Surgical Procedures and Medical Devices for Congestive Heart Failure (CHF)
In certain cases, surgery may be needed to correct or improve the underlying causes of CHF. The following surgical procedures or medical devices may be used:
Heart Valve Replacement
Heart valves regulate the flow of blood inside the heart. If the valves are damaged or defective, heart valve surgery may be recommended.
Description of the Procedure —The surgeon cuts through the skin and breastbone, opens the chest, and connects a heart-lung machine. This machine takes over the functions of the heart and lungs during the operation.
The surgeon stops the heart, makes an incision, and removes the damaged valve. The new valve is stitched into place and checked to make sure it opens and closes properly. The incision in the heart is closed and the heart is restarted. The heart-lung machine is disconnected, the breastbone wired together, and the chest closed.
The surgical site in your breastbone heals in 4-6 weeks. Once recovery from the surgery is complete, you should be able to return to your normal activities. Depending on the type of valve you receive, you may need to take anticoagulant medication for the rest of your life. You will need to take antibiotics before some dental and surgical procedures to decrease the risk of infection.
In recent years, percutaneous valve replacement techniques have been introduced. Minimally invasive valve replacement surgeries can be done utilizing different approaches than sternotomy. Those techniques are not yet widely utilized, and more research is needed to determine their role.
Coronary Artery Bypass
If ]]>coronary artery disease]]> is the cause of congestive heart failure, a coronary artery bypass may be used to reroute the blood supply around a blocked section of the artery.
Description of the Procedure —The surgeon cuts through the skin and breastbone, opens the chest, and connects the heart-lung machine. This machine takes over the functions of the heart and lungs during the operation.
To harvest a blood vessel to graft into the heart, the surgeon may detach an artery from the chest wall, or make one or several incisions in the leg and remove a section of vein from the leg. Sometimes two surgeons work together, one on the chest and one on the leg to remove a vessel for grafting. The harvested vessels are connected (grafted) to the blocked arteries above and below existing obstructions. After the grafts are in place, the heart is restarted. The heart-lung machine is disconnected, the breastbone wired together, and the chest closed.
Most patients can return to office-type work in 4-6 weeks. Bypass surgery restores blood flow through the heart but does not cure heart disease; the grafted blood vessels can also become clogged. Therefore, you will be encouraged to make lifestyle changes to maintain your cardiovascular health.
Many medical centers are evaluating a less invasive approach to coronary artery bypass grafting, called minimally invasive coronary artery surgery. The purpose of this surgery is the same, to bypass the clogged arteries, but the technique and indications are different. Patients who have only one or two clogged arteries may be candidates for this approach.
In this technique, a small incision is made in the chest, over the site of the clogged artery. The surgeon usually uses an artery from inside the chest wall to bypass the obstruction. The key difference in this technique is that the surgeon operates while the heart is beating, thus avoiding the use of the heart-lung machine. This type of surgery is promising, but the benefits and risks of the less invasive versus traditional approach need to be weighed against each individual's medical condition. Talk to your doctor about what is best for you.
When a heart is damaged to the point that no other therapies work and a patient is at risk of dying, a heart transplant may be considered. This is reserved for the most severe cases of congestive heart failure. There are number of conditions that may limit a patient’s ability to receive a heart transplant.
Description of the Procedure —The surgeon cuts through the skin and breastbone, opens the chest, and connects a heart-lung machine. This machine takes over the functions of the heart and lungs during the operation. Doctors remove the diseased heart and sew the new donor heart in place. Next, the blood vessels are connected. The new heart may begin beating on its own or doctors may administer an electrical shock to get it started. Once doctors are sure no leaks exist, the heart-lung machine is disconnected, and the surgeon wires the breastbone together and closes the chest.
The surgical site in your breastbone heals in 4-6 weeks. More than 85% of heart-transplant patients live for at least one year following the surgery. The three year survival is about 75%. The prognosis depends largely on combination of donor and recipient health factors. Patients after a heart transplant need to have close medical follow-up. They are at increased risk for a number of different medical conditions, including rejection of the transplant, infections, and malignancies. Most patients, however, return to normal activities, including work and exercise. A specific rehabilitation program may be suggested to speed recovery and restore cardiovascular health.
Biventricular Cardiac Pacemaker
People with CHF who also have arrhythmias (heart beats too slow, too fast, or irregularly) may benefit from pacemakers. Controlling the rhythm of the heart in a more normal fashion can help the heart pump more efficiently. Patients with dilated cardiomyopathies, unresponsive to medical therapy, may benefit from a biventricular cardiac pacemaker. This type of pacemaker sends carefully timed electrical impulses to the heart’s lower chambers. The pacemaker is implanted in the chest and connected to the heart.
Left-Ventricular Assist Device (LVAD)
This is a mechanical pump that can be implanted in your chest. It temporarily assists the heart's pumping. This device is sometimes referred to as a " bridge to transplant" since it can be used to maintain people awaiting heart transplants.
This is a device that can be implanted in your chest. Patients with heart failure are more prone to certain heart arrhythmias that put them at risk for sudden cardiac death. ICDs are implanted in those patients to prevent such arrhythmias from occurring.
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Last reviewed June 2008 by ]]>Michael J. Fucci, DO]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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