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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 doctor may feel that opening a narrowed or blocked blood vessel will improve your heart failure symptoms. Suggested procedures may include:

  • Angioplasty and stent placement
  • Heart bypass surgery

 

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, 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 patients 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 thru 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 patients 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 and Pagani FD. Mechanical circulatory support. In: Mann DL, Zipes DP, Libby P, et al. eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 29.

Goodlin SJ, Bonow RO. Care of patients with end-stage heart disease. In: Mann DL, Zipes DP, Libby P, et al. eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 31.

Mann DL. Management of heart failure patients with reduced ejection fraction. In: Mann DL, Zipes DP, Libby P, et al. eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 25.

Otto CM, Bonow RO. Valvular heart disease. In: Mann DL, Zipes DP, Libby P, et al. eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 63.

Peura JL, Colvin-Adams M, Francis GS, et al. Recommendations for the use of mechanical circulatory support: device strategies and patient selection: a scientific statement from the American Heart Association. Circulation. 2012;126:2648-2667. PMID: 23109468 www.ncbi.nlm.nih.gov/pubmed/23109468.

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:e240-e327. PMID: 23741058 www.ncbi.nlm.nih.gov/pubmed/23741058.

 
  • Coronary artery disease

    Coronary artery disease

    Animation

  •  

    Coronary artery disease - Animation

    The coronary arteries supply blood to the heart muscle itself. Damage to or blockage of a coronary artery can result in injury to the heart. Normally, blood flows through a coronary artery unimpeded. However, if the inner wall of a coronary artery becomes damaged, cholesterol plaque can build-up, progressively narrowing the available pathway through which blood can flow. Clotted blood attempting to traverse the blood vessel may find it tortuous and too narrow for passage, and the artery may become completely constricted or blocked-off. The blocked artery results in a lack of oxygen, or ischemia, to the part of the heart muscle that the artery supplies. The result is a heart attack.

  • Pacemaker

    Pacemaker - illustration

    A pacemaker is a small, battery-operated electronic device which is inserted under the skin to help the heart beat regularly and at an appropriate rate. The pacemaker has leads that travel through a large vein to the heart, where the wires are anchored. The leads send the electrical impulses to the heart to tell it to beat.

    Pacemaker

    illustration

  • Coronary artery disease

    Animation

  •  

    Coronary artery disease - Animation

    The coronary arteries supply blood to the heart muscle itself. Damage to or blockage of a coronary artery can result in injury to the heart. Normally, blood flows through a coronary artery unimpeded. However, if the inner wall of a coronary artery becomes damaged, cholesterol plaque can build-up, progressively narrowing the available pathway through which blood can flow. Clotted blood attempting to traverse the blood vessel may find it tortuous and too narrow for passage, and the artery may become completely constricted or blocked-off. The blocked artery results in a lack of oxygen, or ischemia, to the part of the heart muscle that the artery supplies. The result is a heart attack.

  • Pacemaker

    Pacemaker - illustration

    A pacemaker is a small, battery-operated electronic device which is inserted under the skin to help the heart beat regularly and at an appropriate rate. The pacemaker has leads that travel through a large vein to the heart, where the wires are anchored. The leads send the electrical impulses to the heart to tell it to beat.

    Pacemaker

    illustration

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        Review Date: 4/20/2015

        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, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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