Surgical Treatment for Congestive Heart Failure LaDale Simpson March 1, 2007.

Surgical Treatment Surgical Treatment for Congestive for Congestive Heart FailureHeart Failure

LaDale SimpsonLaDale Simpson

March 1, 2007March 1, 2007

StatisticsStatistics• Congestive Heart Failure is a common medical problem Congestive Heart Failure is a common medical problem

affecting over 5 million Americans annuallyaffecting over 5 million Americans annually• 1.5-2.0% of the U.S. population at any given time is 1.5-2.0% of the U.S. population at any given time is

inflicted with this diseaseinflicted with this disease• Over 500,000 cases are newly diagnosed annuallyOver 500,000 cases are newly diagnosed annually• Leading cause of hospitalization (80%) in patients over 65 Leading cause of hospitalization (80%) in patients over 65

years of ageyears of age• The impact of heart failure on society is massive, as The impact of heart failure on society is massive, as

approximately $40 billion annually is spent on inpatient approximately $40 billion annually is spent on inpatient and outpatient visits. and outpatient visits.

• An additional $500 million is estimated to be spent on An additional $500 million is estimated to be spent on medications each and every yearmedications each and every year

What is CHF?What is CHF?• Congestive heart failure arises when a person’s heart is Congestive heart failure arises when a person’s heart is

unable to keep up with its required workload.unable to keep up with its required workload.• The pumps in an affected heart are weakened, thus The pumps in an affected heart are weakened, thus

causing the blood to move throughout the circulatory causing the blood to move throughout the circulatory system at a reduced speed.system at a reduced speed.

• As a result, the heart is unable to pump much-needed As a result, the heart is unable to pump much-needed oxygen and nutrients to meet the body’s demand.oxygen and nutrients to meet the body’s demand.

What is CHF?What is CHF?• The chambers in the heart thus respond by stretching to The chambers in the heart thus respond by stretching to

hold more blood or by hardening and becoming thick. hold more blood or by hardening and becoming thick. • This allows the body, for a short time, to compensate for This allows the body, for a short time, to compensate for

the inadequacy of the valves, but with time the muscle the inadequacy of the valves, but with time the muscle walls of the heart begin to weaken as well. walls of the heart begin to weaken as well.

• In response, the kidneys often cause the body to retain In response, the kidneys often cause the body to retain fluid, particularly water and sodium.fluid, particularly water and sodium.

• This fluid can accumulate in the arms, legs, ankles, feet or This fluid can accumulate in the arms, legs, ankles, feet or lungs, causing congestion throughout the body. lungs, causing congestion throughout the body.

Risk FactorsRisk Factors• CHF is closely associated with many major risk factors CHF is closely associated with many major risk factors

including:including:– AgeAge– SmokingSmoking– History of alcohol abuseHistory of alcohol abuse– Metabolic syndromeMetabolic syndrome– Coronary artery diseaseCoronary artery disease– HypertensionHypertension– Valve diseaseValve disease– Diabetes mellitusDiabetes mellitus– ObesityObesity– Family history of heart failure Family history of heart failure

Types of CHFTypes of CHF• There are 2 main types of congestive heart failure: There are 2 main types of congestive heart failure: systolicsystolic

dysfunction and dysfunction and diastolicdiastolic dysfunction. dysfunction.• Systolic dysfunction occurs when the heart is unable to Systolic dysfunction occurs when the heart is unable to

empty completely with contraction, and therefore, empty completely with contraction, and therefore, inadequate amount of blood is sent out into circulation.inadequate amount of blood is sent out into circulation.

• Testing for systolic dysfunction is done by measuring the Testing for systolic dysfunction is done by measuring the ejection fraction.ejection fraction.

• A normal ejection fraction is more than 55% of the blood A normal ejection fraction is more than 55% of the blood volume.volume.

• An ejection fraction An ejection fraction ≤≤45% indicates systolic dysfunction45% indicates systolic dysfunction..• If your ejection fraction is normal then you assume the If your ejection fraction is normal then you assume the

patient has a diastolic dysfunction.patient has a diastolic dysfunction.• This occurs when the heart contracts normally, but the This occurs when the heart contracts normally, but the

ventricles do not relax properly or are too stiff to fill ventricles do not relax properly or are too stiff to fill completely.completely.

