Care Of Your Incisions
As you heal, your incision will look better and the soreness will go away. Changes in the weather, too much or too little activity and sleeping in one position too long may cause increased soreness. You may also feel numbness or itching or see redness or swelling, which will also stop with time. To care for your incisions, we suggest:
- Wash gently with mild soap during your daily shower. Dry carefully with a towel. Pat it dry Do not rub the incision.
- If you have small pieces of white tape over your incision, you must remove them after you have been home for seven days. If the strips come off on their own, you may leave them off.
- If your incisions are puffy, have areas of redness, are oozing, or begin to open slightly, call your surgeon.
- Women should wear a bra. A good support bra will reduce the tension placed on the incision. If the bra bothers you, you may put a small piece of gauze under the bra for added comfort.
- For discomfort or soreness, you may use a heating pad. Apply it four or five times per day on the low setting for about 20 minutes each time. If needed, take pain medication prescribed by your doctor.
Sawing Open The Breastbone
Heart bypass surgery is an open-heart surgery and the heart needs to be exposed. In the case of bypass surgery this is done by sawing through the breastbone in a technique known as median sternotomy. A specially designed electric saw is used for this. A median sternotomy is demonstrated in the next image. Once the bone is cut, small bleeders are cauterized to stop the bleeding.
Heart Bypass Surgery Electric Saw Through Breastbone
Heart bypass surgery cauterizing bleeding breastbone vessels
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 You Need To Know About Open Heart Surgery Scars
Open heart surgery is an operation that requires opening the chest wall to repair a fault in or damage to the heart muscle, its arteries or valves. These surgeries treat complications of ischemic heart disease via bypass surgery of blocked arteries, correct congenital heart disease, or treat other heart diseases such as endocarditis, mitral valve prolapse, and many more. Its clear that open heart surgery is a major operation, which increases the risk of significant scarring. It may seem daunting to have to recover from such a major surgery and worry about how to manage scars afterwards. Which is why were explaining exactly what to do about open heart surgery scars so that you can focus on a safe and healthy recovery.
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.
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 Happens During Open
Heart surgery is complex. Some surgeries may take six hours or longer. You will receive anesthesia and be asleep during the procedure.
Surgery steps vary depending on the heart condition and procedure. In general, your surgeon:
- Makes a 6- to 8-inch long incision down the middle of your chest.
- Cuts the breastbone and spreads your ribcage apart to reach your heart.
- Connects the heart to a heart-lung bypass machine, if youll have an on-pump surgery. An anesthesiologist gives IV medication to stop your heart from beating and monitors you during the surgery.
- Repairs your heart.
- Restores blood flow to your heart. Usually, your heart starts beating on its own. Sometimes, the heart needs a mild electrical shock to restart it.
- Disconnects the heart-lung bypass machine.
- Closes the breastbone or other incision with wires or sutures that remain in your body.
- Uses stitches to close the skin incision.
Cpb In Sickle Cell Anemia Without Exchange Transfusion
Our group is one of the few in the world that has reported successful CPB in sickle cell disease without perioperative exchange transfusion. In a matched pair analysis of patients who underwent hypothermic CPB without exchange transfusion, we demonstrated that perioperative exchange transfusion was not essential for a good outcome in sickle cell patients undergoing CPB a simple transfusion regimen to replace blood loss was found to be safe in sickle cell hemoglobin SS patients. Blood transfusion requirement for hemoglobin SC and hemoglobin AS patients undergoing CPB were similar to those of matched hemoglobin AA controls. Our results also demonstrated that the use of systemic hypothermia during CPB does not increase sickle-cell-related complications and cold crystalloid cardioplegia and topical hypothermia provide safe myocardial protection without the need for more sophisticated measures .
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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
Colopharyngoplasty For Intractable Pharyngoesophageal Strictures
Surgical management of caustic strictures of the upper digestive tract poses difficult challenges because reconstruction above the cricopharyngeal junction interferes with the mechanisms of swallowing and respiration. We recently reported our experience and surgical technique of colopharyngeal reconstruction of the challenging subset of patients with severe diffuse pharyngoesophageal caustic strictures accompanied by upper airway obstruction . We showed good results with the establishment of digestive tract continuity using a suprahyoid anastomotic technique. Rehabilitative training for deglutition was a universal requirement in the postoperative period to establish near-normal swallowing.
