Open heart surgery: Purpose, Procedure, Benefits and Side Effects

Heart surgery is a part of the treatment for cardiac problems. Any procedure that involves cutting open the chest to conduct surgery on the heart's muscles, valves, or other major heart arteries is referred to as open-heart surgery.

The most dependable method for surgeons to do cardiac surgery is open-heart surgery. Through open heart surgery, surgeons can get access to the heart by splitting the ribs and cutting through the sternum (breastbone). This is sometimes referred to as cracking the chest.

If you have one of the following cardiac problems, open heart surgery may be recommended:

• Heart rhythm disorders, such as atrial fibrillation
• Congenital cardiac conditions including hypoplastic left heart syndrome (underdeveloped heart structures) and atrial septal defect (heart hole)
• Cardiovascular disease
• A heart attack
• Heart valve illness
• Aneurysm in the thoracic aorta

Many different types of heart surgery can be performed through smaller, less invasive incisions between the ribs on the right side of the chest. Open-heart procedures often performed through these three procedures:

• Heart bypass surgery (coronary artery bypass graft -- CABG)
• Heart valve surgery
• Surgery to correct heart defects present at birth

Open heart surgery can be done through a variety of procedures. Some of the most typical surgical operations performed for an open heart surgery are;

This is the most popular kind of heart surgery and is also known as heart bypass surgery. During a CABG procedure, the doctor joins a healthy artery or vein from another part of your body to the blocked coronary artery. Blood now has a new route to the heart muscle thanks to the grafted artery or vein, which goes around the blocked area of the coronary artery. Frequently, this is accomplished via a single surgery for many coronary arteries.

Surgery includes repairing the valve, replacing it with a biological valve that is grown from pig, cow, or human heart tissue, or using an artificial valve. Another repair method includes a catheter that needs to be inserted into a large blood artery, guided to the heart, and a tiny balloon can be inflated and deflated at the catheter's tip to enlarge a narrow valve.

To treat arrhythmia, a condition in which the heart beats too quickly, too slowly, or with an irregular rhythm, when medication fails to treat the condition, surgery is typically the last option for treatment. During this procedure, a pacemaker with wires may be surgically implanted beneath the skin of the chest or abdomen to connect it to the heart chambers.

It works when a sensor determines that the heart rhythm is aberrant, the gadget then employs electrical pulses to regulate it. An ICD functions similarly, except when it recognizes a risky arrhythmia, it provides an electric shock to correct the rhythm.

To reroute electrical signals to the lower heart chambers along a regulated channel, the surgeon fashions a pattern of scar tissue within the upper chambers of the heart. The most prevalent severe arrhythmia, atrial fibrillation caused by errant electrical impulses, are all blocked by this surgery.

In order to repair a balloon-like bulge that is formed due to a weak spot in the artery or heart wall, this procedure is used. It replaces the weak section with a patch or graft.

A healthy heart from a dead donor is used to replace the damaged heart.

A mechanical pump called a VAD helps the heart function and regulates blood circulation. The two bottom chambers of the heart are replaced with a TAH.

Transcatheter structural heart surgery is an increasingly popular less invasive option to open-heart surgery in addition to these procedures. During this procedure, a long, thin flexible tube known as a catheter is guided to your heart through blood veins that may be reached from the groin, thigh, abdomen, chest, neck, or collarbone. There must be a little incision made.

Potential benefits of an open heart surgery include:

• A lower risk of stroke
• Fewer heart rhythm problems
• Fewer problems with memory loss and thinking ability
• Less need for transfusion
• Lower death rate - especially among women and 'high risk' patients
• Reduced injury to the heart
• Shorter hospital stay

Open-heart surgery is done for following reasons:

• Heart valve repair or replacement: Open heart surgery can restore or replace heart valves that have deteriorated to the point that blood flow to and from the heart is impeded
• Resolve obstructions: Plaque, which typically consists of fatty substances, cholesterol, cellular waste products, calcium, and fibrin, deposits in the heart causing obstructions. These obstructions prevent blood from reaching the heart, necessitating an open heart surgery
• Repair damaged or dysfunctional heart tissue: Surgery options include repairing the valve, replacing it with a biological valve grown from pig, cow, or human heart tissue, or using an artificial valve
• Device implantation: People who experience arrhythmia, or abnormal heartbeats, can also have medical devices implanted during an open heart surgery. The heart rhythms are controlled by implants
• Heart transplantation: Open heart procedures are useful for replacing a damaged heart with one received from a donor in a patient.

Open heart surgery is undoubtedly quite complicated and a major procedure, and may come with a lot of risks and complications. However their advantages outweigh their risks and complications. Some of these risks are as follows:

• Blood clots that can raise your chances of a stroke, a heart attack, or lung problems
• Fever
• Heart rhythm problems (arrhythmia)
• Infection and bleeding at the incision
• Kidney problems
• Memory loss and trouble thinking clearly
• Pain
• Pneumonia
• Problems breathing
• Reactions to anesthesia
• Stroke

Your age, the number of bypasses you receive, and any additional medical issues you may have all have an impact on these risks. Also, if you have additional illnesses or disorders, such as diabetes, peripheral artery disease, renal or lung disease, the risk is increased. Before your procedure, you should talk about these with your surgeon.

