Systolic heart failure occurs when the lower left chamber of the heart cannot contract forcefully enough to maintain normal blood circulation. As the ventricle pumps harder to compensate, the heart grows weaker and thinner. As the heart can’t pump as much blood, fluids back up, collecting in the upper chamber of the heart and in the lungs.

Diastolic heart failure occurs when a stiff or hardened left lower chamber (ventricle) can no longer fill with blood after the heart contracts. This reduces the amount of blood available to pump through the body. Over time, blood builds in the upper chamber of the heart (atrium) and back up into the lungs, causing fluid congestion and heart failure.

Bypass grafts create an alternative route around blocked arteries. High-risk patients who may be candidates for CABG include those with:

• Severe stable or unstable angina
• Extensive coronary artery disease
• High future risk of a cardiac event
• Myocardial infarctions (heart attack)

During CABG, surgeons create a bypass around obstructions or blockages in the coronary arteries by creating grafts with veins or arteries from the chest, leg or arm. The graft bypasses the clog and restores normal blood flow.

Sometimes a scar can form after a heart attack in the lower left chamber of your heart (ventricle). It's not uncommon for the scarred area to bulge over time and develop into an aneurysm. That aneurysm takes space in the ventricle, making the heart work harder to pump blood. Over time, the left ventricle may become larger than normal, causing further damage to the heart.

Left ventricular reconstruction surgery (or aneurysm repair surgery) allows cardiovascular surgeons to remove the aneurysm and/or scarred tissue to return the left ventricle to its normal shape, slowing the progression of heart disease.

As heart failure progresses, changes in the left ventricle can weaken the muscles that support mitral valve function. This can cause the valve to leak (regurgitate) and interfere with the heart's ability to pump blood properly.

Your Einstein surgical team will either repair or replace the leaking valve, depending on the degree of damage. Sometimes, the leaflets, or flaps, within the valve can be reshaped or patched. If the damage to the valve is too great, a mechanical or biological valve can be used.

Many mitral valve repair surgeries can be performed using minimally invasive techniques. Your surgeon will discuss the best option for you.

Ventricular assistive devices (VADs) are electromechanical pumps that can be implanted in patients with heart failure.

Left Ventricular Assist Device: A left ventricular assist device is a mechanical circulatory support implanted into the left ventricle of the heart to help restore pumping function. This device can act either as a bridge to transplant until a donor heart is available for transplant, or it can be the primary treatment for patients who are not eligible for heart transplant.

Percutaneous Temporary Left or Right Ventricular Assist Device (LVAD/RVAD): A percutaneous temporary left or right ventricular assist device can be used in cases of severe heart failure to restore pumping function. During a minimally invasive procedure, a small pump is delivered via catheter into the right ventricle. Temporary LVAD/RVADs are used as a bridge to transplant while patients await a heart donor.

Extracorporeal membrane oxygenation (ECMO): If you are undergoing a major heart surgery, have significant respiratory (lung) failure or are too sick to adequately pump blood throughout your body, ECMO may be needed to ensure proper blood oxygenation. This is done through connections made between a machine and a major artery and vein. The blood is removed from your body and artificially oxygenated, then put back in. This permits normal circulatory function while your doctor performs a complex procedure or dictates further plans for your heart condition.

Impella®: Your ventricles are the two chambers of your heart. Their ability to pump blood is vitally important to supplying your lungs and the rest of your body. If your ventricles are too weak to adequately pump blood, such as due to severe heart failure, artificial support may be necessary. The Impella® is a type of “ventricular assist device” that is placed through a small incision to artificially pump blood from your left ventricle to the rest of your body.

In certain situations, such as when the electronic signals of your heart are not running appropriately, it may be necessary to generate those signals externally to keep your heart pumping blood. This can be done with electrical leads placed directly into your heart muscle (epicardial leads) through a small open procedure.