Heart failure surgery

Overview

Heart failure, also referred to as congestive heart failure (CHF), occurs when the heart can’t pump sufficient blood to sustain the body’s tissues and organs. Initially, lifestyle modifications and medications are the primary treatments and can be highly effective. However, when these are not enough, surgery might be necessary. Surgical intervention aims to enhance heart function, alleviate symptoms, and potentially extend the patient’s lifespan, leading to an improved quality of life.

Types of heart failure surgery

There are various surgical options for treating heart failure, ranging from less invasive procedures to more extensive surgeries like heart transplants.

• Catheter ablation: This minimally invasive procedure treats abnormal heartbeats (arrhythmias) by using a thin tube called a catheter. It’s inserted into a blood vessel, guided to the heart, and delivers heat or cold to specific areas to correct irregular electrical impulses.
• Implanted devices for arrhythmias: If you have a history of dangerous heart rhythms, you may receive implanted devices like:
  • Implantable cardioverter defibrillator: Detects and corrects abnormal heart rhythms.
  • Permanent pacemaker: Maintains a steady heart rhythm by sending regular pulses to the heart.
• Coronary artery bypass graft (CABG) surgery: This procedure is for those with coronary artery disease, where plaque narrows or blocks blood vessels. Surgeons redirect blood flow around the blockage using a graft from another part of your body, either through open-heart or minimally invasive surgery.
• Coronary angioplasty and stent: To treat coronary artery disease, a catheter is used to:
  • Enter a blood vessel.
  • Navigate to the blocked artery.
  • Inflate a balloon to open the blockage.
  • Place a metal mesh tube (stent) to keep the artery open.
• Heart valve surgery: Heart valve disease can make the heart work harder. Surgery may involve valve repair or replacement, with some procedures performed through small incisions (minimally invasive) or larger chest incisions (open-heart).
• Left ventricular assist device (LVAD): For severe heart failure, an LVAD is implanted to assist the left ventricle in pumping blood. It connects to an external controller worn on your body and can be a long-term solution or a bridge to heart transplant.
• Heart transplant: In end-stage heart failure, a donor heart replaces your own. Strict criteria apply due to donor shortages, making it the last resort.

These surgeries aim to improve heart function, correct rhythm issues, or replace a failing heart, depending on the specific heart condition and its severity.

Reasons for undergoing the procedure.

Heart failure surgery may be advised by your healthcare provider to address the root causes of heart failure, enhance the performance of your heart, and provide a critical, life-saving option for advanced cases of heart failure that have not responded adequately to lifestyle adjustments and medication regimens.

Risks

Potential risks associated with the procedure encompass outcomes such as mortality, strokes, bleeding, and infections, with additional risks possibly varying based on your age and specific medical condition. Prior to surgery, your surgeon will comprehensively discuss these potential risks with you, and it’s essential to communicate any questions or apprehensions you may have regarding the procedure and its associated risks to your surgeon.

Before the procedure

Your healthcare provider will provide you with specific instructions for preparing for surgery, which may include:

• Dietary and fluid intake guidelines.
• Information on medications you should or should not take.
• Guidance on what clothing to wear.
• A list of items to bring with you to the hospital.

Upon your arrival at the hospital on the day of surgery, you will be asked to change into a hospital gown. A nurse will establish an intravenous (IV) line in your arm or hand to administer fluids and necessary medications. Additionally, the nurse may:

• Prepare the surgical area by shaving it if required.
• Cleanse and sterilize the surgical site.
• Cover you with a sterile surgical drape.

For most surgical procedures, you will receive medication to induce anesthesia and put you to sleep.

During the procedure

Heart surgery procedures are personalized to specific conditions, with some necessitating open surgery involving a sternum incision, while others employ minimally invasive techniques with smaller chest incisions. An emerging trend is the use of catheter-based approaches, wherein access to the heart is gained through a small groin incision. These catheter-based procedures typically offer quicker interventions, often lasting one to two hours.

After the procedure

Following surgery, your post-operative destination can be either the hospital’s intensive care unit (ICU) or a hospital room, contingent upon the surgical procedure and your health status. The duration of your hospital stay will be determined by these factors and can range from one night to several weeks. For certain individuals, a period of rehabilitation at a specialized facility may be necessary to restore their physical strength. Prior to discharge, your healthcare team will provide you with a comprehensive plan that outlines your future appointments and offers guidance on self-care.

Outcome

Heart failure can worsen over time, impacting your quality of life. Surgery can help improve symptoms and extend life, but your prognosis depends on factors like heart function, surgery success, and post-operative care. It’s a chronic condition, so stay in touch with your healthcare provider. Report worsening symptoms or new ones like fatigue, shortness of breath, or swelling. After surgery, follow your care plan and attend follow-up appointments, discussing any concerns or issues with your provider as you recover.