open heart surgery is one of the cardiac surgeries that is performed to cure heart-related problems. through this surgery, the surgeons can easily reach the heart.
in this surgery, surgeons open the chest wall, cut the breastbone, and spread the ribs to access the heart. this surgery is performed on the valves, arteries, and muscles of the heart. generally, this procedure is known as "cracking the chest.”
open-heart surgery is a steady way to treat heart diseases, but it is recommended to those people who are strong and can bear the pain.
when is open-heart surgery required?
open-heart surgery is performed to treat the following heart conditions:
arrhythmias - it includes atrial fibrillation
thoracic aortic aneurysm
coronary artery disease
heart valve disease
congenital heart defects - this includes a hole in the heart (atrial septal defect) and underdeveloped heart structures (hypoplastic left heart syndrome)
classification of open-heart surgery
open-heart surgery is carried out in two different ways. underneath is the description of these two ways:
on-pump - in this type, a machine called heart-lung bypass is connected to the heart. this machine controls the functions of the lung and heart. the machine moves the blood away from the heart and regulates it through the whole body. because of this machine, the surgeon can easily operate on the heart as it stops working. after the completion of the surgery, the machine is removed, and the heart starts to function again.
off-pump - this type of open-heart surgery is also known as beating-heart surgery. the off-pump bypass surgery is performed on the heart that continues to beat and work on its own. this method is useful in cabg (coronary artery bypass grafting) surgery.
procedures used in open-heart surgery
there are various procedures that a surgeon can take to treat an unhealthy heart. these techniques provide direct access to the blood vessels and the heart. the procedures can be performed using less harmful methods. the procedures that are carried out while performing the open-heart surgery are listed below:
repairing congenital heart defects
coronary artery disease is treated through coronary artery bypass grafting (cabg) surgery.
heart transplantation to cure heart failure
replacement of heart valve for heart valve disease
placement of artificial heart or lavd (left ventricular assist device) to treat heart failure.
other processes are also performed by surgeons using icds (implantable cardioverter-defibrillators) or pacemakers while performing open-heart surgery.
preparations for open-heart surgery
a person should prepare himself before going for open-heart surgery. he should take his doctor's advice about:
prescription - the person should stop consuming medicines or drugs before the surgery. they should avoid medicines like nsaids (nonsteroidal anti-inflammatory drugs) which cause a risk of excessive bleeding.
nourishment - the doctor will recommend not to drink or eat before the surgery as anaesthesia works better on an empty stomach.
alcohol and smoking - the heart patient must stop consuming alcohol and avoid smoking as these can create complications during open-heart surgery.
complications of open-heart surgery
as open-heart surgery is a crucial surgical process, there are certain risks while performing it. these complications include:
stroke or heart attack
irregular heartbeat (arrhythmias)
difficulty in breathing
infection in chest
low fever and chest pain
kidney or lung failure
loss of memory
allergies caused due to anaesthesia
steps performed in open-heart surgery
before the surgery
certain procedures or tests are performed before open-heart surgery.
tests like ekg (electrocardiogram), x-ray of the chest, etc., help the surgeons to decide the methodology of the surgery.
shaving of the chest.
the surgical area is sterilised with bacteria-killing soap.
providing medications and fluids in the arm through iv (intravenous line).
during the surgery
as open-heart surgery is a complex surgery, it might take 6 hours or more to get complete. the steps taken by the surgeons to carry out this surgery are mentioned below:
the person is given anaesthesia so that he falls asleep during the surgery.
a 6 to 8-inch long incision is made below the middle of the chest.
the surgeon cuts the sternum (breastbone) and spreads the ribcage to reach the heart easily.
then, the heart-lung bypass machine is connected to the heart (if on-pump open-heart surgery is performed).
iv medication is given to the patient to stop his heartbeat so that surgeons can monitor him.
the heart is repaired with certain surgical instruments.
the blood starts flowing through the heart and it starts beating again. if the heart does not respond then a mild electric shock is given.
the heart-lung bypass machine is detached after curing the heart.
stitches are made to close the incision.
after the surgery
the patient is made to stay in the icu (intensive care unit) for a day or longer after the successful completion of the surgery. after some recovery, he is then moved to a regular hospital room. during the stay, the healthcare team helps the patient to take care of their incision. he is also provided with a soft pillow to protect his chest when they sneeze, cough, or get out of bed.
the patient can also experience some problems like:
muscle pain in the chest area
minor swelling, pain, and bruising at the site of incision
recovery after open-heart surgery
a patient may take 6 to 12 weeks to recover after the open-heart surgery. the heart care team will let him know what activities he has to perform or what type of food he has to eat to take care of his heart.
care of the incision site
it is very important to take care of the incision site. following precautions must be taken for incision care.
keep the site of the incision dry and warm.
do not touch the incision area recurrently.
take a shower if there is no drainage at the incision site.
use lukewarm water while showering.
do not hit the incision area directly with water.
inspect the incision site for signs of infections like fever, oozing, redness and warmth around the incision.
management of pain
the recovery speed can be increased by taking care of the pain. management of pain reduces the risks of pneumonia and blood clotting. the patient may suffer from pain from chest tubes, pain in incision areas, muscle pain or throat pain. to cure these pains, the doctor will prescribe some medicines which have to be taken on time. the recommended medication has to be taken both before sleep and daily physical activities.
patients find difficulty in sleeping after the open-heart surgery. but it is important to take proper rest to recover faster. to get a night of good sleep, the patients must follow the given advice:
consume given medication half an hour before going to bed.
use soft pillows to reduce muscle pain.
avoid drinking coffee in the evenings.
some patients do not get proper sleep due to anxiety or depression. for this, they must consult psychologists or therapists.
improvement of heart health
to recover fast and to keep the heart healthy, a patient should:
have a healthy diet.
not eat food items that are high in fat, sugar and salt.
start to continue doing their daily physical activities.
avoid smoking and drinking alcohol
control their high cholesterol and high blood pressure.
alternatives of open-heart surgery
besides the open-heart surgery, the surgeons may choose other methods to treat the heart depending upon the condition of the patient. these methods are:
catheter-based surgery - in this method, the surgeon will thread a hollow, thin tube called a catheter to the heart. after this, surgical instruments are inserted through the catheter to perform the surgery. this process includes stenting, coronary angioplasty, and tavr (transcatheter aortic valve replacement).
vats (video-assisted thoracic surgery) - through this method of surgery, the surgeon inserts a thoracoscope (small video camera) along with surgical instruments through tiny chest incisions. the technique is used to treat arrhythmia, repair heart valves and put pacemaker.
robotically-assisted surgery - this method is used to treat patients suffering from cardiac tumours, septal defects, atrial fibrillation, and valvular heart disease.
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