What is LVAD (Left ventricular assist device)?

If heart transplant is not an option for you, then you can consider undergoing LVAD. Click to know more about this heart surgery.

Dr Anvay Mulay, Head of Cardiac Transplant Team, Fortis Hospital, Mulund says, 'In simple terms, LVAD is a mechanical circulatory support that does the job of the heart. It is not a replacement for the heart but acts as a support. Unlike taking out the heart and replacing it with a machine, in this, a mechanical support is provided for the heart to function in a better way'. Here are 8 tests that can tell if you have heart disease. There are two types of LVAD -

Temporary LVAD: In this, the patient has to lie on a bed and has to be admitted to an ICU. It comprises of a huge machine that has two tubes, one through which blood comes out from the heart and other through which blood goes into the heart. It has a computer attached to it. As the heart pumping is monitored by the machine and the tubes are inserted into the patient's body, the patient cannot move and hence is restricted to the bed. This type of machine, provides a temporary assistance, particularly only for few months, to the patient.

Permanent LVAD: It is a miniature version of the temporary LVAD meaning it is a small machine, which is totally mechanical. It has an electrical unit which has a module control that is located outside the body, attached to the battery. On the whole, it has a battery, console and device. The device is driven by a computer, which understands the blood flow coming to the machine and the resistance for it and hence, adjusts the blood flow automatically. For example, if the patient's heart pumps just one litre of blood, it will automatically monitor to send in 3 litres. If in the due course of time, the patient heart function improves and pumps in 2 litres of blood, then the flow might be adjusted that it comes down to 2 or 3 litres, depending on the need. Here is a real-life story of a person who underwent LVAD.

Who can undergo an LVAD surgery?

If a person suffers from an end-stage heart failure or isolated left ventricle problem, then he can undergo an LVAD surgery, provided the right ventricle is functioning normally. Also, if a person cannot undergo a heart transplant, then LVAD is the preferred option. A key deciding factor that a person can undergo LVAD or not is based on whether the right side of the heart is in good condition.

If instead of this technique, a heart transplant is chosen in a person with high the pulmonary pressure and lung pressure, then the new heart (transplanted one) might not tolerate the lung pressure, causing the right side of the heart to fail. If this happens, then the entire heart will be rejected. In such a case, the patients are given medications to decrease the lung pressure. But if it does not show any improvement then LVAD is the only treatment option.

In some cases, LVAD acts as a bridge to transplant, which is a temporary stage meaning it gives time to a patient to improve the functioning of the lungs and other organs before they become ready for a heart transplant. While in others, LVAD becomes a destination therapy meaning it becomes a survival measure. Here's more on heart transplant you need to know.

How does LVAD work?

As said earlier, LVAD is a mechanical circulatory support. The machine has two holes to regulate the inflow and outflow of the blood. The inflow pipe is put into the left chamber of the heart and stitched. The blood is sucked, which comes out of the outflow tube that is also attached to the heart. The entire mechanical device is fixed to the left ventricle of the heart. When the pump is joined with an electric modular control, that is placed along with batteries in a bag outside the body, the system starts to work automatically.

The machine runs on a single battery when the patient is walking or performing any physical activity, he is put on two batteries. However, there is a third battery in the controller, which works for 15 minutes. The third battery gives a deafening alarm when the battery runs out of power. The patient has to charge the battery every day for eight hours. Hence, in total, there are four batteries which are regulated by a controller, which is enclosed in a bag. The bag weighs around 2 kgs, which the patient has to wear 24X7 and 365, lifelong.

What are the complications of LVAD?

Unlike heart transplant, in which the patient is given immunosuppressants, which makes the patient immunocompromised, a patient undergoing LVAD have to take blood thinners due to the risk of blood clot. Blood thinners should be taken lifelong and the dose of which had to be monitored based on the patient's condition. Moreover, there is a risk of bleeding due to the use of blood thinners. As the machine comprises a titanium metal, there is a risk of thromboembolism, however, the risk is very low as it involves less churning of the blood. Also read about 12 signs that your heart is in trouble.

What is the total cost of LVAD?

The total cost of LVAD implantation is around 90 lakhs - 1 crore. This is due to the high maintenance of the device. The cost might come down in the near future if research studies are conducted.

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