Open-heart surgery involves cutting open the chest and performing surgery on the heart’s muscles, valves, or arteries. Caring for yourself and your incision after surgery can help minimize some risks.

Coronary artery bypass grafting (CABG) is the most common type of heart surgery done on adults. During this surgery, a healthy artery or vein is attached (grafted) to a coronary artery to bypass the blocked area. This allows blood to flow freely to the heart.

Open-heart surgery is sometimes called traditional heart surgery. Today, many new heart procedures can be performed with small chest incisions, known as minimally invasive surgery. Some types of heart surgery can even be done through the skin (percutaneously), with procedures that allow access to the heart using wires and catheters inserted to a vein or artery elsewhere in the body.

Open-heart surgery may be done to perform a CABG. A coronary artery bypass graft may be necessary for people with coronary heart disease.

Coronary heart disease occurs when the blood vessels that provide blood and oxygen to the heart muscle become narrow and hard. This is atherosclerosis, often called “hardening of the arteries.”

Hardening occurs when fatty material forms a plaque on the walls of the coronary arteries. This plaque narrows the arteries, making it difficult for blood to get through. When blood can’t flow properly to the heart, it can lead to heart attack and heart failure.

Open-heart surgery is also done to:

  • repair or replace heart valves, which allow blood to travel through the heart
  • repair damaged or abnormal areas of the heart
  • replace a damaged heart with a donated heart (heart transplantation)

According to the National Institutes of Health, a CABG takes from 3 to 6 hours. It’s generally done following these basic steps:

  • The patient is given general anesthesia. This ensures that they will be asleep and pain free through the whole surgery.
  • The surgeon makes an 6- to 8-inch cut in the chest.
  • The surgeon cuts through all or part of the patient’s breastbone to expose the heart.
  • Once the heart is visible, the patient may be connected to a heart-lung bypass machine. The machine performs the work of the heart so that the surgeon can give medication to stop the heart’s beating to perform surgery
  • The surgeon uses a healthy vein or artery to make a new path around the blocked artery.
  • The surgeon closes the breastbone with wire, leaving the wire inside the body.
  • The original cut is stitched up.

Sometimes sternal plating is done for people at high risk, such as those who’ve had multiple surgeries or people of advanced age. Sternal plating is when the breastbone is rejoined with small titanium plates after the surgery.

Risks for open-heart surgery include:

Tell your doctor about any drugs you are taking, including over-the-counter medications, vitamins, and herbs. Also, inform them about any illnesses you have, including any infections.

In the days before surgery, talk with your surgeon about whether or not you need to stop taking any medications, such as blood thinners.

It’s important to talk with your doctor about your alcohol consumption before you prepare for the surgery. If you typically have three or more drinks a day and stop right before you go into surgery, you may go into alcohol withdrawal. This may cause life threatening complications after open-heart surgery, including seizures or tremors. Your doctor can help you with alcohol withdrawal to reduce the likelihood of these complications.

You may be asked to wash yourself with a special soap the day before the surgery. This soap kills bacteria on your skin and will lessen the chance of an infection after surgery. You may also be asked not to eat or drink anything after midnight.

Your healthcare professional will give you more detailed instructions when you arrive at the hospital for surgery.

When you wake up after surgery, you will have two or three tubes in your chest. These are to help drain fluid from the area around your heart. You will have intravenous (IV) lines in your arm to supply you with fluids” with “to administer certain medications.

You will be carefully monitored by a team of healthcare professionals.

You can expect to spend the first day or two in the ICU and about a week in the hospital

Taking care of yourself at home immediately after the surgery is an essential part of your recovery.

Incision care

Incision care is extremely important. your healthcare team will give instructions about when it is safe to shower and how to care for the incision. You should ensure that the incision site isn’t hit directly by the water. It’s also important to regularly inspect your incision sites for signs of infection, which include:

  • increased drainage, oozing, or opening from the incision site
  • redness around the incision
  • warmth along the incision line
  • fever

Pain management

Pain management is also incredibly important, as it can increase recovery speed and decrease the likelihood of complications like blood clots or pneumonia. You may feel muscle pain, throat pain, pain at incision sites, or pain from chest tubes. Your doctor will likely prescribe pain medication that you can take at home. It’s important that you take it as prescribed. Some doctors recommend taking the pain medication both before physical activity and before you sleep.

Get enough sleep

Some patients experience trouble sleeping after open-heart surgery, but it’s important to get good rest to aid recovery.

A 2021 study found that 78% of patients experienced sleep disturbances for the first month following heart surgery, with some reporting nightmares and night terrors. About half of the participants took over-the-counter medications to help.

Some research has shown that open-heart surgery is associated with a decline in mental functioning. However, this often improves over time, with one study showing that after 6 months, cognitive decline improved in many people.

Some people experience depression or anxiety after open-heart surgery. A therapist or psychologist can help you manage these effects.

Rehabilitation

Most people who’ve had a CABG benefit from participating in a structured, comprehensive rehabilitation program. This is usually done outpatient with visits several times a week. The components of the program include exercise, reducing risk factors, and dealing with stress, anxiety, and depression.

Expect a gradual recovery. It may take up to six weeks before you start feeling better and up to 6 months to feel the full benefits of the surgery. However, the outlook is good for many people, and the grafts can work for many years.

Nevertheless, surgery does not prevent artery blockage from happening again. You can help improve your heart health by:

  • taking medications such as antiplatelet and cholesterol-lowering medications
  • eating a healthy diet
  • cutting back on foods high in salt, fat, and sugar
  • leading a more active lifestyle
  • not smoking
  • controlling high blood pressure and high cholesterol