Complex Heart Disease and Advanced Heart Failure
Treatment Options
There is a new way to treat failing hearts
Based on your test results, your doctor and the heart team may determine that you are not a suitable candidate for cardiac surgery due to higher than normal risks caused by your overall medical condition.
Initially, your cardiologist may recommend medicine to address your coronary artery disease. But if symptoms persist, or if your coronary artery disease worsens, you may need a heart repair procedure, which could include surgery and/or non-surgical procedures.
If appropriate, your cardiologist will prescribe medication as treatment for CAD.
Non-invasive treatment does not require any type of internal treatment. You won’t need to be in a hospital or be at your cardiologist’s office to receive non-invasive treatment.
Risks of taking medicine to treat your coronary artery disease depend on which medication your cardiologist has prescribed. Talk with your cardiologist about the risks of your medication.
Your Heart Team may recommend percutanaeous coronary intervention for you.
Called PCI for short, percutaneous coronary intervention is a less-invasive heart repair procedure and blocked artery treatment that uses a catheter-based system to open or unblock arteries narrowed by hardened plaque.
- The most common type of PCI is angioplasty
During an angioplasty, a balloon is placed on a catheter that is guided up to your narrowed coronary artery. Once in position, the balloon is opened to compress the plaque to the sides of the arteries. By doing this, more blood is able to move through the artery.
- Many angioplasty procedures are followed by a stent or stenting procedure
In some cases, the interventional cardiologist may insert a stent (a small, metal mesh tube) into your narrowed artery after the angioplasty. The stent helps prevent your artery from getting narrowed or blocked again.
After having a stent placed you will be required to take medication to reduce the risk of the stent clotting over time.
PCI is performed by an interventional cardiologist; they specialize in minimally invasive heart procedures.PCI is a term used for several types of minimally invasive heart disease procedures. Unlike open heart surgery, PCI does not require your chest cavity to be opened for the procedure to take place. PCI uses a catheter, inserted through a small incision, to deliver the treatment.
While PCI is less invasive than traditional heart surgery, your cardiologist may be hesitant to refer you to an interventional cardiologist if you have additional health risks (like diabetes, kidney disease, or anatomic issues with your heart). But there are ways to make PCI safer for some patients with additional health risks. Learn more about Protected PCI.
Your interventional cardiologist may want to have hemodynamic support on hand during your PCI, and could recommend Protected PCI.
Protected PCI is a complex PCI procedure that includes the use of a small heart pump.
The use of a heart pump during Protected PCI allows your blood pressure and blood flow to be maintained during the procedure. It may also allow the heart team to perform a more thorough heart repair procedure, without interrupting the normal flow of blood your heart needs to stay healthy during the procedure.
In addition, Protected PCI can mean:
Less recovery time
Less time in hospital
An additional incision through the leg for
use of a standard catheter
While PCI is minimally invasive, there are still risks to the procedure.
Risks include:
You may have an allergic reaction to the medication—for instance, a blood thinner called heparin,
which is used in conjunction with the Impella®
which is used in conjunction with the Impella®
- Clots may develop in your blood vessels that can travel through your blood vessels and block the blood flow to other organs, including your lungs, making breathing difficult
- You may develop an infection, which could be localized or spread throughout your body
- Your heart tissue, valves, and blood vessels may be injured by the device as it is placed into your heart or during the time it sits inside your heart. The injury may result in life threatening conditions
- Your heart tissue may be irritated or injured by the device as it is placed into your heart or during the time it sits inside your heart. The irritation or injury may cause your heart to beat irregularly. These conditions can be life threatening
- Insertion of the device may cause bleeding, low blood pressure, low platelet count, and/or damage to red blood cells. These conditions can be life threatening
- Your liver, kidneys, or other parts of the body may not receive enough blood to function efficiently and may not work normally
- Your heart may not get better, or your heart failure condition may worsen
- The Impella® may have an unexpected problem requiring it to be removed, which would result in your left heart support being stopped
Open heart surgery used to treat coronary artery disease is also referred to as coronary artery bypass grafting, or CABG. During CABG, veins or arteries taken from your leg are used to sidestep the blocked arteries around your heart. With CABG:
- Your breastbone will need to be opened so that the surgical team can work directly on your heart
- You may require a longer recovery due to the invasiveness of the procedure
CABG is performed by a cardiac surgeon, a surgeon who specializes in open heart repair surgery. Because it’s considered more invasive, open heart repair surgery may require more days in the hospital after your surgery, and more follow-up visits, than less invasive procedures.
Not all patients are candidates for PCI:
CABG has been associated with better long-term outcomes in certain patient groups who are candidates for surgery. Check with your cardiologist to see if surgery is a preferred option for your heart disease treatment.
The risks of CABG differ from those of PCI, and include:
- An infection at the incision site. If you are obese, have diabetes, or if you’ve previously had CABG, the risk of infection is greater
- Arrhythmia
- Heart attack
- Kidney failure
- Memory loss and/or loss of mental clarity
You should take time to research and consider all
of your treatment options, making sure you
feel comfortable with the treatment plan.
Download our doctor discussion guide
for tips on talking with your cardiologist