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Open-heart surgeries for the elderly. Open-heart surgery is one of the scariest operations for a person. As soon as his name is mentioned, facial features change, but open-heart surgery is a common procedure among adults, where an incision is made in the chest to open it and reach the heart muscle.

Open heart surgery

• Open heart surgery is called traditional heart surgery and is an operation in which the chest wall is opened to perform surgery on the heart muscles, valves or arteries.
• It performs its function of pumping blood to all parts of the body. This device allows the surgeon to operate on an inactive heart through which blood does not flow.
• This operation could be performed through small incisions between the ribs of the rib cage instead of the usual large incision in the sternum, which is called minimally invasive surgery.
• It is possible to use an artificial heart-lung machine in this type of surgery or to do without it.
• Therefore, sometimes scheduling open heart surgery is inaccurate.
• The doctor decides to perform open-heart surgery when the alternatives that can help the patient have run out, such as medications, a healthy lifestyle, and other means.
• While the cardiologist evaluates the patient’s condition and the need for the operation, conducts the necessary medical examinations to determine the patient’s health condition, and then discusses the topic of the operation with his patient.
• He explains the extent of the difficulty he is suffering from, its severity, and its symptoms, and then the patient needs a recovery period to begin regaining his health and well-being.

Reasons for performing open heart surgery

• Among the reasons a doctor uses open-heart surgery are:.
• Repair damaged heart parts.
• Replace or repair a valve that is not working properly.
• Transplanting a healthy heart from a donor and replacing it with an old heart.
• Implanting cardiac devices that help control heart rhythm and regulate blood flow.
• Treating heart failure and coronary artery disease.

Coronary artery bypass grafting

• Coronary artery bypass grafting (CABG), which is the most common surgery, as this surgery improves blood flow to the heart to treat coronary heart disease.
• Which results from the accumulation of fatty plaques (cholesterol) inside the coronary arteries, which leads to their narrowing and thus to a decrease in blood flow.
• It is responsible for supplying oxygen to the heart muscle, and this can cause severe chest pain (angina).
• Bursting of these plaques can lead to the formation of large blood clots, which completely stop the flow. of blood through the coronary arteries (heart attack).
• During this surgery, a healthy artery or vein is connected to the closed coronary vessel so that it can resupply blood and oxygen to the heart muscle. This operation can be performed on more than one closed coronary artery during surgery.

Repair or replace heart valves

• For the heart to work properly, blood must flow in only one direction, and heart valves perform this function, opening and closing precisely as they pump blood.
• When a valve is damaged (narrowed enough to prevent blood from flowing through it, or closed incompletely to allow blood to flow in the opposite direction), open heart surgery is performed to repair the damaged valve or replace it with a new artificial valve or a biological valve (taken from the heart of a cow or a person).

Treatment of atrial fibrillation

• It is the most common type of arrhythmia, in which the atrium contracts irregularly or rapidly.
• A procedure called (labyrinthine surgery) involves opening new pathways to transmit an electrical signal through the ears to regulate their contractions.

Heart transplant operation

• In this process, the affected person’s heart is replaced with a healthy heart through a deceased donor.
• Implantation of a device (VAD). This device is used to support heart function and regulate blood flow in patients with weak heart muscle.
• Or heart failure, or while the patient is waiting for a donor heart, as it can be used temporarily for months or years, depending on the patient’s condition.

Implantation of artificial heart (TAH)

• This device temporarily replaces ventricles that are damaged during heart transplantation in chronic heart failure.
• Open-heart surgery is performed to repair any damage or abnormalities in the heart.
• Open-heart surgery refers to any operation in which a doctor opens a patient’s chest to perform surgery on the heart muscle, arteries that supply the heart, or valves.
• Open heart surgery is a major operation. The patient may need to stay in the hospital for 7 to 10 days, in addition to staying in the intensive care unit for a day or more immediately after the operation.
• Patients are advised to stop smoking and not take blood-thinning medications, such as aspirin, ibuprofen, and naproxen, two weeks before open-heart surgery.

