can be removed as an emergency. Sometimes these clots accumulate over time and become hard and fixed to the blood vessels of the lung. They can be removed in a complex operation known as a pulmonary endarterectomy. This complex operation is only performed by a handful of surgeons.
Open Heart Surgery – What to Expect as a Patient
Diagnosis – Most patients will see a cardiologist first who will diagnose their problem based on their story, physical exam, and tests. Multiple tests may be required including 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 heart lung bypass machine.
open heart surgery beating heart with a bypass
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.
open heart surgery sternal wiring
open heart surgery closing the chest
After the Operation
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.
open heart wound healing sternotomy
open heart wound healing minimally invasive
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.
Very informative. Great article. Some how I think gaining all the knowledge I can on the subject will make what I am dealing with less scarey. I was wrong. I have been looking for information and everything else out there is very basic. Thank you for the detailed articles. This will contribute to my ability to make an informed decision about my treatment when the time comes.
Anything on pulmonary vein stenosis in Left superior vein related to CABG?
Anything on pulmonary vein stenosis in left superior vein related to CABG?
Very helpful, answered many of the questions and releaved most of the stress I had . Liked the attention about the anesthesiologists and how they can calm the patient before the OR.
Great article! This is the website where everyone needs to be looking for any information on the heart… easy to understand, yet still comprehensive. Thank you!
My sister in law states that the doctor will take her heart out put her on life support fix the 4 blockages 3 in front 1 in back put her heart back in. She is diabetic has had all toes but 2 removed, she is appx 55-56 years old. She has already had open heart surgery about 10 years ago. What are her chances of surviving this operation?
She has misunderstood, there is no way that is going to happen as it doesn’t make sense, yes she would be put on bypass, however the heart is not taken out to perform a bypass as shown in the images in this article.
this is very helpful. I had a PAPVC an isolated anomaly, specifically branching of my pulmonary vein. I’m early 30’s and found out about 2 mos ago and am now 4 wks post op. This is a great overview of what was done by my surgeons for the basics.
My husband has heavy blue thread coming from incision 1 month after quad. bypass & valve replacement. About 6 inches long. What is it?
I think you should get it seen to and make sure it isnt a pacing wire or other retained wire.
Hi,
I was meant to have a quadruple bypass 18 months ago but they could not get to the artery at the back so they used what I remember was a mammory artery instead.
Since my op aprox 18 months ago my left breast and my sternum has been painful and my breast is swollen and has stayed like this with no change. My doctor sent me to a breast clinic to get it examined due to its size but came back all clear… I have been back to see my surgeon who has recommended removing the three middle sternum wires as this area has always been tender to touch even 18 months later.
I have now had this procedure done and I am now home recovering…. I was told it would be 3 very small incisions to remove wires and probably home same day all being well.
I can honestly say I have never been in so much pain…. It was worse than the bypass surgery and I am really struggling to move my upper body without severe pain…. I mentioned this in hospital but they seemed keen on getting me home as soon as possible…. I feel abandoned right now by the hospital and I definately would not have gone through with the removal of the wires had I realised how painful it would be.
One thing I forgot to mention was that they reopened the whole chest rather than 3 small incisions …..
Upon reading my own previous comments I would also like to add that obviously without the bypass operation in the first place I probably wouldn’t be here to tell the tale and it is not my intention to worry any future patients but merely to say that everybody reacts in different ways.
I will always be grateful to the surgeons & staff at NHS for the hard work they do and I accept this wasn’t portrayed in my earlier comments.
We have some of the best surgeons in the world here in the uk and I am truly thankful for everything they have done for me personally.
I’m glad you are doing well. My mother is currently recovering from a bypass that is why I’m on the web searching all I can. Did your incision feel rough to the touch? Hers feels rough not smooth. Not sure if it’s the stitches or the roughness of the bone I’m feeling.
Thank you for this. Now I don’t feel so crazy about how my incision makes my left breast and left shoulder feel so sore. I had quadruple bypass on 09.15.17 and it is still sure now. It kind of feels like some days it hurts all day and on some days it’s not too bad. A lot of times I can’t sleep because it hurts. I will be continuing following this thread to see if more people are experiencing what I am. Thank you for your experience, it was very helpful.
I had quad bypass surgery in 2010. I still have some nerve damage on my left side but its not bad. Some days it itches like crazy. I also have a small hole in my chest on my surgery scar. My dr said not to worry about it so I haven’t. Every now and then I’ll squeeze it to get the white stuff out but it doesn’t get infected or anything.
