Heart Failure Surgery: Types, Risks, Recovery and Outlook
Updated: 6 days ago
Written and medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026 · How we review
Quick Answer: What is heart failure surgery?
Heart failure surgery is a group of procedures, from catheter-based treatments to open-heart surgery and heart transplant, used when medicines and lifestyle changes have not controlled heart failure. Surgery can treat the underlying cause, improve how the heart pumps and ease symptoms. It does not cure heart failure, and risks include stroke, bleeding, infection and death. [1]
What the research says
Bypass surgery helped people with weak hearts live longer. In a trial of 1,212 people with coronary artery disease and an ejection fraction of 35% or less, followed for a median of 9.8 years, 58.9% of those who had bypass surgery plus medicines died, compared with 66.1% of those on medicines alone (Velazquez et al., N Engl J Med, 2016). [2]
A catheter-based mitral valve repair cut hospital stays and deaths. Among 614 people with heart failure and a leaking mitral valve, the repair lowered heart failure hospitalizations from 67.9% to 35.8% per patient-year, and deaths within 2 years from 46.1% to 29.1% (Stone et al., N Engl J Med, 2018). [3]
Catheter ablation for atrial fibrillation improved outcomes in heart failure. In 363 people with heart failure and atrial fibrillation, death or hospitalization for worsening heart failure occurred in 28.5% after ablation versus 44.6% with medicines, over a median of 37.8 months (Marrouche et al., N Engl J Med, 2018). [4]
Key takeaways
Medicines and lifestyle changes come first; surgery is usually considered when they are not enough. [1]
Options range from minimally invasive and catheter-based procedures to open-heart surgery and heart transplant. [1]
Surgery cannot cure heart failure, but it can improve symptoms, length of life and quality of life. [1]
Recovery can mean an overnight hospital stay or several weeks, depending on the procedure and your health. [1]
What is heart failure surgery?
Heart failure surgery is any procedure that treats heart failure or its cause when medicines and lifestyle changes have not worked well enough. [1]
In heart failure, also called congestive heart failure (CHF), the heart cannot pump enough blood to meet the body's needs. [1][5] Lifestyle changes and medicines are usually the first treatment, and they often work very well. [1]
Some people still need surgery. It can improve heart function and symptoms, and help you live a longer, fuller life. [1]
New to the condition? Start with our heart failure guide or our overview of congestive heart failure stages and treatment.
When is heart failure surgery needed?
Heart failure surgery is needed when a doctor wants to treat the cause of heart failure, help the heart work better, or offer lifesaving care for advanced heart failure that has not responded to medicines and lifestyle changes. [1]
Your healthcare provider may recommend surgery to:
Treat an underlying condition that caused heart failure.
Improve how well your heart functions.
Offer lifesaving treatment for advanced heart failure. [1]
What are the types of heart failure surgery?
The types of heart failure surgery are catheter ablation, implanted rhythm devices, coronary artery bypass surgery, coronary angioplasty with a stent, heart valve surgery, a left ventricular assist device (LVAD) and heart transplant. [1]
Procedure | What it treats | How it is done |
Catheter ablation | Abnormal heartbeats (arrhythmias) | Minimally invasive, through a blood vessel |
Implantable cardioverter defibrillator (ICD) | Dangerous heart rhythms | Wires through a vein, controller under the skin |
Permanent pacemaker | Unsteady heart rhythm | Wires through a vein, controller under the skin |
Coronary artery bypass graft (CABG) | Blocked or narrowed heart arteries | Open-heart or minimally invasive surgery |
Coronary angioplasty and stent | Blocked or narrowed heart arteries | Minimally invasive, through the groin or wrist |
Heart valve surgery | Leaky or narrowed heart valves | Catheter, minimally invasive or open-heart |
Left ventricular assist device (LVAD) | Advanced heart failure | Implanted pump with an external controller |
Heart transplant | End-stage heart failure | Surgery that replaces the heart with a donor heart |
Source: [1]
How does catheter ablation help heart failure?
Catheter ablation helps heart failure by treating arrhythmias, which are abnormal heartbeats caused by faulty electrical signals. [1] Arrhythmias can be both a cause and a symptom of heart failure. [1]
A thin tube called a catheter is passed through a blood vessel to the heart. It delivers heat or cold to precise spots, which isolates the tissue sending the abnormal signals. [1]
Learn more in our heart arrhythmia guide and our atrial fibrillation guide.
What implanted devices are used for arrhythmias in heart failure?
The implanted devices used for arrhythmias in heart failure are the implantable cardioverter defibrillator (ICD) and the permanent pacemaker. [1] You may receive one if you have an arrhythmia or have had a life-threatening event caused by an abnormal rhythm. [1]
Both devices have wires placed into the heart through a vein and a controller placed under the skin. The controller sends a charge to the heart to help regulate its rate. [1]
Device | What it does |
ICD | Detects an abnormal rhythm and shocks the heart back to a normal rate |
Permanent pacemaker | Sends steady pulses to keep the heart rhythm even |
Source: [1]
What is coronary artery bypass surgery for heart failure?
