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Surgical Treatments for Heart Failure

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.

Valve Surgery

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.

Heart Transplantation

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