Left Ventricular Assist Device (LVAD).is a life-saving, battery-operated device that is used in heart patients who are at the end-stage of heart failure disease. Left Ventricular Assist Device is an implantable machinal pump whose one end is attached to the left chamber (left ventricle of the heart) of the patient awaiting a heart transplant.
It helps pump blood from the ventricle (lower part of the heart) and pushes it towards the aorta (a blood vessel that carries blood from the heart to the rest of the body). It basically performs the heart’s function and returns the patients (lying on death bed) to ordinary life by restoring the normal blood flow.
LVAD is implanted inside the body to your heart by connecting it to the protected wire placed outside the body. It is further attached to the power source and a control unit that allows a person to check the working of LVAD. Following are the primary purposes of Left Ventricular Assist Device;
- Bridge to transplant therapy (before a transplant): Patients awaiting a heart transplant can use LVAD until finding a heart donor. LVAD is a life-saving therapy that can restore heart failure, and sometimes remove the need for a heart transplant.
- Destination therapy (treat severe heart failure): In some cases, heart patients are unable to bear heart transplants due to age factors (65 years old or above), severe kidney disease, obesity, tobacco use, or diabetes. Therefore, LVAD can be beneficial in providing long-term treatment and improving patients’ lives.
- Bridge to recovery (temporary heart failure): In case of mild/temporary heart failure, your doctor or healthcare professional may recommend implanting LVAD to give support to your heart until it gets healthy to re-pump blood on its own.
Eligible Candidates for LVAD
LVAD is specially designed for people whose body organs are not properly working despite consistent use of medical therapy.
Risk of LVAD
It is commonly observed that there is always a risk associated with any type of surgery. Likewise, LVAD has certain potential risks such as;
- Infection
- Kidney failure
- Heart failure
- Respiratory failure
- Internal bleeding
- Blot clots
- hemolysis, or rupture of red blood cells
- Stroke
- Mechanical breakdown of the LVAD
- Death
Note: In case of severe infection, a doctor or health care professional may be required to remove the LVAD that can be life-threatening. However, the doctor must discuss with the patients about the potential benefits of using LVAD and the risk associated with it. So that the patient can carefully follow the doctors’ instructions.
Benefits of LVAD
LVAD is used to improve the efficiency of the heart and other body organ, such as kidneys. Moreover, it plays a significant role in increasing the survival rate of end-stage heart patients. It also enables the person to;
- walk smoothly for longer distances.
- spend quality life.
- get an improved emotional state of being.
Cost of LVAD
LVAD implantation is costly for a low-class family that includes the following expenses;
- The average LVAD implantation cost is around $175,000-$200,000.
- Monthly outpatient cost is $3,000- $4,000
Difference between LVAD and Pacemaker
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To decide the effectiveness and suitability of LVAD for a specific patient, the doctor will consider the following factors;
- Severity of heart failure
- Other related Patients’ medical conditions
- Working capability of main pumping chambers of the heart
- Social support from family and friends
- Patients’ mental health and ability to take care of a VAD
Working of LVAD
For effective working of LVAD, its one end is connected to the apex or tip of the left ventricle of the heart, while the other end is attached to the aorta (the main vessel that carries the blood to the rest of the body). First of all, blood flows from the heart into the pump and the sensor indicates the sufficiency of required blood in LVAD, after that blood moves into the aorta. Across the globe, there are different types of LVADs available consisting of the following parts;
- Heart pump: It is connected with the left ventricle of the heart that pumps blood to the rest of the body.
- Batteries: It provides power to the pump when the system is not plugged into an outlet.
- Driveline: A tube passes from the device through the skin that connects the heart pump to the external controller and power source.
- Controller: It gives alerts about the effective working of the entire system.
Preparation for the Implantation of LVAD
Before the implantation of LVAD, you should prepare yourself as per the given guidelines;
- Discuss with the doctor about the potential risk and benefits of LVAD implantation.
- Inquire from the doctor about the pre-surgery, during surgery, and post-surgery expectations.
- Stop taking edibles and liquid a few hours before surgery. Your doctor will tell you about the specific time of eating and drinking break.
- Take a break from medicines (using currently) as per doctors’ recommendations.
Bring the following items to the hospitals;
- Eyeglasses, hearing aids, or dentures.
- Personal care items, such as a toothbrush, a hairbrush or comb, and shaving equipment.
- Comfortable clothes.
Note: You must avoid wearing contact lenses, jewelry, nail polish, etc.
Expectations for Surgery
Pre-Surgery:
For LVAD implantation, you will be admitted to the hospital a few days before surgery to perform the following test and evaluation;
- Blood tests
- Chest X-ray
- Electrocardiogram (ECG)
- Echocardiogram
- Cardiac catheterization
During Surgery:
Cardiovascular surgeons, surgical nurses, and anesthesiologists will be present in your surgical team. LVAD implantation is an open-heart surgery that takes almost three or more hours. It includes the various steps such as;
- The anesthesiologist will give you medicines through an IV to make you sleepy and pain-free.
- After that, you will be connected to the ventilator that helps you breathe during surgery.
- In some cases, your heart may be stopped using medications and connected to a heart-lung bypass machine to smoothen the blood circulation.
- The surgeon makes an incision at the center of the chest to separate the chest bone to get a better view of the heart and place the device.
- Then surgeon attached a pump to the tip of the heart and pumped the blood to pass it to the aorta and rest of the body.
- Moreover, a cord is inserted through the skin to connect the mechanical pump, controller) and batteries outside your body.
Post-Surgery:
After the surgery, you will be shifted to the Intensive Care Unit (ICU) to monitor the regular functioning of LVAD and related complications. In ICU, you will get the required medicines and fluid to bring back to normal life. After a few days of stay in ICU, you will be shifted to a regular hospital room. And when you get stable and become habitual of LVAD, doctors will probably discharge you for home with the recommendation of rest, timely medicines, and various exercises to make you healthy and fit.
References:
- https://www.medicinenet.com/survival_rate_with_a_ventricular_assist_device/article.html retrieved on March 05, 2022.
- https://www.mayoclinic.org/tests-procedures/ventricular-assist-device/about/pac-20384529 retrieved on March 05, 2022.
- https://www.medicalnewstoday.com/articles/left-ventricular-assist-device#definition retrieved on March 05, 2022.
- https://www.mylvad.com/patients-caregivers/discuss-connect/forums/1459-lvad-failure retrieved on March 05, 2022.
- https://www.ucihealth.org/medical-services/cardiology/lvad retrieved on March 05, 2022.
- https://pubmed.ncbi.nlm.nih.gov/28017351/ retrieved on March 05, 2022.
- https://ctsurgerypatients.org/adult-heart-disease/left-ventricular-assist-device-lvad retrieved on March 05, 2022.
- https://www.webmd.com/heart-disease/heart-failure/left-ventricular-assist-device retrieved on March 05, 2022.
