Percutaneous Left Ventricular Assist Device
Overview
What is a Percutaneous Left Ventricular Assist Device?
A percutaneous left ventricular assist device (LVAD) is an implantable mechanical pump support device that helps the bottom left chamber of your heart (left ventricle) pump blood to the rest of your body. It is usually implanted if you have heart failure, or if you are awaiting a heart transplant.
Why
Why Percutaneous Left Ventricular Assist Device?
Your doctor may recommend you have an LVAD implanted for the following reasons:
You are waiting for a donor heart
You may have an LVAD implanted while you wait for a donor heart to become available. This is known as “bridge-to-transplant” therapy since the device keeps your blood pumping to help you have a better quality of life and fewer symptoms until you can receive a transplant. The LVAD will be removed when your new heart is implanted. The length of time you will get support from the LVAD will depend on your medical condition, blood type and body size and donor heart availability.
You are not a candidate for a heart transplant
If you have heart failure, but are not a candidate for a heart transplant, your doctor may recommend LVAD as a “destination therapy” since it will support your heart function to improve your quality of life for the rest of your life. LVAD is recommended if all other treatment options, such as medications, lifestyle changes and other heart procedures fail to remedy your condition.
Your heart failure is temporary
If your heart failure is temporary, your doctor may recommend LVAD until your heart can pump blood on its own again. This is called “bridge to recovery” therapy. You may also have an LVAD procedure for a short time after some heart surgeries.
Risks
Percutaneous Left Ventricular Assist Device Potential Risks and Complications
The risks to percutaneous left ventricular assist device may include:
- Blood clots that can lead to stroke or heart attack, or cause your LVAD to stop functioning. Your doctor will prescribe blood-thinning medications to help prevent blood clots.
- Implanting a LVAD requires open-heart surgery, which can increase the risk of bleeding during and after the surgery. While taking blood-thinning medications help reduce the risk of blood clots, they also may increase the risk of bleeding.
- There is a risk of infection since the device control unit is outside your body and connected through a port in your skin, thus increasing the risk of germs entering the port and causing serious infection.
- Your LVAD may stop working properly after implantation, or it may malfunction so that not enough blood pumps through your heart. The power supply may also fail. These problems require immediate medical attention.
- You may experience right heart failure after you have a LVAD implanted since your right ventricle may not be strong enough to pump the increased amount of blood. If this occurs, your doctor may recommend medications and other treatments or a right ventricular assist device (RVAD) implantation to support the right ventricle.
Prep
Preparing for Percutaneous Left Ventricular Assist Device
Your cardiologist will give you instructions to help you prepare for the procedure and discuss the risks and benefits so you can make an informed decision.
What to Expect
What to Expect During Percutaneous Left Ventricular Assist Device
During the Procedure
An LVAD implantation is open-heart surgery, performed by a surgical team comprised of cardiac surgeons, cardiac surgical nurses, and anesthesiologist:
- The procedure takes between four to six hours and you’ll be asleep during the entire surgery.
- You’ll be connected to a ventilator to help you breathe, and may remain on the ventilator for several days after surgery.
- Your surgeon will make an incision down the center of your chest and separate your chest bone and open your ribs to gain access to your heart.
- Your heart may be stopped during the surgery and you’ll be connected to a heart-lung bypass machine to keep oxygenated blood flowing throughout your body.
- Your LVAD will be implanted into the apex of your heart where it receives blood.
- A tube will then deliver the blood from the device to the aorta that takes the blood from the heart to the rest of your body.
- A cable is then inserted through the skin that connects to the control unit and battery pack outside your body. The control unit runs the pump and provides messages and alarms to help you operate your device.
- Rechargeable batteries or a cord that plugs into an electrical socket keeps the LVAD running.
- Your surgeon will then test the device, and after it’s working properly, you’ll be taken off the heart-lung machine so the LVAD can start pumping blood through your heart.
- You’ll then be taken to recovery and subsequent transfer to the ICU for further recovery.
After the Procedure
After surgery, you’ll be in recovery in the intensive care unit (ICU), where you’ll be monitored for signs of infection or other complications. If your lungs don’t work properly, if you were place on a ventilator during surgery you will continue to stay on it, or you may be placed on a ventilator, until you can breathe on your own. You’ll be given antibiotics and blood-thinning medications. As you recover, your recovery team will make sure you become more active to help you gain strength so you can get ready to go home. You’ll be given instructions for your diet and cardiac rehabilitation, as well as how to care and manage of your device. If you need more time for your recovery, you may be transferred to a nursing home for a period of time until you make a full recovery.
After your discharge from the hospital, your doctor may recommend a customized cardiac rehabilitation program as well as implementing healthy lifestyle changes. Depending on your condition and recovery, you may be able to resume many of your daily activities, but it’s important that you clear this with your doctor. Your Saint John’s Physician Partners cardiologist understands that living with a LVAD can be stressful, and may recommend a support group or a professional counselor.
Follow-Up
Be sure to follow your doctor’s instructions about taking your medications, rehabilitation program and to keep your follow-up appointments with your cardiologist. Let your doctor know if you experience any adverse symptoms or have any concerns.
Specialists
