LVAD- Candidacy, Advantages, Success Rate & Cost in India

A left ventricular assist device (LVAD) or simply a ventricular assist device is a mechanical electronic device which is used as a pump for the heart. Mostly, LVAD is implanted when the heart's condition has been deteriorating that can potentially lead to heart failure. The LVAD is surgically implanted which is aids in lifting the left ventricle (main pumping chamber of the heart) pump blood to the rest of the body.

However, don't confuse LVAD for an artificial heart. The artificial heart replaces the failing heart whereas the LVAD instead of replacing the heart, assists it does its job. LVAD is a very good medical option for the patients who are too weak to get open heart surgery to treat heart disease or are in a long queue to get a heart transplant. Sometimes, a permanent LVAD is used for patients who are terminally ill and now their condition may not allow them to get extensive and complicated surgery such as a heart transplant. This kind of treatment is also called destination therapy.

When a patient receives an LVAD while he is waiting for a heart transplant, it’s called Bridge to Transplant. The patient’s LVAD may provisionally aid in pumping blood till the time a heart donor becomes available for a heart transplant.

In a situation where the patient may be declared ineligible for a heart transplant, an LVAD implant becomes the permanent solution. This is called Destination Therapy which has been becoming more common since the time LVAD's benefits are having a huge impact on lives on people who had a diseased heart before LVAD surgery.

When an LVAD is implanted for temporary heart failure, the type of implant is called Bridge to Recovery. In some cases which are rare, a heart may recover its strength after being given time to relax by an LVAD implant for the time being.

3 Types of Devices and Their Features

Doctors often resort to using an artificial heart to replace the ventricle's function in the heart. Individuals with severe heart failure might benefit from this gadget since it aids blood circulation throughout the body. These devices are used not just as a bridge to a heart transplant but also by many patients instead of a transplant altogether.

Device HVAD(Medtronic HeartWare Ventricular Assist Device (HVAD) System)

Unfortunately, heart failure is a progressive illness that, if left untreated, may lead to the latter stages of the disease and ultimately death. Patients with end-stage heart failure have a wide range of unpleasant symptoms, including chronic shortness of breath and fatigue, fluid retention in the lungs and belly, respiratory failure, and severe swelling of the lower limbs.

Patients needing a heart transplant often utilize the Medtronic HVAD System, a ventricular assist device. Bridge-to-transplantation describes this use. Patients with end-stage heart failure who are either not candidates for a heart transplant or whose condition prevents them from receiving one and whose complaints cannot be controlled by medicine may also benefit from the Medtronic HVAD System.

Destination treatment is used for this purpose and may enhance a patient's health and lengthen their life. The Medtronic HVAD System benefits the heart by delivering extra blood flow and helping the weak left ventricle.

The Medtronic HVAD System consists of a pump that is placed in the pericardial space, a controller that regulates the pump's speed and operation, a tube that is placed in the heart to empty the blood, and then a tube that is placed in the aorta to carry the blood away from the body.

The pump is implanted under the patient's skin, and a flexible line connects it to the controller, which stays outside the body. Batteries or an AC adapter may be used to power the controller.

Device HM3(HeartMate 3)

Now that it has received FDA approval, the HeartMate 3 LVAD may be used by patients with advanced heart failure who are not good transplant prospects. Those patients will have to carry their pumps around with them forever. Strong long-term evidence backs up significant advances, including a pump that aims to decrease problems while increasing the survival of patients.

The HeartMate 3 LVAD has reimagined how blood is pumped via a cardiac pump and set a new benchmark for compactness and efficiency in the field. The HeartMate 3 pump uses Full MagLev Flow Technology, which improves flow while also reducing the damage experienced by the blood as it is pumped through the device.

Clinical results from the MOMENTUM 3 study supported the approval of the HeartMate 3 system in the United States. The HeartMate 3 research found an unprecedented two-year survival rate of 83% for individuals using the device.