• At least two weeks before your open-heart surgery, stop drinking and smoking. Both can down the recovery process after surgery, and drinking in particular can damage your immune system, liver, and natural blood clotting, all of which raise the possibility of postoperative problems
• Get a head start on your deep breathing workouts. An incentive spirometer (IS), which encourages you to take slow, deep breaths before surgery, will be provided to you by your medical team. Use it as much as you can. It has been observed that deep breathing exercises a few weeks before surgery can lower the risk of pneumonia and other lung issues following surgery
• Eat healthily and be active. Your postoperative recovery will go more smoothly if you take better care of yourself before the procedure
• Your doctor should go through what to bring to the hospital, when to stop eating the night before your procedure, which medications to take and which to skip that morning with you during your final pre surgery appointment
• You will be provided with antibacterial soap and required to use it the morning of your surgery

Additionally, you must prepare for your post-surgery rehabilitation in advance and may appoint someone to help you take you from hospital to home and also help you around the house.

The patient is put under general anesthesia to start the surgery. The physician creates a significant incision of 8 to 10 inches through the breastbone on your chest during this procedure. The size of this incision enables surgeons to see and access the whole operative region. The patient's body is then attached to a heart-lung bypass machine. For the surgeon to do surgery, the bypass machine stops the heart from beating.

Oxygenated blood from the heart is simultaneously removed by the bypass machine and then returned to the body. The initial incision is closed with stitches, and a wire is inserted into the breastbone. Also, three tubes are placed into the patient’s body that gather waste products from the stomach, bladder, and lungs and expel them from the body.

Here is a detailed description of how open heart surgery is performed;

• Do not eat or drink anything after midnight the day before surgery
• On the day of operation, you will be required to bathe with an antibacterial soap
• You will be given hospital gown to change into before entering operation theater
• On the day of the procedure, you will be monitored for vital signs, weight, and the drains and catheters that will be inserted into your body
• You will be given general anesthesia
• A breathing tube is put into your mouth under general anesthesia. This tube connects to a ventilator, which will help you breathe during and after surgery

• Open heart surgery needs general anesthesia and lasts for about three to six hours. The location and severity of your blockages will determine how many bypasses you require.
• The majority of open heart surgeries are performed while a heart-lung machine maintains blood and oxygen flow throughout your body through a lengthy chest incision. This is called on-pump coronary bypass surgery
• The surgeon cuts through the middle of the chest at the breastbone and opens the rib cage to make the heart visible. After the opening of the chest, the heart is momentarily halted by medicine, and the body's blood circulation is handled by a heart-lung machine.
• In order to reroute blood flow around the damaged artery's restricted portion, the surgeon removes a length of healthy blood vessel, frequently from inside the chest wall or from the lower leg, and joins the ends above and below the blocked artery.
• Off-pump surgery: In order to stabilize the part of the heart the surgeon is operating on during this operation, surgery must be performed while the heart is beating. This procedure is a little complicated as the heart is continuously beating during this operation and not everyone is recommended for this operation.
• Minimally invasive surgery: This operation procedure is not too invasive. It is frequently performed using robots and video imaging to aid the surgeon's work in a limited space. Through tiny incisions in the chest, a surgeon performs coronary bypass surgery. Port-access surgery or keyhole surgery are two variations of minimally invasive surgery.
• The surgeon will restore your heartbeat after completing the transplant, remove you from the heart-lung machine, and use wire to seal your chest bone. After the bone heals, the wire will still be inside of your body.

After the procedure, you will be sent to an ICU in the hospital

• In order to give you water and drugs before the procedure, an IV line was placed. Once you can eat and drink on your own and are no longer dependent on IV drugs, it will be removed
• Your chest has a few tubes connected to it. One of them makes it easier for fluid to drain from the nearby region of the heart. The other is an intravenous line that is used to provide medicine and drinks
• After a few hours, when you can breathe on your own, the tube will be removed.
• Urine is collected from your bladder using a catheter. It will be removed once you're able to stand up and use the restroom on your own
• A gadget linked to your heart will continually monitor your heart
• You will be moved to a hospital room after your health improves; ideally, in 5-7 days.

Depending on the patient's health, open heart surgery in India might cost anything from INR 1,25,000 to INR 2,70,000.

Open heart in Bangalore can cost somewhere between Rs. 1,80,000

A lot of variables may affect the cost of surgery. Along with tier-1 or tier-2 cities; hospital or clinic brand names, the fees of the treating consultant, admission fee, type of the surgery, post-surgical complications that are involved, admission room that you opted for, may have an influence on hospital billing expenses.

The total cost of the procedure may also be impacted by the number of diagnostic tests performed. The entire cost of the surgery may decrease based on the patient's insurance plan.