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What Are The Types Of Open
There are two ways to perform open-heart surgery:
- On-pump: A heart-lung bypass machine connects to the heart and temporarily takes over for the heart and lungs. It circulates blood through the body while moving blood away from the heart. The surgeon then operates on a heart that isnt beating and doesnt have blood flow. After surgery, the surgeon disconnects the device and the heart starts to work again.
- Off-pump:Off-pump bypass surgery takes place on a heart that continues to beat on its own. This approach only works for coronary artery bypass grafting surgery . Your surgeon may call this beating-heart surgery.
The Best Treatment For Open Heart Surgery Scars
As mentioned above, silicone gel and sheeting are considered the first-line therapy to manage and minimize scarring. While there are several brands of silicone gel products on the market, NewGel+ offers the widest variety of silicone scar treatment products available. Our silicone strips, sheets, and gel are perfect for open heart surgery scars as well as scars resulting from any other type of abdominal or back surgeries.
Clinical studies have shown that silicone gel and sheeting are considered the first line therapy to manage and minimize scarring.
If youre searching for silicone gel sheeting in drugstores, you may notice that these sheets are only a few inches long. Since open heart surgery scars can be up to 10 inches long, multiple sheets would have to be overlapped to cover longer scars. One box doesnt go very far! NewGel+ has a variety of lengths to provide plenty of options for the coverage you need, and strips can be cut to fit whatever size scar you have.
Since open heart surgery can be an emotional and stressful procedure, let NewGel+ handle your scar management needs. Find your perfect match by browsing our product collection now.
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Spectrum Of Cardiovascular Surgery
From 2002 to 2011, 2,314 surgical operations were performed at the NCTC 1,775 cardiovascular operations and 539 thoracic operations. Surgery for CHD, rheumatic heart disease, chronic constrictive pericarditis, and aneurysms of the aorta and its abdominal branches were the major cardiovascular procedures performed .
Table 1
Surgery for CHD was the most common group of procedures performed , with the creation of the modified Blalock-Taussig shunt for cyanotic CHD with reduced pulmonary blood flow being the commonest .
Table 2
Chronic pericardial constriction was the predominant indication for pericardiectomy tuberculosis accounted for 63.3% of the etiology of pericardial constriction . We perform this procedure through a median sternotomy with the heart lung machine on standby though we have not had to employ CPB in this procedure.
As in much of sub-Saharan Africa, coronary artery disease is relatively uncommon and its epidemiology remains enigmatic because of a lack of reliable data and adequate diagnostic capabilities. Our surgical data would seem to support the notion that CAD is not as common as the other cardiovascular pathologies presenting for surgery: we performed coronary artery bypass grafting in only 29 patients during the study period. However, on the basis of the increasing prominence of the risk factors of CAD in Ghana, its prevalence is projected to increase in the coming decades.
Table 3
Finding Strength In Her Scars
Although her grandparents suffered from high blood pressure and aortic stenosis, VanSingels condition does not appear to be genetic.
Im the only one in the family with this type of heart condition. It was just a fluke, she says.
As a result of her surgeries, VanSingel has two sternotomy scars as well as other scars associated with various procedures.
However, she has never felt compelled to hide them.
My parents taught me to be proud of who I am, she says, adding, My scars are a part of my identity. I cant envision myself without them.
Nor does VanSingel mind answering questions about her scars.
Im an open book when it comes to talking about my heart condition and scars, she says.
She has also learned an important lesson when faced with hurtful comments about the scars, especially during her teen years: Dont let another persons words change the way you feel about yourself.
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What Is Recovery Like After Open
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.
Cpb In Jehovahs Witnesses
The need to avoid blood transfusion of heterologous blood in Jehovahs Witnesses presenting for open heart surgery prompted us to adopt innovative methods based on pre-operative administration of nutritional supplements, oral iron therapy, erythropoietin, antimalarial treatment, and the modification of the extracorporeal bypass circuit to allow successful CPB in these patients .
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Outcomes Of Surgical Procedures
The patients reviewed here have been reported on earlier in several publications the outcomes of some are briefly presented here. Surgical outcomes at the National Cardiothoracic Center published in peer reviewed journals are comparable internationally and have improved over the years.
There was no hospital mortality after pericardiectomy for chronic constrictive pericarditis among 11 patients who underwent the procedure between 2000 and 2005 . Among 64 patients who underwent modified De Vega annuloplasty for inorganic tricuspid valve regurgitation and followed up for an average of 61.3 months, 64.1% of the patients had no postoperative tricuspid regurgitation, 28.5% had grade 1 regurgitation, and 9.4% grade 2 regurgitation. Hospital mortality was 4.7% .
