Open Surgery Versus Minimally Invasive
Heart disease is the leading cause of death for men and women in the United States. Today, there are about 500,000 open heart surgeries performed each year. It is most often used for complicated procedures, such as coronary artery bypass, or complex procedures to the aorta or the heart itself. These procedures usually involve a hospital stay of a week or more and a lengthy recovery time.
Minimally invasive procedures have proven effective for coronary bypass, valve surgery, or repairing aneurysms. When compared to open heart surgery, it is less disruptive to the body, meaning there is less pain and scarring. There is also a smaller risk of infection and bleeding. Finally, it typically results in a shorter hospital stay and quicker recovery. As a result, it is always better to do the less invasive procedure whenever possible.
For valve issues, minimally invasive procedures allow cardiac surgeons to either replace a valve entirely or do a repair. It is always best to try to retain the healthy part of the valve through repair rather than replacing it.
What Do We Do If The Bypasses Close Off
So far we have said that while LIMA-LAD grafts are an excellent option with great long term results, vein grafts are unfortunately no so good, and have an almost 1 in 2 chance of going down within several years of surgery. The good news is that the LIMA-LAD graft is the most important. And although the vein grafts may go down more frequently, if they do go down the chance of needing another heart operation is very, very low. If required, treatment can typically be undertaken using minimally invasive methods such as using stents.
The decision to treat blocked bypasses depends on many factors. Often the blockage may be silent and without symptoms, in which case no specific treatment is needed. Some bypass graft blockages will present with symptoms such as chest pain, shortness of breath or heart failure, in which case further evaluation can be undertaken and the decision made on the best treatment depending on the results of tests such as stress tests and angiograms. Finally some of these bypass blockages may present as a heart attack in which case often the blockages can be treated through the use of stents and medicines.
Why Might I Need Coronary Artery Bypass Surgery
Your doctor uses coronary artery bypass graft surgery to treat a blockage or narrowing of one or more of the coronary arteries to restore the blood supply to your heart muscle.
Symptoms of coronary artery disease may include:
Swelling in the hands and feet
Unfortunately, you may not have any symptoms in early coronary artery disease, yet the disease will continue to progress until theres enough artery blockage to cause symptoms and problems. If the blood supply to your heart muscle continues to decrease as a result of increasing blockage of a coronary artery, you may have a heart attack. If the blood flow cant be restored to the particular area of the heart muscle affected, the tissue dies.
There may be other reasons for your doctor to recommend CABG surgery.
You May Like: How Low Is Too Low For Heart Rate
What The Future Holds
As a cardiac electrophysiologist, I work with the hearts electrical system. In this area, there are innovations and new technologies that are making treatments faster and smarter, ultimately resulting in better care and outcomes for our patients.
For instance, new wireless devices are now available for those who require pacemakers and defibrillators. This leadless technology means that we can keep hearts beating easier and more effectively. It is also worth noting that the technology used to perform electrical surgeries is always improving.
If you have heart disease, take comfort in knowing there are many ways we can help you. Learn more about our services here.
About the Author:
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.
Recommended Reading: How Long Can You Live With Congestive Heart Failure
Tips To Help You Heal
Keeping the following things in mind will help you heal after heart surgery:
Listen to your body, especially in the first two months after surgery.
The vast majority of your healing about 80 percent of it occurs during the first two months after your surgery. During this time, you will attend cardiac rehabilitation and continue to gradually increase your activity level.
It is very important to work on increasing your activity level before cardiac rehab starts because in most programs this will be six weeks after surgery. Youll want to do as much as possible, but you may find that you tire easily or need to stop and rest during activities that you used to do with ease. Listen to your body. Make sure that youre not pushing yourself too hard and risking injury or complications.
Follow your doctors recommendations.
When it comes to resuming specific activities, its important to listen to your doctor. For example, you may need to wait at least six weeks before riding a bicycle or lifting things because your breastbone needs time to heal. Talk to your doctor about when you can start driving again.
After the first two months, the rest of your recovery will probably move more slowly. The remaining 20 percent typically takes almost a year. During this time, you should expect to continue to regain strength and endurance.
Eat right and get active when youre ready.
What Are The Alternatives To Bypass Surgery
There are a few less-invasive procedures your doctor could try instead of bypass surgery.
Angioplasty. A surgeon threads a deflated balloon attached to a special tube up to your coronary arteries. Once it’s there, they inflate the balloon to widen your blocked areas. Most times, it happens in combination with the installation of something called a stent, a wire mesh tube that props your artery open.
There’s also a version of angioplasty that, instead of a balloon, uses a laser to eliminate the plaque that clogs your arteries.
Minimally invasive heart surgery. A surgeon makes small incisions in your chest. Then, they attach veins from your leg or arteries from your chest to your heart, much like a traditional bypass surgery. In this case, though, your surgeon will put the instruments through the small incisions and use a video monitor as a guide to do the work. Unlike bypass surgery, your heart is still beating during this procedure.
Don’t Miss: Which Part Of The Brain Controls Heart Rate
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.
How Many Times Can You Have Open
Second time bypass has become a very standard procedure nowadays. As many of the patients are operated in late 60s and 70s so the need for a second bypass surgery arises. There is no specific limit of times that a person can undergo bypass surgery. But with each surgery, the risk also goes on increasing.
