What Are Surgical Options for Heart Failure?
When someone is diagnosed with heart failure, their healthcare team will try to find the cause. If the cause is reversible due to conditions like coronary artery disease, arrhythmia, or a valve disorder, then it is important to fix the problem. If there is no reversible cause, then heart failure will be treated with medications and lifestyle changes. Sometimes even after fixing the cause, there is still a need for treatment with medications and lifestyle changes.
There are different kinds of procedures that can be done to treat a variety of cardiac conditions. The procedures can range from those that are minimally invasive, such as cardiac catheterization, performed to diagnose and treat some cardiac conditions, to major operations like a heart transplant.1-2
Cardiac catheterization can be performed as a diagnostic tool to identify coronary blockages or to evaluate the pressures and cardiac output of the heart. It can also be used for certain treatments like coronary angioplasty or stenting if blockages are found.3 When looking for blockages in the coronary arteries (also called left heart catheterization), a long thin catheter is inserted into an artery in the groin or arm which is threaded up through the arteries around the heart. Contrast or dye is injected and x-rays are taken to see if there are blockages in the arteries. It can also be used to see how well the mitral and aortic valves are working. These are the valves on the left side of the heart.
When evaluating the pressures and cardiac output of the heart, a long thin catheter is inserted into a vein in the groin, arm or neck. It is passed through to the right side of the heart into a pulmonary artery and measures pressures. This is also called a right heart catheterization.
Coronary angioplasty is referred to by several names including Percutaneous Coronary Interventions [PCI], Balloon Angioplasty and Coronary Artery Balloon Dilation.1 It is a minimally invasive procedure that uses the cardiac catheterization approach to reach the heart. The catheter has a deflated balloon attached to the tip which is threaded up to the coronary arteries. When it reaches the area where the blood flow is blocked, the balloon is inflated which widens blocked arteries. When successful, angioplasty helps increase blood flow, decreases pain, and improves physical activity.1-2
A stent is a wire mesh tube that is permanently placed in a blocked coronary artery. It is a minimally invasive procedure that uses a left heart catheterization approach. The stent is placed on the end of the wire that is guided into the blocked coronary artery. When in place, a balloon inflates to press the stent open to widen the blocked artery. It is permanently positioned in the artery with the intent to lessen the chance of another blockage developing.1-2 A person can have multiple stents in the same artery and in separate arteries. The stented artery helps to relieve chest pain and improve blood flow to the heart.
Heart valve problems
An abnormal or diseased heart valve can be repaired or replaced with open heart surgery.1-2 A balloon procedure similar to an angioplasty can be performed to try to open up the valve. This is called a valvuloplasty. A valve can be replaced with an artificial or biological valve. A biological valve can be made from pig, cow or human heart tissue.2 A valve replacement can improve symptoms, restore function and help people live longer.1
The type of procedure, open heart surgery or valvuloplasty, depends on many different factors, like age, type of valve disease, other comorbidities, etc. The risks and benefits of each treatment should be discussed with you and your health care team.
Coronary bypass surgery graft, CABG, is a common open-heart surgery that reroutes blood flow around a clogged artery. It does this using healthy arteries or veins taken from other parts of your body. These are called grafts. They are sewn into the aorta and then into the coronary artery to bypass the blockage. This improves the supply of blood and oxygen to the heart. The number of bypass grafts depends on how many arteries are narrowed.1-2 Bypass surgery reduces the risk of a heart attack and improves physical activity.
A left ventricular assist device (LVAD) is a pump that is surgically implanted into the left ventricle. It is used for people with end-stage heart failure, it helps the left ventricle to pump blood out to the body. The mechanical pump of the LVAD is controlled by a controller unit and battery pack that is worn outside the body and that is connected to the LVAD through a cable called a driveline that exits the skin in the abdomen.4
A heart transplant is considered the only cure for heart failure. It is a major surgery during which a donor’s heart is surgically implanted to replace a failing, diseased heart. A heart transplant is often considered a last line of treatment after medications and other cardiac procedures have failed. Not everyone is a candidate for a heart transplant. There are rigorous criteria to be met to even get on the UNOS (United Network of Organ Sharing) list.1-2
Heart surgeries do entail risks.2 According to The National Heart, Lung, and Blood Institute, these risks include:
- Anesthesia reactions
- Tissue damage in the heart, kidneys, liver, and lungs
The outcome is generally influenced by the general health of the patient, the presence of any comorbidities such as kidney or lung disease, diabetes, or other significant medical condition.2