Implantable cardioverter defibrillator (ICD)
Some people who have severe heart failure or serious arrhythmias (irregular heartbeats) may need implantable defibrillators, or ICDs. These devices are surgically placed and deliver pacing – or an electric counter-shock – to the heart when a life-threatening abnormal rhythm is detected. ICDs have saved millions of lives, but are only advisable in certain circumstances. The decision to use an ICD is a shared one by the physician and patient.
Cardiac Resynchronization Therapy (CRT)
Some people with heart failure develop abnormal conduction of the heart’s electrical system that changes how efficiently the heart beats.
In such cases, cardiac resynchronization therapy (CRT), also known as biventricular pacing, may be needed. In this procedure, a special pacemaker makes the ventricles contract more normally and in synchrony.
This therapy can improve heart function, reduce hospitalization risk and increase survival.
Left ventricular assist device (LVAD)
- What is a left ventricular assist device? 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-like 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, sometimes called a “bridge to transplant,” is now used in longer-term therapy. People often must wait a long time before a suitable heart becomes available. During this wait, the patient’s already weakened heart may deteriorate further, losing the ability to pump blood throughout the body. An LVAD can help a weak heart and “buy time” for the patient, or eliminate the need for a heart transplant altogether. Most recently, LVADs are being used longer term as “destination therapy” in end-stage heart failure patients when heart transplantation isn’t 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 can maintain an acceptable quality of life while waiting for a donor heart to become available.
Surgical procedures for heart failure
Surgery isn’t frequently used to treat heart failure. But it’s recommended when the doctor identifies a correctable problem that’s causing heart failure – such as a defect like a heart valve or a blocked coronary artery.
Heart transplantation
Some people have severe, progressive heart failure that can’t be helped by medications or dietary and lifestyle changes. In such cases, a heart transplant may be the only effective treatment option.
Surgeons replace the damaged heart with a healthy one from a donor who has been declared brain dead. It can take several months to find a donor heart that closely matches the tissues of the person receiving the transplant. But this matching process increases the likelihood that the recipient’s body will accept the heart.
During a transplant procedure, the surgeon connects the patient to a heart-lung machine, which takes over the functions of the heart and lungs. The surgeon then removes the diseased heart and replaces it with the donor heart. Finally, the major blood vessels are reconnected, and the new heart is ready to work.
The outlook for people with heart transplants is good during the first few years after the transplant. In fact, about 90 percent of patients live for more than a year after their operations. However, the number of patients who receive heart transplants is still relatively low – around 2,500 each year.
Percutaneous coronary intervention (PCI, also referred to as angioplasty)
Heart failure can develop when blockages in the coronary arteries restrict the blood supply to the heart muscle. Removing these blockages can improve overall heart function, which may improve or resolve heart failure symptoms. PCI, often called angioplasty, is one type of procedure to reopen blocked blood vessels.
The procedure is usually performed in the cardiac catheterization lab. A small tube (catheter) with a tiny deflated balloon on the end is inserted through an incision in the groin (or other area where the artery can be accessed) and pushed through to the diseased artery. Then the balloon is inflated to push open the artery. The balloon is removed once the artery has been fully opened.
A stent may be placed during the procedure to keep the blood vessel open.
Although there’s a slight risk of damage to the artery during PCI, this procedure usually improves the patient’s condition.
Coronary artery bypass
Coronary artery bypass surgery reroutes the blood supply around a blocked section of the artery.
During this procedure, surgeons remove healthy blood vessels from another part of the body, such as a leg or the chest wall. They then surgically attach the vessels to the diseased artery so that the blood can flow around the blocked section.
After a bypass operation, it’s especially important for you to reduce the amount of fat and cholesterol you eat, because these substances cause the arteries to clog. Doctors also recommend increasing physical activity to strengthen the heart muscles.
Valve replacement
Heart failure is sometimes caused by a defective or diseased heart valve.
Heart valves regulate the flow of blood inside the heart. When the valves 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 often improves or resolves the condition as well.
A variety of different replacement valves can be used, including a mechanical valve made from metal and plastic, or 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.
In some patients, heart valve replacement may occur without surgery. But candidacy for this kind of procedure is highly individualized.