LVAD (Left Ventricular Assist Device) Surgery

UT Southwestern Medical Center has been a pioneer in the development, use, and research of left ventricular assist devices, or LVADs. These sophisticated devices support patients whose hearts are failing – either while they wait for a heart transplant or in lieu of having that procedure done. 

Our surgical team has the most experience in North Texas with LVADs. We’ve been part of an exclusive group of hospital systems nationwide approved to use LVADs to help patients in a more permanent way.

A Pioneer in Treating Failing Hearts

Ventricular assist devices (VADs) are small, battery-operated devices that help the heart pump blood. Depending on individual patient needs, ventricular assist devices can be appropriate for short-, intermediate-, or long-term use – typically to treat advanced heart failure.

The left ventricular assist device (LVAD), the most commonly used type, is a mechanical pump that serves as a partial artificial heart. Implanted during an open procedure, an LVAD helps the left ventricle pump oxygen-rich blood to the aorta and the body.

As technology evolves, LVADs continue to get smaller, more durable, more reliable, and easier to implant, bringing the potential for a longer, healthier life to an ever-expanding group of patients.

These state-of-the-art devices can be very effective in treating patients awaiting heart transplantation (bridge to transplant therapy), those who aren’t candidates for heart transplantation (destination therapy), and those with cardiac conditions such as advanced heart failure, cardiomyopathy, and myocarditis.

UT Southwestern has long been a pioneer in LVAD therapy. Among the first U.S. centers approved for LVAD destination therapy for long-term cardiac support, we were involved in groundbreaking clinical trials of LVADs, including the nationwide REMATCH trial.

We are currently taking part in studies to see how heart function can recover while patients are supported by an LVAD.

UT Southwestern is also home to a dedicated Cardiac Rehabilitation Program. Cardiac rehabilitation is a critical component of recovery and can prevent future heart disease.

Heart Conditions We Treat With LVAD

LVADs treat people with advanced heart failure – in particular, those:

• Whose health is too poor or age too advanced to undergo heart transplantation
• Who are on the heart transplant list but are not stable enough to wait for a donor heart to become available
• Whose body mass index (BMI) is considered too high for heart transplant
• Who have advanced stages of dilated cardiomyopathy or myocarditis
• Who have undergone heart surgery but cannot safely be removed from cardiopulmonary bypass
• Who have a health problem that precludes heart transplant
• Who have experienced organ rejection after heart transplantation
• Who have had massive heart attacks with no other treatment options

The three categories of LVAD use are:

• Short-term: For high-risk patients who cannot sustain life over the long term
  
• Intermediate-term: For patients with a high risk of complications for up to 500 days
  
• Long-term: For patients with advanced heart failure who need support outside the hospital
  

What to Expect

LVAD Preoperative Details

The surgeon provides specific instructions to the patient prior to the LVAD surgery, discussing risks such as bleeding, infection, or adverse reaction to anesthesia.

Patients also meet with the anesthesiologist prior to the surgery to review their medical history. Patients should not eat after midnight the night before the surgery.

On the day of surgery, the patient arrives at the hospital, registers, and changes into a hospital gown. A nurse reviews the patient’s charts to make sure there are no problems.

The anesthesiologist then starts an IV, and the patient is taken to the operating room, where the surgeon verifies the patient’s name and procedure before any medication is given. Surgery will begin once the patient is under anesthesia.

LVAD Operative Details

The surgeon makes a long incision on the breastbone and accesses the heart by spreading the rib cage. In some cases, patients are placed on a cardiopulmonary bypass machine, which takes over the work of the heart and lungs until the operation is complete.

The surgeon connects one end of the LVAD tube to the heart’s left ventricle and a tube exiting the other end of the external LVAD to the aorta. A small electrical cord connected to the LVAD (a driveline) exits from the upper abdomen and is connected to a power supply (either batteries or a plug-in) and a small computer to operate the device.

Once the device is working properly, the patient is taken off cardiopulmonary bypass and the chest is closed with stitches.

LVAD Postoperative Details

After surgery, patients are taken to the intensive care unit and monitored. Pain is likely, and pain medication is given as appropriate. Patients are typically on a respirator for up to one day to support their breathing.

The length of the hospital stay depends on how quickly patients recover and can perform some physical activity.

Support Services

UT Southwestern’s cardiac rehabilitation specialists create customized plans that integrate proper nutrition, exercise, and, if necessary, nicotine cessation into patients’ lifestyles to improve their cardiovascular health.

Clinical Trials

As one of the nation’s top academic medical centers, UT Southwestern offers a number of clinical trials aimed at improving the outcomes of patients with cardiovascular disease.

Clinical trials often give patients access to leading-edge treatments that are not yet widely available. Eligible patients who choose to participate in one of UT Southwestern’s clinical trials might receive treatments years before they are available to the public.