Heart Failure Surgery
What is heart failure surgery?
Your heart pumps blood to all the tissues and organs in your body. If you have heart failure (also known as congestive heart failure or CHF), your heart is unable to pump enough blood to meet your body’s needs.
Lifestyle changes and medications are usually the first option for treating heart failure. These treatments are often very effective, but some people need surgery. Surgery can help improve your heart function and symptoms. It can also help you live a longer, fuller life.
When is congestive heart failure surgery needed?
Your healthcare provider may recommend heart failure surgery to:
- Treat underlying conditions that have caused heart failure.
- Improve the functioning of your heart.
- Offer lifesaving treatment for advanced heart failure when lifestyle changes and medications haven’t been effective.
What are the types of heart failure surgery?
There are several different types of surgery for heart failure. They range from minimally invasive procedures to open-heart surgery and heart transplant.
This is a minimally invasive procedure that healthcare providers can use to treat arrhythmias, which are abnormal heartbeats caused by irregular electrical impulses. Arrhythmias can be both a cause and symptom of heart failure.
A catheter ablation procedure uses a thin tube called a catheter inserted into one of your blood vessels. Your provider guides the catheter to your heart and precisely delivers heat or cold to specific areas of your heart. This isolates areas of tissue that are causing the abnormal electrical impulses.
Implanted devices for arrhythmias
If you have an arrhythmia or a history of a life-threatening event caused by an abnormal heart rhythm, you may receive an implanted device. These devices have wires that your provider inserts into your heart through a vein and a controller implanted under your skin. The controller delivers a charge to your heart to help regulate your heart rate.
The types of implanted devices include:
- Implantable cardioverter defibrillator, detects an abnormal heart rhythm and shocks your heart to restore a normal heart rate.
- Permanent pacemaker, continuously delivers pulses to your heart to keep your heart rhythm steady.
Coronary artery bypass graft surgery
In people with coronary artery disease, the arteries that carry blood to your heart muscle become lined with deposits called plaque. When these deposits build up, they can narrow or completely block your coronary arteries. This interferes with blood flow and reduces the amount of oxygen and nutrients traveling to your heart. Over time, this weakens your heart muscle and reduces its ability to pump blood.
In coronary artery bypass graft surgery, a surgeon reroutes blood around a narrowed or blocked coronary artery. They’ll use a blood vessel (graft) from somewhere else in your body and attach it above and below the affected area. Surgeons perform this procedure as open-heart surgery or as minimally invasive surgery, depending on your situation.
Coronary angioplasty and stent
This is a minimally invasive procedure used to treat coronary artery disease. It opens narrowed or blocked coronary arteries from the inside.
In a coronary angioplasty and stent procedure, your provider:
- Inserts the catheter into a blood vessel in your groin or wrist.
- Threads the catheter to the narrowed or blocked artery in your heart.
- Inflates a balloon to compress the plaque inside the artery and open the blockage.
- Installs a metal mesh tube (stent) to hold the artery open.
Heart valve surgery
The valves in your heart separate the upper and lower chambers and keep blood moving in the forward direction. In heart valve disease, your heart valves may leak (regurgitation), allowing blood to flow backward. Valves can also become stiff and narrow (stenosis). In both cases, your heart has to work harder to pump blood. This added stress on the pumping chambers of your heart can lead to heart failure.
Heart valve surgery may involve the repair or replacement of a valve. There are many types of heart valve surgeries. Providers perform some heart valve procedures using catheters, which require only a small incision in your groin. Other heart valve procedures require open-heart surgery or minimally invasive surgery through a smaller incision in your chest.
Left ventricular assist device (LVAD)
Some people with heart failure reach a point where their heart can no longer meet the needs of their body on its own. A left ventricular assist device (LVAD) is an implanted device that helps your left ventricle pump blood. It connects to an external controller worn on the outside of your body.
You may receive an LVAD as a long-term treatment for heart failure or as a bridge treatment while you wait for a heart transplant.
Heart transplant surgery replaces your heart with one from a donor. It’s the last option for people with end-stage heart failure. Due to a shortage of donor hearts, there are strict criteria you must meet to qualify for a heart transplant.
What happens before heart failure surgery?
Your provider will let you know what you need to do to prepare for surgery, including:
- What you can eat and drink.
- Which medications you should take.
- What to wear.
- What to bring to the hospital.
Before surgery, you’ll change into a hospital gown. A nurse will start an intravenous (IV) line in your arm or hand so you can receive fluids and any medications you need. The nurse may also:
- Shave the area where the surgeon will make the incision.
- Cleanse the surgical site.
- Cover you with a sterile drape.
For most procedures, you’ll receive medication to put you to sleep.
What happens during heart failure surgery?
Heart surgery procedures are highly specialized for each condition.
Some procedures require open surgery. This involves making an incision along your breastbone (sternum). Other procedures are minimally invasive and use smaller incisions in your chest.
Catheter-based approaches are becoming more widely available. In these procedures, your provider accesses your heart using a small incision in your groin. Catheter-based procedures are usually quicker and may take an hour or two.
What happens after heart failure surgery?
After surgery, you may go to the hospital’s intensive care unit (ICU) to recover or directly to a hospital room. Your hospital stay will vary based on the type of surgery and your medical condition. You may stay in the hospital overnight or for several weeks. Before going home, some people may need care at a rehabilitation facility to regain their strength.
Before you go home, your healthcare team will give you a detailed plan. This plan will include your follow-up appointments and instructions on how to care for yourself.
Risks / Benefits
What are the risks of heart failure surgery?
Risks include but aren’t exclusive to death, stroke, bleeding and infection. You may have additional risks, depending on your age and medical condition.
Your surgeon will explain your risks to you before surgery. Let your surgeon know if you have any questions or concerns about the procedure and any potential risks.
Recovery and Outlook
What is the outlook for heart failure surgery?
Heart failure causes symptoms that become worse with time and can interfere with your ability to live life fully. For many people, heart failure surgery improves their symptoms and increases their length and quality of life.
Your individual prognosis depends on many factors, including:
- Your heart function and symptoms.
- The success of your surgery.
- How well you care for yourself after surgery and follow your treatment plan.
When to Call the Doctor
When should I see my healthcare provider?
Heart failure is a long-term condition. You should maintain close communication with your healthcare provider. Let your provider know if your symptoms get worse or you notice any new symptoms, such as:
After surgery, follow your provider’s instructions for care and follow-up appointments. Talk to your provider if you have any problems or concerns with your progress as you recover.
A note from Cleveland Clinic
Heart failure surgery is usually an option if other treatments aren’t effective and your condition persists or gets worse. The types of heart failure surgery range from catheter-based procedures to open-heart surgery. Your healthcare provider will help you determine if heart failure surgery is right for you. Talk to your provider about what to expect before, during and after the procedure. Be sure to ask any questions or express any concerns you have about your treatment plan and recovery.
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