What is a Left Ventricular Assist Device (LVAD)?
A left ventricular assist device (LVAD) is a mechanical pump that is implanted in patients with heart failure. It helps the bottom left chamber of your heart (left ventricle) pump blood out of the ventricle to the aorta and the rest of your body. That is why it is called a Left Ventricular Assist Device.
When is a Ventricular Assist Device (VAD) used?
VADs are used to increase blood flow when your heart failure has become severe and is not responding well to medications and other treatments.
Does an LVAD take the place of your heart?
No. A left ventricular assist device does not replace the heart. The LVAD receives blood from the left ventricle and delivers it to the aorta. It pumps along with the patient’s own heart. This helps the left ventricle pump blood.
Why am I being recommended an LVAD?
Your doctors feel you have advanced heart failure. Heart failure is a condition in which your heart is unable to pump enough blood to support the basic needs of your body. Heart failure can make you feel weak and tired; have swollen feet and be short of breath. Although medications and lifestyle changes can improve heart function initially, for most people heart failure gets worse over time. As heart failure becomes more severe, symptoms increase, and other organs may begin to fail (often the liver and kidneys).
You are being asked to consider the possibility of having a ventricular assist device (VAD) surgically implanted in your body. Your doctors feel without a VAD your chance of dying from heart failure in the coming months is very high. Before you undergo this surgery, it is important you and your family understand the options including potential benefits, risks, and expectations associated with having a VAD (heart pump). It is important for you and your caregiver(s) to understand and to agree with the treatment plan and you are willing to participate in the guidelines outlined in the following pages.
How does the LVAD work?
There are a few different LVADs available at KIMS Heart and Lung Transplant Institute. The doctor will recommend the one that is best for you based on your needs and medical condition.
The LVAD is implanted during open-heart surgery. The parts of the LVAD may vary based on the type of device but typically, there are four basic parts:
The pump unit is placed in the chest. It is implanted by the surgeon into the apex of the heart where it receives blood. A tube then delivers this blood from the device to the aorta (the large artery that takes blood from the heart to the rest of the body. It works by pumping blood by continuous flow from the left ventricle to the aorta.
The pump is attached to a driveline (cable) and a control system (controller). The driveline passes from the device through the skin on your belly (abdomen) to the controller (a small computer) on the outside of your body. The controller runs the pump and provides messages and alarms to help you operate the system.
A power supply (rechargeable batteries or cord that plugs into an electrical socket) keeps the LVAD running.
What is the evaluation process?
The evaluation process is designed to help decide if a VAD is the best choice for you. You will undergo (or may have undergone) several blood tests, and consultations. Some of the people that may help evaluate you include Cardiologists, Heart Surgeons, Social Workers, Chaplain, members from the Palliative Care Team, and VAD Coordinators. This evaluation includes assessing your personal support system, your previous medical compliance as well as providing you information about the financial and long-term self-care requirements.
The entire team will assess your readiness, willingness, and the ability for activities that are required as part of the follow-up after the VAD surgery. Your social support and willingness to participate in your care are essential to living successfully with the VAD and will be looked at during your treatment and evaluation for VAD therapy.
Other medical concerns that are found during the evaluation may need to be addressed before a VAD can be implanted. The intent is to evaluate any medical concerns and potential issues to VAD implantation in order to make sure the therapy is right for you.
After the evaluation, the VAD Team will decide if you meet the criteria to have a heart pump implanted. If it is a medically reasonable option, you will also need to decide if it is the right personal choice for you. If you choose that this is not the best option for you, you may choose to be re-evaluated at a later time. In the future, if your condition worsens, you may need to repeat tests to determine if you are eligible for treatment.
Why would I not be a candidate for a Ventricular Assist Device (VAD)?
VADs improve blood flow. These devices can only fix health problems that will improve with better blood flow.
Implantation of a VAD requires major surgery that you must be able to survive. There will also be ongoing issues with the VAD which you must be able to manage. Some of the reasons a VAD may not be a good option include the following:
- Medical issues that would make surgery too difficult or dangerous. For example, if the chances of surviving VAD surgery is felt to be too small. Other examples include; high lung artery pressures and right heart failure, problems with the existing heart valves, a small left ventricle, a damaged aorta, blood clotting disorders, poor food intake, current pregnancy, or high risk of infection.
