"Open heart surgery" is a broad term for procedures that require opening the chest (sternotomy) to operate directly on the heart, most often using a heart-lung bypass machine to temporarily take over your heart and lung function during the operation. It sounds daunting, but modern open heart surgery is remarkably safe and refined, with most patients recovering well and returning to a full, active life. This page gives a general overview of the most common types, why they're performed, and what preparation and recovery actually look like — LVAD implantation and heart transplant, both technically forms of open heart surgery, have their own dedicated pages given how much additional detail applies to them specifically.
What "Open Heart Surgery" Actually Means
Most open heart procedures involve a sternotomy — an incision through the breastbone (sternum) to access the heart directly — and cardiopulmonary bypass (the "heart-lung machine"), which temporarily takes over pumping and oxygenating your blood so the surgical team can safely stop your heart and operate on it without blood flowing through it. Every form of open heart surgery is done under general anesthesia — you're fully asleep and on a breathing machine throughout, with a dedicated anesthesiology team managing this continuously alongside your surgeon. Some newer approaches use smaller incisions ("minimally invasive" cardiac surgery) for select procedures and patients, avoiding a full sternotomy, though a traditional sternotomy remains the most common and often most appropriate approach for complex cases or multiple procedures done at once.
The Most Common Open Heart Surgeries
- Coronary Artery Bypass Graft (CABG) — "bypass surgery." Reroutes blood flow around blocked coronary arteries using a healthy blood vessel taken from elsewhere in your body (commonly the internal mammary artery in the chest wall, or a vein from the leg). Performed for significant, extensive, or multi-vessel coronary artery disease that isn't well suited to a stent. (See Coronary Artery Disease.)
- Valve Repair or Replacement — fixes or replaces a heart valve that's leaking (regurgitation) or narrowed (stenosis) badly enough to cause symptoms or heart strain. Repair (preserving your own valve tissue) is preferred when possible, particularly for the mitral valve; replacement uses either a mechanical valve (durable, but requires lifelong blood thinning) or a biological/tissue valve (no lifelong blood thinner needed, but wears out over time and may eventually need replacement). (See Valvular Heart Disease.)
- LVAD Implantation — surgically places a mechanical pump to assist a severely weakened heart, most often for advanced heart failure. (See What Is an LVAD? for full detail on this specific procedure and what follows it.)
- Heart Transplant — replaces a failing heart with a donor heart, for the most advanced cases of heart failure that haven't responded to other treatment. (See The Evaluation Process and Life After Transplant for full detail.)
- Maze Procedure — creates a specific pattern of scar tissue in the heart's upper chambers to interrupt the abnormal electrical circuits that drive atrial fibrillation, often performed alongside another open heart procedure (like valve surgery) rather than as a stand-alone operation. (See Atrial Fibrillation.)
- Aortic Aneurysm or Dissection Repair — replaces or repairs a dangerously enlarged or torn section of the aorta, the body's main artery, generally performed urgently for a dissection and electively (at a specific size threshold) for an aneurysm found before it ruptures. (See Aortopathies (Aortic Aneurysm & Dissection).)
- Septal Defect Repair — closes a hole between heart chambers (an atrial or ventricular septal defect), whether congenital (present from birth) or, less commonly, acquired.
- Pericardiectomy — surgical removal of a stiff, scarred pericardium (the sac around the heart) in cases of severe constrictive pericarditis that haven't improved with medical treatment. (See Pericarditis.)
Why Surgery vs. a Catheter-Based Option
For several of these conditions (coronary disease, valve disease), a less invasive catheter-based option may also be available — a stent for coronary blockages, or TAVR for aortic valve replacement, for example. The choice isn't simply "which is better" — it depends on the number and location of blockages or the specific valve problem, your overall anatomy and surgical risk, and whether multiple issues need to be addressed at once, and it's often made collaboratively between cardiology and cardiac surgery (a "heart team" approach). (See Procedures I Don't Perform, But May Refer You To for more on how these referral decisions work.)
