Left Ventricular Assist Devices (LVADs)

What is a left ventricular assist device?

A left ventricular assist device (LVAD) is an implanted pump which helps the left, lower chamber of the heart to pump blood out of it. This chamber is called the left ventricle, and pumps oxygenated blood into the aorta and then to the rest of the body. The device is used for people with heart failure.

How does a left ventricular assist device work?

LVADs are implanted into the bottom of the heart by a surgeon. The pump receives blood from the left chamber (ventricle) and then pumps it into the aorta. There are several different types of LVADs available, all of which consist of the following parts:

• Pump: This is attached to a cable and a controller.
• Driveline: This cable goes from the device to the abdomen and out of the skin, where it attaches to the controller (attached to the outside of the body).
• Controller: The controller makes the pump work and sends messages to help the patient operate the system.
• Power supply: Rechargeable batteries keep the pump working. It can also be plugged into an electric output.

Who is fitted with a left ventricular assist device?

LVADs are given to patients with end-stage heart failure. It is fitted until they are able to receive a heart transplant. This is called a bridge to transplant (BTT). It can also be offered to patients who are unsuitable for a transplant, called destination therapy.

Bridge to transplant (BTT)

It can take a long time for a heart transplant to become available, during which patients may be admitted to hospital or other organs may become damaged. BTT can help patients to survive until a donor is available. Fitting an LVAD supports the heart, reduces symptoms and improves quality of life. The device is removed when the transplant surgery is performed.

Destination therapy (DT)

If a transplant isn’t an option, and medication, lifestyle changes and other heart procedures haven’t worked, DT with an LVAD can support the heart and improve the patient’s quality of life. How is a left ventricular assist device fitted? Doctors will first perform a series of tests to determine if a patient is a candidate for an LVAD. Not everyone with heart failure can receive an LVAD, including people living with:

• Blood clotting disorders
• Infections not treatable with antibiotics
• Irreversible kidney failure
• Severe liver disease
• Severe lung disease.

Fitting an LVAD involves open heart surgery while under general anesthetic. An ECMO machine will be used which is a heart-lung bypass which, oxygenates the blood. A ventilator will also be used to perform your breathing. An incision is made on the chest and the chest bone (sternum) is opened so the surgeon can reach the heart. The LVAD is attached, and the surgeon closes the incision site. The procedure usually takes between four and six hours. When awake, patients are taught how to control the LVAD properly. They are given guidelines on how to manage the device during daily life and instructions on lifestyle changes they will need to make.

What are the benefits of receiving a left ventricular assist device?

An LVAD is not a cure, but it can improve the quality of life and extend the life of someone living with end-stage heart failure. As the device increases the amount of blood that flows to the body, it helps:

• Improve strength.
• Improve the function of the liver, kidneys, brain and other organs.
• Patients to leave hospital sooner
• Reduce symptoms associated with heart failure (shortness of breath, fatigue, swelling).

 

What are the risks associated with a left ventricular assist device?

As with every surgery, there are risks associated with a procedure to fit an LVAD. Your doctor will discuss these with you in detail ahead of the procedure. Common risks include:

• Bleeding
• Blood clots
• Infection
• Kidney injury
• LVAD malfunction
• Right heart failure
• Stroke.

Left ventricular assistance devices at Cleveland Clinic Abu Dhabi

LVADs are one of a number of advanced cardiac treatments available at Cleveland Clinic Abu Dhabi. They can improve the quality of life for people living with end-stage heart failure. Talk to your doctor today about the options available to you.