How does an LVAD work?
One end of the LVAD is attached to the apex or tip of the left ventricle, while the other end is connected to the aorta (the body’s main artery). Blood flows through the heart into the LVAD which continuously pumps blood to the rest of the body.
While there are a few different types of LVADs available, all of which are portable, each system generally has four main parts:
- HEART PUMP—connected to the left side of the heart; moves blood from the heart to the rest of the body.
- BATTERIES—provide power when the system is not plugged into an outlet.
- DRIVELINE—a cable that transfers power and information between the controller and the heart pump.
- CONTROLLER—powers and checks the pump and driveline; provides alerts on how the system is working.
Having an LVAD implanted requires open heart surgery, which usually takes 4 to 6 hours. The LVAD is placed inside the body, in the upper part of the abdomen (just below the heart), with the driveline attached to the pump. The tube is brought out of the abdominal wall to the outside of the body and attached to the pump’s battery and controller.
When the LVAD battery is running low, an alarm sounds to let you know that it needs to be changed. Two power sources are always connected to the controller. This way, if one battery runs down, there is another available to power the LVAD for several more hours. The batteries last for approximately 12 hours, and must be recharged at night. The external controller and batteries may be carried in a shoulder bag, backpack, or on a belt/harness along with the necessary backup equipment.
What are the risks involved with the LVAD implantation operation?
As with any surgical procedure, there are risks involved with the LVAD operation. Your physician will discuss with you the specific risks and potential benefits of the LVAD implantation. Some of the possible risks include bleeding, development of blood clots, heart failure, respiratory failure, kidney failure, stroke, infection, and device failure.
When you meet with your physician, ask questions to make sure you understand why the LVAD is recommended and the potential risks of the operation.
After the implantation procedure, you and your caregivers will receive LVAD training, with detailed instructions to ensure safe and proper use of the LVAD. You’ll learn how to manage the device and troubleshoot potential emergency situations. Members of your LVAD team will help you understand:
- How the device works
- What the alarms mean
- Proper system maintenance
- Daily, weekly, monthly, and annual procedures
- How to monitor for changes
- When to notify the LVAD team of changes or issues
Before you are discharged from the hospital, you must demonstrate your knowledge about the device and may be given a test by your care team. You’ll also need to establish independence with self-care activities, so physical and occupational therapists will work with you to build up your strength. In addition, you can expect to meet with a dietician to discuss a “heart healthy” diet now that you have a LVAD.
The goal is to make sure you go home as soon as possible but, on average, patients remain in the hospital for 14 to 21 days. Discharge timing will depend on your physical recovery, medical condition, and familiarity with caring for the LVAD. Some patients stay in an intermediate care facility or rehabilitation center until they are fully ready to return home.
Medications after LVAD
Your physician may prescribe a combination of different medications to support your overall health and heart function, and to prevent complications related to the LVAD. Every patient has different medication needs, based on current health status and medical history. It’s your job to take your medication regularly and exactly as directed.
In general, all LVAD patients take blood thinners (warfarin) and aspirin to help prevent blood clots from forming inside the pump. You also can expect to be on many of the same medications you were taking for heart failure, including beta blockers, ACE inhibitors or angiotensin II receptor blockers (ARBs), and diuretics (water pills).
What is life like after a LVAD implantation?
Recovering and returning to routine daily activities after receiving an LVAD is a gradual process. After receiving an LVAD, you will be able to perform most activities. You can shower, bicycle, hike, and even return to work, in some cases. You also can travel, with minor accommodations. You must keep your equipment with you at all times (not checked in cargo), and your route and destination should include areas with an LVAD program, just in case of an emergency.
LVAD patients cannot swim or take a bath, play contact sports, lift heavy weights, or be away from an electrical power source.
It’s very important to make healthy lifestyle choices before and after receiving your LVAD, including:
- Quitting tobacco use
- Eating a “heart healthy” diet
- Stopping alcohol use
- Not using illegal drugs
- Exercising regularly
If you need help making lifestyle changes, talk to your physician.
It is not uncommon to experience anxiety or depression when you receive an LVAD or when you become a caregiver for an LVAD recipient. If you are feeling especially worried or stressed, reach out to your treatment team, family, and friends. You also may want to consider joining an LVAD support group or talking with a professional counselor.
Reviewed by: Amy E. Hackmann, MD, and Muhammad Faraz Masood, MD