Heart surgery is done to correct problems with the heart. Your provider may recommend surgery after lifestyle changes, medicines, or other procedures no longer work. Heart surgery may also be done in an emergency situation, such as a heart attack. Each year, more than 2 million people around the world have open-heart surgery to treat various heart problems.

People of all ages can have heart surgery. This topic has information about heart surgery for adults.

Depending on your heart problem, your healthcare provider may suggest different types of heart surgery. These can range from minimally invasive surgical options to open-heart surgeries that may require a longer recovery time. Before surgery, your provider may order tests to determine which type of heart surgery will work best for you.

Many heart conditions can be treated with heart surgery. For example, using surgical techniques, surgeons can:

• Repair or replace heart valves, which control blood flow through the heart
• Repair abnormal or damaged structures in the heart
• Implant medical devices that help control the heartbeat or support heart function and blood flow
• Replace a damaged heart with a healthy heart from a donor

As with any type of surgery involving the heart, there are some risks. The risks are generally higher if surgery is done in an emergency situation (to treat a heart attack, for example) or if you have another health condition such as diabetes or kidney disease. For many people, the results of heart surgery are excellent. Heart surgery can reduce symptoms, improve quality of life, and improve the chances of survival.

Heart surgery can be used to treat a variety of heart problems. The type of surgery you have will depend on what heart problem you have, your age, and your overall health, as well as other factors.

The most common conditions treated by heart surgery are listed below.

Aneurysm

An aortic aneurysm is a balloon-like bulge that occurs in the aorta, the main artery carrying oxygen-rich blood to your body. A healthy aorta has thick walls, but certain medical problems, genetic conditions, and trauma can damage or weaken these walls. The force of blood pushing against the weakened or injured walls can cause an aneurysm.

There are two main ways that surgeons can repair aortic aneurysms: endovascular aneurysm repair (EVAR) and open surgical repair. The best procedure for you will depend on the size and location of the aneurysm and your age and overall health.

• Surgeons perform EVAR using a method called cardiac catheterization. This makes it a less invasive option compared to open surgical repair. During the procedure, your surgical team will make a small cut, usually in the groin, then guide a stent graft (a tube covered with fabric) through your blood vessels up to the aorta. The stent graft then expands and attaches to the aortic walls to provide support which helps restore normal blood flow in the vessel.
• Open surgical repair is a type of open-heart surgery. During this procedure, your surgeon will make an incision (cut) in your chest to remove the aneurysm and sew a graft in its place. This graft is typically a tube made of leak-proof polyester.

Arrhythmias

Arrhythmias are problems with the rate or rhythm of the heartbeat. The heart can beat too quickly, too slowly, or with an irregular rhythm. If medicines or other procedures do not treat your arrhythmia, you may need surgery to place a device inside your body that helps control arrhythmias. These include pacemakers and implantable cardioverter defibrillators (ICDs).

• Pacemakers send electrical pulses to help your heart beat at a normal rate and steady rhythm. You may need a temporary (short-term) or permanent (long-term) pacemaker. A temporary pacemaker is normally inserted through a vein in the neck and remains outside your body. You will need surgery to have a permanent pacemaker placed in your chest or abdomen. Learn more about the different types of pacemakers and how they work.
• ICDs are placed through surgery in the chest or stomach area, where the device can check for arrhythmias. An ICD can give off a low-energy shock that speeds up or slows down an abnormal heart rate, or a high-energy shock to correct a fast or irregular heartbeat. Learn more about what to expect if you need an ICD.

Atrial fibrillation

Atrial fibrillation is one of the most common types of arrhythmias. Arrhythmias are problems with the rate or rhythm of the heartbeat.

To treat atrial fibrillation, surgeons can perform a type of surgery called a maze procedure (also called surgical ablation) to stop the faulty electrical heart signals that cause the heart to beat irregularly. During this procedure, a surgeon uses intense cold, heat, or a surgical knife called a scalpel to make several cuts in the upper chambers of the heart. These cuts form a maze of scar tissue. Because scar tissue cannot conduct electricity, the tissue blocks the faulty electrical signals that cause atrial fibrillation.

The procedure may require open-heart surgery, especially if it is done at the same time as another procedure, such as to repair heart valves. The maze procedure has a very high success rate in treating people with atrial fibrillation.

Coronary heart disease

Coronary heart disease is a type of heart disease that occurs when the coronary artery cannot deliver enough oxygen-rich blood to the heart. Depending on how serious your condition and symptoms are, you may need coronary artery bypass grafting (CABG), also called heart bypass surgery.

CABG, pronounced like “cabbage,” uses healthy blood vessels from another part of the body and connects them to blood vessels above and below the blocked artery. This creates a new route for blood to flow that bypasses the narrowed or blocked coronary arteries. The blood vessels are usually arteries from the arm or chest, or veins from the legs.

