Open Heart surgery

Dr. Arvind Kohli
Open heart surgery is any tupe of surgery where the chest is cut open and surgery is performed on the muscles, values, or arteries of the heart. Open heart surgery is sometimes called traditional heart surgery. Today, many new heart procedures can be performed with only small incisions (cuts), not wide openings which is termed as Minimally Invasive Cardiac Surgery.
Why is open Heart Surgery Needed ?
Open Heart Surgery is indicated for following :
* Coronary artery bypass grafting (CABG) During this surgery, ahealthy artery or vein is grafted (attached) to a blocked coronary (heart) artery. This allows the grafted to bypass the blocked artery and bring fresh blood to the heart;
* Repair or replace diseased heart values, which allow blood to travel through the heart;
* Repair damaged or abnormal areas of the heart;
* Put in medical decices that help the heart to beat properly;
* Replace a damaged heart with a donated heart (heart transplantation).
How to p repare for open heart surgery?
In the two weeks before the surgery, patient has to quit smking and to stip taking blood-thinning medications, such as aspirin, ibuprofen, or naproxen. All major investigations required for undergoing General Anesthesia are done and patient is optimized 4 to 5 units to Blood have to be arragned.
How is open heart surgery performed?
The patient is given general anesthesia. This ensures the patient will be asleep and pain-free through the whole surgery . The surgeon cuts through all or part of the patient’s breastbone to expose the heart. This procedure is called Median Strenotimy. Once the heart is visible, the heart is connected to a heart-lung bypass machine. The machine moves blood away from the heart so that the surgeon can operate.  Some newer procedures do   not use this machine they are called as Off Pump Bypass procedures. The surgeon uses a healthy vein or artery to make an new path around the blocked artery. Or heart value is replaced with news value called prosthetic value or any procedure desired for correcting congenital heart disease. The surgeon closes the breastbone with wire, leaving the wire inside the body. The original cut is stitched up.
What are the risks of open heart surgery?
Risks for a open heart surgery includes chest wound infection (more common in patients with obesity or diabetes, or those who have had a CABG before), heart attack or stroke irregular heart beat, lung or kidney failure chest pain and low fever, memory loss or “fuzziness”, blood clot, blood loss and breathing difficulty. The heart-lung by pass machine performing cardiopulmonary bypass is associated with increased risks. These risks include stroke and memory problems.
What happens after open heart surgery?
When patient wakes up after surgery, patient will have two to three tubes in chest. These are to help drain fluids from the area around heart. They are Intravenous (IV) tubes supplying with fluids to body. Indwelling catheter (thin tube) in bladder to remove urine. Ventilatory support with a tube in the lungs called endotracheal tube patient is attached to machines that monitor the heart. Patient spends first night in the intensive care unit (ICU). Subsequently after recovery these supports are weaned off the patient and he is moved to a regular care room for the next three to seven days.
After Surgery?
Expect a gradual recovery. It may take up to six weeks before patient start feeling better, and up to six months to feel the full benefits of the surgery. However, the outlook is good for many people, and the grafts  can work for many  years.
Nevertheless, surgery does not prevent artery blockage from happening again. Patient can help improve heart health by :
* Eathing a healthy diet
* Cutting  back on foods high in salt, fat  and sugar
* Leading a more active lifestyle
* Not smoking
* Controlling high blood pressure and high cholesterol.
(The author is a Cardiac Surgeon SSH GMC Jammu)