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LVAD: A boon to tackle end-stage heart failure

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Clinical Directorate

Heart Failure

LVAD: A boon to tackle end-stage heart failure

Dr. Kewal Krishan
Cardiac Sciences, Cardiac Surgery (CTVS)
Cardiac Sciences, Cardiac Surgery (CTVS)
Program In-charge – Heart Transplant & Ventricular Assist Devices Sr. Consultant - CTVS

What is A Heart Failure?

Heart failure is a condition in which the heart can’t pump enough blood to meet the body’s needs. In some cases, the heart can’t fill with enough blood. In other cases, the heart can’t pump blood to the rest of the body with enough force. Some people have both problems. The term “heart failure” doesn’t mean that your heart has stopped or is about to stop working. However, heart failure is a serious condition that requires medical care. Heart failure develops over a period of time as the heart’s pumping action grows weaker. The condition can affect the right side of the heart only, or it can affect both sides of the heart. Most cases involve both sides of the heart.

Symptoms of Heart Failure

The most common signs and symptoms of heart failure are:

  • Shortness of breath or trouble breathing
  • Fatigue (tiredness)
  • Swelling in the ankles, feet, legs, abdomen and prominent veins in the neck

All of these symptoms are the result of fluid buildup in your body. When symptoms start, you may feel tired and short of breath after routine physical effort such as climbing stairs. Fluid buildup from heart failure also causes weight gain, frequent urination and cough that’s worse at night and when you’re lying down. This cough may be a sign of acute pulmonary edema. This is a condition in which too much fluid builds up in your lungs. Despite widespread use of evidence-based therapies the morbidity and mortality of heart failure are still high.

Risk Factors of Heart Failure

Conditions that damage or overwork the heart muscles can cause heart failure. Over a period of time, the heart weakens. It isn’t able to fill with and/or pump blood in the way it should be. As the heart weakens, certain proteins and substances might be released into the blood. These substances have a toxic effect on the heart and blood flow, and they worsen heart failure.

Causes of heart failure include

  • Coronary heart disease
  • Diabetes
  • High blood pressure
  • Other heart conditions or diseases such as heart valve disease

Other factors

  • Arrhythmia: It happens when a problem occurs with the rate or rhythm of the heartbeat
  • Cardiomyopathy: It happens when the heart muscles becomes enlarged, thick or rigid
  • Congenital heart defects: Problems with the heart’s structure are present at birth
  • Addiction: Alcohol abuse or cocaine and other illegal drug use
  • Infection: HIV/AIDS
  • Thyroid disorders: Thyroid disorders such as thyrotoxicosis

What is LVAD?

Left Ventricular Assist Device (LVAD) is a surgically implanted mechanical pump that is attached to the heart. An LVAD is different from an artificial heart. An artificial heart replaces the failing heart completely whereas an LVAD works with the heart to help it pump more blood with less work. It does this by continuously taking blood from the left ventricle and moving it to the aorta, which then delivers oxygen-rich blood throughout the body. Today’s LVADs are lightweight and smaller than earlier models, so you’ll most likely be able to move around fairly easily. 

The LVAD has both internal and external components. The actual pump sits on or next to your heart’s left ventricle with a tube attached that routes the blood to your aorta. A cable called driveline extends from the pump, out through the skin, and connects the pump to a controller and power sources worn outside the body.

The driveline must be connected to the controller and the controller must be connected to power at all times to keep the pump working properly. The pump is powered by batteries or electricity. Each device has specific carrying cases to allow you to move about freely.

Life after LVAD

Once your LVAD is implanted, you will be connected to the LVAD external controller and power source at all times. Your device will be on battery power whenever you’re active and connected to electrical power when you are sleeping. You will also need to have an extra controller and fully charged batteries (and power cables if applicable) available at all times as an emergency backup. You’ll need to be sure to take this backup equipment with you whenever you leave home.

Today’s LVADs are lightweight and smaller than earlier models, so you’ll most likely be able to move around fairly easily, get certain kinds of moderate exercise and enjoy intimacy with your spouse or partner. Depending on your medical team’s advice and policies, you may also be able to drive. Children and pets should be kept away from the patient so that they don’t damage the equipment or pull the driveline.

Till date more than 28,000 LVADs have been implanted globally and 10,000 patients are on device at present. Out of these, more than 500 patients are on this device for more than 10 years.

Team That Cares

Our comprehensive heart failure services include medical therapy, LVAD, ECMO, ambulatory balloon pumps and heart transplantation. Our specialized team would use innovative technology and therapies to treat patients with heart failure. We have introduced Advanced Heart Failure Clinic with the aim to identify potential candidates for heart transplant and ventricular assist device. The aim of heart failure clinic is an organized effort by heart failure experts to provide quality care for patients suffering from acute and chronic heart failure.