About Open-Heart Surgery
Open-heart surgery concludes with any type of surgery in which the chest is cut open and surgery is performed on the muscles, valves, or arteries of the heart. Open-heart surgery is mostly called traditional heart surgery. Nowadays, many new heart procedures can be performed with only small incisions, not wide openings. Therefore, the term “open-heart surgery” can be misleading. Open-heart surgery may be done to perform a coronary artery bypass graft (CABG), which 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. The “hardening of the arteries” occurs when fatty material forms a plaque on the walls of the coronary arteries; which narrows the arteries, making it difficult for blood to get through. When blood can’t flow properly to the heart, a heart attack may occur.
How is open-heart surgery performed?
Open heart surgery, a term often synonymous with coronary artery bypass grafting (CABG), is a complex and intricate procedure designed to improve blood flow to the heart. It's typically recommended for patients with severe coronary heart disease, where arteries are blocked or narrowed, restricting blood and oxygen to the heart muscle. The surgery aims to create a new pathway for blood to reach the heart, bypassing the affected arteries.
The procedure begins with the patient receiving general anesthesia to ensure they are asleep and pain-free. The surgeon then makes an 8- to 10-inch incision down the middle of the chest and cuts through the breastbone to expose the heart. In traditional open-heart surgery, the patient is connected to a heart-lung bypass machine, which takes over the heart's pumping action, allowing the surgeon to operate on a still heart. However, some newer techniques do not require this machine.
A healthy artery or vein from another part of the body is then grafted to the blocked coronary artery. The grafted vessel creates a new route for blood to flow, effectively bypassing the narrowed or blocked sections of the coronary arteries. The surgeon then uses wires to close the breastbone, which remain in the body and stitches up the initial incision. In some high-risk cases, such as those involving multiple surgeries or elderly patients, sternal plating may be used, where small titanium plates are employed to rejoin the breastbone.
The entire CABG procedure can take between three to six hours, depending on the number of arteries being bypassed and the complexity of the operation. It's a highly skilled surgery that requires a team of expert cardiac surgeons, anesthesiologists, and surgical nurses. The advancements in medical technology and surgical techniques have significantly improved the success rates of open-heart surgeries.
Post-surgery, patients typically spend time in the intensive care unit (ICU) to be closely monitored as they begin their recovery. The recovery process involves managing pain, preventing infection at the incision site, and gradually increasing physical activity. Full recovery can take several weeks or months, and patients are often advised to participate in cardiac rehabilitation programs to regain strength and improve heart health.
When is open-heart surgery needed?
Open heart surgery is a critical procedure performed to address various serious heart conditions. It is most commonly needed for coronary artery bypass grafting (CABG), which is recommended for patients with coronary heart disease (CHD). CHD occurs when the coronary arteries, responsible for supplying blood to the heart muscle, become blocked or narrowed due to plaque buildup, a condition known as atherosclerosis. This can lead to a heart attack if the blood flow becomes too restricted.
Patients may require open heart surgery when they have severe blockages or narrowing in their coronary arteries that cannot be treated with medication or less invasive procedures like angioplasty. It's also necessary when the heart's valves are damaged or diseased, preventing them from opening and closing properly. Valve problems can lead to heart failure, where the heart can't pump blood effectively.
Other conditions necessitating open heart surgery include major heart rhythm problems (arrhythmias), congenital heart defects present at birth, and aneurysms of the aorta, the main artery that carries blood away from the heart. In some cases, medical devices such as pacemakers need to be implanted to help the heart beat properly, or a damaged heart may need to be replaced with a donated heart through transplantation.
The decision to perform open heart surgery is based on several factors, including the severity and type of heart disease, the patient's symptoms, overall health, and the results of tests like angiograms, which show the condition of the coronary arteries. The surgery is a major operation that requires a hospital stay of a week or more, with time spent in the intensive care unit immediately after the procedure.
Open-heart surgery recovery
An open-heart surgery will require a 4-5 days hospital stay and usually takes 6-8 weeks for the breastbone and chest muscle to heal and then patients can gradually return to a normal daily routine.
Open-Heart Surgery Procedure
What are the risks of open-heart surgery?
Open heart surgery, while life-saving, carries a spectrum of risks that are important for patients to understand before undergoing the procedure. The most common type of open-heart surgery is coronary artery bypass grafting (CABG), where a healthy artery or vein is grafted to a blocked coronary artery to bypass the blockage and improve blood flow to the heart. Despite the high success rate of CABG, potential risks are associated with the surgery, and they vary depending on the patient's overall health, the complexity of the operation, and the urgency of the procedure.
Infection is one of the primary risks, particularly at the site of the chest wound. Patients with obesity, diabetes, or those who have had previous CABG are more susceptible to this complication. Heart attack or stroke during or after the surgery is another serious risk, although it is relatively rare. An irregular heartbeat (arrhythmia) may also occur, which can be temporary or require long-term treatment.
