Left Ventricular Assist Device – LVAD

LVADA Left Ventricular Assist Device, better known as a LVAD, is a specialized heart pump that was developed to aid the pumping of blood in the heart. This pump serves as a ventricular assist device that is surgically implanted in order to mechanically pump blood from the ventricles, the lower chambers of the heart, to the rest of the body. A LVAD is typically utilized by patients that have weak hearts or have suffered from heart failure. A LVAD specifically is placed in the left ventricle, however, the device can also be implanted in the right ventricle as well. Whether you are a current LVAD patient or a candidate living in the Nassau or Suffolk county area, Dr. Kavesteen is a heart failure specialist that is available to answer any of your questions or concerns at any one of his three convenient locations.

Are You a Potential Candidate For a LVAD?

Selecting an ideal candidate for LVAD therapy involves a variety of different components, which will ultimately lead to long term patient success. This process involves two issues in evaluating a potential patient. The first question involves deciding if the patient is an appropriate candidate for the implantation of the device. This is based on the condition of the patient, the extent of the patient’s symptoms, and past medical history. The second question involves finalizing the operative liability of the implantation of the LVAD device. This selection process plays a crucial role in the overall prognosis of the outcome of the selected candidate.

Why Is a LVAD So Important?

Heart ChambersA LVAD can be an essential piece to the longevity of an individual that has a weak heart. The heart contracts in a specific sequence, which allows it to effectively push blood out of the heart. Unlike skeletal muscle, cardiac muscle does not use electrical signals from the brain. Instead, it has its owns cells, known as pacemaker cells, that trigger specific action potentials that diffuse across the heart muscle. These cycles are carried about by a specific system in the heart called the intrinsic cardiac conduction system. As impulses are generated at the atrium, the heart contracts. This causes blood to be pumped into the ventricles. The impulse then travels to the ventricles, where it contracts again. This results in blood being pushed out of the heart to the arteries. A LVAD allows this system of specific sequences to function correctly and smoothly.

Why Might Someone Need This Device?

There are three reasons as to why a patient might need a ventricular assist device (VAD).

The first reason why a patient would need this device is if they are waiting for a heart transplant. Since the donor and transplantation process is very time consuming, the VAD device can be implanted to help aid the heart in continuously pumping blood. This provides the patient with additional assistance during their wait on the transplant list.

The second reason as to why a patient would need this device is if heart failure is temporary. In other words if the patient’s heart is weak, but has the potential to function normally again, a doctor can implant this device until the heart is healthy enough to pump on its own again.

The third reason for the use of a VAD device is if a patient is not a good candidate for a heart transplant. For these types of patients the LVAD device can significantly improve their quality of life. When this is the case, it is known as destination therapy, since the device is a permanent solution to heart failure.

Possible Complications And Risks?

The implantation of a Ventricular Assist Device almost never involves any risks, but there are some possible but rare complications that can potentially arise.

Blood Clots

  • As blood flows through the LVAD device there is a possibility that a blood clot can arise. A blood clot has the potential to slow down or even completely block blood flow through the heart. This in turn can result in a heart attack, stroke, or even cause the LVAD to not function and stop working.
  • To help address this potential risk a doctor will prescribe a medication for a blood thinner such as Aspirin or Warfarin (commonly called Coumadin) to assist in inhibiting the development of blood clots after the LVAD is implanted.
  • Being that Warfarin has potential dangerous side effects, it is crucial for the patient to take it as prescribed regularly based on their needs.

Infection

  • Being that the power source and control unit of the LVAD are outside of the body and attached through a section in the skin, the risk of germs and pathogens significantly increases the risk of developing an infection.
  • As a precaution, the patient should be well aware of the implantation site and keep a close eye for indications of an infection such as fever, fluid drainage from the site, soreness and/or redness from where the device is implanted around the skin.

Right Heart Failure

  • The AV bundle is where the impulse from the AV node is transferred from the atria to the ventricle.

Right and Left Bundle Branches

  • In the case of implantation of a LVAD device, it will ultimately pump more blood from the left ventricle of the heart than what the heart was initially used to pumping.
  • As a result of this, the right ventricle can become exhausted and fail at effectively pumping blood.
  • Should this happen, there are medications which can aid in augmenting the capacity of the right ventricle.
  • A final solution to this would be to have a RVAD be implanted in the right ventricle to help support the right ventricle if this occurs.

