What To Expect During Heart Surgery

Heart surgery is done in a hospital. A team of experts is involved. Cardiothoracic surgeons perform the surgery with a team of other doctors and nurses who assist.

The length of time for the surgery depends on the type of surgery. CABG, the most common type of heart surgery, usually takes 3 to 5 hours.

Traditional Open-Heart Surgery

For this type of surgery, you're given medicine to make you fall asleep. A doctor checks your heartbeat, blood pressure, oxygen levels, and breathing during the surgery. A breathing tube is placed in your lungs through your throat and connected to a ventilator (breathing machine).

A surgeon makes a 6- to 8-inch incision (cut) down the center of your chest wall. Your chest bone is cut and your rib cage is opened so that the surgeon can get to your heart.

You're given medicine to thin your blood and keep it from clotting. A heart-lung bypass machine is connected to your heart. This machine takes over for your heart by replacing the heart's pumping action. A specialist oversees the machine. The bypass machine allows the surgeon to operate on a heart that isn't moving and full of blood.

Heart-Lung Bypass Machine

The illustration shows a heart-lung bypass machine attached to a heart during surgery.

You're given medicines to stop your heartbeat once you're connected to the heart-lung bypass machine. A pipe is placed in your heart to drain blood to the machine. The machine removes carbon dioxide (a waste product) from your blood, adds oxygen, and then pumps the blood back into your body. Tubes are inserted into your chest to drain fluid.

Once the bypass machine begins to work, the surgeon performs the surgery to repair your heart problem.

At the end of the surgery, your heart is restarted using mild electric shocks. The pipes and tubes are removed from your heart, and the heart-lung bypass machine is stopped. You're given medicine to allow your blood to clot again.

Your chest bone is closed with wires. Stitches or staples are used to close the incision. The breathing tube is removed.

An advantage of traditional open-heart surgery is that it's easier for the surgeon to operate. This is very important for long and complex surgeries.

Off-Pump Heart Surgery

This type of surgery is the same as traditional open-heart surgery, except you aren't connected to a heart-lung bypass machine. Instead, your heart is steadied with a mechanical device while the surgeon works on it. Your heart continues to pump blood to your body.

The advantages of off-pump heart surgery are:

• No complications related to using a heart-lung bypass machine
• Faster recovery from the surgery

Minimally Invasive Heart Surgery

For this type of heart surgery, the surgeon makes small incisions in the side of your chest between the ribs. These incisions can be as small as 2 to 3 inches. Then the surgeon inserts surgical tools through these small incisions. A tool with a small video camera at the tip also is inserted through an incision. This allows the surgeon to see inside the body.

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

The advantages of minimally invasive heart surgery are:

• Less bleeding during surgery and a lower chance of needing a blood transfusion
• Lower risk of infection
• Less pain
• Smaller incisions and scars
• A shorter hospital stay and faster recovery

Patients who don't need the heart-lung bypass machine aren't at risk for the complications that the machine may cause.