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FAQs about the Left Ventricular Assist Device (LVAD) for Treating Heart Failure

Heart failure is a potentially life-threatening condition in which the heart is not strong enough to pump enough blood to meet the body's needs. The new artificial heart technology called left ventricular assist device (LVAD) has in recent years provided new life and hope for patients.

The heart is a muscular pump divided into four chambers. The upper chambers are called the atria and the lower chambers are called the ventricles. The left ventricle is the heart's main pumping chamber, and is responsible for pumping blood to your body. For some people with heart failure, the left ventricle weakens to the point that it can no longer pump enough blood on its own.

Here, Allison J. McLarty, MD, associate professor of surgery (Cardiothoracic Surgery Division) and co-director of the ventricular assist device program of the Stony Brook Heart Institute, answers frequently asked questions about LVAD and its use for treating heart failure.

Q: What is an LVAD?

A: An LVAD — left ventricular assist device — is a surgically implanted, electrically (battery) powered pump that helps a failing heart's left ventricle pump adequate amounts of blood to the body.

Q: Why do I need an LVAD?

A: 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.

Q: What happens if choose not to have an LVAD?

A: Your doctors will continue to optimize your medications. However, the mortality of Class 4 heart failure, especially if you have been hospitalized multiple times for exacerbations, approaches 50%.

Q: Will I still need medication for my heart after LVAD surgery?

A: Yes. The device helps the left side of your heart. Medications are needed to help optimize function of the right side of the heart and to help remodeling of the heart. A small percentage of patients experience recovery of heart function with this strategy.

Q: What is the hospital stay after LVAD surgery like?

A: Most often, patients stay in the Cardiac Surgical Intensive Care Unit for about 1 week after surgery, and then in our Step Down Unit for 1 to 2 weeks. Discharge timing depends on physical recovery after surgery and familiarity with care of the LVAD.

Q: Will I be able to shower?

A: Yes. A shower kit is provided. We will teach you how to use it and practice in the hospital before you go home.

LVAD
The LVAD is implanted in the
patient's upper abdomen, and
the battery that powers it is
worn around the waist.

Q: Will I be able to go to work?

A: Yes, depending on the kind of work you do. There are some physical restrictions that your physician will discuss with you. But barring these, once you have recovered from surgery, you should be able to return to work.

Q: What activities can I not do?

A: Physical activity involving heavy contact that might cause bruising around the device is inadvisable. Also, you may not submerge in water (as in swimming).

Q: How long does the LVAD last?

A: The longest device has been in a patient for about 7 years. Testing by the manufacturers suggests that the LVAD should provide support for at least 10 years.

Q: How long do the batteries last?

A: Currently, the batteries last for 14 hours.

Q: Can I still get a heart transplant after I receive an LVAD?

A: If you are evaluated and deemed appropriate for a heart transplant, then you may receive an LVAD as a "bridge to transplant." Once a heart is available (waiting times may be as long as 1 to 2 years), you may then receive your transplant. Some patients are initially deemed ineligible for a transplant and receive an LVAD as an alternative, for what is called "destination therapy." This LVAD use may improve your overall condition, where you may now be reassessed and found to be a candidate for heart transplant.

Q: What are the complications of living with an LVAD?

A: Complications include wound infection of the driveline and bleeding. These may be minimized by working closely with your healthcare team.

Q: What happens if the device malfunctions?

A: There are multiple alarms on the device to indicate that a problem is brewing. Notify your LVAD coordinator immediately if there is such a problem.

Q: Can I travel with an LVAD?

A: Yes. Many patients travel by land, air, and sea with their LVAD. You must take all your equipment with you (not packed away in cargo). Your route and destination should include areas with a LVAD program in the event of an emergency.

Q: Who can I call for answers to questions or for advice?

A: Our LVAD coordinators are available 24 hours a day, 7 days a week. For ANY concerns, call our VAD phone at 631-617-2541.

"The field of mechanical support for heart failure is rapidly evolving. As technology improves and our understanding and care for the unique complications are enhanced, the indications for implantation may be broadened. Dissemination of information of this important therapy is critical to ensure patients have access to all options in treatment of their advanced heart failure."

—Allison McLarty. "Mechanical Circulatory Support and the Role of LVADs in Heart Failure Therapy." Clinical Medicine Insights: Cardiology (2015).

Stony Brook Heart Institute's multidisciplinary VAD program is the first and only program of its kind on Long Island; click here for more information about it. Video of Dr. McLarty explaining VAD (half minute).

