Open heart surgery. Is there any medical procedure in history so surrounded by genuine awe and surreal mystique? Cracking open the sternum to reveal the beating heart beneath, and then somehow trusting a heart-lung machine to temporarily take over the jobs of both the human heart and lungs – now, that’s heroic! But when it comes to explaining just how that happens, few of us might guess that the most compelling and straightforward description comes not from the world of medicine, but from the venerable magazine, Popular Mechanics.
Their very useful if unlikely guide, tucked right in there alongside their Gear and Gadget reviews, and penned for us by Oregon Health & Science University’s Dr. Jai Raman, a professor of cardiothoracic surgery. It’s called Extreme How-To: Step By Step Heart Surgery. It’s one of the clearest explanations of this procedure that I’ve seen yet.
Heart Sisters! Do NOT Try This at Home!
“Your heart rests beneath the sternum – the organ’s skeletal chest armor and the central bone to which ribs are attached. Cracking this bone running down the centre of the chest requires pressure, power and precision (for about 30 seconds).
“The most common type of saw used in heart surgery is an oscillating saw, which moves up and down at a rapid speed and works like a jigsaw, enabling the fine blade to cut curved lines.
“Sometimes – especially on patients who have had heart procedures done before – surgeons will use a saw that’s like the one used to remove casts. It stops immediately when it senses tissue.” NOTE FROM CAROLYN: A very comforting concept.
“Surgeons cut through the sternum either completely or partially, straight down the middle, but they don’t remove it. They then slowly spread apart the cut halves of the sternum with retractors, something similar to a brace. This allows the entire chest and heart to be open before them.
“The standard approach to open heart surgery means the entire rib cage is opened and the heart muscle beneath is fully exposed. The patient is then placed on a heart-lung bypass machine (also called a cardiopulmonary bypass machine) which oxygenates and circulates blood throughout the body, replacing the function of both the heart and the lungs, and thus allowing the surgeon to stop the heart and perform surgery while the heart muscle is not moving.
“In the modified approach, the cardiac surgeon performs the surgery on a beating heart without the use of the heart lung machine, using instead a stabilizing instrument – sometimes used even for multi-vessel bypass surgery – without the need of the heart lung machine. This is sometimes an option for a patient with a good, strong heart muscle because the surgery itself places stress on the heart.
“A partial sternotomy can be performed when limited exposure is adequate, frequently used for heart valve surgery. Or some heart patients may be good candidates for Minimally Invasive Direct Coronary Artery Bypass (MIDCAB), a surgical approach that involves a small incision usually on the left anterior portion of the chest wall between the third and fourth or fourth and fifth ribs. In most cases, this incision is made through, not under, the breast.
“Becoming a cardiac surgeon means getting over a huge mental block: ‘You’ve got to get comfortable putting stitches into a beating heart,’ says Dr. Raman.
“The size and strength of stitches surgeons use to repair someone’s heart can vary greatly depending on the procedure and part of the heart.
“Once the surgical procedure is completed, it’s time to put the sternum back together. Surgeons now use customized plates and screws to hold the breastbone and ribs in place as they heal. In the past, doctors used wire to repair the sternum, but this was problematic because bony fragments moved and did not remain lined up.
“Fortunately, because heart surgeons break more bone than even orthopedic surgeons do, repairing the sternum has been the focus of many surgical advances in the past few decades.
“Open heart surgery leaves a vertical scar on the skin over the sternum, and these scars are typically 7 to 10 inches long. See also: Learning To Love Your Open Heart Surgery Scar
“While new sutures, better breastbone plates and less invasive procedures are all marked advancements in the field, doctors aren’t stopping there.
.“The most important thing to realize is that we are trying our best to minimize the trauma to the chest to allow patients to recuperate from the surgery a lot faster. [We’re] going away from the notion of having the whole heart exposed and doing a big cut down the middle. All that is being improved – and evolving – as we speak.”
4 GOOD RESOURCES:
1. I’ve been sharing practical tips from Elizabeth Dole for years on managing your open heart surgery scar once you get home. She’s the best!
2. The Ottawa Heart Institute offers comprehensive and very useful take-home material for cardiac surgery patients to read before discharge. This includes:
- info on going home
- incision care (what’s normal, and what’s not)
- recovery guidelines
- nutrition tips
- managing your medications
- safe physical activities
3. The American Heart Association’s video (2:15) called Your Heart Surgery: Rehab and Recovery shares good ideas from real cardiac surgery patients:
NOTE from CAROLYN: I wrote much more about ‘heading home tips’ for all kinds of heart patients in my book “A Woman’s Guide to Living with Heart Disease“ (Johns Hopkins University Press). You can ask for it at your local library or favourite bookshop, or order it online (paperback, hardcover or e-book) at Amazon – or order it directly from my publisher, Johns Hopkins University Press (use their code HTWN to save 30% off the list price).