Purpose of Open Heart Surgery

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Open heart surgery is an approach that involves cutting through the breastbone and connecting the heart to a device called a heart-lung bypass machine. Depending on the specific procedure involved, the doctor may also have to open up the heart itself. It is used to treat heart problems such as coronary artery disease and atrial fibrillation.

Rather than being a specific treatment, an open heart approach may be employed in number of surgeries, including coronary artery bypass grafting (CABG), heart valve repair or replacement, atrial fibrillation correction, heart transplant, as well as the placement of devices to aid this organ such as ventricular arterial devices (VADs) and total artificial hearts (TAHs).  

Diagnosis Related to Open Heart Surgery

Open heart surgeries are employed to take on a couple different and often very dangerous heart problems:

Atrial Fibrillation

While atrial fibrillation (Afib) is a rapid, irregular heartbeat. It isn’t always deadly on its own (some have this condition for years without issues arising) it can lead to stroke, blood clot, and heart failure. Open heart surgery would not be the first line of treatment; doctors will try prescribing drugs that normalize the heart’s activity.

In addition, in some cases, more minimally-invasive treatments such as electrical cardioversion (the use of electricity to “reset” the heartbeat), ablation (the use of radiofrequency waves to scar heart tissue to prevent errant signals), or other methods may be employed. If these don’t correct the issue, open heart surgery will be indicated.

Coronary Artery Disease

Coronary artery disease (CAD) is defined as hardening and narrowing of arteries in the heart, and it can lead to heart failure (the heart becoming unable to pump enough blood) as well as heart attack (blockage of an artery leading to the heart). Treatment approaches depend on the progression of the CAD or associated conditions.

Coronary artery disease is also called coronary heart disease (CHD).

Coronary artery disease, heart failure, and heart attack may be treated using other methods, such as lifestyle changes, stenting, taking blood-thinning medications, or minimally-invasive approaches first. However, in more extreme cases or if these initial approaches haven’t worked, it’ll be indicated.

Criteria

A diagnosis of atrial fibrillation, coronary artery disease, or any of their related conditions is serious. Your doctor will have to weigh a number of important factors before opting for an open heart surgery approach. These include:

  • Age: Open heart procedures may not be appropriate or become an increased risk for older patients.
  • Prior treatments: As noted above, open heart surgery may not be the first line of treatment. Patients who have had previous treatments, such as stents or ablation, without success are considered.
  • Severity: For more advanced CAD, especially cases that are leading to heart failure or heart attack, open heart surgery may be the only viable option. Basically, the more extensive and complex the damage, the more likely open heart surgery will be indicated.
  • Emergency: Open heart approaches may also be employed in emergency situations, such as heart attack.
  • Location of blockages: In CAD cases, the location of blocked or constricted arteries can also be a factor, especially if this affects larger coronary arteries.
  • Lifestyle factors: Given the influence of diet, exercise, and personal habits on both heart health and response to surgery, lifestyle factors will also need to be weighed when making the decision.
  • Health status: Among health factors that would indicate surgery is taking insulin for diabetes type II, risk of stroke, propensity for infection, or being at higher risk for surgical complications.

Tests and Labs

As with all surgeries, proper evaluation and diagnosis are essential for success. This assessment focuses on heart, lung, and vascular (vein and artery) health. Specific approaches vary based on the case but typically feature:

  • Physical evaluation/medical history: In non-emergency cases, the first step in diagnosis will involve physical evaluation of things like pulse and breathing, as well as answering questions about health status and symptoms. An assessment of medical history will also be performed.
  • Electrocardiogram (EKG): EKG devices are able to measure the heart’s electrical activity, which allows the doctor to understand where, specifically, there are problems. This means figuring out the pattern of heart beat in atrial fibrillation patients, and the scale and scope of coronary artery disease in those affected.
  • Cardiac stress test: Sometimes, the doctor will need to see your heart at work and assess activity as you undergo exertion and exercise. Several imaging techniques may be employed, including magnetic resonance imaging (MRI), echocardiography (see below), or nuclear heart scanning (the use of a radioactive element to boost imaging capability) to help the medical team learn more about the specific issue (or issues) at play. 
  • Echocardiography: This imaging approach uses sound waves to produce a real-time video of your heart in action. Not only does this allow the surgeon to see the size and shape of your heart, but it can also locate areas of constricted blood flow as well as the activity of coronary muscles.  
  • Coronary angiography: In this approach, a special, contrast dye is injected into the coronary arteries using a specialized tube. The chest area is then X-rayed, with the dye allowing doctors to further assess blood flow and the presence of any blockages.  

A Word from Verywell

There’s no doubt that a diagnosis like atrial fibrillation or coronary artery disease can be jarring and frightening; for many, it’s at this moment that they appreciate just how important heart function is.

That said, there’s no reason for despair. Medical technology constantly evolving and better than it’s ever been, and those that operate on the heart are very highly specialized and trained.

Notably, open heart surgeries are the most common approaches to heart problems, and they’re highly successful. Precisely because these approaches have been employed for so long—the first open heart procedure was performed in 1893 (it was a success)—you can rest assured that you’ll be in good hands in the 21st century.

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Article 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. American Heart Association. Cardiac procedures and surgeries. 2017. 

  2. National Heart, Lung, and Blood Institute, National Institutes of Health. Heart surgery. Published 2020. 

  3. Cleveland Clinic. Atrial fibrillation (Afib) diagnosis and tests. Published 2019. 

  4. University of California San Francisco, Department of Surgery. Cardiac surgery: coronary artery bypass grafting (CABG). 2020. 

  5. Harvard Health. Should you have stenting or bypass surgery?. 2012. 

  6. Columbia University Irving Medical Center, Department of Surgery. Daniel Hale Williams and the first successful heart surgery. 2020. 

Additional Reading
  • National Heart, Lung, and Blood Institute, National Institutes of Health. Heart surgery. 2020.