General Preparation
- Pre-operative testing — bloodwork, imaging (often including a coronary angiogram or CT if not already done), an EKG, and sometimes dental clearance, since untreated dental infections raise the risk of complications after surgery involving the heart
- A detailed medication review — specific instructions on which medications to hold and when, particularly blood thinners, which usually need to be stopped for a defined period beforehand
- Optimizing other health conditions beforehand where possible — blood sugar control, smoking cessation, and treating any active infection
- Arranging your recovery support — someone to help at home, and a plan for who's involved in your care during the hospital stay, since your team will want to include your support person in some of the pre-operative education
- A pre-op education session — most programs walk you through exactly what to expect, including what to bring to the hospital and what happens the morning of surgery
What the Hospital Stay Generally Looks Like
Most open heart surgeries involve an initial stay in a cardiac intensive care unit (ICU) for close monitoring in the first day or two, followed by a transfer to a regular cardiac surgery floor for the rest of the hospital stay — typically 5 to 7 days total for a standard CABG or valve surgery, though this varies by procedure and how your recovery goes. You'll have several tubes and lines initially (for monitoring, drainage, and pain control) that are removed progressively as you recover. Early, gentle mobility — sitting up, then walking short distances — usually begins within a day or so of surgery, since movement itself meaningfully speeds recovery and reduces complications like pneumonia and blood clots.
General Recovery Timeline
- First few weeks — sternal precautions apply if you had a sternotomy: avoiding lifting anything over roughly 5-10 lbs, not pushing/pulling with your arms, and not driving, typically for about 6 weeks while the breastbone heals
- 4-6 weeks — most people return to light daily activities and short walks, building gradually
- 6-12 weeks — many people return to work (sooner for desk jobs, later for physically demanding ones) and are cleared for driving and more normal activity, pending your surgeon's specific clearance
- Cardiac rehabilitation — a structured, supervised program strongly recommended after most open heart surgeries, both for physical recovery and for the education and risk-factor management built into the program (see Cardiac Rehabilitation: Protocol, Succeeding & Life After)
- Full recovery — generally by 3 months for most people, though this varies by procedure, your baseline health, and whether any complications occurred along the way
General Guidance for Living Through It
- Follow your sternal precautions exactly — even when you feel stronger than they'd suggest, since the breastbone takes the full 6-8 weeks to heal regardless of how you feel
- Take pain medication as prescribed early on — staying ahead of pain makes it easier to move, cough, and breathe deeply, all of which meaningfully reduce complications
- Do your incentive spirometry breathing exercises as instructed — this simple device helps prevent pneumonia by keeping your lungs fully expanded during recovery
- Watch your incision for infection — increasing redness, warmth, drainage, or fever should be reported promptly
- Expect an emotional dip partway through recovery — many patients describe a period of frustration or low mood a few weeks in, once the initial relief of surviving surgery fades and the slower pace of recovery sets in; this is common and worth mentioning to your care team if it persists (see Mental Health & Heart Failure)
- Attend every follow-up appointment, even when you feel well — your surgical and cardiology teams are watching for things that don't always cause symptoms early
Living With It
The overwhelming majority of people who go through open heart surgery describe it as genuinely worth it — a real turning point after months or years of symptoms limiting their lives. The intensity of the surgery itself and the first few weeks of recovery are real, but they're also temporary; most people are back to meaningfully more activity within a few months than they were capable of before surgery.
When to Call Your Doctor vs. Go to the ER
- Increasing incision redness, warmth, or drainage
- Low-grade fever
- New or worsening fatigue during recovery
- Chest pain, sudden severe shortness of breath, or fainting
- A fever over 101°F (38.3°C)
- Any sudden separation or instability felt at the incision site
Common Questions
Will I feel my sternum clicking or moving?
No — a properly healed or healing sternum shouldn't click or feel unstable; report any sensation like that promptly, since it could indicate a healing problem.
How long until I can drive?
Typically around 6 weeks, once your sternal precautions are lifted and you're off strong pain medication — your surgeon will give you a specific date based on your recovery.
Will I need more than one open heart surgery in my life?
It depends entirely on the reason for your first surgery — a mechanical valve, a bypass graft, or ongoing coronary disease can all eventually need further intervention, but many people never need a second open heart operation.
Is minimally invasive surgery an option for me?
It depends on your specific procedure, anatomy, and whether multiple things need to be addressed at once — ask your surgeon directly whether you're a candidate, since it isn't appropriate or available for every situation.