LVAD Heart Device vs. Heart Transplant: Key Differences

Heart failure is a condition where the heart becomes unable to supply an adequate amount of blood to all the organs in the body for proper functioning. Almost 10 out of 100 patients with heart failure have an advanced stage and severely compromised life quality with symptoms, such as shortness of breath, fatigue, edema, chest pain, etc. Each of the patients received adequate treatment, but still, the mortality rate remains high. 

The medical innovative technology has introduced mechanical heart devices that support the heart's functioning without replacing a diseased heart with a healthy one from a donor. Although these mechanical devices, like a Left Ventricular Heart Device (LVAD), are very effective, it has not fully replaced the need for a heart transplant. Let’s talk about the LVAD heart device and heart transplant in detail so that you can better understand to make an informed decision for yourself or your loved one. 

What is an LVAD?

Left Ventricular Assist Device or LVAD is a heart pump that is implanted in your heart to assist its pumping action. It is one of the treatment options for people with heart failure. The LVAD heart device is implanted in your heart to help the left chamber of the heart pump blood efficiently. Another device, RVAD, is also used, which is termed the Right Ventricular Assist Device and is implanted in patients with right-sided heart failure. 

How LVAD Works?

In normal conditions, your left ventricle is a part that pumps oxygen-rich blood and sends it to the aorta, from where it supplies the whole body. But in heart failure, your heart becomes weak and cannot pump blood. So, the LVAD pump is attached to the left ventricle and aorta to compensate for the loss of function. 

LVAD consists of a pump, driveline, controller, and batteries.  The controller and batteries remain outside the body and control the pump inside the heart. The LVAD pump works and regulates the blood flow while batteries provide the energy. 

Different types of LVADs, such as HeartMate and HeartWare, are also used according to the suitability of patients. LVADs are either used as a bridge to transplant for the patients waiting for a donor heart, or they can be implanted in patients with heart failure as a permanent treatment or destination therapy.  

What Is a Heart Transplant and When Do You Need It?

A heart transplant is a surgical procedure in which your diseased heart is replaced with a healthy heart from a donor. A heart transplant is performed when the heart undergoes irreversible damage or cannot be treated with medications and surgery. The heart is transplanted from a deceased donor whose heart is healthy. 

Heart transplant is performed in the adult population usually because of heart disease, such as ischemic heart disease, arrhythmias, heart valve disease, and rejection of a previous transplanted heart. In children, a heart transplant is performed due to a genetic heart condition, which means that in children who are born with a structural heart defect.

Eligibility Criteria for LVAD vs. Heart Failure:

Not every patient with heart failure is the same, and your doctor will decide the treatment after a complete evaluation and after performing diagnostic tests. Each patient with heart failure can have different stage of severity and have different symptoms, even if they have the same diagnosis. For this reason, each patient should be treated with individualized treatment according to their unique category. Your doctor will select the treatment between the LVAD heart device and a Heart Transplant according to the following criteria:

• Your doctor will make you eligible for LVAD as a destination therapy because you are too weak or too old to undergo a heart transplant procedure. Patients with other health problems, like kidney disease or lung disease, are not suitable to undergo a major operation like a heart transplant.
• After a complete examination, your doctor may suggest that you go for a heart transplant because, according to the evaluation, you may not be suitable for LVAD. 
• You may not currently be eligible for a heart transplant because of temporary situations like hypertension, mental health problems, carcinoma, and others. After complete recovery, you will be eligible for a heart transplant.
• The condition of the patient is such that both heart transplant and LVAD can be performed, but due to long waiting times for heart transplant, the patient needs to go for LVAD. 

How do we choose between LVAD and a Heart Transplant?

There is no hard and fast rule or one for all method to choose between an LVAD heart device and a heart transplant. When your doctor is planning a treatment for heart failure, he has to follow an individualized approach to assess your condition so that he can make an informed decision on choosing one treatment over another. 

During the examination, your doctor considers various variables like the age of the patient, general health, presence of other comorbid diseases, obesity, and carcinoma. These are the factors that can affect the prognosis and recovery. For a heart transplant, it is important to assess for the conditions that can increase the chances of rejection of the transplanted heart and death. For the LVAD heart device, it is important to assess the risk of right-sided heart failure, structural abnormalities to implant an LVAD, and blood clot disorders. Hence, each patient is unique and needs a personalized treatment plan for complete recovery.

