Heart diseases continue to be one of the leading causes of illness and mortality worldwide. While many heart conditions can be managed with medications, lifestyle changes, or minimally invasive procedures, certain situations require a surgical approach.
Open heart surgery is one of the life-saving medical interventions, recommended when other treatment options are no longer effective.
Understanding open heart surgery and its indications may help patients and caregivers make timely, informed decisions. Keep reading to know more about open heart surgery, reasons, symptoms that may signal the need for surgery, complications, and possible side effects.
What Is Open Heart Surgery?
Open-heart surgery is a major surgical procedure in which the chest is opened to give surgeons direct access to the heart. It is sometimes called traditional heart surgery and is performed to treat serious heart conditions that cannot be managed with medications or minimally invasive techniques.
Open-heart surgery is recommended to
- Repair or replace damaged heart valves that regulate blood flow through the heart
- Repair damaged or weakened areas of the heart muscle
- Replace a damaged heart with a healthy donor heart through transplantation
During most traditional open-heart surgeries,
- The patient is given general anaesthesia, and the surgeon makes a 6 to 8-inch incision in the chest and cuts through the breastbone to expose the heart.
- In many cases, the patient may be connected to a heart-lung bypass machine, which temporarily takes over the function of the heart and lungs, allowing the surgeon to perform the necessary procedure safely.
- Once the surgery is completed, the breastbone is closed, and the chest incision is closed to allow healing.
Types of Open Heart Surgeries
There are two primary methods for performing open-heart surgery, depending on the patient’s condition and the complexity of the procedure.
- On-pump open heart surgery: In on-pump open heart surgery, the heart is temporarily stopped, and a heart-lung bypass machine takes over the function of circulating blood and oxygen throughout the body. It allows surgeons to operate on a still heart.
It is used for complex procedures, including multiple bypass grafts or heart valve repair and replacement.
- Off-pump bypass surgery or beating-heart surgery: Off-pump surgery is performed while the heart continues to beat. Specialized equipment is used to stabilize the area being operated on without stopping the heart.
It may reduce certain risks, including stroke or kidney complications, and is suitable for selecting patients undergoing coronary artery bypass surgery.
| Aspect | On-pump open heart surgery | Off-pump bypass surgery |
|---|---|---|
| Heart activity | The heart is stopped, and the heart-lung machine is attached | The heart continues to beat |
| Use of the heart-lung machine | Required | Not required |
| Uses | Multiple bypasses, valve repair or replacement, complex heart surgeries | Select cases of coronary artery bypass surgery |
| Risk of complications | Slightly higher risk of inflammation due to the bypass machine | May reduce the risk of stroke, kidney, or lung complications |
Symptoms That May Indicate the Need for Surgery
Heart disease often progresses silently and may remain unnoticed in the early stages. However, certain warning signals may indicate that the condition has progressed and needs surgical treatment.
Common symptoms that may indicate the need for open-heart surgery include
- Persistent chest pain or discomfort, especially during physical activity or stress
- Shortness of breath, even at rest or with minimal exertion
- Extreme fatigue or weakness that interferes with daily activities
- Irregular or rapid heartbeat
- Swelling in the legs, ankles, feet, or abdomen
- Dizziness and lightheadedness
- Unexplained excessive sweating
Early medical evaluation is necessary to prevent complications and improve the quality of life.
Tests Doctors Use to Decide If Surgery Is Required
The doctors perform a series of tests to confirm the severity of the condition and determine if surgery is required.
The different tests used to decide if surgery is required include
- An electrocardiogram records the electrical activity of the heart and helps detect abnormal heart rhythms.
- An echocardiogram creates images of the heart to assess heart valves, chambers, and pumping function
- A stress test to measure how the heart performs during physical exertion.
- CT scan or MRI to provide detailed images of the heart and major blood vessels to help detect structural abnormalities.
- Blood test to help overall health and identify markers of heart damage
- Chest X-ray to identify the size and shape of the heart.
Based on the results of these tests, the cardiology team determines whether open-heart surgery is necessary.
When Is Open Heart Surgery Needed? Key Medical Indications
Open heart surgery is recommended when heart conditions are severe, complex, or unresponsive to medications or minimally invasive procedures. Below are the most common medical conditions that may require open-heart surgery.
1. Severe Coronary Artery Disease (CAD)
Severe coronary artery disease occurs when plaque buildup significantly narrows or blocks the coronary arteries, reducing blood flow to the heart muscle.
