Traditional open-heart surgery is any kind of surgical intervention in which the chest is cut open to perform surgery on the muscles, valves or arteries of the heart.
Today’s cardiac surgeons are able to perform many new heart procedures, using a tiny camera and just a few small incisions. This type of surgical intervention is much less invasive than earlier techniques, so the term ‘open-heart surgery’ can be a little misleading in that it no longer accurately describes all cardiac surgical procedures.
Cardiac surgery and open heart surgery have now obtained an established role in the treatment of heart conditions. A wide range of surgical methods are used for the treatment of cardiac diseases. These include such frequent operations as bypass surgery or valve surgery. Less common are corrections of congenital heart defects.
Open-heart surgery is commonly used to perform a coronary artery bypass graft (CABG) and address the symptoms of coronary heart disease. This primarily involves restoring proper blood flow through the coronary arteries once ‘hardening’ has occurred, due to a build-up of plaque (fatty material) on the artery walls. This narrows the arteries, making it difficult for blood to flow through the heart and therefore increasing the likelihood of a heart attack.
Open-heart surgery is performed in order to:
- reconstruct or replace heart valves, which control the flow of blood through the heart
- repair damage to the heart or modify areas identified as abnormal
- install small medical devices (e.g. a pacemaker), which help the heart to beat with a stable rhythm
- replace a badly damaged heart with a donor heart (heart transplant procedure)
Heart surgery is the option used when it is necessary to perform restorative surgical procedures by opening the chest wall to operate on the heart. To achieve this, the surgeon cuts through all or part of the patient's breastbone to expose the chest region.
The patient is then attached to a heart-lung bypass machine that controls these functions, thus allowing the medical team to operate on a heart that is at rest and has no blood flowing through it.
A variation on this procedure, known as beating heart surgery, allows the same chest access but does not require the use of a bypass machine. Thus, the heart will continue to beat during the procedure.
Some surgery can now be completed using small incisions between the rib bones to perform some types of cardiac surgery. This minimally invasive intervention avoids the need to open the chest as happens in traditional surgery, and may not always require the support of a heart-lung bypass machine.
These modern methods of cardiac surgery can often reduce the risks associated with surgical intervention and significantly speed up patient recovery times.
The specific techniques of cardiac surgery can vary considerably and depend to a great extent on the disease in question. In any case both a cardiologist and an expert in cardiac surgery must be involved in a case of heart disease so that it can be assessed and treated optimally.
The risks for open-heart surgery include:
- breathing difficulties
- lung or kidney failure
- chest pain and low fever
- memory loss, or feelings of disorientating “fuzziness”
- blood clotting
The following possible risks of surgical intervention apply to both open and minimally invasive surgical procedures:
- blood loss
- stroke or heart attack
- arrhythmia (irregular heart rhythm)
- chest wound infection (more common in diabetic patients, those with obesity or those who have had a previous CABG procedure)
The University of Chicago Medicine reports that the use of a heart-lung bypass machine during surgical procedures is also associated with increased risks (e.g. strokes and memory problems).
There are many sophisticated modern medications that can now address some heart complaints, and other alternatives, such as regular exercise, diet and weight-loss initiatives, stopping smoking, reducing stress and controlling blood pressure, which can all help to reduce the risk of developing a heart disease in the first place. Nevertheless, there is no evidence to show that any of these can act as alternatives to heart surgery when surgical intervention is actually required – although they do have an important role to play in any successful post-operative recovery process.