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Heart failure - surgeries and devices

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.

Pacemaker

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.

Coronary artery disease
Coronary artery disease

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:

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 .

You may need a left ventricular assist device (LVAD) 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 main pumping chamber of your heart 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.

Intra-aortic balloon pumps (IABP) help maintain heart function in people who are waiting for transplants. They can also help patients who have a sudden and severe decline in heart function. The IABP is a thin, implanted balloon. Most often, it is inserted into the artery in the leg and threaded into the artery leading from the heart (aorta).

References

Mann DL. Management of heart failure patients with reduced ejection fraction. In: Bonow RO, Mann DL, Zipes DP, Libby P, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 28.

Otto CM, Bonow RO. Valvular heart disease. In: Bonow RO, Mann DL, Zipes DP, Libby P, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 66.

Updated: 7/17/2013

Michael A. Chen, MD, PhD, Associate Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, Washington Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.


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