Left Ventricular Assist Device (LVAD)

What is a ventricular assist device (VAD)?

The ventricular assist device (VAD) is a mechanical pump implanted inside the chest that takes over the heart’s pumping action when it fails. The device helps the heart do its job by pumping oxygen-rich blood around the body when needed. It is designed to help patients with heart failure.

A VAD is most frequently used in the left ventricle. When placed in the left ventricle, it is called a left ventricular assist device (LVAD).

In the case of end-stage heart failure, an LVAD can give the patient a new lease of life.

How it works

The LVAD is a battery-operated, mechanical device. It is surgically implanted inside a person's chest, at the tip (apex) of the heart’s left ventricle.

One end of the LVAD is attached to the left ventricle, the heart chamber in charge of pumping blood around the body. The other end is attached to the aorta, the main artery in the body. The LVAD pumps blood continuously from the left ventricle to the aorta, where it then flows to the rest of the body.

A fine cable called driveline extends from the pump, out through the skin. It connects the pump to a controller and a power pack worn outside the body. The pump is powered by batteries or electricity. Each device has specific carrying cases to allow the patient to move about freely with the equipment.

Tip: An average healthy adult needs the heart to pump 4 – 5 litres of blood every minute while at rest. The LVAD can pump 6 – 10 litres of blood per minute. With ample blood flow, the LVAD patient can perform normal activities of daily living independently.

When do you need an LVAD?

For patients with heart failure, the LVAD can help restore normal blood flow. This relieves symptoms of heart failure such as constant tiredness or shortness of breath.

By increasing blood flow to the body, the LVAD also improves the function of the kidneys, liver, brain and other organs.

LVADs are used for patients undergoing:

• Bridge-to-transplant therapy
  Bridge-to-transplant is a life-saving therapy that keeps people with advanced heart failure going while they wait for a heart transplant. The LVAD supports the heart function and allows patients to have a better quality of life with fewer symptoms until a donor heart becomes available.
• Destination therapy
  Destination therapy is for patients who are not candidates for heart transplants. Patients undergoing this therapy will continue to rely on an LVAD to support their heart function for the rest of their lives.
• Bridge-to-recovery therapy
  Bridge-to-recovery is where an LVAD is implanted for patients suffering from temporary heart failure. The LVAD therefore helps to give a heart time to "rest" and recover. The LVAD can be surgically removed if heart function recovers. However, in the vast majority of cases, advanced heart failure is a permanent and irreversible condition.

Benefits of LVAD

Patients who are LVAD candidates usually experience poor quality of life before the procedure. They often feel tired, weak and breathless.

An LVAD implantation can help patients to:

• Improve and reduce symptoms of heart failure, such as shortness of breath, excess fluid and fatigue
• Live a longer life than those who are treated with medical therapy alone
• Obtain a viable alternative to heart transplants
• Regain quality of life and satisfactory level of activity

Who should not implant an LVAD?

LVADs are not suitable for patients with medical conditions such as:

• Advanced liver disease
• Blood clotting problems
• Infections
• Kidney failure
• Lung disease

Your doctor will need to evaluate your condition to determine if an LVAD is suitable for you.

What are the risks and complications of an LVAD?

The procedure to implant an LVAD often requires open-heart surgery and has serious risks. However, an LVAD can be lifesaving if you have severe heart failure.

While there are risks with every surgery, steps are taken to manage or reduce those risks. Common surgical risks include:

• Bleeding
• Blood clots
• Infection

An LVAD implantation includes risks such as:

• Gastrointestinal bleeding
• Right heart failure
• Stroke

There are also risks involving device malfunction but these are not common. They are:

• Faulty parts that could cause the LVAD to stop working
• Power failure

How to prepare for an LVAD implant?

Your doctor will put you through a series of tests to determine your suitability for the LVAD implant. These include:

• Dental and psychosocial exams
• Diagnostic testing such as echocardiogram or right heart catheterisation
• General health screening which includes blood tests and chest X-ray

What to expect from LVAD surgery

Implanting an LVAD involves open heart surgery. You may need to be admitted a few days before the procedure to ensure that you are in good health for the operation.

Estimated duration

The procedure lasts about 4 – 8 hours.

Before the procedure

You will be placed under general anaesthesia and connected to a ventilator and heart-lung bypass machine. The role of the machine is to temporarily take over your lung and heart functions.

During the procedure

The surgeon will make an incision in your chest and open the chest bone (sternum).

To implant the LVAD, the surgeon will connect one end of the pump to your left ventricle and the other to your aorta, the biggest artery in the body.

The LVAD is then joined via a special cable to a computer controller and a battery that reside outside of your body.

After the procedure

Once the LVAD is properly implanted and tested, you will be taken off the heart-lung bypass machine. The LVAD will take over and pump blood out of the heart to the aorta.

Care and recovery period for LVAD

You will remain in the ICU for a few days after the procedure. You will receive fluids, nutrition and medication intravenously. Other tubes will drain urine from your bladder and fluids from your chest and heart. You may need to stay on a ventilator until your lungs are able to function normally.

Recovery period

Recovery time will vary depending on your state of health. After transferring out of the ICU, most patients remain in the hospital for at least 2 weeks.

Living with an LVAD

Patients living with an LVAD will have to make adjustments to their daily activities. You will not be able to:

• Sleep on your stomach
• Swim
• Undergo an MRI scan

Follow your doctor’s instructions closely so you can resume your normal activities. You are encouraged to:

• Make healthy lifestyle choices
• Monitor your health closely to ensure that you remain healthy

Return to optimal heart health and a good quality of life with our cardiac rehabilitation service.