LVADs no longer just a bridge, but a long-term alternative to heart transplant
February 12, 2020
As of December 19, 2019, there are 369 Texans waiting for heart transplant. There simply aren’t enough hearts.
While the number of people who are eligible for heart transplants has risen, the donor pool has remained the same. And some patients are not eligible due to advanced age or poor general health.
For many years now, left ventricular devices, or LVADs, have offered these patients a bridge to transplant and a better quality of life leading up to it. But as LVAD technology has improved, the state-of-the-art mechanical devices have evolved from a stopgap measure to a long-term therapeutic solution.
LVAD boosts the functionality of the left ventricle, the chamber of the heart that pumps blood to the body. It essentially functions as a partial artificial heart. UT Southwestern was among the first U.S. centers approved to use LVADs for long-term cardiac support. We are currently involved in studies to examine whether heart function can improve while a patient is on an LVAD.
Studies have shown that LVADs in select patients with advanced heart failure can improve longevity and quality of life compared with medication alone. In some cases, patients can return to work and hobbies they couldn't enjoy before due to advanced heart failure symptoms. And in that regard, an LVAD can be a game-changer for thousands of people who are ineligible (or unlikely) to get a heart transplant.
How LVADs can work long term
Experts at UT Southwestern continually work to make LVAD surgery safer and more effective for patients. One way we are doing this is placing LVADs using minimally invasive surgical techniques when possible rather than by open procedures.
For some patients, we can now make a few small incisions and insert the LVAD without fully opening the chest. This technique can result in better mobility and greater independence, both of which can lead to a shorter hospital stay. While promising, this approach is not yet widely available for all patients or at all centers.
Patients typically develop fewer clotting complications with the newer pumps on the market. So, we are working on strategies to more effectively control them and reduce adverse outcomes.
Managing an LVAD device
LVADs are portable, meaning you can return home once it's placed. However, it contains internal and external components. A surgeon places the pump in the chest and a tube connects the pump to a battery pack and control system outside the body. Your doctor and support personnel will teach you how to clean and inspect your equipment and care for the exit site.
Living with an LVAD requires doing some things a little differently. You will need to avoid getting the device wet. Patients might have to sleep in different positions or rethink their clothing selections to accommodate the device.
UT Southwestern offers a program in which patients who are considering getting an LVAD can meet with patients who already have them. This fellowship can help patients get a better understanding of what it's like to live with a LVAD day to day.
Returning to work and hobbies
We can’t guarantee exactly what your life will be like after you get an LVAD; every patient's experience is different. Depending on your occupation, you may be able to return to your job. For example, I've had patients in their 50s who resumed their administrative careers. But if you do more manual labor, you may not be able to return to your previous position.
That said, exercise is important for patients to maintain heart functionality and to recover after surgery. Walking, playing golf, gardening, and even light jogging or lifting might be OK – your doctor will talk to you about which activities are safe.
We recommend against participating in water exercises or contact sports such as basketball. While you may be able to shoot hoops solo, playing a full game might result in injury or damage to your device.
Sustained cardiac support is the destination
LVAD technology has been available since the 1970s, but until recently it was largely seen as a bridge to a transplant – a partial artificial heart that could sustain a patient only until a donor heart became available.
Advances in the device’s technology – it’s smaller, more durable, more reliable and easier to implant – have made LVAD a legitimate destination therapy, particularly for patients who are not eligible for a transplant.
UT Southwestern was among the first U.S. centers approved for LVAD destination therapy for long-term cardiac support, and our multidisciplinary team can answer any of your questions about this state-of-the-art technology and treatment.