There was no procedure related mortality was observed among 355 patients undergoing permanent pacemaker implantation between 1992 and 2009. Twenty five patients developed complications, the commonest being lead-electrode dislodgement .
Between 1994 and 2009, 16 patients presenting with esophageal perforations underwent surgical intervention. Six patients presented within 24 h of their injury and 10 presented after 24 h. Thoracotomy and intrathoracic primary repair was possible in five cases. Esophagectomy, cervical esophagostomy and feeding gastrostomy were carried out in 11 . One patient died after oesophagectomy from overwhelming sepsis .
Teen’s Scars Tell A Story Of Her Frightening First 2 Years
Maddie Ramon had three open-heart surgeries before she was 2.
Madeline “Maddie” Ramon is used to being asked about the scars that can often be seen poking out the top of her shirt.
“When I was younger, I had a heart problem and I had heart surgery,” she tells people. “And I’m good now.”
Katie Ramon smiles when she hears Maddie say that. Calling Maddie “my little patchwork baby,” Katie considers the scars a source of pride.
“You’re a fighter,” Katie has often told Maddie. “Tell people what you’ve been through.”
Then again, it’s tough for Maddie to remember most of what she went through. Her three open-heart surgeries came before she was 2.
The day after Maddie was born, a team of doctors and nurses entered Katie’s room.
“We think that something with the heart on the left side didn’t form correctly,” a doctor said. The problem couldn’t be resolved at this hospital. Katie needed to be transferred to another hospital in Austin, Texas, with more specialized care.
Katie had just left her newborn swaddled in the nursery. She returned to find her intubated, “with wires and tubes everywhere.”
A nurse offered to take a picture of Maddie. That’s when it hit Katie that she might never see her daughter again.
At the next hospital, Katie learned Maddie had hypoplastic left heart syndrome, a congenital heart defect that occurs when the left side of the heart doesn’t develop properly. Without surgery, the condition is fatal, usually within the first few weeks of life.
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The Rise Of Bloodless Heart Surgery Techniques
One more challenge to the old fashioned way to perform cardiac surgery was brought about by a renewed interest in bloodless heart surgery. The routine use of minimally invasive and beating heart surgery techniques has dramatically improved our ability to avoid transfusion in the majority of our surgical patients. The avoidance of the heart lung machine can in fact improve the bodys ability to stop bleeding after open heart surgery and smaller incisions that do not cut through bones are not as prone to bleeding as a full median sternotomy. Get more details on the page dedicated to bloodless heart surgery.
Strictly Posterior Thoracotomy : A Minimal
In resource poor settings, the MBTS is often performed for symptomatic relief of Fallots tetralogy. We adopted the SPOT, a minimal access technique for the construction of the MBTS . The approach represents a safe and cosmetically superior alternative to the standard posterolateral thoracotomy, the scar being imperceptible to the patient. The excellent cosmetic appeal and preservation of body image makes this approach particularly attractive.
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Open Heart Surgery Scars
As I personally remember, common questions that patients have about open heart surgery scars are, “What will my scar look like?”, “How big will my scar be?” and “Will the scar fade over time?”
Those are all great questions.
So you know, the scar size will depend on the type of open heart surgery performed by your medical team. Not only are the different incision sizes but there are different incision locations that may or may not be used by your specific surgeron.
Open Heart Surgery Patient Risk
The risk of open heart surgery to any patient is very dependent on the patient themselves and how sick they are. Of course a healthy 45 year old is going to have a lower risk than an 85 year old. Several risk factors have been found to be important when determining the risk for any given patient.
Age Older patients are in general at higher risk than younger patients.
Sex In general female patients have higher risk than make patients.
Obesity Obese patients are at higher risk.
Heart Function Pumping function of the heart is important those with impaired heart pumping function are at higher risk.
Kidney Function Patients with impaired kidney function have higher risk the worse the kidney function the higher the risk.
Heart Attack Those that have had a heart attack are at higher risk, particularly if the heart attack is around the time of surgery or if there are active symptoms of chest pain at the time of surgery.
Lung Disease Those with known lung disease, such as COPD, are at higher risk the worse the lung disease the higher the risk.
Emergency Surgery Surgery that needs to be performed emergently due to active symptoms, or instability carries a much higher risk than elective planned surgery.
Presence of Multiple Problems The more issues that need fixing, the higher the risk for example someone needing a simple bypass operation is lower risk than someone needing a bypass and 2 valves fixed at the same time.
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