Open Heart Surgery (OHS)

What is a Open Heart Surgery?

Open Heart Surgery is a procedure performed on the heart where the function of the heart is taken over by heart-lung machine during the surgery. The beating of the heart is temporarily stopped and the body's oxygen demand is met by the heart-lung machine (also called cardiopulmonary bypass machine). This machine is used to help provide oxygen-rich blood to the brain and other vital organs. In Open Heart Surgery the chest is opened by cutting through the breast bone (sternotomy). Beating Heart Surgery is a variant of Open Heart Surgery where the heart is not stopped but is still beating while the surgeon performs the procedure.

Who is an ideal candidate for Open Heart Surgery?

If you have any of the following heart conditions, then you are an ideal candidate for Open Heart Surgery:

• Ischemic Heart Disease that requires Coronary Artery Bypass Surgery
• Congenital Heart Diseases like Transposition of Aorta and Pulmonary artery, Tetrology of Fallot, Atrial Septal Defect, Ventricular Septal Defect
• Heart / Lung Transplantation
• Heart Valve Disease requiring Heart Valve Replacement
• Procedures on aorta like dissection of the aorta, aneurysm of thoracic or arch of aorta
• Coarctation of the aorta
• Tetrology of Fallot

What does Open Heart Surgery procedure involve?

Open Heart Surgery is considered a major surgical procedure performed under general anesthesia in a hospital setting equipped with sophisticated equipment, skilled and experienced surgeons and nurses and excellent post-operative care. Open Heart Surgery may take about 3 - 5 hours depending upon the complexity of procedure. The surgeon opens the chest wall, first by making an incision through the skin and secondly by cutting through the breast bone (sternotomy) to expose the heart. In order to expose the heart completely, thymus gland is removed. The heart is stopped with cold, high potassium solution which protects the heart muscle from damage while it is stopped. Cold saline irrigation over the heart is also used to protect the heart while it is stopped and is without it's own blood supply. Once the heart is stopped, the defect can be repaired in a bloodless environment. In some cases, the heart can be operated upon while still beating with the patient not being supported on the heart-lung bypass machine (Beating Heart Surgery). However, Open Heart Surgery does not always involve opening the heart itself, it can only involve opening the chest cage. The remainder of the procedure is specific to the exact heart problem being treated e.g. Coronary Artery Bypass Grafting, Atrial Septal Defect, Ventricular Septal Defect, Heart Valve Replacement, etc.

How do I prepare for Open Heart Surgery?

Before your Open Heart Surgery, you will have a complete and through evaluation by physician, cardiac surgeon and anesthesiologist. All the routine pre-operative tests like blood and urine examination, x-ray chest, Electrocardiogram, Echocardiogram, Cardiac Catheterization, and Coronary Angiogram will be performed. Please make sure to inform your doctor about all the prescription and non-prescription medications including vitamin, mineral and herbal supplements that you might be taking. You will be instructed to eat a balanced diet, do some exercises to clear your lungs and quit smoking completely before the Open Heart Surgery. Also, plan on staying in the hospital for 5 days or so and arrange for someone to help you around the house for the next couple of weeks after Open Heart Surgery. Do not eat or drink anything for at least 12 hours before the surgery and get a good night's sleep. You will be instructed to shower both on the evening before as well as the morning of surgery with a special antibacterial soap to prevent infection during and following Open Heart Surgery.

What to expect during the recovery period following Open Heart Surgery?

The initial few days following the Open Heart Surgery can be crucial. There will be pain and discomfort which can be relieved by pain medication. Some of the common unpleasant experiences after Open Heart Surgery will be forgetfulness, mood swings, lack of energy, tiring easily, lack of appetite possibly even nausea or constipation, difficulty sleeping through the night or perhaps nightmares or vision changes. Your doctor will provide you a list of specific discharge instructions to follow for the first three weeks at home, after your Open Heart Surgery to help you return to a normal pace of life. Some of the post-operative Open Heart Surgery guidelines will include:

• Make sure to get plenty of rest and sleep, this will help you heal and recover quickly.
• Avoid extreme temperatures i.e. very cold and very hot weather including wind chill factor and humidity.
• Do not perform strenuous activities like lifting, pushing, pulling, mopping, vacuuming, yard work, car washing, laundry etc.
• Eat a well balanced, low salt, low calorie, nutritious diet comprising of fruits, vegetables, dairy and protein.
• Avoid alcohol and limit your caffeine intake.
• Continue coughing and deep breathing exercises.
• Bathe or shower daily with warm water.
• Keep your incision clean, do not apply oils, lotions or creams over your incision.
• Avoid driving or going for long outings.
• Avoid sexual intercourse for at least 4 - 6 weeks after Open Heart Surgery.
• Avoid constipation, eat lots of fruits and vegetables and drink plenty of water to keep your stool soft.
• Follow the Cardiac Rehabilitation Program as outlined by your health care team to provide emotional support and information about the recovery process.
• Make long term lifestyle changes like regular walking, exercising, eat low fat, low calorie diet, quit smoking etc - in short make healthy lifestyle choices.

