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Heart Surgery:
A guide to the procedure, risks, and recovery



1.What is heart surgery?

Heart surgery

A surgical procedure that is performed to resolve a health concern related to the heart is called a heart surgery or a heart operation. A heart surgery may involve:

  • Correcting a damage in the heart, either congenital (such as a hole in the heart) or acquired
  • Repairing heart valves that control the flow of blood to and from the heart and maintain blood pressure
  • A procedure to implant a device in the heart such as a stent to stabilize and normalize heart function is a more common cardiac surgery
  • A heart transplant where a healthy heart from a donor replaces a damaged heart in a recipient



2.Why is heart surgery performed?

A heart surgery is performed to correct any abnormalities in heart functioning that cannot be cured through drugs and lifestyle changes. Any cardiac surgery is undertaken with the purpose of ensuring a steady heartbeat that is not too slow or too fast, and a pumping action that is strong enough to maintain the requisite blood pressure during all forms of bodily activity, as well as to ensure that the heart is able to supply oxygen and nutrients to all parts of the body.

Sometimes, a heart operation does this by clearing an arterial blockage, and other times, this is done by steadying erratic heartbeat. Different types of heart surgery are recommended by cardiologists based on the pathophysiology of the heart and the body's response to non-invasive corrective measures such as heart-specific drugs.

Any number of factors can weigh in on a recommendation for a heart surgery, including:

  • Overall health
  • Age of the patient
  • Susceptibility to complicating factors such as diabetes or a history of heart trouble
  • The number and duration of symptoms, if there
  • Family history of heart and health problems
  • Activity levels

Angina, which is pain associated with reduced blood flow to the chest, shortness of breath without much physical exertion or arrhythmia, which is the irregular beating of the heart, are all indications that you must consult with a cardiologist or heart surgeon immediately.



3.Common types of heart surgery

Heart surgery types

Heart surgery is varied across patients depending on their symptoms and their underlying causes. Cardiac surgery performed has evolved to be specific to different heart concerns over the last few decades. The most commonly performed types of heart surgery are:

Open heart surgery:

The most traditional form of heart surgery, open heart surgery involves an invasive procedure where the chest is cut open to expose the heart and its surrounding blood vessels, after which a surgical procedure corrects the concerns through various techniques.

Heart surgery may be performed directly on the heart muscle, or on one of the arteries or valves connecting to it. This process involves the connection of the patient to a heart-lung machine that substitutes as an artificial heart at the time of the heart surgery, and oxygenates the blood since the heart is being operated upon and has been stopped to allow precision. Heart valve surgery and correction of congenital heart defects such as a hole in the heart walls are the most common types of open heart surgeries.

Open heart surgery has been the reason to reduce heart disease related mortality across the world and has evolved to be a safe procedure for most patients. The fact that open heart surgery cost has gone down in recent times has also made it a more frequently performed procedure and helped make it one of the most relied-upon techniques to drive better patient outcomes.

Heart Bypass Surgery:

It is one of the most common types of open heart surgeries where a graft is needed for the coronary artery which is affected by plaque build up or another kind of irreversible blockage. The grafted artery allows the heart to bypass the blockage while transporting blood, thus normalizing its functioning. Coronary artery disease (CAD) is the major indication for a bypass heart surgery, and most commonly occurs as the arteries harden over time due to fat build up inside them. This can result in shortness of breath, heaviness or tightness felt in the chest region, chest pain or a squeezing sensation. It also often precedes a heart attack. A timely diagnosis can help the doctor recommend a bypass heart surgery as a preventative measure.

Heart transplant surgery:

It is a last resort in case of impending heart failure and is recommended only in the most severe of situations. In case of cardiomyopathy that cannot be corrected by minor procedures or implantation of a medical device, or in cases of irreparable birth defects of the heart, a heart transplant surgery is suggested by the doctor. This procedure requires a donor and heart recipient to match blood and tissue types, despite which the heart transplant surgery requires the use of anti-rejection drugs to ensure that the received heart is accepted by the recipient body.