During open heart surgery

• Procedures for this operation: The surgeon creates a longitudinal opening in the middle of the chest, specifically the sternum, which is between 15-20 cm long.
• During the operation, doctors give the patient a medication that stops the heartbeat, and doctors may resort to using a machine called cardiopulmonary surgery to do the work of the heart.
• They pump blood to all parts of the body, in addition to purifying it from carbon dioxide and filling it with oxygen.
• The duration of open-heart surgery cannot be determined, as it changes depending on the conditions of the operation, and varies from one patient to another, but according to the report of the National Heart, Lung, and Blood Institute.
• Coronary artery bypass graft surgery, the most common open-heart procedure, usually takes 3 to 6 hours.

Minor complications of open heart surgery

• Open-heart surgery, like any other surgical procedure, can cause the patient to suffer from many complications.
• Some of these complications are minor and temporary, and the treatment process is easy for them, but some are serious and can cause harm to the patient’s life, but they are rarely reported.
• The patient’s health condition also plays an important role in the possibility of contracting this infection.
• The most important complications of open heart surgery are:
• Minor complications such as nausea, vomiting, and infection in the wound areas such as infection in the wound on the chest.
• It should be noted that this infection can occur 7-9 days after the operation and in about 1% of cases.
• Minor complications also include the appearance of bruises or minor bleeding. The patient may feel numbness in the skin, and may suffer from skin allergies due to some of the materials used in the procedure.

Serious complications of open heart surgery

• Complications at the heart level, among these complications are heart attack: Some studies have shown that about 2-4% of patients who undergo coronary artery bypass surgery suffer from small to moderate heart attacks.
• Arrhythmia: such as arrhythmia and atrial fibrillation, which can occur in 40% of cases, but can be treated with medications.
• Pericarditis: Inflammation of the pericardium that surrounds the heart. In some cases, it can be accompanied by pericardial effusion, which results from the accumulation of fluid in the pericardial sac.
• Suffering from bleeding: About 30% of patients need a blood transfusion after undergoing coronary artery bypass surgery, but 2% of them need another surgery to stop the bleeding.
• Nervous system complications: About 2-4% of patients suffer from these complications after coronary artery bypass surgery.
• These complications include cerebrovascular accidents, depression, changes in the heart and cognitive level, in addition to delirium.
• Kidney failure: Coronary bypass surgery can lead to a temporary decrease in kidney function in about 5-10% of patients.

Reasons for performing open heart surgery

There are some cases that require open heart surgery, including the following:

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• Coronary artery bypass surgery: It is the most common open-heart surgery and is used in cases of heart attacks or coronary artery disease.
• Because these conditions are due to blockage of the coronary arteries that supply the heart with sediment.
• Fats and calcium, which causes narrowing of these arteries and reduces the flow of blood and oxygen to the heart muscle, so the patient suffers from myocardial ischemia, and in this case the patient may feel chest pain resulting from this.
• It is known as angina pectoris. In severe cases, you may suffer from a heart attack, heart failure, or heart rhythm abnormalities.
• It should be noted that in coronary artery bypass grafting, a blood vessel, artery or vein is taken from somewhere in the body, usually from the legs, to bypass the site of the blockage and thus improve blood flow to the heart.
• Replace or repair heart valves, allowing blood to move easily within the heart.
• Repair any damage to the heart muscle.
• Installing a device that regulates the heartbeat.
• Performing a heart transplant.
• Repairing congenital heart defects in children.
• Treating a condition called an aneurysm, where a bulge occurs in the main artery extending from the heart.

Medical evaluation and diagnostic tests

The doctor talks to the patient about the following:.