Comments

My daughter Sadondra is 32 yrs old and had an LVAD installed two years ago. Currently she is having complications and has not been put on the list for a heart transplant. Per LVAD team at Cleveland Clinic she missed several LVAD appointments and, due to missing her appointments, they decided not to put her on the list for a heart transplant. A young black lady with several young children - I feel helpless as a dad. My daughter missed several appointments due to not having transportation. I live in Murfreesboro, TN, and not there to ensure she didn't miss her appointments. My daughter or any person shouldn't be denied a heart and a chance to live due to man acting on behalf of God. I love my daughter and would give her my heart to prolong her life to be with her children. Please advise what I can do. A concerned and Loving Dad, Donald Petty
Dear Mr. Petty: I can understand your frustration on behalf of your daughter, especially if she is having complications with the LVAD. However, it's critically important that patients show a commitment to keeping appointments with a transplant team before being listed, as missing a few after the transplant could mean the difference between life and death. Even though a heart transplant offers a good quality of life and a freedom that may exceed that with an LVAD, infection and rejection are still common complications and may lead to fatal complications. The good news is, if your daughter can demonstrate to the team at the Cleveland Clinic a willingness to try again and meet the appointments they set, they may be willing to reconsider their decision and list her for transplant. All the best to her. — Allison J. McLarty, MD
My 88-year-old father-in-law has had an LVAD continuous flow type for over two years now, and has done well with it. During this time he has required transfusions on occasion due to the blood breaking down from the LVAD. Now he requires transfusions more frequently. Is there anything that can be done to stop the blood from breaking down due to the action of the LVAD? I look forward to your response, and thank you for your prompt attention.
Dear Ms. Unger: Patients with LVADs bleed for a variety of reasons. If the LVAD is causing the red blood cells to break down, this is called hemolysis. One can also acquire a condition called von Willebrands factor deficiency, where a molecule needed for platelets (one of the body's clotting substances) to work is low. Additionally, tiny clumps of blood vessels called AVMs (arteriovenous malformations) can form on the lining of the intestine, and these can bleed. Finally, the anticoagulation needed when an LVAD is implanted can predispose to bleeding. Turning the speed down on the pump so that blood ejects through the aortic valve of the heart may decrease the rate of hemolysis, improve the deficiency of von Willebrands factor, and decrease the amount of AVMs. However, care needs to be taken to ensure the speed is not so low that the pump no longer helps the heart adequately. Any such changes should be discussed with your father-in-law's doctors, and made with echocardiographic guidance. Finally, the amount of blood thinning medication used may need to be adjusted in the setting of increased transfusion requirement. Hope this is helpful. All the best to you and yours. — Allison J. McLarty, MD
On March 24, my 82-year-old father underwent the LVAD surgery. The surgery was successful; however, he has had probably every complication from 24-hour dialysis to bleeding (and the doctors not knowing where the bleeding is coming from), and illostomy bag, Millrinone, blood pressure meds to keep his pressure up, intravenous feeding, insulin, blood thinner to blood transfusions to platelet replacement and not being able to tolerate the feeding tube at 20 cc's. He was doing well breathing (had done up to 60 hours) on his own until this last aspiration (he has had one other aspiration) where he also became non-responsive. He now opens his eyes but does not focus on you. He will open them if you call his name but does not respond to squeezing of the hand, etc. He has had several set backs and today, July 21st, he is still in the ICU. Without being a doctor I only know what I have been told--that there would be up and down days and sometimes seriously ill days. The current EEG shows no seizure activity and CT scans show no stroke or damage to the brain. He is back on the ventilator and doing some breathing on his own, but now it feels like we are starting over again. He has been on PT and with occupational therapy, but is still not talking. I am so frustrated and just not understanding can this process go as long as my father's recovery and there be a good quality of life? When I visit him I am ok. I sing to him, read, we watch Sanford and Son, or I put his IPad on with an audio book, music, or verbally led relaxation. Signed: I just don't get it! HELP!
Dear Ms. Guy: I am so sorry to hear of the difficulty your father has been having. LVAD implant can be life saving and helpful, but the surgery to perform this carries risk and patients needing VADs are often very ill to start with. The risks include things like bleeding, infection, stroke, pneumonia, and kidney failure; and unfortunately it sounds as if your dad has had them all. It may be possible to recover from these complications, but if he has been in the hospital since March, his recovery will likely be lengthy and involve a stay in a rehabilitation center. Ask his doctors to meet with you to review his progress and give you as realistically as possible his prognosis and projected time for recovery. Your singing and reading to him are excellent therapies for him, and can only help. — Allison J. McLarty, MD
