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Emergency Open Heart Surgery

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Purpose Of Open Heart Surgery

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Open heart surgery is an approach that involves cutting through the breastbone and connecting the heart to a device called a heart-lung bypass machine. Open heart surgery is used to treat heart problems such as coronary artery disease and heart valve disease.

Rather than being a specific treatment, an open heart approach may be employed in number of surgeries, including coronary artery bypass grafting, heart valve repair or replacement, and heart transplant, as well as the placement of devices to aid this organ, such as ventricular arterial devices and total artificial hearts.

Who Will Help Perform The Bypass Surgery

Throughout the surgery, several types of specialists ensure the procedure is performed properly. A perfusion technologist works with the cardiopulmonary bypass machine.

A cardiovascular surgeon performs the procedure and an anesthesiologist ensures anesthesia is delivered to your body properly to keep you unconscious during the procedure.

Imaging specialists may also be present to take X-rays or help ensure that the team can view the site of the surgery and the tissues around it.

When you wake up from heart bypass surgery, youll have a tube in your mouth. You may also feel pain or have side effects from the procedure, including:

  • pain at the incision site
  • pain with deep breaths
  • pain with coughing

Youll likely be in the ICU for one to two days so your vital signs can be monitored. Once youre stable, youll be moved to another room. Be prepared to stay in the hospital for several days.

Before you leave the hospital, your medical team will give you instructions on how to care for yourself, including:

  • caring for your incision wounds
  • getting plenty of rest
  • refraining from heavy lifting

Even without complications, recovery from heart bypass surgery can take 6 to 12 weeks. Thats the least amount of time it takes for your breastbone to heal.

During this time, you should avoid heavy exertion. Follow your doctors orders regarding physical activity. Also, you shouldnt drive until you get approval from your doctor.

  • fever over 100.4°F
  • increasing pain in your chest
  • rapid heart rate

How Dangerous Is An Open Heart Surgery

An open heart surgery, or any form of surgery which requires the chest to be cut open is a major form of surgery with various risks associated with it. Such risks depend on the type of surgery the patient has to undergo along with his general health condition. Risks are also associated with the type and duration of the anesthesia to be used. However, needless to say, open heart surgeries are done by expert surgeons and thus proper method of after-care is usually discussed with the patients and care-givers by the doctor.

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How Do I Manage Post

A cardiac anesthesiologist is also a pain management specialist for conditions related to surgery. Your anesthesiologist will talk to you about your options for managing post-operative pain. Before your surgery, the anesthesiologist may ask about your pain tolerance to help gauge how best to manage your post-operative pain, guiding decisions such as the proper narcotics dosage, the feasibility of nonnarcotic pain medication options, and the need for nerve blocks.

Although most heart surgeries are major surgeries, they are typically not a source of long-term pain. Even in the short term, the pain may be less severe than with operations on other areas of the body. Opioids are used when necessary, but there are many other pain management options, including:

  • Lidocaine infusion

How To Prepare For Open

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Tell your doctor about any drugs you are taking, even over-the-counter medications, vitamins, and herbs. Inform them of any illnesses you have, including herpes outbreak, cold, flu, or fever.

In the two weeks before the surgery, your doctor may ask you to quit smoking and stop taking blood-thinning medications, such as aspirin, ibuprofen, or naproxen.

Its important to talk to your doctor about your alcohol consumption before you prepare for the surgery. If you typically have three or more drinks a day and stop right before you go into surgery, you may go into alcohol withdrawal. This may cause life-threatening complications after open-heart surgery, including seizures or tremors. Your doctor can help you with alcohol withdrawal to reduce the likelihood of these complications.

The day before the surgery, you may be asked to wash yourself with a special soap. This soap is used to kill bacteria on your skin and will lessen the chance of an infection after surgery. You may also be asked not to eat or drink anything after midnight.

Your healthcare provider will give you more detailed instructions when you arrive at the hospital for surgery.

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What Are The Risks

Most heart surgeries are major surgeries. Although often successful, they do entail risks. The National Heart, Lung, and Blood Institute identifies some of these risks as:

  • Damage to tissues in the heart, kidneys, liver, and lungs
  • Death, especially for someone who is already very sick before surgery

The risk is higher if you have other diseases or conditions, such as diabetes, peripheral artery disease, or kidney or lung disease.

Are There Alternatives To Standard Open

Thanks to medical advancements, many procedures that once required opening the chest can now take place using minimally invasive heart surgery or with small incisions. The surgeon sometimes still needs to cut through part of the breastbone .

Depending on your situation, your surgeon may be able to use these methods:

  • Catheter-based: Your surgeon threads a catheter to the heart. The surgeon then inserts surgical instruments, balloons, or stents through the catheter to perform a procedure. Catheter-based procedures include transcatheter aortic valve replacement and coronary angioplasty and stenting.
  • Video-assisted thoracic surgery : Your surgeon performs VATS by inserting a tiny video camera and surgical instruments into several small chest incisions. Your surgeon may use VATS to place a pacemaker, repair heart valves or treat an arrhythmia.
  • Robotically-assisted: Certain patients with valvular heart disease, cardiac tumors, atrial fibrillation and septal defects may be candidates for this minimally invasive approach.

