Left Ventricular Assist Devices (Mechanical Circulatory Support MCS)

Overview

What is a Left Ventricular Assist Device (LVAD)?

A left ventricular assist device (LVAD) is a mechanical pump that is implanted in patients with heart failure. It helps the bottom left chamber of your heart (left ventricle) pump blood out of the ventricle to the aorta and the rest of your body. That is why it is called a Left Ventricular Assist Device.

Does an LVAD take the place of your heart?

No. A left ventricular assist device does not replace the heart. The LVAD receives blood from the left ventricle and delivers it to the aorta. It pumps along with the patient’s own heart. This helps the left ventricle pump blood.

How does the LVAD work?

There are a few different LVADs available at Cleveland Clinic. The doctor will recommend the one that is best for you based on your needs and medical condition.

The LVAD is implanted during open heart surgery. The parts of the LVAD may vary based on the type of device but mainly, there are four basic parts:

The pump unit is placed in the chest. It is implanted by the surgeon into the apex of the heart where it receives blood. A tube then delivers this blood 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.

The pump is attached to a driveline (cable) and control system (controller). The driveline passes from the device through the skin on your belly (abdomen) to the controller (a small computer) on the outside of your body. The controller runs the pump and provides messages and alarms to help you operate the system.

A power supply (rechargeable batteries or cord that plugs into an electrical socket) keeps the LVAD running.

Left Ventricular Assist Device (LVAD)

Abbott and HeartMate IIl™ are trademarks of Abbott. And/or Reproduced with permission of Abbott, ©2018. All rights reserved.

How are LVADs Used?

The LVAD can be used two ways: bridge-to-transplant and destination therapy.

Bridge-to-transplant (BTT)

In 2008, the FDA approved the LVAD device for patients awaiting heart transplant. As patients wait for their transplantation, their heart and medical condition may continue to worsen which may lead to hospital admission, increased symptoms and damage to other organs such as the kidneys, liver and lungs.

If a patient is a candidate for a heart transplant, bridge-to-transplant therapy helps the patient survive until a donor heart becomesis available. The LVAD assists the heart and allows the patient to have better quality of life and fewer symptoms; and is then removed at the time of transplant.

The amount of time you receive support from a VAD until heart transplantation varies and depends on your medical condition, blood type, and body size. Currently, the Heartmate III, HVAD and Heartmate II are FDA approved for BTT.

Destination therapy (DT)

In 2010, the FDA approved the LVAD device for patients as destination therapy (DT) for patients with heart failure who were not candidates for heart transplant surgery. It is considered only for patients when all other treatment options, such as medications, lifestyle changes and heart procedures, have been tried and not effectively managed heart failure.

The goal of DT is to support the patient’s heart function and improve quality of life for the rest of the patient’s life.

Your doctor will determine if destination therapy is an appropriate treatment option for you, based on your medical condition, symptoms, body size and presence of other medical conditions.

Destination therapy 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.

Currently, Heartmate III, HVAD and Heartmate II are FDA approved for DT.

The Cleveland Clinic Experience

For more than two decades, surgeons in the Kaufman Center for Heart Failure at Cleveland Clinic have successfully utilized ventricular assist devices (VADs) as a bridge- to-transplant for patients awaiting heart transplantation. Cleveland Clinic has one of the most experienced VAD programs in the United States. The Cleveland Clinic has access to FDA- approved ventricular assist devices, as well as new investigational devices.

The Kaufman Center is approved by the Centers for Medicare and Medicaid Services and the FDA to offer destination therapy.

Cleveland Clinic is an approved site for disease- specific care for ventricular assist devices as of December 29, 2008.

Quality and Outcomes

Doctors vary in quality due to differences in training, skill and experience; hospitals differ in the number of services available. The more complex your medical problem, the greater these differences in quality become and the more they matter.

Clearly, the doctor and hospital that you choose for complex, specialized medical care will have a direct impact on how well you do. To help you make this choice, please review our Miller Family Heart, Vascular & Thoracic Institute Heart Failure and Transplant Outcomes.

Who can have an LVAD?

An LVAD is a treatment option for certain patients with end-stage heart failure. If you are interested in having an LVAD, you will need an evaluation to see if the treatment option is right for you.

An LVAD is not an appropriate treatment option for all patients. If you have a medical condition, such as clotting problems, kidney failure, liver disease, lung disease, or infections, you may not be a candidate for an LVAD.