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• The type of heart problem he has and the symptoms it causes.
• Previous treatments for the patient’s heart problems, including medications or surgeries and surgeries the patient has had.
• Family history of heart disease.
• Other health problems the patient suffers from, such as diabetes and high blood pressure.
• The patient’s age and general health.
• Some blood tests, such as: complete blood count, cholesterol test, other tests may be performed according to the patient’s needs.
• Diagnostic tests are performed to obtain information about the heart problem and the patient’s general health.
• These examinations help the doctor determine whether to perform the operation, determine its type, and the time required to perform it. These examinations may include tests
• Electrocardiogram: to determine the electrical activity of the heart (determine the speed and regularity of the heart rate).
• Stress test: The patient’s heart is examined while exercising as ordered by the doctor, as some heart problems are easier to diagnose while the heart is working harder than usual.
• Echocardiography: This test uses ultrasound technology, which determines the shape and size of the heart, the shape of its valves, and their working force.
• Coronary angiography (heart catheterization): This test uses a special dye and x-rays to image the coronary arteries. This test helps the doctor understand the health of blood flow through the heart and blood vessels.
• Angiography of the aorta.
• Chest X-ray: Used to image the heart, lungs, and blood vessels in the chest.
• This test is performed to determine the size and shape of the heart.
• Cardiac MRI: This test is performed to find out the fine details of the structure of the heart and blood vessels.

How to prepare for the operation

• The patient prepares in advance for the operation at home several days before the operation to monitor his blood pressure, perform some of the diagnostic tests mentioned above, and choose the appropriate time for the operation.
• The patient is given a solution of special soap for washing to reduce the risk of infection caused by germs and microbes, and then the nurse shaves the hair from the chest area where the incision will be made.
• The patient is given some medications intravenously until he goes to the operating room and undergoes complete anesthesia for the operation.

During open heart surgery

Open heart surgery includes the following:.

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• The specialist doctor monitors the patient’s heart rate, blood pressure, oxygen levels and breathing during surgery.
• A breathing tube is placed into the lungs through the throat and this tube is connected to a ventilator (a device that supports the patient’s breathing).
• The center of the chest is opened (6 to 8 inches), then the sternum is cut and the rib cage is opened until the heart is reached.
• Then a heart-lung machine is connected, which does the work of the heart to pump blood to all parts of the body far from the heart, and then the required heart operation is performed.
• After the operation, the surgeon restores blood flow through the heart. The heart then automatically returns to work, but sometimes mild shocks can be used to restart the heart. The heart-lung machine is then removed.
• Special permanent wires are used to close the sternum, then the chest skin is closed with stitches and the breathing tube is removed

Risks of open heart surgery

• Despite excellent surgical outcomes, heart surgery can carry some risks and complications that improve 6 to 12 months after surgery.
• Inflammatory bleeding.
• Side effects of the medication.
• Arrhythmia.
• Damage to heart, lung, kidney and liver tissue.
• brain attack.
• Death (especially in serious and emergency cases before the operation). – Memory loss in some patients, and these risks affect the elderly, women, and people who suffer from other diseases such as diabetes, as diabetes can prevent wound healing and repair, and thus the patient will be exposed to various infections and inflammations.
• The problem may be aggravated by bleeding.
• Kidney and lung diseases.
• Peripheral artery disease is more common than other conditions.
• In addition, one of the important things that is considered the greatest help in the success of the operation is the patient’s firm will and understanding of the idea of ​​​​the operation and management of the results. These things help the patient to recover quickly and regain your health in a faster time.

When do you need open heart surgery?

• The main goal of open-heart surgery is to improve blood flow to the heart muscle tissue, which is known as coronary artery bypass grafting (CABG).
• This process can be important for people with coronary artery disease, when blood vessels that supply oxygen to the heart become narrow and stiff.
• Vasosclerosis results from the accumulation of fatty deposits on the walls of blood vessels, which causes them to narrow and thus impedes blood flow through them.
• In this condition, blood flow to the heart decreases and the person can have a heart attack.

At the end of our journey with open heart surgery for the elderly, some patients believe that open heart surgery will negatively affect the person’s health, life and daily work practice, despite the fact that many of those who have had the procedure live their lives normally and much better than before.