Left Ventricular Assist Devices (LVAD): What to Know

A left ventricular assist device (LVAD) is a surgically implanted pump used in the treatment of end-stage heart failure. It is a type of mechanical support device that helps provide blood flow when the heart is too weak to adequately meet the body's needs.

LVADs may be recommended for people awaiting heart transplant or they can be implanted long term. While they are not a cure, they can improve survival and quality of life.

While some LVADs are meant only for temporary use in the hospital, this article will focus on durable LVADs, which are meant for long-term use. Read on to learn more about the different types of LVADs, how they work, benefits, complications, and what's involved in LVAD surgery.

Doctor preparing for surgery

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How Does a Left Ventricular Assist Device Work?

LVADs are pumps that are inserted into the main chamber of the heart (the left ventricle) and connected with a tube to the large blood vessel leaving the heart (aorta) to provide blood flow to the body. Blood flows into the LVAD pump from the left ventricle and is pumped out through a tube into the aorta and to the rest of the body.

Durable LVADs are powered by portable batteries that are worn outside of the body. The pump itself is connected to batteries and an electric controller by a driveline, which exits the body through the skin of the abdomen.

Types of LVADs

“Left ventricular assist device” is a broad term for any mechanical support device placed in the left ventricle to help pump blood. Certain types of LVADs are only meant to be used temporarily while in the hospital. These are implanted in the groin and connected to a large machine outside the body.

Temporary LVADs like these are designed to be in place for up to 10 days to a month, depending on the specific device. A person cannot leave the hospital with one of these devices in place.

Durable LVADs, however, are designed to be portable and can be used at home. Durable LVADs may be implanted for people awaiting a heart transplant, a strategy known as "bridge-to-transplant," or they may be implanted long-term without a plan for transplant to improve survival and quality of life.

Durable LVADs were first approved in the 1990s, and since then, there has been great technological innovation in these devices. LVADs nowadays are smaller and use magnets to provide continuous flow while reducing friction and risk of blood clots. These can remain in place for many years. The two available devices are the HeartMate III and HeartWare.

Your advanced heart failure team will help determine the right device and strategy for you.

Who Are LVADs For?

LVADs are for treatment of advanced heart failure. People who may get an LVAD may have:

  • Heart failure symptoms that significantly affect their daily life
  • Multiple hospital admissions for heart failure
  • Inability to tolerate or poor response to medical therapies for heart failure

There are other considerations, such as the size of the left ventricle and the ability of the patient to perform dressing changes and care for the device, in addition to whether they take blood thinners. A multidisciplinary team of heart failure specialists, cardiac surgeons, social workers, and other clinicians helps determine whether the therapy has a good chance of success.

What Are the Benefits of an LVAD?

LVADs improve symptoms, quality of life, and survival in people with advanced heart failure. In advanced stages of heart failure, people may experience symptoms like significant fatigue and shortness of breath and be unable to perform daily activities. They may require frequent hospitalizations to help manage their condition. LVADs can help with these symptoms by providing more blood flow to the body.

LVADs also improve survival, allowing people to live for many years beyond what is expected with their condition, and often allow them additional time in which to receive a heart transplant.

How Long Can Someone Live With an LVAD?

Survival rates depend on many factors, including the type of device, need for treatment, and the type of strategy (bridge-to-transplant vs. destination therapy), but for current generation LVADs, studies have determined survival rates as follows:

  • One-year survival rate of about 84%
  • Four-year survival rate of about 50%

These numbers have improved with advancements in LVAD technology and heart failure therapy. Some people are still alive 15 years after LVAD placement. This is compared to an approximate two-year survival rate of 50% in people with advanced heart failure who do not receive an LVAD or heart transplant.

What Are the Risks of Getting an LVAD?

