Even patients with fragile hearts can always find treatment through Penn Medicine’s Heart Surgery program. Our prominent academic cardiac surgeons routinely tackle open-heart surgical cases other programs cannot. We favor a multidisciplinary approach to open-heart cardiac care, meaning that our specialists work together to bring the most advanced care to our patients and can address multiple needs during one surgical procedure if necessary. Our team routinely accepts referrals and transfers from other heart surgery programs throughout the region and across the country.
What Is Open-Heart Surgery?
Open-heart surgery is a general term for surgical procedures performed to treat heart problems by directly accessing the heart through an opening the chest. During open-heart surgery, the surgeon will cut through the breastbone (sternotomy) and spread the ribs to access the heart.
Open-heart surgery is used to treat a range of heart conditions, including heart failure, heart valve disease, arrhythmias, aneurysms and coronary artery disease.
Understanding the Different Types of Traditional Open-Heart Surgery
There are two ways open-heart surgery is performed:
- On-Pump Open-Heart Surgery: For many open-heart procedures, the heart will be stopped so that the surgeon can perform the procedure while it is still. The patient will be connected to a cardiopulmonary bypass machine (heart-lung bypass machine) that will breathe and circulate blood while the procedure is performed. Once surgery is complete, the patient is disconnected from the machine and the heart begins to beat again.
- Off-Pump Open Heart Surgery: This may also be referred to as beating heart surgery because the procedure does not require the heart to be stopped. The patient will be placed on a ventilator for the procedure, but a cardiopulmonary bypass machine is not required. Coronary artery bypass graft (CABG) surgery is the only open-heart procedure that is performed off-pump.
What Conditions Does Open-Heart Surgery Treat?
At Penn Medicine, we are recognized world-wide for our surgical specialization in many cardiac conditions including:
Types of Open-Heart Surgery at Penn Medicine
Different heart conditions require different surgical techniques to correct. At Penn Medicine, we have cardiac surgeons that specialize in open-heart surgical procedures including:
Aorta Surgery
Through the Aortic Center, our heart surgeons offer a range of innovative treatments for weakened and diseased aortas and aortic valves. Our dedicated aortic surgery team is available 24 hours a day to respond to aortic emergencies. Treatments offered at Penn Medicine include:
Maze Procedure
For patients who have a heart rhythm disorder that cannot be managed with medicine, a device or a procedure, we offer the Maze procedure to block faulty electrical signals and correct arrhythmias. This is the leading surgical approach for atrial fibrillation (A-Fib).
Learn more about the Penn Cardiac Arrhythmia Program
Coronary Artery Bypass Graft (CABG)
If you have coronary artery disease (CAD) that cannot be managed with medicine or interventional procedures, you may need heart surgery. Penn is a leader in using coronary artery bypass graft (CABG) to alleviate heart blockages. The Hospital of the University of Pennsylvania has achieved a three-star rating for isolated coronary artery bypass surgery for the calendar year 2021 from the Society for Thoracic Surgeons, signifying the highest category of quality.
Heart Valve Repair and Replacement Surgery
We provide advanced treatment for every valve condition. Penn’s heart surgeons use both surgical and catheter-based operations to give every patient what they need. In addition to aortic valve surgery, Penn surgeons perform many other mitral, tricuspid and pulmonary valve disease procedures. Some of the treatments and procedures offered by our heart valve disease specialists include:
Septal Myectomy
Many people have hereditary heart conditions, including cardiomyopathies. We are among the few cardiac surgery programs in the nation that perform septal myectomy. This highly specialized procedure provides relief for people living with hypertrophic cardiomyopathy (HCM), a specific type of genetic heart disease.
Learn more about Penn Medicine’s Center for Inherited Cardiovascular Disease
Pericardiectomy
For people with chronic constrictive pericarditis, pericardiectomy provides a surgical solution for long-term relief of symptoms that accompany a stiffened heart membrane. Experienced cardiac surgeons at Penn Medicine may use an open-heart method for this surgery to gain access to the entire pericardium around the heart for total removal, rather than the lesser preferred partial removal.
Heart Transplantation
People suffering from heart failure may be recommended heart transplant surgery if other treatments for this condition are unsuccessful. This procedure involves removing the diseased heart and replacing with a healthy, functioning heart through an incision in the chest. Our heart transplant surgeons have performed more than 1,500 heart transplants and are continually innovating new techniques for better outcomes and heart health.
