Surgery for heart failure
Most people with heart failure do not need surgery and will be treated with drugs. Heart surgery is only done when doctors think it will improve a problem with the heart valves or the blood supply of the heart, and if the heart is strong enough. In most cases surgery cannot cure heart failure. Surgery that can be used to improve heart failure includes coronary artery bypass graft (CABG), valve replacement surgery and heart transplantation (see also ‘Medical devices for heart failure' and 'heart transplants for heart failure').
Some of those with heart valve problems said that surgery had made a real difference to their quality of life; for instance one woman who had already had 4 heart operations told her surgeon she was still prepared to take the risk of having a fifth operation (the replacement of her mitral valve). She had felt better afterwards. Another woman who had avoided seeing doctors about her heart for many years was given a new mitral valve and said the operation changed her life.
She persuaded her surgeon to operate on her and felt her quality of life improved.
By this time I'd developed atrial fibrillation as well which, obviously... could be quite dangerous. And he said, 'Well I'm not going to give you an answer now, I'll have to go away and really think about it'. And I did find out later that he phoned my cardiologist at our hospital and asked him just how I active I was. And he came back at the end of the day and said he'd do it. And I felt wonderful; I couldn't believe the change.
The last one, the surgeon fitted an artificial, a metal valve, a Starr-Edwards valve it's called. And I have to say that it's absolutely brilliant, absolutely. The first thing he said to me when he saw me after I'd had it was 'amazing'. He just stood at the bottom of my bed and said 'amazing, absolutely amazing'.
And this was the surgeon who'd had to have time to think about whether he was going to operate?
Yes, yes. And then, as I say, the latest one was having a pace-maker fitted and there again, it has sort of increased my quality a bit but I still can't do a lot of the things that I'd like to do. You know, we have to think of where we're going or what we're doing and then my husband likes me only to do one thing a day. And then I know I'm going to be all right but if I try to do too many things then by the end of the day I'm out of breath. I don't sleep very well because of it. But apart from that, you know, I just feel that I'm lucky to still be taking a lung full of air as I've always tried to be very positive.
She describes how wonderful she felt after her mitral valve was replaced.
And you know, the most wonderful thing in the world is to have a new valve or whatever, I am sure for other people, other things but that is really how it came about and that's 7 years ago. And since then, I mean another one is playing up a bit now but even so, you know, I mean I'm so much better than I was. For the few years before I couldn't drive for three years before, just couldn't, it wouldn't have been safe, you know and all this sort of thing. So really that is the build up and what I have got to now.
During a routine check-up at the chest clinic Sab told his consultant about his chest pain. Tests showed he needed bypass surgery.
ECG, I always get the words wrong. So he found phoned up and we had that done and it was showing a little blip and then from then on he sent me for more tests so for the next six, seven months I did all the tests, treadmill and so on and finally I went for an angiogram and then they found out that is was much worse than it actually showed and the doctor agreed that they couldn't put the stent in because that would be more dangerous, it would be more than one stent so they decided they wanted to do a triple bypass so then asked me to wait for a date and then they give me a date on December 1st , Thursday and do the operation at 1.30 and, and that's when the operation took place and instead of doing triple bypass then I was told it was a five grafting that they had to do because it was, artery was so bad.
He felt devastated when he was told that he needed bypass surgery one week after his heart attack.
But then when you're taken to [the specialist hospital] and you actually see on the screen the effects of what's going on and then somebody says, 'we're requesting surgical intervention immediately,' it is a shock of some magnitude. Yeah, I knew that, yeah, yeah I knew that there was something seriously wrong with a fundamental part of your anatomy and they'd got to do something about it.
The nurse then that was on the ward, she was just terrific. She was so comforting and sympathetic and I, I think I was in tears, not from a weakness point of view but sheer frustration and aggression. This can't be me, I haven't spent my life playing sport, all my life, and enjoying good health to have to have people hack me open and put this thing that's gone wrong, right.
Her doctors disagreed about whether she should have bypass surgery at her age.
