LVAD Surgery or left ventricular assist device implantation is done to support patients whose hearts are failing.
Some facts about LVAD Surgery:
- Ventricular assist devices can be appropriate for short, intermediate, or long term use depending on the need of an individual to treat advanced heart failure.
- The left ventricular assist device (LVAD) is the most commonly used VAD type that serves as a partial artificial heart.
- LAVD can be implanted during an open heart surgery, and helps the left ventricle pump oxygen rich blood to the aorta and the body.
- LVADs are becoming smaller, more durable, reliable and easier to implant, providing a longer, healthier life to the patients awaiting heart transplantation.
- LVAD can be effective in treating patients awaiting heart transplantation by bridge to transplant therapy, those who are not eligible for heart transplantation by destination therapy, and those with cardiac conditions such as advanced heart failure, cardiomyopathy, and myocarditis.
- Short term LVADs can be used for patients who are at high risk and cannot sustain life over the long term. Intermediate term LVADs can be used for patients with a high risk of complications for up to 500 days and Long term LVADs can be used or patients with advanced heart failure who need support outside the hospital.
- The heart conditions of individuals who are at advanced age or whose health is too poor to undergo heart transplantation can be treated by implanting a LVAD.
- The heart conditions of individuals who requires a heart transplant but are not stable enough to wait for a donor heart to become available, whose body mass index (BMI) is too high for heart transplant, who have advanced stages of dilated cardiomyopathy or myocarditis, and who have undergone heart surgery but cannot safely be removed from cardiopulmonary bypass can be treated by implaning a LVAD.
- LVAD can be used for people who have a health problem that requires heart transplant, have experienced organ rejection after heart transplantation or have had massive heart attacks with no other treatment options.
Preparation for LVAD Surgery:
- Specific instructions will be provided to the patient prior to the LVAD surgery by discussing risks such as bleeding, infection, or adverse reaction to anesthesia.
- Patients are not allowed to eat after midnight the night before the surgery.
- Several tests including routine blood work, x-ray of chest, electrocardiogram (EKG), echocardiogram, left and right heart catheterization, carotid and peripheral ultrasounds are performed to determine if you are a good candidate for surgery in order to receive an LVAD device.
- Some routine health screenings such as colonoscopy or mammogram, and a psychosocial evaluation can also be performed.
Procedure of LVAD Surgery:
- The surgical team include surgeon, Surgical nurses, Anesthesiologists, Perfusionists and Engineers.
- Local anesthesia will be given by an anesthesiologist to make you sleep before the surgery. The anesthesiologist will check your heart rate, blood pressure, oxygen levels, and breathing during the surgery.
- A breathing tube will be placed in your windpipe through your mouth which is connected to a ventilator machine to support your breathing during the surgery.
- Medicines are used to stop your heart so that the surgeons can operate on your heart while it is not moving.
- A long incision on the breastbone is made by the surgeon and the heart will be accesses ed by spreading the rib cage.
- A cardiopulmonary bypass machine will be used in some cases which takes over the work of the heart and lungs until the operation is complete.
- One end of the LVAD tube will be connected to the left ventricle of your heart and a tube exiting the other end of the external LVAD to the aorta.
- A small electrical cord exits from the upper abdomen that is connected to the LVAD. This cord is connected to a power supply and a small computer to operate the device.
- The patient will be taken off cardiopulmonary bypass once the device is working properly and the chest will be closed with stitches.
Recovery from LVAD Surgery:
- The duration to stay in hospital after surgery can be a month or more and the recovery time will depend on your health condition before the surgery.
- You will be moved to the intensive care unit right after surgery.
- Fluids and medications will be given through intravenous (IV) lines.
- Urine from your bladder and fluid and blood from your chest can be drained by other tubes.
- Oxygen can be given through a mask or nasal prongs in your nose.
- Your condition will be monitored and the signs of infection in your incision sites will be watched by your treatment team.
- The pain you have after surgery can be managed by your treatment team.
- You may need to remain connected to a ventilator for several days after surgery until you are able to breathe on your own as your lungs may not work properly immediately after your surgery.
- A combination of different medications will be prescribed by the doctor to support your overall health and heart function, and to prevent complications related to the LVAD.
- Medication may varies depending on current health status and medical history of each patient.
- Usually, antibiotics and blood-thinning medications will be prescribed to prevent infection and other complications while you are in the hospital.
- Blood-thinning medications, including aspirin and warfarin should be continued during the time you have a VAD to prevent blood clots
- You must demonstrate your knowledge about the LVAD device and may be given a test by your care team.
- Physical and occupational therapists will work with you to build up your strength so that you can establish independence with self-care activities. Additionally a dietician will discuss a diet for a healthy heart as you have a LVAD.