Open Heart Surgery

Introduction

Open heart surgery is the name frequently used for a cardiac procedure called as “CABG Surgery or coronary artery bypass graft surgery. This is the treatment of choice for blocked arteries supplying the heart.

The heart pumps blood to the entire body but still depends on a series of blood vessels called as the coronary arteries for its own blood supply. If the arteries become severely blocked, this condition is known as coronary artery disease. Open heart surgery, or bypass surgery, is considered as the gold standard for the treatment of coronary artery disease.

During an open heart surgery, the blocked arteries are bypassed with blood vessels taken from another part of the body. Commonly, two to four coronary arteries are grafted to ensure adequate flow to the heart. Prior to the decision of surgery; other modalities like medical treatment as well as cardiac rehabilitation or coronary angioplasty are tried.

Preparation:

1. A proper history, examination and few lab tests and scans are done to determine the general health. Also, ECG and 2D echocardiography are done.

2. A coronary angiography is the procedure done to diagnose coronary artery disease. The procedure is based on results of this test.

3. Patient should stop anti-inflammatory drugs like aspirin at least 2 weeks before surgery. They can increase the bleeding during surgery.

4. Essential medications being taken for other conditions like diabetes, heart disease, blood pressure should be continued with advice from the treating doctor as well as cardiologist.

5. History of smoking or alcohol drinking should be told to the surgeon. Smoking should be stopped if possible as it interferes with the wound healing.

6. Recent history of cough, cold, fever, viral infections, or other illnesses should be informed to the surgeon.

7. Patient is not allowed to eat or drink anything at least 8 to 12 hours before surgery except essential medicines with sips of water.

Procedure:

1. The heart bypass is done under general anesthesia.

2. An incision is taken of about 8 to 10” in the middle of the chest and the breastbone is retracted. This is called as sternotomy.

3. Then mostly the patient is connected to a heart lung machine. The heart is stopped. This machine does the work of breathing and circulation of blood till the surgeon works on the heart.

4. A new approach to this surgery does not use the heart lung machine. The heart is beating throughout the bypass. This is called as off-pump coronary artery bypass.

5. The surgeon takes a vein from other part of the body and is grafted around the blocked area to restore the reduced blood flow to the heart from a diseased coronary artery.

6. The surgeon can use a vein from the leg called as saphenous vein. First it is separated by an incision on the medial side of the leg from groin to the ankle. This graft vein is connected to an opening made in the aorta and the other end is connected to the coronary artery.

7. Another vessel known as internal mammary artery can also be used as a graft. This is a graft from the chest itself. Other arteries like radial artery of the wrist are also commonly used.

8. The sternotomy is closed with a wire which remains in the chest. The surgical incision is closed with stitches.

9. The entire surgery takes 4 to 6 hours. After reversal of anesthesia, the patient is transferred to an intensive care unit.

Risks for surgery include:

1. Blood clots in the legs travelling to the lungs

2. Medication allergy

3. Breathing problems

4. Infection of lungs, urinary tract or chest

5. Blood loss

Possible risks from of coronary bypass surgery are:

1. Surgical wound infection especially in obese, diabetic or repeat surgery patients.

2. Heart attack or stroke

3. Arrhythmias

4. Kidney failure

5. Memory loss or loss of mental clarity

6. Chest pain and low fever also called as post-pericardiotomy syndrome. The symptoms can persist for about 6 months.

After the Procedure:

1. The total hospital stay after the coronary artery bypass is about 3 to 7 days. Patient is shifted to an intensive care unit (ICU) for 1 or 2 days immediately after the surgery.

2. Two to three chest tubes are present to drain the blood or fluid after surgery. These are usually removed in 1 to 3 days.

3. A urine catheter is present in the bladder. 2 or 3 intravenous lines are also there to infuse fluids and drugs. The patient is monitored closely for blood pressure, oxygen saturation and heart rate changes.

A cardiac rehabilitation program is started within a few days. 4 to 6 weeks are required to feel better. Complete recovery from the heart bypass surgery takes 3 to 6 months. The graft usually remains patent and is functional for many years.