Open Heart Surgery Procedure: Step-by-Step Guide
Open heart surgery is a major surgical procedure performed to repair or replace heart valves, bypass blocked arteries, or correct congenital heart defects. It involves opening the chest and operating directly on the heart.
Preoperative Preparation
- Patient Evaluation: Complete medical history, blood tests, ECG, echocardiogram, and angiography.
- Anesthesia: General anesthesia is administered to ensure the patient is unconscious and pain-free.
- Sterilization & Draping: The surgical site is cleaned, and sterile drapes are applied.
Surgical Steps
1. Incision & Chest Opening
- Median Sternotomy: The surgeon makes an incision along the sternum and uses a sternal saw to split the breastbone.
- Retraction: The rib cage is separated using retractors to provide access to the heart.
2. Cardiopulmonary Bypass (Heart-Lung Machine)
- Cannulation: Tubes are inserted into the aorta and veins to divert blood to the heart-lung machine.
- Heparinization: Blood is thinned to prevent clotting.
- Heart Arrest: A cold cardioplegia solution is injected to stop the heart, allowing a motionless field for surgery.
3. Surgical Procedure (Depending on the Condition)
- Coronary Artery Bypass Grafting (CABG): Uses a graft (vein from the leg or artery from the chest) to bypass blocked coronary arteries.
- Valve Replacement/Repair: A damaged heart valve is either repaired or replaced with a mechanical or biological valve.
- Congenital Heart Defect Correction: Patching of septal defects or reconstruction of malformed valves and vessels.
4. Rewarming & Restarting the Heart
- Blood is gradually warmed, and the heart is stimulated to restart.
- The heart-lung machine is gradually withdrawn.
5. Closure
- The sternum is wired back together.
- The incision is closed with sutures or staples.
- A chest drain is placed to remove excess fluids.
Postoperative Care
- ICU Monitoring: Continuous ECG and blood pressure monitoring.
- Ventilation Support: The patient may need a ventilator for a few hours.
- Pain Management & Medications: Pain relievers, antibiotics, and anticoagulants.
- Recovery & Rehabilitation: Gradual mobilization, breathing exercises, and cardiac rehabilitation.
Surgical Instruments Used in Open Heart Surgery
- Scalpel – Used for making incisions.
- Sternal Saw – Cuts through the sternum.
- Rib Spreaders (Retractors) – Holds the chest open.
- Needle Holders & Suturing Instruments – For sewing blood vessels or suturing incisions.
- Forceps & Clamps – Used for grasping and holding tissues.
- Electrocautery Device – Stops bleeding by sealing blood vessels.
- Cardioplegia Cannula – Delivers solution to stop the heart.
- Heart-Lung Machine – Temporarily takes over the function of the heart and lungs.
- Chest Tubes – Drains excess fluids from the chest cavity.
Post-Operative Management After Open Heart Surgery
After open heart surgery, post-operative care is crucial for recovery. This involves monitoring vital signs, managing pain, preventing complications, and gradually regaining strength. Below is a detailed guide on post-operative management, medication, suture care, diet, and exercises.
1. Immediate Post-Operative Management
ICU Care (First 24-48 Hours)
- Continuous Monitoring: ECG, oxygen levels, blood pressure, and urine output.
- Ventilation Support: Patients may be on a ventilator for the first few hours.
- Drainage Tubes & IV Support: Chest tubes remove excess fluid from the chest, and IV fluids provide hydration and medications.
- Pain Management: Morphine, fentanyl, or other pain relievers are administered.
- Antibiotics: To prevent infections.
Transition to General Ward (After 48 Hours)
- Breathing Exercises: Incentive spirometry to prevent lung infections.
- Early Mobilization: Encouraged to sit up, walk short distances.
- Monitoring for Complications: Checking for signs of infection, arrhythmia, or bleeding.
2. Medications Post-Open Heart Surgery
Here are the typical dosages for medications used post-open heart surgery. However, actual dosages must be prescribed by a doctor based on the patient's condition, kidney/liver function, and other factors.
