When the heart isn’t pumping enough blood, mechanical circulatory support can step in to help. A ventricular assist device is one kind of mechanical circulatory support. It’s a pump that helps the heart send blood to the rest of the body, making sure organs like the brain and kidneys get the blood they need. Mechanical circulatory support helps the heart work better until it’s strong enough on its own.
VAD + mechanical circulatory support for heart failure: Improving heart function
Heart failure happens when the heart can’t pump blood properly. In systolic heart failure, the left side of the heart (the main pumping chamber) can’t push blood out with each heartbeat. One option to help improve heart function is mechanical circulatory support. This includes devices like the ventricular assist device (VAD), which is a mechanical pump surgically placed in your chest. A VAD doesn’t replace your heart, but it helps pump enough blood throughout your body.
The most common type of VAD is the left ventricle assist device (LVAD), which helps the left side of the heart pump blood to the body, keeping organs like the brain and kidneys healthy. Mechanical circulatory support, including VADs, can help improve your quality of life and extend it, giving your heart the support it needs.
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Conditions
Mechanical circulatory support includes various devices and systems designed to replace or support your heart's primary job of pumping blood throughout your body. These include VADs, as well as total artificial hearts and extracorporeal membrane oxygenation (ECMO).
If you have conditions like heart failure, cardiogenic shock or if your heart isn’t pumping enough blood, you may need mechanical circulatory support to help your heart work more effectively. These devices provide the support your body needs until the heart can recover or until a more permanent solution like a heart transplant is possible.
Cardiac amyloidosis
Cardiac sarcoidosis
Cardiogenic shock
End-stage heart failure
Heart attack
Ischemic cardiomyopathy
Myocarditis
Nonischemic cardiomyopathy
Restrictive cardiomyopathy
Treatments
If your symptoms of heart failure have progressed, we may recommend a left ventricular assist device (LVAD) to help stabilize your cardiovascular condition and improve blood circulation. LVADs are used for patients with severe heart failure with reduced ejection fraction (HFrEF) or systolic heart failure, a condition where the heart loses its ability to pump blood effectively, causing the heart chambers to enlarge. LVADs are designed to improve survival, enhance physical function, and relieve symptoms, but they may not be suitable for all types of heart failure or patients with other serious health conditions.
By understanding the options available, you can make informed decisions about managing heart failure and improving your heart health. Whether you're considering temporary or long-term support, these devices are designed to give your heart the help it needs.
How does an LVAD work?
An LVAD is made up of several components that work together to assist your heart:
- Controller: Provides power to the internal pump and displays information about the pump's settings, including alarm conditions, if necessary.
- Driveline: An electrical cord that connects the internal pump to the controller and power supply. The driveline exits through the skin and requires regular clean bandages (sterile dressings) to prevent infection.
- Power supply: The controller is powered either by batteries or by a power cable that plugs into a wall outlet.
Before leaving the hospital, you and your caregivers will be trained on how to manage the LVAD at home.
Temporary mechanical cardiac support for heart failure
If you're critically ill due to heart failure, temporary mechanical cardiac support devices may be used to stabilize your heart. These devices are typically implanted using minimally invasive procedures and require close monitoring in the intensive care unit (ICU). Temporary support can help stabilize patients waiting for heart function recovery, a heart transplant or as a bridge to a long-term LVAD. Extracorporeal Membrane Oxygenation (ECMO) is another form of advanced life support used for severe shock from heart failure and other causes. Types of temporary cardiac support devices include:
- Intra-aortic balloon pumps (IABP)
- Abiomed Impella device
Long-term mechanical circulatory support
For long-term support, the Abbott HeartMate 3 LVAD is the only FDA-approved device for patients who can be discharged from the hospital and live with the device at home. This system is suitable for those awaiting a heart transplant or for long-term use as a heart failure treatment. The HeartMate 3 LVAD helps improve heart function, offering support and enhancing quality of life.
FAQs
What type of LVAD will I need?
Your care team will evaluate your condition and determine the best option for you. Currently, the only FDA-approved device available is the Abbott HeartMate 3. However, investigational devices may sometimes be accessible through participation in a clinical trial.
How long will I need an LVAD?
It depends on what and how the LVAD will support you and your care. There are 2 reasons a LVAD may be recommended:
- Bridge therapy: Designed to keep you stable and physically active as you wait for a heart transplant or until the heart function recovers. The LVAD is temporary and removed.
- Destination therapy: In cases of end-stage heart failure, the LVAD can be a permanent solution when a heart transplant is not an option. In these situations, it is unlikely that the LVAD will be removed unless the heart has fully recovered.
How long is the battery life for my LVAD?
Battery life can last between 8-14 hours. Each LVAD comes with 3 sets of batteries, so you can go freely about your day without worrying about recharging batteries. To prevent your LVAD's battery from draining, it is recommended to connect it to a power source (to a wall outlet) while you sleep at night.
Can I return to work after receiving my LVAD?
Some people are able to return to work depending on their job responsibilities. We strongly recommend speaking with your doctor first before returning to work.
Can I travel with my LVAD?
Traveling with an LVAD is possible and requires thoughtful planning. You can even go on airplanes. We can provide local contact information for LVAD hospitals should a visit be necessary.
Can I drive if I have an LVAD?
People with an LVAD are able to drive once fully healed, which is about 8–10 weeks after after surgery. Your care team will need to clear you before you start driving again.
Can I go swimming if I have an LVAD?
No, you cannot go swimming if you have an LVAD.
Can I shower shortly after surgery for my LVAD?
Showering is possible about 6 weeks after surgery with the use of protective equipment to prevent the controller and batteries from getting wet.
Will I need a full-time caregiver after my LVAD surgery?
Receiving an LVAD requires a big commitment for you, your caregiver and your medical team. You must have full-time support at home with a caregiver knowledgeable about caring for the device in emergencies for the first several weeks and months after the surgery.
Certain patients may need to be transferred to an acute rehabilitation hospital before they can go back home. Typically, long-term care facilities for patients with LVAD are not available for those who still require significant support at home. It's very important for you to have support in place before your surgery in case of a major complication and you're unable to care for yourself.
What can I expect during recovery from LVAD surgery?
While recovering from surgery, you will typically require some help from caregivers once they leave the hospital. We expect that most who receive an LVAD will return to an independent lifestyle, but some long-term help may be required for specific care tasks, such as changing the driveline bandage. After surgery, most will need full-time help from a caregiver for a few weeks.
We'll provide you and your caregiver with education on:
- How to transition between power sources: batteries vs the power cable.
- How to respond to LVAD alarms and when to contact their medical team.
We will make sure that you have the needed resources before you leave the hospital to minimize risk of long-term complications and to optimize your safety and well-being. You will have a full set of backup equipment at home should an emergency arise.
LVAD therapy requires chronic anticoagulation (blood thinners) and we'll help you manage these medications. You will see your care team often after your surgery — initially once a week and then gradually less as you recover from your surgery and become comfortable with your new lifestyle. You will generally be seen at least every 3 months for long-term care and as needed.
Locations
Tufts Medical Center CardioVascular Center
800 Washington Street
Proger Building at Floating Bridge, 6th floor
Boston, MA 02111
Lowell General Heart + Vascular Center
295 Varnum Avenue
Lowell, MA 01854
MelroseWakefield CardioVascular Center
585 Lebanon Street
2nd floor
Melrose, MA 02176
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