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What Approaches Do Surgeons Use To Do Heart Surgery

The approach a surgeon uses to do heart surgery depends on your heart problem, your general health, and other factors. Approaches to heart surgery include:

  • Open-heart surgery is when the surgeon cuts the chest open to reach the heart. Because it’s difficult to operate on a beating heart, medicines are used to stop the heart. A heart-lung bypass machine keeps oxygen-rich blood pumping through the body during the surgery.
  • Off-pump heart surgery is open-heart surgery on a beating heart without using a heart-lung bypass machine. The surgeon holds the heart steady with a device. Surgeons may use off-pump heart surgery to do coronary artery bypass grafts , but only in certain cases.
  • Minimally invasive heart surgery uses small cuts between the ribs. The cuts may be as small as 2 to 3 inches. The surgeon inserts tools into the chest through the cuts. This type of heart surgery may or may not use a heart-lung bypass machine.
  • Robotic-assisted surgery is a type of minimally invasive surgery. The surgeon uses a computer to control tools on the arms of a robot. This allows the surgeon to be very accurate when doing difficult operations.

Preparing For The Surgery

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Preparation for open heart surgery starts the night before. A person should eat an evening meal as usual but must not consume any food or drink after midnight.

It is a good idea to wear loose, comfortable clothing to assist with restricted movement following surgery, but wear whatever is comfortable.

Be sure to have all personal medical information on hand. This might include a list of medications, recent illness, and insurance information.

It is normal to feel anxious before an anesthetic, and people should not hesitate to seek reassurance from the healthcare team.

The doctor may request that the person washes their upper body with antibacterial soap. A member of the healthcare team may need to shave the persons chest area before they can have the anesthetic.

The doctors may also need to run tests before surgery, such as monitoring the heart or taking blood samples. A doctor or nurse might place a line into a vein to enable the delivery of fluids.

After the medical team has completed the preliminary tasks, the anesthesiologist will administer general anesthesia.

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How Should I Prepare For Open

To prepare for open-heart surgery, you should follow your healthcare providers recommendations about:

  • Medications: You may need to stop taking certain medicines a week or two before surgery. People often stop blood thinners and nonsteroidal anti-inflammatory drugs . These medicines can increase bleeding risk.
  • Food and drink: Your healthcare team will ask you to fast before your surgery. Anesthesia is safer on an empty stomach.
  • Smoking and alcohol: Cut back on alcohol and quit smoking. Both can slow postsurgical healing and increase the risk of complications.

Clinical Investigationsemergency Open Heart Surgery For Acquired Heart Disease

Eighteen patients, 15 to 74 years of age, in intractable and life-threatening heart failure underwent emergency open heart surgery. There were 14 long term survivors. One hundred percent mortality was predicted without the application of surgery. The cause of failure was valvular heart disease in 14 and coronary heart disease in four patients. Assisted circulation during the most critical period, namely, the interval between the induction of anesthesia and the institution of total cardiopulmonary bypass, proved life-saving, at least in five patients. On the basis of this study it is postulated that no heart patient is too sick to be operated upon if he is dying from a surgically remediable underlying cardiac condition.

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Who Is In Theater For Open Heart Surgery

A team of doctors and other health professionals work together in the operating theater during open heart surgery.

The team is likely to include:

  • the lead surgeon who will direct others surgeons who will assist during the operation
  • the anesthesiologist, who is in charge of giving and anesthesia and monitoring vital signs
  • the pump team, also known as perfusionists, operate the heart-lung machine and other technical equipment that supports open heart surgery
  • nurses and technicians, who assist the surgical team and prepare the operating theater for surgery

What Are The Methods Of After

Left ventricular assist device (LVAD)

It is important to take care of the patient once the surgery is done. Few methods include-

Incision Care: One of the important things to keep in mind once the open heart surgery patient is discharged is the incision care. The surgery site should be taken care of properly. In case of any signs of infection like redness or puss formation, it should be informed to the doctor immediately.

Rest and Sleep: It is important to get ample sleep. This helps in healing of the open heart surgery site. The patient should lie down in such a way so that muscular strain in any form is avoided.

Rehab: The patient may have to take part in a comprehensive rehabilitation program as a part of the recovery process. Such programs help the open heart surgery patient avoid risk factors and fight anxiety and stress. It also teaches the patient about exercises that facilitate the healing process.

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Minimally Invasive Heart Surgery

and Minimally Invasive Coronary Artery Bypass Graft

What the Procedure Does

An alternative to standard bypass surgery . Small incisions are made in the chest. Chest arteries or veins from your leg are attached to the heart to “bypass” the clogged coronary artery or arteries. The instruments are passed through the ports to perform the bypasses. The surgeon views these operations on video monitors rather than directly. In PACAB, the heart is stopped and blood is pumped through an oxygenator or “heart-lung” machine. MIDCAB is used to avoid the heart-lung machine. It’s done while the heart is still beating. Requires several days in the hospital.

