HCA Virginia Physicians - January 12, 2023

What is a left ventricular assist device (LVAD) and is it right for you?

When a patient is diagnosed with advanced heart failure, their heart often cannot pump enough blood to meet the demands of the rest of the body. Dr. Nikolas Krishna, a board-certified and fellowship-trained advanced heart failure cardiologist and director of Advanced Heart Failure and Mechanical Circulatory Support at the Levinson Heart Failure Clinic in Richmond, Virginia, explains. “A normal squeeze of the heart is 50 to 70 percent, but in heart failure patients it may be as low as five to 10 percent. Even a decade ago there weren't many options for patients with end-stage heart failure, but today we have innovative cardiac technologies, like LVADs, that can significantly increase a person's quantity and quality of life.”

What is an LVAD?

A left ventricular assist device, or LVAD for short, is a mechanical pump that is surgically implanted into the apex of the heart. It consistently pumps blood through a tube to the aorta and out to the rest of the body, essentially taking over the function of the left chamber of the heart. The implanted LVAD pump is connected to a cable that runs through the skin of the abdomen to a small computerized controller device on the outside of the body. It is powered by rechargeable batteries worn in a vest, belt, or purse, that continuously run the LVAD pump. A backup power pack also ensures that the system runs flawlessly. The entire device is portable, allowing patients to resume their normal activities with renewed energy and without feeling overly tired and short of breath.

Who is a candidate to receive an LVAD?

There are two primary therapies for patients who make good candidates to receive an LVAD:

  1. Bridge to Transplant Therapy (BTT): Some patients use an LVAD temporarily while they await a heart transplant. The LVAD works to pump blood throughout the body and can improve the function of other organs, as well. Once the heart transplant occurs, the LVAD device is removed.
  2. Destination Therapy (DT): Patients who are not candidates for a heart transplant because of age or other factors can use an LVAD as a long-term treatment to prolong and improve their quality of life. Typically, these patients have expended all other options to manage their heart failure with medication, lifestyle changes, or other procedures. In these cases, patients use an LVAD to improve their heart function for the remainder of their life.

Following surgery to implant an LVAD, patients typically enter cardiac rehabilitation to maintain an approved exercise regimen and have regular follow up appointments with their surgical team.

Risks and Benefits

According to a 2020 study posted in the Journal of the American Medical Association, LVADs have become a standard therapy for many people experiencing advanced heart failure, with more than two thousand LVADs implanted in the United States each year. Innovations in device design and surgical procedures continue, and “reports of patients who have had an LVAD for four years or more are increasing.”

All procedures come with some risk. The surgical team at Levinson Heart Failure Clinic will help assess the risks versus benefits of LVAD implantation.

Benefits may include:

  • Increased life expectancy
  • Increased quality of life
  • Fewer breathing difficulties and other heart failure symptoms
  • Better outcome following transplantation if using LVAD as a bridge to transplant

Risks may include:

  • Clots
  • Stroke
  • Infection
  • Intestinal or brain bleeding
  • Right heart failure
  • Kidney failure

Recent studies on the two-year and five-year outcomes of patients with advanced heart failure conclude that LVADs are a proven long-term and life-extending treatment. The survival rates at two years were 79%, higher than patients who had a heart transplant, and the risks for stroke, pump thrombosis, and GI bleeding were lower to the patient overall.

The Levinson Heart Failure Clinic Difference

Serving the Central Virginia and Mid-Atlantic regions, the Levinson Heart Failure Clinic is a certified Ventricular Assist Devices (VAD) facility, caring for the most sensitive and intensive diseases of the heart. Dr. Krishna is an expertly-trained heart failure and cardiac transplantation specialist. In his words, “My end goal is not just a successful surgery, but to give patients back their life so that they feel replenished and their weak heart is no longer an issue.”

Learn more about Dr. Krishna and the Levinson Heart Failure Clinic, or call (804) 483-1270 for additional information.