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Heart surgery: What to expect

A man in a hospital bed reaches up, his hands meeting gloved hands to form a heart shape

An overview of what will happen before, during and after open-heart or minimally invasive heart surgery.

Knowing you need heart surgery can leave you with a lot of questions—and stress. It may help to learn what to expect before, during and after surgery.

Why surgery?

Heart surgery can treat a variety of heart problems, including heart failure and coronary artery disease, according to the National Heart, Lung, and Blood Institute (NHLBI). The most common heart surgery is coronary artery bypass grafting, a surgery used to bypass blocked arteries and restore blood flow, reports the American Society of Anesthesiologists.

Surgery is typically recommended only after other treatments—such as lifestyle changes, medicine and other medical procedures—have failed. Along with restoring blood flow, surgery can also be done to:

  • Normalize heart rhythms.
  • Relieve chest pain.
  • Reduce the risk of heart attack.
  • Repair or replace heart valves or other faulty structures.
  • Implant medical devices that regulate heart rhythms or blood flow.
  • Replace a damaged heart with a healthy heart from a donor.

Before surgery

If you are able to plan your surgery, you'll probably meet with your healthcare team to discuss what to expect and receive instructions for how to prepare. However, some people need emergency surgery and don't have time for planning and preparation.

Here are some things to expect, according to the NHLBI:

  • You will have an intravenous (IV) line placed in your arm to supply you with fluids and medicines.
  • The surgical site will be shaved and washed with special soap to reduce the risk of infection.
  • You will be given anesthesia to help you fall asleep and feel no pain during the surgery.

During surgery

Heart surgery is done by a team of medical experts, including a cardiothoracic surgeon and other doctors and nurses. How long the surgery takes depends on the goal of the surgery and whether it is an open-heart or a minimally invasive surgery. Briefly, here are the differences:

Open-heart surgery. Once you are under anesthesia, the surgeon makes a 6- to 8-inch incision down the center of the chest and cuts through the bone below to open the rib cage.

A heart-lung bypass machine may be connected to the heart, taking over its pumping action. Medicines are used to stop the heartbeat, allowing the surgeon to operate on a heart that isn't pumping. After surgery, the heart is restarted with electricity, the chest bone is closed with wires, and the incision is stitched or stapled.

Open-heart surgery can also be done without the bypass machine. For an off-pump heart surgery, the surgeon uses a mechanical device to steady the heart, but the heart continues to beat and pump blood. According to the NHLBI, benefits of off-pump surgery may include less bleeding; a faster recovery; and a reduced risk of complications, such as stroke.

Minimally invasive heart surgery. Instead of opening the chest and rib cage, the surgeon makes small incisions on the side of the chest between the ribs. These incisions are used to insert surgical tools and a small video camera, allowing the surgeon to see and operate inside the body.

Not opening the chest can mean less bleeding during surgery, lower risk of infection, less pain, smaller scars, a shorter hospital stay and a faster recovery.

Some types of minimally invasive surgery use a heart-lung bypass machine; other types don't.

According to the NHLBI, both minimally invasive and open-heart surgeries have risks, which can include:

  • Bleeding.
  • Infection, fever and swelling.
  • An adverse reaction to anesthesia.
  • Arrhythmias (irregular heartbeats).
  • Damage to the heart, kidneys and lungs.
  • Death.

These risks are generally higher if the surgery is done in an emergency situation. Risk may also be higher if you have other conditions, such as diabetes, kidney disease or lung disease.

After surgery

You may spend a day or more in the intensive care unit before being moved to another room in the hospital. There, you will be monitored until your healthcare team decides you can go home.

You will get specific instructions about caring for yourself at home, such as:

  • How to care for incisions.
  • How to recognize signs of infection or other complications.
  • When to call the doctor.
  • When to schedule follow-up appointments.
  • How to take medicines.
  • What to expect, which may include muscle pain; chest pain; swelling; and changes in mood, sleep and appetite.
  • When you can return to regular activities, such as working, driving and exercise.

It may take three months or more to fully recover from open-heart surgery, according to the NHLBI. Recovery from minimally invasive operations may not take as long.

Reviewed 11/18/2023

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