Left Ventricular Assist Device or LVAD is a mechanical support device which helps the heart of a patient pump blood from the left ventricle (lower left chamber of the heart) to the Aorta (an artery that supplies blood from the heart to other organs of the body).
Even though the VAD can be implanted in either of the ventricles but most commonly it is implanted in the left ventricle.
For heart failure patients, LVAD is a support system that helps them to live normal lives. Usually, even normal tasks can become extremely difficult for advanced-stage heart failure patients.
The LVAD medical device helps to maintain the constant blood flow in the body for normal functioning of the lungs, kidneys and other organs of the body.
The process to implant an LVAD machine requires open-heart surgery which can include some risks which are common with all open heart surgeries and manageable by experienced LVAD surgeons.
However, the device, LVAD, is a lifesaving instrument for advanced heart failure patients and the risks of surgeries are far lower as compared to extending life span of an end stage heart failure patient.
The recent data of 1000 LVAD patients presented in the USA confirmed a high 5 year survival rate which is as good as a heart transplant survival rate.
Unlike a completely artificial heart, LVAD does not replace the heart, but rather it only allows the heart to perform its functions more effectively and without much pressure.
The system will help postpone the need for a heart transplant. Hence, it helps keep the patient alive before an effective donor is identified.
For patients undergoing a heart transplant, this is a life-saving LVAD Treatment in India. Patients use LVAD until they find a donor.
The LVAD in some cases will restore the failing heart, removing the need for a transplant. Learning more about LVAD vs heart transplantation, The FDA approved the LVAD system in 2008 for patients undergoing a heart transplant.
While patients wait for their transplantation, their heart and health condition may begin to worsen, leading to hospital admission, increased complications, and damage to other organs such as the kidneys, liver, and lungs.
When a patient becomes a heart transplant recipient, bridge-to-transplant treatment can help the patient survive before a donor ‘s heart is available.
The LVAD protects the heart and encourages the patient to have a better quality of life and fewer complications, and is then extracted at transplantation.
The amount of time you receive support from a VAD before heart transplantation varies, which depends on your condition, source of blood, and size of the body. Currently, FDA approved for BTT are the Heartmate III, HVAD, and Heartmate II.
Many patients do not require a heart transplant. In this situation, patients can use an LVAD to seek long-term care which can extend and enhance the lives of patients.
In 2010, the FDA approved the patient-destination therapy (DT) LVAD system for heart failure patients who were not eligible for heart transplant surgery.
It is only considered for patients when all other treatment options, such as medicine, lifestyle changes, and cardiac LVAD operations, have been tried and have not been effectively managed.
DT’s goal is to help the heart function of the patient and enhance the quality of life for the remainder of the patient’s life.
The doctor will decide if destination therapy is an appropriate treatment choice for you, based on your medical condition, LVAD complications symptoms, body size, and other conditions.
For certain patients with blood clotting disorders, permanent kidney failure, serious liver disease, severe lung disease, or infections that can not be controlled with antibiotics, destination therapy may not be the best treatment option.
Currently, FDA approved for DT are Heartmate III, HVAD, and Heartmate II.
A heart has four chambers including ventricles and atrium that circulate the blood in the body.
Heart failure is usually caused when muscles in the left ventricle don’t pump blood as well as they should. This leads to an improved blood supply to organs.
LVAD is implanted in a patient via open heart surgery. Normally, an LVAD device consists of four different parts namely a pump, a cable, a controller and a rechargeable battery.
There could be some variation in LVAD devices as latest lvad technology is evolving day by day. The basic model of LVAD is as simple as described above.
An LVAD is a treatment option for heart failure patients.
It can be used to support the heart of many patients waiting for a donor’s heart or heart transplant which becomes a challenge in many cases.
LVAD pumps the blood instead of the left ventricle to the aorta and it can be used either as bridge to transplant or destination therapy which essentially means that the recipient of LVAD will live many years without even a need for heart transplant.
It is decided by the doctor if LVAD could be a better option for a specific patient depending on their overall health and severity of heart conditions.
Before getting an LVAD implanted, the patient must undergo several tests which will make sure if the patient is suitable for LVAD or not.
Some of the tests that can be done to evaluate the condition of a patient are:
These tests can be prescribed by a cardiologist or surgeon to get essential information about the normal functioning of the heart.