Blood clots in the pumps were uncommon, with just 1% of patients experiencing a suspected thrombosis after two years. In addition, the two-year stroke rate for the continuous-flow LVAD in the trial was the lowest.. ever reported.

Device HM2(HeartMate 2)

Patients with intermediate to severe stages of heart failure may benefit from either temporary or permanent circulatory assistance provided by the HeartMate IITM Left Ventricular Assist Device (LVAD). This compact and silent pump has a simple design, consisting of just one working element, and can provide blood flow comparable to that of a functional heart.

Suppose the pump develops thrombosis, malfunctions, or becomes infected. In that case, the HM2 LVAD may need to be replaced, given both a description of a unique minimally invasive procedure developed for exchanging HM2 with the latest generation of intrapericardial pumps known as HVAD or HM3 as well as our clinical experience using this technique.

All patients who had a device exchange at our hospital from a HeartMate 2 to a HeartMate 3 were evaluated retrospectively. Survival rate at six months was considered the primary outcome, whereas surgical outcomes and discharge disposition were investigated in a supplementary study.

The Fisher's exact test and the Mann-Whitney U test were used to compare the baseline parameters and the clinical data.

Are you a candidate to get an LVAD implant?

If you are a patient who is seeking to get receive an LVAD implant, you may be having heart disease or progressive heart failure which can not be treated. The cardiologists implant an LVAD on the heart which is sick, but not too sick overall since that would make the LVAD implant surgery a little risky.   To check if the heart is diseased enough, and if the rest of the body is in a decent position to receive an LVAD implant, the cardiologists might run a number of objective tests.The result of these objective tests will help the cardiologist and his team evaluate if getting an LVAD implant is a good fit for you, your heart and the body.

However,  LVAD may not be a good choice of surgical treatment for heart disease if you have:

• Blood clotting disorders
• Irreversible kidney failure
• Severe liver disease
• Severe lung disease
• Infections that cannot be treated with antibiotics.

Advantages of an LVAD Implant

For patients suffering from advanced heart failure, getting an LVAD implant may bring out benefits which are more than expected. 
Some of the benefits of LVAD include:

• A better quality of life
• Less fatigue
• More strength
• Better breathing
• Longer survival.
• Improved functional capacity

How Does an LVAD Work?

An LVAD consists of:

• A pump that is attached to a ventricle inside the body
• An external controller, which is a small computer that monitors the pump
• A driveline cable, which connects the pump to the controller
• Power sources that run the pump and controller

Implanting an LVAD in the heart may take from four to six hours to complete. LVAD is a device which can pump blood just like like the heart. One of the ends of the LVAD is attached to the left ventricle of the heart which is the part or chamber of the heart responsible for pumping blood out of the lungs through the other parts of the body. The second end of the LVAD is attached to the aorta, which is the body's main and longest artery. The heart pumps blood from the left ventricle into the aorta through the aortic valve. A tube passes through the skin reaching to the device. The exterior of the tube is coated in a special material which helps in healing, allowing the regrowth of the skin. The pump and all its connections are implanted when the cardiologist makes incisions to conduct open-heart surgery.

The other surgery equipments consist of a computer controller, a power pack, and a reserve power pack but they function outside the body and are not planted into the interior. Despite the small size of the LVAD, it is capable enough to pump blood every minute in order to curb the heart failure/disease symptoms. The cardiologist will regulate the LVAD pump so that there's an adequate flux of the blood to meet body needs. A connection between the driveline and the pump is made. The cable that connects the pump to the controller is fed through a small incision in your abdomen.

LVAD Risks and Complications

As with any surgery, there are risks involved. After the surgery, there are some LVAD risks ranging to mild to severe. These include:

• Infection
• Weakness
• Internal bleeding
• Fever
• Device problem 
• Blood clots
• Stroke

LVAD Success Rate

Several studies show that surgery conducted to get a permanent LVAD device successfully doubles the one-year survival rate of patients with end-stage heart failure in comparison to patients sticking to drug treatment alone. 

Frequently Asked Questions