Doctor holding open a bag containing a left ventricular assist device and batteries
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Left ventricular assistance devices (LVADs) are small, battery-operated pumps implanted into the chest to help the heart circulate blood. They’re used to help people with end-stage heart failure, either to improve survival while waiting for a heart transplant or as the primary treatment.

The controller has a cable that runs through your skin. minimally-invasive procedures are becoming more common, but LVADs have traditionally been used with open-heart surgery.

The first LVAD was implemented in 1963, and now the annual number of LVAD implantations far exceeds the number of heart transplants.

Read on to learn how LVADs work and who they can help.

Your heart has four chambers. The top two chambers are called the ventricles.

Your left ventricle is the main pump of blood from your heart to the major blood vessel that is called your aorta.

People with weak hearts can use LVADs to pump blood. They help pump blood from your left ventricle into your aorta.

The basic design of LVADs has remained the same since they were FDA-approved in 1994. They usually have four main parts:

  • Pump. A tube is placed inside your left ventricle. Blood travels through this tube, into a pump just below your heart, and into your aorta through another tube.
  • Driveline. The driveline is a cable that connects the pump to the controller. It travels through a hole in your abdomen.
  • Controller. The controller powers the pump and gives you updates about whether the system is working properly.
  • Batteries. Two batteries power the controller when it’s not plugged in. The batteries can be carried on a belt, harness, or backpack.

End-stage heart failure can be managed with LVADs.

Heart disease is the leading cause of death in the United States. The most common type of heart disease is called coronary artery disease, which is when the blood vessels that supply your heart become clogged. It’s almost always caused by a buildup of plaque or cholesterol.

When your arteries become blocked, your heart is unable to pump blood adequately, which is known as heart failure.

The American Heart Association (AHA) has estimated that 5.1 million people are living with heart failure in the United States.

Heart failure tends to gradually get worse over time. It’s known as end-stage heart failure if it progresses to the point where your heart can’t pump enough blood to meet your body’s needs.

At this point, it causes symptoms.

Heart transplantation is still considered the gold standard for end-stage heart failure, but the number of transplantations is limited by the number of donor hearts available. LVADs can be lifesaving for some people and are used in four main ways.

Bridge to transplantation

LVADs can provide support for people waiting for a heart to become available for transplantation. Research has found that bridge-to-transplant LVADs provide excellent survival and similar quality of life to people who receive heart transplants right away.

Destination therapy

Destination therapy is when an LVAD is used as the primary treatment. It’s used in people who aren’t eligible for a heart transplant. Technological improvements have led to increased survival for people who receive destination therapy LVADs.

Bridge to the decision

People with end-stage organ failure due to heart failure are ineligible for heart transplants. LVADs can help stabilize organ failure to make them eligible for a transplant in the future.

Bridge to recovery

Some people with heart failure can be helped by LVADs.

People with late-stage heart failure often experience less fatigue, more strength, and better breathing after receiving an LVAD.

In a 2017 study analyzing data from more than 20,000 people, researchers found 1-year and 2-year overall survival rates of 80 percent and 70 percent respectively in people with continuous-flow LVADs. Continuous flow implants make up more than 95 percent of current LVADs.

A 2021 study found that of 157 people with LVAD implants, 92 died after 5 years. However, in 67.2 percent of these people, the cause of death wasn’t cardiovascular. The average age of the people in the study was nearly 51.

According to the AHA, about half of people with LVADs receive them as destination therapies and 26 percent receive them for bridge-to-transplant.

Outcomes are currently more favorable for people who receive them as bridge-to-transplant. About 30 percent of people receive a heart within 1 year and 77 percent survive for at least 2 years.

People receiving an LVAD as a destination therapy tend to have more health complications but 68 percent of people live at least 2 years.

As technology improves, survival rates will likely continue to increase.

minimally-invasive surgical techniques are becoming more common, but LVADs have traditionally been implanted with open-heart surgery. minimally-invasive surgery is a more practical option as the LVADs get smaller.

Conventional open-heart surgery

During open-heart surgery, you’ll likely experience something like this:

  1. You will be put to sleep with an IV.
  2. Your surgeon will make a large hole in your breastbone to get to your heart.
  3. A cardiopulmonary bypass machine will help you with your heart and lungs.
  4. The surgeon will connect the end of the tube to the heart and the other end to the aorta. The driveline is connected to the pump.
  5. Once your device is working correctly, you will be taken off the cardiopulmonary bypass machine and your chest will be closed with stitches.

Open-heart surgery usually takes 4 to 6 hours.

Minimally invasive alternatives

Various minimally-invasive surgical techniques are being investigated. Your doctor will make one or more smaller incisions to access your heart during a minimally-invasive procedure.

The thoracotomy procedure is performed through the ribs instead of through the breastbone.

Every surgery has risk despite the potential benefits of LVADs.

Here’s a look at some of the complications of LVADs along with their reported rates, according to a 2015 review:

Complication Rate
Bleeding requiring blood transfusion 50 to 85%
Bleeding requiring reoperation 30%
Infection 50%
Pump thrombosis (blockage of blood flow) 2 to 9%
Right heart failure 15 to 25%
Stroke 10 to 15%
Device malfunction Less than 5%

LVADs are expected to continue to get smaller over time and minimally invasive surgery is becoming more common. Minimally invasive LVAD surgery is expected to become the standard of care, making LVADs more widely available at considerably lower risk.

The mechanical pumps are implanted below the heart to treat heart failure. They are used to treat people waiting for a transplant. Many people experience an improvement in their quality of life after receiving an LVAD.

The procedure can have serious consequences such as heavy bleeding or infections. Traditional open-heart surgery can cause more problems than minimally-invasive techniques.

Discuss it with your doctor if you think you might benefit from an LVAD. Your doctor can help you understand if you are eligible and weigh pros and cons.