CABG may be performed in one of three ways.

• Minimally invasive CABG can be performed through small cuts in the chest.
• In traditional CABG, the chest is cut open and a machine pumps your blood.
• In “off-pump” CABG, the chest is cut open, but a machine for pumping blood is not used.

Learn more about how to prepare for CABG and what to expect during the procedure.

Heart failure

Heart failure, also known as congestive heart failure, develops when your heart doesn’t pump enough blood for your body’s needs. This can happen if your heart can’t fill up with enough blood. It can also happen if your heart is too weak to pump properly.

If you have heart failure that does not improve with medicines or lifestyle changes, you may need surgery. The type of surgery depends on the cause of your heart failure.

• Abiventricular pacemaker, also called cardiac resynchronization therapy, helps both sides of your heart contract at the same time to relieve your symptoms.
• An implantable cardioverter defibrillator (ICD) checks your heart rate and uses electrical pulses to correct irregular heart rhythms.
• A mechanical heart pump, such as a ventricular assist device, helps the heart pump blood through the body when it can’t pump enough blood on its own. A different pump called a total artificial heart can be placed to provide circulation and replace heart chambers (called ventricles) that are diseased or damaged.
• A heart transplant replaces a diseased heart with a healthy heart from a deceased donor. This option is typically used when other treatments do not work. Though there are risks to this surgery, survival rates are 85% to 90% one year after surgery.

Heart valve disease

For the heart to work well, blood must flow in only one direction. The heart's valves make this possible. Healthy valves open and close in a precise way as the heart pumps blood. Heart valve repair or replacement may be necessary if something happens to the valves that leads to problems with blood flow in the heart’s chambers.

Learn more about the different types of heart valve disease.

Heart valve repair surgery

Depending on the type of heart valve disease you have, there are several ways surgeons can repair a valve. For example, your surgeon may fix the flaps of your heart valve by patching tears or reattaching loose flaps. They may also use a balloon that stretches the opening of a valve and allows blood to flow through more effectively. They may also insert devices or stents to help valves that leak. The repair may be minimally invasive or require open-heart surgery.

Learn more about heart valve repair.

Heart valve replacement surgery

Sometimes faulty or diseased heart valves cannot be repaired and must be replaced. Your surgeon will replace the faulty or diseased valve with either a mechanical or a biological heart valve. Learn more about the difference between mechanical and biological heart valves.

Surgeons replace heart valves during open-heart surgery or with a minimally invasive procedure using a catheter — a thin tube threaded through a blood vessel to the heart. A common example of the procedure using a catheter is transcatheter aortic valve replacement (TAVR). TAVR, which is sometimes called transcatheter aortic valve implantation (TAVI), replaces the aortic valve to treat aortic stenosis, a condition in which the aortic valve is narrowed.

Like any surgery, heart surgery has risks. Your provider will talk with you about the benefits and risks of your procedure before you have surgery. Risks will vary depending on the heart problem, type of surgery, and your overall health. Some risks include:

• Arrhythmias (irregular heartbeats)
• Bleeding
• Blood clots that can cause stroke or venous thromboembolism (VTE)
• Damage to tissues including the heart, kidneys, liver, and lungs
• Infection, fever, swelling, or other signs of inflammation at the incision site
• Memory loss and other issues, such as problems concentrating or thinking clearly, which often improve within a year after surgery
• Pneumonia

Death is also a risk of heart surgery. However, heart surgery is more likely to be life-threatening in people who are very sick before the surgery.

In general, the risk of complications is higher if heart surgery is done in an emergency situation (for example, during a heart attack). The risk is also higher if you have other diseases or conditions, such as diabetes, kidney disease, lung disease, or peripheral artery disease (PAD).

There are many types of heart surgery. The type depends on your heart condition and how serious it is. This means that one person’s experience preparing for surgery can be very different from another person’s. For example, some people are able to carefully plan their heart surgeries with their healthcare providers, while others require emergency surgery.

If you're having a planned surgery, your healthcare team will meet with you to explain how to prepare, what to expect during the surgery, and how to recover afterward.

Diagnostic tests before surgery

Before your surgery, you will have a physical exam and your provider will do blood tests and heart tests to learn more about your condition and your general health. These tests help your provider decide whether you need heart surgery, what type of surgery you need, and when to do it. Some heart tests your provider may do include:

• Cardiac catheterization
• Coronary angiography
• Echocardiography (“echo”)
• Electrocardiogram (ECG or EKG)
• Heart imaging tests such as cardiac computed tomography (CT) scan, chest X-ray, coronary calcium scan, cardiac magnetic resonance imaging (MRI), carotid ultrasound, or nuclear heart scan
• Holter and event monitors
• Stress tests

Immediately before your surgery, your provider will place an intravenous (IV) line into a blood vessel in your arm or chest to give you fluids and medicines. A member of your healthcare team may shave the area where your surgeon will make the incision (cut). Also, your skin might be washed with antibiotic soap to reduce the risk of infection. Soon after, you'll be moved to the operating room and given anesthesia, a medicine that makes you lose consciousness and not feel pain during the surgery.