My Dad who is 75 is undergoing surgery for LVAD next week. What sort of recovery time would he be looking at? He has been in heart failure for about a month (though he had his first heart attack at age 62).
Dear Ms. Vogt: There are several factors affecting post-operative recovery. 1) The condition you are in going into surgery is important. That is why your dad's doctors may take some time getting his nutritional health, his kidney function, or his fluid balance optimized prior to the operation. The more stable you are going in, the smoother the recovery. A lot of attention is often paid to the right side of the heart to make sure it will be able to handle the workload with the extra bloodflow due to the LVAD. 2) The extent of surgery performed also matters. If this is a second heart operation for your dad, or if he needs additional work on his heart done in addition to the LVAD (for example valve repair), then the surgery may be more complex and recovery may take longer. Having said that, if all goes well, a typical recovery period for an uncomplicated operation might be 10 to 15 days in the hospital. By the time he heads home, your father should be walking and eating on his own, and be able to connect and disconnect himself from battery power. It may take several months of recovery at home to be back to (or hopefully better than) baseline. Best wishes for his speedy recovery. — Allison J. McLarty, MD
I have been referred to a heart failure clinic, for last stage heart failure, I am 56 years old, and have an ICD and pacemaker with 3 stents. I have left ventricular failure, and have been told it's time for the heart failure team to evaluate me. How long does it take once you start going thru the tests before you are scheduled for your LVAD?
Dear Ms. Miethe: Once you are referred to a heart failure clinic, a comprehensive evaluation begins to see if 1) your medical regimen can be further optimized; 2) you are a transplant candidate; and 3) you are a VAD candidate. This involves evaluation of not just your heart, possibly requiring repeat catheterization and echocardiogram, but also of your lungs, liver, gastrointestinal tract, kidneys, and blood vessels. You may, therefore, require CT scans, ultrasounds, endoscopy and blood tests. This may take several days or weeks depending on how quickly your doctors feel you need the appropriate therapy. If there are any abnormalities found during the evaluation, these may first need to be corrected, further delaying planned surgery. We have found, however, that taking the time to make sure patients are well selected and well prepared for their VAD surgery greatly facilitates the surgery and post-operative course, leading to quicker discharge from the hospital and better overall results. — Allison J. McLarty, MD
I have had LVAD for apx 7 months. Is it possible to eventually have LVAD totally removed? Also, rather than taking warfarin, can I use holistic measures for keeping my blood thin? Can I continue to take omega supplements?
It is possible to have the LVAD totally removed. This procedure is usually done for patients who experience recovery of their own heart function, or have a bad complication of the LVAD, such as an intractable infection. To totally remove the device, however, does require another open heart operation and so is not a trivial procedure. Sometimes, instead of removing it, the device is simply turned off, the driveline amputated sterilely and the end buried, and the LVAD is left in place. This does carry with it some risk of infection and stroke, but has been successfully done. If there has not been recovery of native heart function, turning off or removing the LVAD will result in a recurrence of severe heart failure. Warfarin is the recommended anticoagulant for patients with an LVAD. Some patients with severe bleeding complications have had their warfarin discontinued without complication, but the concern always is of clot forming in the pump, causing it to malfunction or stop. There are no studies looking at holistic measures for blood thinning in LVAD patients, and so this is not recommended. Additionally, some non-traditional medicines may increase the likelihood of one's blood clotting and, therefore, increase the risk of clot in the pump. In general, you should be able to continue taking omega supplements. However, always check with your doctors to make sure there is no specific contraindication for you. — Allison J. McLarty, MD
My brother had the LVAD surgery on January 12, 2014. On Tuesday (am) he started waking up; they immediately put him back to sleep. I asked them why, and they said that they wanted his kidneys and liver functioning better. (I understand.) I guess my concern is that as of today 1/17/14, they still have him "sleeping." Is this "normal"? My brother is sixty years old. There was some fluid retention, but now his kidneys are functioning better. I just have a problem with him being out so long. Thanks for your help, maybe I'm over reacting.
