If your coronary arteries (arteries that supply blood to the heart) become blocked or lined with plaque causing less-than-normal blood flow through them, the heart muscle can’t get the right amount of oxygen-rich blood to work properly. Your heart cannot pump normally, and this can lead to heart failure.
Coronary artery bypass graft (CABG) surgery involves the use of a blood vessel graft to bypass one or more blocked coronary arteries. The bypass restores normal blood flow to the heart muscle. The graft goes around the clogged artery/arteries and forms new pathways for oxygen-rich blood to flow to the heart muscle. The blood vessel grafts usually come from your own arteries and veins in the chest, leg or arm.
Your doctor will determine if your heart failure is caused by coronary artery disease and if CABG surgery is right for you. Although patients with heart failure have an increased surgical risk during CABG surgery, new strategies before, during and after surgery have decreased the risks and improved outcomes.
As heart failure gets worse, changes in the left ventricle (lower chamber of the heart) may cause the papillary muscles to stretch out of shape. The papillary muscles support mitral valve leaflet function to keep blood flowing in only one direction. When the papillary muscles get weak, they can’t properly support the mitral valve leaflets, and the valve starts to leak. Mitral valve repair usually involves reshaping the leaflets and supporting the mitral valve with a ring.
Mitral valve repair surgery helps to
- Preserve the natural anatomy of the heart
- Improve the heart’s ability to pump properly
- Decrease heart failure symptoms
- Improve survival
Heart failure can be caused by aortic valve stenosis (stiffness) or regurgitation (leaky valve). If the valve cannot open fully, or if blood leaks backward into the left ventricle, the heart has to pump more strongly to meet the body’s needs for oxygen-rich blood and heart failure can occur.
There are two types of aortic valve surgery — aortic valve repair and aortic valve replacement. If your heart failure is caused by aortic valve disease, your surgeon will determine the type of treatment best for you after considering a variety of factors, including the results of diagnostic tests, the structure of your heart, age and the presence of other medical problems.
A left ventricular assist device (VAD -- also called ventricular assist system or VAS) is a type of mechanical circulatory support device (MCSD). It is a mechanical pump that is implanted in patients who have heart failure to help the heart’s weakened left ventricle (major pumping chamber of the heart) pump blood throughout the body.
The VAD devices can be used as “bridge to transplant” or destination therapy. Cleveland Clinic is one of the few institutions worldwide that has access to all clinically available mechanical ventricular assist systems, including the Heartmate II®, HVAD, and Impella® devices, allowing us to choose the device that will best suit an individual patient's clinical needs. Cleveland Clinic also participates in clinical trials so we are able to offer the newest technology developed for our patients.
Although there have been much progress in the medical and surgical treatment of chronic heart failure, some patients will continue to progress to advanced, end-stage failure.
Heart transplant is recommended only when absolutely necessary and when all other treatment options have been tried or considered. Patients who are considered for a heart transplant must not have other medical conditions that would prevent a successful surgery and recovery, and there must be an excellent chance of long-term transplant 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.
During heart transplant, your surgeon will remove most of your heart and the donor heart will be placed in proper position and attached to your major blood vessels.
When a heart attack occurs in the left ventricle, a scar may form. 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 cause heart failure. Initially, your heart will pump harder, but over time, the left ventricle becomes larger than normal and pumps less effectively.
During the Modified Dor aneurysm repair 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 your heart’s pumping ability.