Congestive heart failure (CHF) is a chronic, progressive condition in which the heart muscle is unable to pump enough blood to meet the body’s needs for blood and oxygen. The key terms related to CHF are:
- Congestion – fluid buildup in the lungs and other parts of the body
- Heart failure – the heart can’t pump enough blood and oxygen to meet the body’s needs
- Chronic – ongoing, long-term condition
- Progressive – tends to get worse over time
In CHF, the weak heart muscle leads to blood and fluid backing up in the blood vessels and body tissues. This results in congestion and a range of symptoms including shortness of breath, fatigue, swelling in the legs and feet, and chest pain. There are two main types of CHF:
- Systolic heart failure – the heart can’t contract strongly enough to pump sufficient blood into circulation
- Diastolic heart failure – the heart muscle is stiff and doesn’t relax properly between beats, reducing the amount of blood that can enter the heart
CHF is a serious condition that requires ongoing medical care. However, there are treatment options available that can help relieve symptoms and improve quality of life. In some cases, surgery may be recommended as part of the treatment plan.
When is surgery considered for CHF?
The main goals of CHF treatment are to relieve symptoms, improve quality of life, prevent hospitalizations, and prolong survival. The initial treatments focus on lifestyle changes and medications, but surgery may be considered if medications and other therapies are not sufficiently effective. Reasons surgery may be recommended include:
- Severe heart damage – If medications cannot improve heart function because of extensive damage, surgery can help restore pumping ability.
- Coronary artery disease – Blocked arteries reducing blood flow to the heart can be treated with coronary bypass surgery.
- Valve problems – Leaky or narrow heart valves may require valve replacement or repair surgery.
- Ventricular restoration – Remodeling the enlarged, spherical ventricle to a more normal shape can improve pumping efficiency.
- Arrhythmias – Abnormal heart rhythms may be helped by an implanted pacemaker or defibrillator.
- Heart transplant – In end-stage heart failure, transplanting the diseased heart with a healthy donor heart may be an option.
In general, surgery is considered for CHF when medications and other standard treatments are not enough to control symptoms and prevent frequent hospitalizations. The goals are to improve heart function, allow the person to be more active, and improve long-term outcomes.
What types of surgery are used?
There are several surgical procedures that may be performed in people with CHF:
Coronary artery bypass grafting (CABG)
CABG or “bypass surgery” involves taking a healthy blood vessel from another part of the body and using it to route blood around blocked arteries in the heart. This can improve blood supply to heart muscle damaged by heart attacks or coronary artery disease. CABG is the most common heart surgery performed on CHF patients.
Heart valve surgery
Damaged or abnormal heart valves can be repaired or replaced through open-heart surgery. Valve problems that may require surgery include:
- Valve stenosis – Narrowing of the valve opening that restricts blood flow.
- Valve regurgitation – Leaky valve causing blood to flow backward.
- Valve prolapse – Valve bulges into upper heart chamber.
Valve surgery can help normalize blood flow and reduce strain on the heart.
Ventricular restoration
Also called ventricular remodeling, this procedure reshapes an enlarged, spherical left ventricle into a more normal oval shape. This can improve pumping efficiency and symptoms in people with CHF. It involves surgically removing a section of the heart muscle.
Implantable devices
CHF patients at risk of abnormal heart rhythms may have a small defibrillator (ICD) surgically implanted under the skin to monitor heart rate and deliver shocks if dangerous arrhythmias occur. A pacemaker device can also be implanted to coordinate electrical signaling between the upper and lower heart chambers.
Heart transplantation
This surgery removes the diseased heart and replaces it with a healthy donor heart. Transplant is generally reserved for end-stage heart failure when other treatments have failed. Survival after heart transplant has improved, but there are risks of organ rejection and infection.
What is the recovery like after CHF surgery?
Recovery time after CHF surgery varies considerably depending on the type of procedure performed. In general:
- CABG surgery – Hospital stay is typically 4-7 days, followed by 4-6 weeks recovery at home.
- Valve surgery – Hospitalization ranges from 5-14 days. May take 4-6 months for full recovery.
- Ventricular restoration – Hospital stay around 2-4 weeks. Several months of home recovery.
- Pacemaker/ICD implant – Typically 1-3 day hospital stay and limited activity for 4-6 weeks.
- Heart transplant – Hospital stay is 2-4 weeks. Will need lifelong anti-rejection medication.
During surgical recovery:
- Follow all post-op instructions carefully, including medication, diet and activity restrictions.
- Expect some pain, swelling and fluid drainage from surgical incisions.
- Participate in cardiac rehab to safely rebuild strength and stamina.
- Make significant lifestyle changes to support heart health.
- Attend all follow-up appointments to monitor recovery.
Recovery takes patience and commitment. With proper self-care and ongoing medical management, many CHF patients achieve greatly improved quality of life after surgery.
What are the risks and complications of CHF surgery?
As with any major surgery, CHF procedures involve some risks, such as:
- Excessive bleeding
- Infection of incision or heart valves
- Adverse reactions to anesthesia
- Blood clots
- Stroke
- Heart rhythm disturbances
- Renal failure
- Cognitive dysfunction
- Prolonged recovery period
- Death
Specific risks according to procedure include:
CABG surgery risks
- Graft closure or blood clot
- Heart attack
- Abnormal heart rhythms
- Chest wound infection
- Respiratory complications
Valve surgery risks
- Blood clots on replacement valves
- Leakage around replacement valves
- Infection in valve replacement patients
- Repeat valve surgery
Ventricular restoration risks
- Ventricular arrhythmias
- Bleeding
- Respiratory failure
- Post-operative delirium
The risks of each surgery will depend on the person’s overall health status and should be carefully reviewed with the medical team before proceeding.
Surgery results: survival rates and outlook
The benefits of CHF surgery in terms of survival rate and prognosis depend on many factors, including:
- Severity of heart failure symptoms
- Extent of heart damage
- Type of procedure
- Presence of other diseases
- Age and frailty
- Skill of the surgical team
Some general observations on surgical outcomes:
- CABG – About 90% survive at least 5 years. Reduces risk of death for certain patients.
- Valve surgery – 80-90% 5-year survival. Replacement valves last 10-20 years.
- Ventricular restoration – 60-70% 5-year survival. Helps moderate CHF cases.
- Heart transplant – Median survival 11 years. About 75% survive at least 5 years.
Younger age and less advanced CHF typically have better outcomes. Results are best when surgery is combined with medications, lifestyle changes, and ongoing care. Close follow-up is key to monitor for complications.
Conclusion
In summary, surgery can be a valuable treatment tool in certain CHF patients when optimal medical therapy is insufficient. Procedures like CABG, valve repair, ventricular restoration, arrhythmia devices, and heart transplant may help prolong and improve quality of life in selective cases. However, surgery has inherent risks, so the potential benefits and risks must be carefully weighed for each individual. For best results, surgery should be viewed as one component of a comprehensive CHF treatment plan. With the right surgical approach, eligible patients can achieve significant symptom relief and enhanced well-being.