Surgical Options & Devices

• Surgical options and devices pt1:

  • A number of devices are available to individuals with CRF depending on their severity and therefore need.
  • All devices require a degree of surgery to a greater or lesser extent
  • Obviously, as previously stated any cause of CHF due to a correctable structural defect will be surgically addressed as soon as possible (i.e. before structural remodelling of the heart occurs if possible)
  • Structural defects could include stenosis or incompetence of cardiac valves, rupture of the septum, coarctation of the aorta etc
• Surgical options and devices pt2:

  • Arrhythmias are common in CHF and more common the severer the condition is
  • Consider that normally electrical activity flows across the myocardium from myocyte to myocyte or via high-speed conduction pathways in an organised co-ordinated manner within a very tight time frame
  • In CHF where structural changes have occurred remodelling produces an irregular cardiac muscle mass which disrupts electrical flow
• Surgical options and devices pt3:

  • Furthermore, hypertrophy of cardiac muscle produces isolated islands of fibrosis (scar tissue) which is non-conductile, and therefore disrupts electrical flow
  • In addition, as already acknowledged although there are very many causes of CHF the prime cause is AMI secondary to ACS (atherosclerosis)
  • Where an AMI has occurred, cardiac muscle is replaced by a significantly sized “sticking plaster” of fibrotic tissue, disturbing electrical flow