Surgery isn't frequently used to treat heart failure. However, it's recommended when the doctor can identify a correctable problem that's causing heart failure – such as a defect or a blocked coronary artery. Today, doctors are able to correct many problems by implanting devices.
Heart failure is sometimes caused by a defective or diseased heart valve. Heart valves regulate the flow of blood inside the heart. When they don't work properly, this puts extra strain on the heart and can lead to heart failure. For some valve problems, medical management is the first step in treatment. Correcting the problem surgically can often improve or resolve the condition.
A variety of different replacement valves can be used: a mechanical valve made from metal and plastic, one made from human or animal tissue. During the surgery, the patient is connected to a heart-lung machine that supplies blood to the brain and body. The bad valve is removed and replaced.
After the operation and depending on the type of replacement heart valve used, patients may take medicines to prevent blood clots from forming around the new heart valve. This treatment is often long-term to ensure the new valve works properly. Most heart valve surgeries are a success, but the operation is only considered as an option when a defective or diseased valve threatens someone's life. Read more about heart valve surgery.Defibrillator implantation
Some people who have severe heart failure or serious arrhythmias (irregular heartbeats) are candidates for implantable defibrillators. These devices are surgically placed and deliver pacing, or an electric countershock, to the heart when a life-threatening abnormal rhythm is detected.
Learn more about implantable devices
- What is a left ventricular assist device (LVAD)?
The left ventricle is the large, muscular chamber of the heart that pumps blood out to the body. A left ventricular assist device (LVAD) is a battery-operated, mechanical pump-type device that's surgically implanted. It helps maintain the pumping ability of a heart that can't effectively work on its own.
These devices are available in most heart transplant centers.
- When is an LVAD used?
This device is sometimes called a "bridge to transplant," but is now used in long-term therapy. People awaiting a heart transplant often must wait a long time before a suitable heart becomes available. During this wait, the patient's already-weakened heart may deteriorate and become unable to pump enough blood to sustain life. An LVAD can help a weak heart and "buy time" for the patient or eliminate the need for a heart transplant. Most recently, LVADs are being used longer-term as ‘destination therapy’ in end-stage heart failure patients when heart transplantation is not an option.
- How does an LVAD work?
A common type of LVAD has a tube that pulls blood from the left ventricle into a pump. The pump then sends blood into the aorta (the large blood vessel leaving the left ventricle). This effectively helps the weakened ventricle. The pump is placed in the upper part of the abdomen. Another tube attached to the pump is brought out of the abdominal wall to the outside of the body and attached to the pump's battery and control system. LVADs are now portable and are often used for weeks to months. Patients with LVADs can be discharged from the hospital and have an acceptable quality of life while waiting for a donor heart to become available.
Some people with heart failure develop abnormal heartbeats, or arrhythmias. Some arrhythmias may reduce how well the heart's lower chambers (ventricles) function. Cardiac resynchronization therapy, also known as biventricular pacing, may be needed. In this procedure, a special pacemaker is used to make the ventricles contract at the same time. Learn more about cardiac resynchronization therapy.
This content was last reviewed on 04/06/15.