Understanding Left Ventricular Assist Devices (LVADs): A Comprehensive Guide

What is the role of the Left Ventricular Assist Device (LVAD) in the human body?

People with advanced heart failure face significant complications affecting their daily lives, including frequent hospitalisation, reduced physical activities, swelling, and risk of cardiac arrest. A left ventricular assist device (LVAD) offers new hope for those struggling with this condition. Doctors surgically implant this small mechanical pump to help a weak heart pump blood more effectively. As a result of the device, the heart’s lower left chamber (left ventricle) effectively pumps blood out into the aorta. For someone whose heart is too weak to work on its own, an LVAD can be life-changing. Some people use this device while waiting for a heart transplant. It enables the heart to do its job, allowing patients to feel more energetic, enjoy daily activities, and improve their quality of life.

LVAD Procedure: How Does it Work?

The LVAD procedure involves a complex surgical process that is performed by a team of experienced cardiac surgeons and specialists.

Pre-operative Preparation: Doctors will assess your condition and conduct various diagnostic tests to see if a left ventricular assist device suits you. These tests include:

• Blood test
• Chest X-ray
• Electrocardiogram
• Echocardiogram
• Stress test

LVAD Procedure:

The procedure typically follows these steps:

• Anaesthesia Induction: The surgical team will administer general anaesthesia, and you will be asleep throughout the procedure.
• Connection to Heart and Lung Machine: The surgeon will circulate oxygen-rich blood throughout the body using a heart-lung bypass machine. The doctor will also use a breathing machine (ventilator) to ease breathing during the surgery.
• Incision and Exposure: The surgeon makes an incision in the chest, often through the breastbone, to access the heart and surrounding blood vessels.
• Placement of the LVAD: The LVAD device is then carefully positioned and connected to the left ventricle, typically through a small opening in the apex (tip) of the heart. The surgeon will connect the outflow tube from the LVAD to the aorta, the principal artery carrying blood from the heart to the rest of the body.
• Power Source Connection: The LVAD is connected to a power source through a driveline that passes through the skin or a transcutaneous energy transfer system that transmits power through the skin without a physical connection.
• Monitoring and Adjustment: After the LVAD is in place, the surgical team carefully monitors the device’s performance and makes any necessary adjustments to ensure optimal blood flow and patient recovery.

What Are The Problems Associated with Ventricular Assist Devices?

While LVADs are generally reliable and effective, they can sometimes experience problems or complications. Some of the most common issues associated with these devices include:

• Infection: The site where the power cable passes through the skin (the driveline) is a common entry point for bacteria and can sometimes cause serious infections. Proper hygiene practices and wound care are essential to prevent this.
• Bleeding and Clotting: LVADs can sometimes cause excessive bleeding or the development of blood clots, which can be life-threatening. Careful monitoring and medication management are necessary to mitigate these risks.
• Device Malfunctions: Although rare, LVAD devices occasionally experience mechanical failures or other technical issues. Therefore, regular check-ups and close communication with your medical team are essential.
• Psychological Adjustments: Living with an LVAD can be a significant adjustment, both physically and emotionally. Some individuals may struggle with the psychological impact of the device and the ongoing medical care required.

What are the Benefits of Left Ventricular Assist Device (LVAD)?

Despite the potential challenges, LVADs offer numerous benefits for individuals with severe heart failure, says Dr. Ashwini Kumar Pasarad. Some of the key advantages of using an LVAD include:

• Improved Cardiac Output: By taking over most of the left ventricle’s pumping function, an LVAD can significantly improve the heart’s ability to circulate blood throughout the body, leading to better cardiovascular health.
• Increased Mobility and Independence: The LVAD’s power source’s portability allows for greater mobility and independence, enabling individuals to be more physically active and enjoy a higher quality of life.
• Bridge to Transplantation: For those awaiting a heart transplant, an LVAD can serve as a crucial “bridge” to keep the heart functioning until a suitable donor becomes available.
• Destination Therapy: In some cases, an LVAD may be used as a long-term, or “destination,” therapy for individuals who are not eligible for a heart transplant, providing them with an alternative solution to manage their heart failure.
• Reduced Symptoms: By improving the heart’s ability to pump blood, an LVAD can help alleviate the debilitating symptoms associated with heart failure, such as shortness of breath, fatigue, and swelling.

How long is Recovery After LVAD?

The recovery process following LVAD surgery can be extensive and varies from individual to individual. However, several key steps are generally involved:

• Immediate Post-Surgery Care: Immediately after the surgery, the surgical team will closely monitor you in the intensive care unit (ICU) to ensure the LVAD functions correctly and to manage any potential complications.
• Rehabilitation and Physical Therapy: As you begin to recover, you’ll work with a team of medical professionals, including physical therapists, to regain your strength and mobility. These may involve exercises, gait training, and other rehabilitation activities.
• Ongoing Medical Monitoring: Throughout your recovery, you’ll need to attend regular check-ups with your medical team to monitor the LVAD’s performance, adjust medication as needed, and address any issues that may arise.
• Psychological Support: LVAD can significantly impact emotional and psychological health, and you may benefit from a mental health specialist who may help you adapt to this new way of life.

Lifestyle Changes and Tips for Living with an LVAD

Living with an LVAD requires some significant lifestyle adjustments, but with the right approach, you can continue to have a high quality of life. Here are some tips to help you navigate this new chapter:

• Embrace the Portability: Take advantage of the LVAD’s portability by engaging in activities that you enjoy, such as walking, light exercise, and social outings. These can help you maintain your independence and sense of normalcy.
• Prioritise Wound Care: Keeping the driveline site clean and properly cared for is crucial to prevent infections. Follow your doctor’s instructions carefully and be vigilant about maintaining good hygiene.
• Adapt Your Wardrobe: Consider clothing that makes it easy to access and manage the LVAD’s power supply and control unit, such as loose-fitting shirts or dresses with pockets.
• Stay Hydrated: Proper hydration is essential for LVAD function, so drink plenty of fluids throughout the day.
• Manage Stress: The emotional and psychological adjustments of living with an LVAD can be challenging. Stress-reducing activities like meditation, yoga, or counselling can help you to cope.
• Communicate with Your Medical Team: Stay in close contact with your medical team, promptly reporting any changes or concerns. This will help ensure that your LVAD is functioning optimally and that any issues can be addressed quickly.