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What Happens During Heart Surgery

Open Heart Surgery: What to Expect (English CC)

What happens during your surgery depends on the type youre having. It also depends on the method your surgeon uses to perform the operation.

Surgeons use different methods for operating on your heart. These include open-heart surgery, off-pump bypass surgery and minimally invasive heart surgery. Your care team will discuss which method is best for you, and why.

Open-heart surgery

Open-heart surgery is what most people think of when they hear someone say heart surgery. Your surgeon makes a 6-to 8-inch long incision in the middle of your chest and spreads your ribcage to reach your heart. Youll be connected to a heart-lung bypass machine, so your heart wont be beating during the surgery.

The length of traditional open-heart surgery varies based on whats being fixed. CABG surgery takes about three to six hours.

Off-pump bypass surgery

Off-pump bypass surgery is also called beating heart surgery. Its similar to traditional open-heart surgery, but you wont be on a heart-lung bypass machine. This method can only be used for CABG surgery. And its most suitable when only one or two coronary arteries need to be bypassed.

Minimally invasive surgery

Minimally invasive heart surgery is also called a keyhole surgery. This means your surgeon makes smaller incisions to access your heart.

A partial sternotomy involves a 3- to 4-inch incision through part of your sternum . A mini-thoracotomy avoids your breastbone and instead uses small cuts between your ribs.

What Is The Mitral Valve And How Does It Work

The heart constantly pumps blood throughout the body. Blood enters the heart from the lungs, coming in to the two pumping chambers on the left, called the left atrium and the left ventriclethe mitral valve helps blood flow through them. Like other heart valves, the mitral valve has leaflets, or flaps, that act like small gates, opening to let blood flow through and closing to keep it from flowing backward.

Problems can develop with any of the hearts four valves, but the mitral valve is one of the most likely to require repair or replacement surgery.

Why Do I Need Heart Bypass Surgery

Bypass surgery treats symptoms of coronary artery disease. That happens when a waxy substance called plaque builds up inside the arteries in your heart and blocks blood and oxygen from reaching it.

Your doctor may suggest heart bypass surgery if:

  • You have severe chest pain that your doctor thinks happens because several of the arteries that supply blood to your heart are blocked.
  • At least one of your coronary arteries has disease thatâs causing your left ventricle â the chamber that does most of your heartâs blood pumping â to not work as well as it should.
  • Thereâs a blockage in your left main coronary artery, which gives your left ventricle most of its blood.
  • Youâve had other procedures, and either they havenât worked or your artery is narrow again.
  • You have new blockages.

Coronary artery disease can lead to a heart attack. It can cause a blood clot to form and cut off blood flow. Bypass surgery can give your ticker a big health boost.

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For Severe Heart Disease Bypass Surgery Slightly Better Than Stenting With Caveats Study Finds

Among heart-disease patients in a study who received stents, the incidence of a major complication death, heart attack, stroke or the need for a repeat procedure was 10.6% after a year. Among bypass patients, the rate was 6.9%.

William Fearon

Patients with severe coronary artery disease generally fared better with bypass surgery than with stents to open blocked arteries, according to a major new multinational study led by Stanford Medicine investigators.

However, some patients benefited more from stents, particularly if their disease wasnt complex, the researchers found.

The good news for patients is that both groups did better than what was found in previous studies, and the differences between the two strategies has lessened, said William Fearon, MD, professor of cardiovascular medicine and principal investigator of the trial. He said the trial, the largest of its kind, will serve as a guide for determining which approach is best for individual patients.

I think it will have an immediate impact on how patients and physicians choose treatment, said Fearon, who is also the director of interventional cardiology at Stanford.

A paper describing the study, called the FAME 3 trial, was published online Nov. 4 in The New England Journal of Medicine. Fearon shares lead authorship on the paper with Frederick Zimmermann, MD, of Catharina Hospital in the Netherlands. Nico Pijls, MD, PhD, of Catharina Hospital, was the papers senior author.

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Give Your Heart Time To Heal

What is difference between cardiac bypass and stent insertion?

Its important to remember that not everyone heals at the same rate. Health conditions such as diabetes or if you are on steroids can increase the time it takes your body to heal after surgery. Complete recovery takes about three to six months.

At any phase in your recovery, using common sense is the best way to keep yourself from overdoing it, Dr. Tong says.

If an activity causes pressure or pain, stop. If your sternum doesnt heal properly after surgery, it can cause you a lot of pain and complicate the healing process.

If you arent sure an activity is safe, check with your surgeon first. Contact your doctor right away if you experience:

  • Redness on your chest larger than a quarter or drainage that resembles pus .
  • A clicking noise in your chest when you cough or breathe deeply .