Thanks to continuing advances in heart surgery and improved life expectancy, many people live long enough to require a second heart operation, commonly called a heart reoperation. An operation duplicating your first surgery is often successful, but if youre considering this type of surgery, you need to understand its unique challenges.
What Makes a Reoperation Surgery More Challenging?
First of all, youre older than you were when you had your initial heart surgery, and you are possibly dealing with additional medical problems. Depending on how serious your other medical issues may be, a reoperation can be more difficult to recover from.
Second, you probably have adhesions which are similar to scar tissue. These web-like connections between the structures in your chest can develop as a result of the first operation. This may present technical difficulties for your surgeon, especially if they are not experienced in performing reoperations. A preoperative CT scan can be helpful to determine the safety of and strategy for reentering your chest.
Progression of your disease
Why Would You Need Heart Reoperation Surgery?
. Type of bypass used
Drive Before Youre Ready
If your doctor tells you not to get behind the wheel â whether itâs for 2 weeks or 2 months â itâs for a good reason. Your reaction time may be slower and you could get into an accident. Until youâre ready to handle it, get lifts from a friend or family member. Or ask them to do your errands for you.
You May Like: Thrz Calculator
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.
Recommended Reading: Does A Higher Heart Rate Burn More Calories
You May Like: Can Statins Cause Heart Palpitations
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.
When Can Life Resume After Open Heart Surgery
If you had open heart surgery and the surgeon divided your sternum, it will be about 80% healed after six to eight weeks. By that time, youll generally be strong enough to get back to normal activities such as driving, Dr. Tong says. You can probably also return to work, unless your job is physically strenuous.
Read Also: What To Wear After Heart Surgery
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.
Sleeping Can Be Hard After Surgery
Its hard to find a comfortable position to sleep in. If you are a side or belly sleeper it can be hard laying on your back. Finding your favorite chest pillow will be your savior. You might also experience nightmares for a bit after surgery, but it will pass. If you continue to experience them, speak to your doctor and seek help if you feel like you are experiencing PTSD.
Recommended Reading: Can Gas Cause Heart Palpitations
The Evolution Of Heart Surgery
When people think about heart surgery, it is usually the idea of open heart surgery. This surgery is considered invasive. It not only includes a large incision in the chest, but also, the heart is stopped and the patient is put on a heart-lung machine during the procedure.
In the last two decades, great advances have been made in the field of minimally invasive procedures. Treating the heart is no exception. Minimally invasive procedures involve small incisions, through which surgeons can use a camera and robotic surgical tools that allow for greater precision.
How To Prepare For Open
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.
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.
Read Also: What To Take For Heart Attack
What To Expect During Open
Open-heart surgery is any kind of surgery in which a surgeon makes a large incision in the chest to open the rib cage and operate on the heart. For this type of surgery, you’ll be given anesthesia, a medicine to make you unconscious and unaware of pain.
Your surgeon will make a 6- to 8-inch incision down the center of your chest wall. Then, they will cut your breastbone and open your rib cage to reach your heart. During the surgery, you’ll receive medicine to thin your blood and keep it from clotting. Your surgeon will connect a heart-lung bypass machine to your heart. The machine will take over your heart’s pumping action and move blood away from your heart. This is done because surgeons can better perform some procedures on a heart that isn’t beating and doesn’t have blood flowing through it.
Heart-lung bypass machine. The image shows how a heart-lung bypass machine works during surgery. You’ll be given medicine to stop your heartbeat once you’re connected to the heart-lung bypass machine. A tube will be placed in your heart to drain blood to the machine. The machine will remove carbon dioxide from your blood, add oxygen to your blood, and then pump the blood back into your body. Your surgeon will insert tubes into your chest to drain fluid.
What Are Some Types Of Heart Surgery
There are many types of heart surgery. The National Heart, Lung, and Blood Institute, which is part of the National Institutes of Health, lists the following as among the most common coronary surgical procedures.
In addition to these surgeries, a minimally invasive alternative to open-heart surgery that is becoming more common is transcatheter structural heart surgery. This involves guiding a long, thin, flexible tube called a catheter to your heart through blood vessels that can be accessed from the groin, thigh, abdomen, chest, neck, or collarbone. A small incision is necessary. This type of surgery includes transcatheter aortic valve implantation to replace a faulty aortic valve with a valve made from animal tissue, MitraClipÂ® placement for mitral valve abnormalities, and WATCHMANÂ® placement for nonvalvular atrial fibrillation patients.
Recommended Reading: Left Sided Heart Failure Treatment
You May Feel Like Youre On An Emotional Roller Coaster
Recovering from open-heart surgery involves physical and emotional healing. The recovery process uses emotional and physical energy.
If you feel upset or emotional in the weeks after your operation, dont worry this is a normal reaction. Many patients report these feelings up to three months after the operation:
Mood swings that may include depression, fear, anxiety, loneliness, helplessness and anger
Crying easily for no apparent reason
Lack of energy or motivation
Getting easily frustrated
Having good days and bad days
Feeling more emotional or sentimental than normal
Even though you may feel drained physically and emotionally, its important to follow guidelines for good self-care:
Get dressed every day
Walk daily within your limits
Get plenty of rest