Heart Failure Surgery
To work well and stay healthy, tissues and organs throughout the body need a steady supply of oxygen-rich blood. When heart failure happens, the heart is unable to pump enough blood to meet the needs of all of the body’s tissues and organs. It does not mean that the heart is no longer working, but rather that it is not working as well as it should.
Though it is a serious condition, doctors have tools to treat many instances of heart failure effectively. Changes to diet and lifestyle can help the heart work better. Medications can relieve symptoms and improve the heart’s ability to pump blood.
In some cases, though, treatment involves surgery. Having heart failure surgery or getting a mechanical device like a pacemaker implanted can be scary. The good news is that the surgical procedures used to treat heart disease can substantially improve heart function and help people with heart disease live longer, healthier lives.
What are the symptoms of heart failure?
People with heart failure often have difficulty breathing, feel more tired and weak than normal, and may have swelling in their legs and abdomen. Usually, the condition progressively worsens over time, and when heart failure reaches an advanced stage, people may find it hard to perform even routine physical activities
What causes heart failure?
A number of conditions can cause heart failure, including coronary artery disease, atrial fibrillation, and heart valve disease, among many others.
When is surgery used to treat heart failure?
For most people with heart failure, treatment involves lifestyle changes and medications. Following a heart healthy diet, staying physically fit, and avoiding smoking and excessive alcohol consumption can improve symptoms and quality of life. Medications may be also used to treat the symptoms of heart failure and to help the heart function better.
Some people with heart failure, though, may benefit from a surgical procedure. Surgical procedures may be used to correct the underlying issues mentioned above, for example. In other cases, such as heart transplantation, surgery is used to treat people with advanced heart failure whose condition cannot be improved with lifestyle changes or medication. In still other cases, treatment involves the surgical implantation of a mechanical device, such as a pacemaker, that helps the heart function properly.
What types of heart surgery are used to treat heart failure?
A number of surgical procedures are used to treat heart failure. Some patients may require open-heart surgery, while others can have a minimally invasive procedure that uses smaller incisions than an open-heart procedure. Doctors will determine which surgical intervention is the best fit for each patient’s situation.
Some of the types of heart surgery used to treat heart failure include:
Heart procedures. During surgery, the patient may be connected to a heart-lung bypass machine that takes over the heart’s functions while the surgeon performs the procedure.
- Coronary artery bypass graft (CABG). In coronary artery disease, the arteries that deliver oxygen-rich blood to the heart muscle become narrowed and stiff due to buildup of plaque (known as atherosclerosis). This reduces the amount of blood that flows through the arteries to the heart, which can cause the heart muscle to weaken, thus lessening its ability to pump blood. This problem can be treated by CABG (pronounced “cabbage”). In this procedure, a surgeon grafts a section of healthy blood vessel (a vein or artery taken from elsewhere in the body) to the affected coronary artery. The ends of the healthy blood vessel are attached above and below the narrowed section of the coronary artery. This allows blood to flow through the newly attached blood vessel and thus bypass the narrowed section of the coronary artery. CABG may be done using open-heart surgery or a minimally invasive procedure.
- Heart transplants. During a heart transplant, a patient’s heart is removed and replaced with a healthy heart from a deceased donor. Heart transplants are used for patients with end-stage heart failure whose condition cannot be treated effectively with medications or other treatments.
- Heart valve replacement surgery. The heart has four chambers and four valves. The valves control the flow of blood between the heart’s chambers and to the lungs and the rest of the body. Heart failure can occur if one or more of these valves is not working properly. Defective heart valves can be surgically repaired or replaced via open heart valve replacement surgery or minimally invasive procedure. Increasingly, though, these procedures are done using non-surgical techniques like TAVR.
