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Left Ventricular Assist Device (LVAD)

  • What is a left ventricular assist device (LVAD)?

    Left Ventricular Assist Device (LVAD)

    The left ventricular assist device, or LVAD, is a device that takes over the left ventricle’s pumping action when it fails. The main pumping of the heart, the left ventricle pumps oxygenated blood to tissues in the body in order to maintain healthy blood circulation.

    An LVAD is normally used for patients with severely weakened hearts despite medication therapy, particularly in cases where the patient has end-stage congestive heart failure. In heart failure, the heart's muscle weakens and loses its ability to pump enough blood to support the body's functions.

    Patients suffering from end-stage congestive heart failure may experience these symptoms:

    • Persistent low blood pressure
    • Breathlessness
    • Swelling of the body
    • Lethargy
    • Difficulty in sleeping, eating, walking
    • Disruption of organ functions such as the kidney and liver

    The LVAD helps to increase blood flow to the body, helping to improve organ function and relieve the common symptoms of congestive heart failure. In turn, patients can expect greater life expectancy and better quality of life, with more energy and freedom to be active.

    How does an LVAD work?

    The LVAD is a battery-operated, mechanical device that is surgically implanted inside a person's chest, at the tip (apex) of the heart’s left ventricle. The LVAD pump is attached to the heart's left ventricle, while a synthetic tube (graft) connects the pump to the body's main artery called the aorta. The LVAD pumps blood continuously from the left ventricle to the aorta, where it then flows to the rest of the body.

    A fine cable called driveline extends from the pump, out through the skin, and connects the pump to a controller and power sources worn outside the body. The pump is powered by batteries or electricity. Some LVADs have an adaptor that also allows them to run off the car battery. Each device has specific carrying cases to allow the patient to move about freely with the equipment.

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    For patients with heart failure, the LVAD can help restore normal blood flow, thereby relieving symptoms of heart failure such as constant tiredness or shortness of breath. By increasing blood flow to the body, the LVAD also improves the function of the kidneys, liver, brain and other organs.

    LVADs are used for patients undergoing:

    • Bridge-to-transplant therapy

      This is a life-saving therapy that keeps people with advanced heart failure going while they wait for a heart transplant. The LVAD supports the heart function and allows patients to have a better quality of life with fewer symptoms until a donor heart becomes available.
    • Destination therapy

      Destination therapy is for patients who are not candidates for heart transplants. Patients undergoing this therapy will continue to rely on an LVAD to support their heart function for the rest of their lives.
    • Bridge-to-recovery

      Sometimes, a heart may recover after being given time to “rest” with the help of an LVAD. Bridge-to-recovery is where an LVAD is implanted for patients suffering from temporary heart failure. The LVAD can be surgically removed if heart function recovers. However, in the vast majority of cases, advanced heart failure is a permanent and irreversible condition.

    LVADs are not suitable for patients who have certain medical conditions such as clotting problems, kidney failure, advanced liver disease, lung disease or infections. Your doctor will need to evaluate your condition to determine if an LVAD is suitable for you.

    What are the benefits of an LVAD?

    Most patients who are considered for an LVAD have a very limited quality of life before the procedure. They constantly feel tired, weak and breathless. With an LVAD implantation, patients who have been too unwell are able to regain quality of life and satisfying level of activity.

    Patients with an LVAD tend to live longer life than those who are treated with medical therapy alone. The LVAD can also help to improve and reduce symptoms of heart failure, such as shortness of breath, excess fluid and fatigue.

  • As a candidate for an LVAD, your doctor will likely be putting you through a series of tests to determine suitability before the implant.

    Some of the tests and exams include:

    • Diagnostic testing such as echocardiogram or right heart catheterisation
    • General health screening which includes blood tests and chest X-ray
    • Dental and psychosocial exams

    Implanting an LVAD involves open heart surgery, so you may need to be admitted a few days beforehand to ensure you are healthy enough for the procedure.

    During a left ventricular assist device (LVAD) implantation

    Surgery to implant an LVAD takes approximately 4 – 8 hours. During the procedure, you will be placed under general anaesthesia and connected to a ventilator and heart-lung bypass machine to temporarily take over your lung and heart functions.

    To attach the LVAD, the surgeon will make an incision in your chest and open the chest bone (sternum). The LVAD comprises of a pump directly implanted into the tip (apex) of the left ventricle of the heart. This pump will deliver blood via tube to the aorta so it can be distributed to the rest of the body. A cable connects the pump to a control unit and battery pack outside the body.

    Once the LVAD is properly implanted and tested, you will be taken off the heart-lung bypass machine, and the LVAD will take over and pump blood out of the heart to the aorta.

    After a left ventricular assist device (LVAD) implantation

    After the procedure, you will remain in the ICU for a few days where you will receive fluids, nutrition and medication intravenously, while other tubes will drain urine from your bladder and fluids from chest and heart. You may need to remain on a ventilator until your lungs are able to function normally.

    Recovery period for a left ventricular assist device (LVAD) implantation

    Recovery time will vary depending on your health, and after transferring out of the ICU, most patients will need to remain in the hospital for at least 2 weeks.

    Living with a left ventricular assist device (LVAD)

    Patients living with an LVAD will have to make adjustments to their daily activities. There are some things that you will not be able to do, like swimming, sleeping on your stomach or undergoing an MRI scan. Fortunately, the external parts of the LVAD are getting smaller and batteries are now lighter and longer lasting. You should be able to resume your normal activities by following your doctor’s instructions closely. You will be encouraged to make healthy lifestyle choices and monitor your health closely to ensure that you remain healthy and adapt well to life with the LVAD.

    Risk/complications of a left ventricular assist device (LVAD) implantation

    While there are risks with every surgery, such as infection, bleeding or blood clots, steps are taken to manage or reduce those risks. After an LVAD implantation, there is the additional risk of stroke, gastrointestinal bleeding and right heart failure. Device malfunction such as power failure or faulty parts that could cause the LVAD to stop working is uncommon.

  • Mount Elizabeth Hospitals are established private hospitals with over 40 years’ experience serving patients with various heart conditions. We offer a comprehensive range of heart treatment such as left ventricular assist device implant, supervised by an experienced cardiovascular team.

    Our facilities at both Mount Elizabeth Orchard and Mount Elizabeth Novena Hospitals, together with a multidisciplinary team of specialists, nurses and therapists are well-equipped to provide quality, customised treatment and support during recovery.

    Our staff are ready to and welcome inquiries on LVAD and any related heart health concerns.

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