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Heart failure

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.

She persuaded her surgeon to operate on her and felt her quality of life improved.

Age at interview: 68
Sex: Female
Age at diagnosis: 48
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And I was all right until 1996, and we'd been to Ireland for a holiday. Didn't feel well in Ireland, very congested around the liver area, very out of breath, my legs were puffy. But anyway we toured, not doing a great deal of walking, mostly in the car, and came home on the Tuesday. And on the Friday my husband had a committee meeting here which hadn't been planned, it was going to be a somebody else's house. And just a good job that he was here because I collapsed and got rushed into hospital, spent 7 weeks in there because, you know, having 5 operations is a bit dicey as you can well imagine.  And my cardiologist only wanted me to see one surgeon. He said, 'He may not want to do but I think it's worth going for, how you do feel?' And I said, 'Well I don't want to be like this for what days I've got left' because I couldn't walk, I couldn't do anything. And I finally got admitted to hospital in London and the surgeon there looked at my notes and he said, 'Definitely not, you've had far too many operations'. And I said to him 'oh dear' and he said, 'You surely don't want me to operate on you?' And I said, 'I don't want what time I've got left being like this because, you know, it's no good to me at all'.  

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.

She describes how wonderful she felt after her mitral valve was replaced.

Age at interview: 72
Sex: Female
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The wonderful specialist at our local hospital was doing the angiogram and he said, 'My God, my God, here we've got some blackmail for the health authorities. You must be in immediately!', and they gave me a mitral valve you know, metal or carbon or something, and when I was even coming out of intensive care, even when I was in intensive care and I was really not compos mentis I just felt wonderful! I cannot tell you. It was like being for years and years and years in a sort of, and I kept having heart failures, all the way along I was having little heart failures but you know, you sort of get used to a situation almost, it sounds stupid, but you do!  

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.
Coronary artery bypass surgery, also known as Coronary Artery Bypass Graft (CABG, pronounced "cabbage") is a type of surgery that improves blood flow to the heart. It diverts blood around narrowed or clogged parts of the major arteries (blood vessels), to improve blood flow and oxygen supply to the heart. A CABG operation involves the use of a piece of a vein from the leg or artery from the chest or wrist. The surgeon attaches this to the coronary artery above and below the narrowed area or blockage. This new blood vessel is known as a graft (for more on CABG see Coronary Artery Bypass Graft Surgery on our Heart Attack website).

People can have CABG surgery following a heart attack, several months later, or following tests results such as an angiogram. Sab avoided a heart attack just because during a consultation for a lung condition he told the consultant about his chest pain. He went on to have a series of tests including an angiogram. It showed that his artery was so bad that it would be dangerous to put a stent in and doctors decided to do a triple bypass instead. One man described how he felt when he was told during his angiogram that he would need bypass surgery immediately.
 

During a routine check-up at the chest clinic Sab told his consultant about his chest pain. Tests showed he needed bypass surgery.

During a routine check-up at the chest clinic Sab told his consultant about his chest pain. Tests showed he needed bypass surgery.

Age at interview: 65
Sex: Male
Age at diagnosis: 64
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I had an appointment with a chest clinic in the [name of hospital]. So we went to see the my own specialist, the chest was fine, I had a bronchiectasis and he was saying that we now those tablet's working and I don't need to see you for another year which I was very pleased. Anything else you want to talk about? And I sort of said no, that's fine. My wife jumped in and said, "Tell him about the pain you had," and he sort of looked at me and said, "What pain?" So I explained to him so he said, "We'll do a GC," what do you call it?

ECG.

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.

He felt devastated when he was told that he needed bypass surgery one week after his heart attack.

Age at interview: 71
Sex: Male
Age at diagnosis: 65
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The few days I spent in [the local hospital], they explained lots of things about heart attacks and said that 'because of the readings they were getting, they felt it was a heart attack, but if it settled down then I would go through a normal convalescent period and things would be fine,' and you think that's going to be alright. You think, 'yeah, I'll get fit again.' 

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. 

One woman in her eighties explained how some of the doctors advised against bypass surgery, and why she wanted to go ahead with it. One man reported how the surgeon described the operation to him before he asked him to sign the consent form for bypass surgery. Another man wanted to know how many bypass operations the cardiac surgeon had done before he signed the consent form and what things might go wrong.
 

Her doctors disagreed about whether she should have bypass surgery at her age.

Her doctors disagreed about whether she should have bypass surgery at her age.

