Open-Heart Surgery 101

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Surgery Specifics

What types of surgeries qualify as open-heart surgery?
In the past 10 years or so, the notion of open-heart surgery has changed. However, what doctors still call open-heart surgery can be divided into two categories.

“The traditional type of open-heart surgery is called ‘cracking the chest open,’ where the breast bone is divided and the chest literally opened up to allow the surgeons to operate,” Mihaljevic says. “The other type of open-heart surgery is less invasive. Instead of dividing the breast bone, smaller incisions are made between ribs that allow the doctors to operate.”

Instead of the 8- to 10-inch scar down the center of the chest left by the traditional type of surgery, the less invasive surgery leaves only a couple of 2- to 3-inch scars. In addition, the two-incision method usually is less traumatic and allows patients to recover faster.

What happens during surgery?
First, to diagnose the problem, dye will probably be injected into the veins. A tube is inserted into the leg arteries that lead to your heart and dye is pumped into your vessels so the cardiologist can see where the blockages are. The dye provides the roadmap to assist the bypass surgery.

The surgery is usually done the first day you check into the hospital. Some additional tests may be conducted before heading under the knife. Like any other surgical procedure, you’re prepped beforehand and made ready, then put under general anesthesia.

For bypass surgery, the first step is to remove veins from the leg to use for the bypass. The veins will be used later to literally bypass blockages and improve circulation and blood supply to the heart muscle.

The surgery can be done with the heart beating or with the heart stopped. If the heart is stopped, a heart and lung machine breathes and circulates blood for the patient while the surgery takes place.

The surgery begins with an incision on the front part of the chest, and then a tool divides the breast bone. At this point the patient will be put on a heart and lung machine if needed. Then the doctor will stop the heart by placing a special clamp on the aorta and drenching the muscle with a potassium solution, which will stop it from beating. The next step is to connect the vessels, which is very intricate work. The vessels used are often only 1–3 millimeters in width. Once all the sutures are finished, the clamp is removed, normal blood flow is resumed, and the heart is sometimes given a small electrical shock to get it beating again.