Cardiovascular Institute and Center for Cardiovascular Health

Left Ventricular Assist Devices

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left ventricular assist device or LVAD is a surgically implanted mechanism that helps your heart to pump blood.

Your heart has four chambers. The upper two are called the "atria"; the lower two are called the "ventricles". The two chambers on the right, pump blood to your lungs. The two chambers on the left, pump oxygen and nutrient-rich blood to all the other parts of your body.

A left ventricular assist device can take over the left ventricle's pumping role when that ventricle fails to function properly.

Part of the device is implanted (in your heart and abdomen), and part remains outside your body. You can carry the external portions of the device on a belt around your waist or under a shoulder strap.

What does an LVAD consist of?
Left ventricular assist devices vary from manufacturer to manufacturer, but most versions have an electric pump, an electronic controller (which is the size of a WalkmanÒ), an energy supply, (usually a battery weighing eight pounds), and two tubes. One tube carries blood from your left ventricle into the device. The other receives blood from the device and brings it to a large blood vessel called, the "aorta". Your aorta brings blood to your brain and other organs.

Why has my doctor ordered this device for me?
Some people require a ventricular assist device after cardiopulmonary bypass surgery, to temporarily assist one of the ventricles until the heart recovers, and can function on its own.

You may have "congestive heart failure". If you have this disease, your heart is unable to pump enough blood to meet your body's demands. Your heart is working, but not as efficiently as it should . Mild or moderate heart failure usually can be treated with medication and lifestyle changes. Severe heart failure may be unresponsive to medicine and other interventions. In such cases, heart transplants are often recommended.

Most likely, your doctor ordered an LVAD for you because your are a candidate for transplantation. You need this device for survival until a suitable donor heart is available. That is why an LVAD is sometimes called, "The bridge to transplantation."

Every person who needs a transplant, must register on a waiting list. For purposes of heart transplants, the United States is divided into geographic regions. Each region has its own waiting list. Some lists are longer than others. Everyone on your list is assigned to a hospital in your region. The length of time you will spend on your waiting list depends on the length of the list, the availability of suitable donor hearts, and your status.

If you require an LVAD, you are Status One. This means that when a suitable heart is available in your region, it will be offered to the first person on the Status One list who matches the blood type of the donor and meets other criteria. The average wait on the Status One list varies from region to region. In New York, for example, the average wait is 4 to 5 months.

Is there anyone who should not get an implantable LVAD?
An LVAD is a fairly large device. It is not suitable for very small people You must be at least five feet tall and weigh over one hundred pounds.

If you have severe liver or lung disease, severe circulation problems or a bacterial infection, irreversible kidney failure, or advanced cancer, you would probably not be a candidate for transplantation of an LVAD.

Are there any risks associated with an LVAD?
Implantation of the LVAD is a life-saving step, but there are risks associated with the procedure. There is a significant incidence of stroke and infection. Other risks include uncontrollable heart failure and death. There is also a small incidence of device failure. Your doctor will explain the risks and benefits in greater detail and ask you to sign a consent form. Do not hesitate to ask questions and voice your concerns.

What happens after I'm admitted to the hospital?
In the hospital, you will meet with several members of the surgical team. They may include, the surgeons, the anesthesiologist (who administers medication to make you sleep during the surgery), and a cardiac nurse. Each will explain his role in the surgery. This is the time to seek clarification of any issues which are of concern to you.

What happens during the operation?
In the Operating Room, will be the surgical team members you have already met ,and a perfusionist whose job it is to monitor the "heart-lung" machine. This machine performs the functions of your heart and your lungs during the operation. It keeps your blood supplied with oxygen and keeps it circulating throughout your body.

Your blood pressure, temperature and respiration will be closely monitored. Intravenous lines will provide you with medication during the surgery.

Before the surgery begins, the surgical team will shave your chest, clean and drape you, and prepare a sterile environment.

A surgeon will begin the operation, by making an incision in your chest, and then dividing and separating apart your breastbone. You will receive an injection of Heparin, which prevents blood clots from forming.

You will be attached to the heart lung machine. Then the surgeon will attach a tube from the LVAD to your left ventricle. He will advance another tube into your aorta This tube will exit your body near your stomach and will be attached to the external portion of the device.

You will be removed from the heart-lung machine. the surgeons will close the incision.

How long is the operation?
The operation lasts from four to eight hours.

What happens after the procedure?
After the operation, you will be taken to the Intensive Care Unit (ICU). Your family and friends can visit you there.

When you awaken, you may feel groggy, thirsty, cold, or in pain. The nurse. can give you a pain killer.

You will be connected to intravenous lines and heart monitoring equipment. A tube for breathing will be in your mouth. Try to relax . The nurse will test your ability to breathe on your own. As soon as this occurs, the tube will be removed. You will not be able to talk while the tube is in your mouth, but the nurse will teach you how to communicate for that brief period of time. He or she will also help you cough, which is an important part of the healing process.

After the breathing tube is removed , you will be able to swallow liquids. You will be able to eat solid foods in a day or two.

What happens after I leave the ICU?
You will go from the ICU to a hospital floor where they can monitor your heart continuously. You will be encouraged to sit up after 24 hours,. and to get out of bed on the third or fourth day.

Electrocardiograms, echocardiograms, and other testing will continue throughout your hospitalization.

How long will I remain in the hospital?
You may go home after your situation is stable, provided that you have a friend or family member who is capable of performing cardiopulmonary resuscitation (CPR), and who is available all the time. Most likely, you will remain in the hospital until a suitable donor heart is available.

What happens if I do go home?
You will be able to resume your regular activities. You may exercise and go back to work.

Will I be able to dress normally after the implantation?
The equipment will not limit your choice of clothing.

How long can I have an LVAD?
An LVAD lasts indefinitely. These devices can theoretically last years. For now, you will be on an LVAD until your transplant which would probably be months. One day, there may be a device which can act as a permanent artificial heart

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