What is an LVAD? A Beginner's Guide for Patients & Families

LVAD is an implant device that assists with the normal pumping action of the heart to supply blood. LVAD is usually implanted in patients who have terminal heart disease and are waiting for a major heart surgery.

Your doctor may suggest you undergo an LVAD implant surgery if you have symptoms like shortness of breath, arrhythmia, poor quality of life, and heart failure. You may need some support for your heart, even if you need to undergo a major surgery like a heart transplant. This support is provided with a device called LVAD, or Left Ventricular Assistive Device.

What is an LVAD?

An LVAD, or Left Ventricular Assist Device, is a pump that helps to pump blood from the lower chambers of the heart to the body. The lower chambers of the heart are known as ventricles, and when the device is implanted in the left ventricle, it is known as a left ventricular assistive device. It is also known as a mechanical circulatory support device, as it helps with the circulation of blood.

When the ventricles pump blood to the aorta, the main artery in your body, it further supplies oxygenated blood throughout the body through its branches. But when it does not get enough blood to supply to the body, it needs some help, which is provided through LVAD. 

What are the indications of LVAD Implant Surgery?

Here are some of the conditions in which your doctor will recommend that you go for LVAD implant surgery. You need LVAD implant surgery if:

• You have end-stage heart failure

• You need some support for transplantation

• You cannot go for a heart transplantation

• You need it as destination therapy

• You need some support in the recovery process

• You need some time to make an informed decision

• You have severe cardiogenic shock

• You are on medications for heart failure

• You are suffering from acute decompensated heart failure

• You have a left ventricular ejection fraction (LVEF) of less than 25%.

How does a left ventricular assist device work?

LVAD is an assistive device that allows a constant flow of blood from the heart to the body through the aorta. LVAD consists of an operating battery, which is the main source of pumping action to the heart. LVAD is attached or implanted on the left ventricle of the heart and is attached through a tube to the control system, which is present outside the body. This control system and battery should be kept in a gear known as the LVAD gear. You need to wear LVAD gear in order to carry it without compromising comfort and quality of life. 

What to expect from LVAD Implantation?

Your doctor will assess your condition and will categorize you under the specific type of patient who needs LVAD. Either you will need it while waiting for your heart transplant surgery scheduled 6 months from now, or you may require an LVAD implant as a permanent treatment. However, life after LVAD Implantation is completely different compared to living without it. Let’s discuss what an LVAD is, the whole procedure, and what you should expect from it.

Preparation for the Procedure:

After the decision of LVAD implantation, your doctor will perform a number of tests to assess your general health. These tests help to prepare for additional procedures in case you have other medical problems, such as diabetes, hypertension, etc. You can also ask about your queries regarding the procedure before actually going for the procedure. It is best to talk with your doctor in detail before the surgery to understand its risks, specific instructions, and aftercare.

Diagnostic tests:

Various diagnostic tests are performed in the preparation phase, such as X-ray, ECG, Blood tests, blood sugar levels, renal tests, and Heart catheterization. These tests are usually performed to assess and stabilize your condition so that you can go for LVAD implantation surgery.

Avoiding meals:

You may need to skip your meal several hours before the surgery, and you may also not be allowed to take fluids.

Medications:

If you are already taking medications or have some type of allergy to specific medications, you need to tell your doctor about it to avoid any complications during or after the procedure.  

Procedure:

The procedure usually takes five to seven hours and consists of the following steps:

Anesthesia & Surgical Incision:

Your doctor will use general anesthesia before starting the procedure to make you unconscious, and then he will perform an incision according to a suitable approach and experience.

Cardiopulmonary bypass:

A cardiopulmonary bypass machine is used to take over the functioning of the heart and lungs while performing the procedure. It allows your doctor to operate your heart more efficiently. 

LVAD Implantation:

After that, your doctor will implant an LVAD pump on the left ventricle and then place a driveline to connect the pump inside to the battery and control system outside. 

Assessment of the device:

After completing the whole procedure, your doctor will activate the LVAD pump so that it can be assessed before closing the incision and making surgical sutures.

Post-operative Phase:

The recovery time after an LVAD implantation surgery depends on the general health of the patient, the type of approach used by the doctor, and the cardiac rehabilitation. Usually, it may require 8 to 12 weeks for proper recovery.

Hospital Stay:

You may need to spend some days in the hospital, but the number of days in total depends on the type of procedure performed, your general health, your response to a newly placed device, and your recovery.

Antibiotics and Anti-coagulants:

After the procedure, you may need antibiotics to prevent infection and blood-thinning medications to reduce the workload of the heart initially. 

LVAD Device Management and Maintenance

You need to follow proper instructions and take care of device maintenance and monitoring. You should know about battery levels, monitor system controller readings, and make sure that the driveline site is clean and infection-free. It will become your daily routine to carry a controller, batteries, and a backup power source, especially if you are going out. You may need to wear LVAD gear to carry them with maximum comfort.

Regular follow-ups are an essential part of the post-operative phase in which your doctor closely monitors the device, your symptoms, and complications if they occur. You also need to avoid high-impact physical activities like sports and modify your sleep style, as you will not be able to sleep on your stomach.

With support, education, and self-care, many LVAD recipients can return to work, travel, and enjoy a more active life. Emotional support and counseling also play a key role in adapting to life with an LVAD.

Possible Complications and Risks of LVAD Implants:

Although medical advancement and innovations have reduced the chances of complications after LVAD, there are possibilities that the following may occur: 

• Infection (especially driveline infection)

• Bleeding

• Clot formation

• Brain hemorrhage

• Pump thrombosis

• Right heart failure

• Hemolysis

• Arrhythmias

• Device malfunction

• Kidney dysfunction

• Bleeding

How does it feel to live with an LVAD?

Living with an LVAD may demand a whole modified lifestyle, from resting or sleeping at home to travelling and wearing clothes. It is because you need to carry your LVAD batteries and the controller with you all the time. 

When experiencing a sudden change in your lifestyle, it may be overwhelming for a lot of patients. Even if you face challenges initially, you will learn effective ways to care for and manage the device. Driveline care is one of the essentials that you need to know. It involves changing a bandage twice or three times weekly and maintaining hygiene to prevent infection.

The other most important things to carry the device securely, even when you rest, when you move, or when you are actively engaged in a physical activity. For this, LVAD apparel, like the LVAD vest, the LVAD shirt, or the LVAD belt, helps accommodate the device securely in place. LVAD gear has specifically designed to make life easier and more active to further promote a good quality of life.

How can support from family help improve life after an LVAD?

Family support and the concern of a caregiver are the things we often overlook, but having the right support from family and friends matters a lot. While it is not impossible to live without a caregiver, you must have a single family member initially to help you with dressing, changing batteries, and everyday care. 

Having someone with the intentions of care is a blessing, and that gives life meaning and also encourages you not give up yet. Family support is not just about care but also about mental health and awareness that your life matters; you matter.

Final Thoughts

LVAD implantation can be a difficult decision to make, but with all the knowledge about the device, its maintenance, and adaptation, you can live a good quality of life. Patients with LVAD usually have a more productive life than heart patients without LVAD.

FAQs

What are the possible complications with an LVAD?

The most common complications that may occur with an LVAD may include infection, bleeding, and stroke. But with proper care and medications, one can prevent such conditions.

How effective is an LVAD?

LVAD is very effective and can actually help people with heart failure live longer. LVAD also improves symptoms like shortness of breath and helps you engage in activities of daily living independently.

Can you live a normal life with an LVAD?

Yes, life with an LVAD can be a new normal with a modified lifestyle. With the right care and support of LVAD gear, one can effectively manage the device while moving through the day.