Open Heart Surgery Risks and Complications

Every open heart surgery presents the risk of complications. These risks are specific to the procedure being performed, in addition to the general risks of surgery and the risks associated with anesthesia. The risks vary from one type of heart surgery to another (including coronary artery bypass grafting, congenital defect repair, valve repairs and more), and may be higher if the heart is stopped and blood is pumped by a cardiopulmonary bypass machine rather than by the heart during the procedure.

Your individual risk of complications from open heart surgery can only be determined by your surgeon as your current state of health, the procedure you are having, and additional personal factors like your age and gender impact your level of risk. Risk is increased in patients 70 and older, patients who have had previous heart surgeries, and those who have chronic conditions such as diabetes, coronary artery disease, and high blood pressure.

In some cases, your level of risk can be reduced by taking prescription medications, making lifestyle changes including eating a nutritious diet before surgery and eliminating the use of tobacco.

Potential Complications During and After

Some of the more common complications of heart surgery are routinely dealt with during the hours and days of recovery in the hospital. The patient is closely monitored for these complications by staff and through lab tests.

• Bleeding: May occur at the incision site or from the area of the heart where surgery is performed
• Abnormal Heart Rhythm: In rare cases, a temporary external, or permanent internal pacemaker may be necessary to correct this problem.
• Ischemic Heart Damage: Damage to heart tissue caused by a lack of blood flow to the heart
• Death: The risk of death is increased in surgeries where the heart is stopped for the procedure.
• Blood Clots: Clots may form in and around the heart or travel through the bloodstream.
• Stroke: Often caused by clots that form in the blood after surgery
• Blood Loss: In some cases, a transfusion may be necessary.
• Emergency Surgery: If a problem is discovered after surgery, emergency surgery may be necessary to repair any problems.
• Cardiac Tamponade (Pericardial Tamponade): A life-threatening condition where the pericardium, the sac surrounding the heart, fills with blood. This makes it difficult, or impossible, for the heart to fully function.
• Separation of the Breastbone During Healing: Separation of the sternum may slow the healing process of the bone. Sternal precautions help prevent this as well as excessive pulling on the surgical incision.

Risks of “On Pump” Heart Surgery

During some heart surgeries, the heart must be stopped in order for the surgeon to complete the procedure. This is done for two reasons. First, a pumping heart is a “moving target,” which makes surgery difficult or impossible for the surgeon. Second, some surgeries require the surgeon to make an incision in the heart to work inside the chambers of the heart, which would cause uncontrollable bleeding if the heart was pumping.

If it is necessary to stop the heart, a ​cardiopulmonary bypass machine will be used. This oxygenates the blood and pumps it through the bloodstream when the heart and lungs cannot. Procedures that require the bypass machine are often called “on pump” procedures. While the heart bypass machine has improved greatly in recent years, there are still risks associated with the use of the pump.

• Bleeding: Risk is increased due to the blood-thinning medications used during pumping.
• Blood Clots
• Stroke: Cardiopulmonary bypass increases the risk of clots that may travel to the brain.
• Kidney or lung damage
• “Pump Head”: In some patients, the use of the cardiopulmonary bypass pump can cause foggy thinking and confusion after surgery.
• Death: After the heart is stopped, in rare cases, it may not be able to be started again once the procedure is complete.