Are you feeling very tired and short of breath even when walking a short distance? It is common for these symptoms to occur when the heart function is very weak, that is, in severe heart failure. The heart loses the strength it needs to pump blood throughout the body. So at times like these, with the amazing advances in medical science, there is a special device that can help your heart. We are going to talk about it today. That is a device called LVAD (Left Ventricular Assist Device).
Simply put, what is this LVAD?
An LVAD is a mechanical pump that is surgically implanted into the body of patients with end-stage heart failure. In other words, it's like an 'assistant' that helps your heart.
Our heart has four main chambers. The one on the bottom left is called the Left Ventricle . It is the one that does the main job of pumping oxygenated blood to the whole body. So, in a heart attack, this left ventricle becomes weak. What the LVAD does is to help that weak left ventricle. That is why it is called a Left Ventricular Assist Device.
This pump is attached to the lower part of the heart, takes blood from there, and sends it through a tube to the aorta . The aorta is the largest blood vessel in our body. From there, oxygen-rich blood is distributed throughout the body. So the LVAD helps to do exactly this important job.
The important thing is that an LVAD is not an artificial heart. It is not something that you remove and transplant from your heart. Instead, it is a device that works alongside your own heart and supports it.
What are the main parts of an LVAD?
The LVAD system consists of several main parts. All of these parts work together to make this amazing device work. Let's take a look at what those parts are.
| Part of the device | Simple explanation |
|---|---|
| Pump | This is the main part. This pump is surgically implanted inside the chest and is what takes blood from the left ventricle of the heart and pumps it into the aorta. |
| Driveline | This is a special cable. It goes from the pump inside the body, comes out through the skin on the abdomen, and connects to the controller outside. It is very important to take good care of it and keep it clean. |
| Controller | This is like a small computer. It's a device that's kept outside the body. It controls the pump's operation, changes its speed, and issues alarms if there's a problem. |
| Power Supply | The LVAD requires electricity to operate. It uses rechargeable batteries. These batteries can provide power for about 14 hours. When the battery charge is low, you need to replace it with new batteries. You can also plug it directly into an electrical outlet at home. |
Who needs this LVAD?
An LVAD is usually used in two main situations. Your doctor will carefully examine your condition and decide which method is best for you.
1. As a bridge to heart transplant (Bridge to Transplant - BTT)
Some patients need a heart transplant. But they have to wait for a while until a matching donor heart is available. During this time, the patient's condition may worsen. Other organs, such as the kidneys and liver, may also be damaged.
In such cases, the LVAD acts as a "bridge" to keep the patient healthy and strong until a heart is available . This improves the patient's quality of life, reduces symptoms, and gives them the strength to successfully undergo heart transplant surgery. The LVAD device is removed at the time of the heart transplant.
2. As a last resort (Destination Therapy - DT)
Some patients are not eligible for a heart transplant due to age or other health problems. If their heart function remains severe despite all other treatments, including medications and lifestyle changes, they are implanted with an LVAD to provide lifelong support .
This is called Destination Therapy. Here, the LVAD supports the heart for the rest of the patient's life, allowing them to live a better, more active life.
How to prepare before LVAD surgery?
The decision to implant an LVAD is not made overnight. A team of doctors will examine you thoroughly. For this, several tests will be performed, including:
- ECG (Electrocardiogram): To check the electrical activity of the heart.
- Chest X-ray: To see the condition of the heart and lungs.
- Blood tests: To measure the overall health of the body, kidney and liver function.
- Echocardiogram: A scan to see how the heart's chambers and valves are functioning and how they pump blood.
- Metabolic stress test: To see how the heart responds to exercise.
- Heart catheterization: To check for blockages and pressure in the blood vessels of the heart.
Also, there are certain medical conditions that make an LVAD implant unsuitable. For example:
- Blood clotting diseases
- End-stage renal failure
- Severe liver disease
- Severe lung disease
- Infections that cannot be controlled with antibiotics
How the surgery is performed and the time after
LVAD implantation is an open-heart surgery. It takes between 4 and 6 hours. You are under anesthesia, which means you are completely asleep, throughout the surgery.
After the surgery, you will need to stay in the hospital for about 2 to 3 weeks. During this time, doctors, nurses, and specialist teams will teach you how to live with the LVAD device.
- How the device works
- How to change the battery
- How to keep the wound clean where the driveline comes out
- What to do in an emergency
Only after it is confirmed that you are capable of doing all of these things will you be allowed to go home.
Life with an LVAD
Your life will change somewhat after you return home, but you can live successfully with those changes.
- Bathing: You cannot bathe, swim, or generally immerse the device in water with an LVAD. However, special equipment is available to help you take a shower.
- Medications: You will need to take anticoagulants for the rest of your life. This is very important.
- Diet: It is very important to follow a healthy diet.
- Exercise: You can engage in appropriate exercise by participating in cardiac rehabilitation programs, as directed by your doctor.
- Healthy lifestyle: Smoking and alcohol consumption should be completely stopped.
What are the benefits and risks of an LVAD?
Like any surgery, LVAD implantation has benefits as well as some risks.
Main advantages
- Significant reduction in symptoms such as shortness of breath and fatigue.
- Improved blood supply to other organs such as the kidneys, liver, and brain.
- Being able to leave the hospital, go home, and spend time with my family.
- Increased ability to exercise and engage in daily activities.
- Overall, the standard of living has improved greatly .
- People living with an LVAD device have a longer lifespan than those receiving drug treatment alone.
Possible risks
Every surgery has risks. Your doctor will talk to you about how to minimize these risks and how they affect you.
| Risk situation | Description |
|---|---|
| Infection | Infections can occur, especially where the driveline exits the skin. Therefore, it is essential to keep that area very clean. |
| Blood Clots and Stroke | There is a risk of blood clots forming inside the device. If these travel to the brain, a stroke can occur. Anticoagulants are given to prevent this. |
| Bleeding | Because you are taking blood-thinning medications, even a minor injury can cause excessive bleeding. |
| Right Heart Failure | When the LVAD helps the left side of the heart, sometimes the right side may not be able to handle the pressure. |
| Device Malfunction | Since these are mechanical devices, errors can occur very rarely. However, the controller notifies you of such things in advance. |
When should you see a doctor?
Once you have an LVAD, it is important to have a close relationship with your medical team. You will need to be checked weekly at first, and then monthly. If you experience any of the following symptoms, tell your doctor or hospital immediately .
- Fever.
- Redness, swelling, or pus oozing where the driveline exits the skin.
- Chest or stomach pain.
- Abnormal bleeding.
- Swelling of the legs and back.
- Difficulty breathing.
- A problem with some part of the LVAD device or an abnormal signal (alarm) is emitted.
Deciding whether or not to get an LVAD is a very personal and big decision. Talk to your doctor and family about it carefully. Ask all your questions and clear up any doubts. Thanks to this technology, thousands of people with severe heart conditions are now living better, happier lives.
Take-Home Message
- An LVAD is not an artificial heart. It is a mechanical assist pump that helps your own heart pump blood in cases of severe heart failure.
- This is mainly used as a "bridge" for those awaiting a heart transplant or as a "lifelong treatment" for those who cannot have a heart transplant.
- Although the quality of life after LVAD surgery is greatly improved, it is essential to properly manage the device, take medications, and follow a healthy lifestyle.
- If you experience any problems with the device or your health condition, it is very important to inform your medical team without delay.
- This is a big decision. Talk openly with your doctor about all the benefits and risks and make the decision that is best for you.
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