Open Heart Surgery: What to Expect on the Day of Surgery

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There are several surgeries that are classified as open heart surgeries. While this form of surgery entails opening up a person's chest with a large incision to expose and operate on their heart, what a specific operation entails from start to finish differs.

Coronary artery bypass graft (CABG) is the most common type of open heart surgery. This operation involves going around a blocked coronary artery in order to restore blood flow to the heart. Open heart surgery may also be performed to repair or replace a diseased heart valve, transplant a donor heart, fix a congenital heart defect, or implant a life-saving medical device.

Here, the basic steps of open heart surgery are reviewed. While this gives you a good sense of what lies ahead, be sure to speak with your healthcare provider about what your procedure will look like.

Surgeons performing open heart surgery

Arctic-Images/Getty Images

Before the Surgery

On the day of your open heart surgery, you will arrive at the hospital, check-in at the front desk, and be directed to a pre-operative holding area.

Here you can expect the following:

  • You will be asked to remove all jewelry and clothing and change into a hospital gown.
  • A nurse will record your vitals and place an intravenous (IV) line into a vein in your hand or arm. A surgical assistant may place an additional IV in your neck called a central line) All IVs are used to administer fluids and medications during and after surgery.
  • The surgical assistant may also place a thin catheter in your wrist (arterial line) to monitor your heart and blood pressure during and after the surgery.
  • The anesthesiologist and surgeon will come to greet you and review the surgical plan with you. You may need to sign some consent forms.

When the surgical team is ready, you will be wheeled into the operating room on a gurney. Your loved ones will be asked to wait in a waiting room where they will be provided with regular updates on your status during the operation.

During the Surgery

In the operating room, you will be assisted onto a metal operating table and positioned on your back. General anesthesia—inhaled or intravenous medications that put you to sleep—will then be administered by the anesthesiologist. You will not feel or be aware of anything happening during surgery.

After you are asleep, the anesthesiologist will insert a tube down your throat into your airway. This endotracheal tube is connected to a ventilator that breathes for you during surgery.

Around this time, while you are asleep, your surgical team will also insert a Foley catheter in your bladder to drain urine. In some cases, your surgeon may place a thin tube called a Swan-Ganz catheter in your neck for heart monitoring purposes.

If you are undergoing a heart valve replacement or repair, the surgeon may place a transesophageal echocardiogram (TEE) probe into your esophagus. This tool allows the surgeon to monitor the function of the valves during surgery.

While the flow of your surgery depends on the specific operation you are undergoing (e.g., coronary artery bypass surgery (CABG), heart valve repair or replacement, heart transplant, etc.), here is a general sense of what you can expect:

1) Skin cleansing: A nurse or surgical assistant will clean the skin over your chest with an antiseptic solution. Other areas of the body that are being operated on (your leg or arm to obtain a blood vessel graft for a CABG, for example) will also be cleaned.

2) Chest incision: Using a scalpel, the surgeon will make a large (approximately 8-inch) skin incision down the center of your chest wall.

3) Breastbone incision: The surgeon will then cut your breastbone (sternum) lengthwise in half using a special surgical saw. The breastbone will be separated and spread apart in order to expose the heart.

4) Heat-lung bypass machine placement: Once your heart is exposed, tubes will be inserted into it so that blood can be pumped by a heart-lung bypass machine. Once your blood is pumping through the machine (essentially, taking over for your heart temporarily), the surgeon will inject your heart with a cold solution to stop it from beating for the duration of the procedure.

5) Operating on the heart: Depending on the type of open heart surgery being performed, various steps will occur.

  • With coronary artery bypass surgery, the surgeon will harvest and place a graft. Harvesting involves removing a portion of a healthy blood vessel from another part of the patient's body and then sewing the graft into a small opening below the diseased artery.
  • With a heart transplant, a diseased heart is removed and replaced with a donor heart.
  • With a heart valve replacement, a diseased valve is removed and replaced with an artificial valve.

