Open Heart Surgery

Open Heart Surgery is done to treat various heart conditions, such as heart failure, congenital heart defects, arrhythmias, aneurysms, and coronary artery disease. In this procedure, the surgeon cuts through the breastbone and spreads the ribcage to access the heart.

Common Open-Heart Surgeries are Coronary Artery Bypass Grafting (CABG), heart transplant, and valve replacement. This method involves opening the chest wall to facilitate access to the heart. Surgeons achieve this by cutting through the sternum (breastbone) and spreading the ribs, a process often referred to as "Cracking the Chest".

While Open Heart Surgery is a reliable approach for treating heart problems, various advancements in heart surgery has paved path for smaller, less invasive incisions also. These may include small incisions between the ribs on the right side of the chest, offering alternatives for those who may benefit from less extensive procedures.

Why Is Open Heart Surgery Needed?

Open heart surgery may be recommended if you are diagnosed with any of the following heart conditions:

• Arrhythmias, including atrial fibrillation
• Congenital heart defects, such as atrial septal defect (a hole in the heart) or hypoplastic left heart syndrome (underdeveloped heart structures)
• Coronary artery disease
• Heart failure
• Heart valve disease
• Thoracic aortic aneurysm

In preparation for Open Heart Surgery, it is crucial to adhere to your healthcare provider's guidance regarding:

• Medications: Your healthcare provider may recommend discontinuing certain medications a week or two before the surgery. This often includes blood thinners (such as aspirin, warfarin, or other anticoagulants) and nonsteroidal anti-inflammatory drugs (NSAIDs), as they can heighten the risk of bleeding.
• Food & drinks: Your healthcare team will advise you to fast, refraining from eating or drinking before the surgery. An empty stomach enhances the safety of anesthesia.
• Smoking & alcohol: It is advisable to reduce alcohol intake and cease smoking before the surgery. Both habits can impede post-surgical healing and elevate the risk of complications.

Before undergoing Open Heart Surgery, you can anticipate the following preparations:

• Diagnostic tests: Chest X-rays, an electrocardiogram (EKG), or other tests will be conducted to assist the surgeon in planning the procedure.
• Chest preparation: Your chest may be shaved in preparation for the surgery.
• Surgical area sterilization: The surgical site will be sterilized using antimicrobial soap to eliminate bacteria.
• Intravenous line (IV): An intravenous line will be established in your arm to administer fluids and medications.

Heart surgery is an intricate procedure which may extend for six hours or more. Throughout the surgery, you will be under anesthesia, ensuring you are asleep and unaware of the proceedings.

In the operating theater during Open Heart Surgery, a collaborative team of healthcare professionals, including doctors, works together. The team typically comprises:

• The lead surgeon, who oversees other assisting surgeons during the operation
• The anesthesiologist, responsible for administering anesthesia and monitoring vital signs
• The pump team, also known as perfusionists, who operate the heart-lung machine and other technical equipment essential for supporting open heart surgery 
• Nurses and technicians who assist the surgical team and ensure the operating theater is prepared for the surgery

The specific steps of the open heart surgery vary based on the heart condition and the nature of the procedure. Your surgeon will proceed in following manner:

1. An incision, typically 6 to 8 inches in length, will be made down the middle of your chest
2. The doctor will cut the breastbone and spread the ribcage apart to gain access to your heart
3. If the open heart surgery involves the use of an on-pump technique, the heart is connected to a heart-lung bypass machine. An anesthesiologist administers intravenous medication to halt your heart's beating and monitors your condition throughout the surgery
4. Heart repairing will be performed
5. Restores blood flow to the heart. Typically, the heart resumes beating on its own, but occasionally a mild electrical shock may be applied to restart it.
6. Disconnects the heart-lung bypass machine.
7. Closes the breastbone or other incision using wires or sutures that remain in your body.
8. Utilizes stitches to close the skin incision.

Open Heart Surgery is a major surgical intervention, and like any surgical procedure, it comes with inherent risks. The likelihood of complications is higher for individuals with existing health issues such as diabetes or obesity. Conditions like chronic obstructive pulmonary disease (COPD) that affect the lungs can also elevate the risk. Additionally, those who smoke are more susceptible to both surgical and post-surgical complications.