Dear Ms. Beverly: After LVAD surgery, it is critically important that the right side of the heart not be stressed, to avoid the need for re-operation and an RVAD. Sometimes if the kidneys and liver are temporarily dysfunctional after surgery, there can be fluid retention, which can increase the work of breathing so that one has to struggle to catch one's breath. That kind of struggle to breathe can be bad for the smooth functioning of the right side of the heart. It would therefore be wiser to keep the breathing tube in to help with breathing until the kidneys/liver (etc) are optimally working, and all excess fluid is gone.While the breathing tube is in, for his comfort, he should be kept asleep so that he is not uncomfortable and gagging on the tube. There can be complications if one is kept asleep too long, but in this case the benefit should be worth the risk. Best wishes for your brother. — Allison J. McLarty, MD
I am 58 years old and have now had my LVAD for 20 months. I am DT not XT. No issues, no infections, no bleeding, no other issues. The question I have and have been unable to find -ANYWHERE- answered is: When the VAD eventually fails, years from now I would hope, What happens in my body and what will the failure sequence be like? What can I expect? Last EF was <10%; no change in EF since LVAD was placed. I have not been able to get a straight answer from my own MCS group or my cardiologists. Thank you for your help.
Dear Mr. Doble: I am glad to hear you are doing well with your LVAD. Short of complications such as infection or thrombosis causing the pump to malfunction, there have been no reports of the LVAD "wearing out" and failing. Testing in the lab suggests the pump should work for over 10 years and the longest living person with their original HeartMate 2 LVAD has had it for about 9 years without signs of mechanical trouble. Having said that, IF the pump were to gradually fail, you would probably redevelop signs of heart failure once again. Fortunately, pump replacement is an option and can often be accomplished via a smaller operation than used for initial implantation. All the best to you. — Allison J. McLarty, MD
Does having the LVAD have any effect on a patient's status on the heart transplant list, i.e., does the LVAD make the patient at less immediate risk, thus making it harder for them to receive a heart? My father-in-law is opting not to have the LVAD, for fear of this. Thank you.
Dear Mr. Montgomery: One's position on a transplant list is dependent on how sick the patient is. So if the patient is very unstable or rapidly deteriorating, he or she would be placed higher. An LVAD would certainly stabilize a patient who may therefore not be at the top of the list. However, the wait for an appropriate heart maybe lengthy, especially if the patient is blood type O, and many people die while on the waiting list. Before declining an LVAD, it might therefore be helpful for your father-in-law to discuss with his doctors the potential wait he might have for a heart, and his risk of dying while he waits. — Allison J. McLarty, MD
I received an LVAD in 2013 and I am fine ever since. I am back to work and enjoy my life. I am torn whether to agree to a transplantation or not as the organ donation is going back here in Europe and only 80% of the patients make it through the first year. So, is an LVAD a final solution, or do I eventually have to undergo a transplantation? I hope that the process of finding alternatives to a transplantation goes on. The part that really bothers me is the entourage that comes with the LVAD. Thank you for your help. Kind regards, Katrin Laugsch
Dear Ms. Laugsch : I am glad to hear you are doing well with your LVAD. These pumps can be implanted as a "bridge to transplant" (BTT) or as "destination therapy (DT) or a final permanent solution for people who are not candidates for transplant. Interestingly, the quality of life with an LVAD can be so good, as it sounds like yours is, that patients who are BTT sometimes choose not to undergo transplantation. So you do not HAVE to have a transplant. In general, these pumps are durable. There are now many patients with their original pump over 5 years, and the longest running pump has been in for about 9 years. There is a bit of an "entourage" with the VAD, but we treat all our patients as VIPs and, as you know, entourages are the status quo for celebrities :-) — Allison J. McLarty, MD
If you already have an LVAD and don't qualify for a heart transplant and your doctor said they don't have to give you another LVAD, what happens after 10 years? Can you get worse from the LVAD if you don't take your meds?
Dear Ms. Moore: If you have an LVAD and are not a candidate for transplant, then you are a "Destination Therapy" or "DT" patient. The longest running pump has been in for about 10 years, so the honest answer is we do not know what happens at 12, 15, or 20 years of support. However, all the lab testing done suggests the pump should not wear out at 10 years. Also, if a complication does occur, the old pump can be exchanged for a new one. Recent studies have shown that the surgery for pump exchange can be safely done. As for your medicines, it is very important that you take them to ensure the best result and quality of life with your VAD. Blood thinners are important; if you skip them, the pump might clot and stop working. Blood pressure medicines are important; if you skip them and your blood pressure is too high, there is an increased risk of a stroke. There are other problems like leaky valves and poor function of the right side of the heart that can develop if you skip some of the medicines. If some of your meds bother you, please check with your doctor before stopping them. — Allison J. McLarty, MD
