Tabatha Robbins
Eng.111
November 6, 2015
Alphanumeric Outline

Left Ventricular Assist Device (LVAD)

I What is a LVAD A. Basic LVAD info. B. Where LVAD goes

II Who needs LVAD A. Who needs a LVAD B. Hearts health

III The Surgery of a LVAD A. Steps of the surgery B. Recovery

IV Life after LVAD A. What can you do B. What cant you do C. Heart Transplant List

Left Ventricular Assist Devices

“Left ventricular assist devices (LVAD) is a mechanical heart pump used to help a failing heart in patients with advanced heart failure” said MedicineNet.com. LVAD are lifesaving modules for patients who need a heart transplant that are waiting for a heart but their heart is not healthy enough to work on its own. LVAD is a key potential area of focus for researchers and various manufacturers at present. “Unlike a total artificial heart, the LVAD doesn't replace the heart; it just helps it do its job” according to MedicineNet.com. One of the heart pumps is called HeartMate II Left Ventricular Assist Device. It helps move blood through the body. A small motor inside the pump turns the motor that moves the blood. This pump is placed right below the heart and is implanted under your skin. One end of the LVAD connects to the left ventricle the heart’s main pumping chamber. The other side is connected to the Aorta the large blood vessel that sends blood through out the body. The LVAD helps your heart by pumping your blood so that your left ventricle doesn’t have to work. The pump will send oxygen-rich blood from the heart to the aorta. Then the aorta will send the blood throughout your body. A control unit and battery packs will run the pump twenty-four hours a day and seven days a week. “An LVAD restores blood flow to a person whose heart has been weakened by heart disease. The LVAD helps relieve some symptoms that people with heart disease have, such as being tired or short breath. In some cases, it lets the heart restore function it once had and gives it a chance to rest. It also maintains or improves other organ functions; it helps increase exercise performance, and enables participation in cardiac rehabilitation” according to WebMD. Someone may benefit from getting a ventricular assist device (VAD) if his or her heart doesn’t work like it should. Heart failure can slow down or even prevent your heart from pumping enough blood throughout his or her body. This is life-threatening condition because your heart isn’t strong enough to pump blood throw out your whole body. “Heart failure, where the heart is not strong enough to pump blood for your body's needs, is classified from Class 1 (mild) to 4 (severe). Heart transplantation is the gold standard treatment for Class 4 heart failure. If you are waiting for a heart transplant or are ineligible for transplant and are doing poorly with maximal medical therapy, an LVAD can be lifesaving and improve your quality of life” according to Stony Brook School of Medicine. If someone that needs an LVAD chooses not to get one the doctor will continue to optimize the medication that you are on. However, the mortality of a Class 4 heart failure, if you have been in the hospital multiple times for exacerbations, approaches 50%. Most LVAD candidates will be admitted into the hospital for several days before having the LVAD surgery. In most cases, patients are already in the hospital for heart failure related problems when the decision is made to implant an LVAD. Before the surgery can be performed, the doctor will conduct extensive medical evaluation and talk to the patient with every detail of the operation. An LVAD coordinator or other members of the LVAD team will provide information about the LVAD. They will also teach and talk to the patient about life after surgery. While waiting for the LVAD surgery you may or may not meet another person with an LVAD or waiting on one as well. According to MyLVAD.com “while waiting for the LVAD depending on the status of the patient the doctor may admit the patient to a special hospital unit where you can be monitored more closely and receive stronger medications to help the patients get stronger. The purpose of extra care will be to improve the patient’s condition. The doctors want your health to be the best it possible can be before surgery, sometimes they call it preoperative tune-up.” Before you are able to have the surgery the patient has to meet with the LVAD coordinator, who will introduce the patient to the LVAD pump and its external components. The coordinator is responsible for training the patient to manage and care for the external pump and driveline that exit your body. The hospital social worker will help the patient identify the support systems and resources available to the patient at home. They will also help you with post-operative home life. As with any surgery, there are risks that are involved. The surgeon will discuss the risks of the problems that you may have after surgery. After surgery, there are other risks, including infection, internal bleeding, heart failure, device failure, blood clots, stroke, respiratory failure and kidney failure. In studies, therapy with the permanent LVAD device double the one-year survival rate of patents with end-stage heart failure as compared with just drug treatment. Even though there are some risk like infection, stroke, and bleeding. The day of the surgery the LVAD surgical team will