Heart Failure Surgery
What is Heart Failure?
Heart failure, also called congestive heart failure or CHF, is diagnosed when your heart is unable to pump blood well enough to meet your body’s needs.
Heart failure may result from coronary artery disease (narrowed arteries in your heart) or high blood pressure (hypertension). Over time, these conditions cause the heart muscle to deteriorate, limiting the organ’s ability to fill and pump blood effectively.
Patients who have heart failure will hear their cardiologist use the term “ejection fraction.” This is a measure of how well your heart is pumping. Ejection fraction compares the amount of blood contained in the heart to the amount pumped out in each beat. In a normal heart, the percentage may be between 50 and 70.
An ejection fraction of between 41 and 49 percent is considered “borderline” and a measurement of less than 35 percent may indicate heart failure.
Physicians use the ejection fraction measurement to classify the severity of a patient’s condition and guide his or her heart failure treatment.
Ejection fraction can be measured using:
- An echocardiogram
- A magnetic resonance imaging (MRI) scan of the heart
- A nuclear medicine scan (also called a nuclear stress test)
When is Heart Failure Surgery Advisable?
Heart failure surgery may be appropriate for select patients, especially those who have an ejection fraction of less than 25 percent. The types of surgery that can be helpful for patients with heart failure include coronary artery bypass, left ventricular assist device implantation, valve repair procedures, and minimally invasive procedures such as transcatheter aortic valve replacement (TAVR) and transcatheter mitral valve repair (TMVR). These procedures offer an alternative to heart transplant surgery for some patients. Results often are good, and many patients have been able to avoid heart transplantation for many years.
Heart Transplant Surgery
If heart failure is severe and no longer responds sufficiently to other treatments, a heart transplant may be necessary. Before a patient is put on a list for a heart transplant, the program team and transplant surgeon will determine whether the patient is healthy enough for transplant surgery and will assess and confirm the need for a transplant. The suitability of a donor heart for a patient on the waiting list is based on his or her body size and blood type.
Circulatory support devices, such as the Impella heart pump, the CentriMag blood pump, and extracorporeal membrane oxygenation (ECMO), provide short-term mechanical support of the heart, as needed.
ECMO is used:
- For patients recovering from heart failure, lung failure, or heart surgery.
- As a bridge to further treatment, when doctors want to assess functioning of other organs such as the kidneys or brain before performing heart or lung surgery.
- For support during high-risk procedures in the cardiac catheterization lab.
- As a bridge to a heart-assist device, such as left ventricular assist device (LVAD).
- As support for patients awaiting lung transplant. The ECMO helps keep tissues well oxygenated, which makes the patient a better candidate for transplant.