Surgical and other medical procedures used for heart failure

Heart valve replacement

Heart valves control the flow of blood through your heart's four chambers by opening and closing with each heartbeat. When a valve does not work properly, the added stress it places on the heart can eventually lead to heart failure. When the problem is advanced, surgery to repair or replace the valve may be considered.

The replacement valve can be mechanical (made of man-made materials) or a tissue valve (made of sterilized tissue from animal or human donors). Mechanical valves typically last much longer than tissue valves, which usually need to be replaced after 10 to 15 years. Mechanical valves increase the risk for blood clots, however, so patients receiving them must take anti-clotting medicines after surgery.

Angioplasty

A blockage in the coronary arteries that makes it difficult for enough blood to reach the heart is sometimes the cause of heart failure. Angioplasty is a procedure used to re-open the arteries. A thin, flexible tube with a deflated balloon near its tip is passed through an artery in your upper leg (groin) area or arm and into the blocked artery. The balloon is then inflated to push open the blockage. In most cases, a metal stent, which acts like a coiled spring, is placed in the artery to hold it open. Clearing blocked arteries can improve overall heart function.

Coronary artery bypass surgery

When blockages can't be fully cleared with angioplasty, bypass surgery may be performed. Bypass surgery involves re-routing blood flow around a blocked section of an artery. Surgeons remove healthy blood vessels from another part of the body, such as the leg or chest wall, and then surgically re-attach them to the diseased artery to create an alternative route for blood to flow around the blocked section. During surgery, the patient is typically connected to a heart-lung machine to keep blood circulating through the body. After bypass surgery, it's important to limit fat and cholesterol in your diet, since these can clog arteries. Your doctor may also recommend exercise to strengthen your heart.

Defibrillator implantation

People with severe heart failure or serious arrhythmia (irregular heartbeat) may be candidates for implantable cardioverter defibrillators (ICDs). These pager-sized devices, which are usually implanted in the upper chest near the shoulder, continuously monitor your heartbeat. ICDs deliver electric shocks to the heart as needed to restore a normal heartbeat. Patients with ICDs are sometimes cautioned against driving for some time and against exposure to certain electronic devices that may interfere with an ICD. The ICD runs on a battery that typically lasts for several years; replacement requires a simple outpatient procedure.

Cardiac resynchronization therapy

With this treatment, electrical impulses are used to stimulate the heart's chambers — typically the lower chambers — so they beat simultaneously and can better pump blood to the body. This is done by implanting a special pacemaker or implantable cardioverter defibrillator and connecting pacing leads to the heart tissues. Cardiac resynchronization therapy is approved for patients with moderate-to-severe heart failure whose heart chambers do not beat simultaneously. It can reduce symptoms of heart failure and also prolong your life.

Ventricular assist devices

These mechanical pumps can be attached to a weakened heart to help it pump blood. The pumps are usually powered by an external battery pack that you wear and recharge as needed. There are several different kinds of heart pumps. Some are meant to stay in the body for a short time, while others may stay long-term or permanently. Ventricular assist devices can cause serious side effects, including blood clots, infection, and bleeding. These devices are usually used only for patients with severe heart failure.

Heart transplant surgery

A heart transplant is surgery that replaces the patient's weakened heart with a healthy heart from someone who has recently died and whose heart tissue closely matches the heart tissue of the patient receiving the transplant. Because finding a matching donor can take months or even years, a heart pump is usually implanted in the meantime. A transplant is recommended only when all other treatments cannot control heart failure symptoms.

Although regular doctor visits and medications are always needed to treat heart failure, there are many things you can do on your own that may help slow or prevent heart failure from progressing to an advanced stage.

Information for Patients about BiDil®

BiDil is approved for use in addition to routine heart medicines to treat heart failure in black patients, to extend life, improve heart failure symptoms, and help patients stay out of the hospital longer. There is little experience in patients with heart failure who experience significant symptoms while at rest. Most patients in the clinical study of BiDil received routine heart failure medicines.

Important Safety Information

Tell your doctor about any allergies you have, especially if you're sensitive to nitrates, such as nitroglycerin tablets or isosorbide dinitrate (Sorbitrate® or Isordil®). BiDil has a nitrate component, so you need to let your doctor know.

Tell your doctor if you're taking any erectile dysfunction or pulmonary hypertension drugs, like Viagra®/Revatio™ (sildenafil), Levitra® (vardenafil) or Cialis® (tadalafil). Mixing these with BiDil may cause a sudden drop in blood pressure, fainting, chest pain, or heart attack.

Also tell your doctor if you are taking any medication to decrease blood pressure because when taken with BiDil, blood pressure may become too low.

Drinking alcohol when taking BiDil could make you feel very lightheaded. We recommend that you try to avoid drinking alcohol while taking BiDil.

It is possible you'll get headaches, especially at first. For some patients, Tylenol® (acetaminophen) helps ease the discomfort. Keep your doctor posted on your headache progress and Tylenol use; he or she may want to adjust your dosage.

If you experience dizziness, call your doctor. Please make sure to tell your doctor about any of the signs or symptoms mentioned below or about any unusual events that worry you.

Drinking less fluids than your doctor recommends or losing fluid due to diarrhea, sweating, or vomiting may cause low blood pressure, lightheadedness, or fainting. If fainting occurs, stop taking BiDil and contact your doctor immediately.

Lightheadedness may occur when standing, especially after sitting or lying down.

If you experience any achy and/or swollen joints, unexplained fever for more than a few days, skin rashes, chest pain, prolonged weakness or fatigue (even after a good night's sleep), or any other unexplained signs or symptoms, make sure to tell your doctor as they may be signs of a serious medical condition.

You may also experience rapid heartbeat that could lead to chest pain or aggravate chest pain, or numbness or tingling in the hands or feet.

Sorbitrate is a registered trademark of AstraZeneca LP; Isordil is a registered trademark of Bioavail Corporation; Viagra is a registered trademark and Revatio is a trademark of Pfizer Inc.; Levitra is a registered trademark of Bayer Healthcare, GlaxoSmithKline, and Schering-Plough; Cialis is a registered trademark of Lilly ICOS LLC. Tylenol is a registered trademark of McNeil Pharmaceuticals, a Division of McNeil PPC, Inc.

Please see full Prescribing Information for BiDil.