Implantable cardioverter defibrillator (ICD)
Some people who have severe heart failure or serious arrhythmias (irregular heartbeats) might need implantable cardioverter defibrillators, or ICDs. These devices are surgically placed and detect life-threatening arrhythmias. When they do, they deliver a shock to the heart to reset its rhythm so it can resume normally. Some newer pacemakers can also work as ICDs.
ICDs have saved millions of lives but are only advisable in certain circumstances. The physician and patient share the decision to use an ICD.
Learn more about implantable devices.
Cardiac Resynchronization Therapy (CRT)
Some people with heart failure develop abnormal heart beats, called arrhythmias. This can reduce how well the heart’s lower chambers (ventricles) can function. Cardiac resynchronization therapy, also known as biventricular pacing, may be needed. In this procedure, a special pacemaker makes the ventricles contract at the same time. This helps the lower heart chambers pump and relax together.
This therapy can improve heart function, reduce hospitalization risk and increase survival.
Learn more about cardiac resynchronization therapy.
Left ventricular assist device (LVAD)
The left ventricle is the large, muscular chamber of the heart that pumps blood out to the body. An LVAD is a mechanical pump-type device. Some people use this device permanently, but it’s most often considered a bridge to transplant, or a short-term fix if surgery or a heart transplant is needed.
Learn more about LVADs.
Surgical procedures for heart failure
Surgery isn’t frequently used to treat heart failure. But your health care team might recommend it when they identify a correctable problem that’s causing heart failure, such as a defect, including a heart valve or a blocked coronary artery.
Surgery may also be needed if heart failure is so severe that it can’t be helped with medications and lifestyle changes.
Some people have severe, progressive heart failure that can’t be helped by medications, other devices and procedures, or eating and lifestyle changes. In such cases, a heart transplant could be the only effective treatment option.
Surgeons replace the damaged heart with a healthy one from a donor who has identified themselves as an organ donor while alive and been declared brain dead. It can take several months to find a donor heart that closely matches the tissues of the person receiving the transplant. But this matching process is essential to reduce the chances of rejection.
During a transplant procedure, the surgeon connects the patient to a heart-lung machine, which takes over the functions of the heart and lungs. The surgeon then removes the diseased heart and replaces it with the donor heart. Finally, the major blood vessels are reconnected, and the new heart is ready to work.
The outlook for people with heart transplants is good after the transplant. In fact, about 90% of patients live for more than a year after their operations and on average, survival is greater than 12 years. However, the number of patients who receive heart transplants is still relatively low, around 3,500 each year.
Read more about heart transplants.
Percutaneous coronary intervention (PCI, also referred to as angioplasty)
Heart failure can develop when blockages in the coronary arteries restrict the blood supply to the heart muscle. Removing these blockages can improve overall heart function, which can improve or resolve heart failure symptoms. PCI, often called angioplasty, is one procedure to reopen blocked blood vessels.
The procedure is usually performed in the cardiac catheterization lab. A small tube (catheter) with a tiny, deflated balloon on the end is inserted through an incision in the groin (or other area where the artery can be accessed) and pushed through to the diseased artery. Then the balloon is inflated to push open the artery. The balloon is removed once the artery has been fully opened.
A stent can be placed during the procedure to keep the blood vessel open.
Although there’s a slight risk of damage to the artery during PCI, this procedure usually improves the patient’s condition.
Coronary artery bypass
Coronary artery bypass surgery reroutes the blood supply around a blocked section of the artery.
During this procedure, surgeons remove healthy blood vessels from another part of the body, such as a leg, wrist or the chest wall. They then surgically attach the vessels to the diseased artery so that the blood can flow around the blocked section.
After a bypass operation, it’s especially important to reduce the amount of fat and cholesterol you eat because these substances cause the arteries to clog. Health care professionals also recommend increasing physical activity to strengthen the heart muscles.
Heart valves regulate the flow of blood inside the heart. When the valves don’t work properly, this puts extra strain on the heart and can lead to heart failure.
For some valve problems, medical management is the first step in treatment. Correcting the problem surgically often improves or resolves the condition as well.
During valve repair, the damaged sections of the valve are strengthened. During valve replacement, the failing valve is removed, and a new valve is used in its place. A variety of different replacement valves can be used, including a mechanical valve made from metal and plastic, or one made from human or animal tissue. During the surgery, the patient is connected to a heart-lung machine that supplies blood to the brain and body.
After the operation and depending on the type of replacement heart valve used, patients can take medicines to prevent blood clots from forming around the new heart valve. This treatment is often long-term to ensure the new valve works properly. Most heart valve surgeries are a success, but the operation is only considered as an option when a defective or diseased valve threatens someone’s life.
In some patients, heart valve replacement can occur without surgery. TAVR is a minimally invasive procedure where a new valve is inserted without removing the old, damaged valve. But candidacy for this kind of procedure is highly individualized.
Read more about heart valve surgery.