Nikki Elmi
A left ventricular assist device (LVAD) is a surgically implanted mechanical pump designed to take over the function of a severely weakened left ventricle. This chamber of the heart is responsible for pumping oxygen-rich blood throughout the body. LVADs are considered for patients with advanced heart failure who are no longer responding adequately to medications or other therapies. They serve two primary purposes: as a "bridge to transplant" for patients awaiting a donor heart, or as "destination therapy" for those who are ineligible for a transplant due to age or other health factors.
The LVAD system consists of several components. A pump is placed inside the chest, usually near the apex of the heart. A tube (inflow cannula) draws blood from the left ventricle into the pump. The pump then propels the blood into another tube (outflow cannula) that is connected to the aorta, the body's main artery. A driveline cable passes through the skin, connecting the pump to an external controller and battery pack worn outside the body. This supplies the necessary power for the pump to operate continuously.
LVADs have become a critical lifeline for many patients with advanced heart failure. Studies consistently demonstrate significantly improved survival rates in LVAD patients compared to those managed with only medications. For example, some studies indicate that approximately 80% of LVAD recipients survive for at least one year after implantation, with around 50% surviving for five years or longer. Additionally, patients often report a substantial reduction in heart failure symptoms such as shortness of breath and fatigue. This allows them to engage in daily activities with greater ease, resulting in an overall enhanced quality of life.
While the decision to implant an LVAD requires careful consideration and there are potential risks involved, the device offers hope and improved outcomes for many patients facing the challenges of advanced heart failure. LVADs not only extend life but crucially improve its quality. Ongoing advancements in this technology promise smaller, more efficient devices and potentially reduce the chance of complications, making LVADs an increasingly viable option for a wider range of patients.
References:
1. EMCrit. (n.d.). HeartMate 3 LVAD Overview. EMCrit Blog. Retrieved from https://emcrit.org/emcrit/heartmate-3-lvad-overview/
2. University of Washington. (n.d.). Study sifts potential factors in device implant complication. UW News. Retrieved from https://newsroom.uw.edu/news-releases/study-sifts-potential-factors-device-implant-complication
3. Slaughter, M. S., Rogers, J. G., Milano, C. A., Russell, S. D., Conte, J. V., Feldman, D., ... & Oz, M. C. (2004). Advanced heart failure treated with continuous-flow left ventricular assist device. New England Journal of Medicine, 351(9), 885-892. https://doi.org/10.1056/NEJMoa042552
4. Mayo Clinic. (n.d.). Ventricular assist device (VAD). Mayo Clinic. Retrieved from https://www.mayoclinic.org/tests-procedures/ventricular-assist-device/about/pac-20384529
5. Kiernan, M. S., Grandin, E. W., Brinkley, M., Kapur, N. K., Pham, D. T., Khalique, O. K., ... & Kapur, S. (2021). Contemporary outcomes of continuous-flow left ventricular assist device implantation. ASAIO Journal, 67(5), 506-511. https://doi.org/10.1097/MAT.0000000000001345
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