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Heart failure - surgeries and devices

CHF - surgery; Congestive heart failure - surgery; Cardiomyopathy - surgery; HF - surgery; Intra-aortic balloon pumps - heart failure; IABP - heart failure; Catheter based assist devices - heart failure

The main treatments for heart failure are making lifestyle changes and taking your medicines. However, there are procedures and surgeries that may help.

Pacemakers and Defibrillators

A heart pacemaker is a small, battery-operated device that sends a signal to your heart. The signal makes your heart beat at the correct pace.

Pacemakers may be used:

  • To correct abnormal heart rhythms. The heart may beat too slowly, too fast, or in an irregular manner.
  • To better coordinate the beating of the heart in people with heart failure. These are called biventricular pacemakers.

When your heart is weakened, gets too large, and does not pump blood very well, you are at high risk for abnormal heartbeats that can lead to sudden cardiac death.

  • An implantable cardioverter-defibrillator (ICD) is a device that detects heart rhythms. It quickly sends an electrical shock to the heart to change the rhythm back to normal.
  • Most biventricular pacemakers can also work as implantable cardio-defibrillators (ICD).

Procedures and Surgery to Improve Blood Supply to the Heart

The most common cause of heart failure is coronary artery disease (CAD), which is a narrowing of the small blood vessels that supply blood and oxygen to the heart. CAD may become worse and make it harder to manage your symptoms.

After performing certain tests, your health care provider may feel that opening a narrowed or blocked blood vessel will improve your heart failure symptoms. Suggested procedures may include:

Heart Valve Surgery

Blood that flows between the chambers of your heart, or out of your heart into the aorta, must pass through a heart valve. These valves open enough to allow blood to flow through. They then close, keeping blood from flowing backward.

When these valves do not work well (become too leaky or too narrow), blood does not flow correctly through the heart to the body. This problem may cause heart failure or make heart failure worse.

Heart valve surgery may be needed to repair or replace one of the valves.

Surgery for End-stage Heart Failure

Some types of surgery are done for severe heart failure when other treatments no longer work. These procedures are often used when a person is waiting for a heart transplant. They are also sometimes used long term in cases when transplant is not planned or possible.

Examples of some of these devices include left ventricular assist devices (LVAD), right ventricular assist devices (RVAD), or a total artificial hearts. They are considered for use if you have severe heart failure that cannot be controlled with medicine or a special pacemaker.

  • Ventricular assist devices (VAD) help your heart pump blood from the pumping chambers of your heart to either the lungs or to the rest of your body These pumps may be implanted in your body or connected to a pump outside your body.
  • You may be on a waiting list for a heart transplant. Some people who get a VAD are very ill and may already be on a heart-lung bypass machine.
  • Total artificial hearts are being developed, but are not yet in wide use.

Devices inserted through a catheter such as intra-aortic balloon pumps (IABP) are sometimes used.

  • An IABP is a thin balloon that is inserted into an artery (most often in the leg) and threaded into the main artery exiting the heart (aorta).
  • These devices can help maintain heart function in the short term. Because they can be placed quickly, they are useful for people who have a sudden and severe decline in heart function
  • They are used in people who are waiting for recovery or for more advanced assist devices.
Open References

References

Aaronson KD, Pagani FD. Mechanical circulatory support. In: Libby P, Bonow RO, Mann DL, Tomaselli GF, Bhatt DL, Solomon SD, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Philadelphia, PA: Elsevier; 2022:chap 59.

Ewald GA, Milano CA, Rogers JG. Circulatory assist devices in heart failure. In: Felker GM, Mann DL, eds. Heart Failure: A Companion to Braunwald's Heart Disease. 4th ed. Philadelphia, PA: Elsevier, 2020:chap 45.

Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines. J Am Coll Cardiol. 2023;81(15):1551. PMID: 35379503 pubmed.ncbi.nlm.nih.gov/35379503/.

Mann DL. Management of heart failure patients with reduced ejection fraction. In: Libby P, Bonow RO, Mann DL, Tomaselli GF, Bhatt DL, Solomon SD, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Philadelphia, PA: Elsevier; 2022:chap 50.

Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines. Circulation. 2021;143(10):e784. PMID: 33332149 pubmed.ncbi.nlm.nih.gov/33332149/.

Rihal CS, Naidu SS; Society for Cardiovascular Angiography and Interventions (SCAI), et al. 2015 SCAI/ACC/HFSA/STS clinical expert consensus statement on the use of percutaneous mechanical circulatory support devices in cardiovascular care: Endorsed by the American Heart Association, the Cardiological Society of India, and Sociedad Latino Americana de Cardiologia Intervencion; affirmation of value by the Canadian Association of Interventional Cardiology-Association Canadienne de Cardiologie d'intervention. J Am Coll Cardiol. 2015;65(19):e7-26. PMID: 25861963 pubmed.ncbi.nlm.nih.gov/25861963/.

  • Coronary artery disease

    Animation

    •  

    Coronary artery disease - Animation

    If we looked inside the chest cavity, we would see the lungs and pericardium, which is the fibrous covering of the heart. We could also see the heart beating. Here are the left and right coronary arteries. They supply blood to specific regions of the heart. If either is damaged or blocked, it could injure the heart wall. In a healthy artery, red blood cells flow through unimpeded. But if the inner wall is damaged, cholesterol plaque can build up. This progressively narrows the space through which blood flows. Eventually, the artery may become too narrow for clotted blood to pass through. If it does, the artery could become completely blocked. That would cause a lack of oxygen, or ischemia, in the part of the heart the artery supplies. The result is a heart attack, known as a myocardial infarction.

