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Overview

Heart failure occurs when a damaged or weakened heart does not pump blood as efficiently as the body needs. Although the condition is serious, doctors have the tools to treat many instances of heart failure effectively.

Yale Medicine Cardiac Surgery is a national leader in clinical research, repairing problematic heart conditions, implanting artificial devices, and performing cardiac transplantation.

What is heart failure?

The human heart has four chambers, including a left ventricle and a right ventricle. Most often, patients are suffering failure of the left ventricle, which pumps blood throughout the body. (With the failure of the right ventricle – which pumps blood toward the lungs – a patient has a lower chance of survival.)

Left ventricle failure compromises heart function and results in symptoms from shortness of breath and sudden weight gain to heart pain.

Patients who come in with heart failure may have suffered a heart attack, have type 2 diabetes or high blood pressure, or be diagnosed with coronary artery disease.

A common condition that brings patients to Yale Medicine is low-pumping action, or low-ejection fraction, a measurement that describes how well the heart is pumping out blood to the body.

Many of the patients have chronic congestive heart failure and are seeking second opinions.

What are the options for heart failure surgery?

If the patient’s heart failure has an underlying cause, doctors first consider treating that. That may mean coronary bypass surgery to unblock clogged arteries or, if the condition has been caused by a faulty valve, heart valve repair or replacement.

Other surgical options include:

Left ventricular assist device (LVAD). LVADs are mechanical devices that supplement the work of the heart. They take over the work of the left ventricle, assuming the responsibility of pumping blood around the body.

An LVAD can be an effective long-term solution for cases of heart failure, or it can be a way to stabilize and improve a patient’s cardiac health while she waits for a heart transplant to become available.

“Some patients come in with late stages of heart disease, and they’re the ones who can benefit from LVAD and transplant,” says Pramod Bonde, MD, surgical director of Mechanical Circulatory Support.

Heart transplant. Heart transplantation is a solution that can radically improve a patient’s heart function and quality of life, but receiving a transplant depends on availability. Donations are tightly regulated, and to be on the list, a patient must be relatively young, have excellent organ function in the rest of the body, and document strong family and social support.

“A few years ago, people were dying while waiting for the heart to come,” Dr. Bonde says. "Now, thanks to LVADs, they have an option that will help them survive."

Who is a good candidate for heart failure surgery?

general anesthesiaIf patients have confirmed congestive heart failure, and other therapies aren’t working or they keep ending up in the hospital, then our cardiac surgeons will consider them candidates for surgery.

When a patient comes in, doctors look over everything in a patient’s record to see whether there are options besides surgery, such as adjusting medications. Once they rule out alternative treatments and confirm that surgery is the right option, doctors will determine what surgical intervention is the best fit.

Many left ventricular assist devices (LVAD) patients are in their late 70s, and may not necessarily in good health overall. So when doctors talk about a “good fit,” it’s more about whether the device will increase a specific patient’s quality of life than about any particular health requirements.

Yale Medicine's track record enables the cardiac surgery team to expand the LVAD application to patients who might not have previously seemed like viable candidates. “We have been carefully offering the therapy for the last five years,” says Dr. Bonde.

What is the patient experience like?

On the day of surgery, most left LVAD patients come in straight from home. A communications team advises them on how to prepare for surgery. If they’re already in the hospital because of their heart failure, a team of nurses prepares them.

The patient receives general anesthesia, and the surgery takes from 4 to 6 hours. Patients will usually wake up with a tube to help them breathe, which doctors remove when patients can breathe on their own. Most stay in the intensive care unit for at least a few days.

What is recovery like?

Usually, patients remain in the hospital for a few weeks. After that, depending on a patient’s overall health, he or she may transfer to a rehabilitation center, or go home.

Eventually, most patients will be able to resume normal activity – and even play golf – once they’ve recovered fully.

What risks or side effects come with heart failure surgery?

Surgery carries some risks, though outcomes are typically good. Risks include bleeding and infection, and some short-term reactions to anesthetics, such as confusion.

LVADs tend to last five to 10 years, so having a device put in does run the risk of failure eventually. Other complications include bleeding, clotting, and infection, mainly as a result of blood coming into contact with a foreign object.

It’s also important to note that having an LVAD requires a new approach to caring for the body. The LVAD is powered by batteries and is attached to monitors outside the body. Patients will have a cord that runs through the chest and out her side. That means that patients and caretakers must be ready for a certain amount of maintenance: Patients must care for a wound by showering carefully and sleeping on their back or side, for example. They also must keep track of equipment.

In addition, the LVAD does not prevent problems of the right ventricle, which can still lead to heart failure.

What makes Yale Medicine’s approach to surgery for heart failure unique?

Yale Medicine’s cardiac doctors are national leaders in clinical research. In addition to his clinical work, Dr. Bonde runs a laboratory devoted to advancing the long-term success of artificial heart transplants.

Dr. Bonde sees part of his work as working out ways to extend treatment to patients who might not be traditional contenders for surgery because of their age or overall health.

“A lot of the patients who are not candidates for regular heart surgery – bivalve, heart replacement – I consider them for high-risk surgery with an LVAD backup,” he says. “If you’re told you have no options because your heart function is poor, that doesn’t mean anything. You might get help from us.”