Reason for the Procedure

  • Manages blockage of blood flow to the heart and improves the supply of blood and oxygen to the heart.
  • Reduces risk of heart attack.
  • Improves ability for physical activity.

When Should I Call The Doctor

You should call your healthcare provider if you experience:

  • Chest pain other than normal discomfort at the incision.
  • Signs of infection at the surgical site, such as oozing and redness.
  • Slurred speech or other signs of stroke.

A note from Cleveland Clinic

Open-heart surgery is a life-saving procedure. But it is also a major surgery. Recovery can be long. When possible, you should take steps to improve your health like exercising, losing weight and quitting smoking before surgery. These actions may make recovery easier. Its normal to have concerns before undergoing a heart procedure. Dont hesitate to share questions and concerns with your healthcare provider.

Last reviewed by a Cleveland Clinic medical professional on 03/25/2021.

References

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Heart Procedures And Surgeries

If you’ve had a heart attack, you may have already had certain procedures to help you survive your heart attack and diagnose your condition. For example, many heart attack patients have undergone thrombolysis, a procedure that involves injecting a clot-dissolving agent to restore blood flow in a coronary artery. This procedure is administered within a few hours of a heart attack. If this treatment isn’t done immediately after a heart attack, many patients will need to undergo coronary angioplasty or coronary artery bypass graft surgery later to improve blood supply to the heart muscle.

See diagnostic tests and procedures to better understand the tests you may have to undergo to find out if you had a heart attack, how much damage was done and what degree of coronary artery disease you have.

Cardiac Resynchronisation Therapy And Cardiac Resynchronisation Therapy Defibrillator Device

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If you have heart failure, you may need a special type of device called cardiac resynchronisation therapy device. As well as treating heart arrhythmias, this device also synchronises your hearts chambers to contract and relax in a regular way, which improves the pumping action of your heart.

There is also a type of CRT that can be used as above and in addition can deliver a “shock” to treat dangerous heart arrhythmias and then synchronise your hearts chambers to normal rhythm once more. This is CRT-D .

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What Is Traditional Heart Surgery

Traditional cardiac surgery, or open heart surgery as it is often referred, is performed by making a large incision, roughly 6-8, in the chest to gain access to the heart. Once the heart is exposed, the heart is actually stopped and the patient is connected to a heart-lung bypass machine that does the work of the heart and lungs to allow the surgeon to perform the surgery.

Four Blocked Arteries Lead To Emergency Surgery

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After tests in the Emergency Department, John was diagnosed by cardiologist Craig A. Sukin MD with unstable angina, a precursor to an imminent heart attack. He told John he would not be getting on an airplane, and instead immediately performed an angiogram where he found four blocked arteries. Unfortunately, stents were not an option this time. Emergency open heart surgery was required. By now it was evening, but Johns heart could not wait until morning. A surgery team led by cardiothoracic surgeon Eric J. Okum MD was called in. After a successful quadruple bypass, John was on his way to recovery.

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What Happens After Open

When you wake up after surgery, you will have two or three tubes in your chest. These are to help drain fluid from the area around your heart. You may have intravenous lines in your arm to supply you with fluids, as well as a catheter in your bladder to remove urine.

You will also be attached to machines that monitor your heart. Nurses will be nearby to help you if something should arise.

You will usually spend your first night in the intensive care unit . You will then be moved to a regular care room for the next three to seven days.

Taking care of yourself at home immediately after the surgery is an essential part of your recovery.

What Is Recovery Like After Open

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Recovery time varies depending on the surgery type, complications and your overall health before surgery. It can take 6 to 12 weeks to recover from an open-heart procedure.

Your surgeon will let you know when you can return to work and other activities. Typically, you shouldnt drive or lift anything heavy for the first six weeks.

Some people need to take blood thinners after heart surgery to prevent blood clots. Your healthcare provider may also recommend cardiac rehabilitation. This medically supervised program can help you regain strength and stamina and improve overall heart health.

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Overview Of Open Heart Surgery

Open heart bypass surgery is a treatment for coronary artery disease , also known as heart disease. CAD is narrowing or blockage of the coronary arteries, which are essential for your heart to function properly.

Heart bypass surgery is known medically as coronary artery bypass graft surgery. CABG surgery creates a new route for blood to flow around the blocked part of the coronary artery to the heart muscle.

CABG is an incredibly common procedure, with more than 200,000 performed in the United States each year. If you or a loved one may be a candidate for CABG, talk with your doctor to understand how this treatment could help reduce symptoms and treat your heart disease.

Our team of expert cardiac surgeons at Dignity Health performs open heart bypass surgery. If you would like to learn more, Find a Doctor near you today.

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