  • Heart failure

    Animation

    •  

    Heart failure - Animation

    If you cough a lot, often feel weak, have lost your appetite, and need to urinate a lot at night, you might have symptoms of heart failure. Heart failure is a long-term condition that usually comes on slowly. However, it can develop suddenly, for instance, after a heart attack. You have heart failure when your heart does not pump blood out of your heart very well, or when your heart muscles are stiff and do not easily fill up with blood. When you have heart failure, your heart cannot pump enough oxygen-rich blood to the rest of your body, especially when you exercise or move around a lot. As the heart loses the ability to pump blood, blood backs up in other parts of your body, including your lungs, liver, gastrointestinal tract, and your arms and legs. The most common cause of heart failure is coronary artery disease, the narrowing of the blood vessels that supply blood and oxygen to your heart. So, how do you know if you have heart failure? Get to your doctor. You may have trouble breathing, an irregular heartbeat, swollen legs, neck veins that stick out, and sounds from fluid built up in your lungs. Your doctor will check for these and other signs of heart failure. A test called an echocardiogram is often the best test to diagnose your heart failure. Your doctor can also use this test to find out why you have heart failure, and then monitor your condition going forward every three to six months. Your doctor will talk to you about knowing your body and symptoms that mean your heart failure is getting worse. You will need to learn to watch for changes in your heart rate, pulse, blood pressure, and weight. You will also need to limit salt in your diet, stop drinking alcohol, quit smoking if you need to, exercise, lose weight if you need to, and get enough rest. Your doctor will probably ask you to take medicines to treat your heart failure. These medicines can treat your symptoms, prevent your heart failure from getting worse, and help you live longer. If you have heart failure, taking your medicines, changing your lifestyle, and treating the condition that caused heart failure can go a long way toward improving your health. But heart failure is a chronic, or long-term, illness, which means it may get worse over time. Make sure you call your doctor if you start coughing more, have sudden weight gain or swelling, or feel week. Have someone take you to the emergency room right away if you have trouble with fainting, a fast and irregular heartbeat, or feel severe crushing chest pain.

  • Pacemaker

    Pacemaker - illustration

    A pacemaker is a small, battery-operated electronic device which is inserted under the skin to help the heart beat regularly and at an appropriate rate. The pacemaker has leads that travel through a large vein to the heart, where the wires are anchored. The leads send the electrical impulses to the heart to tell it to beat.

    Pacemaker

    illustration

  • Coronary artery disease

    Animation

    •  

    Coronary artery disease - Animation

    If we looked inside the chest cavity, we would see the lungs and pericardium, which is the fibrous covering of the heart. We could also see the heart beating. Here are the left and right coronary arteries. They supply blood to specific regions of the heart. If either is damaged or blocked, it could injure the heart wall. In a healthy artery, red blood cells flow through unimpeded. But if the inner wall is damaged, cholesterol plaque can build up. This progressively narrows the space through which blood flows. Eventually, the artery may become too narrow for clotted blood to pass through. If it does, the artery could become completely blocked. That would cause a lack of oxygen, or ischemia, in the part of the heart the artery supplies. The result is a heart attack, known as a myocardial infarction.

  • Heart failure

    Animation

    •  

    Heart failure - Animation

    If you cough a lot, often feel weak, have lost your appetite, and need to urinate a lot at night, you might have symptoms of heart failure. Heart failure is a long-term condition that usually comes on slowly. However, it can develop suddenly, for instance, after a heart attack. You have heart failure when your heart does not pump blood out of your heart very well, or when your heart muscles are stiff and do not easily fill up with blood. When you have heart failure, your heart cannot pump enough oxygen-rich blood to the rest of your body, especially when you exercise or move around a lot. As the heart loses the ability to pump blood, blood backs up in other parts of your body, including your lungs, liver, gastrointestinal tract, and your arms and legs. The most common cause of heart failure is coronary artery disease, the narrowing of the blood vessels that supply blood and oxygen to your heart. So, how do you know if you have heart failure? Get to your doctor. You may have trouble breathing, an irregular heartbeat, swollen legs, neck veins that stick out, and sounds from fluid built up in your lungs. Your doctor will check for these and other signs of heart failure. A test called an echocardiogram is often the best test to diagnose your heart failure. Your doctor can also use this test to find out why you have heart failure, and then monitor your condition going forward every three to six months. Your doctor will talk to you about knowing your body and symptoms that mean your heart failure is getting worse. You will need to learn to watch for changes in your heart rate, pulse, blood pressure, and weight. You will also need to limit salt in your diet, stop drinking alcohol, quit smoking if you need to, exercise, lose weight if you need to, and get enough rest. Your doctor will probably ask you to take medicines to treat your heart failure. These medicines can treat your symptoms, prevent your heart failure from getting worse, and help you live longer. If you have heart failure, taking your medicines, changing your lifestyle, and treating the condition that caused heart failure can go a long way toward improving your health. But heart failure is a chronic, or long-term, illness, which means it may get worse over time. Make sure you call your doctor if you start coughing more, have sudden weight gain or swelling, or feel week. Have someone take you to the emergency room right away if you have trouble with fainting, a fast and irregular heartbeat, or feel severe crushing chest pain.

  • Pacemaker

    Pacemaker - illustration

    A pacemaker is a small, battery-operated electronic device which is inserted under the skin to help the heart beat regularly and at an appropriate rate. The pacemaker has leads that travel through a large vein to the heart, where the wires are anchored. The leads send the electrical impulses to the heart to tell it to beat.

    Pacemaker

    illustration

A Closer Look

 
 

Review Date: 4/10/2023

Reviewed By: Michael A. Chen, MD, PhD, Associate Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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