I don't know where to start. My son is 21 and has congenital heart. His defect is double outlet right ventricle with pulmonary valve atresia and a moderate-sized ventricular septal defect and a parachute mitral valve. The docs are great but since he was 16 his heart started to fail. I mean fail in the words. First it was high blood pressure meds, and now it's 10 meds to treat all of his complications from his heart not pumping correctly 0 to 10 in 5 years' time. It seems we are chasing one problem after the next. Right now he is stable but the doctors have discussed whether he needs this LVAD. His Mitral valve leaks (over the course of his life causing issues). His charts have been sent from one coast to the other, and most have said to fix the mitral valve. However, now we are told that his heart may still have issues not solving the problems and since he doesn't qualify for a heart transplant because of these underlying illnesses, his option would be the device in order to rule out those issues. Pulmonary hypertension, kidney failure. I have an issue with a system that doesn't see priority with congenital heart children>adults which may be high risk but needs a heart. However, this is a big step. Going into a device over seeing how he can manage himself as long as he can before becoming too sick to go through this high-risk surgery. As a mom I am still protective and he wants more freedom to be active again. Risks vs Reward? What is idea about this? If his condition improves and he gets on a list (which he is African American/Latin and O positive), how available how long is his wait? What about new technology that may be on the horizon for less invasive options?
Dear Concerned Mom: Congenital heart disease is the most complex form of heart disease, and even in the best hands it can be tricky to care for. The decision for a VAD for your son should be made by the congenital and transplant teams together. Having said that, the device has proven to be durable, and has significantly improved the quality of life for recipients. Many patients can resume an almost normal lifestyle while they wait for a donor heart to be available. For blood type 0, the wait may be several years. In terms of new technology, clinical trials with the new Heartmate 3 pump have begun, but it may be several years more before we have FDA approval for its use. There are some less invasive techniques for implanting the smaller Heartware VAD. There is no doubt that in appropriate patients, the LVAD can be lifesaving and life altering. I hope this may be helpful for your son. — Allison J. McLarty, MD
Hello, my Dad is 76 and has had the LVAD for a year now. He has not had any of the complications that I have read about here. What he does have is a continuous low flow on his controller, and we have to make him drink water to bring the flow back up. Do you know anything else that we could do to make the flow stay where it needs to be?
Dear Regenia: I am glad to hear your Dad is doing well with his LVAD. If he is clinically stable, but having low flow alarms, one possibility is that the low flow limit, which is set on the pump after implant, may not be appropriate for him any longer and may need to be adjusted. This should be discussed with your LVAD care team. If this is felt not to be the case, and it is felt that dehydration is causing the low flow, then adjusting medications he may be on a diuretic, such as Lasix or Spironolactone. This may help improve his volume status. Finally, sometimes evaluating the LVAD with an echocardiogram while making adjustments to the set speed of the pump can be valuable in understanding why these alarms occur and help guide appropriate changes that might need to be made. Again, discussion of these options with your LVAD team is critical to ensure they are appropriate for your father. — Allison J. McLarty, MD
Hello, my name is Tom. I got an LVAD about 1 month ago. I have been doing great and the doctor said I was ahead of schedule, but the doctor said she wanted the drain line to heal first to be on the heart transplant list. So, my question is, how long does it take to heal? I know it varies from person to person, but is there an estimated guess?
Dear Tom: Congratulations on your VAD! I'm glad you are doing well. Most surgical wounds, including the drain sites and the driveline exit site, should be well healed in 6 to 8 weeks. Each individual's body is a little different, however, and sometimes it can take a bit longer. I would think by the 3-month mark, though, that the wounds should be healed. You should talk about your healing concerns with your VAD team (they know your wounds best). — Allison J. McLarty, MD
My husband just recently got a Heartware LVAD, and he developed a brain bleed after the blood thinners. He was taken off them, and put back on after a few days. Then his bleeding increased. Can he live with an LVAD without blood thinners?
Dear Mrs. Haluszczak: I'm sorry to hear your husband has had the complication of a brain bleed after his LVAD implantation. These heart pumps are designed to be used with anticoagulation, but specific complications, like a bleeding event, may indicate stopping the anticoagulation for a while. Although the pump may continue to work off anticoagulation, there may be the risk of clot forming within the pump, causing dysfunction or stoppage of the pump, or leading to a stroke. The delicate balance of anticoagulation versus bleeding is best managed by your LVAD team, who will be able to weigh the risks and benefits based on your husband's data and clinical condition. — Allison J. McLarty, MD