Is this another heart attack?
I ended up in intensive care and then I ended up being taken to [the specialist] hospital where the same thing happened again. You're too old to be operated on.
We might lose you on the table and we don't want to do that so we'll see how it goes. Well this went on for another six weeks and then the doctors came and said, 'I think you better go home because it's too risky to operate on you, you know your chest is not all that good.'
So one of the, one of the surgeons he said, 'I could do it', but he said, 'we all have to agree." So I said, 'Well what chance would I have?' He said, 'Well I consider you would have a 50/50 chance.' So I said, 'Alright you do 50 and I'll do the other 50.' But he said, 'It's not so easy as that.'
He said, 'we've got to be perfectly sure that you're strong enough to go to the theatre and go through the operation.' So I said, 'Well I'm sure I'll be alright, I'm sure I will.' He said, 'I'm sure you will but I'm the only one.'
Well this went on for some time and one of the doctors came and said to me 'Well we're sending you home tomorrow because we don't think we can do anymore. You'll be given treatment and looked after but we're sending you home.'
So they were getting me ready in the morning, had my breakfast, got up, went to the bathroom and had another heart attack. Right out, that's it.
Well along comes the surgeon who said he thought he could do it against the advice of all the others but he got the vote that day. And I was taken down to the operating theatre and operated on and it was a success.
You see I could quite understand they don't want to lose a patient, it's not good for them to lose a patient and if the chances are 50/50, I think they'd rather take their 50 on their side and have you die at home than on their table.
That is fair enough, but then from the patient's point of view, who hasn't got much chance anyway, she would rather take the chance on the other side of the 50 and go ahead.
He felt well informed before he signed the consent form for bypass surgery two weeks after his...
And also he explained what's going to happen to me in the next few days because when he was talking to me, there's pipes sticking in my mouth and in my groin, all over the place.
And he explained that progressively they was going to remove all the different pipes, and the purpose for them and everything else, and I thought it was marvellous that a surgeon would take the time out to explain everything he was going to do, or had done, in the next few days. And I was very, very impressed with this surgeon, I've got to be truthful.
So the only person that was really good, as far as I was concerned, was the surgeon and he didn't mince his words, you know, he spat it straight out.
He called a spade, a spade and I loved that, I knew exactly where I stood. I knew the risk from living and dying on the operation or from a stroke and everything else and that's the way I like it, I knew exactly where I stood. I knew the odds were against me but I went for it.
He asked the surgeon how many bypass operations he had done before he consented to surgery.
So that was you know, quite reassuring. And I also asked him what the prognosis was and he told me that 95% of all cases of, who have bypass surgery are successful, and 5% are not. So you've got a 1 in 20, is it? yes 1 in 20 chance that something might go wrong and I said what can go wrong.
He said mostly what can go wrong is that you get some kind of sepsis and we can fix that. So I thought the odds were pretty good, bearing in mind that my cardiologist said I've got to have this done, not much choice.
He had bypass surgery to reduce his chances of sudden death.
So I had the surgery, and then I hit the problems that nurses and doctors get when they're in the hands of their colleagues. My heart went into very strange rhythm problems, and because I'm a doctor as was well-known in my hospital, (though I'm a GP I was very well-known in my hospital), the junior doctors waited until the consultants were able to see me and sort out my problems. As I say there was quite a delay sometimes between me developing problems of my rhythm and somebody actually deciding what to do about it, and that is one of the disadvantages of being a doctor in that situation.
Sometimes people had expected tests to lead to some kind of surgery and felt slightly disappointed to learn that surgery would not help them. In Brian’s case an angiogram revealed that his heart would no longer be able to cope with surgery. Several described having newer smaller pacemakers fitted which they were pleased about; one man said his doctor had shown him a new and old pacemaker side by side.
It took him some time to realise that surgery wouldn't help his heart failure.
So you get talking to the patients and then you find out this patient is waiting to go on to go to another hospital to get his angiogram or bypass or whatever, and he's been in 6 times. And that bloke's been waiting 18 months and you know, you start to get a better picture of what actually is going on.