Stages of CHFStages of CHF• In 2001, the American Heart Association developed four stages In 2001, the American Heart Association developed four stages

(A-D) to classify patients suffering from congestive heart failure, (A-D) to classify patients suffering from congestive heart failure, which were later revised in 2005which were later revised in 2005..

• Stage A: patients that are high risk to develop CHF but have no Stage A: patients that are high risk to develop CHF but have no structural damage or symptoms pertaining to the diseasestructural damage or symptoms pertaining to the disease..

• Stage B: patients have some sort of structural damage to the Stage B: patients have some sort of structural damage to the heart, usually detected with an echocardiogram test, but are yet heart, usually detected with an echocardiogram test, but are yet to experience any symptomsto experience any symptoms

• Stage C: patients are those patients who have structural Stage C: patients are those patients who have structural damage and also have prior or current symptoms.damage and also have prior or current symptoms.

• Stage D: patients are patients who, even after receiving Stage D: patients are patients who, even after receiving optimum medical care, still have advanced symptoms. These optimum medical care, still have advanced symptoms. These are the patients that become candidates for surgical procedures are the patients that become candidates for surgical procedures and/or mechanical assist devices, and often require and/or mechanical assist devices, and often require hospitalization or hospice care.hospitalization or hospice care.

SurgerySurgery• Surgery is not often used to treat patients with congestive Surgery is not often used to treat patients with congestive

heart failure.heart failure.• However, it can be a logical method of treatment in cases However, it can be a logical method of treatment in cases

in which traditional treatments are not working for in which traditional treatments are not working for whatever reason. whatever reason.

• These such surgeries present a great risk, thus physicians These such surgeries present a great risk, thus physicians seek to identify patients who have the greatest to gain seek to identify patients who have the greatest to gain from surgical intervention.from surgical intervention.

Heart TransplantHeart Transplant• Perhaps the only current Perhaps the only current

treatment that is capable of fully treatment that is capable of fully reversing the congestive heart reversing the congestive heart failure is receiving a complete failure is receiving a complete heart transplant, in which heart transplant, in which surgeons replace the damaged surgeons replace the damaged heart with a healthy one taken heart with a healthy one taken from a donor who has been from a donor who has been pronounced brain dead.pronounced brain dead.

• Surgeons remove the healthy heart Surgeons remove the healthy heart from the donor, keep it in a cooled from the donor, keep it in a cooled environment, and then it is environment, and then it is transported to the medical facility transported to the medical facility in which the recipient is waiting in which the recipient is waiting for it. for it.

• The back walls of the atrias in the The back walls of the atrias in the recipient’s body are kept intact recipient’s body are kept intact and the atrias of the new heart are and the atrias of the new heart are sewn together at this point. sewn together at this point.

• Blood vessels are then Blood vessels are then reconnected.reconnected.

• Timing is everything, as a healthy Timing is everything, as a healthy heart can only exist out of the heart can only exist out of the human body for 4-6 hours.human body for 4-6 hours.

Heart TransplantHeart Transplant• There is a much greater number of patients who suffer from There is a much greater number of patients who suffer from

congestive heart failure and could potentially benefit from a congestive heart failure and could potentially benefit from a heart transplant than there are healthy donated hearts. heart transplant than there are healthy donated hearts.

• Due to this fact, there is a strictly screened heart transplant Due to this fact, there is a strictly screened heart transplant list. list.

• Possible patients are evaluated on many different levels Possible patients are evaluated on many different levels including age, medical history, diagnostic test results, social including age, medical history, diagnostic test results, social history and psychosocial evaluation. history and psychosocial evaluation.

• Only patients who are believed to be able to survive the Only patients who are believed to be able to survive the surgery and who will comply with years of disciplined living surgery and who will comply with years of disciplined living afterwards are considered for the list. afterwards are considered for the list.

• This list is prioritized according to the severity of illness, This list is prioritized according to the severity of illness, blood type and geographic location. blood type and geographic location.