Minimally invasive cardiac surgery procedures:

They are safer and have a lower risk of complications that open heart surgeries. Another benefit is that the recovery period after a minimally invasive procedure is much less than an open heart surgery. A minimally invasive cardiac surgery requires the heart surgeon to make smaller incisions around the chest region, instead of opening up the heart cavity completely. Today, even a coronary arterial bypass heart surgery may be performed through a minimally invasive cardiac surgery procedure, resulting in reduced trauma to the body, overall.

Pediatric heart surgery:

It refers to heart surgery procedure that is performed on a child who may be born with heart defects, or at some stage, has acquired one. Pediatric cardiac surgery is an especially sensitive process in infants, but have become safer over time, offering a high rate of success. This may involve a heart transplant surgery, or sometimes a closed heart surgery (thoracotomy) where the rib cage does not need to be cut open, but an incision is made between the ribs.

Angioplasty and stent replacement surgery:

It is performed when major arteries near the heart are clogged due to plaque build up. A stent heart surgery involves a stent, which is a small tube with a balloon attached at one end, that is inserted into the artery. This cardiac surgery procedure is very commonly used and helps restore blood flow despite the blockage. The balloon is inflated once the stent is in place, and causes the arterial wall to be pushed outward and essentially widening the blood vessel to aid normalized blood flow. A stent replacement procedure is done to replace an existing device in case it is worn out or otherwise defective.

A heart valve may become defective due to several factors, and would then require either correction or replacement. A valve replacement surgery addresses one of the four major valves near the heart, namely:

  • Mitral valve
  • Tricuspid valve
  • Pulmonary valve
  • Aortic valve

Each of these valves allows blood to flow in a single direction between chambers in the heart, or out of the heart to the body and vice versa, preventing oxygenated and deoxygenated blood from mixing. Heart surgery types involving these valves are annuloplasty which address a concern where a ring around the valve becomes loose, or valvuloplasty, wherein the valve flaps stiffen or fuse with each other.



4.Are you the right candidate for heart surgery?

Heart operation consultation

A candidate for cardiac surgery needs to satisfy a few criteria to be considered for undergoing the procedure. Depending upon many factors such as age, attitude, overall health, the severity of the heart condition and symptoms of heart disease.

While considering the patient's recovery, a heart doctor will necessarily consider such concerns such as their willingness to make lifestyle changes such as quitting smoking and reduction in alcohol consumption. It is also understood that octogenarian patients may not fare as well as younger patients after cardiac surgery, and may show more severe trauma symptoms during the recovery period.

If you have an underlying heart disease and suffer from frequent fainting spells, momentary blackouts, chest pain, shortness of breath and / or recurring fatigue and palpitations, you may be a candidate for one of the types of heart surgery. It is best to clarify all questions and concerns with your doctor relating to recovery and required lifestyle changes if you are to undergo an open heart surgery and continue to live an active lifestyle.



5.How do I prepare for heart surgery?

A life-changing event, a heart surgery can free you from limiting circumstances of health and heart conditions, and allows most patients to enjoy a better quality of life. Preparing for a heart surgery requires a few changes, a major one being that of appointing a caregiver who is present throughout the recovery time which can be a length of several months for some patients. In case an episode of loss of consciousness or an acute shortness of breath occurs, it is best to have a person contact the doctor while performing emergency measures.

Other changes include quitting smoking two to three weeks prior to surgery, light exercises to regularize blood circulation and blood pressure as much as possible prior to cardiac surgery, and a generally healthier lifestyle. It also includes stopping certain medication that may interfere with the heart operation or the anaesthesia that is administered during the procedure. This helps the body prepare itself for a heart surgery which is an invasive procedure that is quite straining on the body.



6.Complications and risks that may arise

Complications are possible after a heart surgery is carried out, and the risk of heart surgery complications vary from patient to patient.

The side effects of open heart surgery include:

Infections: This is rare but possible, and may occur in patients who have undergone heart surgery in a hospital environment that is not sterile, or may be due to contagion.

Angina: Chest pain is a usual symptom that necessitates cardiac surgery, but may also show up as a side effect. It may happen due to venous thrombosis and will be resolved by doctors if happening when the patient is under observation after surgery.

Blood clots: Clots in veins can arise after surgery due to several reasons, and these can cause angina, and in severe cases, myocardial infarction. The risk of such an incident is rare today, but observation of a patient after heart surgery is recommended to monitor occurrence of such symptoms.