Overall, give yourself time to heal, while gradually doing a little more each week. Continue to work with your doctor until youre up to speed on your normal activities.

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Why Might I Need Heart Valve Repair Or Replacement Surgery

Valve repair or replacement surgery is done to correct the problems causedby one or more diseased heart valves.

If your heart valve becomes damaged or diseased, you may have thefollowing symptoms:

  • The repaired or replaced valve doesnt work correctly

There may be other risks depending on your specific medical condition. Besure to discuss any concerns with your healthcare provider before theprocedure.

You May Experience Sleep Issues

Many people complain of having trouble sleeping for some time after heart surgery. You may experience insomnia because of:

  • Effects of anesthesia

  • Changes in your daily routine

  • Stress from personal concerns

Normal sleeping patterns typically return in two to three weeks. Until then, try these tips:

  • Take enough rest breaks in between your normal daily activities but avoid a daytime nap longer than 20 minutes.

  • If you have pain, take your pain medication about 30 minutes before bedtime.

  • Arrange the pillows so you can maintain a comfortable position and decrease muscle strain.

  • If you feel anxious or nervous, talk to your spouse, partner or a trusted friend. Get your troubles off your mind.

  • Avoid caffeine in the evenings.

  • Listen to relaxing music or a guided imagery audio program.

  • Ask your partner to give you a back rub.

  • Take a relaxing shower.

  • Follow a bedtime routine to let your body know its time to relax and get to sleep.

  • Its OK to sleep on your back, side or stomach. You will not hurt your incisions.

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Your Personality And Mood May Change After Open

After open-heart surgery, many people experience personality and mood changes. The most commonly experienced emotions are depression, fatigue and anxiety. These can be caused by being on bypass, anesthesia, or medication such as oxycontin. You may experience mood swings like crying or getting angry or easily frustrated.

I mostly experienced this after my second open heart surgery when I was a teenager and my third open-heart surgery. After both of them, I experienced depression, anxiety and PTSD. Before my second open heart surgery, I was more outgoing but afterward, my personality changed and I was quieter and self-reflective. I struggled with suicidal thoughts and mood swings. After my most recent surgery, I finally got the therapy I needed after years of not seeking help. If you are struggling, please find help, be open with your doctor and make sure you have someone to talk to.

Wearing Certain Types Of Clothing Might Be Hard During Surgery Recovery

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Usually in discharge, they tell you to wear button-down clothing for a while, but what they dont tell you is that your skin is super sensitive and wearing tight clothing even a couple of months after might be hard. For women, wearing bras might be tough. Try to find comfortable sports bras you can unclasp or undershirts. I tend to wear bras now that dont have underwires and have a t-shirt cotton feel.

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Preparing For The Surgery

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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Can A Heart Valve Repair Itself

No, a heart valve cant repair itself. Valve disease doesnt go away. It gets worse with time. As the disease gets worse, youll have more symptoms and your overall health will suffer. These changes often happen slowly, but they can also occur very quickly.

Depending on the type and extent of valve disease you have, you may be able to take medication for the short term. Surgery is the only effective long-term solution, and your healthcare provider will help determine when its time to pursue that option.

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Recovering From Mitral Valve Replacement Surgery

You will spend five to seven nights in the hospital following your surgery. After discharge, you will need to rest and recover for three to four weeks at home. Your doctor will talk to you about how to slowly increase your activity for a safe and successful recovery. You will need someone to drive you home from the hospital.

You will be on a blood thinner medication for at least several months following your surgery. Some patients will need to take a blood thinner for the rest of their life.

What Are The Advantages Of Heart Ablation

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If you have an arrhythmia that cant be controlled with medication, cardiac ablation can be lifesaving. Most people are able to have catheter ablation. This minimally invasive procedure carries fewer risks.

Heart ablation success rates are high. For most people, cardiac ablation restores normal heart rhythms. It typically eliminates the need to take antiarrhythmic medication.

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When Do You Go Home After Heart Surgery

Then you will be moved to another part of the hospital for several days until you go home. The National Heart, Lung, and Blood Institute notes that the length of your recovery time at home will depend on the type of surgery you had, your overall health before the surgery and whether you experienced any complications from surgery.

