Open
Heart Surgery
According to the National
Heart, Lung, and Blood Institute (NHLBI)Trusted Source, coronary artery
bypass grafting (CABG) is the most common type of heart surgery done on adults.
During this surgery, a healthy artery or vein is grafted (attached) to a
blocked coronary artery. This allows the grafted artery to “bypass” the blocked
artery and bring fresh blood to the heart.
Open-heart surgery is
sometimes called traditional heart surgery. Today, many new heart procedures
can be performed with only small incisions, not wide openings. Therefore, the
term “open-heart surgery” can be misleading.
When is open-heart
surgery needed?
Open-heart surgery may be
done to perform a CABG. A coronary artery bypass graft may be necessary for
people with coronary heart disease.
Coronary heart disease
occurs when the blood vessels that provide blood and oxygen to the heart muscle
become narrow and hard. This is often called “hardening of the arteries.”
Hardening occurs when fatty
material forms a plaque on the walls of the coronary arteries. This plaque
narrows the arteries, making it difficult for blood to get through. When blood
can’t flow properly to the heart, a heart attack may occur.
Open-heart surgery is also
done to:
repair or replace heart
valves, which allow blood to travel through the heart
repair damaged or abnormal
areas of the heart
implant medical devices that
help the heart beat properly
replace a damaged heart with
a donated heart (heart transplantation)
How is open-heart
surgery performed?
According to the National
Institutes of Health, a CABG takes from three to six hours. It’s generally done
following these basic steps:
The patient is given general
anesthesia. This ensures that they will be asleep and pain free through the
whole surgery.
The surgeon makes an 8- to
10-inch cut in the chest.
The surgeon cuts through all
or part of the patient’s breastbone to expose the heart.
Once the heart is visible,
the patient may be 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.
The surgeon uses a healthy
vein or artery to make a new path around the blocked artery.
The surgeon closes the
breastbone with wire, leaving the wire inside the body.
The original cut is stitched
up.
Sometimes sternal plating is
done for people at high risk, such as those who’ve had multiple surgeries or
people of advanced age. Sternal plating is when the breastbone is rejoined with
small titanium plates after the surgery.
What are the risks of
open-heart surgery?
Risks for open-heart surgery
include:
chest wound infection (more
common in patients with obesity or diabetes, or those who’ve had a CABG before)
heart attack or stroke
irregular heartbeat
lung or kidney failure
chest pain and low fever
memory loss or “fuzziness”
blood clot
blood loss
breathing difficulty
pneumonia
According to the Heart and
Vascular Center at the University of Chicago Medicine, the heart-lung bypass
machine is associated with increased risks. These risks include stroke and
neurological problems.
How to prepare for
open-heart surgery
Tell your doctor about any
drugs you are taking, even over-the-counter medications, vitamins, and herbs.
Inform them of any illnesses you have, including herpes outbreak, cold, flu, or
fever.
In the two weeks before the
surgery, your doctor may ask you to quit smoking and stop taking blood-thinning
medications, such as aspirin, ibuprofen, or naproxen.
It’s important to talk to
your doctor about your alcohol consumption before you prepare for the surgery.
If you typically have three or more drinks a day and stop right before you go
into surgery, you may go into alcohol withdrawal. This may cause
life-threatening complications after open-heart surgery, including seizures or
tremors. Your doctor can help you with alcohol withdrawal to reduce the
likelihood of these complications.
The day before the surgery,
you may be asked to wash yourself with a special soap. This soap is used to
kill bacteria on your skin and will lessen the chance of an infection after
surgery. You may also be asked not to eat or drink anything after midnight.
Your healthcare provider
will give you more detailed instructions when you arrive at the hospital for
surgery
What happens after
open-heart surgery?
When you wake up after
surgery, you will have two or three tubes in your chest. These are to help
drain fluid from the area around your heart. You may have intravenous (IV)
lines in your arm to supply you with fluids, as well as a catheter (thin tube)
in your bladder to remove urine.
You will also be attached to
machines that monitor your heart. Nurses will be nearby to help you if
something should arise.
You will usually spend your
first night in the intensive care unit (ICU). You will then be moved to a
regular care room for the next three to seven days.
Recovery, follow-up,
and what to expect
Taking care of yourself at
home immediately after the surgery is an essential part of your recovery.
Incision care
Incision care is extremely
important. Keep your incision site warm and dry and wash your hands before and
after touching it. If your incision is healing properly and there is no
drainage, you can take a shower. The shower shouldn’t be more than 10 minutes
with warm (not hot) water. You should ensure that the incision site isn’t hit
directly by the water. It’s also important to regularly inspect your incision
sites for signs of infection, which include:
increased drainage, oozing,
or opening from the incision site
redness around the incision
warmth along the incision
line
fever
Pain management
Pain management is also
incredibly important, as it can increase recovery speed and decrease the
likelihood of complications like blood clots or pneumonia. You may feel muscle
pain, throat pain, pain at incision sites, or pain from chest tubes. Your
doctor will likely prescribe pain medication that you can take at home. It’s
important that you take it as prescribed. Some doctors recommend taking the
pain medication both before physical activity and before you sleep.
Get enough sleep
Some patients experience
trouble sleeping after open-heart surgery, but it’s important to get as much
rest as possible. To get better sleep, you can:
take your pain medication a
half hour before bed
arrange pillows to decrease
muscle strain
avoid caffeine, especially
in the evenings
In the past, some have
argued that open-heart surgery leads to a decline in mental functioning.
However, most recent research has found that not to be the case. Though some
patients may have open-heart surgery and experience mental decline later on,
it’s thought that this is most likely due to the natural effects of aging.
Some people do experience
depression or anxiety after open-heart surgery. A therapist or psychologist can
help you manage these effects.
Rehabilitation
Most people who’ve had a
CABG benefit from participating in a structured, comprehensive rehabilitation
program. This is usually done outpatient with visits several times a week. The
components to the program include exercise, reducing risk factors, and dealing
with stress, anxiety, and depression.
Long-term outlook for
open-heart surgery
Expect a gradual recovery.
It may take up to six weeks before you 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. You can help improve your
heart health by:
eating 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
Jan Ricks Jennings, MHA, LFACHE
Senior Consultant
Senior Management
Resources, LLC
JanJenningsBlog.Blogspot.com
412.913.0636 Cell
724.733.05009 Office
December 07, 2021
No comments:
Post a Comment