A person who has experienced a heart attack, cardiogenic shock or advanced heart failure may require mechanical circulatory support to pump blood throughout their body when their weakened heart can't. That's where a ventricular assist device (VAD) comes in. It's a type of treatment that helps your vital organs receive the right amount of blood.
Support for you + your heart
Heart failure happens when the heart can't pump blood effectively. Systolic heart failure is when the heart's main pumping chamber, the left ventricle, can't eject blood during each heartbeat.
One option to help improve these conditions and improve and extend your life is by using a ventricular assist device (VAD). A VAD is a mechanical pump that is surgically implanted into your chest. It won't replace your heart, but it will help circulate enough blood throughout your body. The majority of VADs are implanted in the left ventricle (LVAD), which is the main pumping chamber of the heart.
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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 any of the following conditions, you may need mechanical circulatory support.
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 suggest an LVAD to help stabilize your cardiovascular condition and improve your blood circulation. LVADs are designed to prolong survival and enhance symptoms and physical functioning in patients with severe forms of heart failure with reduced ejection fraction (HFrEF or systolic heart failure), which is caused by a loss in pumping function with enlargement of the heart chambers. It is important to note that LVADs are not a treatment option for all forms of heart failure and those with other serious health conditions.
An LVAD contains:
- A controller provides power to the internal heart pump and has a screen that displays information about the pump settings and status, including alarm conditions when necessary.
- An electrical cord, called the "driveline," connects the internal parts to the controller and power supplies (batteries or a power cable that plugs into the wall). The driveline exits through the skin and requires clean bandages (sterile dressings). Before you leave the hospital, we'll teach you and your caregivers how to manage and live with the LVAD at home.
Temporary support for heart failure
If you are critically ill due to heart failure, we may recommend other types of temporary mechanical cardiac support devices to stabilize your heart. These devices are typically implanted with minimally invasive procedures and require monitoring in the intensive care unit. They can help stabilize those who are waiting for their heart function to recover, waiting for a heart transplant or as a transition to a long-term LVAD. Extracorporeal Membrane Oxygenation (ECMO) may be used as another form of advanced life support that can be used to treat severe shock from heart failure and other causes.
These temporary LVADs can be implanted with less invasive procedures that require small incisions in the upper chest wall or groin areas. They include:
- Intra-aortic balloon pumps (IABP)
- Abiomed Impella device
Long-term support
The only FDA-approved long-term left ventricular device is the Abbott HeartMate 3 LVAD. This system is designed for those who can be discharged from the hospital and live with the device at home, either permanently or while waiting for a heart transplant.
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.
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