Learn more about the Heart Transplant Program at Penn Medicine
Preparing for Open-Heart Surgery
Your surgeon or a member of the team will talk with you about any medicines you might be taking and whether it is safe to continue them. To ensure you receive the best care possible, they will arrange for specific tests that may include:
- Blood tests
- Chest X-ray
- Echocardiogram (EKG)
- Urinalysis
Your surgical team will also teach you breathing exercises to help you remove or prevent mucus buildup in your lungs after surgery. If you smoke, now is the time to stop. Smoking increases the demands on your heart and prevents proper healing.
Starting at midnight on the day of surgery you should stop eating or drinking. If your doctor told you to take any medicines, please use only a small sip of water.
What to Expect During Open-Heart Surgery
Open-heart surgery at Penn takes place in our state-of-the-art cardiac operating rooms. They are often lengthy and complex procedures and it is common for heart surgery to take between four and six hours to complete.
Before we take you to the operating room, one of our cardiothoracic anesthesiologists will place an IV to deliver medicines into your vein. The medication will help you relax and keep you comfortable. Your anesthesia team will remain in the operating room throughout your procedure to ensure you are safely sedated.
During the procedure:
- You will be placed under general anesthesia and constantly monitored by our expert cardiac anesthesiologists.
- If you are undergoing an on-pump procedure, you will be placed on a cardiopulmonary (heart-lung) bypass machine that will pump blood through your body during the procedure. You may also be placed on a ventilator to support your breathing.
- To access your heart, your surgeon will perform a sternotomy which involves creating a long incision in the right part of your chest near your breastbone and your ribs will be spread open.
- Depending on your procedure, the surgeon may stop your heart to perform the repair. Once blood flow is restored it will usually start beating again on its own. In some cases, it may need a mild electrical shock to restart it.
- Once the procedure is complete and the heart is beating again, you will be removed from the cardiopulmonary bypass machine.
- Your surgeon will close your breastbone and incision with wires and sutures that will remain in your body.
Open-Heart Surgery Recovery
When you are stable, you will be transferred to another floor to resume recovery. Your care team includes:
- Your surgeon and the cardiac surgery fellows under their supervision
- Nurses and nursing assistants
- Nurse practitioners and physician assistants
- Physical and occupational therapists
- Social workers
The team will encourage you to move as soon as you are able and to keep moving throughout your hospital stay. Movement promotes blood flow and breathing. Your team will give you specific movement goals and exercises for each day you are in the hospital.
A respiratory specialist will see you in the hospital to help you perform deep breathing and coughing exercises that keep your lungs clear.
Pain is part of the healing process, but we work closely with you to ensure you are comfortable. Communicate with your nursing or surgical team about the level of pain you experience.
We may discharge you to your home, a rehabilitation unit or other skilled care unit. Before discharge, we will give you information about how often to continue your activity and breathing exercises.
Long-Term Recovery
It takes time to recover from heart surgery. Your care team will provide detailed instructions on activity and rest, showering and incision care, medications and follow-up appointments.
You can expect to start feeling better within four to six weeks. You may experience these typical symptoms, which will improve over time:
- Constipation
- Decreased appetite
- Difficulty sleeping
- Mood swings
- Muscle pain or tightness in your shoulder
- Swelling
If your surgeon prescribed medications, it is important to take them exactly as prescribed. Contact your doctor if you have any side effects such as vomiting, fever, weight gain or changed heart rate.
You should continue light activity and breathing exercises, but stop immediately if you:
- Are short of breath
- Experience an irregular heartbeat
- Feel dizzy
- Have chest pain
Your surgeon will tell you when it’s safe to drive and return to work. Typically, you will be ready between six and 12 weeks following surgery.
Cardiac Rehabilitation
Following surgery, your doctor may recommend you participate in cardiac rehab. Penn’s team of outpatient cardiac rehab experts work with you to regain your strength and stamina using gentle exercises. Learn more about cardiac rehabilitation.
Open-Heart Surgery: Why Choose Penn Medicine
Penn Medicine cardiac surgeons have specialized skills and deep experience performing many types of open-heart surgical procedures. At Penn Medicine, you can expect:
- Experience and precision: Penn cardiac surgeons are some of the most experienced and innovative practitioners in the country. Our researchers are responsible for many of the breakthroughs in heart treatment over the past two decades.
- Multidisciplinary approach: Our surgeons and interventional cardiologists work together in our state-of-the-art hybrid operating rooms performing open-heart and catheter-based treatments at the same time, if necessary.
- Dedicated cardiac operating rooms: Our state-of-the-art cardiac operating suites offer the latest technologies. We offer dedicated hybrid operating rooms with advanced imaging capabilities that enable your care team to perform catheter-based procedures and traditional operations in one room at one time.
- Care across your community: Penn Medicine has cardiology practices throughout the region allowing convenient consultations, second opinions and pre- and post-operative care close to home.
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