Left Ventricular Assist Device (LVAD)
Left Ventricular Assist Device
If you have advanced heart failure, you may need a left ventricular assist device (LVAD). An LVAD is surgically implanted in the heart and takes over the work of the left ventricle, one of the heart’s two lower chambers.
An LVAD helps the heart pump oxygenated blood to the body when the heart isn’t healthy enough to do so. This can lessen the heart’s workload, reduce symptoms and keep a person alive longer.
Also called a mechanical circulatory support device, an LVAD can be used in several ways, including:
- A bridge to recovery. The LVAD is placed temporarily until the heart can pump effectively on its own.
- A bridge to transplant. The LVAD keeps the heart pumping until a donor heart organ is available.
- Destination therapy. The LVAD is used as a permanent implant to lessen symptoms for people who can't have other treatments, such as transplantation.
How does an LVAD work?
An LVAD is a battery-operated pump implanted inside the heart’s left ventricle or attached to it.
A tube runs from the LVAD pump to the outside of the body and connects to the LVAD’s control system and battery, worn on a strap or belt.
Inside the body, the pump pulls blood from the left ventricle, then pushes the blood into the aorta (the large blood vessel exiting the left ventricle). From there, the blood can reach the rest of the body.
What is LVAD surgery?
Before LVAD surgery, you may have tests to assess your heart, such as:
Left ventricular assist device implantation is performed during an open-heart surgery, which takes several hours in the hospital. Your surgical team will:
- Give you anesthesia through an intravenous (IV) in your arm so that you will sleep and be comfortable
- Connect you to a ventilator, which is a machine that helps you breathe
- Use medications to stop the heart, then connect a heart-lung bypass machine to do the work of those organs
- Make an incision down the middle of your chest and open the chest bone
- Implant the pump and connect it
- Thread a tube from the pump to the outside of the body to go to the control system
- Close the incision with staples and stitches, then place bandages over the wound
After LVAD surgery, you’ll likely receive IV medications to prevent infections and thin your blood. Other tubes may drain fluids from the surgical wounds and urine from your bladder.
You’ll be in the intensive care unit for a few days. When you’re ready, the health care team will take you off the ventilator and bypass machine. Most patients stay in the hospital or a rehabilitation facility for another one to three weeks.
During your stay, you will have several tests to ensure the device is working, including:
- Blood tests
- Echocardiograms
- X-rays
Your team will also teach you:
- How the LVAD works
- What the alarms mean
- How to take care of your system
- When to notify your health care team
- What to expect regarding future treatments, such as medications or transplantation
You’ll also work with physical and occupational therapists to build your strength and function. A dietician will give you guidance on maintaining a heart-healthy diet.
The Latest in Left Ventricular Assist Devices | FAQ with Dr. Ahmet Kilic
LVAD Surgery Risks
LVAD surgery can improve symptoms and prolong your life if you have advanced heart failure. Like all surgeries, there is some risk.
Bleeding complications are the most common problems after LVAD implantation. Some people experience:
- Hemolysis (rupture or destruction of red blood cells)
- Thrombosis (formation of blood clots, which can lead to stroke)
Your doctor will prescribe anticoagulant therapy (blood thinners) to help prevent LVAD bleeding complications.
Other possible LVAD complications include:
- Arrhythmias
- Infection, such as systemic infection or surgical site infection
- Pump failure or dysfunction
To identify complications early, your health care team will:
- Look for signs of infection, such as fever, chills, drainage from the wound or redness around the tube insertion site
- Monitor your heart to make sure you don't develop problems with heart rate or rhythm
- Perform tests during your hospital stay and follow-up visits to ensure that the pump is working properly
LVAD Surgery Success Rate
According to recent research, about 80%–85% of recipients of LVAD are alive one year after surgery. On average, 50% of patients remain alive five to 10 years after LVAD surgery. Recent improvements in LVAD technology are expected to improve these numbers.
Another important way to define LVAD success is quality of life. Most patients report that LVADs help them:
- Breathe better
- Conduct daily activities such as bathing, shopping and preparing food
- Do things they enjoy, such as spending time with family
- Sleep more soundly
Living with an LVAD
An LVAD can help you feel better and live longer. But learning to live with an implanted medical device requires some adjustments. After LVAD surgery, your health care team will help you get used to life with an LVAD.
Instructions may include:
- Always wear the LVAD control system to keep your heart pumping correctly
- Change the bandages where the LVAD exits your body, as instructed by your health care specialist.
- Charge the battery as instructed and keep a backup battery available.
- Don't drink alcohol or smoke.
- Don't get the control system wet. Do not swim. Ask your health care team when you can start taking baths or showers - this is often possible after the exit wound heals.
- Eat an LVAD diet by focus on heart-smart-eating.
- Sleep in a position that wont compress or tangle the tube. The best positions are on your back or on your side.
- Talk to your cardiologist if you plan to fly on a plane. You may need to take precautions.
- Talk to your doctor about LVAD exercise. The doctor may recommend certain activities, or precautions or guidelines. Mild or moderate activity may be possible.
- Tell all of your health care specialists about LVAD. You may need to avoid tests such as MRI's.
Can an LVAD be removed?
LVADs generally function well, are durable and last for many years. But if it fails to work, LVAD replacement surgery can be performed.
A person who no longer needs an LVAD can have a surgical procedure to remove it. For example, if the LVAD was implanted as a bridge to heart transplantation, the device may be removed during the transplantation.
