Surgical Options For Heart Failure: When Is It Necessary?

Heart failure is a serious medical condition and a common cause of hospitalisation in India. Around 8-12 million Indians suffer from heart failure annually. Heart failure doesn’t mean that the heart has stopped functioning. Also referred to as congestive heart failure (CHF), heart failure occurs when the heart is unable to pump sufficient blood to meet the body’s requirements. Heart failure can impact the right and/or left side of the heart and can be either acute or chronic. Timelyheart failure treatmentimproves long-term recovery reduces complications and reduces no. of hospitalisation and burden over the health infrastructure. In this article, we will explore heart failure treatment options, including surgical treatment for heart failure.

Importance Of Understanding Surgical Options For Heart Failure

Medications and lifestyle changes may help to treat the early stages of heart failure by alleviating symptoms, improving the ability of the heart to pump blood, and preventing the condition from worsening. The surgically treatable cause of heart failure should be addressed first with the simultaneously introduction of medical therapy to aid in recovery. The goals of surgical treatment for heart failure include improving heart function, addressing the underlying causes and offering life-saving treatment in the case of advanced heart failure.

Surgical Options For The Heart Failure Treatment

In some cases, heart failure treatment may include surgery to improve heart function. Some surgical treatments for heart failure include heart transplant, heart valve replacement surgery, angioplasty or percutaneous coronary intervention (PCI),coronary artery bypass, implantation of devices such as cardiac resynchronisation therapy (CRT),ventricular assist device (VAD)and implantable cardioverter-defibrillator (ICD) to assist heart function.

Mitral Valve Repair

The mitral valve sits between the left ventricle and the left atrium of the heart. Mitral valve disease, which includes issues like narrowing, leakage, or stiffness of the valve, can be addressed through surgical treatment. Mitral valve repair surgery is performed to treat the following conditions: Mitral Valve Regurgitation (Leaky Valve) When the valve flaps don't close completely, causing leakage of blood. Mitral stenosis Narrowed valve opening, hampering blood flow. Mitral valve prolapse Caused because of stretchy or floppy valve flaps.

What Surgical Techniques Are Used For Mitral Valve Repair?

Mitral Valve Repair Surgery is usually recommended for individuals with mitral valve disease. It can be done via open-heart surgery,minimally-invasive heart surgery, robot-assisted heart surgery, or catheter-based procedure. This surgery aims to prevent potential heart and lung damage and reduce the risk of future complications. During the mitral valve repair surgery, the surgeon may patch holes, remove excess tissue, reconnect valve leaflets, separate fused valve leaflets, or replace supporting cords. Some mitral valve repair techniques include:

• Annuloplasty:In this method, a partial or complete, flexible or rigid ring is placed around the rim of the valve.
• Triangular Or Quadrangular Resection:Used mainly to treat posterior leaflet prolapse, this procedure involves removing the damaged portion of the leaflet and suturing the remaining edges.
• Chordal Repair:Mainly used to repair anterior leaflet prolapse. During this surgery, the elongated or ruptured chords are replaced with healthy chords from another area or synthetic chords.

What Are The Advantages Of Mitral Valve Repair?

Advantages of mitral valve repair include:

• Increased long-term expectancy and survival rates
• Improved quality of life
• Improved overall heart function
• Reduced risk of complications like endocarditis and stroke
• Elimination of the long-term need for blood thinners

Left Ventricle ( Left Side Of Heart) Reduction Surgeries

It is a kind of surgery where the size/ volume of the heart is reduced i.e. the part of the heart which remains not working/dead which prevents the heart from functioning properly. The deceased segment of the heart is carefully removed and the left side of the heart is reduced to bring the heart within the functioning parameters ( Frank-sterling wow).

Challenges

• Such surgeries are not done everywhere and require a lot of expertise.
• Many patients who fall into these subsets of patients are often missed.

Ventricular Assist Devices (Vads)

What Are Vads And How Do They Work?

Ventricular assist devices improve heart function by providing vital support to individuals with weak or failing hearts. These implantable devices aid in pumping blood from the heart's lower chambers to the body, serving as both a temporary solution while patients await other treatments (like a heart transplant) and a long-term option for maintaining proper blood circulation.

Indications For Vad Implantation

Ventricular assist device implementation provides benefits to individuals with advanced heart failure, including:

• Supporting the gradual recovery of heart function
• Serving as temporary support during the waiting period for a heart transplant
• Providing permanent cardiac support for those who are not eligible for transplantation, improving longevity and quality of life

Different Types Of Vads And Their Functions

Types of ventricular assist devices and their functions include:

• Right Ventricular Assist Device (Rvad):Pumps oxygen-deficient blood from the right side of the heart to the lungs
• Left Ventricular Assist Device (Lvad):Helps the left side of the heart to deliver oxygen-rich blood to the body
• Biventricular Assist Device:Supports both chambers of the heart.
• Paediatric Vads:Compact devices with smaller pumps and cannulas designed for newborns to young adults

What Are The Advantages Of Vads?