Internal bleeding: In case of incorrect placement of a stent or a different medical device during a cardiac surgery, bleeding near the heart region might occur and may be either as a hematoma that forms clots, or a haemorrhage which is active bleeding and needs to be stemmed to prevent blood leaking into surrounding tissue. Hematomas chances can increase for patients receiving anticoagulation drugs prior to heart surgery.

Organ failure: In case of older patients, trying to stimulate the heart can cause failure in the kidneys. Susceptibility to such may also be due to factors unrelated to age, and have been seen during coronary bypass heart surgeries.

Over the last two decades, open heart surgery as well as closed heart surgery have grown significantly more sophisticated, and continuous monitoring of all vital signs, as well as non-vital health related symptoms allow preparedness for eventualities such as severe side effects. Heart surgery has become safer and is now commonly offered by some of the top heart surgeons in India and abroad as a more or less mainstream solution for heart trouble.



7.How do I recover from heart surgery?

Diet after heart surgery

Open heart surgery recovery time can be a stressful period, overall recovery will take a few weeks to a few months, based on care provided post-operation, genetic preclusion of heart disease, post-operative stresses in life that might hamper open heart surgery recovery by countering its benefits, and consistent care towards lifestyle and overall well being.

The following recommendations are provided by the best cardiac surgeons in India on our medical staff:

Quit smoking: It is hard to wean a patient off a particular long term habit such as smoking, and it is necessary that this change is made to their lifestyle even prior to heart surgery.

Incision care: The skin around the incisions during surgery may become swollen, red, itchy and even open up or ooze fluid, making it very necessary to continue to monitor the area after the procedure.

Pain management: Open heart surgery may cause pain during the healing time for some patients, and efficient medication aids in less stressful recovery and quicker healing.

General lifestyle changes: Open heart surgery recovery time may be reduced if a diet causing lower inflammation levels in the body and light exercises that aid blood pressure and circulatory balance are incorporated as part of daily life.



8.Precautions to take after heart surgery

  • Exercise after open heart surgery should be light, and not involve raising the arms over the head for very long durations or heavy lifting
  • Medications must be taken after consultation with cardiologist who will determine if it can negatively affect heart health
  • Diet after open heart surgery should be wholesome and lack processed foods if possible, and be anti-inflammatory for the body. An open heart surgery diet plan would normally include a diet rich in heart-healthy fats and protein such as oily fish, legumes and nuts, and reduce acidity and gastric complication causing foods that are high in processed sugar and saturated fats and cholesterol;.
  • Presence of a caregiver would be highly recommended in case of an open heart surgery procedure to prevent sudden occurrences of symptoms such as loss of consciousness



9.Heart surgery FAQs: All your concerns addressed

Q.   What are my restrictions after open-heart surgery?

  1. After heart surgery, it is for your betterment to follow the doctor's guidelines strictly. Your breastbone after heart operation may take two or three months to heal, so you have to be much careful about your actions. The following are the restrictions for heart patients after cardiac surgery.
    1. Do not drive without your surgeon's permission
    2. Avoid extreme stretching of arms
    3. Don't lift heavyweight
    4. Don't put pressure on your arms for supporting your upper body
    5. Don't bend, push, pull, and stretch
    6. To decrease pressure while coughing or taking deep breaths, hold a pillow for a support

Q.   How do I lower my risk of pneumonia after heart surgery?

  1. After the removal of your breathing tube, your surgeon prescribes an incentive spirometer device that helps you in breathing. It is vital for improving your breathing and deplete the risk of pneumonia. You can do breathing exercises ten-time each hour when you are in the hospital. Ask your physician about how to use an incentive spirometer.

Q.   What should I do after heart surgery to heal my body?

  1. The healing process of heart surgery can take 4 to 6 weeks. Before your discharge from the hospital, learn all the important instructions that help you in getting rid of heart surgery pain and wounds.
    1. Keep the wound clean and dry.
    2. Take prescribed painkillers for pain relief
    3. Standing for more than 15 minutes can hurt you.
    4. Healthy food choices will help you in the healing process.
    5. Try to take small meals to not create pressure on your digestive tract.
    6. You can do a little exercise to maintain the blood flow.
    Don't follow anything without your doctor's advice.