What is the outcome of Open Heart Surgery?

Open Heart Surgery is a fairly common procedure performed on people of all ages. Morbidity and mortality is dependent on the heart defect being repaired by Open Heart Surgery. Corrective surgical procedures for Atrial Septal Defect and Ventricular Septal Defect have a very low mortality rate. Most of the indications for Open Heart Surgery procedure are clear cut however, some complicated defects may require different possible approaches for either correction or palliation of the heart disease.

B . R . A . N . D . of Open Heart Surgery

Benefits of Open Heart Surgery

• Open Heart Surgery can mean a difference between life and death. In general, your doctor will recommend Open Heart Surgery only if it is less risky than the heart problem itself. Most commonly, Open Heart Surgery is performed world wide for Heart Valve Replacement, Coronary Artery Bypass Grafting, and several other congenital and acquired heart problems. During Open Heart Surgery, the heart is motionless and the surgeon has a bloodless field to work in.

Risks of Open Heart Surgery

• Stroke - There is a danger of stroke during or after Open Heart Surgery procedure
• Systemic inflammatory response
• Air or fat embolism
• Excessive bleeding
• Allergic reaction to anesthesia
• Heart attack
• Arrhythmias
• Compromised kidney or lung function

Alternatives to Open Heart Surgery

• Medications - Most commonly used medications are Ace Inhibitors, Bata-blockers, Antiarrhythmics, Digoxin, Diuretics.
• Beating Heart Surgery - Also known as Minimal Invasive Direct Coronary Artery Bypass (MIDCAB), Robotic Assisted Coronary Artery Bypass (RACAB) and Off-Pump Coronary Artery Bypass (OPCAB). This is a sophisticated procedure where the heart is not stopped but continues to beat while the surgeon performs the Coronary Artery Bypass Grafting procedure. This alternative to Open Heart Surgery is considered if you have poor heart and / or lung function, if you have acute or chronic kidney disease, if you are at a high risk for stroke or if you have a calcified aorta.
• Cardiac Catheterization - Cardiac Catheterization is a surgical procedure where a thin, flexible tube is inserted and threaded through your artery or vein in the groin (femoral or iliac), neck (carotid) or forearm either elbow or wrist (radial).
• Coronary Angioplasty - Coronary Angioplasty or Balloon Angioplasty is a minimally invasive procedure in which the blocked or narrowed coronary arteries are opened to facilitate profusion of the heart tissue. Coronary Angioplasty reduces the need for medication and eliminates angina chest pain.
• Coronary Stenting - Coronary Stenting is a procedure in which a metal mesh or tube (stent) is placed to help keep your coronary artery open.
• Drug Eluting Coronary Stenting - In the procedure for Drug Eluting Coronary Stenting, the implanted stent is coated with a medication that prevents re-stenosis. This type of stent consistently releases a chemical substance that prevents clot formation and narrowing of coronary artery. Drug Eluting Coronary Stenting has been 20-30% more successful than bare metal stenting.
• Valvuloplasty - Valvuloplasty is a procedure in which a small balloon is inserted and inflated to stretch and open a narrowed (stenosed) heart valve.

Now or Never

• Over the past few years, there have been great advances in the surgical treatment of heart disease. The diagnostic tests like Coronary Angiogram, Echocardiogram and Electrocardiogram helps your physician to identify the location, type and extent of your heart disease. The results of these tests, the structure of your heart, your age, and your lifestyle will help your cardiologist, surgeon, and most importantly YOU to decide what type of procedure will be best for you.

Decision to have Open Heart Surgery

• For your peace of mind, it is very important to discuss all the aspects of Open Heart Surgery with your surgeon to help you make an informed decision. Your team of health care professionals will tailor the management of your heart condition according to your unique needs to provide you the most benefit from Open Heart Surgery.