Left Ventricular Assist Device (LVAD)

Left ventricular assist device (LVAD) therapy may be an option if you have end-stage heart failure and a failing left ventricle. The device can be used as:

• Bridge to Transplant—to improve your quality of life if you’re on the heart transplant list.
• Destination Therapy—to prolong your life if you’re not on the heart transplant list. Patients who receive the device as destination therapy can still get on the heart transplant list. Discuss this with your physician at follow-up visits to see if you are a candidate.

LVAD therapy may not be an option if you have:

• Bleeding or blood clotting disorders
• Failure of the right ventricle
• Infections not successfully treated with antibiotics
• Kidney or liver failure
• Severe lung disease

A surgeon implants the device directly into your heart through the chest. A driveline, or tube, connects the internal pump to the external controller and power source. St. Francis Hospital & Heart Center® uses the FDA-approved Heartmate II LVAD by Abbott. This is the most widely used device in the world and the only one approved for both destination therapy and bridge to transplant.

Once you and your physician determine that LVAD therapy is right for you, our heart failure team conducts an in-depth evaluation that includes lab imaging and neurocognitive, neurology, palliative care, physical therapy and social work assessments. You may also be referred for a heart transplant if eligible.

To ensure you’re ready, your team also covers many topics before surgery such as:

• Advance directives like a health care proxy or a living will
• Inpatient treatments and tests before surgery, including echocardiogram (echo), electrocardiogram (EKG) labs and X-rays
• Preparation and restrictions the night before surgery

The LVAD procedure is an open-heart surgery that includes general anesthesia and a breathing tube. You will also be placed on a heart-lung machine. During the procedure, your surgeon makes an incision down the middle of your chest then places the LVAD in the left ventricle of the heart and connects it to the aorta.

A driveline that contains a power cable goes through the skin of the abdomen. The power cable is connected to a small controller and power source on the outside of your body. Once the device is implanted, the heart-lung machine stops and the LVAD takes over. The surgery takes about six hours.

After surgery, you are moved to the Cardiothoracic Intensive Care Unit (CT-ICU). Our CT-ICU nurses are specially trained and provide round-the-clock care. Over the next few days, your VAD team removes the breathing tube, stops administering intravenous (IV) medications and removes invasive lines. During this time, you will work with various members of our team, such as physical and occupational therapists.

From the CT-ICU, you move to a Step-Down Unit to learn more about your LVAD device, medications and how to resume normal daily activities. The typical hospital stay is two to three weeks.

Most of our patients go home after the surgical procedure. Some may require subacute or acute inpatient rehab. Follow-up visits start within a week of discharge and become less frequent over time. When you’re ready, your team recommends outpatient cardiac rehabilitation.

As with any surgery, there are risks. We make every effort to minimize these risks. Before your surgery, your team will talk with you about possible complications, including:

• Blood clots—This can lead to heart attack and stroke. We will prescribe a blood thinner to reduce the risk.
• Bleeding—Bleeding can occur due to blood thinners.
• Infection—The driveline is susceptible to infection. We will show you how to reduce the risk.
• Device malfunction—This risk is small. Proper care can ensure good device function.
• Right heart failure—The LVAD does not support the right side of the heart, which may cause the right side to weaken.