Heart failure is a potentially life-threatening condition in which the heart is not strong enough to pump enough blood to meet the body's needs. The new artificial heart technology called left ventricular assist device (LVAD) has in recent years provided new life and hope for patients.
The heart is a muscular pump divided into four chambers. The upper chambers are called the atria and the lower chambers are called the ventricles. The left ventricle is the heart's main pumping chamber, and is responsible for pumping blood to your body. For some people with heart failure, the left ventricle weakens to the point that it can no longer pump enough blood on its own.
Here, Allison J. McLarty, MD, associate professor of surgery (Cardiothoracic Surgery Division) and co-director of the ventricular assist device program of the Stony Brook Heart Institute, answers frequently asked questions about LVAD and its use for treating heart failure.
Q: What is an LVAD?
A: An LVAD — left ventricular assist device — is a surgically implanted, electrically (battery) powered pump that helps a failing heart's left ventricle pump adequate amounts of blood to the body.
Q: Why do I need an LVAD?
A: Heart failure, where the heart is not strong enough to pump blood for your body's needs, is classified from Class 1 (mild) to 4 (severe). Heart transplantation is the gold standard treatment for Class 4 heart failure. If you are waiting for a heart transplant or are ineligible for transplant and are doing poorly with maximal medical therapy, an LVAD can be lifesaving and improve your quality of life.
Q: What happens if choose not to have an LVAD?
A: Your doctors will continue to optimize your medications. However, the mortality of Class 4 heart failure, especially if you have been hospitalized multiple times for exacerbations, approaches 50%.
Q: Will I still need medication for my heart after LVAD surgery?
A: Yes. The device helps the left side of your heart. Medications are needed to help optimize function of the right side of the heart and to help remodeling of the heart. A small percentage of patients experience recovery of heart function with this strategy.
Q: What is the hospital stay after LVAD surgery like?
A: Most often, patients stay in the Cardiac Surgical Intensive Care Unit for about 1 week after surgery, and then in our Step Down Unit for 1 to 2 weeks. Discharge timing depends on physical recovery after surgery and familiarity with care of the LVAD.
Q: Will I be able to shower?
A: Yes. A shower kit is provided. We will teach you how to use it and practice in the hospital before you go home.
Q: Will I be able to go to work?
A: Yes, depending on the kind of work you do. There are some physical restrictions that your physician will discuss with you. But barring these, once you have recovered from surgery, you should be able to return to work.
Q: What activities can I not do?
A: Physical activity involving heavy contact that might cause bruising around the device is inadvisable. Also, you may not submerge in water (as in swimming).
Q: How long does the LVAD last?
A: The longest device has been in a patient for about 7 years. Testing by the manufacturers suggests that the LVAD should provide support for at least 10 years.
Q: How long do the batteries last?
A: Currently, the batteries last for 14 hours.
Q: Can I still get a heart transplant after I receive an LVAD?
A: If you are evaluated and deemed appropriate for a heart transplant, then you may receive an LVAD as a "bridge to transplant." Once a heart is available (waiting times may be as long as 1 to 2 years), you may then receive your transplant. Some patients are initially deemed ineligible for a transplant and receive an LVAD as an alternative, for what is called "destination therapy." This LVAD use may improve your overall condition, where you may now be reassessed and found to be a candidate for heart transplant.
Q: What are the complications of living with an LVAD?
A: Complications include wound infection of the driveline and bleeding. These may be minimized by working closely with your healthcare team.
Q: What happens if the device malfunctions?
A: There are multiple alarms on the device to indicate that a problem is brewing. Notify your LVAD coordinator immediately if there is such a problem.
Q: Can I travel with an LVAD?
A: Yes. Many patients travel by land, air, and sea with their LVAD. You must take all your equipment with you (not packed away in cargo). Your route and destination should include areas with a LVAD program in the event of an emergency.
Q: Who can I call for answers to questions or for advice?
A: Our LVAD coordinators are available 24 hours a day, 7 days a week. For ANY concerns, call our VAD phone at 631-617-2541.
"The field of mechanical support for heart failure is rapidly evolving. As technology improves and our understanding and care for the unique complications are enhanced, the indications for implantation may be broadened. Dissemination of information of this important therapy is critical to ensure patients have access to all options in treatment of their advanced heart failure."|
—Allison McLarty. "Mechanical Circulatory Support and the Role of LVADs in Heart Failure Therapy." Clinical Medicine Insights: Cardiology (2015).
Stony Brook Heart Institute's multidisciplinary VAD program is the first and only program of its kind on Long Island; click here for more information about it. Video of Dr. McLarty explaining VAD (half minute).