Patients with severe heart failure can rely on the latest left ventricular assist device models to prolong and improve their lives.
A left venticular assist device (LVAD) is one of the most common electromechanical tools used to assist heart patients. The left ventricle is a large, muscular chamber of the heart that pumps blood out to the body. An LVAD is a battery-operated, mechanical pump-type device that is surgically implanted, when the heart can’t work effectively on its own.
Heart failure often develops, because the heart has been damaged by a heart attack, or as a result of conditions, such as cardiomyopathy (a disease of the heart muscle). Patients who have very severe heart failure and can’t be treated with medications or other interventions may be considered for a heart transplant. An LVAD can quite literally be a lifesaver for a patient on the donor list.
At the Center for Advanced Heart Failure at the CardioVascular Thoracic Institute of Keck Medicine of USC, an entire LVAD team manages each patient’s individual care. The team is made up of surgeons, cardiologists, advanced practice nurses, dietitians, and occupational and physical therapists, who monitor and evaluate our LVAD patients, in an outpatient setting.
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How does it work?
The LVAD has both internal and external components. The most common type of LVAD has a tube that pulls blood from the left ventricle into a pump. The pump then sends blood into the aorta, which is the large blood vessel leaving the left ventricle. The aorta then delivers oxygen-rich blood throughout the body. The pump is placed in the upper part of the abdomen, to help the weakened ventricle. Another cable, called the driveline, is attached to the pump and is brought out of the abdominal wall to the outside of the body. It connects the pump to a controller and power sources worn outside the body.
The driveline needs to be connected to the controller, and the controllers must be hooked up to power at all times, to keep the device working properly. The pump runs on either batteries or electricity. Some LVADs have an adapter that also allows them to run off the car battery. Each device has specific carrying cases or a backpack, which helps the user move about freely with the equipment. These portable LVADS can be used for weeks to months. Patients with LVADs can be discharged from the hospital and have a regular quality of life, as they wait for the suitable donor heart to become available.
Earlier LVAD models used to be much bulkier, noisier and less durable, with bigger power sources. Even newer, more compact LVADS are currently undergoing the approval process in the United States. These newer models have already been approved in Europe, where the approval process is shorter than in the U.S.
Temporary and permanent solutions
When an LVAD is implanted in a patient waiting for a heart transplant, it’s called bridge-to-transplant. The patient’s LVAD may remain in place for several years, until a heart donor becomes available for transplant. When a patient is not eligible for a heart transplant, an LVAD may be implanted as a permanent solution. This is called destination therapy and is becoming more and more common, as LVAD technology continues to evolve and get better.
Led by Vaughn A. Starnes, MD, a world-recognized leader and innovator in heart, heart-lung and lung transplantation; and cardiothoracic surgery, the USC Heart Transplant Program offers a bridge-to-transplantation, utilizing the left ventricular assist device.
by Ramin Zahed