perform under a general anesthesia, which means the patient is asleep for all of the operation. Before everything begins, an anesthesiologist will start the intravenous line (IV) and give the patient the medicines needed to put the patient to sleep. Once the patient is asleep, the patient will be hooked up to a ventilator to help the patient breathe while under anesthesia. Next, an incision will be made in the sternum and that will expose the heart. The blood that is running through the heart will be rerouted to the heart-lung machine that will take over the work for your heart and lungs during the time of the surgery. Depending on what the surgeon prefer either they can place the LVAD next to the heart in the chest or they can put the LVAD next to the heart, which they call that, a chest pump pocket. The chest pump pocket is in the left upper abdomen, right below the heart and diaphragm. The driveline, which is the cable from the pump, will exit at the abdomen, will it will connect to the controller and power source. Once the LVAD is implanted and the surgeon connects the controller the doctor will wean the patient off the heart-lung machine and blood will begin the pump through your hearts new pump. After that, the doctors will update the family to let them know how the surgery went and what they should expect in the next couple of hours or days after surgery. Sometimes the surgeons have to leave the patient open over night to make sure that the left side of their heart is keeping up the left side and they don’t need an RVAD (Right ventricular assist devices). Once the doctors see that the right side of the heart is holding up to the left side then they will make the decision to close the patients chest up. According to MyLVAD.com “once the surgery is over, the patients will be taken to an intensive care unit (ICU). This is the place in the hospital where the doctors will awake the patient from anesthesia.” They will connect tubes to bring fluids to and from the body. The patient may be connected to a ventilator for a few days until they are able to breathe on their own. When the patient can be moved off the ventilator the next step is to be moved out of ICU. They will move the patient out of ICU to a step down cardiac floor where they will stay until they recover from surgery and able to take care of the LVAD and walk. The hospital stay after surgery most often, patients stay 2-3 weeks depending on any complications. Discharge timing depends on physical recovery after surgery and familiarity with care of the LVAD. At least one family member of the patient has to be trained on the LVAD and how to work the pump. They also have to be trained on the driveline and how to clean where it comes out of the abdomen. The driveline is covered with a special material. It lets skin cells grow into the driveline. Skin growth on the driveline is a barrier that can lower the risk of infection. Keeping the skin clean and dry near the driveline exit site also lowers infection risks. After about six weeks post surgery you will be able to shower with a kit that the hospital provides. The LVAD team will teach the patient how to use it and practice it I the hospital before being discharged. Will life be ever normal again? Physical activities involving heavy contact that might cause bruising around the device is inadvisable. Also, the patient may never be submerge in water no swimming or baths. The longest LVAD that has lasted is 10 years. The LVAD should be able to work about 12 years as of now with the HeartMate 2. They are working on a HeartMate 3. The device runs off of batteries the patients, the patients has to have two batteries at all times hooked up to the device. The batteries last currently for about 14 hours. While awake the doctors want the patient to be on batteries and while asleep the patient needs to be hooked up to the monitor. The monitor is a system that controls the LVAD and the pump inside the patient’s heart. After getting a LVAD the patient still can get a heart transplant. If the patient is evaluated and deemed appropriate for a heart transplant, then you may receive an LVAD as a “bridge to transplant.” Once a heart us available (waiting times may be about 1 to 2 years), then the patients may receive a transplant. My mother had LVAD surgery on March 10, 2015 she is only 57 years old. Her heart function was at 8 percent before surgery and now six months after surgery its at about 25 percent. This process of getting her back on her feet and healthier has been a long road for the family and her self. I am thankful this device and all the doctors that made it possible for her to have more time with her kids and grandchildren. She is currently getting evaluated for the bridge to transplant list. As more patients with congenital heart disease survive into adulthood and develop heart failure, LVAD therapy may be appropriate therapy, with better patient selection based on defined protocols to improve morbidity and mortality.

Works Cited

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“FAQs about the Left Ventricular Assist Device for Treating Heart Failure” medicine.stonybrookmedicine.edu. Stony Book Surgery 2012.
“Heart Failure and the LVAD.” Webmd.com. WebMD, LLC., 2005-2015.
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“What is a LVAD and how does it work” Mylvad.com. Mylad.com, Inc.,