Lung or kidney failure are potential risks, especially in patients with pre-existing conditions affecting these organs. After the surgery, some patients may experience chest pain and low fever, which are usually temporary but should be monitored closely. Memory loss or 'fuzziness' can also occur, often improving within six months after the surgery.
Blood clots are a risk factor that can lead to serious complications such as deep vein thrombosis or pulmonary embolism. To mitigate this risk, patients are often prescribed blood-thinning medications post-surgery. Blood loss during the surgery may require a transfusion, although this is less common with advances in surgical techniques.
Long-term side effects of open-heart surgery can include chronic pain in the chest area, cognitive changes such as issues with concentration, and emotional changes like anxiety, stress, or depression. These side effects are influenced by the type of heart issue, the method of surgery, and the patient's general health. Most side effects should dissipate within about six months, and proper aftercare and health-promoting habits can help minimize these risks.
To minimize long-term risks following open heart surgery, it's crucial to follow the doctor's aftercare instructions, make heart-healthy lifestyle changes, manage stress and anxiety, and maintain a healthy sleep schedule. Most hospitals offer a cardiac rehabilitation program, which typically includes education, physical therapy, and emotional support to aid in recovery.
How to prepare for open-heart surgery
Preparing for open heart surgery is a critical process that involves several steps to ensure the best possible outcomes. It's a collaborative effort between the patient, their family, and the healthcare team. The preparation begins with understanding the procedure and its risks, and it extends to physical, emotional, and logistical planning.
Firstly, patients should have detailed discussions with their cardiac surgeon and care team to fully understand the nature of their condition, the specifics of the surgery, and what to expect during recovery. This is also the time to discuss any concerns or questions about the procedure.
Patients will undergo a series of preoperative tests, including blood tests, chest X-rays, and an electrocardiogram (EKG/ECG) to assess their health status and prepare the surgical team for the operation. It's also essential to inform the doctors about all medications and supplements being taken, as some may need to be stopped before surgery.
In the weeks leading up to the surgery, patients are advised to eat a healthy diet, get plenty of sleep, and, if possible, increase their physical activity to boost their strength and endurance. Smoking cessation is crucial, as smoking can interfere with the healing process and increase the risk of complications. Limiting alcohol intake and managing stress through relaxation techniques or counseling can also be beneficial.
The night before the surgery, patients will typically be asked to bathe using antibacterial soap to reduce the risk of infection. They will also need to fast, usually starting at midnight, meaning no food or drink, including water, should be consumed.
On the day of the surgery, patients should wear comfortable, loose-fitting clothing and leave jewelry, makeup, and valuables at home. It's important to follow all the instructions provided by the healthcare team regarding medications and arrival time at the hospital.
Patients should also prepare their home for the return after the surgery. This might include arranging for help with daily tasks, setting up a comfortable sleeping area on the first floor to avoid stairs, and ensuring easy access to everything they might need during recovery.
Emotional preparation is equally important. Patients are encouraged to talk about their feelings and concerns with family, friends, or a professional counselor. Support groups can also provide comfort and advice from those who have gone through similar experiences.
Open Heart Surgery in Iran
Coronary artery bypass graft surgery is the most frequent type of heart surgery performed in Iran. Annually, 30 to 40 thousand Open Heart Surgeries are performed in Iran. Iran takes first place in the world for children's heart surgery through video or the Franz Freudenthal method in which heart surgery is performed through a camera-like device without opening the chest, and it can be claimed that babies can be cured through outpatient surgeries. The first fetal heart surgery in 2012 was the first operation in the region, successfully performed in Shiraz and the fetus was born in perfect health. This type of advanced surgery is performed in some medical centers in the United States, Britain, and Brazil and now in Iran.
Open-heart surgery cost in Iran
Open-heart surgery in Iran represents a significant cost advantage for patients seeking high-quality medical care without the financial burden often associated with such procedures in Western countries. The cost of open-heart surgery in Iran is estimated to be one-fourth to one-tenth of what patients might expect to pay in the United States or Australia. This affordability is due to a combination of factors, including government subsidies, lower operational costs, and the strategic positioning of Iran in the global medical tourism market.
In Iran, the average cost of open-heart surgery is around 7,000-10,000 USD, which is significantly lower than the average cost of $75,000 in the United States. This cost includes the surgery itself, hospitalization, and the pre- and post-operative care required for a successful recovery. Patients are often provided with comprehensive packages that cover all aspects of their medical journey, from initial consultations to follow-up care.
The lower cost does not imply a compromise in the quality of care. Iran boasts some of the best cardiac care facilities in the region, staffed by highly skilled and experienced cardiac surgeons who are well-versed in the latest surgical techniques and technologies. The country has made remarkable strides in healthcare, particularly in cardiology, and is recognized for performing a wide range of complex cardiac procedures with high success rates.
Medical tourists considering Iran for open heart surgery can expect state-of-the-art medical services at a fraction of the cost. The hospitals are equipped with modern infrastructure and adhere to international standards of medical care. Moreover, the cultural hospitality and the ease of communication with English-speaking medical staff add to the appeal for international patients.
