This is an abbreviated version of the complete article.*
A left ventricular assist device, or LVAD, is an implantable pump device that supports a weakened left ventricle.
When the heart is unable to pump enough oxygen-rich blood to the rest of the body due to disease or surgery, an LVAD can provide the extra strength needed.
LVADs are often used for heart failure or during the period prior to heart transplant.
A left ventricular assist device (LVAD) is a device used to substitute for the heart's inability to pump blood. It is a battery-powered mechanical pump that is surgically implanted into the chest and abdomen of patients whose hearts do not work effectively on their own. The left ventricle is the most muscular heart chamber because it pumps oxygen-rich blood out of the heart through the entire body. This process is essential to life. If the left ventricle becomes weakened or diseased, an LVAD may be used to supplement its pumping ability and improve blood flow.
The LVAD consists of a tube connected to the left ventricle, a pump, and another tube connected to the aorta. When the left ventricle fills with blood, it flows through the tube and into the internal pump, which pushes it forcefully out into the aorta. The pump is implanted in the patient's chest and connected to a computer controller and power supply outside of the body. A belt or harness that holds these external items may be given to the patient to wear. The most commonly used LVADs are the size of a compact disc (CD), although newer versions may be much smaller.
WHEN IS IT INDICATED?
An LVAD is generally indicated in patients who:
Were not helped by medical therapy;
Have end-stage heart failure;
Recently had heart surgery and need to reduce demand on the heart temporarily;
Are awaiting heart transplant and need a supplemental pumping mechanism to stay alive in the meantime; or
Are ineligible for other treatments but need long-term support for a weak heart.
The physician will perform a physical examination and take a medical history as well as discuss the surgical plan with the patient and his or her family. Although the physician may provide specific pre-procedure instructions, typically food and drink may not be permitted within 12 hours of LVAD implantation.
WHO IS ELIGIBLE?
Patients are typically eligible for LVAD implantation if their heart's left ventricle is weakened and unable to pump enough oxygenated blood on its own.
RISK FACTORS FOR POSSIBLE COMPLICATIONS
Complications are more likely in patients with weakened immune systems and/or those who are prone to infection, and people with a history of depression or other mental health disorder.
WHAT TO EXPECT
To begin the operation, the surgeon makes an incision, called a sternotomy, through the breastbone to open the chest and ribcage and access the heart. Once the chest is open and the surgeon accesses the heart and the aorta, the heart is stilled and the patient is connected to a heart-lung machine.
The surgeon makes a pocket in the abdominal wall to implant the LVAD. The LVAD tubes, which are covered with a special material to encourage healing and to allow the skin to re-grow, will be attached to the left ventricle and aorta. When the pump is adequately supporting the patient's heart, the surgeon stimulates the heart with pacing wires so that it resumes normal contractions. The heart-lung machine is then removed and the tube access sites are closed.
After surgery, the patient will be taken to the intensive care unit for monitoring. Breathing tubes and IVs will be used to help the patient breathe and recover. Once stable -- usually after about 2 to 5 days -- he or she will move to a regular hospital room for 2 to 4 weeks of recovery.
After the implantation, the patient is monitored for:
Heart failure; and
Mechanical breakdown of the device.
Medical Review Date: December 7, 2009
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