Left Ventricular Assist Devices (LVADs)

What is a left ventricular assist device?

A left ventricular assist device (LVAD) is a mechanical pump that providers implant in people who have heart failure. The device helps the lower left chamber (left ventricle) of your heart pump blood out of the ventricle to your aorta and the rest of your body. Because it helps your left ventricle, it’s a left ventricular assist device.

This is an important job because your aorta sends oxygen-rich blood to your whole body. You can’t live without a steady supply of oxygen to your cells and tissues.

How does a left ventricular assist device work?

A left ventricular assist device works by pumping blood from your left ventricle to your aorta. Your aorta is the large artery that takes blood from your heart to the rest of your body.

A surgeon implants the left ventricular assist device’s pump unit at the bottom of your heart inside your chest. The device receives blood and sends it through a tube to your aorta.

What are the parts of a left ventricular assist device?

Parts of a left ventricular assist device include:

• Pump: Attaches to a driveline (cable) and control system (controller).
• Driveline: Passes from the device through the skin on your belly (abdomen) to the controller (a small computer) on the outside of your body.
• Controller: Runs the pump. Messages and alarms from the controller help you operate the system.
• Power supply: Keeps the LVAD running with rechargeable batteries or a cord that plugs into an electrical outlet. Batteries can provide up to 14 hours of power, depending on the device. When the batteries are low on power, you need to replace them.

There are a few different LVADs available. Your healthcare provider will recommend the one that’s best for you based on your needs and medical condition.

What does a left ventricular assist device manage?

A left ventricular assist device is for people with end-stage heart failure. It’s a bridge to transplant for people waiting for a heart transplant. It can also help people who aren’t candidates for a heart transplant. Healthcare providers call that destination therapy.

Bridge to transplant (BTT)

While you wait for a heart transplant, your medical condition may continue to get worse. This may lead to hospital admission, increased symptoms and damage to other organs such as your kidneys, liver and lungs.

Bridge to transplant (BTT) helps you survive until you can receive a donor’s heart. The LVAD assists your heart and allows you to have a better quality of life and fewer symptoms. A surgeon removes the device at the time of your transplant.

The amount of time you receive support from an LVAD until heart transplantation varies and depends on your medical condition, blood type and body size.

Destination therapy (DT)

Destination therapy (DT) is for people with heart failure who aren’t candidates for heart transplant surgery. Healthcare providers consider this only for people after they’ve tried everything else (like medications, lifestyle changes and heart procedures).

A left ventricular assist device supports your heart’s function and improves your quality of life for the rest of your life.

Your provider will determine if a left ventricular assist device is an appropriate treatment option for you, based on your medical condition, symptoms, body size and presence of other medical conditions.

How common is a left ventricular assist device?

Better survival odds with today’s LVAD devices have led to an increase in the number of people who receive the devices. Each year, more than 2,500 people with heart failure receive a left ventricular assist device in the United States.

How should I prepare for receiving a left ventricular assist device?

Healthcare providers will evaluate you to see if you’re a candidate for a left ventricular assist device. Your medical exam will include several tests:

• Electrocardiogram.
• Chest X-ray.
• Blood tests.
• Echocardiogram.
• Metabolic stress test.
• Heart catheterization.

A left ventricular assist device isn’t an appropriate treatment option for everyone with heart failure. You may not be a candidate for an LVAD if you have:

• Blood clotting disorders.
• Irreversible kidney failure.
• Severe liver disease.
• Severe lung disease.
• Infections that antibiotics can’t treat.

What happens during a left ventricular assist device procedure?

You’ll receive general anesthesia and will be asleep throughout your entire open-heart surgery.

A healthcare provider will:

• Use a heart-lung bypass machine to circulate oxygen-rich blood throughout your body during surgery.
• Use a breathing machine (ventilator) to take over your breathing during the surgery.
• Make an incision down your chest and open your chest bone (sternum) to reach your heart and attach the LVAD. Depending on your situation, the provider may make an incision on the left side of your chest (thoracotomy).
• Close the incision after putting the left ventricular assist device in place.

How long does it take to implant a left ventricular assist device?

The procedure to implant a left ventricular assist device takes four to six hours.

What happens after a left ventricular assist device procedure?

Before you leave the hospital, you’ll learn how to manage the device and troubleshoot potential emergencies. You’ll have to demonstrate your knowledge about the device before you go home. You’ll also need to show that you can take care of yourself.

