Patient Lecture: Living with a Left Ventricular Assist Device (LVAD)

Dr K. Damman, Cardiologist

Dr. M.E. Erasmus, Cardiothoracic Surgeon

Heart Failure (HF) is one of the leading causes of death in cardiovascular disease. The prevalence of HF is rising, especially in the aging cardiovascular population. Heart failure is a devastating syndrome caused by coronary artery disease, genetic cardiomyopathies, end stage hypertension, and congenital heart disease. More importantly, HF causes severe impairment of all organ systems, including the heart, liver, kidney, and brain. Blood flow to all of these organs is impaired and as a result, the patient with HF experiences fatique, shortness of breath, orthopnea, and signs of congestion with peripheral edema, ascites and weight gain. If not treated, severe HF is life threatening, and survival is extremely poor, worse than most cancers.

Most patients with HF can be treated with medication, pacemakers, and adaptations to daily life. However, patients with severe forms of HF are frequently admitted to hospital, have severely impaired quality of life, experience life threatening rhythm disturbances, and require something more than medication. Some of these patients may require a heart transplantation eventually. However, the waiting list for a donor heart is long and median waiting time is over 3 years. For some patients, with a median survival of less than 2 years, this would mean they would not survive the time to transplantation.

These patients, with certain characteristics, may require a Left Ventricular Assist Device (LVAD) implantation to bridge the time on the heart transplant waiting list. An LVAD is a mechanical pump that supports the body circulation and is surgically implanted in patients with severe HF. The new generation LVADs is no larger than the palm of the hand and can support up to 10 liters per minute. Patients who receive an LVAD generally have an improved clinical outcome, strongly improved exercise tolerance, fewer symptoms, and better quality of life. However, it does come with adaptations to daily life, as patients require carrying batteries to power the LVAD (via a cable that runs through the skin), are attached to the electrical grid at night, and frequently experience complications. Yet, this technology has made it possible for many patients to survive the time to transplant with considerable improvement in quality of life. Furthermore, patients that cannot receive a heart transplantation can be candidates for LVAD therapy, as destination therapy.

In this patient lecture, we will present a patient who underwent an LVAD-implantation.