Heart Failure: Surgical Treatment Options

Heart failure (also known as congestive heart failure) happens when the heart is unable to pump enough blood around the body to meet its needs. Usually, lifestyle changes and medication are prescribed as first line treatment. However, for some people, they aren’t effective, and surgery is needed.

Surgery can improve the function of the heart and help people with heart failure to live fuller and longer lives.

There are many different types of surgery for heart failure, ranging from catheter-based procedures through to open-heart surgery. Technological advances in heart failure surgery mean that today, there is a wide range of minimally invasive, life-saving surgical options for patients with heart failure.

The Heart Failure Program at Cleveland Clinic Abu Dhabi is at the forefront of cardiac medicine innovation and offers patients with heart failure the most advanced surgical treatment options available in the world.

When is heart failure surgery needed?

Your doctor may recommend surgery to treat heart failure if:

• Lifestyle modifications and medications haven’t been effective.
• The functioning of the heart needs to be improved.
• Underlying conditions have caused heart failure.

What types of heart failure surgery are available?

Catheter ablation

A minimally invasive procedure, catheter ablation is used to treat abnormal heartbeats (arrhythmias) which can be a cause and a symptom of heart failure. A thin tube (the catheter) is inserted into a blood vessel and guided to the heart. It delivers either heat or cold to destroy (ablate) the part of the heart tissue that is causing the abnormal electrical impulses.

Implanted devices

Arrhythmia or abnormal heart rhythms may be treated with implanted devices. The device’s wires are inserted into the heart via a vein and deliver a charge to the heart which regulates the heartbeat. The charge is controlled by a device which is implanted under the skin. An implantable cardioverter defibrillator is a device which can detect an abnormal heart rhythm and sends a charge to the heart to restore its normal rate. A permanent pacemaker is a device which continuously delivers charges to the heart to maintain a steady rhythm.

Coronary artery bypass graft surgery

Coronary artery bypass graft surgery is usually offered to people with coronary artery disease, a condition in which arteries to the heart have become lined with fatty deposits called plaque. If plaque builds up, the arteries narrow or become completely blocked, reducing blood flow and the amount of oxygen and nutrients which can reach the heart. This eventually weakens the heart muscle and its ability to pump blood. During surgery, which can be performed as an open surgery or in a minimally invasive way, the blood is rerouted and a blood vessel (graft) from another part of the body is attached above and below the affected vessel.

Coronary angioplasty and stent

Also used to treat coronary artery disease, this is a minimally invasive procedure in which blocked arteries are opened from the inside. A catheter is inserted into a blood vessel in the groin or wrist and moved to the affected vessel. A balloon is inflated which compresses the plaque and opens the blockage. The stent is put in place which holds the artery open.

Heart valve surgery

There are many types of heart valve surgery, which aim to repair or replace a heart valve in people with heart valve disease. This condition can cause the valves to stiffen and narrow, meaning the heart has to work harder to pump blood around the body, and can lead to heart failure.

Ventricular assist devices

Ventricular assist devices (VADs) are devices that help the heart to pump blood from the lower chambers to the body. It is a treatment given to people with heart failure whose heart can no longer meet their body’s demands. VADs are implanted devices that connect to an external controller, which is worn outside the body. Thanks to advancing technology, VADs are now smaller and more efficient than ever before. The new generation of devices are more durable and less prone to complications, making them more comfortable and safer for patients.

There are different types of VADs available:

• Left ventricular assist device VADs are usually placed in the left lower heart chamber (left ventricle) and are called a left ventricular assist device (LVAD). They are sometimes given while a patient waits for a heart transplant or may be used for longer term treatment for patients who are not suitable for a transplant.
• Biventricular Assist Devices Biventricular assist devices (BiVADs) are given when both heart ventricles are failing. They support both sides of the heart, helping it pump blood to the body more effectively.
• Fully Implantable VADs

Technology is emerging which is focusing on developing fully implantable VADs that don’t require external components, reducing the risk of infection and improving the quality of life for patients.

Heart transplant

Usually given to patients with end-stage heart failure, a heart transplant is surgery to replace a heart with a healthy one from a donor.

Surgery is usually a treatment option when all other options haven’t been effective and heart failure persists or continues to get worse. Your doctor will discuss the most suitable procedure with you in detail, helping you to decide what is right for you.

Heart failure (also known as congestive heart failure) happens when the heart is unable to pump enough blood around the body to meet its needs. Usually, lifestyle changes and medication are prescribed as first line treatment. However, for some people, they aren’t effective, and surgery is needed.

Surgery can improve the function of the heart and help people with heart failure to live fuller and longer lives.

There are many different types of surgery for heart failure, ranging from catheter-based procedures through to open-heart surgery. Technological advances in heart failure surgery mean that today, there is a wide range of minimally invasive, life-saving surgical options for patients with heart failure.

The Heart Failure Program at Cleveland Clinic Abu Dhabi is at the forefront of cardiac medicine innovation and offers patients with heart failure the most advanced surgical treatment options available in the world.