Age at interview: 84
Sex: Female
Age at diagnosis: 81
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Well I had several nasty attacks in the hospital but they said well perhaps it would be wiser to just let things go for a while and see what happened. This went on for about six weeks and then I had a really nasty one and 

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...

He felt well informed before he signed the consent form for bypass surgery two weeks after his...

Age at interview: 69
Sex: Male
Age at diagnosis: 67
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The surgeon, I think he was a very good communicator. He came and sat on the side of the bed, explained everything he was going to do. After the operation he came back and he explained everything he had done. 

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.

He asked the surgeon how many bypass operations he had done before he consented to surgery.

Age at interview: 77
Sex: Male
Age at diagnosis: 69
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I'm telling you this because one of the things that the surgeon told us was that the, one of the things that I wanted to know from the surgeon was how many of these things had he done. Was he, sort of, did he know what he was doing and he told me, this was September, he told me by that time he had done about 140 bypass operations that year. 

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.

Some people felt they wanted to have surgery; for instance a man who had CABG surgery because doctors thought it would prevent sudden death, said that he wanted to feel everything was being done that could be done (for more information see 'Sudden arrhythmic death syndrome' Information sheet from the British Heart Foundation January 2013).
 

He had bypass surgery to reduce his chances of sudden death.

He had bypass surgery to reduce his chances of sudden death.

Age at interview: 59
Sex: Male
Age at diagnosis: 58
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Well there are a number of tests done, and the disease was found to be ischaemic heart disease... and amongst other findings was that I had some severely blocked major arteries in the heart. The muscle of my heart is badly damaged, and my specialists told me it was unlikely that surgery would actually improve the quality of the muscle that had already been damaged, but my chance of sudden death would be reduced they felt, so I went forward for a coronary artery bypass operation in January of 2002, a little uncertain as to whether it had been a sensible thing to do, because I think the evidence as to whether I should have been managed medically or go through the surgery were pretty finely balanced. I think my family were keen though that I had the surgery and it was important to me that everything was being demonstrated to be done that could be done.  

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.

It took him some time to realise that surgery wouldn't help his heart failure.

Age at interview: 46
Sex: Male
Age at diagnosis: 45
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And okay, I'm still here and the tablets are helping but you know, at the end of the day, I sometimes wish they had said, 'Let's do the operation,' because you've psyched yourself up mentally now to say 'Well then, okay.' You're talking to the nurses and what have you and they're all saying 'Well, it looks like you're have to have a bypass or... could be a transplant.' And I says to them well, you know, they don't know but they're just talking you know what I mean? And I'm thinking, 'Yeah, right!'  

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.

Brian explains why he didn’t have any more surgery after his pacemaker was fitted.

Age at interview: 76
Sex: Male
Age at diagnosis: 70
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Well, the, the pacemaker was fitted in eight years ago, so, so that was minor surgery and it was in 2005 which is six years ago that I had , I believe it’s called an angiogram but the; I had a number of tubes shoved up from my groin into my heart.

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.
When surgery had led to further complications and people had to stay in hospital longer than expected they said their families often felt under strain. Several said that they were disappointed not to recover from bypass surgery as fast as others around them; one man said that he had expected his bypass to make his heart better but was told afterwards that it was more damaged than he had thought.
 

His by-pass surgery didn't make him feel any better.

His by-pass surgery didn't make him feel any better.

Age at interview: 56
Sex: Male
Age at diagnosis: 53
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I get slightly annoyed, though I'm happy for other people who get bypass surgery and feel wonderful afterwards, I think it was just, I was just treated under the assumption that I've had the surgery and I was gonna be fully fit, fully operative and so interestingly at that point stopped, because that was supposed to be corrective. But unfortunately there was more damage done to my heart than just replacing the, the veins, the arteries..I don't know how do you say, it didn't enhance what I've got in any way. It remedied one part of my problem, and I've now got the heart failure problem. Its not difficult to live with now, its annoying its restrictive, at first it was terrifying when the limitations of what you could and couldn't do was brought home to you. 

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.
 
CABG surgery usually lasts three-to-six hours. However, some people need more than one bypass and so it may take longer depending on how many blood vessels are being grafted (NHS Choices, April 2012).
 

Sab talks about how he felt and looked like following his CABG surgery.

Sab talks about how he felt and looked like following his CABG surgery.

