Ventricular Assist Device and LVAD Implantation

Why Choose UH Harrington Heart & Vascular Institute?

Our expert ventricular assist device team uses a multidisciplinary approach to offer care that is specific to each patient’s unique needs. We consistently maintain certification in ventricular assist device with the Joint Commission and are recognized as a VAD Center of Excellence by Optum. In addition, UH Cleveland Medical Center was one of the first sites in the country to participate in the MOMENTUM-3 trial, which is the landmark trial for HeartMate 3, the LVAD of choice for centers around the world.

What is a Ventricular Assist Device?

A form of mechanical circulatory support (MCS), a VAD is a mechanical heart pump that is implanted in the chest and is used to assist the heart when it is too weak to circulate blood on its own. The most common type of VAD is a left ventricular assist device, or LVAD, which supports the left side of the heart (left ventricle). Pumps can also be used to support the right ventricle (RVAD) or both sides of the heart (BiVAD), but these types are rare and only used in special circumstances.

Regardless of the type, a VAD helps to continuously circulate blood flow 24 hours a day, using tubes that connects the pump to the major blood vessels leaving the heart. In the case of an LVAD, the tube connects to the aorta (large blood vessel that exits the heart).

Who Can Benefit from an LVAD?

The most common situation in which a VAD is recommended is progressive heart failure from cardiomyopathy. LVAD candidates are identified by progressive symptoms of heart failure and diagnostics test such as echocardiogram, heart catheterization and cardiopulmonary exercise test (CPET). A VAD may be necessary when heart failure progresses to the point that medications and other treatments are no longer effective.

VAD are used for two primary purposes – as short-term therapy to stabilize patients and allow time for either recovery (bridge to recovery) or to wait for a heart transplant (bridge to transplant); or as long-term support for patients who are currently not eligible for heart transplant (destination therapy). For some patients, the LVAD can help adjust some risk factors so that the patient can eventually become eligible for heart transplant. The goal of LVAD implantation is to improve the patients’ overall quality of life as well as improving survival.

As with every surgery, there are risks associated with an LVAD implantation. These may include risk of infection, blood clots or bleeding, heart failure, and malfunction of the LVAD. The doctor will discuss these and other risks with patients and help them weigh the risks and benefits before undergoing the LVAD procedure.

LVAD Implantation Procedure

This procedure is performed under general anesthesia. The most common approach is through the chest bone (sternum), which is the standard approach for the majority of heart operations. A heart-lung bypass machine is used during the procedure. The main LVAD pump is inserted into the ventricle (inflow) and the tube leaving the LVAD (outflow graft) is then connected to the aorta. The surgery takes several hours, and the length of the procedure is dependent on many factors. If the patient has a pre-existing implanted defibrillator or pacemaker, it will remain in place.

Recovery from LVAD Implantation

Patients will typically be in hospital two to three weeks after the LVAD procedure. Initial recovery is in the intensive care unit. Subsequently the patient is transferred to a standard room, where they continue their recovery in preparation for discharge. This time will include adjusting medications such as blood thinners and blood pressure medications, working on mobility, and completing education with the patient and caregivers. After discharge from the hospital, patients will be monitored closely in our LVAD clinic. As they progress, they will be referred to cardiac rehabilitation to continue to build up their strength and stamina.