Thank you so much for these articles. As a heart patient all my life, I can tell you anxiety can make it difficult to retain what you are being told. I had an awake minimally invasive valve surgery, and I wasn’t intentionally trying be uncooperative, but my anxiety didn’t allow me to think rationally. This time it will be an open surgery. I met my surgeon last week and feel very confident and safe in his hands. However, when he explained the procedure, after he got to the part where he told me he will put tubes in my heart and drain the blood, I have no memory of our conversation. Fear sets in. So, this is just the explanation I needed. Geez Louise I wouldn’t wish being a heart patient on anyone.
I had my surgery done on July 5th 2017. They took a vein from behind my heart instead of the leg. They then replaced the complete aorta (6 inches)and aorta valve and the left coronary by-pass. About a 5 hour job.They gave me NO pain meds but lots of drugs during surgery that took about 11 days to clear my system. I feel great except for the cough and slow rib recovery.
Doug
I had exactly the same experience with my triple bi-pass. My Kidneys were failing so I had to stay in hospital 2 more weeks to get them back but they did and only problem ive had in my 3 months since my bi-pass was some blood pressure spiking and took long time for the swelling in my legs to go away. Good luck to you and your full recovery
Jason
I have had a terrible time with my valve replacement, had it done Nov 2016 painless
However six months later I felt my wires pop as it turned out another surgery was done and a plastic surgeon was called in repair the damage, the sternum had died the wires were not broken but pushed into the sternum. I was told that there was a large gap and the bone had turned to mush. I have been suffering since the repair. I suppose I was pulled together in the front area however my collar bones, neck area and shoulder area are KLICKING……..nothing fits is the best way I can describe this feeling. I feel like my sternum area has pressure, it feels like someone is pushing hard in one spot. There is a lump the size of a fifty cent piece on the sternum. Probably from trauma A new ct scan was done and will be reviewed next week…………WHAT WOULD CASE THE STERNUM TO DIE AND THE BONE TURN TO MUSH….will I be in pain forever
This was very informative. I wish I had seen this before my surgery. Had no idea what to expect. I had an ASD closed using open heart surgery in December 2017. They tried to close it doing a cath, but didn’t work. 5 weeks after surgery, still some discomfort in sternum, but feeing great otherwise. Hopefully I won’t have any problems with sternal wiring in the future. That is my main concern.
Thank you Dr for this article and these incredible pictures.I left the hospital 2 days ago after undergoing a 5 bypass operation. In 6 weeks I went from a couple of pains to this wonderful recovery. If they had shown me this article beforehand I think I’d have been far less worried, but of course people rarely react how we think they will.LOL Some prefer knowing less. Again, thank you Dr for showing me in these INCREDIBLE moving pics exactly what a highly trained team of doctors and nurses and technicians helped me survive. Age 59 and still kicking.
Glad you found it useful..
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As an active no smoking 64 year old male and always healthy I found myself feeling tired and fatigued for no reason. When I physically pressed myself I could repeatedly feel a burning sensation in my chest…never any pain. On 2-1-18 I went to an appt . at Heart Hospital and experienced a heart attack during a treadmill stress test. Immediately I was admitted to the Heart Hospital and experienced a 5 bypass procedure at noon the next day. Honestly I was not aware of how detailed and invasive the procedure was until it was over. All I knew was my living wife,my family, and a special Dr. friend from Monroe,La was there with all their love and prayers to see me thru. The cardiologist said…he is young and healthy…he was made for this type of surg
I had the bypass surgery with harvesting the veins from the left leg. After the bypass they kept the heart lung machine on until the heart stabilized for a minute or so. Before the operation they told me that 10% die in OR, another 25% have a stroke and my require a longer stay, 10-15% may get an infection, and 10% may get pneumonia. The a six week recovery with no exercise, then an extended recovery period.
I had a triple bypass December 2018. I am doing fine so far, 5 weeks post surgery. Tiny bit of pain, almost back to normal. Just a little weak and I tire easily. I am a young 80 years old, very active, and want to know how long before I can drive, and do normal things like shovel snow on my walkway, basic carpentry & home maintenance, things that I did before surgery. Or am I always going to be limited in what I do for the rest of my life?
These questions are different case by case and should be answered at first post op follow up.
