What To Expect During Heart Surgery

Heart surgery is done in a hospital. A team of experts is involved. Cardiothoracic surgeons perform the surgery with a team of other doctors and nurses who assist.

 

An open heart bypass surgery is performed under general anesthesia, which requires that the patient be on a ventilator during surgery.

 

Surgery begins with harvesting the blood vessels that will become the grafts. The saphenous vein in the leg is commonly used because it is long enough to create multiple grafts. If the saphenous vein cannot be used, vessels from the arm can be used instead. The left internal mammary artery is used for a single graft and is taken once the chest is opened for surgery.

 

Once the saphenous vein has been recovered, the chest is opened by making an incision along the sternum, or breastbone. The surgeon then cuts the sternum, allowing the chest cavity to be opened, giving the surgeon access to the heart.

 

In the traditional CABG procedure, the heart is stopped with a potassium solution so the surgeon is not attempting to work on a moving vessel, and the blood is circulated by a heart-lung machine. At this time the heart-lung machine does the work of the heart and the lungs, and the ventilator is not used.

 

The surgeon places the grafts, either rerouting blood around the blockage, or removing and replacing the blocked vessel. The amount of time on the heart-lung bypass machine is determined by the speed at which the surgeon is able to work, primarily, how many grafts are needed.

 

Once the grafts are complete, the heart is started and provides blood and oxygen to the body. The sternum is returned to its original position and closed using surgical wire, to provide strength the bone needs to heal, and the incision is closed.

 

 

Traditional Open-Heart Surgery

For this type of surgery, you're given medicine to make you fall asleep. A doctor checks your heartbeat, blood pressure, oxygen levels, and breathing during the surgery. A breathing tube is placed in your lungs through your throat and connected to a ventilator.

 

A surgeon makes a 6- to 8-inch incision down the center of your chest wall. Your breastbone is cut and your rib cage is opened so that the surgeon can get to your heart.

 

You're given medicine to thin your blood and keep it from clotting. A heart-lung bypass machine is connected to your heart. This machine takes over for your heart by replacing its pumping action.

 

A specialist oversees the machine. The bypass machine allows the surgeon to operate on a heart that isn't moving and full of blood.

 

 

Heart-Lung Bypass Machine

 

 

 

The illustration shows how a heart-lung bypass machine works during surgery.

 

You're given medicines to stop your heartbeat once you're connected to the heart-lung bypass machine. A tube is placed in your heart to drain blood to the machine.

 

The machine removes carbon dioxide from your blood, adds oxygen, and then pumps the blood back into your body. Tubes are inserted into your chest to drain fluid.

 

Once the bypass machine begins to work, the surgeon does the surgery to repair your heart problem.

 

After the surgery is done, blood flow to your heart is restored. Usually, the heart starts beating again on its own. In some cases, mild electric shocks are used to restart the heart.

 

Once the heart has started beating again, the tubes are removed and the heart-lung bypass machine is stopped. You're given medicine to allow your blood to clot again.

 

The surgeon uses wires to close your breastbone. The wires stay in your body permanently. After your breastbone heals, it will be as strong as it was before the surgery.

 

Stitches or staples are used to close the skin incision, and the breathing tube is removed when you're able to breathe without it.

 

Off-Pump Heart Surgery

This type of surgery is the same as traditional open-heart surgery, except you aren't connected to a heart-lung bypass machine. Instead, your heart is steadied with a mechanical device while the surgeon works on it. Your heart continues to pump blood to your body.

 

Minimally Invasive Heart Surgery

For this type of heart surgery, the surgeon makes small incisions in the side of your chest between the ribs. These incisions can be as small as 2 to 3 inches. Then the surgeon inserts surgical tools through these small incisions.

 

A tool with a small video camera at the tip also is inserted through an incision. This allows the surgeon to see inside the body.

 

Some types of minimally invasive heart surgery use a heart-lung bypass machine; other types don't.

 

What Are the Risks of Heart Surgery?

Heart surgery has risks, even though its results often are excellent. Risks include:

 

In general, the risks of heart surgery are higher for people who:

 

The use of a heart-lung bypass machine increases the risk of blood clots forming in your blood vessels. Clots can travel to the brain or other parts of the body and block the flow of blood. This can cause stroke or other problems.

 

Improvements in heart-lung bypass machines and heart surgery techniques are helping reduce the risk of blood clots.

 

 

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