Q.   How do I care for someone who has undergone heart surgery?

  1. It is important to ensure that the patient's lifestyle changes are supported by those around them, and to care for patients of cardiac surgery, it is helpful to offer psychological support by aligning some of these changes, especially those that have to do with social habits such as smoking and alcohol consumption, as well as meals. It is also helpful to someone recovering from heart surgery to have a companion during exercise after open heart surgery since injuries resulting from a fall or dizziness at this time can be much more severe for them.

Q.   How long should I stay in the hospital after heart surgery?

  1. Depending on the procedure, patients of heart surgery can be asked to stay anywhere between 2 to 7 days under observation in a hospital. In case of post open heart surgery complications, the stay may go up to 3 weeks to ensure that all symptoms are closely monitored and any abnormalities are addressed with immediacy by hospital staff. Minimally invasive cardiac surgery usually has the lowest recovery and hospital stay durations.

Q.   Will the heart operation be painful

  1. Heart operation is performed on the patient while under anaesthesia, either general or local, and it is rare for pain to be felt during the procedure, although the numbing sensation is uncomfortable for some patients. A tightness may be felt in the chest as well. Pain medication is prescribed after the heart surgery that does not interfere with heart complications, but aids recovery by reducing stress and trauma borne by the body. If you feel any pain during the process, it is necessary to communicate it to the heart surgeon so that the requisite adjustments may be made by team performing cardiac surgery. It is, however, common to feel pain sometimes in postoperative conditions.

Q.   What is the duration of heart surgery?

  1. Average heart surgery can last for three to four hours, but sometimes the timing can depend on the complexity of the surgery as well. The doctors and nurses will prep you one hour before the surgery takes place, this means that they will make you feel as comfortable and secure as possible.

Q.   Can a patient go through open-heart surgery, twice?

  1. Some patients may experience complications after surgery, like a heart valve infection, and this may lead to another surgery. Sometimes, successful valve replacements and coronary artery bypasses may require a re-operation. However, this is not a common occurrence.

Q.   How long will it take for open-heart surgery?

  1. The length of time to schedule a heart surgery depends on the patient’s heart condition and their needs. Mostly, coronary artery bypass surgery will take around three to six hours. If the patient is scheduled for open-heart surgery then they will have to stay at the hospital for seven to ten days; this is including a day in the intensive care unit after the surgery is done. The prep for the surgery will start the night before, and the patient cannot have any meal or drink after midnight. Since this surgery is a major operation, it will require close monitoring and immediate post-surgery support.

Q.   Is open heart surgery painful?

  1. During the recovery process, you will experience some discomfort and pain around the cur and in your muscles. Sensations like itching, tightness, and numbness are completely normal. The pain intensity won’t be severe, and if you have has a bypass then you may feel some pain in the legs because the surgeon has used leg veins as grafts in your chest. Once you are ready to leave the hospital, the doctor will prescribe you some pain medications.

Q.   Will heart surgery shorten your life span?

  1. While heart surgery can’t cure heart diseases completely, it should be able to provide relief from chest pain and help you live longer. Patients who are suffering from serious artery diseases and who have undergone bypass surgery are fifty percent more likely to be alive and have a longer life span than patients who receive only drug treatment.

Q.   Can you die during heart surgery?

  1. With the latest advancements in technology and medicine today, more than ninety-five percent of patients who have undergone bypass surgery do not experience any severe complications or at risk of death during/after the surgery. Also, patients are at higher risk if they have not done heart surgery (above the age of 70) and are relying on drugs for their health.

Q.  Can you live a long and healthy life after heart surgery?

  1. Mostly, yes. However, the life expectancy after the coronary bypass surgery depends on the individuals’ risk factors; this includes ventricular functions and how well the muscles of the heart work. If the heart muscles are well, then the life expectancy will be normal.

Q.   Is open heart surgery and bypass surgery the same?

  1. Heart bypass surgery is usually an open heart surgery, where the surgeon will cut open the chest to reach the heart. The surgeon will perform the surgery “off-pump” or “on-pump”. “On-pump” surgery will involve a heart-lung machine that will circulate blood and oxygen through the body, during the operation.