Key Differences between LVAD and Heart Transplant

For a heart failure patient, both LVAD and Heart transplant are treatment options and can improve symptoms and quality of life, but they differ in several important ways:

Procedure Complexity:

Both types of treatments involve major surgery, but a heart transplant procedure is more complicated as it involves the replacement of an old, diseased heart with a donor heart. An LVAD surgery is not one that we can call less serious, but as compared to the heart transplant, it is a less complex procedure. 

Recovery Time:

The heart transplant procedure usually requires a longer recovery time as compared to LVAD. Because a new organ is introduced into the body, it needs time to adjust to it. You may need to take medications for a very long period to prevent organ rejection. LVAD patients may recover quickly in comparison with a heart transplant. But, they have to adapt a new lifestyle with major modifications, including learning to manage the device and its equipment with LVAD-specific clothing and LVAD accessories. 

Long-Term Survival and Outcomes:

Heart transplant generally offers long-term survival rates for patients who meet the eligibility criteria. On the other hand, with the latest LVAD types, it is now possible to limit the risk and support patients for many years. LVAD is a beneficial option, especially for patients who cannot undergo Heart Transplant surgery. 

Quality of Life:

Heart transplant patients can live a more active lifestyle after recovery, as compared to LVAD patients who need to carry and manage the controller and battery at all times. For example, you need to wear an LVAD shirt HeartMate 3, to carry your LVAD HeartMate 3 type. 

Cost and Accessibility:

Both LVAD and Heart Transplant are complicated procedures and may require proper assessment and evaluation from your doctor. But a heart transplant involves higher costs and post-surgical medications for life. LVAD is more affordable to patients and is feasible even when a donor heart is not available. 

Availability and Wait Times:

You can only get a heart transplant if there is a donor available. Your doctor places your name on a waiting list, and you have to wait until a suitable donor heart is available. On the other hand, LVAD is available all the time, even for those who are on the waiting list for a heart transplant. 

Lifestyle Impact:

Heart transplant patients live without external equipment, while LVAD users have to wear LVAD gear for regular maintenance. 

Why do you need LVAD gear after LVAD implantation?

LVAD consists of internal and external components, and you need to keep the external components with you at all times. To carry these LVAD components, you need to wear LVAD-specific clothing instead of your regular wear. For example, the LVAD vest HeartMate 3 is specifically designed to keep the LVAD HeartMate 3 secured and composed. 

Because the heart depends on the LVAD to circulate blood, the LVAD gear must be worn at all times. It also allows you to move freely without worrying about the device’s safety and accommodation. 

Possible Complications Associated with LVADs:

The LVAD device benefits and risks are an important thing to consider before choosing a heart failure treatment. Although with the latest LVAD types, there are fewer chances of the risk, there are still chances of the following complications:

• Infection, especially at the driveline site
• Blood clots
• Stroke
• Internal bleeding
• Device malfunction or failure
• Right heart failure
• Damage to red blood cells inside the blood vessels

Possible Complications Associated with Heart Transplants:

A heart transplant has the same complications as any other organ transplant and may need proper care and medications to prevent them. Here are the possible complications:

• Organ rejection
• Infection
• Side effects from organ rejection medications
• Coronary artery disease
• Kidney damage
• High blood pressure

Can you replace Heart Transplant Treatment with an LVAD Implantation?

LVAD devices have improved in recent years, which means they are now more effective in function with fewer chances of complications. It has also increased its demand and is now recommended in treatment options more often. LVAD is also used as a bridge to transplant treatment when the patient has to wait for an organ donor. 

As described earlier, it is not a simple approach to choose LVAD over a Heart Transplant. It requires careful evaluation and examination. You may be eligible for a heart transplant, but you may not have an organ donor. In that case, you will need an LVAD heart device. Here are some of the tips to choose the most suitable option:

Tips to choose a suitable treatment for Heart Failure:

1. Choose a specialized healthcare professional for proper assessment and examination.
2. The doctor will categorize the patient with heart failure and identify the stage of severity.
3. Your doctor will perform a number of tests on you to describe your condition.
4. Prefer a multidisciplinary approach to make an informed decision for a particular treatment.
5. Discuss the treatment options with your doctor and choose the most suitable option for you. (LVAD vs. Heart Transplant)
6. Your doctor will rule out the contraindications to choose the best option for you. 

Conclusion

Both the Left Ventricular Assist Device (LVAD) and heart transplant are important options for treating advanced heart failure. LVAD helps the heart pump blood better without needing a donor heart, which makes it suitable for patients who are not eligible for heart transplant surgery. On the other hand, a heart transplant replaces a damaged heart with a healthy one from a donor and is used when the heart cannot be fixed by other treatments. Your doctor may choose between these two options according to your health, age, and the presence of other health problems.