left ventricular assist device (LVAD)
A left ventricular assist device (LVAD) is a pump to help patients with a weakened or failing heart that restores blood flow throughout the body. Many advances have been made to improve and miniaturize left assist ventricular devices (LVAD). LVADs are no longer large and cumbersome, requiring long-term hospitalization. LVADs are now small, electronically driven and extremely reliable.
By improving blood flow to vital organs, LVAD patients generally feel more energetic and are able to resume normal activities they were unable to do prior to receiving the device because of shortness of breathe or fatigue. Their small size means LVAD patients can engage in many recreational activities including golf, shopping, gardening, or just spending time with the family.
A patient should be evaluated for LVAD treatment if they have:
- ejection fraction (EF) less than 25%
- one heart failure admission in the past year
- decreasing tolerance to current heart failure medications (beta blockers and/or ACEI/ARB)
- persistent heart failure symptoms after resynchronization therapy
- increasing diuretic dose
- inability to walk one block without shortness of breath
- worsening kidney function
Many patients do not meet transplant criteria due to comorbid conditions or age but remain relatively fit and functional. Destination therapy offers long-term support with markedly improved prognosis and quality of life for patients ineligible for cardiac transplantation.
Bridge to Transplant
For some patients, LVADs are implanted as a “bridge to transplant,” increasing end-organ perfusion. The benefits are obvious. With good perfusion, renal and liver function remain optimized, avoiding cardiorenal and cardiohepatic syndromes. Nutritional status also does not decline, making the patients better surgical candidates.
what to expect
Today’s LVADs are smaller and easier to implant, thanks to ever-improving technology. The device is implanted under general anesthesia.
Before the procedure
Before the LVAD is implanted, you will most likely stay in the hospital for some time preparing for your surgery, during which time you may undergo other treatments to help improve your condition. Your doctor will monitor you to make sure you’re strong enough for the implant procedure.
After the procedure
When you wake up from your LVAD surgery, you’ll most likely be in the intensive care unit (ICU). The amount of time you’ll spend in the ICU and in the hospital can vary, depending on your condition before and after the surgery.
Education is a vital part of your post-surgical stay. After the procedure, you and your caregivers will learn how to manage the device, how to manage your condition through activities, medication and diet, and how to troubleshoot potential emergency situations. Before you’re discharged, you’ll have to show that you’ve learned all the key information.
Who can benefit from an LVAD?
An LVAD can be a life-extending option for end-stage heart failure patients who are no longer responding to medical management. While one in five people suffer left side ventricular failure, only a minority are candidates for LVADs. Your doctor will determine if an LVAD is right for you.
What are the risks of LVAD?
As with any surgical procedure, there are risks to the LVAD implantation procedure. These possible risks include respiratory failure, bleeding, kidney failure, stroke, blood clots, infection and failure of the device. There may also be other possible risks. When you meet with your doctor, please ask questions to make sure you understand why the procedure is recommended and what the risks are.
Living with your LVAD
After you’re released from the hospital, you may be able to return to most of your daily activities, including working and driving. Your doctor will tell you what activities are appropriate for you. You will most likely have regular appointments at a specialized clinic or hospital to monitor your LVAD and your response to it. Your doctor may also recommend a cardiac rehabilitation program to aid in your recovery.