Sometimes our hearts get a little weak, don't they? Just like a car engine that has worked well for years, its performance can decrease over time. Especially when it reaches the end-stage of heart failure, it becomes a big challenge for the heart to pump blood to the whole body on its own. At such times, we are talking about a special mechanical device that can help the weakened heart.
Simply put, what is this LVAD?
The full meaning of LVAD is Left Ventricular Assist Device. In Sinhala, it means 'a device that assists the left ventricle'. This is actually a mechanical pump. This is implanted in the body of people with severe heart failure.
The main pumping chamber in our heart is the left ventricle. This is what sends oxygen-rich, clean blood to the entire body through the aorta. When the heart is weak, this job doesn't work properly. The LVAD helps that left ventricle. That is, it takes blood from the left ventricle, pumps it, and sends it to the aorta. This is very important, because every cell in our body cannot live without oxygen.
How does this device work? What are its parts?
The LVAD device is attached to the lower part of the heart and is implanted inside the chest. When it receives blood, it is sent through a tube into the aorta. This entire system has several main parts.
| Part of the device | Functionality |
|---|---|
| Pump | This is the main part. This is what is implanted in the heart. This pump does the work of pumping blood. |
| Driveline | This is a cable that comes from the pump. It exits the body through the skin of the abdomen and connects to the controller on the outside. |
| Controller | This is like a small computer. It controls the operation of the pump. If there is a problem, we can know through the signals (alarms) and messages that it sends. |
| Power Supply | It runs on rechargeable batteries. Or you can plug it into an electrical outlet. The batteries can provide about 14 hours of power. |
What kind of people use an LVAD?
This is used for people in the final stages of heart failure. That too for two main purposes.
1. As a bridge to a heart transplant (Bridge to Transplant - BTT)
Imagine that someone needs a heart transplant. But they have to wait until a compatible heart becomes available. During this time, the patient's condition can worsen. Other organs, such as the kidneys and liver, can also be damaged.
In such cases, the LVAD helps to preserve the patient's life and maintain a good quality of life until a heart transplant is available . It is like a bridge. Once a heart is available for transplantation, the LVAD device is removed during surgery.
2. As a lifelong treatment (Destination Therapy - DT)
Some people cannot undergo a heart transplant due to age or other medical conditions. For such people, this LVAD is used to support the heart throughout their lives. Doctors consider this option only when all other treatments, including medications and lifestyle changes, have failed. This can not only extend the patient's life, but also improve the quality of life.
How to prepare for LVAD surgery?
Doctors perform several tests before deciding if you are suitable for an LVAD.
- E.C.G. (Electrocardiogram - ECG)
- Chest X-ray
- Blood tests
- Echocardiogram
- Heart catheterization
However, it is not suitable for everyone with heart failure. You may not be able to have an LVAD implant if you have any of the following conditions:
- Blood clotting diseases
- Incurable kidney disease
- Severe liver disease
- Severe lung disease
- Infections that cannot be cured by antibiotics
How is the surgery done?
This is open-heart surgery. That means you are fully anesthetized and asleep until the surgery is complete.
During the surgery, a heart-lung bypass machine is used to provide oxygen to your body. A ventilator is also used to breathe for you. The surgeon makes an incision in the middle of your chest, opens the breastbone, and reaches the heart. The LVAD is then implanted and the incision is closed again. The entire surgery can take about four to six hours.
What happens after surgery? Things to pay attention to when you go home
Before you leave the hospital, you will be given thorough training on how to manage this equipment and what to do in an emergency. You will also need to demonstrate your knowledge of this before you go home.
After returning home, it is imperative to follow a healthy lifestyle .
- Quitting smoking completely.
- Getting used to a healthy diet.
- Stop drinking alcohol.
- Exercising as per the doctor's instructions.
- Taking prescribed medications, including blood thinners (anticoagulants), on time.
It is also very important to participate in a cardiac rehabilitation program after surgery. Also, there may be restrictions on activities such as swimming, weight lifting, and contact sports. You should discuss all of these with your doctor and get advice.
What are the benefits of using an LVAD?
Although this does not cure heart disease, it has been shown that patients with an LVAD can live longer than those taking medication alone.
| Advantage | Description |
|---|---|
| Function of organs | Major organs like the kidneys, liver, and brain receive better blood flow, improving their function. |
| Reduction of symptoms | Symptoms such as fatigue, shortness of breath, and body swelling are greatly reduced. |
| Energy and activity | As the body gains strength, it is able to do things, such as exercise, that it was previously unable to do. |
| Discharge from the hospital | You don't have to stay in the hospital. You get the chance to go home and live a normal life. |
What are the risks and complications of this?
As with any surgery, there are some risks. Your medical team will explain these risks to you and how you can minimize them.
The main risks are infection, blood clots and stroke, excessive bleeding, right heart failure, and device malfunction. Before you panic, it's important to talk openly with your doctor and ask all your questions.
When should you see a doctor immediately?
If you experience any of the following symptoms, notify your medical team immediately.
| Emergency symptoms to watch out for | |
|---|---|
| Fever | Redness or swelling where the device's driveline exits the skin |
| Chest or stomach pain | Heavy bleeding |
| Swelling in the legs or lower back | Difficulty breathing |
| A problem with some part of the equipment | Sudden chest pain |
Are LVAD and pacemaker the same thing?
No. The two are completely different. An LVAD helps the left ventricle of the heart pump blood. A pacemaker controls irregular heartbeats.
Whether or not to get an LVAD is a very personal decision, so talk to your doctor about it carefully and get a clear understanding of the benefits, risks, and benefits you will get from it.
Take-Home Message
- An LVAD is a mechanical device that helps pump blood to the heart of patients with severe heart failure.
- This is not a complete cure for the disease, but it is a great help in extending life and improving the quality of life.
- This device can be used as a bridge before a heart transplant or as a lifelong treatment.
- Before and after LVAD surgery, it is imperative to make lifestyle changes such as quitting smoking, eating a healthy diet, and exercising.
- Before making any decision, it is important to have an open discussion with your doctor about the benefits and risks and gain a clear understanding.
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