Open Heart Surgery in Delhi, India

Heart surgery, a medical intervention for addressing cardiac issues, often involves open-heart surgery as a method to access the heart.

In this procedure, the chest wall is opened to facilitate the surgeon's access to the heart. To achieve this, the surgeon makes an incision through the sternum (breastbone) and spreads the ribs, commonly referred to as "cracking the chest."

Open-heart surgery is a dependable approach for surgeons conducting cardiac procedures. Surgeons may suggest an open procedure when the patient possesses the strength to endure it.

There are two ways to perform open-heart surgery:

On-pump 

In this approach, a heart-lung bypass machine is employed, connecting to the heart and temporarily assuming the functions of both the heart and lungs. It circulates blood throughout the body, diverting it away from the heart. The surgeon then operates on a non-beating heart devoid of blood flow. Post-surgery, the surgeon disconnects the device, allowing the heart to resume its normal function.

Off-pump

Off-pump bypass surgery is conducted on a heart that continues to beat independently. This technique is specifically applicable to coronary artery bypass grafting (CABG) surgery, commonly known as bypass surgery. Surgeons may refer to this as beating heart surgery.

Open-heart surgery may be undertaken to conduct a Coronary Artery Bypass Graft (CABG), a procedure often required for individuals with coronary heart disease.

Coronary heart disease manifests when the blood vessels responsible for supplying blood and oxygen to the heart muscle undergo narrowing and hardening, a condition commonly referred to as "hardening of the arteries."

This hardening is a result of fatty material forming plaque on the walls of the coronary arteries, subsequently constricting them and impeding proper blood flow. In instances where blood cannot flow adequately to the heart, it may lead to a heart attack.

Additionally, open-heart surgery is employed for the following purposes:

• Repairing or replacing heart valves, facilitating the passage of blood through the heart.
• Addressing damaged or abnormal areas within the heart.
• Implanting medical devices is designed to assist the heart in maintaining a proper beat.
• Conducting heart transplantation by replacing a damaged heart with a donated one.

As per the National Institutes of Health Source, a Coronary Artery Bypass Graft (CABG) typically lasts between three and six hours and follows these fundamental steps:

• The patient is administered general anaesthesia to ensure they remain asleep and pain-free throughout the entire surgery.
• The surgeon makes an incision of 8 to 10 inches in the chest.
• The breastbone is partially or entirely cut through to expose the heart.
• If needed, the patient may be connected to a heart-lung bypass machine, diverting blood away from the heart to facilitate the surgical procedure. Some newer techniques may omit the use of this machine.
• A healthy vein or artery is utilised by the surgeon to create a new pathway around the blocked artery.
• The breastbone is closed using wire, with the wire remaining inside the body.
• The initial incision is stitched up.
• In certain cases where individuals are at high risk, such as those who have undergone multiple surgeries or are of advanced age, sternal plating may be performed. This involves rejoining the breastbone using small titanium plates after the surgery.

Open-heart surgery is a significant surgical undertaking, and like any medical procedure, it comes with inherent risks.

The likelihood of complications increases for individuals with pre-existing health conditions such as diabetes or obesity. Conditions like chronic obstructive pulmonary disease (COPD) that affect the lungs also elevate the risk, and individuals who smoke are more susceptible to both surgical and post-surgical complications.

Potential Surgical Risks Encompass:

• Allergic reactions to anaesthesia.
• Irregular heartbeats (arrhythmias).
• Bleeding.
• Damage to surrounding blood vessels or organs, such as the lungs or kidneys.
• Infections.
• Stroke.

Patients are advised to disclose all medications, including over-the-counter drugs, vitamins, and herbs, to their healthcare provider. Additionally, any existing illnesses, including herpes outbreaks, colds, flu, or fevers, should be communicated.

In the fortnight leading up to the surgery, the cardiac surgeon may recommend ceasing smoking and discontinuing the use of blood-thinning medications like aspirin, ibuprofen, or naproxen.

It is crucial to discuss alcohol consumption with the doctor before surgery preparation. Individuals habitually consuming three or more drinks daily should be cautious, as sudden cessation before surgery may lead to alcohol withdrawal, posing potential life-threatening complications such as seizures or tremors. Medical professionals can assist in managing alcohol withdrawal to minimise these risks.

On the day preceding the surgery, patients may be instructed to cleanse themselves with a specialised soap to eliminate skin bacteria, reducing the risk of post-surgery infections. Additionally, refraining from eating or drinking anything after midnight might be advised.

Detailed instructions will be provided by healthcare providers upon the patient's arrival at the hospital for the surgery.

During the Open-Heart Surgery Procedure 

Heart surgery is an intricate procedure, with some surgeries lasting six hours or more. Patients undergoing such surgeries receive anaesthesia to induce a state of unconsciousness throughout the procedure.