Potential risks associated with Open Heart Surgery are:

• Allergic reactions to anesthesia
• Arrhythmias, characterized by an irregular heartbeat
• Bleeding
• Damage to surrounding blood vessels or organs, including the lungs or kidneys
• Infections
• Stroke

Depending on the specific procedure, your stay in the hospital intensive care unit (ICU) may extend for a day or more. Once you are deemed ready, you will be transferred to a standard hospital room. You can a hospital stay of several days, during which your heart care team will provide instructions on caring for your incision. You might be provided with a specialized firm pillow to safeguard your chest when coughing, sneezing, or getting out of bed.
Post-surgery, you may encounter:

• Constipation, which is a common side effect of potent pain relievers
• Feelings of depression or mood swings
• Insomnia or difficulty sleeping
• Loss of appetite
• Memory problems
• Muscle pain in the chest area
• Pain, bruising, and slight swelling at the incision site

The duration of recovery after open heart surgery depends on factors such as the type of surgery, potential complications, and your pre-surgery health. Recovering from an open-heart procedure may take anywhere from 6 to 12 weeks, and in some cases, even longer.

Your surgeon will provide guidance on when you can resume work and other activities. Generally, it is advised to refrain from driving or lifting heavy objects for the initial six weeks.

Some individuals may require blood thinners post-open heart surgery to mitigate the risk of blood clots. Additionally, your healthcare provider might suggest participation in cardiac rehabilitation, a supervised program aimed at helping you regain strength and stamina while enhancing overall heart health.

Open Heart Surgery, despite its complexity, boasts a remarkably low risk of mortality. In a 2013 study, the in-hospital mortality rate was as low as 2.94 percent. The positive outlook continues with impressive survival rates that vary depending on the specific procedure and the extent of issues addressed during the operation. However, its important to highlight that while this surgery may carry more risk for individuals who are severely ill or have underlying medical conditions, the overall survival rates underscore its success in providing positive outcomes. Success rates of various open heart surgeries are mentioned below:

• Mitral valve repair for mitral valve prolapse exhibits 100% survival rate
• Aortic valve replacement demonstrates 98.1% survival rate
• Coronary artery bypass surgery (CABG) shows 97.8% survival rate

The cost of Open Heart Surgery in India is generally more affordable than Western nations, while still maintaining world-class quality. The typical price range for such procedures in India spans from Rs. 75,000 to Rs. 1,00,000 ($939 - $1252).

Following are the factors affecting cost of Open Heart Surgery in India:

• Out of pocket expense
• Health insurance coverage
• Consultation fees
• Pre Surgical expenses
• Surgery cost
• Hospital fees
• Doctor fees
• Patients age
• Type of heart disease
• Type of surgery
• Overall health status of the patients
• Complications involved after the surgery
• City where hospital is located

The expenses associated with the preliminary assessments and examinations conducted prior to the Open Heart Surgery might cover various diagnostic procedures. These additional charges encompass tests such as X-rays, CT scans (computed tomography), MRI scans (magnetic resonance imaging), pulmonary function tests (PFTs), carotid doppler/ultrasound studies (carotids), ankle-brachial index (ABIs), surface echocardiograms (Echo), vein mapping, trans-esophageal echocardiograms (TEE), ECG-gated SPECT myocardial perfusion imaging (stress test), heart catheterization (Cath), cardiac magnetic resonance imaging (MRI), and other diagnostic evaluations. The total expenses for these tests can vary between INR 1,00,000 and INR 1,50,000.

MedFlick, your trusted healthcare companion, is dedicated to ensuring that your medical journey goes as smoothly and successfully as possible.

• Individualized Guidance: Personalized guidance throughout your medical journey.
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• MedFlick provides everything from travel arrangements to hotel and visa help to lodging.
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• The road to a successful open heart surgery is challenging, full of hope, resilience, and the promise of a brighter future. With MedFlick as your guide, navigating this life-changing adventure becomes simple and liberating.