Open heart surgery is a medical procedure involving direct access to the heart through an incision in the chest. It is necessary when less invasive treatments are insufficient for severe heart conditions. Surgeons operate directly on the heart’s muscles, valves, or arteries to correct issues. This article explores the primary reasons for this procedure, aiming to restore heart function and improve overall health.
Addressing Blocked Coronary Arteries
A common reason for open heart surgery is coronary artery disease (CAD), a condition where the arteries supplying blood to the heart muscle become narrowed or blocked. This narrowing occurs due to the buildup of fatty material, known as plaque, within the artery walls. Plaque accumulation restricts the flow of oxygen-rich blood to the heart, potentially leading to symptoms like chest pain (angina) or, in severe cases, a heart attack.
Coronary Artery Bypass Grafting (CABG), or heart bypass surgery, is the primary surgical solution for CAD. This procedure uses healthy blood vessels from other body parts, like a leg vein or chest artery, to create new pathways around blocked coronary arteries. The surgeon attaches the grafted vessel above and below the blockage, re-routing blood flow to the heart muscle. CABG aims to relieve symptoms, improve heart function, and reduce future cardiac events.
During traditional CABG, a surgeon makes an incision down the center of the chest and cuts through the breastbone to access the heart. The heart is often temporarily stopped, and a heart-lung bypass machine circulates blood and oxygen throughout the body. This allows the surgeon to operate on a still heart.
Repairing or Replacing Heart Valves
Heart valve diseases are another reason for open heart surgery. The heart has four valves—aortic, mitral, tricuspid, and pulmonary—that ensure blood flows correctly. When damaged or diseased, these valves malfunction, leading to complications.
Common valve problems include stenosis, where the valve flaps become stiff or thick, causing the valve opening to narrow and restrict blood flow. Another issue is regurgitation, also known as a “leaky valve,” which occurs when the valve flaps do not close tightly, allowing blood to leak backward. Both conditions force the heart to work harder to pump blood, potentially leading to heart failure over time.
Surgical intervention aims to either repair or replace the damaged valve. Repair restores the valve’s ability to open and close properly. If repair is not feasible, the valve is replaced with a prosthetic valve. These can be mechanical (artificial) or biological (from animal tissue or human donors). The choice depends on the specific valve, damage, and patient health.
Treating Aortic Conditions
Conditions affecting the aorta, the body’s largest artery, often require open heart surgery due to their life-threatening nature. The aorta originates from the heart and distributes oxygenated blood throughout the body. Problems like aortic aneurysms or aortic dissections can compromise this vessel.
An aortic aneurysm is a weakening or bulging in a section of the aortic wall. If it grows too large or weakens significantly, it risks rupture, leading to severe internal bleeding. Aortic dissection involves a tear in the inner layer of the aortic wall, allowing blood to surge between layers. This can impede blood flow to organs or cause the aorta to rupture.
Open heart surgery for these conditions involves repairing or replacing the damaged segment of the aorta. Surgeons remove the compromised section and replace it with a synthetic graft. This procedure aims to prevent rupture or to address an existing rupture or dissection, stabilizing the aorta and restoring proper circulation.
Correcting Congenital Heart Defects
Congenital heart defects (CHDs) are structural heart abnormalities present at birth. They arise from improper fetal heart development, ranging from simple holes to complex malformations of chambers or vessels. Examples include atrial or ventricular septal defects, which are holes in the heart’s walls.
Surgery for CHDs corrects these structural problems to normalize blood flow and improve heart function. A surgeon might patch a hole in the septum to prevent abnormal blood mixing or reconstruct malformed valves or vessels. While many CHDs are treated in infancy or early childhood, some individuals undergo corrective surgery later in life. The surgical approach is tailored to the specific defect, enabling the heart to function effectively.
Other Critical Cardiac Issues
Beyond common conditions, open heart surgery is necessary for other less frequent cardiac issues, such as heart tumors. While rare, these growths can interfere with the heart’s pumping action or obstruct blood flow. Surgeons remove the tumor and reconstruct any damaged heart tissue.
Severe heart trauma may require immediate open heart surgery to repair damaged heart muscle, vessels, or chambers. These emergent procedures stop bleeding and restore cardiac integrity. Open heart surgery is also part of a heart transplant procedure. For individuals with end-stage heart failure, a heart transplant involves replacing the diseased heart with a healthy donor heart, offering a new treatment option.