While LVADs can improve survival and quality of life, there are several risks to know about. LVADs carry a risk of the following complications:

When to Contact a Healthcare Provider About Complications

Your advanced heart failure team will follow you closely after LVAD implantation. It's important to discuss any concerns regarding your LVAD with your team. Talk with your healthcare provider if you have any concerning symptoms, or develop any of the following:

  • Signs of infection, such as fever, redness, pain, or bleeding around the driveline site
  • Chest pain
  • Shortness of breath
  • Swelling
  • Neurological signs such as weakness, facial droop, difficulty speaking, or confusion


How to Prepare for LVAD Surgery

If your cardiologist recommends placement of an LVAD, you will meet with many people to discuss what to expect with an LVAD. Getting an LVAD is life-changing. It can improve symptoms drastically but also requires being connected to a machine that requires special care and attention, taking medication like blood thinners, and caring for a surgical site.

You might think of it as trading one disease (advanced heart failure) for another condition that requires frequent visits to healthcare providers, medications, and specialized care.

Members of a specialized team will meet with you and any family members or caregivers who may be involved in helping you recover and care for an LVAD. Deciding to get an LVAD is not a decision that is made overnight, and you will be given a lot of education about LVADs and how to care for them and yourself before surgery.

To help prepare, make sure to ask any questions to your healthcare team and bring up any concerns you have. Follow medication instructions and attend all clinic visits leading up to surgery.

What Happens During an LVAD Procedure?

LVAD surgery is a major open-heart surgery that requires a cardiac surgeon to cut open the chest to implant the device. You will be given general anesthesia so that you are sleeping and do not feel pain during the procedure. You will be placed on a ventilator (breathing machine) for the surgery.

The heart surgeon will place you on cardiopulmonary bypass, a machine that pumps blood while the heart is operated on. The surgeon then implants the LVAD, attaching the components to the heart and the aorta. The driveline that connects the internal pump to the external controller and battery pack is tunneled through the skin below the ribs.

What Happens After Getting an LVAD?

After getting an LVAD, you will receive care in a specialized intensive care unit and you can expect to stay in the hospital for a couple of weeks while you recover. You will be connected to many wires and tubes.

A breathing machine will remain in place for some time, This can range from as little as six to eight hours after surgery to much longer, depending on your breathing status. Medications and fluids will be given to help stabilize your blood pressure. Your heart rhythm, vital signs, and urine output will be closely monitored.

Heart surgery takes a toll on the body and physical and occupational therapists will work with you to help you regain strength and teach you how to maneuver with the LVAD. Throughout your hospitalization, you will continue to receive training about caring for your LVAD and the incision site. By the time you are ready to leave the hospital, you and any caregivers involved are comfortable managing the device.

How Long is Recovery After Receiving an LVAD?

Recovery after LVAD implantation can take several weeks. It is not only a major heart surgery, but the initial recovery time in the intensive care unit can lead to deconditioning of (a loss in fitness in) your muscles. You can expect to spend at least a few weeks in the hospital, during which time you will work with physical therapists as you regain strength and work on mobility. You may also participate in a cardiac rehab program with exercise prescription and counseling.

Summary

LVADs are a type of surgically implanted heart pump for certain people with end-stage heart failure. With durable, or long-term LVADs, a small pump placed in the heart connects to a portable electric controller and battery pack that must be worn at all times.

Durable LVADs aren't a cure, but they improve symptoms, quality of life, and survival in people with advanced heart failure. They require special care and follow-up care with an advanced heart failure specialist, who will ensure appropriate functioning of the device and monitor for complications like infection, bleeding, and blood clots.

11 Sources
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By Angela Ryan Lee, MD
Angela Ryan Lee, MD, is board-certified in cardiovascular diseases and internal medicine. She is a fellow of the American College of Cardiology and holds board certifications from the American Society of Nuclear Cardiology and the National Board of Echocardiography. She completed undergraduate studies at the University of Virginia with a B.S. in Biology, medical school at Jefferson Medical College, and internal medicine residency and cardiovascular diseases fellowship at the George Washington University Hospital. Her professional interests include preventive cardiology, medical journalism, and health policy.