In addition, you’ll receive guidelines about your daily life, including:

• Swimming.
• Showering.
• Bathing.
• Resuming sexual activity.
• Taking medications. (This includes anticoagulants you’ll need to take after receiving an LVAD.)
• Diet.
• When to call a provider.

At home, you’ll need to have an accurate scale and a thermometer. Some people need to monitor their blood pressure at home. You should receive information about how to reach your healthcare team when necessary.

It’s very important to continue making healthy lifestyle changes before and after the LVAD implant procedure, such as:

• Stop using tobacco products.
• Eat a healthy diet.
• Stop drinking alcohol.
• Don’t use illegal drugs.
• Exercise regularly. Cardiac rehabilitation is an important program to take part in after surgery. You may have some restrictions such as swimming, contact sports and weightlifting.

If you need help making lifestyle changes, talk to your healthcare providers to assist with strategies or to refer you to other resources.

What are the benefits of a left ventricular assist device procedure?

For people with end-stage heart failure, those who have LVAD devices tend to live longer than those who receive medical therapy alone.

By increasing blood flow to your body, a left ventricular assist device:

• Improves the function of your kidneys, liver, brain and other organs.
• Reduces symptoms such as fatigue, shortness of breath and swelling.
• Improves your strength and ability to take part in activities you couldn’t do before, such as cardiac rehab.
• Allows you to go home from the hospital.

How successful is a left ventricular assist device procedure?

Although a left ventricular assist device improves quality of life for people with heart failure, it’s not a cure. But 80% of people who receive a left ventricular assist device today are alive one year later. Almost 50% are alive four years later.

What are the risks or complications after a left ventricular assist device procedure?

Every surgery carries risk. Your provider will talk to you about the risks that are specific to this surgery and how they can help reduce those risks.

Some of the most common risks are:

• Infection.
• Blood clots and stroke.
• Bleeding.
• Right heart failure.
• Kidney injury.
• Left ventricular assist device malfunction.

When you meet with your provider, ask questions to make sure you understand the device’s potential risks and why they recommend the procedure.

Advance directives can let your healthcare team know your wishes concerning medical treatment if you become unable to communicate your wishes.

What is the recovery time after receiving a left ventricular assist device?

Everyone has a different recovery, so the amount of time you’ll stay in the hospital depends on your individual needs. A typical hospital stay after LVAD surgery is 14 to 21 days.

Your rate of recovery and your medical condition will determine when you can go home. You may need to stay in an intermediate care facility or rehabilitation center for a while until you’re strong enough to go home. If you think you’ll need care at home, talk to your healthcare team so they can help you arrange it.

What follow-up appointments will I need?

You’ll have many follow-up visits after you get your LVAD. You’ll have weekly appointments for a few weeks, which will taper off to monthly visits. Going to these appointments allows your provider to make sure your LVAD is working as it should and that you’re doing well.

After the first year, you’ll have fewer visits. Your provider will let you know how often they need to see you. If you’re waiting for a heart transplant, you’ll need an appointment at least once every three months.

When should I call my healthcare provider?

Contact your provider if you have left ventricular assist device complications, such as:

• Fever.
• Redness around the area where your LVAD goes through your skin.
• Pain in your chest or belly.
• Bleeding.
• Swelling in your back or lower body.
• Shortness of breath.
• Chest pain.
• Issues with any part of your left ventricular assist device.

How long can a person live on an LVAD?

The amount of time you can receive support from a left ventricular assist device varies. It depends on the type of LVAD you have, whether it’s a bridge to transplant or destination therapy, and your overall health. The newest devices last several years. Some people have been living with an LVAD for more than five years.

Does an LVAD take the place of your heart?

No. A left ventricular assist device doesn’t replace your heart. The LVAD receives blood from your left ventricle and delivers it to your aorta. It pumps along with your heart, helping your left ventricle pump blood.

Is a left ventricular assist device a pacemaker?

No. A left ventricular assist device helps the left ventricle of your heart pump blood. A pacemaker helps stabilize your heart’s abnormal rhythms.

A note from Cleveland Clinic

Deciding whether it’s the right time to get a left ventricular assist device (LVAD) — or get one at all — is a personal choice. Talk with your healthcare provider about the risks and benefits of an LVAD. Getting answers to your questions can help you make an informed decision that makes sense for you.