Surgical treatments for heart failure include:
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Coronary artery bypass surgery
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Valve surgery
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Left ventricle reconstruction surgery
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Heart transplant
Coronary artery bypass graft (CABG) surgery
If a coronary artery becomes blocked or there are many coronary arteries that have plaque buildup leading to less-than-normal blood flowing through them, less oxygen-rich blood reaches the heart muscle. The heart muscle becomes starved for oxygen and is unable to pump normally, leading to heart failure.
During coronary artery bypass graft surgery, one or more blocked coronary arteries are bypassed by a blood vessel graft to restore normal blood flow to the heart muscle. These grafts usually come from the patient's own arteries and veins located in the chest, leg, or arm. The graft goes around the clogged or semi-clogged artery (or arteries) to create new pathways for oxygen-rich blood to flow to the heart muscle.
Your doctor will determine if your heart failure is caused by coronary artery disease and if you have blockages that can be bypassed. Although patients with heart failure have an increased surgical risk during CABG, new strategies before, during and after surgery have decreased the risks and have improved outcomes.
Valve surgery
As heart failure progresses, changes in the left ventricle cause 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. Mitral valve repair surgery preserves the natural anatomy of the heart, improves cardiac function, decreases heart failure symptoms and complications.
Heart failure can occur from aortic valve stenosis (or blockage). If the valve cannot open fully, less blood is pumped from the left lower chamber of the heart (left ventricle) to the body, leading to less oxygen-rich blood to the organs and muscles.
Aortic valve replacement surgery improves exercise tolerance and quality of life for patients with heart failure.
Left ventricular reconstruction surgery (Dor Procedure)
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 muscle damage you have, may result in heart failure. Initially your heart will pump harder, but over time, the left ventricle becomes larger than normal and pumps less effectively. In left ventricular reconstruction surgery, the surgeon removes the scarred heart muscle and/or the aneurysm tissue to return the left ventricle to a more normal shape. In some cases, a patch is placed in the area that was previously scar tissue.
The goal is to improve the function of your heart. Symptoms of heart failure or chest pain will be improved, as will quality of life.
Heart transplantation
Despite medical and surgical advances in the treatment of chronic heart failure, many patients will continue to progress to advanced, end-stage failure.
Heart transplantation is recommended only when absolutely necessary and when all other treatment options have been tried or considered. Heart transplant is performed when there are no other existing conditions that would prevent a successful surgery and recovery, and when transplant is likely to be associated with long-term success.
All transplant candidates are carefully screened before they are placed on the transplant waiting list. The purpose of the pre-transplant evaluation is to determine the severity of the patient’s heart disease and the therapy that is best suited to the patient’s condition.
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 3/20/2006