What Did It Find

  • Pooled data from 85 studies estimated that 89.7% of people survived for two years after surgery, 78.4% at five years, 57.0% at 10 years, 39.7% at 15 years, and 24.7% at 20 years. Subgroup analysis showed that five-year survival declined with increasing patient age .
  • The average estimated survival after surgery was 16 years for patients aged 65 or less. This compares to a life expectancy of 22.2 in the comparative general US population. In those aged 65 to 75 median survival was 12 years , seven years in those aged 75 to 85 , and six years in those aged more than 85 .
  • Structural valve deterioration was reported in 12 studies, including 7,703 people. There were 418 cases of valve deterioration during a median follow-up of 6.4 years, giving an estimated deterioration rate of 6% by 10 years, 19.3% by 15 years and 48% by 20 years.
  • Eight studies reported 64 strokes among 6,702 people. This gives a stroke rate of 0.26 per 100 person years , or less than one per 100 persons each year.
  • Two studies reported 21 cases of atrial fibrillation among 177 people. This gives a rate of 2.90 per 100 patient years , or about three per 100 persons each year.
  • The average length of hospital stay in these studies was 12 days as reported by seven studies including 6,405 people.

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Surgery To Place Ventricular Assist Devices Or Total Artificial Hearts

A VAD is a mechanical pump that is used to support heart function and blood flow in people who have weak hearts.

Your doctor may recommend a VAD if you have heart failure that isnât responding to treatment or if youâre waiting for a heart transplant. You can use a VAD for a short time or for months or years, depending on your situation.

A TAH is a device that replaces the two lower chambers of the heart . You may benefit from a TAH if both of your ventricles donât work well due to end-stage heart failure.

Placing either device requires open-heart surgery.

What Are The Risks Or Complications Of This Procedure

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CABG is a major surgery, which means there are some potential risks and complications. While most of these risks and complications are avoidable or treatable, its still important to understand them. Possible risks include:

  • Irregular heart rhythms . The most common arrhythmia after CABG is atrial fibrillation, which causes an increased risk of stroke. Fortunately, its usually only a temporary concern.
  • Bleeding. This is a risk with any major surgery. To avoid this, people who take blood thinners will need to stop taking them before the surgery.
  • Infections. Another possible complication of surgery is infection. When infections spread throughout your body, they can cause , a life-threatening overreaction of your immune system. Sepsis is a medical emergency, and having two or more of its symptoms should be considered as dangerous as a heart attack or stroke. Fortunately, major infections after CABG are rare thanks to improved surgical care and techniques.
  • Confusion or delirium. These cause symptoms like agitation, trouble thinking clearly, memory problems or someone behaving unusually .
  • Kidney problems.
  • Survival Rate of Heart Valve Replacement Surgery Center
  • The survival rate for a heart valve replacement surgery depends on which valve is involved. This was analyzed in a large study in which the lifespan of a large population, who went ahead with the surgery, is observed for a specific timeframe.

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    Why Use Sternal Precautions

    Open heart surgery usually requires that your cardiac surgeon divide your sternum to gain access to your heart and surrounding structures. After the surgery, your surgeon must repair your sternum by returning the bone to its proper place. Usually, a strong wire is used to hold the bone together while healing occurs.

    During your recovery, your healthcare provider may instruct you to follow sternal precautionsa method to protect your sternum after youve had open heart surgery.

    Sternal precautions are adjustments that you need to make in your day-to-day life to help prevent the separation of your breastbone as it heals. Separation of your sternum may slow the healing process of the bone, and sternal precautions also help to prevent excessive pulling on the surgical incision. This may help to keep the skin closed to prevent infection in your incision.

    Excessive pulling on your breastbone while it is healing after open heart surgery can cause something called dehiscence, or a separation of the bone. This separation can become an opening for infection to enter into your body.

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    What To Avoid For Sternum Healing

    For the first 6 weeks after surgery, a person should avoid lifting anything that causes them to strain. This could be a heavy grocery bag, briefcase, backpack, a pet, or a child.

    Activities to avoid for the first 3 months after surgery, or until a doctor says it is safe to continue, include:

    • household activities that strain the chest or upper arm muscles, such as mowing the lawn, vacuuming, and mopping the floor
    • sports such as tennis, golf, cycling, weight lifting, running, and vigorous aerobics
    • pulling the body up using the arms, such as getting into a high truck or SUV

    People heal at different rates depending on a range of different factors, including their underlying state of health and their age.

    A small 2019 observational study examined rates of sternal healing at midterm followup after open heart surgery. Midterm followup occurred between 13 and 21 months after surgery. At this point, the researchers found that the sternums of 65.9% of the people had healed. They also found that younger people healed faster.

    Additionally, an older 2015 study assessed the CT scans of 197 people recovering from coronary artery bypass graft surgery. The researchers found that it takes at least 3 months for the sternum to heal completely. The sternums of almost all of the people involved in the study were completely healed 24 years after surgery.

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