Questions to ask your provider

Talk with your provider about the benefits and risks of your upcoming procedure and about what will happen if you do not have the procedure. You can also ask about how to prepare and what to expect.

You may want to add your own questions about what you should do to prepare for heart surgery to the common questions below.

• How long before surgery do I need to stop eating or drinking?
• Do I need to change any of my current medicines before surgery?
• How long will the surgery take?
• How much pain should I expect after surgery and how will it be managed?
• How long will I be in the hospital after surgery?
• Will I be referred to a cardiac rehabilitation program? If so, how long will I be there?
• How long until I can return to work and resume normal daily activities?

Heart surgeries are done in hospitals. Typically, heart surgeries are performed by highly trained doctors called cardiothoracic surgeons. A team of healthcare providers including your surgeon, imaging specialists, anesthesiologists, and nurses will care for you during your hospital stay.

Depending on many factors including your heart condition and overall health, your surgeon may perform minimally invasive heart surgery, off-pump surgery, or open-heart surgery. For example, coronary artery bypass graft surgery (CABG) can be performed using any of these methods. Your provider will work with you to decide which one is best based on how serious your heart problem is and any factors that may put you at risk for complications.

What to expect during open-heart surgery

Open-heart surgery is any kind of surgery in which a surgeon makes a large incision (cut) in the chest to open the rib cage and operate on the heart. For this type of surgery, you'll be given anesthesia, a medicine to make you unconscious and unaware of pain.

Your surgeon will make a 6- to 8-inch incision down the center of your chest wall. Then, they will cut your breastbone and open your rib cage to reach your heart. During the surgery, you'll receive medicine to thin your blood and keep it from clotting. Your surgeon will connect a heart-lung bypass machine to your heart. The machine will take over your heart's pumping action and move blood away from your heart. This is done because surgeons can better perform some procedures on a heart that isn't beating and doesn't have blood flowing through it.

Once the bypass machine starts to work, the surgeon will repair your heart problem. After the surgery is done, they will restore blood flow to your heart. Usually, your heart will start beating again on its own. Sometimes mild electric shocks are used to restart the heart.

Procedures that may use open-heart surgery

• CABGto treat coronary heart disease
• Heart transplant to treat heart failure
• Heart valve repair or replacement to treat heart valve diseases
• Maze procedure to treat atrial fibrillation
• A total artificial heart or a ventricular assisted device placement to treat heart failure

What to expect during off-pump heart surgery

Surgeons often use off-pump, or beating heart, surgery to perform CABG. This approach is similar to open-heart surgery because the breastbone is opened to access the heart. However, the heart isn't stopped, and a heart-lung bypass machine isn't used. Instead, your surgeon will steady your heart with a mechanical device in order to operate on it. Your heart will continue to pump blood to your body during the surgery.

Off-pump heart surgery isn't right for all people. Your provider will carefully consider your heart problem, age, overall health, and other factors that may affect the surgery to decide whether this type of surgery will work for you.

What to expect during minimally invasive heart surgery

To perform minimally invasive heart surgery, a surgeon makes small incisions (cuts) in the side of the chest between the ribs. They do not cut through the breastbone to open the chest as is done in open-heart surgery. During the procedure, your surgeon will insert a tool with a small video camera at the tip. This tool will allow the surgeon to see and operate on your heart using small tools inserted through the incisions in the side of your chest.

Another type of minimally invasive heart surgery called robotic-assisted surgery is becoming more common. With this method, the surgeon uses a computer that controls small robotic arms inserted through incisions to perform heart surgery while watching a high-definition video of your heart and the inside of your chest. This method allows the surgeon to perform precise, controlled movements.

Compared to open-heart surgery, you may have a shorter recovery time and lower pain levels after minimally invasive surgery. Many heart conditions can be treated using minimally invasive surgery, though it isn’t right for everyone. Your provider will discuss whether you are eligible depending on the severity of your heart problem and your overall health.