Coronary artery bypass graft (CABG) surgery reroutes blood around a blocked or narrowed heart artery using a blood vessel taken from another part of the body. [1]
In coronary artery disease, plaque builds up inside the arteries that feed the heart muscle. Over time, reduced blood flow weakens the muscle and its pumping power. [1] The surgeon attaches the graft above and below the blockage, either through open-heart surgery or a minimally invasive approach. [1]
See how bypass compares with stenting in our guide to coronary revascularization: PCI vs. bypass surgery, and read more about coronary artery disease.
How do coronary angioplasty and stenting work?
Coronary angioplasty and stenting open a narrowed or blocked heart artery from the inside through a minimally invasive procedure. [1]
The procedure follows four steps: [1]
A catheter is inserted into a blood vessel in the groin or wrist.
It is threaded to the narrowed or blocked artery.
A balloon is inflated to press the plaque against the artery wall.
A metal mesh tube (stent) is left in place to hold the artery open.
How does heart valve surgery help heart failure?
Heart valve surgery helps heart failure by repairing or replacing a valve that leaks or has become stiff and narrow, so the heart no longer has to work as hard. [1]
Valves keep blood moving forward between the heart's chambers. A leaky valve (regurgitation) lets blood flow backward, and a stiff valve (stenosis) restricts flow. Both add stress that can lead to heart failure. [1]
Some valve procedures use a catheter through a small cut in the groin. Others need open-heart surgery or a smaller cut in the chest. [1] Explore our heart valve disease guide, mitral valve disease and aortic valve replacement articles.
What is a left ventricular assist device (LVAD)?
A left ventricular assist device (LVAD) is an implanted pump that helps the heart's left ventricle push blood to the body when the heart can no longer keep up on its own. [1]
It connects to a controller worn outside the body. An LVAD can be a long-term treatment or a "bridge" while you wait for a heart transplant. [1]
When is a heart transplant needed for heart failure?
A heart transplant is needed when heart failure reaches its end stage and other options are no longer enough; it is the last treatment option. [1]
The surgery replaces your heart with a donor heart. Because donor hearts are in short supply, there are strict criteria to qualify. [1]
What happens before heart failure surgery?
Before heart failure surgery, your care team tells you how to prepare, then you change into a hospital gown, receive an IV line and, for most procedures, medicine that puts you to sleep. [1]
Your provider will explain:
What you can eat and drink.
Which medicines to take.
What to wear.
What to bring to the hospital. [1]
On the day, a nurse places an IV in your arm or hand for fluids and medicines. The nurse may also shave and clean the surgical site and cover you with a sterile drape. [1]
What happens during heart failure surgery?
During heart failure surgery, the care team reaches the heart through one of three approaches, chosen for your specific condition: open surgery, minimally invasive surgery or a catheter-based procedure. [1]
Approach | Where access is made | What to know |
Open surgery | Incision along the breastbone (sternum) | The traditional open-heart approach |
Minimally invasive surgery | Smaller incisions in the chest | Uses smaller cuts than open surgery |
Catheter-based procedure | Small incision in the groin | Usually quicker, often about 1 to 2 hours |
Source: [1]
Catheter-based approaches are becoming more widely available. [1]
What happens after heart failure surgery?
After heart failure surgery, you recover in the intensive care unit (ICU) or a regular hospital room, and your stay can last from one night to several weeks depending on the procedure and your condition. [1]
Some people need time at a rehabilitation facility to regain strength before going home. [1] Before you leave, your team gives you a detailed plan with follow-up appointments and self-care instructions. [1]
What are the risks of heart failure surgery?
The risks of heart failure surgery include death, stroke, bleeding and infection, and you may face added risks based on your age and medical condition. [1]
Your surgeon will explain your personal risks before the procedure. Share any questions or concerns about the operation and its risks with your surgeon. [1]
What is the outlook after heart failure surgery?
The outlook after heart failure surgery is favorable for many people, because surgery often improves symptoms and increases both length and quality of life. [1]
Heart failure symptoms tend to worsen over time and can limit daily life. [1] Your individual outlook depends on:
Your heart function and symptoms.
How successful the surgery is.
How well you care for yourself after surgery and follow your treatment plan. [1]
When should you call your healthcare provider about heart failure?
You should call your healthcare provider if your heart failure symptoms get worse or you notice new symptoms such as fatigue, weakness, shortness of breath or swelling. [1]
Heart failure is a long-term condition, so stay in close contact with your care team. [1] Report:
After surgery, follow your provider's care and follow-up instructions, and speak up about any problems with your recovery. [1] Read more about edema causes and treatment.