6) Heart-lung bypass machine removal: After the operation is finished, the surgeon will divert blood flowing through the bypass machine back to your heart. The heart usually begins beating on its own; sometimes, the surgeon will need to give the heart mild electric shocks to get it started again.

7) Temporary pacemaker placement: Your surgeon may place temporary, thin wires onto the surface of your heart during surgery. These wires are then attached to a pacemaker outside your body.

8) Breastbone closure: The breastbone will then be sewn back together with small wires. Chest tubes may be placed to drain blood and other fluids around the heart.

9) Muscle/skin closure: Muscles and skin are then closed with sutures. A sterile bandage is applied over the large incision site.

The length of time you can expect to be in the operating room depends on the specific type of open heart surgery being performed. A CABG, for example, takes about three to five hours. A heart transplant may anywhere between three to eight hours.

After the Surgery

After surgery, you will be wheeled into a post-anesthesia care unit (PACU). Nurses will monitor your vital signs carefully as you slowly wake up from anesthesia.

When your vitals are stable, and you are awake (expect to still be drowsy), you will be wheeled into an intensive care unit (critical, surgical, or transplant, depending on the hospital).

Here you can expect the following:

  • You will be given IV pain medication for your surgical site pain.
  • Your breathing tube will be removed when you are fully awake. At this time, you may begin drinking clear liquids. Of note, you may experience a sore throat or hoarse voice from the tube for a day or two after its removal.
  • Your nurse or a respiratory therapist will teach you deep breathing and coughing exercises to help prevent pneumonia, a potential complication of surgery.
  • If a Swan-Ganz catheter or temporary pacemaker wires were placed, they will be removed by the surgical team around the second or third day after surgery.
  • Chest tubes that drain blood and other fluids into a plastic container located on the side or foot of your bed are typically removed around one to three days after surgery.

If you underwent a heart transplant, expect to begin taking immunosuppressants right away. These medications prevent your body from rejecting your new heart.

Once your condition is stable and your Swanz-Ganz catheter, chest tubes, and pacemaker wires have been removed, if applicable, you will be moved to a regular hospital room.

Here you can expect the following:

  • You will advance your diet to a low-sodium, low-fat diet as tolerated.
  • Your Foley catheter will be removed.
  • With the assistance of a physical therapist, you will begin leg exercises, getting of bed, and walking around.
  • You will be transitioned from IV pain medication to oral pain medication.

Depending on the type of surgery you underwent, you can expect to stay in the hospital for around five to 14 days. Your stay may be longer if postoperative complications occur.

Once you are discharged from the hospital, you may go home, or you may go to a rehabilitation facility to regain strength after surgery. You will have various post-operative instructions to follow, and close adherence to them will be critical to your recovery.

A Word From Verywell

Being a major operation, it's normal to feel apprehensive if you are undergoing open heart surgery. Try to remain focused on preparing for the surgery and the healing process. Educate yourself as much as possible and ask your surgical team lots of questions.

8 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. University of California San Francisco Department of Surgery. Coronary Artery Bypass Grafting (CABG).

  2. Johns Hopkins Medicine. Coronary Artery Bypass Graft Surgery. 2021.

  3. Johns Hopkins Medicine. Heart Valve Repair or Replacement Surgery. 2021.

  4. Stanford HealthCare. During the CABG Procedure. 2020.

  5. Cleveland Clinic. Coronary Artery Bypass Surgery. Reviewed June 2019.

  6. University of Pittsburgh Medical Center. Heart Transplant Surgery: Preparation and Procedure. 2021.

  7. Massachusetts General Hospital, Corrigan Minehan Heart Center. Your heart surgery: what you need to know. 2015. 

  8. Cleveland Clinic. Post Transplant Process & Recovery. 2021.

By Jennifer Whitlock, RN, MSN, FN
Jennifer Whitlock, RN, MSN, FNP-C, is a board-certified family nurse practitioner. She has experience in primary care and hospital medicine.