No, your heart is not taken out of your body during open heart surgery. In the vast majority of procedures, your heart stays right where it is inside your chest. The surgeon accesses it by cutting through your breastbone and spreading your ribs apart, then works on the heart directly while it sits in place. The one exception is a heart transplant, where the diseased heart is removed and replaced with a donor organ.
How Surgeons Reach Your Heart
Open heart surgery gets its name from opening the chest wall, not from removing the heart. The surgeon makes a vertical incision down the center of your chest, running from the top of your breastbone to the bottom. The breastbone is then split along this line and the two halves are spread apart, giving the surgeon a direct view of and access to the heart and the major blood vessels connected to it.
This approach, called a median sternotomy, remains the standard for most cardiac surgeries because it gives the widest, clearest view of the heart. Whether you’re having bypass surgery, a valve repaired, or a congenital defect corrected, the heart stays in your chest throughout.
What Happens to Your Heart During Surgery
For many open heart procedures, your heart is temporarily stopped so the surgeon can work on a still, bloodless surface. This is where the heart-lung machine comes in. Tubes route your blood out of the heart and into this machine, which adds oxygen, removes carbon dioxide, manages temperature, and pumps the refreshed blood back into your body through your aorta. While the machine handles circulation, a potassium-based solution is delivered to the heart to make it stop beating. The heart muscle essentially goes quiet, reducing its need for oxygen and protecting it from damage while the surgeon operates.
Patients typically spend between 55 and 175 minutes connected to the heart-lung machine, depending on how complex the procedure is. A straightforward bypass surgery falls on the shorter end, while combined procedures (like a valve replacement plus bypass) take longer.
Not all open heart surgeries require stopping the heart. In off-pump bypass surgery, the surgeon works on a beating heart using a small stabilizing device that holds the specific area still while the graft is sewn into place. This approach avoids the heart-lung machine entirely, which can mean a shorter procedure and a lower risk of certain complications, particularly for older patients or those with other health conditions. However, on-pump surgery allows for more complete work and remains the more common technique, especially in complex or emergency cases.
Restarting the Heart
Once the repair or grafting is finished, the surgical team restores blood flow to the heart. In most cases, the heart starts beating again on its own as it warms back up and receives oxygenated blood. Sometimes mild electric shocks from small internal paddles are needed to get a normal rhythm going. The patient is then gradually weaned off the heart-lung machine as the heart takes over its own pumping duties again.
The One Exception: Heart Transplants
A heart transplant is the only open heart surgery where your heart is actually removed from your body. The surgeon cuts away most of the diseased heart, leaving behind small cuffs of tissue where the upper chambers connect to the major veins. The donor heart is then sewn to these remaining cuffs and to the aorta and pulmonary artery. After the connections are complete, the surgical team restores blood flow, and the new heart is given at least 30 minutes to recover before the patient is taken off the bypass machine.
There’s also a rare variation called a heterotopic transplant, where the donor heart is implanted alongside the original heart rather than replacing it. But the standard approach involves full removal of the recipient’s heart.
How Safe Is Open Heart Surgery
Open heart surgery carries real risk, but the numbers are more reassuring than many people expect. At high-volume centers, operative mortality for isolated bypass surgery runs around 0.8% to 1.2%. Isolated aortic valve replacement carries a predicted mortality of about 1.5%, and isolated mitral valve repair is around 0.6%. When procedures are combined, such as valve replacement plus bypass, the risk climbs but generally stays in the low single digits. Individual risk depends heavily on your age, overall health, and the complexity of what needs to be fixed.
Recovery and Breastbone Healing
Because the breastbone is split to access the heart, healing that bone is a significant part of recovery. Surgeons traditionally tell patients it takes six to eight weeks, but imaging studies paint a more cautious picture. CT scans show that complete bone healing often takes more than three months. At six months post-surgery, only about one in four patients showed fully healed breastbones on imaging. Nearly all patients reached complete healing within two years.
During the early months, you’ll be told to avoid lifting heavy objects, pushing yourself up from chairs with your arms, or any activity that puts strain on your chest. This protects the healing bone and the wires holding it together. Most people return to normal daily activities within six to eight weeks, but full recovery, including a return to strenuous exercise, can take three months or longer depending on your progress and the type of surgery you had.