• Once a patient is added to the donor list it is a long, Once a patient is added to the donor list it is a long, stressful wait before he or she might receive a healthy heart stressful wait before he or she might receive a healthy heart

Left Ventricular Assist Left Ventricular Assist DeviceDevice

• The left ventricular assist The left ventricular assist device (LVAD) serves as a device (LVAD) serves as a “bridge to transplantation” “bridge to transplantation” for patients in whom medical for patients in whom medical therapy has not worked and therapy has not worked and are waiting for a heart are waiting for a heart transplant, or as a destination transplant, or as a destination therapy for patients who are therapy for patients who are non-transplant candidates non-transplant candidates due to age or comorbidity due to age or comorbidity

• This device supplements the This device supplements the function of the left ventricle function of the left ventricle when its pumping ability is when its pumping ability is damaged damaged

• It is a portable, battery-It is a portable, battery-powered pump which is powered pump which is implanted in the abdominal implanted in the abdominal wall and is connected to the wall and is connected to the heart in two places. heart in two places.

Left Ventricular Assist Left Ventricular Assist DeviceDevice

• The pump pulls blood from the The pump pulls blood from the left ventricle and then sends it left ventricle and then sends it to the aorta, from which blood to the aorta, from which blood is pumped out into circulation. is pumped out into circulation.

• Thus, this allows blood to keep Thus, this allows blood to keep pumping through the heart at pumping through the heart at the rate in which the body the rate in which the body demands.demands.

• An additional tube extends An additional tube extends from the LVAD to the outside from the LVAD to the outside of the body and transports of the body and transports wires to a controller which the wires to a controller which the patient typically wears on a patient typically wears on a belt. belt.

• The batteries are normally The batteries are normally located on a shoulder holster located on a shoulder holster which also connects to the which also connects to the controller. controller.

Left Ventricular Assist Left Ventricular Assist DeviceDevice

• Left ventricular assist devices are typically worn for weeks Left ventricular assist devices are typically worn for weeks to months and serve to buy time for the patient, regardless to months and serve to buy time for the patient, regardless of whether he or she is a candidate for a heart transplant. of whether he or she is a candidate for a heart transplant.

• It allows the patient to return home and attempt to live a It allows the patient to return home and attempt to live a semi-normal life.semi-normal life.

Coronary Artery Bypass Coronary Artery Bypass GraftGraft

• The most common type of The most common type of surgical procedure surgical procedure performed on a patient performed on a patient suffering from congestive suffering from congestive heart failure is a coronary heart failure is a coronary artery bypass graft (CABG). artery bypass graft (CABG).

• During a bypass operation During a bypass operation an artery or vein is removed an artery or vein is removed from another healthy part of from another healthy part of the patient’s body, such as a the patient’s body, such as a leg, arm or the chest wall. leg, arm or the chest wall.

• This removed blood vessel This removed blood vessel is then surgically attached is then surgically attached in a way that it allows blood in a way that it allows blood to bypass, or go around, the to bypass, or go around, the affected portion of the pre-affected portion of the pre-existing blood vessel and existing blood vessel and thus becomes a graft.thus becomes a graft.

Coronary Artery Bypass Coronary Artery Bypass GraftGraft

• A coronary artery bypass traditionally calls for an open-A coronary artery bypass traditionally calls for an open-heart surgery and the use of a heart-lung bypass machine heart surgery and the use of a heart-lung bypass machine to circulate the blood while the patient is having the to circulate the blood while the patient is having the surgery. surgery.

• Minimally invasive procedures have been developed in Minimally invasive procedures have been developed in which multiple smaller openings, or “keyholes,” are made which multiple smaller openings, or “keyholes,” are made in the chest.in the chest.

• This procedure has many benefits:This procedure has many benefits:– less scarringless scarring– shorter hospital stayshorter hospital stay– faster recoveryfaster recovery– less bleeding during surgeryless bleeding during surgery– reduced chance of post-operative infectionreduced chance of post-operative infection– less pain afterwardsless pain afterwards

Coronary AngioplastyCoronary Angioplasty• Coronary angioplasty is a Coronary angioplasty is a

medical surgery that is used to medical surgery that is used to restore blood flow through a restore blood flow through a narrowed or blocked artery in narrowed or blocked artery in the heart.the heart.