I have an LVAD, and my doctor has begun to increase the pump speed. I was advised that this is good. But would like better understanding. Pls elaborate.
Dear Beatrice: When an LVAD is first implanted, the speed is set based on multiple factors, including your volume status and the function of your right heart. In our institution, it is rare for the original speed at which the pump is set to be the final speed at which it is set, because as one progresses after surgery, and volume status, and blood pressure and activity level change, the speed of the LVAD may also need to be changed. Often these changes are guided by looking at some of the pump parameters, like the "pulsatility index" or by an echocardiogram where the relative function of the right and left ventricles can be appreciated. — Allison J. McLarty, MD
Hi my sister is 30 with 4 small kids, she just had the lvad surgery today at Delray medical center in south florida. She was in surgery for 4.5 hours, surgery went great and was taking off of the breathing machine. The doctors wake her up after the surgery and she started screaming at the top of her lungs, she couldn't see us or hear us. Is this normal??? Lettecha loving and worried older sister in Palm Beach Florida
Dear Lettecha: Even when surgery goes well, the effects of the anesthesia used to keep patients asleep during the operation can linger. It sounds as if this might have been the case with your sister as she woke up from the sedation she received. It can be difficult to see our loved ones confused or disoriented or combative or disinhibited after surgery. The good news is that these effects are almost always temporary, and as time goes by will fade completely. If there remain concerns as your sister continues her recovery, her VAD team should be able to clarify for you the possible reasons. I wish for her a speedy recovery. — Allison J. McLarty, MD
Hello. My husband received his Heartmate II 9/28/2012. He passed away 10/4/2015. While he lived for 3 years with the LVAD his quality of life greatly declined. Within 3 months of surgery he began having gastro bleeds, requiring transfusions almost weekly. When blood thinners were discontinued, he suffered a stroke. Finally, he contracted a deadly driveline infection which led to sepsis and ultimately, his death. In the 3 years since his surgery he probably spent 1 year in the hospital. In light of all this, I believe the device itself is NOT safe and should not be marketed as destination therapy. I also believe the medical community is too quick to recommend LVADs without properly informing the unsuspecting patient of the very real and life threatening complications that are known to arise. Let's face it, it's a money maker for the hospitals and practitioners. Thank you.
Dear Mrs. Patterson: I am sorry that your husband had such a tough time with his LVAD. There can be complications with the device, and unfortunately it sounds as if he experienced many of them. It must have been a difficult three years. While these complications occur, it is not the universal experience of people with LVADs. Many people living with them have regained a good quality of life and returned to work, caring for their families and themselves. The device was thoroughly studied before approval by the FDA as "destination therapy," and in view of how many patients die of heart failure each year, I believe it is underutilized. I will say, however, that maybe as healthcare providers we do not thoroughly enough explain to our patients and their families the risk versus benefit of the procedures we perform so that they can consider upfront the possible consequences of their choice and the likelihood of them occurring. Certainly we could work on that. Again, I am sorry for your struggle and ultimate loss. — Allison J. McLarty, MD
How many people roughly a year receive an LVAD in the USA?
Dear Ms. Green: The number of LVADs implanted each year keeps rising as more people benefit from the technology. So far this year about 3,500 have been implanted: 2,000 patients have received the HeartMate II pump and about 1,500 the HeartWare pump. — Allison J. McLarty, MD
My father had the LVAD implanted Sept 5, 2013, at 65 years old. While the recovery was long due to medical issues he had after surgery, the LVAD gave him a quality of life he couldn’t have had without it and his health improved tremendously. He has been very faithful attending follow-up appointments, taking medications, going for his INR tests, etc. Late October of this year, he began urinating blood and was admitted to the hospital for 2 days and released with no diagnosis except a referral to an urologist. The week after his discharge, we went to his urology appointment and, before he could go for the tests the urologist prescribed, he was back in the hospital. Now he was experiencing dizziness, shortness of breath, and continuous blood in the urine. His doctor determined it was hemolysis and the LVAD would need to be replaced. He was seen in July 2015 for his annual visit and had an echo done with no signs that there was a problem. How quickly does hemolysis happen? He is currently in a rehab center to get back on his feet, but I am concerned for his future and concerned that we (and his doctors) didn’t recognize anything was going on until he started urinating blood. Are there other signs that occur in hemolysis that we missed? We had hoped (and continue to hope) the LVAD would be used as his destination therapy. How often can the LVAD be replaced? If he ends up in this situation again, is replacement even possible? I am thinking this is not something that doctors continuously do. I haven’t had this conversation with his doctor yet but I am planning on it. Thank you for any advice.
