Treatment for heart failure can include lifestyle changes and medicines. But in some cases, surgery may be necessary to more effectively ease the workload of the heart. Among the most common methods practiced at Texas Heart Institute at St. Luke's Episcopal Hospital are coronary bypass surgery and transmyocardial laser revascularization.

Coronary Artery Bypass Graft

Coronary artery bypass graft operation (often abbreviated as CABG and pronounced "cabbage") is a surgical procedure that attaches a piece of vein or artery from another part of the body to the heart artery. Doctors most frequently use a vein from the patient's leg or an artery from the chest or wrist. By attaching this vein or artery to to the heart artery above and below an area that has been blocked or narrowed, the doctor creates a bypass around the blockage. Rerouting blood around the clogged arteries in this manner improves blood and oxygen flow to the heart.

During bypass surgery, the breastbone (sternum) is divided, the heart is stopped, and blood is sent through a heart-lung machine. Unlike other kinds of heart surgery, the chambers of the heart are not opened during bypass surgery. During the operation, a surgeon, cardiac anesthesiologist, surgical nurse, and blood flow specialist will all be present.

According to the National Heart, Lung, and Blood Institute (NHLBI), "Bypass surgery may be needed due to various reasons, such as an angioplasty that did not sufficiently widen the blood vessel, or blockages that cannot be reached by, or are too long or hard for, angioplasty. In certain cases, bypass surgery may be preferred. For instance, it may be used for persons who have both coronary heart disease and diabetes."

Some patients may require two, three or more bypasses, depending on how many coronary arteries are blocked. These cases are known as "double-" or "triple-bypass" surgeries. Most people stay in the hospital for about a week after bypass surgery, and this time almost always includes a few days in the intensive care unit (ICU).

After bypass surgery, patients should limit the fat and cholesterol in their diet and may start walking or swimming to regain strength. St. Luke's offers a cardiac rehabilitation program that many doctors recommend for their patients. The cardiac rehabilitation program at St. Luke's is an outpatient program to help people who have experienced a cardiac event or heart disease recover faster and return to full and productive lives.

Patients with an office job can usually go back to work in four to six weeks. Those who have more physically demanding jobs may need to wait longer. In some extreme cases, you may need to find a job that is not as physically demanding. A bypass also can close again; this happens in more than 10 percent of bypass surgeries, usually after 10 or more years, according to the NHLBI.

Transmyocardial Laser Revascularization

Transmyocardial laser revascularization (TMLR) is a treatment option for patients with angina who are not suitable candidates for more conventional medical intervention or surgery. The laser creates anywhere from 10 to 50 channels to provide blood flow from the left ventricle -- the heart's main pumping chamber -- into the ventricular cavity in the area of the heart suffering form a lack of oxygenated blood.

The TMLR procedure is performed under general anesthesia. They surgeon begins with an incision in the patient's left chest then, with access to the heart, uses a laser to create multiple narrow channels through the wall of the left ventricle into the ventricular cavity in the area of the heart. The inside surface of the channels develop a smooth, permeable membrane that allows blood to flood to heart muscle. The exterior surface opening of the channel is sealed off as blood coagulates and scar tissue closes the hole. The TMLR procedure usually takes about two hours.

Sometimes, one part of the heart can be treated with bypass surgery while another part of the heart can be treated with TMLR. In these cases, TMLR and bypass surgery are done at the same time.

Recovery requires between three to four days in the hospital. After the procedure patients patients will have to rest and limit their activities. St. Luke's offers a cardiac rehabilitation program that many doctors recommend for their patients. Patients with an office job can usually go back to work in four to six weeks. Those who have more physically demanding jobs may need to wait longer.

Most of the time, the symptoms of coronary artery disease and angina get better after TMLR, but it may take three months or more to see improvement.