Open Heart Surgery — Procedure Guide, Recovery & Risks | MyMedicPlus

Open heart surgery involves operating on the heart's structures through a sternotomy incision while cardiopulmonary bypass (CPB) temporarily takes over heart and lung function. It is used for coronary artery bypass grafting (CABG), valve repair or replacement, and congenital defect correction.

Indications include multi-vessel coronary artery disease unsuitable for PCI, severe aortic or mitral valve disease, aortic root aneurysm, ascending aorta dissection, complex congenital heart defects, and combined procedures requiring surgical exposure not achievable by catheter-based techniques.

The sternum is divided, the pericardium opened, and arterial and venous cannulae connect the patient to the cardiopulmonary bypass machine. Cardioplegia arrests the heart while the surgeon performs CABG with saphenous vein or mammary artery grafts, valve repair or prosthetic replacement, then weaning from bypass and sternal closure with wires.

Patients spend 1–3 days in the cardiac ICU and 5–10 days total in hospital. Sternal wound healing requires 6–8 weeks of lifting restrictions. Cardiac rehabilitation begins at 4–6 weeks to improve functional capacity and reduce rehospitalisation.

Risks include stroke (1–3%), atrial fibrillation (20–40%), wound infection, mediastinitis, renal impairment, prolonged ventilation, and cognitive changes (pump head). Elective CABG carries under 2% in-hospital mortality at experienced centres.

CABG provides superior long-term outcomes to PCI for multi-vessel and left main disease, with 10-year survival exceeding 85% in suitable patients. Valve repair is preferred over replacement when feasible, offering better durability and freedom from anticoagulation.