• A narrow, hollow catheter with A narrow, hollow catheter with a balloon on the end is inserted a balloon on the end is inserted into a blood vessel in the arm into a blood vessel in the arm or upper thigh and is guided to or upper thigh and is guided to the diseased portion of the the diseased portion of the artery.artery.

• It is then inflated, which forces It is then inflated, which forces any plaque that is responsible any plaque that is responsible for the narrowing outward for the narrowing outward against the wall of the artery, against the wall of the artery, thus widening the artery and thus widening the artery and restoring the blood flow. restoring the blood flow.

• After the widening of the After the widening of the artery takes place, the balloon artery takes place, the balloon and catheter are removed.and catheter are removed.

Coronary AngioplastyCoronary Angioplasty• Since its development in 1977 the Since its development in 1977 the

stent has decreased the risk by stent has decreased the risk by 50% of an artery closing again 50% of an artery closing again after an angioplasty. after an angioplasty.

• Stents are tiny structures made Stents are tiny structures made of wire mesh that surgeons insert of wire mesh that surgeons insert to prop open arteries that have to prop open arteries that have been dangerously narrowed or been dangerously narrowed or clogged with fatty plaque. clogged with fatty plaque.

• The first stents were made with a The first stents were made with a bare metal but now most of them bare metal but now most of them are coated with medications that are coated with medications that aid the recovery of the artery aid the recovery of the artery from the surgery. from the surgery.

• The usage of plaque removers The usage of plaque removers and lasers have also provided and lasers have also provided beneficial tools to aid beneficial tools to aid angioplasty. angioplasty.

• Plaque removers are used to cut Plaque removers are used to cut away the plaque while lasers away the plaque while lasers dissolve plaque in the arteries dissolve plaque in the arteries while performing the angioplasty.while performing the angioplasty.

Electrical SignalingElectrical Signaling• The pumping of a normal, healthy heart is achieved from The pumping of a normal, healthy heart is achieved from

impulses sent through the organ by its very own electrical impulses sent through the organ by its very own electrical system. system.

• It is vital that this rhythm of squeezing blood through the heart It is vital that this rhythm of squeezing blood through the heart is done at a steady rate, for if not, the heart will ultimately lose is done at a steady rate, for if not, the heart will ultimately lose its functioning capability. its functioning capability.

• Some patients have an abnormality of this electrical system in Some patients have an abnormality of this electrical system in the heart:the heart:– bradycardiabradycardia– tachycardiatachycardia

• The majority of congestive heart failure patients suffer from an The majority of congestive heart failure patients suffer from an additional abnormality of this rhythm, in which the two additional abnormality of this rhythm, in which the two ventricles do not contract simultaneously.ventricles do not contract simultaneously.

• Treatment of all three of these conditions may be done Treatment of all three of these conditions may be done surgically, with implantation of some sort of electrical device. surgically, with implantation of some sort of electrical device.

Electrical SignalingElectrical Signaling• A pacemaker is a small device that aids a heart’s SA node. A pacemaker is a small device that aids a heart’s SA node. • This device detects heart rate of a patient. This device detects heart rate of a patient. • When the heart rate drops below a set rate (which is When the heart rate drops below a set rate (which is

determined by a physician) it send an electrical impulse determined by a physician) it send an electrical impulse that passes through the heart’s muscle, just as the SA node that passes through the heart’s muscle, just as the SA node does. does.

• Thus, the heart contracts and pumps as it is intended to, Thus, the heart contracts and pumps as it is intended to, correcting the bradycardia.correcting the bradycardia.

Electrical SignalingElectrical Signaling• A pacemaker is implanted just A pacemaker is implanted just

below the skin of the chest of below the skin of the chest of the patient in a minor the patient in a minor procedure. procedure.

• It is comprised of a pulse It is comprised of a pulse generator and the leads. generator and the leads.

