LVADs Giving Back What Heart Disease Has Taken Away

Patients often ask what a Left Ventricular Assist Device (LVAD) can do for them.

Medically, the answer is that this implantable mechanical pump can help circulate blood through the body of patients with advanced heart failure. But from a lifestyle perspective—although every patient is different—it can offer most patients the chance to live longer and enjoy a better quality of life.

MedStar Heart & Vascular Institute was among the first four hospitals in the world to perform this surgery in 1988. Since then, we’ve implanted the device in about 700 patients. Currently, we perform 80 to 90 LVAD surgeries a year—and our outcomes are excellent.

A Look at the Device

A cable through the skin of your abdomen connects the pump on the inside of the body with a small computer and batteries that you carry.

As new technology revolutionizes this field, we’re seeing pumps that last longer than ever before. It’s not uncommon now to see patients who’ve been supported by their pumps for six, seven, or eight years after implantation.

Three Possible Pathways to Care

• The first pathway through which a patient might have this device implanted is as a temporary bridge to transplant. This means that—for patients who qualify for a heart transplant, have waited a very long time for a donor heart, and are getting progressively more ill—we may go ahead and implant an LVAD to rescue them from that difficult situation. These patients can then have a transplant procedure when a donor heart becomes available
• Another pathway, destination therapy, means that patients receive an implantable LVAD that will be with them forever. This pathway is typically employed for patients who are not good candidates for a heart transplant
• A third pathway we commonly employ is known as bridge to decision. Although some patients are not candidates for heart transplantation when they receive their LVAD, it’s expected that they may be well enough for the transplant in the near future. The device gives them time to decide how they’d like to proceed

Patient Selection

There are strict standards for what type of patients qualify to receive an LVAD implant. Guidelines established by the Center for Medicare and Medicaid Services (CMS) set three main criteria for patient selection:

• The patient’s heart must be unsuccessful at ejecting enough blood
• The patient must have heart failure symptoms
• Medical therapy must have proven unsuccessful for at least 15 days

Of course, there are many other things to consider from within the patient’s individual medical profile.

In addition, certain other constraints may make a patient ineligible for an LVAD. For example, we strive to allow the patient to gain at least one year of life; so, for patients whose life expectancy is less than a year—for example, when an advanced cancer is involved—an implant is usually not recommended.

Other disqualifying conditions include a severe neurologic disease like advanced dementia, failure of certain organs (like the liver), or inability to receive blood thinners.

What Patients Can Expect After Surgery

There are two main benefits for patients who do qualify to receive a left ventricular device. One is quantity of life, meaning the procedure can prolong life. Without an LVAD, you have a 10–25% chance of being alive in a year. With an LVAD, it’s 85–90%, a huge difference.

The other benefit is quality. About 80% of patients who receive an LVAD feel significantly better. Their heart symptoms go away, and they are likely able to do things they were unable to do before. Many can return to work. They can drive and play sports.

The only thing you can’t do with an LVAD is be submerged in water. For example, you cannot swim in the sea because the external components of the device are not immersible.

Aside from that limitation, you can have a normal life. There are few limitations if you're doing well post-surgery.

Recovery is not instantaneous, however. All the processes triggered by a patient’s heart failure take time to reverse. On top of that, the patient is healing from a relatively invasive operation. While everybody’s different, it takes at least three months for the patient to recover and be fully active again. In some cases, we can perform minimally invasive surgery, which can cause less trauma when implanting the device.

LVADs vs. Pacemakers

As much as we'd like to liken them to pacemakers, LVADs are not there yet. But if you compare the functions of the two, you’ll understand why.

A pacemaker is implanted completely under the skin, and its battery can last as long as 15 years. A pacemaker monitors your heart rhythm—a function that does not consume much energy—and occasionally, as needed, it will shock the heart into a regular rhythm. Pacemakers can only provide a modest improvement of your heart’s ability to pump blood.

On the other hand, an LVAD must continuously pump an average of five liters of blood per minute, a function that consumes a lot of energy. They can completely replace the function of the left side of your heart and that’s why they can help you live longer and without heart failure symptoms.

And what is the future of the LVAD?  A main goal is to design a device that can be fully implantable. This means that, first, its battery will need to reside completely inside the patient’s body. Second, we must solve the challenge of charging the battery through the skin.

Giving Back What Heart Failure Takes Away

For many of our patients, life is completely different after their implant. When they first come to us, they can only walk a few steps, their kidneys are failing, and their liver is starting to fail, maybe they're depressed or have lost a lot of weight. They just want to give up.

After the LVAD procedure, the improvement is dramatic. They look healthy again. They're happy. They’re enjoying regular family dynamics. They’re back to work. They don’t look like heart failure patients.

Obviously, it’s frightening to live with heart failure. For patients in the Mid-Atlantic region, MedStar Heart & Vascular Institute has effective tools and a team that dedicates their lives to helping patients. I’d urge them to have hope—and know that we do our absolute best to treat them like family.