These tests help the doctor to analyze if LVAD is the right treatment option for the heart failure patient or not.
Left ventricular assist devices can be used to benefit patients with a broad variety of chronic heart problems. It includes:
LVADs treat patients with advanced heart failure conditions. The patients include the ones :
The real responsibility starts after getting the criteria for LVAD implanted into the patient.
The doctor or the medical staff will educate the patient as well as the guardians or family of the patient about the working of the LVAD.
They will teach you about how-to manage the device and what to do to troubleshoot any emergency.
The patient will be asked to visit the medical professionals weekly which will reduce to monthly follow-up visits.
The patient will be able to live a normal life after the implant but there will be few restrictions on heavy activities such as running, swimming, diet and medications etc.
Some of the few lifestyle changes that a patient is required to make are:
If you have any allergies or other medical conditions, consult your doctor before taking any medications.
As there is risk in every surgery, the same goes for LVAD surgery in India. There could be a few complications that may interfere with the patient’s life. Some of these risks are given below:
These risks may not affect every patient as every patient has a different case.
LVAD devices are tested, and FDA approved which have extremely rare chances of side effects.
Previously, LVADs were used as a ‘bridge-to-transplant’ before a corporeal donor was available.
These LVADs were costing in the range of USD 30.000-60.000. However, these days, LVADs are also available at Destination Therapy (DT) which acts as a heart for the rest of life. The costs of DT LVADs could be almost double of the former.
LVAD devices assist in many ways by providing support to the heart to pump blood in the body. It helps in increasing the blood flow in the body which eventually improves the functioning of kidneys, lung, liver, brain etc.
Some other benefits of LVAD are:
1. Increased life expectancy – By using LVAD to assist the heart to pump blood, the patient also increases life expectancy.
It increases the life expectancy by increasing the ability of the other organs to work properly. There are as many as 35000 LVAD implanted till date worldwide and there are patients who are on follow up even after 8-10 years of surgery.
2. Increased quality of life – It also increases the strength and potential to do normal everyday tasks of a heart failure patient.
Hence, it helps the patient to perform the activities they were not able to do before the LVAD implantation. The only limitation after LVAD is that the patient is suggested to not take swimming because it can hamper the functions.
All other activities such as driving, walking or attending day to day life activities can be restarted by the patient in a few weeks post LVAD surgery.
3. Decreased unwanted symptoms of heart failure – The patients of heart failure experience a few unwanted symptoms that makes their day-to-day life more difficult. Some of these symptoms are shortness of breath, fatigue and weakness.
These lvad complications symptoms can be reduced by LVAD devices and give more strength to the body to perform normal activities.
Before going into the open-heart surgery for an LVAD implant surgery, the patient is required to avoid eating or drinking anything a few hours ahead of it.
The medical professionals will tell you about the necessary changes that the patient needs to make before surgery. They will ensure the medications the patient is taking and give a review about the same.
Before getting an LVAD implant, ask your doctor about any queries you have regarding the process or the treatment. Discuss any concerns or doubts in advance.
The patient will be asked to avoid wearing items such as contact lenses, glasses, or any type of jewelry or makeup before the surgery.
The doctor will ensure the medical condition of the patient before the surgery by diagnostic tests and normal health checkups.
Before LVAD implantation several tests are done to get necessary information about the condition of the patient’s heart and other organs.
After the surgery goes successful, the patient will be kept under observation in the ICU for several days to examine the functioning of the LVAD device, other organs and complications if any.
After the surgery, the lungs of the patient may take some time to work properly again, hence the patient needs to remain on the ventilator for a few days till they can breathe normally on their own.
The recovery may take some days, but after discharging from ICU the patient can go home depending on the pace at which they are recovering.
LVAD surgery can go well and still require regular health check-ups. These health checkups are necessary for the patient and the doctor to keep track of any signs or symptoms of infection or side effects. Special care and support are required by the patient after surgery.
After getting an LVAD implanted, the doctor may prescribe the patient to go under cardiac rehabilitation, which is a program that helps heart failure patients take care of themselves.
This program teaches the patients exercises and ways to stay healthy after heart surgery.
The total number of days required to be in hospital is usually between 15-20 days before the patient is sent back home and next follow up is required after every 1 month for the first 2-3 months and then based on individual patient needs and response to the LVAD implant.