• Take your medications
• Manage your weight
• Take proper rest
• Take care of your surgical wound
• When you feel good enough to walk, take small strolls around the house before gradually increasing the distances
• Follow your doctor’s appointments

You'll need to take a nutritious diet after your open heart surgery as this will facilitate your body's healing process, lower your risk of problems, and help you recover quickly. A diet high in fruits, vegetables, whole grains, nuts, and seeds has been shown to lower the risk of heart disease.

Your body receives a lot of heart-protective elements from a balanced diet, including vitamins, minerals, antioxidants, and dietary fiber. Your diet should ideally contain;

• Lean meat including fish
• Eggs
• Tofu
• Legumes
• Nuts
• Fruits
• Vegetables
• Wholegrains
• Low fat milk
• Water

Moreover, use as little salt as possible when cooking to reduce sodium consumption, which will lower blood pressure and minimize fluid retention. Avoid sugary foods since they can lead to weight gain.

Also, you could realize that you don't have much of an appetite and that the flavor of your meals has diminished. You can notice a change in your sense of smell and a peculiar metallic taste in your tongue. This may take three months to fully recover from depending on your medication or the procedure you have. Try to consume little meals often.

Open heart surgery is pretty much safe and secure. However, your doctor will only suggest the procedure if you are fit for the surgery. Depending on how complicated the operation is, heart surgery typically lasts between three and six hours.

During the process, you won't experience any pain or discomfort and won't even remember anything as the surgery is performed under general anesthesia. However, for the first several weeks following surgery, you will feel worn out and painful. On each side of your chest, you can experience some sharp pain. Your upper back, shoulders, and chest can also hurt. Although, these symptoms normally start to improve after 4 to 6 weeks.

Also, in the first few months following surgery, numbness, tingling, or even hypersensitivity near the chest incision is very usual.

Getting back to a regular schedule after having heart surgery will take some time since your body's systems have slowed down due to the operation, medicines, and decreased exercise. It will take at least two to three months for the wound to heal.

Your recovery period will vary depending on the type of surgery you undergo, but for the majority of heart surgeries, you may expect to stay in the hospital's critical care unit for a day or more. After that, you will spend several days in another area of the hospital before being discharged.

You may anticipate having good and terrible days at this period, and you can experience fatigue, irritability, anxiety, depression, or just a general lack of self-confidence for a few weeks.

Open heart surgery is a significant major operation that like any major surgery comes with some side-effects which are listed below:

• Swelling: It's typical for incisions made in the leg for grafting to result in swelling in the feet.
• Appetite loss: A few weeks after surgery, there is a temporary drop in taste and appetite that is typical and not a serious problem.
• Nausea: It's normal to feel repulsed by food after only smelling or seeing it, and this sensation will eventually pass.
• Sleeping problems: Sleep problems are typical following surgery. Sleep disturbances and frequent awakenings are both typical and not cause for concern.
• Constipation: A compromised digestive system and constipation are side effects of surgery. A high-fiber diet aids in the relief of constipation.
• Mood swings: It's normal to have mood swings and an unstable temperament after surgery.
• Lump at top of incision: The danger of infection if a lump forms at the incision site exists.
• After surgery, it's possible to experience a clicking sound coming from your chest. If it doesn't go away on its own, you should see a doctor.
• Heart rhythm issues: Patients undergoing open heart surgery for any cardiac condition run the risk of experiencing irregular heartbeats, or arrhythmia.
• Anemia: Patients undergoing open heart surgery are prone to experience persistently low blood levels. That causes weariness and exhaustion quickly or even with minimal exertion.

The type of surgery you underwent, your general health before the operation, and whether you had any postoperative issues will all affect how long you need to recover at home. For instance, it can take six to twelve weeks or longer for a typical coronary artery bypass patient to fully recover post surgery.

Surgical wounds
The patient must always keep the area around the wound clean and dry. To clean it, use soap and water. If you notice any redness or drainage coming from the incision, visit your doctor.

Diet
It's typical to not feel like eating in the days following surgery. Try, nonetheless, to consume meals in moderation. If the loss of appetite does not go away in a few weeks, talk to your doctor. Prefer using vegetable oil to cook your food than butter. Also, reduce your alcohol consumption, especially if you're on medication.

Driving
Avoid driving till the time your doctor tells you to do so.

Exertion
Try to be active and move about but do not move large objects about the house by pushing or tugging them. Try to gradually pick up your previous activities and employment during recovery time after the operation.

Bathing
Use warm water for bathing, not really hot. Very hot water will make you feel woozy.

Sleeping habits
Try to avoid spending extended amounts of time in bed. Avoid drinking soda, coffee, or tea two to three hours before going to bed.

Walking
Walking is crucial for easing muscular stiffness, enhancing blood flow throughout the body, and helping you overcome depression.

Smoking
It's crucial to maintain the practice of quitting smoking during the recovery period following surgery.

An open heart surgery is a life saving operation and is required to treat a number of heart illnesses and conditions. Though it's a major operation and can take somewhere from 1 to 6 hours, there are some minimally invasive procedures that can lower the surgical risk and complications based on your age, health, condition and many other factors.