Evaluation for LVAD

To see if you are a candidate you need to be carefully evaluated by a team from the George M. and Linda H. Kaufman Center for Heart Failure Treatment and Recovery. This team also cares for you after you get your LVAD in the hospital as well as after you leave the hospital for follow-up appointments.

Your medical exam includes several tests and a review by the Heart Failure Committee.

  • Electrocardiogram
  • X-ray
  • Bloodwork
  • Echocardiogram
  • Metabolic stress test
  • Heart catheterization

These tests may be ordered by your heart failure cardiologist or by your surgeon. Some of these tests may have been performed before and will only be repeated if they were not recently performed (within the last 6 to 12 months, depending on the type of test).

The Heart Failure team consists of

  • Heart failure cardiologist, specialized in treating advanced heart failure
  • Cardiac surgeon, who is specially traiianed in operating on patients with poor heart function
  • Nurse practitioners, physician assistants and registered nurses help plan your care and answer questions before surgery, during your hospital stay and when you go home
  • Social worker, to get a better understanding of the support system you have and concerns you may have about your ability to live with a LVAD. He or she will also meet with your family and caregivers to provide support and resources, including information about housing and other community resources.
  • Bioethicist will make sure you understand LVAD therapy and how it will affect your long-term care. They will also discuss advanced directives with you.
  • Palliative Medicine specialists discuss symptom management with you and help identify your personal goals as they relate to your medical care.
  • Cardiac Rehabilitation for activity and exercise
  • Dietitians, to make sure you are eating right for best possible recovery and long term health
  • And other team members as needed; for example, you may need to see a lung specialist or kidney doctor if these organs have been affected by your illness

Procedure Details

What types of LVADs are used at Cleveland Clinic?

The most common types of LVADs used at Cleveland Clinic are the Heartmate 3 and the HeartWare. Your doctor will talk to you about these LVADs if they are right for you.

HEARTMATE 3

The Heartmate 3 is approved by the US Food and Drug Administration (FDA) for bridge-to-transplant and destination therapy.

Heartmate 3 is a circular pump that is implanted into the apex of the heart. The controller is powered by two batteries or electricity from a wall outlet.

Abbott and HeartMate III™ are trademarks of Abbott. And/or Reproduced with permission of Abbott, ©2018. All rights reserved.

Heartware HVAD

The HeartWare is approved by the FDA for bridge-to-transplant therapy and destination therapy.

HeartWare HVAD is a circular pump that is implanted into the apex of the heart. The controller is of the HVAD 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 2

Abbott and HeartMate II™ are trademarks of Abbott. And/or Reproduced with permission of Abbott, ©2018. All rights reserved.

The Thoratec Heartmate II is approved by the FDA for bridge-to-transplant therapy and destination therapy. It is a pump that is implanted into the apex of the heart under the muscle layers of the abdomen. The controller is powered by two batteries or electricity from a wall outlet.

LVAD Surgery

Open heart surgery is needed to implant an LVAD. The surgery is done under general anesthesia and you will be asleep the entire time. The procedure lasts 4-6 hours.

The surgeon will make an incision down your chest and open your chest bone (sternum) to reach your heart and attach the LVAD. At times, depending on your situation, the doctors may elect to make an incision on the left side of your chest (Thoracotomy).

During the surgery, a heart-lung bypass machine may be used to circulate oxygen-rich blood throughout your body during surgery. A breathing machine (ventilator) will take over for your breathing during the surgery. The incision will be closed after the LVAD is in place.

Every patient has a different recovery, so the amount of time you will stay in the hospital depends on your individual needs. A typical hospital stay after LVAD surgery is 14-21 days.

Risks / Benefits

What are the benefits of LVAD?

By increasing blood flow to the body, the LVAD improves the function of the kidneys, liver, brain and other organs; improves the patient’s strength and ability to participate in activities such as cardiac rehabilitation; and allows the patient to be discharged from the hospital.

Greater life expectancy

Patients with advanced heart failure who have an LVAD tend to live longer than those who are treated with medical therapy alone.

Better quality of life

An LVAD can help patients with advanced heart failure take part in activities that were not possible before the implant.

Fewer symptoms of heart failure

An LVAD can help improve and reduce symptoms of heart failure, such as shortness of breath, excess fluid and fatigue. This helps patients feel better and take part in daily activities and avoid hospitalization for heart failure.