Dear Dana: I'm glad your Dad is experiencing the benefit of his LVAD. In addition to the good, there are some complications with the device, and pump thrombosis is one of them. This occurs when clot forms in the pump. A lot of clot will cause the pump to malfunction and maybe stop. A little will cause destruction of blood cells, though the pump may continue to work. This is called hemolysis. Early signs of hemolysis can be picked up with a blood test measuring the LDH (lactate dehydrogenase), a product of hemolysis. When you have a lot of hemolysis, the urine turns brown and looks like blood. An echocardiogram can sometimes confirm clot in the pump leading to malfunction. The speed at which clot forms is highly variable from individual to individual, but can occur over days to months. Sometimes the clot can be melted away with blood thinners. But sometimes reoperation to do a pump exchange is necessary. This can be repeated if necessary, but better by far to prevent a repeat of the problem if possible by being very careful with anticoagulation and monitoring for early signs of hemolysis. I agree with you about speaking to your dad's doctors about this tricky problem, so you can be proactive with them in preventing a recurrence. — Allison J. McLarty, MD
My dad who had an LVAD put in about a year ago is having a few complications here and there, but is overall doing pretty well. He is 73 years old and has an LVAD and AICD device. Would he still be able to be put on a heart transplant list? What are the requirement that go along with heart transplants? Also, I saw that most LVAD patients last around 7 years with the device. Does that mean after those 7 years it quits helping them? Or what happens? Thanks for your time.
Dear Ms. Kile: Many transplant centers have an age limit of 70 years, and so your dad's age alone might be a limiting factor for eligibility for a heart transplant. There are many other fairly stringent requirements that need to be met, including no recent history of cancer and good organ (kidney, lung) function. However, it is best to discuss the possibility of transplant with your dad's LVAD team, who should be able to clearly explain the criteria and whether it's possible or not for him. In terms of durability of the pump, the patient with the longest implanted original pump has had it for over a decade. One can have complications with the pump, where there is clot or infection and it needs to be exchanged or removed, but the pumps tend to not wear out. The technology is new enough that we don't really know how long they can last, but all indications are that the current LVADs are very durable. Pump exchange can be accomplished with a surgical procedure, should it be necessary. — Allison J. McLarty, MD
My 68 yo father had LVAD surgery on 12/14/15. He has PMH of AF lung Ca and had portion of right lung removed. He has pacemaker defib implant and has COPD stage 2-3. He is home now but still has CHF symptoms SOB O2 sat drop to 80's with slightest exertion approx +1 bilateral pitting edema with compression socks on. He is exhausted and has poor appetite. Is this normal? When will his health improve? Where is the better quality of life they swore would happen? He is worse than when we admitted him for surgery.
Dear Ms. Tardiville : I am sorry to hear your dad is having trouble after his LVAD implant. How one does post-operatively is in part dependent on what shape you are in pre-operatively. It sounds like he may have had some breathing trouble before from COPD and his lung resection. From your description, it sounds like he may also now be experiencing having some excess fluid in his system, and may be somewhat weakened from the open heart operation to put the pump in. Both these things can make you have swollen legs, be fatigued and with a poor appetite, and have your oxygen level drop with exertion. The good news is that the excess fluid is treatable, and over a period of weeks with medication can be removed from his system. Also, as he recovers from the operation, especially if he has help with physical therapy, his endurance should improve and his fatigue get better. We often tell our patients that it will take about 2 to 3 months after surgery to experience the full benefit of the operation. This gives the body a chance to heal. I encourage you to share your concerns with your VAD team; they may be able to answer your questions and provide an approximate timeline for his recovery. — Allison J. McLarty, MD
My father is 74 years old and has had an LVAD for 3 years. He has had a few complications along the way but for the most part has been doing well. He now has a driveline infection that the NYU team states is life limiting. They have already moved the driveline to the other side and the infection is still seeping. They are trying to keep it from getting worse but my understanding is that is the best we can hope for. I am unable to get a straight answer as to what I can expect for him. Can you live with a drive line infection if they can keep it from getting worse? What are the expected complication from the infection? Is it inevitable that it will get worse? What will happen if it gets worse?
