The Center for Advanced Heart Failure evaluates end stages heart failure patients for mechanical circulatory support including intra-aortic balloon pump (IABP), Impella, Extracorporeal membrane oxygenation (ECMO) and left ventricular assist device (LVAD). It is always our goal to increase quality of life for end-stage heart failure patients who may improve with ventricular assist devices.
What is a Left Ventricular Assist Device (LVAD)?
A left ventricular assist device (LVAD) is an artificial mechanical pump that is surgically implanted in patients with chronic systolic end stage heart failure. It helps to pump oxygenated blood from the bottom left chamber of your heart (left ventricle) to the rest of your body. It’s a durable form of mechanical circulatory support device for the failing heart.
Who will Benefit from LVAD?
Patients with chronic systolic heart failure who continue to suffer from heart failure symptoms despite on optimal/maximally tolerated guideline directed heart failure medical therapy. They are defined as End-Stage Chronic Systolic Heart Failure.
End-Stage Chronic Systolic Heart Failure is defined as:
- More than 2 hospitalizations or ER visits for heart failure in the last one year
- Persistent dyspnea or fatigue
- Rest required while dressing or bathing, or walking one block on level ground
- Weight loss without other causes
- Progressive deterioration in renal function
- Frequent systolic blood pressure greater than 90 mmHg
- Frequent ICD shocks
- Progressive decline in serum sodium
- Intolerance to ACE-I due to hypotension and/or worsening renal functions
- Intolerance to Beta-blockers due to worsening heart failure or hypotension
- Recent need to escalate diuretics to maintain volume status
How does the LVAD work?
The LVAD is surgically implanted in the chest as an open-heart surgery. There are four main components of the LVAD:
- Chest Component: Pump unit with an inflow canula surgically implanted into the apex of the left ventricle and an outflow canula surgically sutured to the aorta. The pump takes the blood from the left ventricle continuously and pumps it out to the aorta and hence supply oxygenated blood to the rest of the body.
- Driveline: The pump is attached to a driveline (cable) which passes under the skin and exist out on the abdomen/belly.
- Controller: The pump is run by a computer program/system called the controller. It also provides data and alarms to help LVAD team and patient manage the pump externally.
- Power Supply: Rechargeable batteries and cord that plugs into an electrical socket provides the power to keep the LVAD running.
Are LVADs permanent?
No. The LVAD can be used for two purposes:
Destination Therapy (DT): Patients who aren’t candidates for heart transplantation can be treated with LVAD as DT to help with improved quality of life (without heart failure symptoms) and longevity.
Bridge-to-transplant (BTT): LVAD can be used to improve heart failure symptoms and maintain kidney/liver functions while waiting for heart transplantation. LVAD in this situation also improves patient survival and outcomes while waiting for transplantation. LVAD will be removed along with the native heart during heart transplantation.
Our Advanced Heart Failure team will determine if LVAD destination therapy is an appropriate treatment option for you, based on your medical condition, age, body size and presence of other medical/surgical conditions.
Do I need an LVAD?
LVAD is advanced surgical heart failure therapy in certain patients with end-stage heart failure. You could start this discussion with your primary cardiologist (heart specialist) or doctor. If you would like to explore this option for you or your dear ones suffering from heart failure, please contact us to have a detailed evaluation to determine whether LVAD is the right therapy.
Who manages the LVAD after the surgery?
Advanced Heart Failure Cardiologists along with Nurse Practitioners and Registered Nurse Coordinators manage you both in the hospital, outpatient clinic and also while at home. We will require you to be available for close follow ups in the clinic after the initial surgery
How long does LVAD last?
The longevity of the LVAD is dependent on a number of factors including but not limited to the following:
- Age at implantation
- Associated health conditions at the time of implantation
- Whether done as bridge to transplantation or as destination therapy
- Nature of progression of heart failure
Some patients have been living with LVAD for more than 5 years.
To be evaluated for a left ventricular assist device, call the LVAD team at (602) 406-1150.