• The generator houses the The generator houses the battery and a tiny computer battery and a tiny computer that monitors the patient’s that monitors the patient’s heart rate and determines heart rate and determines when to send an electrical when to send an electrical impulse. impulse.

• The leads are wires that are The leads are wires that are threaded through the veins threaded through the veins into the heart and implant in into the heart and implant in the heart muscle. the heart muscle.

• They are the connection that They are the connection that sends impulses from the sends impulses from the generator as needed.generator as needed.

Implantable Cardiovascular Implantable Cardiovascular DefibrillatorDefibrillator

• Tachycardia is repaired by a Tachycardia is repaired by a device known as an device known as an implantable cardiovascular implantable cardiovascular defibrillator, or ICD. defibrillator, or ICD.

• It, also, is a pace-making It, also, is a pace-making device that is placed just device that is placed just below the skin of the patient’s below the skin of the patient’s heart which monitors its rate heart which monitors its rate and rhythm. and rhythm.

• When the ICD detects an When the ICD detects an abnormally fast heart rate, it abnormally fast heart rate, it delivers a series of small delivers a series of small electrical impulses in a similar electrical impulses in a similar manner as the typical manner as the typical pacemaker. pacemaker.

• This impulse causes the heart This impulse causes the heart to beat in a normal, slower to beat in a normal, slower rhythm again.rhythm again.

Cardiac Resynchronization Cardiac Resynchronization TherapyTherapy

• The hearts of some congestive The hearts of some congestive heart failure patients have a heart failure patients have a delay in electrical conduction delay in electrical conduction through the left bundle through the left bundle branch, which transmits the branch, which transmits the heart’s electrical impulses to heart’s electrical impulses to the left ventricle from the left the left ventricle from the left atrium. atrium.

• This is termed a left bundle This is termed a left bundle branch block, or LBBB, and branch block, or LBBB, and causes a delay in left causes a delay in left ventricular contraction ventricular contraction compared to that of right compared to that of right ventricular contraction. ventricular contraction.

• This results in an This results in an asynchronous contraction, asynchronous contraction, which further weakens the which further weakens the heart’s pumping efficiency. heart’s pumping efficiency.

Cardiac Resynchronization Cardiac Resynchronization TherapyTherapy

• The recommended treatment The recommended treatment for LBBB is cardiac for LBBB is cardiac resynchronization therapy, or resynchronization therapy, or CRT, which requires a sort of CRT, which requires a sort of biventricular pacemaker. biventricular pacemaker.

• Tiny electrical impulses are Tiny electrical impulses are sent via leads to the right sent via leads to the right atrium and then to the two atrium and then to the two ventricles concurrently, ventricles concurrently, ensure their simultaneous ensure their simultaneous contractions. contractions.

• This method of surgical This method of surgical treatment eliminates the treatment eliminates the delay caused by the LBBB delay caused by the LBBB and is typically recommended and is typically recommended for patients suffering from for patients suffering from stage D congestive heart stage D congestive heart failure.failure.

Heart Valve RepairHeart Valve Repair• Heart valves are flaps of tissues that ensure that blood Heart valves are flaps of tissues that ensure that blood

traveling through different chambers of the heart and into traveling through different chambers of the heart and into circulation moves in the proper direction and does not flow circulation moves in the proper direction and does not flow back from where it came from. back from where it came from.

• Heart valve disease can be caused by infection, congenital Heart valve disease can be caused by infection, congenital heart disease or aging, and may cause the valves to either heart disease or aging, and may cause the valves to either not close properly, resulting in a leaky valve, or not open not close properly, resulting in a leaky valve, or not open completely, resulting in a decrease in blood flow. completely, resulting in a decrease in blood flow.

• Both of these circumstances make the heart work harder Both of these circumstances make the heart work harder than normal and may worsen the extent of congestive than normal and may worsen the extent of congestive heart failure the patient is suffering from.heart failure the patient is suffering from.

• Depending on the severity of the condition, defective Depending on the severity of the condition, defective valves may need to be either repaired or completely valves may need to be either repaired or completely replaced.replaced.

Heart Valve RepairHeart Valve Repair• Complete valve replacement Complete valve replacement

involves the removal of a involves the removal of a damaged valve and insertion damaged valve and insertion of a new valve in its place. of a new valve in its place.

