Operating on the Heart: Open-Heart Surgery

Many older people worry that they are too frail to go through open-heart surgery. Such surgery seems drastic. An incision is made in the chest, and the breastbone is cut and separated. The heart is exposed, and its beating is usually stopped. However, this surgery can mean a difference between life and death. In general, open-heart surgery is recommended if it has less serious risks than the disorder without the surgery. Most often, open-heart surgery is done to replace a malfunctioning heart valve or to bypass blocked coronary arteries.

When the heart's beating is stopped, a heart-lung (cardiopulmonary bypass) machine does the work of the lungs and heart. It puts oxygen into the blood and pumps blood to the body. A tube connects the atria to the machine. (The atria are the heart chambers that receive blood from the body.) This tube carries blood from the heart into the machine. Another tube connects the machine to the aorta, which carries blood to the body. Thus, the heart is clear of blood and is still, making the work of the surgeon easier. After the work on the heart is completed, the surgeon restarts the heart. Occasionally, open-heart surgery leads to problems, such as a stroke, a heart attack, confusion, or blood clots, or even death.

After surgery, people recover in a special coronary or intensive care unit. There, they are hooked up to many tubes, which are used to give drugs, monitor the heart, help with breathing, and drain fluids. A temporary external pacemaker may be connected to the heart with wires inserted into veins. These tubes and wires are removed as people recover. The incision is painful, and the nose and throat are sore from insertion of tubes. However, the pain can usually be relieved. People usually stay in the hospital for 5 to 7 days. Recovery and rehabilitation take about 6 to 8 weeks. Rehabilitation programs begun in the hospital help speed recovery.