So you know, I come back down to earth then, I says, 'Well, I ain't going to go and have an operation,' because if he's been here 12 times and he's been here 18 months, in and out, and every 5 weeks he gets a phone call, come in we're ready, and he comes in and spends 2 weeks, and I'm sorry you know I'm saying, 'What chance have I got?' I mean I'm just here like, so you know, so I says 'Okay then.'
So I talked to this one nurse and she says, 'Well, that's the way to think about it, have a positive think that the tablets will help you. Do light exercises, do things that will help motivate the heart to get back or to help the arteries open' or what have you. And that's what I've been doing ever since, know what I mean.
Brian explains why he didn’t have any more surgery after his pacemaker was fitted.
And this was an assessment of the condition of my heart prior to the possibility or even the probability of having heart valve surgery, having the valves replaced and it was then that this diagnosis was made, that my left ventricle was so far below normal levels of activity and was probably the main problem and may in fact of developed as a result of my heart struggling with the weak valves [clock chimes] for maybe who knows, maybe ten years. I had no symptoms of a problem prior to that but, but it is believed that, that, the poor fitting of the two valves resulted in the heart having to work harder and this resulted in the left ventricle weakening and so the decision was taken that heart surgery would not help me and therefore the only invasion of my body that I’ve had [laughs] is a pacemaker and an angiogram but I’ve had no other surgery.
His by-pass surgery didn't make him feel any better.
But now although I've learned that I've just got to live with this its not going to get any better. The medicine that I'm on, the treatment with medicine, is not going to cure, it will prevent hopefully, any further damage, or will slow down further damage, it won't cure it, and I'm all right with that, because I could be an awful lot worse off than what I am, and it has been explained to me, by the powers that be, that if it does get worse, what the position is gonna be.
'when the surgeon cut me open he would have said 'What the hell have we got here?', because it must have looked like a bundle of mush! But nobody told me that, nobody..if it was on records its never been explained that I was setting out thinking I'd been almost cured by bypass surgery, only to find it wasn't so.
Sab talks about how he felt and looked like following his CABG surgery.
And that was a scary part and being on your own in this private room, nobody else then, no visitors and you're looking round and you can't understand, you can't move, you can't really shout, you can press a button for a nurse if you want to and you even shout, "Why is that happening, what's wrong?" and it just feels that you're not in the room. Every day the room looked different so I was thought I was in a different room again – how did I get here? And then, those, for two days was like that and it was so scary to shut the eyes and it was so scary to open the eyes so you didn't know what, which, you know dimension you were in and how do you get out of here. Night time I opened the room and thinking, 'Am I asleep or am I awake?' and it was so difficult. But the support from nurses and the people in charge, it was so brilliant, they were there to make sure that, reassure you that you are alright. And day and night were just the same, there was, you know, you couldn't, it was nothing to look forward to whether it was daytime or night time so those were the first two days.
And the pain was so, you couldn't move, yeah I was petrified of moving. Only the hand that could move and press the button. And then what… I think about two, two days later then you get up and you drag these things with you to go to toilet and the first time they took a tube out, out of m what do they call it, the willy? And you can pee naturally. That was a lovely feeling, you can feel something that you're doing on your own and the first feeling that you have. So I didn't want to get out of the toilet, I was like ‘I’m staying here now’ and then you drag yourself back.
And so that was a horrendous experience and once I started walking and I was, after three days I was walking up and down the hallway to get yourself fit and I then got better, then I had, one of the male nurse give me a shower which was brilliant and from then on the things got better and better then I was eating a little bit more, drinking a lot, I drank so much water. I remember my first day when I realised I was awake that they said the more water I drink the quicker, better I will get.
He describes the pain he felt after his first operation and how he needed to have the bones in his chest re-aligned.
Sab talks about what he was able to do at the various stages of his recovery.
Last reviewed April 2016.
Last updated April 2016.