What is a Heart transplant?
A heart transplant is a major procedure used to remove a diseased heart and implant a healthy heart that is received from a donor. A heart transplant is the only treatment for patients with chronic heart failure and is usually considered when the patient’s condition does not improve with medications or other procedures. However, it is not always possible to get a donor heart due to a shortage of donors and an increased number of recipients. This has led to the use of alternative strategies, including the left ventricular assist device (LVAD) therapy.
What is a Left Ventricular Assist Device (LVAD)?
A left ventricular assist device (LVAD) is an implantable mechanical circulatory pump that helps the left ventricle to pump blood to the aorta and throughout the body. Since the device is placed in the left ventricle, it is called a left ventricular assist device. This is an alternative therapy for patients with chronic heart failure or end-stage heart failure who are waiting for heart transplantation.
Why is LVAD recommended?
A left ventricular assist device (LVAD) is recommended for patients with chronic heart failure or end-stage heart failure who are waiting for heart transplantation (bridge to transplant)”. The LVAD is temporarily implanted and is removed during a heart transplantation procedure.
It is also recommended for end-stage heart failure patients who are inoperable due to their age or other health conditions (destination therapy).
It can be recommended as a therapy to revive the heart so that it can function normally again (bridge to recovery).
What is the procedure for implanting an LVAD?
This is open-heart surgery performed under general anaesthesia.
A large incision is made in the chest wall (thoracotomy) or the breastbone (sternotomy).
The procedure involves a cardiopulmonary bypass (heart-lung machine).
There are many internal and external components to a left ventricular assist device (LVAD). The internal components include a pump that is implanted into the apex of the heart and a tube, which is connected to the pump and delivers blood from the pump to the aorta. The external components include a cable that connects the pump and a controller or control system which is placed outside the body. The controller or the control system controls the pump. The device draws power from rechargeable batteries or through an AC adapter (a cord that is plugged into an electrical socket).
Advantages of an LVAD:
This is a lifesaving procedure in patients with severe heart failure.
During "bridge to recovery" therapy, LVAD may improve the condition of the heart so that the heart may function on its own again.
During the "destination therapy”, implantation of a left ventricular assist device (LVAD) may improve the functions of other organs or improve a patient’s overall health, making him/her fit for a heart transplant procedure.
Implantation of LVAD may improve life expectancy, enhance the quality of life, the patient will be able to perform routine activities, reduce the symptoms of heart disease, etc.
For the Best LVAD Placement in Delhi, get in touch with Manipal Hospitals.
Why is LVAD done?
A Left ventricular assist device (LVAD) is an implantable mechanical circulatory support device that helps pump blood from the lower-left chamber or the left - ventricles of the heart to the rest of the body. This is done in patients with heart failure or weak heart, who are waiting for heart transplantation or those who cannot tolerate an open-heart surgery due to their age or other health conditions, or in those who simply want to revive the functioning of the heart.
Who are the candidates?
A left ventricular assist device is indicated in any patient:
1) Who is on Inotropes with weak heart, inability to reduce the inotropes i.e. bridge to recovery.
2) If there is deterioration in renal or liver or other organ function despite maximum medical therapy and if transplant can not be done due to age /comorbidities/ unavailability of heart.
3) With refractory heart failure or history of recurrent admission for heart failure despite being on maximal medical therapy.
Certain risks associated with implanting a left ventricular assist device (LVAD) may include:
Stroke or cardiac arrest: Blood clots may form in the LVAD causing the device to stop working, or block/slow down the flow of blood through the heart, which can lead to stroke or heart attack. To avoid this, blood thinners or anticoagulants are prescribed after implanting an LVAD.
Bleeding. The procedure performed to implant an LVAD may increase your risk of bleeding during or after the surgery.
Infection: There are many internal and external components to a left ventricular assist device (LVAD). The internal components that are implanted inside the body are connected to the external components placed outside the body using a port. There is an increased risk of infection if germs enter the port. Make sure to check the port regularly for signs of infection like tenderness, swelling, discharge, etc.
Malfunctioning of the device: Post-implantation, LAVD may fail to perform the pumping functions effectively.
Weakening of the right ventricle: An LVAD may cause the pumping of more blood from the left ventricle and the right ventricle may be too weak to pump more blood. This may cause right heart failure and require implanting a right ventricular assist device (RVAD).
Allergic reactions to the anaesthesia
Difficulty in breathing
How to prepare for the procedure?
