Other Treatments for Congestive Heart Failure
In some cases, heart failure persists or worsens in spite of treatment. An ultrafiltration process called aquapheresis, which uses a mechanical system called the Aquadex FlexFlow™, may be used to remove excess fluids and salt in CHF patients who do not respond to lifestyle modifications and medication.
In this treatment, blood is withdrawn using catheters (small tubes) inserted into veins in the arm, leg, or neck. The blood is then passed through a filter that removes excess fluid and is returned to the body. Studies have shown that ultrafiltration can remove more fluid at a faster rate than medication. The length of each treatment depends on the rate at which fluid can be removed from the body and the amount that must be removed.
Other treatments, which often depend on the cause of heart failure, include the following:
- Coronary angioplasty
- Coronary artery bypass surgery
- Implantable cardiac defibrillator (ICD)
- Intra-aortic balloon pump (IABP)
- Left ventricular assist device (LVAD)
- Valve repair or valve replacement surgery
Heart failure caused by reduced blood flow in the heart as a result of blockages (plaques) in one or more coronary arteries may be treated using coronary angioplasty. In this procedure, a hollow tube (catheter) is inserted through an artery (usually the femoral artery in the groin), into the coronary artery, and to the blockage. A small balloon is then inserted through the catheter and is inflated to open the blocked artery.
There is a slight risk for damage to the artery during angioplasty, but heart failure symptoms usually improve following the procedure.
Coronary artery bypass surgery reroutes the blood supply around a blocked coronary artery. In this procedure, the surgeon removes a healthy section of an artery from another part of the body and attaches it to the coronary artery so blood can flow around the blocked section.
An implantable cardiac defibrillator (ICD) may be used to treat severe heart failure. An ICD is a small electronic device that is surgically implanted under the skin in the chest to monitor heart rhythm. When an abnormal rhythm is detected, the defibrillator delivers an electrical "shock" to the heart to restore normal heart rhythm.
Another type of cardiac resynchronization involves a biventricular ICD (also called biventricular pacing). In this treatment, a three-lead device is implanted to pace both ventricles to contract at the same time, reducing symptoms of heart failure.
An intra-aortic balloon pump (IABP) is a device that is inserted through an artery in the groin (femoral artery) and then placed within the main artery (aorta). An IABP is an inflatable balloon that expands and deflates in coordination with each heartbeat. It can be left in place for days to weeks, and decreases the strain on the heart, and increases blood flow throughout the body.
Patients with heart failure caused by an abnormal heart valve may require valve repair or valve replacement surgery. These are open-heart procedures in which an abnormal valve is repaired or replaced with a porcine valve (from pig tissue), a mechanical valve (made of synthetic material), or a homograft valve (from a human donor).
Complications include bleeding, blood clots, infection, kidney failure, stroke, heart attack, and death.
A left ventricular assist device (LVAD) is a mechanical pump that is surgically implanted in the upper abdomen to bypass the left ventricle and pump blood throughout the body. This device may be used in patients with end-stage heart failure who are awaiting heart transplantation. Long-term use of the device in patients with severe heart failure is being explored and defined.
