Open-heart surgery

Open-heart surgery is a general term for surgical procedures performed to treat heart problems by directly accessing the heart through an opening of the chest. During open-heart surgery, the surgeon will cut through the breastbone (sternotomy) and spread the ribs to access the heart.

Open-heart surgery is used to treat a range of heart conditions, including heart failure, heart valve disease, arrhythmias, aneurysms, and coronary artery disease.

There are two ways open-heart surgery is performed:

• On-Pump Open-Heart Surgery: For many open-heart procedures, the heart will be stopped so that the surgeon can perform the procedure while it is still. The patient will be connected to a cardiopulmonary bypass machine (heart-lung bypass machine) that will breathe and circulate blood while the procedure is performed. Once surgery is complete, the patient is disconnected from the machine and the heart begins to beat again.
• Off-Pump Open Heart Surgery: This may also be referred to as beating heart surgery because the procedure does not require the heart to be stopped. The patient will be placed on a ventilator for the procedure, but a cardiopulmonary bypass machine is not required. Coronary artery bypass graft (CABG) surgery is the only open-heart procedure that is performed off-pump.

At Penn Medicine, we are recognized world-wide for our surgical specialization in many cardiac conditions including:

• Aortic disease
• Arrhythmias
• Coronary artery disease (CAD)
• Heart failure
• Heart valve disease
• Hypertrophic cardiomyopathy

Your surgeon or a member of the team will talk with you about any medicines you might be taking and whether it is safe to continue them. To ensure you receive the best care possible, they will arrange for specific tests that may include:

• Blood tests
• Chest X-ray
• Echocardiogram (EKG)
• Urinalysis

Your surgical team will also teach you breathing exercises to help you remove or prevent mucus buildup in your lungs after surgery. If you smoke, now is the time to stop. Smoking increases the demands on your heart and prevents proper healing.

Starting at midnight on the day of surgery you should stop eating or drinking. If your doctor tells you to take any medicines, please use only a small sip of water.

Open-heart surgery at Penn takes place in our state-of-the-art cardiac operating rooms. They are often lengthy and complex procedures and it is common for heart surgery to take between four and six hours to complete.

Before we take you to the operating room, one of our cardiothoracic anesthesiologists will place an IV to deliver medicines into your vein. The medication will help you relax and keep you comfortable. Your anesthesia team will remain in the operating room throughout your procedure to ensure you are safely sedated.

During the procedure:

• You will be placed under general anesthesia and constantly monitored by our expert cardiac anesthesiologists.
• If you are undergoing an on-pump procedure, you will be placed on a cardiopulmonary (heart-lung) bypass machine that will pump blood through your body during the procedure. You may also be placed on a ventilator to support your breathing.
• To access your heart, your surgeon will perform a sternotomy which involves creating a long incision in the right part of your chest near your breastbone and your ribs will be spread open.
• Depending on your procedure, the surgeon may stop your heart to perform the repair. Once blood flow is restored it will usually start beating again on its own. In some cases, it may need a mild electrical shock to restart it.
• Once the procedure is complete and the heart is beating again, you will be removed from the cardiopulmonary bypass machine.
• Your surgeon will close your breastbone and incision with wires and sutures that will remain in your body.

Penn Medicine cardiac surgeons have specialized skills and deep experience performing many types of open-heart surgical procedures. At Penn Medicine, you can expect:

• Experience and precision: Penn cardiac surgeons are some of the most experienced and innovative practitioners in the country. Our researchers are responsible for many of the breakthroughs in heart treatment over the past two decades.
• Multidisciplinary approach: Our surgeons and interventional cardiologists work together in our state-of-the-art hybrid operating rooms performing open-heart and catheter-based treatments at the same time, if necessary.
• Dedicated cardiac operating rooms: Our state-of-the-art cardiac operating suites offer the latest technologies. We offer dedicated hybrid operating rooms with advanced imaging capabilities that enable your care team to perform catheter-based procedures and traditional operations in one room at a time.
• Care across your community: Penn Medicine has cardiology practices throughout the region allowing convenient consultations, second opinions, and pre- and post-operative care close to home.