Conclusion
Heart failure surgery is usually an option when other treatments are not working and heart failure persists or worsens. [1] The choices range from catheter-based procedures to open-heart surgery, LVADs and heart transplant, and each aims to treat the cause, support the heart and help you live more fully. [1]
Your healthcare provider will help decide whether surgery is right for you. Ask what to expect before, during and after the procedure, and raise any concerns about your treatment plan and recovery. [1]
Want to protect your heart before and after treatment? Read our Heart Health: The Complete Plain-Language Guide for the daily habits and numbers that matter most, and bookmark our heart failure guide for your next appointment.
FAQ
What is heart failure surgery?
Heart failure surgery is a range of procedures, from catheter-based treatments to open-heart surgery and heart transplant, used when medicines and lifestyle changes have not controlled heart failure. It can treat the cause, improve heart function and ease symptoms.
Who needs heart failure surgery?
People with severe heart failure that has not responded to medicines and lifestyle changes may need surgery. It is also used to treat an underlying cause, such as blocked arteries or a faulty valve, or to offer lifesaving care in advanced heart failure.
Can surgery cure heart failure?
No, there is no cure for heart failure. Surgery can improve symptoms and help many people live longer, fuller lives.
Is heart failure surgery always open-heart surgery?
No, many heart failure procedures are minimally invasive or catheter-based. Catheter procedures usually reach the heart through a small incision in the groin, while open surgery uses an incision along the breastbone.
What is an LVAD?
An LVAD (left ventricular assist device) is an implanted pump that helps the left ventricle move blood to the body. It connects to a controller worn outside the body and can be a long-term treatment or a bridge to a heart transplant.
What are the risks of heart failure surgery?
The main risks are death, stroke, bleeding and infection. Your age and medical condition can add other risks, which your surgeon will explain before the procedure.
How long is the hospital stay after heart failure surgery?
The hospital stay ranges from overnight to several weeks, depending on the type of surgery and your medical condition. Some people also spend time at a rehabilitation facility before going home.
When should I call my doctor after heart failure surgery?
Call your doctor if your symptoms get worse or you notice new ones, such as fatigue, weakness, shortness of breath, or swelling in your feet, ankles, legs or abdomen. Also speak up about any problems or concerns during recovery.
How long is recovery after heart failure surgery?
Recovery depends on the procedure. Catheter-based treatments may take days to weeks, while open-heart surgery or a transplant can take months. Your care team will give you a personal plan.
What is a biventricular pacemaker?
A biventricular pacemaker, also called cardiac resynchronization therapy (CRT), is a device that helps both lower heart chambers beat together. This can help the heart pump better in some people with heart failure.
Related Reading
Heart Failure: Symptoms, Causes & Treatment Guide explains heart failure symptoms, causes and treatment options.
Heart Failure Medications: Types, Benefits, Side Effects, and How to Take Them Safely explains the main heart failure medicines and how they help.
Left Ventricular Assist Device (LVAD): How It Works, Benefits, Risks and Recovery describes how an LVAD pump supports a weak heart.
Heart Transplant: Who Needs One, Surgery and Recovery explains who needs a heart transplant and what recovery involves.
References
Cleveland Clinic. Heart Failure Surgery: Options, Outlook & Risks. Cleveland Clinic. Last updated September 15, 2022. https://my.clevelandclinic.org/health/treatments/12905-heart-failure-surgery
Velazquez EJ, Lee KL, Jones RH, et al. Coronary-Artery Bypass Surgery in Patients with Ischemic Cardiomyopathy. N Engl J Med. 2016;374(16):1511-1520. PMID 27040723. https://doi.org/10.1056/NEJMoa1602001
Stone GW, Lindenfeld J, Abraham WT, et al. Transcatheter Mitral-Valve Repair in Patients with Heart Failure. N Engl J Med. 2018;379(24):2307-2318. PMID 30280640. https://doi.org/10.1056/NEJMoa1806640
Marrouche NF, Brachmann J, Andresen D, et al. Catheter Ablation for Atrial Fibrillation with Heart Failure. N Engl J Med. 2018;378(5):417-427. PMID 29385358. https://doi.org/10.1056/NEJMoa1707855
American Heart Association. Heart Failure. American Heart Association (heart.org). Accessed October 30, 2026. https://www.heart.org/en/health-topics/heart-failure
Centers for Disease Control and Prevention. About Heart Failure. CDC Heart Disease. Last updated May 15, 2024. https://www.cdc.gov/heart-disease/about/heart-failure.html
Medical disclaimer
This article is for general education only and does not replace advice from your doctor or another qualified healthcare professional. Always talk to your care team about your symptoms and treatment options. If you have chest pain, severe shortness of breath or fainting, call your local emergency number right away.
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