Cardiac surgery

What is the heart and how does it work?

The heart is a muscle inside your chest, which pumps blood around your body to your vital organs. It’s a very special piece of plumbing, made up of four chambers with pipes into and out of it. Between each chamber, and in each of the tubes, there are valves which control the flow of blood. Your heart receives its own supply of blood full of oxygen, from a few vessels called the coronary arteries. These arteries wrap around your heart and keep it alive.

What is cardiac surgery and what different types are there?

In medicine, the word “cardiac” refers to the heart. Cardiac surgery is a broad term that covers a few different operations. Some people refer to it as “open heart surgery”. This involves a cut down the middle of your chest, through your sternum (breastbone) to access your heart. For most of these operations, your heart will be deliberately stopped and you will be placed on a heart-lung bypass machine. This machine performs the function of your heart and lungs while the doctor operates. It helps to understand what kind of surgery you’re having and why.

Different types of cardiac surgery include:

  • Coronary artery bypass graft (CABG). In this operation, a surgeon will take one or more blood vessels from within your body (often inside your chest, wrist or legs). This vessel will then be attached to the coronary arteries around your heart to bypass blockages.
  • Valve repair or replacement. Your heart has four valves to ensure one-way flow of blood through its chambers. These valves can become damaged and function poorly, preventing your heart from pumping effectively. In this operation, a surgeon can either repair the valve, or remove the damaged valve completely and replace it with a prosthetic valves. Prosthetic valves are either mechanical or made from animal tissue.
  • Pacemaker insertion. In this operation, a surgeon will make a small cut under your collarbone and insert a thin tube (catheter) through a blood vessel that will lead to your heart. Using this tube, one or more wires will be connected to your heart. The other end of these wires is connected to the pacemaker generator, which will send electrical signals to regulate your heart’s rhythm. Once the wires are placed, the surgeon will insert the pacemaker generator (the bulky part which can be felt under the skin). It will sit just under your collarbone on your non-dominant side.
  • Ventricular assist device (VAD) or total artificial heart (TAH) insertion. These are devices that can support the pumping and function of your heart if you have severe heart failure. You may have this operation while you wait for a heart transplant, or if you are not a candidate for a heart transplant. The surgeon will make a long cut through the sternum and insert the device into your heart.
  • Heart transplant. This is an operation to replace your heart with a donor’s heart. You will be connected to a heart-lung bypass machine, your heart stopped and removed, and the donor heart will be sewed in place by the surgeon. This is a treatment option for end-stage heart disease where other options have been exhausted.
  • Aneurysm repair. The main vessel that carries blood from your heart to the rest of your body is called the aorta. Sometimes, there are weak patches in the wall of the aorta that bulge. This is called an aneurysm. The same thing can happen to the muscular wall of your heart. This operation fixes the bulge with a patch or graft, repairing the aneurysm.
  • Maze surgery. This is an operation which tries to fix an irregular heart rhythm known as atrial fibrillation. A surgeon will cut through the sternum and open the heart. With either a hot or cold tool, or a scalpel, the surgeon will deliberately scar one of the chambers of the heart. This should prevent abnormal electrical impulses from causing an irregular rhythm. This operation isn’t usually performed by itself – it is often done at the same time as other open heart surgery, like a CABG or valve replacement.

What is the recovery like?

Most cardiac surgery involves a stay in the intensive care unit (ICU) and at least a week’s stay in hospital. Recovery from open heart surgery can take months, and can be difficult both physically and mentally. You will have a team to support you through this process, including your surgeon, anaesthetist, cardiologist, GP, nurses, family, rehabilitation staff and others.