Age at interview: 65
Sex: Male
Age at diagnosis: 64
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I was still under Intensive Care so and then one; I had, the one thing that really was irritating, I had an oxygen in my nose and making… the mask I had with wire… loads of wire from here, here – chest and you don't do nothing, you just lie there, you're almost as good as dead. There's no part of the body you can move. Unbelievable pain, unbearable pain , you can't breathe properly, you can't turn, you just sit still, there's no sleep for three days but you want to close your eyes to sleep but they made no difference and the experience I had, I forgot it and tell is that the dreams that you hallucinate, hallucinations.

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.
Recovering from surgery could take time. Many people noticed they'd lost weight. Sometimes surgery did not go as well as planned and several people had experienced pain; one man said it had taken 2 years to get the original surgery corrected.

 

He describes the pain he felt after his first operation and how he needed to have the bones in his chest re-aligned.

He describes the pain he felt after his first operation and how he needed to have the bones in his chest re-aligned.

Age at interview: 35
Sex: Male
Age at diagnosis: 35
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In 1993 when I had the operation you know they opened the chest okay, when they put it back they didn't put it back straight, the ribs weren't like this, they were not in line they were like this. And my chest was corrugated it was like this, you know exactly like this if you feel it and I was, I was in agony, tremendous pain for years but I went to the doctor and I said "Doctor there's a great pain in here." And I saw other patients with you know who had similar operations and they recovered, twenty days after the operation they're fine, six months later everything is forgotten and it's gone. They said "This can take up to a year."  And then I went next year and he said "It can take up to two years." It was so bad to the extent that I couldn't touch it, I couldn't touch the scar. And even at night if the duvet touches it it's a problem so I used to sleep like this or if I'm on my tummy I sleep like this so it doesn't hurt my scar [laughs]. Until 1990, but I lived normally, completely normally I mean I take the pain smiling [laughs]. 1997 they said "Okay let's do an xray."  They did an x-ray... the actual thing, the bones were like this and the said "Okay we have to re-cut them, align them." In 1998 I had a second operation and that was when you know this came to my mind. The nurse before the operation said "What do you think about this, this, this?" and one of the questions was "What do you think about dying?" and I laughed and said "You don't know what I went through so dying is yeah I'm fine, don't worry I'll sign the form." So I signed the form, went to the operation and they aligned the, re-aligned the bones together. They were, actually some, the wires, the metal wires were hitting some sort of, some nerves stuck in the middle and literally it was just like an electric shock, every time you touched the scar it was just like an electric shock goes through your body "Argh".  But it's fine [laughs] it's gone.
 
It takes most people several months to recover after the operation. For the first three to six months many people feel very tired, especially at the end of the day. Usually this improves gradually over 12 to 18 months.
 

Sab talks about what he was able to do at the various stages of his recovery.

Sab talks about what he was able to do at the various stages of his recovery.

Age at interview: 65
Sex: Male
Age at diagnosis: 64
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And then for the next few days of being home was very, very emotional and because you can't do very much, you sit and everybody doing everything for you, they're running up and down and every time I moved, "What would you like?" my wife would stand up and [laughs] run for it. And then about three days later I thought, 'Well why don't you go to work and I'll be fine.' Because I knew that if she's not here I will do things for myself. And another friend of mine who also had a triple bypass a year earlier and he came to see me and talked to me about the thing I was going through is normal you know, that you will feel a pain, you don't want, you can't walk, you don't feel like to eat and so this is normal but it get better and, and support from families and friends I think that was the biggest help and encouragement to move on and do that. And then about four/five days later I started walking up and down in the house. It was so cold I couldn't go out for about six weeks and I was so desperate to go and walk. And then as the thing got better, I think about four or five weeks later I went to walk for forty five minutes and I went from [Village] to [Town] and back which is about just under three miles and I felt brilliant. And then I slept for two hours [laughs] because I was exhausted.
 
So from then on, you know, it got better and better and the next, my aim was to go and play golf and I remember going to check up in hospital and say, "Everything's fine we don't need to see you anymore, you are discharged from hospital," which was the more really a reassurance and give me more confidence. And I came home and just carried on, you know, as a normal life – walking and lots of walking and doing things, not sitting down and feeling sorry for myself and that's something you must learn to do. You know it's a wonderful world out there, you need to make effort and believe in yourself and you go and do things that you want to do.

 

For more on surgery for heart failure see our resources.


 

Last reviewed April 2016.
Last updated April 2016.

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