People who have heart failure with chest pain (angina) or who have had a heart attack in the past may benefit from coronary artery bypass surgery or angioplasty to open clogged arteries.

Some people may have surgery to repair specific underlying causes of heart failure, such as damaged valves. In cases that have a specific treatable cause, surgery sometimes can greatly improve or eliminate heart failure symptoms.

Doctors may only consider a heart transplant if you have severe, life-limiting symptoms of heart failure that do not respond to available treatments. In addition, you must be unlikely to benefit from coronary artery bypass surgery, and you must not have any other serious medical conditions that would reduce your life expectancy.

Experts are studying several different experimental treatments for heart failure, including:

• Cardiomyoplasty, a procedure in which the surgeon tries to make the heart pump better. The surgeon takes muscle from the back and abdomen and wraps it around the heart. A pacemaker makes the muscle beat with the heart.
• Ventricular assist devices (VADs), which are mechanical pumping devices that are inserted into the chest to help the heart pump more blood. VADs are used to keep people alive until a donor heart is available for transplant. VADs may also be used as an alternative to heart transplant for long-term treatment of severe heart failure. These devices require surgery to place the device and to make the connections between the heart and the device. See an illustration of a ventricular assist device.

Surgery Choices

Coronary artery bypass (CABG) surgery

Angioplasty (with or without other procedures, such stents or atherectomy)

Heart transplant

For more information on procedures to restore blood flow (called revascularization) to the heart muscle, see the topic Coronary Artery Disease.

What to Think About

Some people with heart failure may want to consider specific testing to find out whether they would benefit from angioplasty or bypass surgery. The decision to have more testing is difficult. It is not clear that restoring blood flow (revascularization) improves heart failure symptoms and prolongs life in people who do not have chest pain.

Evidence shows that starting ACE inhibitor medicines after a heart attack can help lower the risk of heart failure.