What is a left ventricular assist device (LVAD)?
A left ventricular assist device (VAD -- also called ventricular assist system or VAS) is a type of mechanical circulatory support device (MCSD). It is a mechanical pump that is implanted in patients who have heart failure to help the heart’s weakened left ventricle (major pumping chamber of the heart) pump blood throughout the body.
The LVAD can be used two ways:
- Bridge-to-transplant, which means it can help a patient survive until a donor heart becomes available for transplant. This option may be appropriate for people whose medical therapy has failed and who are hospitalized with end-stage systolic heart failure. As a bridge-to-transplant, the LVAD allows the patient to be discharged to an outpatient setting while waiting for transplant.
- Destination therapy, which is an alternative to heart transplant. Destination therapy provides long-term support in patients who are not candidates for transplant.
The LVAD may provide blood pressure support; maintain or improve other organ function by improving blood flow to the kidneys, liver, brain and other organs; and when used as destination therapy or bridge-to-transplant, improve the patient’s strength and ability to participate in activities such as cardiac rehabilitation; and allow the patient to be discharged from the hospital.
How does the LVAD work?
A LVAD does not replace the heart. The left ventricular assist device (LVAD) receives blood from the left ventricle and delivers it to the aorta. It assists the patient’s own heart to pump blood throughout the body, decreasing the work of the left ventricle.
What are the components of the VAD?
There are a few different types of LVADs available at Cleveland Clinic. The type of VAD selected will depend on each patient’s individual needs and medical condition. The components of the VAD vary, according to the specific device used. In general, the device consists of an implanted pump unit, a controller, and an energy or power supply.
Types of VADs
Reprinted with permission from HeartWare
The HeartWare Ventricular Assist Device is attached to the left ventricle. A tube goes from the device to the aorta (the large artery that takes blood from the heart to the rest of the body. It works by pumping blood by continuous flow from the left ventricle to the aorta.
A cable (also called driveline) then passes from the device through the skin on your abdomen to a controller, a small external computer. The controller runs the pump and provides messages and alarms to help you operate the system.
The controller is powered by one battery and either a second battery, or an AC adapter (plugs into the wall) or a DC adapter (plugs into car). The controller requires two power sources to be connected at all times. One battery will provide 4-5 hours of power. When the battery is low on power, it will need to be replaced. You will have extra batteries and a battery charger.
Heartmate II by Thoratec
The Thoratec Heartmate II device is attached to the left ventricle. A tube goes from the device to the aorta (the large artery that takes blood from the heart to the rest of the body). A small motor in the pump drives the rotor (similar to a propeller) that pushes the blood from the left ventricle to the aorta.
A flexible tube then passes from the device through the skin on your abdomen to a small controller outside your body. The controller runs the pump and provides messages and alarms to help you operate the system.The controller is powered by two batteries or electricity from a wall outlet.
Who is eligible to receive a LVAD?
A LVAD is a treatment option for certain patients with end-stage heart failure. Your doctor will determine if a VAD is an appropriate treatment for you, based on your medical condition, symptoms, age, body size and presence of other medical conditions.
A LVAD may not be the appropriate treatment choice for some patients who have blood clotting disorders, irreversible kidney failure, severe liver disease, severe lung disease, or infections that cannot be treated with antibiotics.
What are the risks of the LVAD implantation procedure?
As with any surgical procedure, there are risks to the VAD implantation procedure. Your doctor will talk with you about the specific risks and potential benefits of this procedure. Some of the possible risks include bleeding, development of blood clots, respiratory failure, kidney failure, stroke, infection and device failure. Special precautions are taken to decrease these risks.
There may be other possible risks. When you meet with your doctor, please ask questions to make sure you understand why the procedure is recommended and the potential risks of the procedure.
If you need more information or would like to make an appointment with a specialist, contact us, chat online with a nurse or call the Miller Family Heart and Vascular Institute Resource & Information Nurse at 216.445.9288 or toll-free at 866.289.6911. We would be happy to help you.
Lee S, Fukamachi K, Golding L, Moazami N, Starling RC, Left Ventricular Assist Devices: From the Bench to the Clinic, Cardiology 2013;125:1-12 , http://www.karger.com/Article/FullText/346865. Accessed 7/29/2014
Kirklin, JK, Naftel DC, Kormos RL, Stevenson LW, Pagani FD, Miller, MA, Ulisney, KL, Baldwin JT, Young, JB. Third INTERMACS Annual Report: The evolution of destination therapy in the United States, The Journal of Heart and Lung Transplantation. Volume 30, Issue 2 , Pages 115-123, February 2011. http://www.jhltonline.org/article/S1053-2498(10)00754-0/abstract. Accessed 7/29/2014