Device Implants and Cardiac Surgeries

Cardiac Resynchronization Therapy (CRT)

Cardiac Resynchronization Therapy (CRT) is a pacemaker treatment for patients with enlarged hearts (cardiomyopathy) which often beat in uncoordinated (dys-synchronized) way. Pacemakers are small metal devices implanted beneath the skin connected to insulated wire(s) tunneled to the heart chamber. The insulated wires, called leads, transmit electrical impulses and stimulate the heart to beat or correct an abnormal heart rhythm. “Resynchronization” means that the heart rhythm is put back in synch. With CRT, the left and right ventricles are paced to contract in a coordinated (synchronized) manner. This therapy is frequently referred to as “bi-ventricular pacing”.

Implantable Cardiac Defibrillators (ICD)

Implantable Cardiac Defibrillators (ICD) are recommended for patients at high risk of developing a dangerous and life threatening abnormal heart rhythm. A defibrillator is a small device implanted under the skin, like a pacemaker, to treat abnormal and potentially deadly heart rhythms. The device fits into the palm of an average-sized female hand. ICDs are connected to insulated wires (leads) tunneled to the heart chamber. An ICD monitors heart rhythms and works as a pacemaker for slow heart rhythms and delivers life-saving shocks for dangerously fast heart rhythms. If you have a low ejection fraction, with or without a past medical history of abnormal heart rhythms, your physician may recommend you have an ICD.

Coronary bypass surgery

This is a common heart surgery procedure used to increase blood flow to an area of the heart with reduced blood supply, caused by a blocked or significantly narrowed coronary artery. The surgeon uses blood vessels from the legs or chest to bypass the area of blockage and restore adequate blood flow through the arteries and to the heart. Adequate blood flow to the heart via the coronary arteries is important because these arteries provide oxygen and nutrients to the heart, helping it to remain viable and able to meet the needs of the body. Your cardiologist can tell you if this procedure is recommended for you.

Modified DOR Procedure (left ventricular reconstruction)

Patients with ischemic cardiomyopathy and an akinetic (loss of movement) or dyskinetic (abnormal movement) anterior wall may be candidates for high-risk coronary bypass surgery with a modified DOR procedure. This procedure helps restore the normal geometry of the left ventricle, thereby improving symptoms of left ventricular failure and chest pain.

Heart valve repair or replacement

Mitral valve regurgitation and aortic valve regurgitation are conditions where the heart valves do not close completely and blood leaks backwards. Mitral valve stenosis and aortic valve stenosis are conditions where the heart valves don’t open properly and blood cannot move forward properly. Each condition can cause the heart muscle to pump harder, and can result in heart failure. These valves can be surgically repaired or replaced. In many cases, heart function significantly improves after surgery. If you have a damaged heart valve, your cardiologist and cardiac surgeon will talk with you about the options most appropriate for you.

Heart Transplantation

Heart transplantation is the surgical removal of a severely damaged heart and replacing it with a healthy heart from another human donor. Heart transplantation remains an excellent option for patients who have exhausted all medical and surgical therapies for heart failure. The number of transplantations done each year continues to be limited by donor availability, but short and long–term results are generally very good. Emory surgeons have performed more than 550 adult heart transplant surgeries since 1985.

Mechanical Circulatory Support Device or Ventricular Assist Device (VAD)

Ventricular Assist Devices (VADs) are surgically attached to the heart to assist with its workload. Most commonly, the devices are attached to the left ventricle and are referred to as LVAD (left ventricular assist devices). Ventricular assist devices have been used as a bridge to transplant in patients with acute decompensated heart failure - they help patients survive until a transplantation could occur. In recent years, newer models have been developed for use as a permanent device or “destination therapy”. These are used in patients who have end stage (severe) heart failure and heart transplantation is either not an option or the person prefers to have the VAD implanted as a long term life sustaining measure.