- Catheter ablation. This procedure is used to treat people who have both heart failure and atrial fibrillation or other heartrate or rhythm problems. During catheter ablation, a doctor inserts a catheter (a thin, flexible tube) into a blood vessel in the groin, arm, or neck. He or she then guides the catheter through the blood vessel to the heart. When the catheter is in place, the doctor applies a laser, high-energy radiofrequency signals, or cold temperatures to the part of the heart responsible for the irregular heartbeat or rhythm. This ablates, or destroys, a small section of heart tissue. The doctor may need to implant a pacemaker as part of the procedure.
- Surgical ventricular reconstruction (SVR). When a coronary artery becomes blocked by the buildup of plaque or a blood clot, it cuts off blood flow to the heart muscle and can lead to a heart attack. This starves an area of the heart muscle of oxygen-rich blood, leading to tissue death and scarring. This can occur in the left ventricle, the heart chamber responsible for pumping blood to the rest of the body. The damaged portion of the heart muscle no longer works properly, and it can also bulge outward (known as a ventricular aneurysm). These changes may reduce the amount of blood the ventricle can pump and can also be a cause heart failure. To treat this condition, a surgeon may perform an SVR, or what is sometimes called left ventricular reconstruction or ventricular aneurysm repair. In SVR, the surgeon removes the scarred tissue and repairs the ventricular wall by sewing it together or patching it with a piece of synthetic fabric. This restores the shape of the ventricle and helps the ventricle pump blood more effectively.
Implantable medical devices. Doctors may surgically implant a mechanical device to help the heart improve its ability to pump blood.
- Cardiac resynchronization therapy (CRT). To pump blood effectively, the ventricles—the heart’s two lower, muscular chambers—must contract in a coordinated rhythm. In some people with heart failure, the contraction of the ventricles is not properly coordinated, which reduces the amount of blood the heart can pump. CRT is used to resynchronize the ventricles. In this minimally invasive procedure, a surgeon implants a small pacemaker (known as a biventricular pacemaker) in the chest. Whenever the contraction of the ventricles is not coordinated, the device delivers an electrical impulse to the ventricles to resynchronize their contractions.
- Implantable cardioverter-defibrillator (ICD). An irregular heart rate—known as arrhythmia—can cause heart failure. To treat this condition, a surgeon may implant an ICD, a device that can sense abnormal heartbeats and, in response, send an electrical impulse to the heart to correct the heart’s rhythm. ICD implantation is done using a minimally invasive procedure.
- Ventricular assist device (VAD). VADs are battery-powered, mechanical pumps that help the ventricles pump blood to the lungs and around the body. VADS are usually implanted via open-heart surgery. The device is connected to the heart and blood vessels using tubes, and a cable connects the device to a power supply and computerized controller, which are carried outside the body through a hole in the abdomen. VADs may be used temporarily, for example, while a patient waits for a heart transplant, or they may remain in place permanently.
What are the risks of heart failure surgery?
All surgical procedures carry risks. Heart surgery risks include:
- Abnormal heartbeat (arrhythmia)
- Damage to other organs and tissues such as the lungs or kidneys during the procedure
- Heart attack
- Allergic reaction to anesthesia
What is the outlook for people who undergo heart failure surgery?
Heart failure is a chronic condition that typically worsens over time. While treatments, including surgery, usually cannot cure heart failure, they can reduce symptoms, improve quality of life, and help people live longer lives.
A number of factors play a role in determining how well surgery will work for people who have heart failure. A person’s age, overall health apart from heart failure, and severity of heart failure all have an effect on the outcome.
The surgical procedures mentioned above can improve the heart’s ability to pump blood around the body and thus help people breathe easier and feel more energized. People who undergo any of these procedures, though, may need to take medication—possibly for the rest of their lives, make lifestyle changes, and see their doctor regularly to monitor their heart health.
What makes Yale Medicine's approach to heart failure surgery unique?
Yale Medicine Cardiac Surgery is a national leader in clinical research, repairing problematic heart conditions, implanting artificial devices, and performing heart transplantation.
“Yale Cardiac Surgery strives to offer extraordinary solutions by being at the forefront of new advanced heart failure therapies,” says Yale Medicine cardiac surgeon, Robert Davis, MD, PhD.