Ventricular assist devices provide versatile support for the heart, offering both temporary and permanent solutions. By reducing the heart's workload, VADs improve symptoms like breathlessness and fatigue, leading to better organ function and increased energy levels. VADs can aid in heart recovery, allowing patients to regain their physical abilities and improve overall health and lifespan.

Heart Transplant

What Is Heart Transplantation?

Heart transplantation is a surgery that replaces a damaged or failing heart with a healthy heart from a deceased donor. It is a life-saving procedure for individuals whose cardiac conditions have not improved with other treatments. Heart transplant has high success rates, providing recipients with an extended lifespan, often spanning several decades.

Who Needs A Heart Transplant?

Heart transplantation is the definitive treatment for individuals with end-stage cardiac failure after all other options have been exhausted. End-stage heart failure, caused by various factors, leads to weakened or permanently damaged heart function. Heart transplants are suitable for both children and adults up to 70 years of age. Some conditions requiring a heart transplant include:

• Cardiomyopathy:Often caused by genetic diseases, infections, or idiopathic (unknown) causes, this condition damages the heart muscle.
• Coronary Heart Disease:Heart attacks can be caused due to blocks in the arteries of the heart, causing permanent heart damage.
• Congenital Heart Disease: Structural defects in the heart from birth can cause end-stage heart failure, requiring a heart transplant.

What Are The Advantages Of Heart Transplantation?

• A chance to live again where no alternative is a feasible option.
• A ray of hope amidst panelling doom.

What Are The Disadvantages Of Heart Transplantation?

There is none, getting a chance to live again but it has some challenges:

• Lack of awareness to donate which could have saved more than a life.
• Heart transplantation is a complex surgery that needs specialised expertise and facilities.
• Some patients may be too weak to withstand the procedure.
• The body may reject the donor heart, requiring lifelong immunosuppressive medication to prevent rejection which could also inform more to worsening infection or those infections with which normal people are immune.
• The donor's heart may not function properly, leading to complications or death after transplant.
• Poor compliance with patients to cellure to meals and healthy lifestyle.

When Are Surgical Options For Heart Failure Necessary?

Surgical treatment for heart failure becomes necessary in severe cases unresponsive to medications or lifestyle changes to alleviate the correctable/ treatable causes of heart failure. It ranges from minimally invasive to open-heart procedures, aiming to alleviate symptoms and improve quality of life. Surgeons may recommend it to optimise heart function, address underlying conditions and provide life-saving heart failure treatment when other methods are ineffective.

Assessment Of Severity And Progression Of Heart Failure

Assessing the severity and progression of heart failure is crucial for effective management. Stages of heart failure, ranging from class 1 to 4, guide treatment decisions based on symptoms. Regular monitoring through physical exams, lab tests, and imaging helps tailor heart failure treatment to optimise patient outcomes and address individual needs.

Determining The Need For Surgical Intervention

Heart failure treatment is usually based on medication, and surgical procedures are generally not required is a myth. A lot of treatable causes of heart failure goes undiagnosed or missed and eventually lead to frank heart failure. Typically, surgical interventions are recommended for specific cases such as blood supply or heart valve problems, provided that the heart is adequately strong. Procedures such as mitral valve repair surgery,Coronary Artery Bypass Grafting(CABG) and heart transplantation can contribute to improvement in case of heart failure.

Conclusion

Surgical treatment of heart failure is not considered or seen as a first life of defence yet it forms the important cornerstone in heart failure management. What’s needed is a role of a heart failure team with surgeons and cardiologists working together for the HEART. Deciding the adequate line of management where if surgically treatable heart failure is present it should be addressed within time preferably after initial stabilisation. One can not ignore the importance of surgical team in keeping the HEART healthy. Yes, a failing heart can be given a chance to enjoy the miracle of life by a joint effort.

Frequently Asked Questions

1) Are There Any Lifestyle Changes Or Modifications That Need To Be Made After Heart Failure Surgery?

Yes. Some lifestyle changes that need to be made after heart failure surgery include eating healthy, exercising regularly, avoiding smoking, managing stress and maintaining a healthy weight.

2) How Successful Are Surgical Treatments For Heart Failure In Improving Patients' Outcomes?

While surgery cannot cure heart failure, it can help to reduce symptoms, enhance the quality of life and increase lifespan.

3) Are There Any Factors That Might Make A Patient Ineligible For Heart Failure Surgery?

The factors that may make an individual ineligible for heart failure surgery include advanced age, insufficient heart function, and severe comorbidities.

4) How Long Does The Surgical Procedure For Heart Failure Typically Take?

Heart failure surgery is a complex procedure and may take 6 hours or longer.

5) Are There Any Long-Term Considerations Or Follow-Up Appointments Required After Heart Failure Surgery?

Yes, long-term considerations such as lifestyle modifications are necessary to maintain good health. In addition, regular follow-ups are needed after a heart failure surgery to manage any potential complications and monitor the patient’s progress.