Surgery isn't frequently used to treat heart failure. However, it's recommended when the doctor can identify a correctable problem that's causing heart failure – such as a defect or a blocked coronary artery. Surgery also may be needed when the heart failure is so severe that it can't be helped with medications or dietary and lifestyle changes.

How to find a surgeon
You can find a skilled surgeon in several ways. In most cases, your treating physician will recommend one or more names. Research the recommended surgeons' backgrounds to find out whether heart or chest surgery is their specialty. Also call the surgeons' hospitals to ask how often the recommended surgeons have performed the particular operation. You can also call the state medical board to find out if the surgeons have ever faced disciplinary action. Make sure the recommended surgeon is on your health plan.

Schedule an in-person meeting so you can get a better sense of each surgeon's attitude. Is he or she frank and honest with you? Does her or she take the time to explain proposed procedures and follow-up so that you can understand them? Is he or she willing to answer your questions? 

What surgical and other medical procedures might be used?

• Valve replacement
• Percutaneous coronary intervention (PCI) (formerly referred to as angioplasty)
• Coronary artery bypass
• Defibrillator implantation
• Heart transplant
• Left ventricular assist device (LVAD)

Valve replacement
Heart failure is sometimes caused by a defective or diseased heart valve. Heart valves regulate the flow of blood inside the heart. When they don't work properly, this puts extra strain on the heart and can lead to heart failure. Correcting the problem surgically can often improve or resolve the condition.

A variety of different replacement valves can be used: a mechanical valve made from metal and plastic, 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. The bad valve is removed and replaced.

After the operation and depending on the type of replacement heart valve used, patients may 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.

Watch an animation of how heart valves work
Watch an animation about heart valve surgery

Back to procedures list

Percutaneous coronary intervention (PCI) (formerly 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 may improve or resolve heart failure symptoms. PCI is one type of procedure to reopen blocked vessels. The procedure is usually performed in the cardiac catherization lab. A small tube – a catheter – with a tiny deflated balloon on the end is inserted through an incision in the groin area 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 may be placed during the procedure to keep the blood vessel open. Although there's a slight risk of damage to the artery during this procedure, PCI usually improves the patient's condition.

Watch an animation about angioplasty

Back to procedures list

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 or the chest wall. They then surgically attach the vessels to the diseased artery in such a way that the blood can flow around the blocked section.

After a bypass operation, it's especially important for you to watch your diet and reduce the amount of fat and cholesterol you eat, since these substances cause the arteries to clog. Doctors also recommend following a routine of increased physical activity to strengthen the heart muscles.

See an illlustration of a coronary artery bypass

Back to procedures list

Defibrillator implantation
Some people who have severe heart failure or serious arrhythmias (irregular heartbeats) are candidates for implantable defibrillators. These devices are surgically placed and deliver pacing, or an electric countershock, to the heart when a life-threatening abnormal rhythm is detected.

Watch an animation about implantable defibrillators
Learn more about implantable devices  

Back to procedures list

Heart transplant
Some people have severe, progressive heart failure that can't be helped by medications and dietary and lifestyle changes. In such cases a heart transplant may be the only effective treatment option.

Surgeons replace the damaged heart with a healthy one taken from a donor who has 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 increases the likelihood that the recipient's body will accept the heart. In some cases surgeons will implant a left ventricular assist device to help the heart function during this waiting period. This mechanical pump helps the left ventricle (lower left chamber) to pump.

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 during the first few years after the transplant. In fact, over 85 percent of patients live for more than a year after their operations. However, the number of patients who receive heart transplants is still relatively low (around 2,200 each year).

Watch an animation about heart transplant

Back to procedures list

One typical type of LVAD will have a tube going into the left ventricle that pulls blood from the ventricle into a pump. The pump then sends blood into the aorta (the large blood vessel leaving the left ventricle). This effectively "bypasses" the weakened ventricle. The pump is placed in the upper part of the abdomen. Another tube attached to the pump is brought out of the wall of the abdomen to the outside of the body and attached to the control system for the pump. LVADs are typically used for weeks to months.

See an illustration of a left ventricular assist device

Back to procedures list

This content is reviewed regularly. Last updated 04/10/09.