What is a Left Ventricular Assist Device (LVAD)?
An LVAD, also known as a left ventricular assist device, is a mechanical pump that is surgically implanted in patients suffering from heart failure. Its purpose is to assist the left ventricle in pumping blood from the heart to the rest of the body through the aorta.
When is a Ventricular Assist Device (VAD) used?
Ventricular assist devices (VADs) are implanted to improve blood flow in cases where medication and other treatments have proven ineffective in managing severe heart failure.
Does an LVAD take the place of your heart?
No, a left ventricular assist device does not replace the heart entirely. Instead, it works in conjunction with the patient's own heart by receiving blood from the left ventricle and delivering it to the aorta. This collaborative effort helps the left ventricle effectively pump blood throughout the body.
Why am I being recommended an LVAD?
Your doctors believe you have advanced heart failure, a condition where your heart cannot pump enough blood to meet your body's needs. Symptoms include weakness, fatigue, swollen feet, and shortness of breath. Medications and lifestyle changes can initially help, but heart failure usually worsens over time. As it progresses, symptoms increase and other organs may fail, such as the liver and kidneys.
You're being asked to consider a ventricular assist device (VAD) implantation. Without it, the risk of death from heart failure in the coming months is high. Before the surgery, it's crucial you and your family understand the options, benefits, risks, and expectations of having a VAD. You must agree with the treatment plan and be willing to follow the guidelines.
How does the LVAD work?
There are several distinct LVAD options available, and your physician will recommend the most appropriate one based on your specific requirements and medical condition.
The implantation of the LVAD occurs during open-heart surgery. While the specific components may vary depending on the device, there are typically four fundamental components:
The pump unit is surgically placed within the thoracic cavity, precisely at the apex of the heart, where it receives blood. Subsequently, a conduit facilitates the transfer of this blood from the device to the aorta, the major artery responsible for systemic circulation. The LVAD operates by continuously propelling blood from the left ventricle to the aorta, thereby augmenting cardiac output.
The pump is interconnected with a driveline (a cable) and a control system (a controller). The driveline traverses from the device through the integument of the abdomen, terminating at the external controller, which functions as a compact computing device. The controller governs the pump's operation and provides pertinent notifications and alerts to facilitate optimal system management.
To ensure uninterrupted functionality of the LVAD, a reliable power source is imperative. This may encompass rechargeable batteries or a cord that can be connected to an electrical outlet, thereby ensuring sustained power supply for the LVAD.
What is the evaluation process?
The evaluation process helps determine if a VAD is right for you. It involves blood tests, consultations, and assessments by a team of experts including Cardiologists, Heart Surgeons, Social Workers, Chaplain, members from the Palliative Care Team, and VAD Coordinators. Your support system, medical compliance, and financial considerations are evaluated. Your readiness, willingness, and ability to participate in post-surgery care are also assessed. Any medical concerns are addressed before VAD implantation. After evaluation, the VAD Team decides if you meet the criteria for a heart pump. You can choose to be re-evaluated later or repeat tests if your condition worsens.
Why would I not be a candidate for a Ventricular Assist Device (VAD)?
VADs improve blood flow and are suitable for health issues that benefit from enhanced circulation. However, implanting a VAD requires major surgery and ongoing management. There are cases where a VAD may not be the best choice, such as:
- Medical issues that may pose risks for surgery include: low chances of surviving VAD surgery, high lung artery pressures, problems with existing heart valves, small left ventricle, damaged aorta, blood clotting disorders, poor food intake, current pregnancy, or high infection risk.
- Other non-cardiac conditions that increase VAD therapy risk include cancer, kidney disease, liver disease, severe lung emphysema, leg or brain artery blockages, uncontrolled diabetes, and frailty.
- Possible limitations to the patient's long-term VAD care include impaired thinking (dementia or psychiatric disorders), substance abuse, non-adherence to medical recommendations, lack of social support, or financial hardship.
What are my other options?
If you are not eligible for a VAD or decide against it, you will receive standard medical care. The reason for considering a VAD is that your current treatments are not effectively managing your heart failure. Without a VAD, your condition is likely to worsen, increasing the risk of death in the coming weeks to months. Patients with advanced heart failure who decline VAD surgery often turn to palliative care and hospice for end-of-life support.
What will the VAD surgery be like?
The VAD implantation surgery involves a 6-12 hour open-heart procedure. An incision is made on your chest, granting access to your heart. Under general anesthesia, a breathing tube is inserted, and in some cases, a heart/lung machine is used. The VAD is placed below your heart, connected to pump blood alongside your heart. After the surgery, you will be transferred to the ICU for recovery.
What about my medical care post-discharge?
Our team, including your surgeon, cardiologist, VAD coordinators, nurses, nurse practitioners, physician assistants, pharmacists, therapists, and social workers, will provide daily follow-up. They will monitor your recovery and help you adjust to life with your VAD. Preparing for discharge is crucial, requiring physical strength and the ability to care for your VAD. Most patients return home, while some may live with a caregiver or need short-term rehabilitation. A home health nurse may assist with your care if necessary.
What do I need to learn before going home with a VAD?
During your hospital stay after surgery, you and your family will be trained by a VAD coordinator and other healthcare professionals on how to care for the VAD and yourself at home. It is important that you and your caregiver(s) can manage the VAD, understand its functioning, troubleshoot problems, and care for the driveline exit site. A caregiver(s) must be present during your hospital stay to learn how to care for you and your VAD before discharge. Your home must have consistent electricity and phone services, so timely payment of utility and phone bills is crucial.
How often do I see my doctors after I go home?
After your discharge, you will have follow-up appointments at the clinic with your Advanced Heart Failure/VAD/Transplant Team. They will collaborate on your care and treatment decisions. Initially, you will visit every alternate day for the first week, with less frequent visits as your health improves. Once stable, follow-up appointments may be scheduled every 2-3 months. Alongside consultations with a Heart Failure Cardiologist, regular testing such as blood tests, electrocardiograms, echocardiograms, and ICD checks will be conducted to monitor your health.