Patient education: Choosing surgical treatment for heart failure (The Basics)

What is heart failure? — 

Heart failure is a condition in which the heart does not pump well. This means the heart cannot move blood throughout the body as well as usual. As a result, fluid backs up in the body, and the organs do not get as much blood as they need. This can lead to symptoms, such as swelling, trouble breathing, and feeling tired.

Heart failure is a long-term problem and, for most people, gets worse over time. Your doctor will work hard to treat your heart failure and to keep you as healthy as possible.

What are the treatment choices for heart failure? — 

There are many treatments. Heart failure can sometimes be treated with medicines. For more serious cases, a procedure or surgery might be needed to:

●Place a device to help the heart pump with more force or beat at the right rhythm

●Treat coronary heart disease and improve blood flow to the heart

●Repair or replace the heart valves

●Replace the heart

Surgery is only an option for people with who have severe symptoms even after treatment with medicines.

Your treatment options depend on the cause of your heart failure as well as your symptoms. For example, you might have:

●"Arrhythmia" – This is an abnormal heart rhythm. It can cause heart failure, or it can be a symptom of heart failure. An arrhythmia might be treated with a procedure such as:

•An implantable cardioverter-defibrillator, or "ICD" – This device shocks the heart if it detects an abnormal rhythm (figure 1).

•Cardiac resynchronization therapy, or "CRT" – This uses a special device called a "biventricular pacemaker," also called a BiV pacemaker or BiV pacer (figure 2). It sends electrical signals to the heart to make the walls of the left ventricle pump at the same time.

●Coronary heart disease – This is when the arteries that supply blood to the heart get clogged with fatty deposits. It is also called "coronary artery disease." It might be treated with:

•Cardiac catheterization and stenting – This is a procedure to unblock the coronary arteries. Doctors use a thin, plastic tube called a "catheter" to open narrowed arteries in the heart (figure 3). They can also use a tiny metal tube called a "stent" to hold the artery open.

•Coronary artery bypass graft surgery, or "CABG" (pronounced "cabbage") – Doctors use healthy pieces of blood vessels from other parts of the body (called "grafts") to re-route blood around the blockages (figure 4).

●Heart valve problems – Normally, the valves keep blood flowing through the heart in the right direction (figure 5). There is more strain on the heart if the valves do not work properly. Valve problems might be treated with:

•Heart valve repair – In some cases, the doctor can do a procedure to reshape the valve. This can help prevent or reduce the backward flow of blood.

•Heart valve replacement – In other cases, the valve is too damaged and needs to be replaced.

If you have very severe heart failure that has not improved with other treatments, you might need open heart surgery for:

●A ventricular assist device, or "VAD" – This helps the heart by pumping blood throughout the body. A VAD might be used instead of a heart transplant or while you wait for a heart transplant.

●Heart transplant – The weak heart is removed and replaced with a heart from a healthy donor.

Is surgery always an option? — 

No. Surgery is not an option for some people. For example, a person with an infection or cancer might not benefit from a heart transplant. Your age, other conditions, and overall health will determine if you can get surgery to treat your heart failure.

Should I get surgery? — 

Tell your doctor how you feel about the different treatment options. If there is something specific that worries you, tell them about that, too. Listen to what your doctor says about their experiences with people who had similar situations. Together, you can decide which treatment option is right for you. When you choose your treatment, you can learn more details about that option.

More on this topic

Patient education: Heart failure (The Basics)
Patient education: Heart failure with preserved ejection fraction (The Basics)
Patient education: Heart failure with reduced ejection fraction (The Basics)
Patient education: Medicines for heart failure with reduced ejection fraction (The Basics)
Patient education: Overview of heart arrhythmias (The Basics)
Patient education: Implantable cardioverter-defibrillators (The Basics)
Patient education: Cardiac resynchronization therapy (The Basics)
Patient education: Coronary artery disease (The Basics)
Patient education: Cardiac catheterization (The Basics)
Patient education: Stenting for the heart (The Basics)
Patient education: Coronary artery bypass graft surgery (The Basics)
Patient education: Tricuspid regurgitation (The Basics)
Patient education: Mitral stenosis in adults (The Basics)
Patient education: Heart transplant (The Basics)

Patient education: Heart failure (Beyond the Basics)
Patient education: Implantable cardioverter-defibrillators (Beyond the Basics)
Patient education: Stenting for the heart (Beyond the Basics)
Patient education: Coronary artery bypass graft surgery (Beyond the Basics)
Patient education: Mitral regurgitation (Beyond the Basics)
Patient education: Heart transplantation (Beyond the Basics)