The steps of the surgery can vary based on the specific heart condition and procedure, but generally, the surgeon:

• Makes an incision of 6 to 8 inches in length down the middle of the patient's chest.
• Cuts the breastbone and separates the ribcage to access the heart.
• Connects the heart to a heart-lung bypass machine in the case of an on-pump surgery. An anaesthesiologist administers IV medication to halt the heartbeat and monitors the patient during the surgery.
• Undertakes repairs on the heart.
• Restores blood flow to the heart, typically allowing the heart to resume beating on its own. In some instances, a mild electrical shock may be applied to restart the heart.
• Disconnects the heart-lung bypass machine.
• Closes the breastbone or other incision using wires or sutures that remain within the patient's body.
• Utilises stitches to close the skin incision.

After the Open-Heart Surgery Procedure

Depending on the specific procedure, patients might be admitted to the hospital's Intensive Care Unit (ICU) for at least one day or longer before transitioning to a standard hospital room when deemed ready.

The expected hospital stay typically spans several days, during which the heart care team will provide instructions on incision care. Patients may be provided with a specialised firm pillow to safeguard the chest during activities such as coughing, sneezing, or getting out of bed.

Post-surgery, individuals may encounter:

• Constipation is often a common side effect of potent pain relievers.
• Feelings of depression or mood swings.
• Insomnia or difficulties sleeping.
• Loss of appetite.
• Memory issues.
• Muscle pain in the chest area.
• Pain, bruising, and minor swelling at the site of the incision.

Patients will receive guidance and support from their healthcare team to navigate these post-surgery experiences effectively.

The duration of recovery after heart surgery is contingent on factors such as the type of surgery, potential complications, and the individual's pre-surgery health. Generally, recuperation from an open-heart procedure can span from 6 to 12 weeks, and in some cases, even longer.

The surgeon will guide you when it is safe to resume work and other activities. Usually, during the initial six weeks post-surgery, individuals are advised against driving or lifting heavy objects.

In certain cases, patients may be prescribed blood thinners as a preventive measure against blood clots. Additionally, healthcare providers might recommend participation in cardiac rehabilitation, a supervised program designed to aid in regaining strength and stamina, ultimately enhancing overall heart health.

How long does heart surgery generally take?

The duration of heart surgery varies depending on the type of procedure, but it can typically last anywhere from 3 to 6 hours or longer.

Are open-heart surgery and bypass surgery the same?

Open-heart surgery and bypass surgery are related terms, but they are not the same. Bypass surgery, specifically Coronary Artery Bypass Grafting (CABG), is a type of open-heart surgery. Open-heart surgery encompasses various procedures beyond just bypass surgery.

Can you have open-heart surgery twice?

Yes, it is possible to have open-heart surgery more than once, depending on the individual's health condition and the necessity of further interventions.

Can open-heart surgery be performed on elderly patients?

Open-heart surgery can be performed on elderly patients, and the decision is based on the overall health of the individual and the specific heart condition requiring treatment.

Who is in the operating room during open-heart surgery?

The operating room team for open-heart surgery typically includes the cardiac surgeon, anaesthesiologist, perfusionist (if a heart-lung bypass machine is used), surgical assistants, and nurses.

What are my restrictions after surgery?

Post-surgery restrictions vary but may include limitations on driving, lifting heavy objects, and specific physical activities. Patients should follow the guidance provided by their healthcare team.

What are the side effects of open-heart surgery?

Side effects of open-heart surgery may include constipation, mood swings, insomnia, loss of appetite, memory problems, muscle pain, pain, bruising, and minor swelling at the incision site.

How long will the breathing tube be used?

The breathing tube is usually removed within a day or two after open-heart surgery, once the patient is stable and able to breathe independently.

How long will I be in the hospital after open-heart surgery?

The length of the hospital stay after open-heart surgery can range from several days to a week or more, depending on the type of procedure and individual recovery progress.

When can I return to work or regular activities after open-heart surgery?

The timeline for returning to work or regular activities after open-heart surgery varies, but is generally within 6 to 12 weeks, following the surgeon's guidance.

Are there restrictions on lifting weights after heart surgery?

Lifting weights after heart surgery may have restrictions initially, and individuals should follow their healthcare provider's advice on when and how much weightlifting is safe.

What is the survival rate for open-heart surgery?

The survival rate for open-heart surgery is generally high, with success rates varying depending on the specific procedure, the patient's overall health, and any potential complications. Patients should discuss their prognosis with their healthcare team.

Reviewed By Dr. Vaibhav Mishra, Director & Head - CTVS Cardiac Surgery (CTVS), Cardiac Sciences on 18 July 2024.