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About Open-Heart Surgery

Open Heart 1

How Does the Heart Work?

As the strongest muscle in the body, the heart is responsible for pumping 4 to 8 liters of blood per minute to supply oxygen and nutrients to the circulatory system. 1

Within the heart, there are four chambers that work in coordination. The right side receives deoxygenated blood from the body and transfers it to the lungs, while the left side works to move the oxygenated blood from the lungs to the rest of the body. 2

How Does Blood Flow Through the Heart?

To understand blood flow, the easiest thing to remember is that veins move blood towards the heart and arteries move blood towards the body and other organ systems.2

While the heart contracts and expands, four valves control the flow of blood in and out of the heart ensuring that blood is pumped in the correct direction. These valves are known as the mitral valve, tricuspid valve, aortic valve and the pulmonary valve. These valves open to let the blood move ahead, then quickly close to keep the blood from flowing backward. 2

Common Open Heart Surgeries

Open Heart 2

Coronary Artery Bypass Graft

Coronary artery disease occurs when plaque builds up in the coronary arteries preventing the heart from getting the enriched blood it needs. When the blood vessels that transport blood become narrow due to plaque build-up, a coronary artery bypass graft (CABG), needs to be performed. This is also called bypass surgery.3

In this procedure, the surgeon uses a section of vein sourced from another part of the body, such as the leg, to make a new route for blood supply to the heart muscle. Oxygen-rich blood will be rerouted around the narrowed or blocked section of the coronary artery and into the heart muscle. If there are multiple blockages, then the procedure may require multiple bypasses.3

Open Heart 3

The image above shows how the valves of the heart open and close in sync with each other to pump blood through the heart. The closing of the valves creates the “lub dub” sound heard when listening to the heart.

Valve Repair and Replacement

The heart has four valves that open and close in a steady rhythm to pump blood through the four chambers of the heart in the correct direction. These valves can malfunction for a variety of reasons including bacterial infection, congenital heart defects or coronary artery disease.4

The aortic valve and the mitral valve are most commonly replaced, while pulmonary and tricuspid valve replacements are uncommon in adults. Valve repair and replacements are mostly caused by regurgitation or stenosis.4

Regurgitation occurs when the valve does not close properly causing the blood to flow backward through the valve and into the heart instead of moving it forward and out to the body. This forces the heart to work harder to pump blood through the body.4

Stenosis, or narrowing of the valve, is caused when valve tissue has thickened or fused together, causing a reduction in blood flow because the valve will not open as well as it should.4

A surgeon may opt to repair or replace a malfunctioning valve with a mechanical valve made of metal or with valve tissue from a cow, pig or human donor. Most of the time, heart valve replacement or repair is an open-heart operation. In some cases, the valve can be replaced or repaired without opening the chest, such as in a transcatheter aortic valve replacement (TAVR) procedure.

How is the Heart Accessed?

If you are having open-heart surgery, your surgeon will access the heart by making an incision vertically down the center of your chest. The size of the incision varies depending on the type of surgery being performed. After the incision is created, the breastbone (sternum) will be cut to access your heart. This process is called a sternotomy.5

Open Heart 4
Open Heart 5

Wire closure

How is the chest wall closed?

Following the operation, a surgeon will close the breastbone by bringing the two halves back together. While other bones of the body are fixed with plate and screw technology, the breastbone is still primarily closed with surgical steel wires. 5

One of the alternatives to wire closure is rigid fixation; the use of metal plates and screws to immobilize fractured bone. The SternaLock Blu Study showed that patients treated with SternaLock Blu showed improved sternal healing, fewer breastbone complications and improved recovery when compared to patients treated with wires. For more information see the SternaLock Blu Study & Product page.6, 7

Open Heart 6

SternaLock Blu (rigid fixation) closure

After the breastbone closure, your surgeon will sew the tissues and muscles together with stitches or sutures. Most operations will take approximately three to six hours depending on the complexity of the procedure.8

As with most surgery, sternal closure comes with risk, including the risk of infection, implant wear, loosening, screw or plate breakage and delayed or incomplete bone healing.9 For more information on risks, see What are the risks associated with sternal fixation using SternaLock Blu?

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References

  1. http://ht.edwards.com/scin/edwards/sitecollectionimages/edwards/products/presep/ar04313hemodynpocketcard.pdf
  2. https://www.nhlbi.nih.gov/health/health-topics/topics/hhw/anatomy
  3. https://www.nhlbi.nih.gov/health/health-topics/topics/cabg/
  4. http://www.yourheartvalve.com/heartbasics/pages/valvediseases.aspx
  5. http://ctsurgerypatients.org/pre-post-operative-care/day-of-heart-surgery
  6. CR 0712S (Clinical Study Report) SternaLock Blu Study, 2014-15, an evaluation of rigid plate fixation in supporting bone healing: a prospective, multi-center trial of 236 total patients undergoing full midline sternotomy.
  7. CR 0712E (Economic Study Report) SternaLock Blu Study, 2014-15, an evaluation of rigid fixation in supporting bone healing; a prospective, multi-center trial of 236 total patients undergoing full midline sternotomy.
  8. https://www.nhlbi.nih.gov/health/health-topics/topics/hs/during
  9. SternaLock Blu IFU 01-50-1215

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The information herein is of a general nature and does not represent or constitute medical advice or recommendations and is for general education purposes only. The information includes descriptions of a medical device that a thoracic (heart) surgeon may choose for patients undergoing open-heart surgery.

Zimmer Biomet manufactures medical devices, including metal plates and screws that may be used by your heart surgeon to hold together the sternum (breastbone) after heart surgery. We do not practice medicine; all questions regarding your medical condition must be directed to your doctor(s).

Results with breastbone (sternum) plates and screws (rigid fixation) will vary due to health, weight, activity and other variables.  Not all patients are candidates for this product and/or procedure.  Only a medical professional can determine the treatment appropriate for your specific condition.  Appropriate post-operative activities will differ from patient to patient.  Talk to your surgeon about whether rigid fixation is right for you and the risks associated therewith, including but not limited to the risks of infection, implant wear, loosening, screw or plate breakage or incomplete bone healing. For a complete list of risks associated with Zimmer Biomet’s rigid fixation system, see Patient Risk Information.

The SternaLock Blu study was funded by Zimmer Biomet.

All content herein is protected by copyright, trademarks and other intellectual property rights, as applicable, owned by or licensed to Zimmer Biomet or its affiliates unless otherwise indicated, and must not be redistributed, duplicated or disclosed, in whole or in part, without the express written consent of Zimmer Biomet.

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