• This new valve may be an This new valve may be an artificial valve made of metal artificial valve made of metal or plastic, or may be a or plastic, or may be a donated valve from a human donated valve from a human donor. donor.

• During this surgery a patient During this surgery a patient is connected to a heart-lung is connected to a heart-lung machine. machine.

• Following the surgery the Following the surgery the patient must be placed on a patient must be placed on a regimen of anticoagulation regimen of anticoagulation therapy to prevent blood clots therapy to prevent blood clots in the area of the new valve.in the area of the new valve.

Heart Valve RepairHeart Valve Repair• New developments over the years have developed a New developments over the years have developed a

minimally invasive repair option for patients. minimally invasive repair option for patients. • With this most advanced technology a damaged valve can With this most advanced technology a damaged valve can

be repaired with an incision between the ribs of be repaired with an incision between the ribs of approximately 2.5 cm in diameter, opposed to the approximately 2.5 cm in diameter, opposed to the traditional open-heart surgery. traditional open-heart surgery.

• This surgery, called a mini-thoracotomy, lessens a patient’s This surgery, called a mini-thoracotomy, lessens a patient’s post-operative scarring, recovery time and discomfort. post-operative scarring, recovery time and discomfort.

• The “Bow Tie” procedure uses a single stitch to join the The “Bow Tie” procedure uses a single stitch to join the valve leaflets when they do not properly come together, valve leaflets when they do not properly come together, and can be done in a minimally invasive manner.and can be done in a minimally invasive manner.

Heart Valve RepairHeart Valve Repair• Mitral regurgitation is a condition Mitral regurgitation is a condition

in which the mitral valve – the in which the mitral valve – the valve between the left atrium and valve between the left atrium and the left ventricle – allows the left ventricle – allows backflow of the blood from the backflow of the blood from the ventricle into the atrium after is ventricle into the atrium after is has been pumped through the has been pumped through the valve. valve.

• This condition is existent in This condition is existent in virtually all patients with virtually all patients with congestive heart failure and is congestive heart failure and is due to remodeling of the left due to remodeling of the left ventricle.ventricle.

• Mitral valve repair typically Mitral valve repair typically involves restructuring the leaflets involves restructuring the leaflets of the valves and providing a sort of the valves and providing a sort of support with a ring.of support with a ring.

• Preservation of the mitral valve Preservation of the mitral valve contributes to decreasing wall contributes to decreasing wall stress, improving systolic and stress, improving systolic and diastolic function and enhances diastolic function and enhances proper geometry of the left proper geometry of the left ventricle.ventricle.

Left Ventricular Left Ventricular ReconstructionReconstruction

• In a failing heart, the normal elliptical shape of the left In a failing heart, the normal elliptical shape of the left ventricle is lost. ventricle is lost.

• The ventricle dilates and remodels in response to its The ventricle dilates and remodels in response to its inability to pump efficiently, creating a spherical shape. inability to pump efficiently, creating a spherical shape.

• Ironically, this remodeled shape eventually turns from Ironically, this remodeled shape eventually turns from being compensatory and beneficial to a contributing cause being compensatory and beneficial to a contributing cause of heart failure and mitral regurgitation. of heart failure and mitral regurgitation.

• As the ventricle walls pull apart the mitral valve is no As the ventricle walls pull apart the mitral valve is no longer able to close completely, thus regurgitation takes longer able to close completely, thus regurgitation takes place. place.

• In this instance it proves beneficial to reconstruct the In this instance it proves beneficial to reconstruct the shape of the left ventricle.shape of the left ventricle.

Left Ventricular Left Ventricular ReconstructionReconstruction• The leading procedure by today’s The leading procedure by today’s

standards is the Dor procedure. standards is the Dor procedure. • With this technique a mannequin With this technique a mannequin

device is used to remove any scar device is used to remove any scar tissue in the left ventricle that may tissue in the left ventricle that may be present from previous damage. be present from previous damage.

• The surgeon enters the left ventricle The surgeon enters the left ventricle through the anteroapical scar. through the anteroapical scar.

