Surgical procedures are used to treat heart failure. They may also be used to treat or improve other heart conditions that contribute to your heart failure.
If your heart failure is not responding to medical therapy, you may need a surgical procedure. These procedures will help your heart to work more efficiently and help minimize further damage. These include:
People with heart failure who also have heart arrhythmias may benefit from pacemakers. Controlling the rhythm of the heart in a more normal fashion can help the heart pump more efficiently. People with dilated cardiomyopathies, unresponsive to medical therapy, may benefit from a biventricular cardiac pacemaker. This type of pacemaker sends carefully timed electrical impulses to the heart’s lower chambers. The pacemaker is implanted in the chest and connected to the heart.
This is a device that can be implanted in your chest. People with heart failure are more prone to certain heart arrhythmias that put them at risk for sudden cardiac death. ICDs are implanted in people to prevent such arrhythmias from occurring.
This is a mechanical pump that can be implanted in your chest. It assists the heart's pumping. This device is sometimes referred to as a bridge to transplant, since it can be used to maintain people awaiting heart transplants. This device can also be used as permanent treatment in people who:
LVAD has shown promising success in extending life and eliminating the need for a heart transplant in some people.
When a heart is damaged to the point that no other therapies work and a person is at risk of dying, a heart transplant may be considered. This is reserved for the most severe cases of heart failure. There are number of conditions that may limit a person’s ability to receive a heart transplant. People who are eligible for a heart transplant are placed on a waiting list for a donor heart. Waiting times for a heart can range from days to months, which are dependent on several factors.
During the waiting period, people who need transplants continue with treatment until a donor becomes available. Depending on the severity of the heart failure, and treatment response, it is possible to receive an implantable medical device during this time.
Close medical follow-up is essential after a heart transplant. After surgery, there is an increased risk for a number of different health conditions, including rejection of the transplant, infections, and malignancies. Most people, however, return to normal activities, including work and exercise. A specific rehabilitation program may be suggested to speed recovery and restore cardiovascular health.
Surgery can help repair or improve any underlying heart conditions that may contribute to heart failure. These include:
ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults. A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2009;119(14):1977-2016.
Atluri P, Goldstone AB, et al. Minimally Invasive Mitral Valve Surgery Can Be Performed With Optimal Outcomes in the Presence of Left Ventricular Dysfunction. Ann Thorac Surg. 2013;96(5):1596-1601.
Bernard ML, Gold ML. Economic implications and cost-effectiveness of implantable cardioverter defibrillator and cardiac resynchronization therapy. Heart Fail Clin. 2011;7(2):241-250.
Edelman JJ, Yan TD, et al. Off-pump coronary artery bypass surgery versus percutaneous coronary intervention: a meta-analysis of randomized and nonrandomized studies. Ann Thorac Surg. 2010;90(4):1384-1390.
Grossi EA, Galloway AC, et al. Impact of minimally invasive valvular heart surgery: a case-control study. Ann Thorac Surg. 2001;71:807.
Heart failure. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated October 7, 2013. Accessed October 9, 2013.
Heart transplant. Transplant living website. Available at: http://www.transplantliving.org/before-the-transplant/about-the-operation/heart. Accessed October 9, 2013.
Implantable medical devices for heart failure. American Heart Association website. Available at: http://www.heart.org/HEARTORG/Conditions/HeartFailure/PreventionTreatmentofHeartFailure/Implantable-Medical-Devices-for-Heart-Failure_UCM_306354_Article.jsp. Updated September 20, 2013. Accessed October 9, 2013.
Leclercq C, Kass DA. Retiming the failing heart: principles and current clinical status of cardiac resynchronization. J Am Coll Cardiol. 2002;39(2):194-201.
Steinman TI, Becker BN, et al. Guidelines for the referral and management of patients eligible for solid organ transplantation. Transplantation. 2001;71:1189.
Surgical procedures for heart failure. American Heart Association website. Available at: http://www.heart.org/HEARTORG/Conditions/HeartFailure/PreventionTreatmentofHeartFailure/Surgical-Procedures-for-Heart-Failure_UCM_306345_Article.jsp. Updated September 20, 2013. Accessed October 9, 2013.
What to expect before a heart transplant. National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov/health//dci/Diseases/ht/ht_before.html. Accessed October 9, 2013.
2/1/2013 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Peura JL, colvin-Adams M, et al. Recommendations for the use of mechanical circulatory support: device strategies and patient selection: a scientific statement from the American Heart Association. Circulation. 2012;126(22):2648-2667.
Last reviewed September 2014 by Michael J. Fucci, DO
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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