by Carolyn Thomas ♥ @HeartSisters
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
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:
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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).
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♥
heart image: surviving-heart-surgery.myshopify.com
Q: What tip (big or small) helped you the most while recuperating from open heart surgery?
See also:
How long does it take to heal from open heart surgery?
“Don’t lift anything heavier than a fork”: really bad advice after heart surgery
Learning to love your open heart surgery scar
Handling the homecoming blues: the third stage of heart attack recovery
Heart Sisters 
Keep sharing the blogs – good work!
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Thanks, Cedar Valley!
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My niece was born with an atrial septal defect, and because of that, she had to undergo heart transplant surgery at just 1 year of age. I was scared of the whole thing, so I watched a lot of videos of the surgery online. It is fascinating to me, how in the open-heart procedure, the ribcage of the person is opened completely, and they are still able to survive through 5 – 10 hours of the surgery on a machine.
My niece is growing like a healthy child today, and you won’t be able to tell that she received a heart transplant when she was just 1.
I am not entirely sure which type of heart surgery was performed on her, but it was an open-heart surgery combined with some modified approach. There were several complications in her surgery. Her age being a major one, of course. Doctors were worried about the development of her breastbones, and she did take almost 5 – 6 months to recover completely. My sister used to tell me how she wouldn’t stop crying for months after the surgery. But thankfully, everything turned out fine.
It’s good to see that new minimally invasive technologies are being introduced, because the post-operative trauma of open heart surgery can be very hard to bear.
And I would also like to appreciate HeartSisters, and what you are doing. My niece is almost 17 now, and she introduced me to the website and book.
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Thank you Hemant for sharing your niece’s story here and for your kind words about my website and book. That must have been terrifying for your whole family when such a young toddler goes through serious surgery – and then cries for months afterwards.
Did you know that, because of cardiothoracic surgical advancements, there are now more adults living with congenital heart defects than children? Imagine a time not so long ago when there was nothing that could be done to save these babies like your niece…
I’m so glad she recuperated and is now a healthy teenager!
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My open heart surgery replacing my aortic valve was 4 years ago. Reading this now is fascinating and encouraging.
I am immensely thankful to be living in Canada and realize how lucky I am. Sad because my Dad would have benefited from a similar op, but it was not available then. I had a lot of fear in the beginning, hearing voices in the CICU describing “she is in heart failure” scared me to death.
Post op was smooth with a few bumps in the road after I got home. More fear. I needed to learn to trust my cardiologist that with med adjustments things would right themselves. In a nutshell, I can’t say enough about my excellent care by a team of carers. One of the best things was the classes run by Carolyn Thomas @ HeartSisters.
Mentally,I am better equipped to face a second surgery if at all necessary. Fear is manageable. I can do it. Head out of sand!
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Thank you so much for your kind words Penny, and especially for the four-year update since your surgery. I often think that the more we learn, and the more we manage to actually get through what we were so afraid of at the beginning, the more confident we can feel, like you, about the future – no matter what comes next.
Also like you, I am SO grateful every day to be Canadian, and to have had my world-class cardiac care here. Our healthcare system’s not perfect – but it’s so much better than whatever is in second place…
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