LVAD

A Left Ventricle Assist Device (LVAD) is a mechanical heart pump used to facilitate the activity of the heart in patients with severe heart conditions. The LVAD is a “bridge to transplant” for patients ineligible for heart transplant. The use of LVAD improves the survival of such patients. LVAD stands for Left Ventricular Assist Device. It is a mechanical heart pump that is used to help support the patient’s heart in instances of severe heart disease. The LVAD Bridge to Heart Transplant Procedure involves the use of the LVAD as a bridge to heart transplant and, thus, a temporary support to the patient’s heart until a heart transplant can take place. Several reasons explain why an LVAD Bridge to Heart Transplant Procedure is performed.

LVAD Bridge to Heart Transplant Indications

The LVAD Bridge to Heart Transplant procedure is indicated for patients with end-stage cardiomyopathy who are too sick to be placed on the transplant list or survive until the heart transplant can take place. The end-stage cardiomyopathies that qualify for an LVAD Bridge to Heart

Transplant Procedure include:

1. Dilated cardiomyopathy

2. Ischemic cardiomyopathy

3. Non-ischemic cardiomyopathy

4. End-stage heart failure

5. Cardiogenic shock

The Way an LVAD Works

The LVAD is placed inside the chest; it connects to the heart and pumps the blood from the heart into the aorta. An LVAD is a mechanical heart pump that is used to assist the heart in patients suffering from severe heart conditions. The LVAD Bridge to the Heart Transplant is a mechanical circulatory support that is used when the patient’s heart is not able to pump enough blood to meet the body’s requirements. The LVAD is usually connected to a portable battery pack and worn externally. The LVAD is usually placed in the abdomen; it is connected to the heart. In addition, an LVAD outflow graft is connected to the aorta. The LVAD can be classified into two main categories based on the mechanism of flow generation. They are the continuous flow and the pulsatile flow. The continuous flow LVADs have been widely used over the pulsatile ones due to their durability and lesser complications such as clotting and malfunction. However, the pulsatile devices are still in use, although to a lesser extent. The two most commonly used continuous flow LVADs are the HeartMate III and the HeartWare HVAD. The pulsatile flow devices are less commonly used due to the superior performances of the continuous flow devices.

LVAD Procedure

The LVAD Bridge to Heart Transplant Procedure usually requires open-heart surgery and is done under general anesthesia. The following are the steps involved in the LVAD Bridge to Heart Transplant

Procedure:

Preparation for surgery:

The patient undergoes a series of tests to confirm that he/she is fit for the surgery and the severity of the heart failure. The tests may include imaging scans and blood tests.

Surgery:

The patient is placed under general anesthesia, and a sternotomy is performed to access the heart. The LVAD is connected to the left ventricle to begin assisting the heart. The heart pump is connected to the aorta so that the blood can circulate to the rest of the body. In addition, the battery pack and monitor for the LVAD are implanted inside the patient’s body. The patient is closely monitored to ensure that there are no complications following the surgery.

The recovery process:

The patient is then moved to the intensive care unit to begin the recovery process. The patient is taught how to use the portable battery pack and the monitor.

Post Hospital Recovery:

The patient is then discharged from the hospital following the initial recovery process from the LVAD surgery. The patient has to stay in the hospital for a while longer to allow his/her condition to stabilize. The patient is taught how to take care of the LVAD Bridge to the Heart Transplant. He/she is also taught how to use the monitor and how to change the batteries.

LVAD Bridge to Heart Transplant

LVAD Bridge to the heart transplant is necessary for several reasons. Some of the most crucial reasons include:

Stabilizing the patient:

LVAD allows the patient to be stable. The patient is placed on the LVAD, thus reducing the risk of failure of other organs. This way, the patient survives until it is time for the heart transplant.

Improved symptoms:

Having the LVAD decreases the symptoms of heart failure and, thus, improves the quality of life of the patient while waiting for the transplant.

The LVAD ensures survival:

A patient survives significantly longer with the LVAD compared to a patient who does not have the LVAD Bridge to the Heart Transplant. Thus, the LVAD ensures that the patient survives long enough to receive the donor heart.

The LVAD ensures that the patient is considered as a candidate for heart transplant:

The LVAD stabilizes the patient, thus allowing him/her to be considered as a candidate for heart transplant.

The post-transplant care and LVAD removal process:

The following are the post-transplant care and LVAD removal processes:

Heart transplant surgery:

Like the surgery for placing the LVAD, a heart transplant is also an open-heart surgery that is performed under general anesthesia. The patient is placed on a heart-lung machine that pumps the blood around the body making sure that it is oxygenated while the heart is stopped during the surgery. The LVAD is removed after the new heart has started functioning.

Post transplant recovery:

The patient is admitted to the hospital for a while following the transplant surgery. The patient also undergoes treatment and medication to prevent infection and organ transplant rejection. The patient has frequent follow-up visits to ensure that everything is running smoothly after the transplant. The patient would also have to take immunosuppressant medication to prevent organ transplant rejection during the post-transplant recovery period.

LVAD Bridge to Heart Transplant Risks and Potential Complications

The LVAD Bridge to heart transplant procedure comes with several risks and potential complications, some of which are discussed below:

Infections:

The most frequent complication following LVAD implantation surgery is infection. The risk of infection increases because the patient has an external battery pack and controller connected to the LVAD. In addition, the LVAD implantation surgery also increases the risk of infection.

Blood clots:

LVAD implantation surgery can lead to the formation of blood clots in different parts of the body. The formation of blood clots in the heart can lead to blockage and damage to the LVAD. The formation of blood clots can be prevented by the administration of anticoagulant medication to the patient. Strokes can also occur due to blood clots; thus, anticoagulant medication can prevent strokes by preventing the formation of blood clots.

Bleeding complications:

Administration of anticoagulant medication can lead to various complications resulting from bleeding.

Malfunction or failure of the implanted LVAD Bridge to the Heart Transplant:

This is one of the severe complications that can arise following the implantation of the LVAD Bridge to the Heart Transplant. Failure or malfunction of the implanted LVAD Bridge to the Heart Transplant rarely occurs.

Failure of the right ventricle:

It is important to note that the LVAD only provides support to the left ventricle; thus, right ventricular failure may occur after the implantation of the LVAD. Right ventricular failure occurs due to fluid buildup in the lungs that increases the pressure in the lungs, thus, causing right ventricular failure. The patient would require another device to provide support to the right ventricle.

Device and surgical complications:

Various complications can arise from the LVAD implantation surgery. Some of these complications include infection, bleeding, and damage to other organs.

Late complications:

Since the LVAD is a temporary mechanical circulatory support, various late complications may arise from its use in patients with end-stage cardiomyopathy. Some of the most frequent late complications associated with the use of the LVAD include pump thrombosis and pump infection.

LVAD prognosis and survival rates

The use of the LVAD Bridge to Heart Transplant has significantly improved the prognosis of patients with end-state cardiomyopathy. Various research studies have demonstrated the survival rates for patients who have undergone LVAD Bridge to Heart Transplant procedures.

One year survival rate following implantation of LVAD: 75%

Survival to heart transplant: When a patient has received an LVAD Bridge to the Heart Transplant, he/she can survive to the time when a donor heart is available for the transplant.

One year survival rate following heart transplant: 85%

Five year survival rate following heart transplant: 70%

Conclusion
The LVAD Bridge to Heart Transplant Procedure has proven to be highly effective in managing patients with end-stage cardiomyopathy until a heart transplant can take place. Even though there are several risks and potential complications associated with the LVAD Bridge to the Heart Transplant Procedure, it is currently an essential step for patients who are scheduled to undergo heart transplant.