A left ventricular assist device (LVAD) is a pump to help patients with a weakened or failing heart that restores blood flow throughout the body. Many advances have been made to improve and miniaturize left assist ventricular devices (LVAD). LVADs are no longer large and cumbersome, requiring long-term hospitalization. LVADs are now small, electronically driven and extremely reliable.
By improving blood flow to vital organs, LVAD patients generally feel more energetic and are able to resume normal activities they were unable to do prior to receiving the device because of shortness of breathe or fatigue. Their small size means LVAD patients can engage in many recreational activities including golf, shopping, gardening, or just spending time with the family.
A patient should be evaluated for LVAD treatment if they have:
- ejection fraction (EF) less than 25%
- one heart failure admission in the past year
- decreasing tolerance to current heart failure medications (beta blockers and/or ACEI/ARB)
- persistent heart failure symptoms after resynchronization therapy
- increasing diuretic dose
- inability to walk one block without shortness of breath
- worsening kidney function
Many patients do not meet transplant criteria due to comorbid conditions or age but remain relatively fit and functional. Destination therapy offers long-term support with markedly improved prognosis and quality of life for patients ineligible for cardiac transplantation.
Bridge to Transplant
For some patients, LVADs are implanted as a “bridge to transplant,” increasing end-organ perfusion. The benefits are obvious. With good perfusion, renal and liver function remain optimized, avoiding cardiorenal and cardiohepatic syndromes. Nutritional status also does not decline, making the patients better surgical candidates.