Before the procedure, your doctor will explain to you the procedure and the risks associated with it. You will be educated about how the device will be implanted in your body, its mechanism of action, safety precautions, how to contact an emergency if the device is not working well or is broken, and other issues like recharging the batteries, care while showering, travelling, etc. You can ask questions about your fears and concerns about the procedure. You will be asked if you are taking any medications, supplements, or herbs and if you are allergic to any medications or injections. You will also be asked if you have any underlying medical conditions like diabetes, hypertension, or have undergone any surgeries previously. You can talk to your doctor about exercise, diet restrictions, medication, lifestyle changes that you must follow post-surgery. You may be asked to avoid wearing jewellery, makeup, heavy clothing, etc on the day of the surgery.
What to expect?
Before the procedure:
Before the procedure, you may be expected to be in the hospital a few days before the surgery to undergo some treatments for your weakened heart and prepare for the surgery. Your overall conditions will be evaluated to ensure that you can undergo the surgery. Many tests and investigations will be performed including:
Blood investigations: Certain blood tests may be performed to check the functioning of your heart, thyroid, kidney, liver, etc., and to look for signs and symptoms of infections in your body before surgery.
ECG (Electrocardiogram): ECG will be performed to know the timing and duration of the electrical activity of your heart.
Echocardiogram: The pumping function of your heart is measured using an echocardiogram.
Chest X-ray: The size and shape of your lungs and heart are viewed.
Cardiac catheterization: The pressure of the blood flow in your heart is measured by inserting a catheter (thin, flexible tube) through a larger vein or artery in your arm, leg, or neck into your heart.
During the procedure:
On the day of the procedure, your chest area is shaved and sterilized with alcohol, iodine, or antiseptic solution. A urinary catheter is inserted into your bladder so that urine is collected inside a bag during surgery while under anaesthesia. A skilled and experienced multidisciplinary team of cardiac surgeons, nurses, anaesthesiologist, technicians, etc work closely together while performing the procedure. You will be put on a pump or cardiopulmonary bypass machine and your blood pressure and cardiac output are controlled by the anaesthesiologist using some medications. The entire procedure of implanting a left ventricular assist device (VAD) is performed through open-heart surgery and may last about 4 - 6 hours long.
After the procedure:
After the procedure, you will be shifted from the operation theatre to the recovery room. After you regain consciousness, you will be shifted to the intensive care unit (ICU) where your vitals will be monitored constantly. You will be given painkillers, antibiotics, fluids, nutrition, and other medications through intravenous (IV) lines. You may be placed on a ventilator for a while or until you can breathe on your own. Drainage tubes from the incision site will be monitored for any signs of bleeding. Once your condition is stable, you will be shifted to a hospital room. You will be encouraged to sit or get out of your bed and take a walk. You will also do some breathing exercises to strengthen your lungs. Before you are discharged, you will be given detailed instructions on how to care for your surgical wound, operate the device, charge its batteries, diet modifications, and lifestyle changes. Antibiotics are prescribed to prevent any infection and blood thinners to prevent blood clots and other complications. Make sure to follow all the instructions provided by your health care team and do not miss out on any follow-up visits.
Frequently Asked Questions:
1. How long can a person live after LVAD?
A left ventricular assist device (LVAD) implantation has led to improvement in the quality of life, and rate of survival in most patients with chronic heart failure, who are waiting for heart transplantation, or those who cannot tolerate an open-heart surgery due to their age or other health conditions, or in those who simply want to revive the functioning of the heart. A person can live from 5 to 7 years post-implantation. There are reports that some patients have lived up to 13 years as well.
2. Can I exercise with LVAD?
Maintaining a healthy body weight by following a healthy lifestyle and exercise is very important for a healthy heart. Exercising is safe and beneficial for individuals with LVAD. Low-intensity exercises like walking, yoga, can be done regularly based on the individual’s conditions. Talk to your doctor about the types of exercises that suit your condition. Make sure to avoid heavy and strenuous exercises.
3. Can I take a shower with an LVAD?
You can take a shower with an LVAD but with precautions. Before bathing switch off the batteries but do make sure they are fully charged. Rest well before a shower and avoid rushing. Place your device in a shower bag and put it around your neck while showering. After showering, remove the device from the bag and place it in your regular carrier.
4. Who can get an LVAD?
LVAD is indicated for patients with end-stage heart failure awaiting transplantation, (bridge to transplant) where the device is implanted temporarily and is removed during a heart transplantation procedure. It is also recommended for end-stage heart failure patients who are inoperable due to their age or other health conditions (destination therapy). It can be recommended as a therapy to revive the heart so that it can function normally again (bridge to recovery).