LVAD

What Is The Left Ventricular Assist Device (LVAD)?

An LVAD is a mechanical device that is implanted in the body and connected to the left lower chamber of the heart to help pump blood to the rest of the body. They are normally used to assist the functioning of a failing heart. Depending on the underlying conditions, they may be used for a short time or a long time as life-sustaining devices.

Alternate name

• Mechanical Circulatory Support Device

Is this procedure an elective or an emergency procedure?

Left Ventricular Assist Device implantation is an elective procedure.

Types of procedure

Left Ventricular Assist Device may be of the following types based on the mechanical device being used

• Pulsatile LVAD: They mimic the pulsatile motion of the heart
• Continuous Flow LVAD

Indications of LVAD

Some indications for a Left Ventricular Assist Device implantation include

• Stage D and Class IV Heart Failure
• To support an individual recovering from cardiogenic shock or Myocardial Infarction
• As a bridge before a heart transplant procedure
• Endocarditis not responding to conventional therapy
• Before a high-risk procedure to clear a coronary artery blockage

Contraindications and risk factors for LVAD

Some contraindications for a Left Ventricular Assist Device implantation include

• Extremely underweight or overweight individuals
• Severe right ventricular dysfunction
• Irreversible renal failure
• Severe peripheral vascular disease
• Irreversible brain damage
• Terminal metastatic cancer
• Severe liver disease
• Coagulopathies
• Severe lung dysfunction
• Pulmonary hypertension
• Uncontrolled diabetes
• Sepsis
• Advanced age

Investigations before the LVAD procedure

Some investigations that are done before an LVAD implantation include

• Laboratory tests:
  • CBP & ESR
  • Coagulation Profile and blood typing
  • Liver and Renal Function tests
  • Complete urine examination
  • Arterial and Venous Blood Gas measurement
• Imaging tests:
  • Echocardiography
  • Angiography
• Electrocardiography
• Pulmonary Function tests
• Cardiac Catheterization

Preoperative advice

Before an LVAD implantation, the following is done

• Risks and benefits of the procedure are explained
• Nothing by mouth after midnight on the night before surgery

Intraoperative details

Duration: LVAD implant may take up to a few hours

Anaesthesia: LVAD implant is done under general anaesthesia

Description of the Procedure: With the individual lying on the back, after the anaesthesia has taken effect, and all the monitoring lines are in place, a median sternotomy (incision in the midline of the chest) is done. A cardiopulmonary bypass and mechanical ventilation are done. An LVAD pocket is created within the body to hold the device. The heart is stopped using cardioplegic drugs. The left ventricle is then connected to the inlet of the LVAD and the outlet of the LVAD is connected to the aorta. A cable is used to connect the pump to the battery unit that is present outside the body. The device is checked to see that it is working properly. After this, the incisions in the chest are closed and chest tubes are left in place.

Postoperative details

After an LVAD implant, the following is usually done

• The individual is moved to a recovery room, and then to an ICU and placed under observation
• Mechanical Ventilation is needed for a few days and extubation is done a few days after the procedure
• Drainage tubes are removed from the chest 1- 3day after the procedure

• Pacing wires are also removed 1-3 day after the procedure if there are no rhythm abnormalities
• Shifting to a regular room may be done 5-7 days after the procedure depending on conditions and recovery

Medications: Anticoagulant medication, antibiotics are generally prescribed.

Discharge: Is usually 1-2 weeks after the procedure.

Review: Usually done 3-5 days after discharge, with periodical follow up thereon.

Resumption of normal activities: Usually with restrictions 3-4 weeks after the procedure.

Role of diet/exercise/lifestyle changes

Some measures that will be needed after an LVAD implant include

• Cardiac rehabilitation
• Regular cardiology consultations to monitor and plan further course of action

Complications of LVAD

Some of the complications that may arise after an LVAD implant include

• Bleeding
• Infections
• Right ventricular failure
• Air embolism
• Arrhythmias
• Respiratory failure
• Renal failure
• Liver failure
• Ischemic stroke or hemorrhagic stroke
• Thrombosis of the pump

Prognosis of LVAD

The prognosis of an LVAD implant depends on the underlying condition, the reason why it is done, as well as on the general health of the individual.

Indications for hospitalization if required

Hospitalization will be required.

Suggested clinical specialist/Department to consult for the procedure

LVAD implant is done by specialists from the Department of Cardio-Thoracic Surgery, and Heart Failure & Transplant Cardiology.