- Other non-heart diseases that would increase the risk of VAD therapy include; cancer, permanent kidney disease, liver disease, severe emphysema of the lung, blockages of the arteries to the legs, or the brain, uncontrolled diabetes, and frailty.
- Factors that would likely limit the ability of the patient to properly care for the VAD long term. Examples include; impaired thinking (dementia or significant psychiatric disorder), use of illicit drugs or alcohol, a history of not following medical recommendations or self-destructive behavior, inadequate social support (patients must identify a primary “caregiver”), or financial hardship.
What are my other options?
If you are not found to be a candidate for a VAD, or if you decide that a VAD is not the best option for you, you will continue to receive standard medical care. The reason you are being evaluated for a VAD is that the current therapies you are receiving are not adequately treating your heart failure. Without a VAD your doctors feel it is likely your condition will worsen and there is a high chance of death in the coming weeks to months. Patients with advanced heart failure who do not proceed with VAD surgery often use palliative care and hospice to help them with the end of life care.
What will the VAD surgery be like?
The surgery to implant the VAD will be open-heart surgery and can take between 6-12 hours. The surgeon will make an incision (cut) down the front of your chest to reach your heart. You will have a breathing tube and be under general anesthesia. In some cases, you will be on a heart/lung machine during the surgery. The VAD is placed below the heart and the surgeon will connect the pump to your heart and secure it in place. Once the pump is in place, the VAD and your heart will together pump blood through your body. After the surgery is completed, you will return to the intensive care unit (ICU).
What about my medical care post-discharge?
Our team including your surgeon, your cardiologist, VAD coordinators, nurses, nurse practitioners, physician assistants, pharmacists, physical/occupational therapists, and social workers will follow up with you on an everyday basis. They will monitor your recovery and help you adjust to life with your VAD. Soon after your surgery, it will be very important to begin preparing to go home. You will have to be both physically strong and able to care for your VAD to be discharged from the hospital. Most patients return home, but some patients choose to live with a caregiver or need a rehabilitation facility for a short period before returning home. If necessary, a home health nurse may come to your home for a few hours a week to help with your care.
What do I need to learn before going home with a VAD?
During the time in the hospital after surgery, it is expected that you and your family will learn how to take care of the VAD and how to take care of yourself at home. You and your caregiver(s) will be trained by a VAD coordinator to take care of your VAD. Other staff, such as your bedside nurse, the occupational and physical therapists, and cardiac rehabilitation therapists will also provide training. You and your caregiver(s) must be able to manage the VAD, understand how it works, troubleshoot problems, and care for your driveline exit site. It is expected that a caregiver(s) will be present and available while you are in the hospital to learn how to take care of you and your VAD before leaving the hospital. The education will be ongoing while you are in hospital. Your home must have consistent electricity and phone services, so it is vital that you pay your utility and phone bills on time.
How often do I see my doctors after I go home?
After you are discharged, you will follow up in the clinic with your Advanced Heart Failure/VAD/Transplant Team. They will work together to care for you and make decisions about your treatment. Typically, your first visit will be every alternate day for the first week after discharge. As your health improves, visits may be further apart. Once you are considered stable and ready to go home, your doctors may decide that you can follow-up every 2-3 months. Along with seeing a Heart Failure Cardiologist, you will have testing done regularly to monitor and maintain your health. The types of testing that you may need will be decided by your doctors, but the most common tests include blood tests, electrocardiograms, echocardiograms, and implantable cardioverter-defibrillator (ICD) checks.
Be in touch with us
This document was designed to provide you with a basic overview of the Ventricular Assist Device (VAD/ LVAD) support. It is intended to start the conversation, not end it. When you have additional questions, please feel free to reach out to our medical team now and in the coming days. You should also speak openly with your family and loved ones. Some people find it helpful to speak to patients who have undergone VAD implantation, and if that is of interest to you the team can help make that happen. Let the people around you help you in this difficult time.