What Is Open Heart Surgery — And What Actually Happens?

Open heart surgery is the phrase that stops a conversation. A cardiologist says it and the patient's family goes quiet, because nobody is quite sure what it means and it sounds like the worst thing imaginable. It is serious surgery, no question. But the term covers several different procedures, the outcomes at experienced centres are consistently good, and the fear of the unknown often makes it seem worse than the reality.

What "Open Heart" Actually Means

Open heart surgery refers to any cardiac surgical procedure where the chest is opened and the surgery is performed on the heart or great vessels. In most cases, the breastbone (sternum) is divided down the middle, the chest is held open with a retractor, and the surgeon operates directly on the exposed heart.

During most open heart procedures, the patient is connected to a heart-lung machine (cardiopulmonary bypass) — a pump that takes over the job of circulating blood and oxygenating it while the heart is stopped. This lets the surgeon work on a still, bloodless field. Modern bypass machines are remarkably safe; patients are on them for two to six hours for most procedures.

Some surgeons perform certain bypass surgeries "off-pump" — on the beating heart, without the bypass machine. This reduces some complications but requires different surgical technique and is not appropriate for all cases.

The Main Types of Open Heart Surgery

1. Coronary Artery Bypass Grafting (CABG)

The most common open heart procedure. The coronary arteries — the vessels supplying the heart muscle — become blocked by atherosclerosis. When blockages are severe enough and not suitable for angioplasty and stenting, bypass surgery creates new routes around them.

The surgeon harvests graft vessels — usually the internal mammary artery from the chest wall (the best long-term graft, with ten-year patency rates above 90 percent) and sometimes saphenous vein from the leg. These grafts are attached above and below each blockage, creating a detour that restores blood supply to the deprived heart muscle.

A single bypass, double bypass, triple bypass — these refer to the number of blockages being bypassed, not the severity of the surgery.

2. Heart Valve Surgery

The heart has four valves — mitral, aortic, tricuspid, pulmonary — that keep blood flowing in the right direction. When valves are damaged, they either fail to open fully (stenosis) or fail to close properly (regurgitation). Both problems make the heart work harder and progressively damage its function.

Valve surgery is either repair or replacement

Repair — the surgeon rebuilds the patient's own valve using sutures, patches, rings, or other techniques. Repair is preferred when technically possible because the patient keeps their own tissue, avoids a foreign body, and in many cases does not need lifelong anticoagulation.

Replacement — the damaged valve is excised and replaced with a prosthetic. Mechanical valves are durable but require lifelong anticoagulation (warfarin, with regular monitoring). Biological (tissue) valves avoid anticoagulation but have a lifespan of ten to fifteen years before they degrade and need replacing.

For younger patients with rheumatic valve disease — common across Africa — repair is strongly preferred if achievable.

3. Congenital Heart Surgery

Operations to correct structural heart defects present from birth. Closing holes between chambers (ASD, VSD), repairing abnormal connections between blood vessels, correcting valve abnormalities. Some are performed in infancy. Others are done in childhood or even adulthood in patients who reach those ages with uncorrected defects.

4. Aortic Surgery

Surgery on the aorta — the main blood vessel leaving the heart. Aortic aneurysms (bulges that risk rupture), aortic dissections (tears in the aortic wall), and aortic stenosis all require different surgical approaches.

What to Expect — Before, During, and After

Before surgery: Pre-operative assessment — blood tests, ECG, chest X-ray, echocardiogram, and sometimes coronary angiography. Anaesthesia assessment. Medications review. Patients are typically admitted the day before surgery.

During surgery: General anaesthesia. The chest is opened, cardiopulmonary bypass is initiated, the procedure is performed, the heart is restarted, bypass is ended, and the chest is closed with wires holding the sternum together and sutures closing the skin. Most valve or bypass procedures take three to six hours.

Immediately after: One to two days in the cardiac intensive care unit, initially sedated on a ventilator, then weaning off as the patient wakes and breathing becomes independent. Chest drains removed on day two. Most patients are out of ICU by day three.

Hospital stay: Five to eight days for uncomplicated bypass or valve surgery.

Recovery: The sternum takes six to eight weeks to heal, during which lifting restrictions apply and driving is typically suspended. Cardiac rehabilitation — supervised exercise and education — is important for long-term recovery. Most patients return to full normal activity by three months.

Open Heart Surgery at Prime Medical's Partner Hospitals

Artemis Hospital, Gurugram (JCI, NABH) — Prime Medical partner. Strong cardiac surgery department including bypass and valve surgery. Good option for patients from Ethiopia and East Africa.

Fortis Memorial Research Institute, Gurugram (JCI, NABH, NABL) — Advanced cardiac programme including complex valve cases, aortic surgery, and off-pump CABG.

Max Super Speciality Hospital, Saket, Delhi (JCI, NABH, NABL) — Dr. Balbir Singh leads cardiology. Full cardiac surgery programme.

Indraprastha Apollo Hospital, New Delhi (JCI, NABH) — Over 15,000 cardiac procedures annually. Africa desk.

For patients from Addis Ababa, Dar es Salaam, Kampala, Banjul, or anywhere in Africa who have been told open heart surgery is needed: share your echocardiogram, any angiogram done, and a summary of the diagnosis with Prime Medical Solutions. A cardiac specialist reviews within 48 hours. To book a consultation, call the number on our website.