• Once the dead tissue determined, a Once the dead tissue determined, a Dacron patch is sutured for the Dacron patch is sutured for the ventricle to close over. ventricle to close over.

• This prevents destruction of the left This prevents destruction of the left ventricle. ventricle.

• Another leading surgery involves a Another leading surgery involves a polyester mesh cardiac support polyester mesh cardiac support device, the Acorn CorCap. device, the Acorn CorCap.

• The device wraps around the The device wraps around the ventricle from posterior to anterior, ventricle from posterior to anterior, using sutures, and girdles the heart, using sutures, and girdles the heart, helping to retain its elliptical shape. helping to retain its elliptical shape.

• It provides more end diastolic It provides more end diastolic support and reduces wall stress.support and reduces wall stress.

Post-Operative RecoveryPost-Operative Recovery• Patients who receive a surgical measure of treatment for congestive Patients who receive a surgical measure of treatment for congestive

heart failure often face a long road of recovery following the heart failure often face a long road of recovery following the procedure. procedure.

• These patients are given a strict set of guidelines in which they are These patients are given a strict set of guidelines in which they are responsible to follow for a period of weeks to months. responsible to follow for a period of weeks to months.

• The patient should take proper care of any incisions in which he or The patient should take proper care of any incisions in which he or she obtained with the procedure. she obtained with the procedure.

• They should be kept clean and dry, using only a mild soap and water They should be kept clean and dry, using only a mild soap and water to clean them. to clean them.

• If there are any signs of an infection, such as drainage, opening of If there are any signs of an infection, such as drainage, opening of the incision line, redness or warmth around the area or an increase the incision line, redness or warmth around the area or an increase in body temperature then a physician should be contacted in body temperature then a physician should be contacted immediately. immediately.

• If the patient underwent an open-heart procedure a physician If the patient underwent an open-heart procedure a physician should also be contacted if he or she feel as if the sternum has should also be contacted if he or she feel as if the sternum has moved or feels like it has popped moved or feels like it has popped

• Pain relievers are typically given to make a patient feel more Pain relievers are typically given to make a patient feel more comfortable, but the patient and/or his or her family should take comfortable, but the patient and/or his or her family should take care to make sure that no more than the prescribed dosage is taken. care to make sure that no more than the prescribed dosage is taken.

ConclusionConclusion• Congestive heart failure has become an emerging Congestive heart failure has become an emerging

epidemic the in the world today, affecting over 5 million epidemic the in the world today, affecting over 5 million Americans in our country alone. Americans in our country alone.

• Pharmacologic treatments are considered a first option for Pharmacologic treatments are considered a first option for its treatment, but a wave of new, surgical courses of its treatment, but a wave of new, surgical courses of treatments has began to develop. treatments has began to develop.

• It is essential for critical appraisal of these surgical It is essential for critical appraisal of these surgical therapies so that they can be offered to the growing therapies so that they can be offered to the growing population suffering from heart failure. population suffering from heart failure.

• Although a complete heart transplant is considered to be Although a complete heart transplant is considered to be the gold standard of treatment for a failing heart, there are the gold standard of treatment for a failing heart, there are far too few donor hearts to supply an ever-growing far too few donor hearts to supply an ever-growing population who potentially could benefit from them. population who potentially could benefit from them.

• This is why it is crucial to seek other approaches to This is why it is crucial to seek other approaches to correcting this problem.correcting this problem.

ConclusionConclusion• All of the methods described All of the methods described

have proven beneficial to have proven beneficial to expanding the duration and expanding the duration and increasing the quality of the increasing the quality of the lives of congestive heart lives of congestive heart failure patients, and have failure patients, and have allowed the majority of them allowed the majority of them who have received the who have received the operations to maintain a operations to maintain a normal lifestyle. normal lifestyle.

• Although these surgeries are Although these surgeries are currently considered to be a currently considered to be a bridge to transplantation, bridge to transplantation, prolonging life until a donor prolonging life until a donor heart may come available in heart may come available in the future it is a great the future it is a great possibility that they will be possibility that they will be considered an equally life-considered an equally life-saving method.saving method.

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