surgeon can operate on a still heart, there is a
growing trend toward “off pump” operations that
do not use cardiopulmonary bypass.
Surgical Procedure
For open heart surgery, the surgeon makes a long
incision lengthwise along the top of the sternum
(breastbone) through the SKINand tissues beneath,
and then makes a similar saw-cut through the
sternum to enter the chest cavity. Special retrac-
tors spread the sternum and hold the incision
open. To reach the heart, the surgeon must open
the PERICARDIUM, the protective membranous sac
that surrounds the heart. Often the surgeon leaves
the pericardium open after the operation on the
heart, to shorten surgery time and reduce the risk
for postoperative complications.
For operations using cardiopulmonary bypass,
the surgeon attaches the heart’s major vessels to
large tubes called cannulas, then clamps the heart
vessels closed. The blood reroutes through the
bypass machine. The surgeon can then bathe the
heart in a cold concentrated potassium solution,
which causes the heart to stop beating (cardiople-
gia). After completing the operation the surgeon
reverses the process to restore circulation through
the heart, closes the sternum with sturdy wire
sutures and the skin with nylon sutures or staples.
The SCARthat remains after the surgical wound
heals remains fairly prominent for two to three
years, after which it fades to a thin line.
When the operation is “off pump,” the surgical
team lowers the person’s body temperature to
slow body functions including heart contractions.
The surgeon operates on the moving heart, which
requires precise technique and timing. Inadvertent
damage to the heart is a significant risk.
Risks and Complications
Many of the risks of open heart surgery are the
same regardless of the operation. Key among
them are
- excessive bleeding due to anticoagulants
- air embolism during cardiopulmonary bypass,
which can cause STROKE - difficulty restoring the heart to normal rhythm
- failure of the surgical procedure
- surgeon error
- unexpected anatomic anomalies
General complications that can occur after sur-
gery include- bleeding at the operative site or at the surface
surgical wound - INFECTION, either affecting the heart or the surgi-
cal wound - blood clots, which may cause PULMONARY
EMBOLISM, HEART ATTACK, or stroke - ARRHYTHMIA
- HYPERTENSIONandHEART FAILURE
Surgeons and the health-care team are alert for
complications that can arise. Most people stay for
12 to 48 hours in a specialized cardiac surgery
intensive care unit, where staff monitor cardiopul-
monary function continuously. Many potential
postoperative complications become less likely by
48 hours from surgery, though many people stay
in the hospital for up to 10 days until the surgeon
is confident that HEALINGis well under way.Outlook and Lifestyle Modifications
The outlook following open heart surgery depends
to great extent on the reason the surgery was nec-
essary. Many people return to normal activities
after they recover from their operations, though
may require frequent follow-up visits or medica-
tions. This is especially true for heart transplant
recipients. The likelihood of complications dimin-
ishes as time passes and healing becomes complete.
Most people need to make some lifestyle
changes after open heart surgery, typically in eat-
ing and exercise habits. Cardiologists recommend
a diet that is nutritiously balanced and daily exer-
cise such as walking. CARDIAC REHABILITATIONpro-
grams help people get started with such changes,
providing customized plans to accommodate the
person’s starting point as well as recovery goals.
See also LIFESTYLE AND CARDIOVASCULAR HEALTH;
LIVING WITH CARDIOVASCULAR DISEASE; POSTOPERATIVE
PROCEDURES; PREOPERATIVE PROCEDURES; SURGERY BEN-
EFIT AND RISK ASSESSMENT.Ornish program An intensive lifestyle-oriented
method for reducing the risk for CORONARY ARTERYOrnish program 91