Rather than being a specific treatment, an open heart approach may be employed in number of surgeries, including coronary artery bypass grafting, heart valve repair or replacement, and heart transplant, as well as the placement of devices to aid this organ, such as ventricular arterial devices and total artificial hearts.  

Open heart surgeries are employed to take on several different and often very serious heart problems.

Coronary Artery Disease

Coronary artery disease (CAD) is defined as hardening and narrowing of arteries in the heart. It can lead to heart failure (the heart becoming unable to pump enough blood) as well as heart attack (blockage of an artery leading to the heart). Treatment approaches depend on the progression of the CAD or associated conditions.

Coronary artery disease, heart failure, and heart attack may initially be treated using other methods, such as lifestyle changes, stenting, or minimally invasive approaches. Open-heart surgery is indicated in cases of coronary artery disease in which multiple coronary arteries are severely blocked, or when stenting cannot be used to address coronary artery blockages.

Criteria

A diagnosis of coronary artery disease, heart valve disease, or any of their related conditions is serious. Your healthcare provider will weigh a number of important factors before opting for an open heart surgery approach. These include:

Age: Open heart procedures may not be appropriate or may have increased risks for older patients. Severity and location of blockages: For more advanced CAD, especially cases that are leading to heart failure or heart attack, the number of vessels involved and their anatomical locations determine whether open-heart surgery is indicated over stenting. Emergency: Open heart approaches may also be employed in emergency situations, such as heart attack. Lifestyle factors: Given the influence of diet, exercise, and personal habits on both heart health and response to surgery, lifestyle factors may need to be weighed when making the decision. Health status: Among the health factors that may contraindicate surgery are taking insulin for diabetes type II, risk of stroke, propensity for infection, or being at higher risk for surgical complications.

Tests and Labs

As with all surgeries, proper evaluation and diagnosis are essential for success. Your healthcare provider’s assessment will focus on heart, lung, and vascular (vein and artery) health. Specific approaches vary based on the case, but typically feature:

Physical evaluation and medical history: In non-emergency cases, the first step in diagnosis will involve physical evaluation of vital signs—factors like pulse and breathing—as well as answering questions about health status and symptoms. An assessment of medical history will also be performed. Electrocardiogram (EKG): EKG devices are able to measure the heart’s electrical activity, which allows the practitioner to understand where, specifically, there are problems. This means figuring out, for example, the scale and scope of coronary artery disease in those affected. Cardiac stress test: Sometimes, the healthcare provider will need to see your heart at work and assess activity as you undergo exertion and exercise. Several imaging techniques may be employed, such as magnetic resonance imaging (MRI), echocardiography (see below), or nuclear heart scanning (the use of a radioactive element to boost imaging capability), to help your medical team learn more about the specific issue (or issues) involved.   Echocardiography: This imaging approach uses sound waves to produce a real-time video of your heart in action. Not only does this allow the surgeon to see the size and shape of your heart, but it can also locate areas of constricted blood flow as well as the activity of coronary muscles.   Coronary angiography: In this approach, a contrast dye is injected into the coronary arteries using a specialized tube. The chest area is then X-rayed, with the dye allowing healthcare providers to further assess blood flow and the presence of any blockages on the resulting image.  

A Word From Verywell

There’s no doubt that a diagnosis like coronary artery disease or heart valve disease can be jarring; for many, it’s at this moment that they appreciate just how important heart function is.

That said, medical technology is constantly evolving and is now better than it’s ever been, and those who operate on the heart are very highly specialized and trained.

Notably, open heart surgeries are the most common approaches to heart problems, and they’re highly successful. Precisely because these approaches have been employed for so long—the first open heart procedure was performed in 1893 (it was a success)—you can rest assured that you’ll be in good hands in the 21st century.