| | Surgery & Procedures | Open Heart Surgery

Open Heart Surgery: Indications, Procedures & What to Expect

Conditions Requiring Open Heart Surgery

Open heart surgery (median sternotomy with cardiopulmonary bypass) addresses structural/functional cardiac pathology unresponsive to medical or percutaneous therapy.

Condition	Pathophysiology	Common Surgical Approach
Coronary Artery Disease (CAD)	Atherosclerotic narrowing/occlusion of epicardial coronaries → ischemia/infarction.	CABG (coronary artery bypass grafting) — venous/arterial grafts.
Valvular Heart Disease	Stenosis (narrowing) or regurgitation (leak) of aortic, mitral, tricuspid, pulmonic valves.	Valve repair (annuloplasty, leaflet reconstruction) or replacement (mechanical/bioprosthetic).
Congenital Heart Defects	Structural anomalies present at birth (ASD, VSD, TOF, TGA, coarctation).	Corrective/reparative surgery (often staged); some now percutaneous.
Aortic Aneurysm / Dissection	Pathologic dilation/tear of ascending/arch/descending aorta (rupture risk).	Graft replacement (Bentall, David, hemiarch, elephant trunk).
Infective Endocarditis	Vegetations on valves/chords → destruction, abscess, embolism, heart failure.	Débridement, valve repair/replacement, root reconstruction.
Severe Heart Failure / Mechanical Support	End-stage cardiomyopathy, post-infarct VSR, papillary muscle rupture.	VAD implantation, transplant, surgical ventricular restoration (SVR).
Cardiac Tumors	Primary (myxoma) or metastatic.	Resection with reconstruction.

Surgical Workflow

Anesthesia & Monitoring: GA, arterial line, CVP, PA catheter, TEE.
Sternotomy & Cannulation: Aortic + venous (bicaval) cannulation for CPB.
Cardioplegia & Arrest: Cold blood/ crystalloid cardioplegia; aortic cross-clamp.
Procedure-Specific Repair: As above.
Weaning from CPB: Rewarm, de-air, inotropic support, TEE assessment.
Hemostasis & Closure: Protamine, chest tube placement, sternal wiring, layered closure.
ICU Transfer: Ventilated, hemodynamic monitoring, bleeding surveillance.

Recovery Milestones

Extubation: 6–24 hrs (fast-track protocols)
ICU: 1–3 days
Hospital: 5–10 days (uncomplicated)
Sternal precautions: 8–12 weeks (no lifting >10 lbs, no driving)
Cardiac rehab: Phase II (outpatient) starts 2–4 weeks post-discharge.

Risks (STS Database Averages)

Operative mortality: 1–3% (isolated CABG), higher for combined/redo/emergent.
Stroke: 1–2%; Renal failure: 2–3%; Mediastinitis: 0.5–1%; Atrial fibrillation: 20–40%.

Decision-Making

Heart Team evaluation (cardiologist, surgeon, imaging, anesthesia) weighs syntax score, frailty, comorbidities, patient goals. Shared decision-making essential.