Other Treatments for Congestive Heart Failure
Implantable devices. As heart failure worsens, lifestyle measures and medication may not be enough to control symptoms. When this happens, devices implanted in the chest, such as cardiac resynchronization therapy (CRT) or a left ventricular assist device (LVAD), may help.
CRT is a type of pacemaker that delivers electrical impulses to improve the heart's pumping capacity, primarily by improving the coordination of different portions of the heart muscle. An LVAD is a mechanical pump that helps pump blood from the heart to the rest of the body.
Your doctor may also consider an implantable cardioverter-defibrillator (ICD), which monitors heart rhythm and delivers a shock in an attempt to restore normal rhythm when a fatal, fast heart rhythm occurs.
Heart transplants. In people with class IV heart failure, a heart transplant may be needed when other treatments no longer work. Transplant recipients should be younger than age 60 and have no other major diseases like cancer or kidney disease that could shorten their lifespan.
The success of heart transplants has improved significantly over the past decade: About 85 percent of transplant patients are alive after one year, and about 70 percent survive for at least five years. These improvements in survival are primarily the result of advances in the prevention and early detection of tissue rejection, which occurs when the immune system recognizes the donated heart as foreign and attempts to destroy it.
If you've undergone a heart transplant, your doctor will prescribe medications to suppress your immune system. These immunosuppressive drugs include cyclosporine (Gengraf, Neoral, Sandimmune), azathioprine (Azasan, Imuran) and prednisone.
You will also need to undergo biopsies of your heart on a regular basis to identify signs of early rejection. In a biopsy, a small piece of heart tissue is removed and examined under the microscope.
Many people with a donor heart develop plaques in the coronary arteries of their new heart. The risk can be reduced by adopting the same lifestyle changes and taking the same medications that help prevent CHD in non-transplant patients. To monitor for CHD, heart transplant patients often undergo coronary angiography once a year.
Artificial hearts. In 2004, the FDA approved the first implantable artificial heart. Weighing about 2 pounds, it is surgically implanted in the chest, is powered by electricity that passes through the skin from an external battery, and mimics the pumping activity of the heart. This artificial heart is for people with class IV heart failure who are waiting for a donor heart. In one study, 79 percent of 81 patients with class IV heart failure who received the temporary artificial heart survived until they were able to have a transplant, compared with 46 percent of 35 patients who did not receive the artificial heart.
In 2006, a second artificial heart won a limited FDA approval known as a humanitarian device exemption. The device, called the AbioCor implantable replacement heart, is approved for class IV heart failure patients who are ineligible for a heart transplant and are unlikely to live more than one month without intervention.
Unlike the temporary artificial heart, which replaces the failing heart's ventricles and valves, the AbioCor heart is a permanent replacement for the entire heart.