In people with severe heart failure, medications and lifestyle changes may not be enough to keep symptoms under control. People with severe heart failure are often housebound and are frequently admitted to hospital for more intensive treatment, including intravenous medications and oxygen. Surgery may be considered in this situation, to improve symptoms and prolong life.

There are two surgical treatments for heart failure: Mechanical devices and heart transplantation.

Mechanical devices Mechanical devices take over the heart’s pumping ability, reducing the strain on the heart. They are very rarely used and tend to be kept for patients who are waiting for a heart transplant; this is known as a “bridge to transplant”. Examples include cardiac resynchronization therapy (CRT), and left ventricular assist devices (LVADS). Another mechanical device is the “intra-aortic balloon pump” (IABP or counterpulsation). With this treatment, a balloon is implanted near the heart and is inflated and deflated by a machine outside the body. This helps the heart to beat. IABPs are used for short periods of time in hospitalized patients.

Heart transplantation Heart transplantation is only used for heart failure that cannot be treated by any other medical or surgical means. It is restricted to people with very severe heart failure, who have a high risk of dying if they do not have a heart transplant. Heart transplantation involves replacing the damaged heart with a healthy heart from someone who has died, using surgery. There is a shortage of hearts for transplantation and some people have to wait for many months or even years before a suitable donor is found. Heart transplantation can have complications, including rejection of the heart by the recipient’s body, infection, side effects from anti-rejection drugs, and blockages in the arteries to the heart. Despite these complications, many heart transplants are successful and allow the recipient to lead a full and active life.

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