Left Ventricular Assist Device (LVAD) is an electromechanical circulatory support system with an implantable pump that assists lower chambers of the left ventricle. Powered by battery, it assists an ineffective left ventricle in pumping out the blood and supplying it into aorta – the largest artery that facilitates oxygen-rich blood supply to all major organs.
Ventricular Assist Devices are designed to support either the right ventricle (RVAD), left ventricle (LVAD) or both ventricles (BiVAD).
LVAD is recommended for those patients with a weak and failing left ventricle especially after suffering from myocardial infraction (a heart attack in layman terms), as a support system post-cardiac surgery in certain cases and most importantly for those patients with an end stage heart failure.
LVADs are surgically implanted, to partially or fully support the functioning of a failing heart. In most cases, the use of LVAD could be short term till the patient gets a donor but few patients may have to use it for longtime, depending on their condition.
The need for experimenting with successful heart implantations occurred in the second half of the twentieth century, after coronary heart disease was reported as one of the leading causes of death in richer nations.
The first ever successful implantation of LVAD was performed by Dr Michael E.DeBakey, a Lebanese-American Cardiovascular surgeon in 1966, on a 36-year-old woman, which was able to provide mechanical support assisted by an external circuit for around 10 days, post-surgery.
Subsequently, Dr William F Bernhard of Boston’s Children Hospital conducted the first ever long term implantation of LVAD in 1988, as a part of National Institutes of Health research contract.
LVAD became popular in 1990s and over the years, this device underwent several modifications. The latest LVADs, often referred as second generation VADs are designed to provide perpetual flow pumps, in smaller sizes with optimum reliability.
Who Needs LVAD?
Cardiac surgeons recommend LVAD to those patients with a fully damaged left ventricle that is unable to pump blood efficiently.
In many cases, it could be a short term arrangement till the patient gets a heart donor and it is called bridge-to-transplant therapy.
However, in few cases LVAD is recommended for those patients as a permanent solution, if an option for a heart transplant gets completely ruled out.
Bridge –To-Transplant Therapy:
Bridge-To-Transplant therapy is applicable for those patients awaiting a transplant and for preventing further damage to the heart and other organs, till the donor becomes available. In other words, LVAD takes off some burden from your heart, improves the quality of life, as it pumps oxygen-rich blood.
In few cases it can even can dispose the need for a heart transplant.
Destination Therapy (DT) is for those patients with a heart failure but are not fit for heart transplant surgery. It is recommended only for those patients when all other treatment options such as drugs, lifestyle changes and other heart procedures have failed and proved ineffective in managing heart failure.
The main aim of DT is to serve as a long-term treatment, which can lengthen and promote patient’s longevity even while improving heart function.
Destination therapy may not be a preferable treatment option for few patients with blood clotting disorders, chronic kidney failure, liver disease, respiratory disease or severe infections that cannot be cured with antibiotics.
Evaluation For LVAD
To determine if a patient would need an LVAD is done after running various medical examinations, evaluations and tests, reviewed by the cardiologist or the surgeon. The tests may include electrocardiogram, X-ray, blood tests, echocardiogram, metabolic stress test, heart catheterization and other evaluations.
How Does An LVAD Work?
LVAD is a battery operated device that assists an ineffective left ventricle in pumping out the blood and supplying it into aorta – the largest artery that facilitates oxygen-rich blood supply to all major organs.
Different LVADs are available and doctors suggest the best suited one based on the patient’s medical conditions.
The implantation of LVAD is done through an open heart surgery and it is performed under general anesthesia and the surgery duration can last up to 4-6 hours.
During surgery, the pump is positioned in the chest, device is implanted by the surgeon into the apex of the heart where blood is received. A tube then distributes this blood from the device to the aorta, for supplying it to the rest of the body.
The pump can also be attached to a driveline (cable) and control system that passes from the device through the skin onto the patient’s abdomen to the controller- a small computer outside the body. This controller runs the pump and deliver messages and alarms that aids patients in operating the system, post LVAD.
In the course of the procedure, a heart–lung bypass machine may be used in circulating blood throughout the body. A ventilator supports breathing during the surgery and opening is closed once the LVAD is placed.
Recovery time depends upon individual patient’s conditions and need, generally a patient would require to stay in the hospital for 2-3 weeks post implantation.
Benefits of LVAD
LVAD surgery improves the blood flow and circulation thereby promoting the functioning of the kidneys, liver, brain and other vital organs, enhancing the patient’s strength to involve in cardiac rehabilitation and also enabling the patient’s discharge as early as possible from the hospital.
Life expectancy of the patients with advanced heart failure with an LVAD implantation prolongs remarkably than those who are on other medical treatments.
The quality of life improves and patients after LVAD procedure take part actively in activities that were not possible before implant.
LVAD can significantly improve and lower symptoms like shortness of breath, fluid accumulation, and fatigue.
The risks of LVAD
Risks are associated with all surgeries and LVAD is no exception. Your surgeon will talk about explain certain risks involved with LVAD surgery and may advise certain necessary precautions.
Post-surgery patients may have many follow-up weekly visits initially and would later will reduce to monthly visits. The follow up visits ensure LVAD is functioning as it should be and patients are doing well.
After completion of first year the patients will have lesser visits. If a patient is awaiting a heart transplant, the review is suggested at least once in three months.
The following guidelines should be adhered by the patients with LVAD for ensuring better quality of life.
Patients will be provided with a detailed and comprehensive educative session to ensure safety and proper use of the device.
Patients should learn to manage the device and to handle it well in case of technical error or during emergency situations.
Patients will be also be given adequate information about daily activities including swimming , bathing and restarting sexual life, medications to be taken, diet plan and follow up reviews.
Ways To Stay Healthy Post LVAD
It is very potent to follow a healthy lifestyle modifications before and after the LVAD procedure. Quit smoking, eat healthy, stop drinking alcohol and stick to moderate exercise. Most importantly, keep up with your doctor visits.
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