Heart failure - surgeries and devices
CHF - surgery; Congestive heart failure - surgery; Cardiomyopathy - surgery; HF - surgery; Intra-aortic balloon pumps - heart failure; IABP - heart failure; Catheter based assist devices - heart failure
The main treatments for heart failure are making lifestyle changes and taking your medicines. However, there are procedures and surgeries that may help.
Pacemakers and Defibrillators
A heart pacemaker is a small, battery-operated device that sends a signal to your heart. The signal makes your heart beat at the correct pace.
Pacemakers may be used:
- To correct abnormal heart rhythms. The heart may beat too slowly, too fast, or in an irregular manner.
- To better coordinate the beating of the heart in people with heart failure. These are called biventricular pacemakers.
When your heart is weakened, gets too large, and does not pump blood very well, you are at high risk for abnormal heartbeats that can lead to sudden cardiac death.
- An implantable cardioverter-defibrillator (ICD) is a device that detects heart rhythms. It quickly sends an electrical shock to the heart to change the rhythm back to normal.
- Most biventricular pacemakers can also work as implantable cardio-defibrillators (ICD).
Procedures and Surgery to Improve Blood Supply to the Heart
The most common cause of heart failure is coronary artery disease (CAD), which is a narrowing of the small blood vessels that supply blood and oxygen to the heart. CAD may become worse and make it harder to manage your symptoms.
After performing certain tests, your health care provider may feel that opening a narrowed or blocked blood vessel will improve your heart failure symptoms. Suggested procedures may include:
Heart Valve Surgery
Blood that flows between the chambers of your heart, or out of your heart into the aorta, must pass through a heart valve. These valves open enough to allow blood to flow through. They then close, keeping blood from flowing backward.
When these valves do not work well (become too leaky or too narrow), blood does not flow correctly through the heart to the body. This problem may cause heart failure or make heart failure worse.
Heart valve surgery may be needed to repair or replace one of the valves.
Surgery for End-stage Heart Failure
Some types of surgery are done for severe heart failure when other treatments no longer work. These procedures are often used when a person is waiting for a heart transplant. They are also sometimes used long term in cases when transplant is not planned or possible.
Examples of some of these devices include left ventricular assist device (LVAD), right ventricular assist devices (RVAD) or a total artificial hearts. They are considered for use if you have severe heart failure that cannot be controlled with medicine or a special pacemaker.
- Ventricular assist devices (VAD) help your heart pump blood from the pumping chambers of your heart to either the lungs or to the rest of your body These pumps may be implanted in your body or connected to a pump outside your body.
- You may be on a waiting list for a heart transplant. Some people who get a VAD are very ill and may already be on a heart-lung bypass machine.
- Total artificial hearts are being developed, but are not yet in wide use.
Devices inserted through a catheter such as intra-aortic balloon pumps (IABP) are sometimes used.
- An IABP is a thin balloon that is inserted into an artery (most often in the leg) and threaded into the main artery exiting the heart (aorta).
- These devices can help maintain heart function in the short term. Because they can be placed quickly, they are useful for people who have a sudden and severe decline in heart function
- They are used in people who are waiting for recovery or for more advanced assist devices.
References
Aaronson KD, Pagani FD. Mechanical circulatory support. In: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Philadelphia, PA: Elsevier; 2019:chap 29.
Allen LA, Stevenson LW. Management of patients with cardiovascular disease approaching end of life. In: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Philadelphia, PA: Elsevier; 2019:chap 31.
Ewald GA, Milano CA, Rogers JG. Circulatory assist devices in heart failure. In: Felker GM, Mann DL, eds. Heart Failure: A Companion to Braunwald's Heart Disease. 4th ed. Philadelphia, PA: Elsevier, 2020:chap 45.
Mann DL. Management of heart failure patients with reduced ejection fraction. In: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Philadelphia, PA: Elsevier; 2019:chap 25.
Otto CM, Bonow RO. Approach to the patient with valvular heart disease. In: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Philadelphia, PA: Elsevier; 2019:chap 67.
Rihal CS, Naidu SS, Givertz MM, et al; Society for Cardiovascular Angiography and Interventions (SCAI); Heart Failure Society of America (HFSA); Society of Thoracic Surgeons (STS); American Heart Association (AHA), and American College of Cardiology (ACC). 2015 SCAI/ACC/HFSA/STS clinical expert consensus statement on the use of percutaneous mechanical circulatory support devices in cardiovascular care (endorsed by the American Heart Association, the Cardiological Society of India, and Sociedad Latino Americana de Cardiología Intervencionista; affirmation of value by the Canadian Association of Interventional Cardiology-Association Canadienne de Cardiologie d'intervention). J Am Coll Cardiol. 2015;65(19):e7-26. PMID: 25861963 pubmed.ncbi.nlm.nih.gov/25861963/.
Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation. 2013;128(16):e240-e327. PMID: 23741058 pubmed.ncbi.nlm.nih.gov/23741058/.
Review Date: 5/8/2021
Reviewed By: Michael A. Chen, MD, PhD, Associate Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