Dear Donna: I am sorry to hear your dad has a driveline infection. They can be tricky to manage, but are often treatable. One can live with a chronically infected driveline, if the infection can be kept under control and mostly at the skin level. That may require more frequent dressing changes and long-term antibiotics. It is not inevitable that it get worse; that depends in part on how advanced the infection is and how aggressive the bacteria causing the infection is. The two most troubling things that could happen if the infection worsened would be that the infection spread to the pocket where the pump sits or to the blood stream. It is very difficult to predict if these things will happen. If the patient can tolerate it, as a final option if the pocket and pump get infected, sometimes the pump can be removed or replaced but these measures require a bigger operation with greater risk. I wish your dad all the best. — Allison J. McLarty, MD
Hi, my father age 55 has an LVAD and was just admitted into the hospital as they ran an EKG and found his heart has stopped pumping. Right now the LVAD is the only thing keeping him going. Prior to this, there was talk of his heart repairing itself and doing really well. They're sending him for a shock treatment to attempt to "wake up" his heart. I am told this is not normal. Any advice or further information?
Dear Sherry: It sounds as if your father developed an abnormal heart rhythm known as ventricular fibrillation. This is a lethal rhythm and indeed the heart stops pumping effectively. The treatment for this is an electric shock to restore a normal rhythm, medicines to keep the heart from returning to ventricular fib, and an implantable defibrillator to automatically shock him out of it if his heart does it again. Patients with weak hearts and heart failure are at increased risk of this abnormal rhythm and "sudden death." Many have a defibrillator placed even before needing an LVAD. For patients who have an LVAD and no defibrillator, this event is unusual but certainly not unheard of. If your father is successfully treated for this, his heart may still go on to improve in function. You should discuss this with the members of his LVAD team who should be able to clarify for you his prognosis. — Allison J. McLarty, MD
My 39-year-old son has had an LVAD and RVAD implant since November 30, 2015. He was diagnosed with non-ischemic dilated cardiomyopathy in August of 2015. He needed to be hospitalized on October 1st because his heart was drastically deteriorating. While in the hospital waiting to receive the LVAD, the right side of his heart weakened and he ended up needing an RVAD also. They induced him into a coma on October 26th; he was put on total life support. From October 1st until November 22nd, he battled a blood infection (sepsis which he contracted while in the hospital), pneumonia and fevers. He has had to have blood transfusions, developed hematomas, and his veins are scared to the point they call him a hard stick. The doctors extubated him several times to get him off the ventilator because of issues with his BP and HR. After all that he has gone through, by the grace of God the doctors were able to perform the VAD surgery. It has been three weeks since his discharge from the hospital, and he is now back in because of an infection at the left driveline site. The doctor has done an Echo of his heart and a CT scan along with a series of blood tests to make sure that the infection is not blood-borne. The Echo and CT scan came back negative, and the blood test has shown that the pus from the driveline so far is localized. The doctor is treating him with an IV of vancomycin. The doctor thinks that this is a subcutaneous infection that was caught early and doesn't seem to worried about its being serious. His EF rate is at an 18 since his VAD surgery; before it was a 9. What does all of this mean for his health going forward? I have been trying to digest it all. I am his caregiver and have taken all necessary precautions when changing his driveline dressings. The doctor thinks the infection may have come from the handling and accidental tugging of the driveline.
Dear Theresa: It sounds like both your son and you have been through a rough time, but as you said, by the grace of God he made it home. If he is back in the hospital with a superficial driveline infection, and the blood tests show that his blood and pumps are NOT infected, then that is generally a very manageable problem. With intravenous and then maybe oral antibiotics, and if necessary with a little debridement at the driveline exit site, these infections can usually be cleared. As you were taught, sterile technique is critical during dressing changes to keep the driveline site infection free. The other important factor is stabilization of the driveline. This is because tugging causes separation of healthy tissue growth around the driveline and forms a port of entry for bacteria. Most dressing kits come with a stabilization device, which can help minimize unexpected tugging. Your son's LVAD team should be able to provide you with these. Going forward, if the infection clears and he experiences no other complications, as he recovers from his hospitalization he should begin to also recover a better quality of life. — Allison J. McLarty, MD

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