Surgery for Heart Failure

After a heart failure (HF) diagnosis, your doctor will try to find the cause. This can help suggest the right treatment for your situation. Lifestyle changes and medicines are usually the first option for treating HF. If these treatments are not effective, you may need heart surgery. Heart surgery can also treat underlying conditions.¹

Surgery can improve your heart function and help you live longer. Different procedures treat different heart conditions. They include minimally invasive procedures, such as cardiac catheterization. This is used to diagnose and treat some heart conditions. They also include major operations, like a heart transplant.¹

Cardiac catheterization

Cardiac catheterization can be used to diagnose or treat certain heart conditions. During the procedure, a thin tube (catheter) is threaded through a blood vessel to the heart. Doctors use it for different diagnostic tests, including:^2,3

• Locating blockages in blood vessels that cause chest pain and decreasing blood flow to the heart muscle
• Taking samples of tissue from your heart
• Seeing how well heart valves work
• Measuring pressure and oxygen levels
• Seeing how well the heart pumps blood

Doctors may use cardiac catheterization procedures as part of certain HF treatments, including:^1,3

• Coronary angioplasty
• Heart valve surgery
• Stent implantation
• Cardiac ablation (using heat or cold on areas of the heart to treat irregular heartbeats)

Coronary angioplasty

Coronary angioplasty may also be called percutaneous coronary interventions (PCI), balloon angioplasty, or coronary artery balloon dilation. It is a minimally invasive procedure used to treat coronary artery disease.⁴

During the procedure, a doctor inserts a catheter into a blood vessel. The catheter has a deflated balloon attached to the tip. Your doctor will thread the catheter to the blocked artery. The balloon is then inflated to widen the blocked artery. Angioplasty increases blood flow, decreases chest pain, and improves physical activity.¹

Stent implantation

A stent is a wire mesh tube placed in a blocked coronary artery during angioplasty. It is a minimally invasive procedure. The stent is placed on the end of a catheter and guided into the blocked artery. When in place, a balloon inflates to press the stent open to widen the blocked artery. The stent is permanently positioned to reduce the chance of another blockage developing. The stented artery helps relieve chest pain and improve blood flow to the heart.^1,4

Heart valve surgery

Heart valve surgery can repair or replace an abnormal or diseased heart valve. There are many surgery options. In one option, a balloon procedure can be used to open up the valve. This is called a valvuloplasty.^1,2,4

Another option is to replace the valve with an artificial or biological valve. A biological valve can be made from pig, cow or human heart tissue. Valve replacement can improve symptoms, restore function, and help people live longer.^1,2,4

Bypass surgery

Coronary artery bypass graft (CABG) surgery reroutes blood flow around a blocked artery. In people with coronary artery disease, plaque deposits build up along heart muscles. This can block arteries and interfere with blood flow.^1,2,4

CABG surgery uses a healthy blood vessel from other parts of your body. This is called a graft. The graft is attached above and below the blocked artery. This improves the supply of blood and oxygen to the heart. Bypass surgery reduces the risk of a heart attack and improves physical activity.^1,2,4

Left ventricular assist device

A left ventricular assist device (LVAD) is a pump surgically implanted into the left ventricle. It is used for people with end-stage heart failure. LVAD helps the left ventricle to pump blood out to the body. The mechanical pump connects to an external controller worn outside the body.^1,5

Surgical ventricular reconstruction

Surgical ventricular reconstruction (SVR) can treat heart failure caused by complications from a heart attack (myocardial infarction). After a heart attack happens, a scar can form in the heart’s left ventricle. Over time, the scar can cause the ventricle to change shape and weaken. This can lead to congestive heart failure.^6,7

SVR restores the ventricle to normal by removing scar tissue and fixing its shape. The procedure improves how the ventricle pumps blood. It may be done along with other heart surgeries.^6,7

Heart transplant

A heart transplant is considered the only cure for HF. It is a major surgery that replaces your heart with one from a donor. A heart transplant is usually the last line of treatment after medicines and other procedures have failed. There are strict criteria to meet to qualify for a heart transplant. Not everyone is a candidate for a heart transplant.^1,4

Heart surgeries do entail risks. These risks include:⁸

• Bleeding
• Infection
• Anesthesia reactions
• Tissue damage in the heart, kidneys, liver, and lungs
• Stroke
• Death

You may need to take medicine after surgery to prevent deadly blood clots from forming. There are many choices and your doctor will talk to you about which ones are best for you.