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Surgery for Heart Failure

Surgery is aimed at stopping further damage to the heart and improving the heart's function. Surgical procedures for heart failure treatment include:

High risk conventional surgeries

Coronary artery bypass surgery

The most common surgery for heart failure treatment is bypass surgery. If a coronary artery becomes blocked, less oxygen-rich blood reaches the heart muscle. The heart muscle becomes "starved" for blood (ischemia) and is unable to pump normally; heart failure occurs. Your doctor will determine if your heart failure is caused by coronary artery disease and if you have blockages that can be "grafted" or bypassed. Although patients with heart failure are at an increased surgical risk, new strategies before, during and after surgery have decreased the risk and improved outcomes.

Valve surgery

Reshape the mitral valve leaflets and provide support to the mitral valve with a ring

As heart failure progresses, remodeling of the left ventricle causes the papillary muscles (which support the mitral valve leaflets) to stretch out of shape, causing the valve to leak. Mitral valve repair usually involves reshaping the leaflets and providing support to the mitral valve with a ring. Experience at the Cleveland Clinic Foundation has shown that repair of the mitral valve:

  • Preserves the natural anatomy of the heart
  • Improves cardiac function
  • Decreases symptoms
  • Improves survival
  • Decreases complications and risks

If the aortic valve leaks, aortic valve repair or replacement may be an option.

Surgery of the ventricle

Left ventricular reconstructive surgery (Dor Procedure)

Incision line through dead scarred tissue

Pursestring stitches around the dead tissue

Pulling of pursestring and closing of left ventricle

When a heart attack occurs in the left ventricle (left lower pumping chamber of the heart), a scar forms. The scarred area can become thin and bulge out with each beat. The bulging thin area is called an aneurysm. These changes, along with other heart damage you may have, may result in heart failure. Initially your heart is able to handle pumping harder, but over time, your left ventricle becomes larger than normal and pumps less effectively. Infarct exclusion surgery allows the surgeon to remove the infarcted (dead) area of the heart tissue and/or the aneurysm and return the left ventricle to a more normal shape. The goal of the heart failure treatment surgery is to improve heart failure and/or angina (chest pain) symptoms and possibly improve the pumping ability of your heart.

Implantable left ventricular assist device (LVAD)

The LVAD is known as the "bridge to transplantation" for those whose medical therapy has failed and are hospitalized with end-stage systolic heart failure. This device helps your heart pump blood throughout your body. CCF is one of the few institutions worldwide who have access to all clinically available mechanical ventricular assist systems including the Heartmate, Novacor, Thoratec, and Abiomed devices, allowing us to choose the machine which will best suit an individual patient's clinical needs.

For selected individuals with severe, refractory heart failure, we can now offer the option of permanent LVAD therapy or "destination therapy."

Cleveland Clinic surgeons are participating in two randomized trials comparing permanent support with an implantable (Novacor) and a continuous flow (Debakey) pump to the Heartmate device.

Heart transplant

When systolic heart failure is severe enough, a heart transplant may be suggested.

Heart (cardiac) transplant involves replacing a diseased heart or heart and lungs with a healthy donor organ or organs. The donor organ is completely removed from someone who has died, then kept cool in a special solution as it is transported. The disease heart is removed, leaving the back walls of the atria (heart's upper chambers). The hearts are sewn, atria to atria into the chest, the blood vessels are reconnected, and blood flows through the new heart into the body.

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