Left ventricular assist devices (LVADs)

Overview

A mechanical pump called a Left Ventricular Assist Device (LVAD) is implanted in patients with heart failure. The gadget facilitates the heart’s lower left chamber, or left ventricle, pumping blood to the aorta and other parts of your body. It is a left ventricular assist device because it benefits your left ventricle.

The way an LVAD functions is by pumping blood into the aorta from the left ventricle. Your aorta supplies your entire body with oxygen-rich blood, so this is a crucial function. Your cells and tissues need a constant flow of oxygen to survive.

The pump unit of the left ventricular assist device is implanted by a surgeon inside your chest, at the base of your heart. Blood is drawn by the device and sent to your aorta via a tube.

Parts of an LVAD

A left ventricular assist device’s components are as follows:

• Pump: connects to a control system (controller) and driveline (cable).
• Driveline: Passes from the gadget through your stomach’s skin to the controller, a tiny computer, which is located outside of your body.
• Controller: This operates the pump. The controller provides messages and alarms to assist you in controlling the system.
• Power supply: Either an electrical outlet-plugged cord or rechargeable batteries to power the LVAD. Depending on the device, batteries can run it for up to 14 hours. You must change the batteries when their power is low.

A few distinct LVADs are available. The ideal option for you will be suggested by doctor based on your needs and health.

Reasons for undergoing the procedure

An LVAD is intended for patients in the last stages of heart failure. For those in waiting for a heart transplant, it serves as a bridge to transplantation. Those who are not eligible for a heart transplant can also benefit from it. Doctors refer to that as destination therapy.

Bridge to Transplant (BTT)

As you await a heart transplant, your health can deteriorate further. This could result in hospitalization, worsening symptoms, and harm to other organs like your liver, kidneys, and lungs.

Bridge to transplant (BTT) keeps you survive until you are able to get a heart from a donor. With the LVAD, your heart receives assistance, improving your quality of life and reducing symptoms. During your transplant, the gadget is taken out by a surgeon.

The length of time you get LVAD support before receiving a heart transplant depends on a number of factors, including your body size, blood type, and medical condition.

Destination Therapy (DT)

Those with heart failure who are not candidates for heart transplant surgery can receive destination treatment (DT). Medical professionals only take this into account for patients who have exhausted all other options (such as prescription drugs, dietary modifications, and cardiac surgeries).

For the remainder of your life, a left ventricular assist device enhances your quality of life by supporting the proper operation of your heart.

A left ventricular assist device may be a suitable treatment choice for you, depending on your medical condition, symptoms, body size, and the existence of additional medical issues. Your doctor will make this determination.

Before the procedure

Your doctor will assess you to see if a left ventricular assist device is right for you. There will be multiple tests throughout your medical exam:

• Chest X-ray
• Blood tests
• Electrocardiogram
• Echocardiogram
• Metabolic stress test
• Heart catheterization

Not every patient with heart failure should receive treatment with a left ventricular assist device. An LVAD may not be appropriate for you if you have:

• Permanent Irreversible kidney failure
• Severe lung or liver disorder
• Infections resistant to antibiotic treatment.
• Blood clotting problem

During the procedure

During the whole open-heart surgery, you will be put under general anesthesia and remain unconscious.

A doctor will:

• During surgery, use a heart-lung bypass machine to circulate blood that is rich in oxygen throughout your body.
• During the procedure, a breathing machine (ventilator) take over your breathing.
• To access your heart and attach the LVAD, the surgeon makes a cut down the middle of your chest and open your sternum. The surgeon may do a thoracotomy, or left side of the chest incision, depending on your circumstances.
• After inserting the left ventricular assist device, the incision is sealed.

A left ventricular assist device must be implanted, which can take four to six hours.

After the procedure

You will be taught how to operate the gadget and troubleshoot any emergencies before you leave the hospital. Before you leave for home, you’ll need to prove that you understand how to operate the equipment. Additionally, you must demonstrate your ability to care for yourself.

You will also receive guidance for your day-to-day activities, such as:

• Intake of food and drinks
• Taking a bath or shower
• Going back the sexual activity
• Taking prescription drugs. (This includes any anticoagulants you will have to take following implantation of an LVAD.)
• Swimming

To effectively manage your health at home, you should have essential tools on hand, including a precise scale and a thermometer. Certain individuals require home blood pressure monitoring. You should receive guidance on how to get in touch with your healthcare team in case of any concerns or questions.

Continuing to make healthy lifestyle choices before and after undergoing an LVAD implant procedure is of utmost importance. Here are some key steps to follow:

• Quit using tobacco products.
• Adopt a nutritious diet.
• Cease alcohol consumption.
• Refrain from using illegal substances.
• Incorporate regular exercise into your routine. Enrolling in a cardiac rehabilitation program is particularly valuable post-surgery. Keep in mind that there may be certain limitations, such as avoiding swimming, contact sports, and heavy weightlifting.

If you encounter challenges or require assistance in implementing these lifestyle changes, don’t hesitate to communicate with your healthcare providers. They can offer strategies to help you or connect you with additional resources for support.

Risks

Every surgery carries risk. Your doctor will talk to you about the risks that are specific to this surgery and how they can help reduce those risks.

Some of the most common risks are:

• Bleeding
• Infection
• Kidney injury
• Right heart failure
• Blood clots and stroke
• Problems with the left ventricular assist device’s function

Make sure you understand the possible hazards associated with the device and the reasoning behind the recommended procedure by asking questions of your doctor during your visit.

In the event that you are unable to express your wishes, advance directives can inform your doctor of your preferences for medical care.

Outcome

Since every person recovers differently, the length of your hospital stay will depend on your specific requirements. After LVAD surgery, a patient typically stays in the hospital for 14 to 21 days.

When you can return home will depend on your medical condition and rate of recuperation. Until you’re well enough to return home, you might need to spend some time in an intermediate care facility or rehabilitation center. Speak with your doctor so that you will be assisted in making arrangements if you believe you will require care at home.

Cardiac rehabilitation

Your doctor could suggest an individualized exercise and education regimen after receiving an LVAD. It’s known as the cardiac rehabilitation program. It teaches you how to take better care of your heart after heart surgery. Heart-healthy eating advice, emotional support, and supervised exercise are frequently included in the program.