Device Malfunctions

  • There is a potential chance that the LVAD can cease to function following implantation.
  • The pumping mechanism can malfunction and this can lead to not enough blood pumping throughout the heart.
  • The power supply can fail to work, as well as other components of the device.
  • These problems will need immediate medical attention.

Preparation for LVAD Implantation

card-cathOnce a Long Island heart failure specialist has determined you need an LVAD,  you will be required to spend time in a hospital in order to prepare for surgery. This hospital stay is crucial being that the doctors will evaluate the patient and make sure that the patient is healthy enough for the implantation of the device. Tests and procedures that have to be done prior to surgery can include but are not limited to:

Blood Tests

  • Blood tests can determine if a patient’s liver and kidneys are working to their full potential prior to implantation.
  • The doctor can also analyze a blood test for chemicals in the blood that can assess how well the heart is functioning.

Cardiac Catheterization

  • This test is performed to check the pressures in the heart and can be used to see if a patient is an ideal candidate for the surgery.
  • Cardiac catheterization involves the usage of a short tube that gets inserted into an artery or vein in the upper leg or arm.
  • A hollow and more flexible and longer tube is then inserted into the short tube as a guide catheter.
  • The doctor utilizes the guide catheter through the artery until it ultimately reaches the heart.

Chest X-Ray

  • An x-ray of the chest can be used to examine the size and shape of the heart and lungs.

chestxray

Electrocardiogram (EKG)

  • This can be used by the doctor to observe a patient’s heart rhythm prior to surgery.

ekg

Echocardiogram

Echocardiogram

  • This is an imaging test that can help determine the pumping function of the heart and can potentially determine the pumping action of the heart.

Expectations

During the Procedure:

The implantation process usually takes about four to six hours and is similar to open heart surgery. Anesthesia is administered during the procedure so the patient is not awake during the procedure. Throughout the surgery, the patient is connected to a ventilator, which assists with breathing. There is also a tube that will help the patient with breathing, which ultimately connect back to the ventilator. Following surgery, the patient may still need to remain on the ventilator for a few days. There will be an incision running down the center of the chest. The sternum (chest bone) gets dissected and the rib cage is opened in such a way that will provide easy access for the surgeons to operate. While in surgery, the heart is stopped and as a result of this the patient is connected to a heart-lung bypass apparatus, which allows oxygenated blood to keep flowing throughout the body during the surgery. After the VAD is implanted in place, the doctors will make sure all the connections are properly made and that it is functioning to its full potential prior to removing the patient off of bypass.

After the Procedure:

After the surgery is complete, the patient is placed in an intensive care unit. They will remain there for several days where they be watched to make sure there LVAD device is performing correctly. Following the ICU stay, the patient is then moved into a normal hospital room and from there they are equipped with a team of nurses and therapists who are all dedicated to help aid the patient in becoming active again. The team of nurses and physical therapists will work with the patient so they can gain back their endurance and get back to their daily routine. The duration spent both in the ICU and the hospital is dependent on how well the patient recovers and their state prior to having the LVAD implanted. Typically after such a procedure, the patient is prescribed various medications to take such as antibiotics to avoid an infection and blood thinning medicine to avoid other probable complications. Also blood tests will be conducted once again to keep track of proper kidney function and to ensure that the medications are working properly.

Results:

Subsequently after being discharged from the hospital, many LVAD patients living in the Long Island area are able to return to their typical activities. The continuation of their daily routines have to be determined and discussed by a doctor. As a follow up to the surgery, the patient will have weekly appointments at clinics that are centered around LVAD care to ensure that the device is working properly. Often times, patients are referred to cardiac rehabilitation programs. These programs are tailored uniquely for each patient based on their individual needs. It consists of a custom schedule of exercises, education sessions centered on post heart attack recovery, various cardiovascular diseases, as well as surgeries for the treatment of such diseases. Life with an LVAD can be difficult and can get stressful at times, however, with a strong support system the patient will have a better prognosis and will gain the strength on their own for a quick and speedy recovery.

If you live in either Nassau or Suffolk county and are either a current LVAD patient or a candidate, Dr. Kavesteen can help you live a long and healthy life. As an experienced Long Island heart failure specialist, Dr. Kavesteen can determine the best course of treatment for your cardiac condition. Contact us today.