Heart surgery corrects structural or functional issues affecting the heart and major blood vessels. Procedures range from repairing damaged valves to rerouting blood flow around blocked arteries, aiming to restore healthy cardiac function. Advancements in surgical techniques and technology have made many complex heart operations routine and safe, relying on precise planning and skilled surgical teams.
The Primary Surgical Approaches
The method used to access the heart is determined by the patient’s condition and the required procedure. Traditional open-heart surgery, known as a median sternotomy, involves a vertical incision down the center of the chest. The surgeon divides the sternum (breastbone) using a specialized saw, providing the widest view of the heart. This approach is necessary for complex cases requiring extensive access, such as multiple coronary artery bypass grafts or heart transplants.
Minimally invasive surgery accesses the heart through smaller incisions made between the ribs, avoiding the need to cut the breastbone. Techniques such as a mini-thoracotomy or hemi-sternotomy typically result in less pain, reduced blood loss, and a shorter hospital stay. A mini-thoracotomy involves a three to four-inch incision on the side of the chest, allowing the surgeon to operate with a specialized camera and long instruments.
Robotic-assisted surgery utilizes a computer-guided system controlled by the surgeon at a console. Robotic arms, equipped with tiny instruments and a high-definition camera, are inserted through small incisions (ports) between the ribs. This technology enhances precision and dexterity for intricate procedures, such as valve repair or single-vessel bypass grafting.
Common Types of Heart Procedures
One of the most frequent types of heart surgery is Coronary Artery Bypass Grafting (CABG), which reroutes blood flow around severe blockages in the coronary arteries caused by plaque buildup. The surgeon creates this detour using a healthy blood vessel, or graft, taken from another part of the patient’s body, often the internal mammary artery or a leg vein. This graft is attached to the aorta and sewn onto the blocked coronary artery past the obstruction, restoring oxygen-rich blood flow to the heart muscle.
Heart valve procedures address conditions where the heart’s four valves are either too narrow (stenosis) or leak (regurgitation), impairing the heart’s pumping efficiency. Surgeons may opt for a repair, which preserves the patient’s native valve tissue through techniques like annuloplasty (tightening the valve ring). If the valve is too damaged, replacement is necessary, involving the removal of the malfunctioning valve and the implantation of a prosthetic one.
Replacement valves are either mechanical or biological (bioprosthetic). Mechanical valves are made from durable synthetic materials and last for decades, but require lifelong blood-thinning medication to prevent clots. Biological valves are created from animal tissue, usually from a cow or pig. While they do not typically require long-term blood thinners, they may wear out and need replacement after 10 to 20 years.
Repair of an Aortic Aneurysm fixes a weakened, bulging section of the aorta, the body’s main artery. If left untreated, this bulge can rupture and cause life-threatening internal bleeding. The surgeon removes the damaged section and replaces it with a synthetic fabric tube (graft), which reinforces the artery wall and allows blood to flow safely.
The Surgical Process Step-by-Step
The surgical process begins with the patient receiving general anesthesia to ensure they are completely asleep and feel no pain. The anesthesia team places monitoring lines in major arteries and veins to continuously track vital signs. Once surgical access is established, the team prepares for the operation.
For many open-heart procedures, the heart must be stopped to allow the surgeon to work in a bloodless, still field. This requires the use of the Cardiopulmonary Bypass (CPB) machine, often called the heart-lung machine. The process starts with cannulation: specialized tubes are placed into the patient’s major veins to drain deoxygenated blood into the CPB circuit. The blood then flows through an oxygenator, which functions as an artificial lung by adding oxygen and removing carbon dioxide.
The machine’s pump returns this oxygenated blood back into the patient’s circulatory system, usually through a cannula placed in the aorta. A specialized solution called cardioplegia is delivered to the heart muscle to stop the heart’s beating, allowing the surgeon to perform the repair or bypass grafting. A perfusionist, a trained specialist, operates and monitors the CPB machine, managing blood pressure, temperature, and oxygen levels.
After the procedure, the surgical team begins weaning the patient off the bypass machine. The heart is monitored as it is warmed and blood flow is redirected, often causing the heart to restart spontaneously. If needed, a mild electrical shock prompts the heart to resume a normal rhythm. Once heart function is stable and the cannulas are removed, the chest is closed. Following a sternotomy, the breastbone is wired back together with stainless steel wires that remain permanently in the body.
Immediate Post-Operative Care and Recovery
Following surgery, the patient is transferred to the Intensive Care Unit (ICU) for close monitoring. Sophisticated equipment continuously tracks heart rhythm, blood pressure, and vital parameters. Initially, the patient has a breathing tube connected to a ventilator, which supports breathing while anesthesia wears off.
Chest tubes are present to drain excess fluid or blood from the chest cavity. The medical team manages pain using intravenous medication to ensure the patient is comfortable. The breathing tube is typically removed within a few hours to a day once the patient is awake and can breathe strongly.
Early mobilization is a fundamental part of post-operative care, helping prevent complications like blood clots and pneumonia. Within the first 24 to 48 hours, nurses and physical therapists encourage the patient to sit up and take short walks. The initial hospital stay for major heart surgery is generally five to seven days, transitioning the patient from the ICU to a regular room before discharge.