Open heart surgery may be required when symptoms persist despite medication, arteries are critically narrowed, blood flow to vital heart muscle is affected or when there is a high risk of a heart attack.
2. Multiple Blockages Requiring Bypass Surgery
When multiple coronary arteries are significantly blocked or narrowed, blood flow to the heart muscle becomes severely restricted. In such cases, medications or stents may not be sufficient.
Patients with multiple or complex artery blockages may require an open-heart coronary artery surgery. This approach creates new pathways for blood flow, improves heart function, and reduces long-term complications.
3. Diseased or Damaged Heart Valves
When valves become narrowed, leaky, or damaged due to age, infection, or disease, blood flow is disrupted, and the heart must work harder, straining the heart.
Open heart surgery is often needed to repair or replace severely affected valves, helping restore normal circulation and prevent complications, including heart failure.
4. Aortic Aneurysm And Aortic Dissection
An aortic aneurysm is an abnormal weakening and bulging of the aorta, while an aortic dissection involves a tear in the inner wall of the aorta. Both conditions may be life-threatening and may lead to severe internal bleeding or rupture if left untreated.
Open heart surgery is required to repair the damaged portion of the aorta and prevent rupture or internal bleeding.
5. Congenital Heart Defects
Congenital heart defects are structural problems of the heart that are present from birth and may affect the heart walls, valves, or blood vessels, potentially interfering with normal blood flow.
Open heart surgery may be required to correct moderate to severe congenital heart defects and support long-term heart health.
6. End-Stage Heart Failure
End-stage heart failure occurs when the heart becomes too weak to pump blood effectively, despite optimal medications and other treatments. Patients may experience severe breathlessness, fatigue, and fluid retention.
In advanced cases, open-heart surgery may be required for the implantation of mechanical assist devices or heart transplantation.
7. Other Rare Conditions (Tumors, Infections)
In rare cases, open-heart surgery is necessary to treat unusual but serious heart conditions. These may include heart tumors, which need to be removed to restore normal function, or severe infections, including advanced infective endocarditis that can not be managed with medications alone.
Surgery helps prevent life-threatening complications and protects overall heart health.
Risks and Side Effects of Open Heart Surgery
Like all major surgeries, open-heart surgery carries certain risks and side effects. The risks and side effects associated with open-heart surgery include
- Infection at the incision site
- Bleeding from the sutured area
- A blood clot that may lead to serious complications
- Irregular heartbeat
- Heart attack or stroke
- Lung-related complications and kidney problems.
- Damage to the heart or surrounding structures
The risk of developing complications is higher if the individual has health issues, including diabetes, obesity, COPD, kidney disease, and peripheral heart disease. However, modern surgical techniques and careful monitoring may have significantly improved safety outcomes.
Conclusion
Open heart surgery plays an important role in treating advanced, complex, and life-threatening heart conditions. Advancements in the medical field have made it safer and more effective, significantly improving the quality of life for many patients.
If you have any heart conditions and are seeking the best treatment options, book a consultation with Heart 360 Care for expert guidance and a tailored treatment regimen.
Frequently Asked Questions
Bypass surgery is not always necessary for heart blockages. Mild to moderate blockages may often be managed with medications, lifestyle changes, or procedures, including angioplasty and stenting. Bypass surgery is usually recommended only for severe, multiple, or complex blockages that significantly reduce blood flow to the heart.
Heart blockages may not disappear naturally. The buildup of plaque in the arteries may not be completely reversed. However, with healthy lifestyle modifications, appropriate medications, and proper medical care, its progression may be slowed, and the risk of developing complications may be significantly reduced.
Open heart surgery is generally safe when performed by experienced surgeons and with careful operative care. Advances in the medical field and post-operative care have significantly improved success rates. However, the risk of complications is higher if the patient has other comorbidities, including diabetes, kidney disease, lung disease, or peripheral artery disease.
Yes, elderly people may undergo open heart surgery if they are medically fit. Doctors may evaluate overall health, existing medical conditions, and surgical risk before recommending the procedure to ensure safety and better recovery outcomes. Also, medical advancements have improved the outcomes.
The recovery time after an open-heart surgery may vary depending on the surgery type, complications involved, and the overall health of the patient. It may vary between six and 12 weeks depending on the patient’s health.