Procedures that may use minimally invasive heart surgery

• CABGto treat coronary heart disease
• Heart valve repair or replacement to treat heart valve diseases
• Maze procedure to treat atrial fibrillation
• Pacemaker or implantable cardioverter-defibrillator (ICD) insertion to treat arrhythmias
• Ventricular assisted device (VAD) placement to treat heart failure

Recovery in the hospital

After your surgery, you may spend a day or more in the hospital's intensive care unit (ICU), depending on the type of surgery you had. An intravenous (IV) needle might be inserted in a blood vessel in your arm or chest to give you fluids until you're ready to drink on your own. Your healthcare team may also give you extra oxygen through a face mask or nasal prongs that fit just inside your nose. They will remove the mask or prongs when you no longer need them.

When you leave the ICU, you will be moved to another part of the hospital for several days before you go home. While you're in the hospital, your healthcare team will closely watch your heart rate, blood pressure, breathing, and incision site(s).

Recovery at home

People respond differently to heart surgery. Your recovery at home will depend on what kind of heart problem and surgery you had, as well as your overall health. Before you go home, your provider will tell you how to:

• Care for your healing incision(s)
• Recognize signs of infection or other complications
• Cope with the after-effects of surgery

Your healthcare team will give you information about follow-up appointments, medicines, and situations when you should call your provider right away. They will also let you know when you should expect to resume daily activities such as driving and working.

Discomfort and some pain after heart surgery are normal. Your provider will work with you to give you medicine to ease any pain you may feel. Some common after-effects of heart surgery include:

• Constipation, especially if you are taking pain medicine
• Difficulty sleeping
• Loss of appetite
• Memory problems
• Mood swings or depression
• Pain in your chest or muscles, especially if you have an incision in your leg from coronary artery bypass grafting (CABG)

Ongoing care and recovery

You will need to see your provider regularly to monitor your recovery and take steps to prevent another heart problem.

• Schedule regular checkups. Checkups with your provider or surgeon are an essential part of your ongoing care after heart surgery. During these visits, you may have blood tests or heart tests such as an electrocardiogram (EKG), echocardiography, or a stress test. These tests will show how your heart is working after the surgery.
• Take your medicine as prescribed. Depending on your condition and type of heart procedure, you may need to take a blood-thinning medicine for several months following your surgery.
• Make heart-healthy lifestyle changes. Your provider may recommend lifestyle changes to help you stay healthy. For example, your provider may advise you to quit smoking, choose heart-healthy foods, be physically active (when it is safe to do so), manage stress, and get enough good quality sleep.
• Learn more about how to protect your heart and prevent future problems. Depending on the type of heart surgery, your provider may refer you to cardiac rehabilitation. Cardiac rehabilitation is a medically supervised program for people recovering from heart problems. It usually includes exercise training, education on heart-healthy living, and counseling to reduce stress and help you recover. Your provider can help you find a cardiac rehabilitation program near your home.

What is heart surgery?

Heart surgery can correct certain heart problems when other treatments haven't worked or can't be used.

In some cases, heart surgery may be a medical emergency. For example, surgery for a severe heart attack may need to be done right away. In other cases, you can plan heart surgery ahead of time. Some heart surgeries are major operations, such as heart bypass surgery for blocked arteries in the heart. Other surgeries are more minor heart procedures, such as putting in a pacemaker.

What conditions does heart surgery treat?

There are different types of heart surgery that can help treat many heart conditions:

What approaches do surgeons use to do heart surgery?

The approach a surgeon uses to do heart surgery depends on your heart problem, your general health, and other factors. Approaches to heart surgery include:

• Open-heart surgery (also called traditional heart surgery) is when the surgeon cuts the chest open to reach the heart. Because it's difficult to operate on a beating heart, medicines are used to stop the heart. A heart-lung bypass machine keeps oxygen-rich blood pumping through the body during the surgery.
• Off-pump heart surgery is open-heart surgery on a beating heart without using a heart-lung bypass machine. The surgeon holds the heart steady with a device. Surgeons may use off-pump heart surgery to do coronary artery bypass grafts (CABG), but only in certain cases.
• Minimally invasive heart surgery uses small cuts between the ribs. The cuts may be as small as 2 to 3 inches. The surgeon inserts tools into the chest through the cuts. This type of heart surgery may or may not use a heart-lung bypass machine.
• Robotic-assisted surgery is a type of minimally invasive surgery. The surgeon uses a computer to control tools on the arms of a robot. This allows the surgeon to be very accurate when doing difficult operations.

What are the risks of heart surgery?

Like all surgery, heart surgery has risks even though the results are often excellent. The risks include:

• Bleeding
• Infection, fever, and swelling
• A problem from anesthesia (medicine that makes you sleep during surgery)
• Arrhythmia
• Damage to the heart, kidneys, liver, and lungs
• Stroke

The risks of heart surgery tend to be higher if:

• The surgery is an emergency.
• You have other medical conditions, including:
  • Diabetes
  • Kidney diseases
  • Lung diseases
  • Peripheral artery disease (PAD)