Outcomes at Cleveland Clinic

Cleveland Clinic is one of the most experienced centers in the nation for LVADs, with more than 25 years of experience and lower-than expected rates of in-hospital deaths for patients who receive these devices.

What are the risks of LVAD?

There are risks with every surgery. Your doctor will talk to you about the risks that are specific to LVAD surgery and how we help reduce them.

Some of the most common risks are:

  • Infection
  • Blood clots and stroke
  • Bleeding
  • Right heart failure
  • Kidney injury
  • LVAD malfunction

Special precautions are taken to decrease these 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.

Advance Directives

We encourage you to create advance directives to let your doctor and others know your wishes concerning medical treatment in the event that you become unable to communicate your wishes.

If you already have advance directives, please review these documents to make sure that they still reflect your preferences if you are e a candidate for LVAD therapy.

Please share information about your advance directives with your surgical team.

Recovery and Outlook

The following are common questions about recovery and care for those with an LVAD. You will receive more information when you are evaluated for LVAD.

How often do you need to follow up?

You will have many follow-up visits after you get your LVAD. You will have weekly appointments for a few weeks, which will taper off to monthly visits. The visits are needed to make sure your LVAD is working as it should and that you are doing well.

After the first year, you will have fewer visits. Your doctor will let you know how often you need to be seen. If you are waiting for a heart transplant you will need to be seen at least once every three months.

If you do not live near Cleveland Clinic you may be able to have your follow-up visits with an LVAD team near your home. Your Cleveland Clinic doctor will talk to you about this option if needed.

How long can you be supported by a LVAD?

Although implantation of a left ventricular assist device as destination therapy is considered permanent therapy, it does not cure heart failure.

The amount of time you can receive support from an LVAD varies. It depends on the type of LVAD you have, whether it is being used as a bridge to transplant or destination therapy, and your overall health. The newest LVADs are designed to last a few years, but because the technology is so new, it is not possible to know just how long they can support patients with them. Some Cleveland Clinic patients have been living with an LVAD for more than 5 years.

How will I know how to care for my LVAD?

To enhance quality of life, all patients with a LVAD must carefully follow the guidelines provided by their health care team.

After the implantation procedure, a detailed education program is provided to you and your caregivers to ensure safety and proper use of the device. You’ll learn how to manage the device and trouble-shoot potential emergency situations. You’ll be required to demonstrate your knowledge about the device before you are discharged from the hospital. You’ll also need to demonstrate independence with self-care activities before you are discharged.

In addition, you’ll be given guidelines about your activities, including swimming, showering, bathing and resuming sexual activity; medications, diet, and when to call the doctor.

At home, you’ll need to have an accurate scale as well as a thermometer. Some patients will need to monitor their blood pressure at home. Your nurse will provide specific guidelines. You will receive information about how to reach the health care team when necessary. A medical team member is always available to answer your questions, 24 hours a day.

Can I go home after receiving the LVAD?

Yes. When you are able to go home will depend on your rate of recovery and your medical condition. Our goal is to help you go home as soon as possible. Some patients may need to stay in an intermediate care facility or rehabilitation center for a while until you are strong enough to go home. Your health care team will help you with this process. If you think you will require care at home, talk to your health care team. Our Center for Connected Care can assist with local service as well as nationwide.

If you live more than two hours away from Cleveland Clinic, you will need to stay in the local area for two weeks before you go home.

Staying Healthy

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

  • Stop using tobacco – your health care provider can refer you to a smoking cessation specialist if you need help.
  • Eat a healthy diet, recommended by your health care team.
  • 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 weight lifting.

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

Learn more about recovery after LVAD

Resources

Make an Appointment

The George M. and Linda H. Kaufman Center for Heart Failure Treatment and Recovery is one of the premier facilities in the United States for the care of people with advanced heart failure

To be evaluated for a left ventricular assist device, call the LVAD team at 216-445-3366.

To refer a patient please call the LVAD team at: 216-445-3366

The phone number listed for either a LVAD evaluation or referral provides immediate access to the LVAD team who will address your needs promptly. We will need information about the patient and will ask for medical records to assist this process.

More Information

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, Vascular & Thoracic Institute Resource & Information Nurse at 216.445.9288 or toll-free at 866.289.6911. We would be happy to help you.

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Last reviewed by a Cleveland Clinic medical professional on 05/03/2019.

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