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Surgical Procedures for Heart Failure

Animation Movie Available Related Media: The Implant Procedure (Pacemaker)

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.

Treating 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:

Biventricular Cardiac Pacemaker

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.

Implantable Cardioverter Defibrillator Implantation (ICD)

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.

Left-Ventricular Assist Device (LVAD)

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:

  • Are not candidates for transplant
  • Do not respond to medical therapy
  • Have a low risk of surviving one year

LVAD has shown promising success in extending life and eliminating the need for a heart transplant in some people.

Heart Transplant

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.

Treating Other Heart Conditions

Surgery can help repair or improve any underlying heart conditions that may contribute to heart failure. These include:

  • Heart valve replacement: Improves the blood flow inside the heart, but has not been shown to improve heart failure survival. It may be considered for some situations.
  • Coronary artery graft bypass (CABG): More commonly known as open-heart or bypass surgery. Grafted veins from the legs are used to go around clogged arteries that feed the heart muscle. This will improve blood flow to the heart muscle and help it work more efficiently.

Revision Information

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  • 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%5FUCM%5F306354%5FArticle.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%5FUCM%5F306345%5FArticle.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%5Fbefore.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.