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I am now 40 years old. I’ve had 4 open heart surgeries. I was diagnosed with Hypertrophic Cardiomyopathy at age 17 so my first surgery was a septummyoectomy in the process my aortic valve was torn. My second surgery was to replace the aortic valve, but the surgeon thought he could repair it, but it didn’t take. My third they actually replaced it with a porcein valve. My fourth surgery they replaced it with a mechanical valve. In the process my heart became weaker and weaker, which put me into heart failure. My next surgery is going to have to be a heart transplant, but due to all the previous surgeries and complications with scar tissue my Heart Transplant, Heart Failure team do not feel comfortable doing it so I have to find another doctor.. Needless to say I’m very frustrated and terrified…
Hello Doctor Ahmed, I had a Double Bypass in 2004 and 2 stents in 2017. I have now developed a soreness in my chest when I breathe deeply, or make any arm movements. I have a continuous aching feeling in my chest. It feels as if my muscles are sore continuously. My General Practioner says it is muscular (arthritis?). With what can I treat myself to relieve the soreness?
Thank you,
William Simon
I was life flighted to a hospital to perform an emergency aortic dissection and aneurysm on January 16, 2019. I am 70 years old and was about 40 pounds over weight. I will be home for for the Super Bowl tomorrow (go Rams). I was at the hospital for 12 days. Rehab for 5, mainly due to my wife having to go out of town for other family concerns.I have a little pain in the chest and with some deep breathing, but able to take care of my personal needs and walk, using a walker just in case. The most important part was being able to get to the correct trauma in time. Thanks to the skilled surgical team.
After bypass surgery, will the sternum grow back together? It’s wired , but will it be the same as before the surgery?thank you.
It heals yes to most extent.
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I had triple bypass in june of 2018. After surgery I found that my right nerve to my lung was damaged or cut somehow> now after pulmonary rehab it has yet to move my diaphragm. So I use oxygen and inhaler and now neubulizer to get by day to day. Was never told about this being a possibility of happening.
I am about to undergo my 3rd open hear surgery. I just had one seven months ago and a mechanical vavle was ise instead of pig skin. Because I am only 31 they said that would be the best option. So I wont have to repeat sugury every 7-8 years. Well, little did we know I’m one of the rare cases that warfarin does not work for me and I had to be on it to make sure my blood stayed thin enough for the mechanical valve. I’m worried, because of them surgerys being so close together. My cardiologist was saying my chest plate may be removed. I go see the surgeon April 2. I hope my body my chest plate can with hold.anoter surgery
Why is the warfarin not working, did they feel you’re resistant? Has an issue come up with the actual valve itself?
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Help, I am having a difficult time deciding on Where to have my Triple bypass surgery. I have seen a Dr at RI hospital who says the cut will be 7-8 inches.
I also saw a Dr at Brigham &Womens who tells me 3-4 inch incision. Is this true?
Different in different places, important to choose the surgeon, not the incision, minimally invasive is only good in true expert hands.
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Disclaimer: The comment response is opinion and in no way affiliated with my employer. It is a vague response that is not to be used as direct medical advice and in no way should replace the opinion of a medical provider.
Hello Mustafa,
My father has had triple bypass surgery about 3 years ago and ever since his chest did not seem to be connected at the sternum. Over the last 7-8 months he has lost a lot of weight, 25kg and now you can see that his sternum is not connected and also see a minor step at the sternum. When he breaths or moves sometime you can hear it make a clunking sound. He was recently told that it did not look like the surgeon has used any wire to connect chest back together.
I would like your general opinion regarding not using anything to connect the sternum before closing the chest with my fathers operation.
Regards,
Sean
First of all, we are very thankful for your article. It is very happy to share the feelings that your article is very helpful to people to gain knowledge in the field of Nursing. We suggest you go through our article where it also helps you as well as others.
Do the wires used to hold your breastbone together keep you from being able to have MRIs in the future? I have MS and need MRIs every year.
Do they remove the sternum wires eventually after open heart surgery.
No they are left in place unless there are issues that require removal.
You can follow our twitter at @MustafaAhmedMD
Disclaimer: The comment response is opinion and in no way affiliated with my employer. It is a vague response that is not to be used as direct medical advice and in no way should replace the opinion of a medical provider.
I had a double bypass just over 3 weeks ago in Cape Town, and although I’m still in a fair amount of pain, I’m healing rapidly and even managed a kilometer long walk today 🙂
Thank you for an extremely informative article. About an hour from now, my husband will have his surgery. I so much appreciate your pics and videos. My problem is only with others who left comments. Some of them sound like horror tales. God bless you for the work you do.