The goal of surgery to treat heart failure is to stop further damage and
improve how well the heart works. Cleveland Clinic’s surgeons use several types
of surgical treatments to treat patients with heart failure. The surgeons will
consider your medical history, condition and other factors when choosing the
best treatment option for you. The procedures include coronary artery bypass
graft (CABG) surgery, valve surgery, aneurysm repair, left ventricular assist
device (LVAD) surgery and heart transplant.
Coronary Artery Bypass Graft (CABG) Surgery
If your coronary arteries (arteries that supply blood to the heart) become
blocked or lined with plaque causing less-than-normal blood flow through them,
the heart muscle can’t get the right amount of oxygen-rich blood to work
properly. Your heart cannot pump normally, and this can lead to heart failure.
Coronary artery bypass graft (CABG) surgery involves the use of a blood
vessel graft to bypass one or more blocked coronary arteries. The bypass
restores normal blood flow to the heart muscle. The graft goes around the
clogged artery/arteries and forms new pathways for oxygen-rich blood to flow to
the heart muscle. The blood vessel grafts usually come from your own arteries
and veins in the chest, leg or arm.
Your doctor will determine if your heart failure is caused by coronary artery
disease and if CABG surgery is right for you. Although patients with heart
failure have an increased surgical risk during CABG surgery, new strategies
before, during and after surgery have decreased the risks and improved outcomes.
Valve Surgery
As heart failure gets worse, changes in the left ventricle (lower chamber of
the heart) cause the papillary muscles to stretch out of shape. The papillary
muscles support mitral valve leaflet function to keep blood flowing in only one
direction. When the papillary muscles get weak, they can’t properly support the
mitral valve leaflets, and the valve starts to leak. Mitral valve repair usually
involves reshaping the leaflets and supporting the mitral valve with a ring.
Mitral valve repair surgery preserves the natural anatomy of the heart,
improves the heart’s ability to work properly, decreases heart failure symptoms
and complications, and may improve survival.
Heart failure can be caused by aortic valve stenosis (stiffness). If the
valve cannot open fully, less blood is pumped from the left ventricle to the
body, which results in less oxygen-rich blood being pumped to the organs and muscles.