The goal of surgery to treat heart failure is to stop further damage and
improve how well the heart works. Cleveland Clinic’s surgeons use several types
of surgical treatments to treat patients with heart failure. The surgeons will
consider your medical history, condition and other factors when choosing the
best treatment option for you. The procedures include coronary artery bypass
graft (CABG) surgery, valve surgery, aneurysm repair, left ventricular assist
device (LVAD) surgery and heart transplant.
Coronary Artery Bypass Graft (CABG) Surgery
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) 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 preserves the natural anatomy of the heart,
improves the heart’s ability to work properly, decreases heart failure symptoms
and complications, and may improve survival.
Heart failure can be caused by aortic valve stenosis (stiffness). If the
valve cannot open fully, less blood is pumped from the left ventricle to the
body, which results in less oxygen-rich blood being pumped to the organs and muscles.
There are two types of aortic valve surgery — aortic valve repair and aortic
valve replacement. If your heart failure is caused by aortic stenosis, 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.
Aneurysm Repair Surgery
When a heart attack occurs in the left ventricle, 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 cause heart failure. Initially, your heart will pump harder, but over time,
the left ventricle becomes larger than normal and pumps less effectively. In
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.
Implantable Left Ventricular Assist Device
The left ventricular assist device (LVAD) can be used as a "bridge to
transplantation" or as destination therapy for patients with heart failure.
Destination therapy means that you will go home with the device in place, and it
will remain in use for the rest of your life, unless your heart recovers enough
to remove it. There are multiple types of LVADs that your doctor may select for
use, but LVADs are only used when medical treatments have not improved your
symptoms and quality of life, and you require hospitalization for end-stage
systolic heart failure. Many LVADs are implanted below the natural heart with
connections to the aorta and the left ventricle. The pump is usually placed
inside the body and lines come through the skin to attach to a console or
battery pack. The LVAD helps the heart pump the right amount of blood throughout the body.
Although there have been much progress in the medical and surgical treatment
of chronic heart failure, 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. 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.
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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: 12/10/2010...#12905