Medication Dosages Post-Open Heart Surgery
| Medication Type | Purpose | Examples | Typical Dosage |
|---|---|---|---|
| Anticoagulants (Blood thinners) | Prevents blood clots | Warfarin | 2–10 mg once daily (adjusted per INR) |
| Aspirin | 75–325 mg once daily | ||
| Clopidogrel | 75 mg once daily | ||
| Pain Relievers | Manages post-op pain | Paracetamol | 500–1000 mg every 6 hours (max 4g/day) |
| Ibuprofen | 200–400 mg every 6–8 hours (max 1200 mg/day) | ||
| Tramadol | 50–100 mg every 4–6 hours (max 400 mg/day) | ||
| Beta-Blockers | Lowers heart rate & BP | Metoprolol | 25–100 mg twice daily |
| Carvedilol | 3.125–25 mg twice daily | ||
| ACE Inhibitors | Controls BP & heart function | Enalapril | 2.5–20 mg once or twice daily |
| Ramipril | 2.5–10 mg once daily | ||
| Diuretics | Reduces fluid overload | Furosemide | 20–80 mg once or twice daily |
| Spironolactone | 25–50 mg once daily | ||
| Statins | Lowers cholesterol | Atorvastatin | 10–80 mg once daily |
| Rosuvastatin | 5–40 mg once daily | ||
| Antibiotics | Prevents infection | Ceftriaxone | 1–2 g IV/IM once daily |
| Amoxicillin | 500–875 mg every 8–12 hours |
⚠ Note:
- These are general guidelines. Always follow doctor's instructions.
- Warfarin dosage varies based on INR levels (needs regular blood tests).
- Pain relievers should be used cautiously, especially NSAIDs (Ibuprofen) in heart patients.
- Statins & ACE inhibitors may require dose adjustment based on kidney function.
Let me know if you need more details! 😊
💡 Important: Regular INR monitoring is required for patients on Warfarin
3. Suture (Stitch) Care & Wound Management
Proper suture care ensures faster healing and prevents infections.
Sternal Wound Care
- Keep the wound clean and dry.
- Avoid scratching or touching the stitches.
- Use mild soap and water (no scrubbing) while bathing.
- Watch for infection signs: Redness, swelling, pus, or fever.
- Sutures Removal: If non-absorbable, removed after 7-14 days.
Precautions for Sternal Stability
Since the sternum is wired together after surgery:
- No heavy lifting (above 5kg) for 6-8 weeks.
- No pushing, pulling, or sudden arm movements.
- Support the chest when coughing/sneezing using a pillow (splinting technique).
4. Post-Operative Diet Plan
A heart-healthy diet aids in healing and prevents future heart problems.
Diet Guidelines
- Low Salt & Low Fat: Reduces strain on the heart.
- High Protein: Helps in wound healing (Fish, eggs, legumes).
- Fiber-Rich Foods: Prevents constipation (Fruits, vegetables, whole grains).
- Plenty of Fluids: Prevents dehydration (Avoid caffeine and alcohol).
- Small, Frequent Meals: Easier digestion.
Foods to Eat & Avoid
| Foods to Eat | Foods to Avoid |
|---|---|
| Lean meats, fish | Fried & processed foods |
| Fruits & vegetables | Sugary foods, soft drinks |
| Whole grains (oats, brown rice) | White bread, pasta |
| Low-fat dairy | Full-fat dairy, butter |
| Nuts & seeds | Red meat, organ meats |
💡 Tip: Avoid excess caffeine & alcohol as they can raise heart rate.
Video Explanation
5. Post-Operative Exercises & Rehabilitation
Cardiac rehabilitation is essential for regaining strength and improving heart function.
Exercise Guidelines
✅ Week 1-2:
- Light walking (Few steps to short distances)
- Deep breathing exercises to expand lungs
✅ Week 3-4:
- Increase walking time (10-15 minutes daily)
- Leg exercises to improve circulation
✅ Week 5-6:
- Mild stretching exercises (Avoid heavy lifting)
- Short flights of stairs can be climbed slowly
✅ After 2 Months:
- 30 minutes of daily moderate exercise
- Slowly resume normal physical activities
Exercises to Avoid (First 3 Months)
❌ Lifting heavy objects
❌ Running or high-impact workouts
❌ Swimming (until full wound healing)
❌ Driving (Usually after 6-8 weeks)
💡 Tip: Always start slowly and stop if you feel chest pain, dizziness, or breathlessness.
Final Recovery Timeline
| Recovery Phase | Expected Timeline |
|---|---|
| Hospital Stay | 5-7 days |
| Return to Daily Activities | 4-6 weeks |
| Return to Work | 2-3 months (if non-strenuous) |
| Full Recovery | 3-6 months |
Key Takeaways for a Smooth Recovery
✔️ Follow medication schedules strictly
✔️ Take care of your wound – Keep it clean, avoid infections
✔️ Eat a heart-healthy diet – Low salt, low fat, high protein
✔️ Start light exercises & cardiac rehab – Walking is key
✔️ Avoid stress & get enough sleep – Helps in healing
✔️ Monitor for complications – Any fever, chest pain, or shortness of breath should be reported immediately
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