Surgical Treatment for Heart Failure: Understanding Your Options

Learn the next step in heart failure treatment when medications and lifestyle changes aren’t enough.

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The term “heart failure” is a bit misleading. It doesn’t mean your heart has stopped working, per se. “It’s a misnomer,” says Satjit Bhusri, MD, a cardiologist at Lenox Hill Hospital in New York City. “Heart failure is treatable.” In fact, more than 6 million Americans are living with heart failure.

Heart failure occurs when the heart muscle has become weak and can’t pump blood well enough to meet the body’s needs. Basically, it can’t keep up with its workload. Here’s more about what happens to your heart during heart failure.

After you’re diagnosed with heart failure, your doctor will likely suggest a heart failure treatment regimen, which may include a series of lifestyle changes, heart failure medications, or, depending on the severity, devices or surgery.

“After you’ve been on a series of medications, [we’ll check] to see if the pumping of the heart improved,” says Rachel Bond, MD, a cardiologist at Lenox Hill Hospital. If the heart muscle still remains weak, your doctor may then suggest surgical treatment options, she says.

 

How Doctors Treat Heart Failure with Surgery or Procedures

“The first and foremost thing we have to always do is make sure that the heart failure is not due to coronary artery disease or a heart attack, because we’d want to open the arteries so that the muscle can get blood and can get stronger,” says Dr. Bhusri.

Stents

To open the arteries up, doctors may suggest putting in a stent. A stent is a small mesh tube that’s placed in the artery to improve blood flow and help prevent the arteries from bursting.

Defibrillator

If the heart muscle is still weak after lifestyle modifications and medications, it puts your heart at risk for an arrhythmia (abnormal heart rhythm), which can be life-threatening. In this case, doctors may then recommend a device such as an implantable defibrillator. “What [the defibrillator] does is, if your heart were to go into an abnormal rhythm, it would ultimately shock you out of it and ultimately save your life,” says Dr. Bond.

Left Ventricular Assist Device (LVAD)

Sometimes, despite doctors’ best efforts to treat heart failure with medication, lifestyle changes, and device therapy (like defibrillators), patients are still hospitalized for their heart failure. “Patients find that their heart failure is really limiting their quality of life,” says Michelle Weisfelner Bloom, MD, a cardiologist at Stony Brook University Medical Center. “In those situations we tend to escalate care. For example, we start to evaluate patients for more aggressive therapies like a left ventricular assist device (LVAD), or in certain situations a heart transplant.”

An LVAD is a special type of machine, a heart pump, that is implanted into the heart in an open heart surgery, to help the heart pump blood to the rest of the body, says Dr. Bloom. LVAD therapy is characterized as either bridge to transplant or destination therapy.

Bridge to transplant: These patients will receive an LVAD, but there will be a plan in place to offer those patients a heart transplant when a heart becomes available after they wait on the waiting list, says Dr. Bloom.

Destination therapy: These patients will receive an LVAD with the intention of living with it for the rest of their lives.

The success of heart failure treatment greatly depends on your commitment to managing the condition by following your doctor’s recommendations and making the necessary changes in diet, exercise, and lifestyle to give you the highest possible quality of life.