LVAD(Left Ventricular Assist Device) cost in India

Know More About Procedure & Surgery

What is LVAD?

A ventricular assist device (VAD) also known as a mechanical circulatory support device is an implantable mechanical pump that helps pump blood from the lower chambers of your heart (the ventricles) to the rest of your body. A VAD is used in people who have weakened hearts or heart failure. A VAD can be placed in the left, right or both ventricles of your heart, it is most frequently used in the left ventricle. When placed in the left ventricle it is called a left ventricular assist device (LVAD).

Why it is done?

• If you’re waiting for a heart transplant. You may have a VAD implanted temporarily while you wait for a donor heart to become available. A VAD can keep blood pumping despite a diseased heart and will be removed when your new heart is implanted. It may also help improve the function of other organs in your body that may not be working properly and may improve other medical conditions.
• If you’re not currently eligible for a heart transplant because of age or other conditions. A VAD may sometimes be implanted if you have heart failure, but you're not eligible for a heart transplant due to age or other medical conditions. This is called destination therapy. In some cases, the VAD may improve these conditions so that you can become a heart transplant candidate, or you may keep the VAD as a permanent treatment. Generally if you're older than age 65, you may not be eligible for heart transplantation. In that situation the VAD would be implanted as therapy for heart failure. A VAD can enhance your quality of life.
• If your heart's function can become normal again. If your heart failure is temporary, your doctor may recommend implanting a VAD until your heart is healthy enough to pump blood on its own again. This is referred to as bridge to recovery. VADs may be temporarily implanted after some heart surgeries. A RVAD can help keep blood flowing from the right ventricle to your lungs.

Risks Involved in Surgery

• Blood clots. As your blood moves through your VAD, blood clots may form. Blood clots can slow or block normal blood flow through your heart, which can lead to stroke or heart attack, or cause your VAD to stop working. Doctor will prescribe blood-thinning medications, including warfarin (Coumadin, Jantoven) and aspirin to help prevent blood clots after your VAD is implanted. You'll need to have regular blood tests to monitor warfarin's effects.
• Bleeding. Implanting a VAD requires open-heart surgery. Having open-heart surgery can increase your risk of bleeding during or after your procedure. Taking blood-thinning medications to reduce your risk of blood clotting also increases your risk of dangerous bleeding into the gastrointestinal tract and the brain.
• Infection. Because the power source and control unit for your VAD are located outside your body and are connected through a port in your skin, there's an increased risk of germs getting in the port and causing a serious infection.
• Device malfunctions. It's possible that your VAD may stop working properly after it's implanted. The pumping action of the device might not work correctly, making it so not enough blood pumps through your heart. The power supply to the device could also fail, or other parts of the device may quit working properly. Each of these problems requires immediate medical attention.
• Right heart failure. If you have an LVAD implanted, it will pump more blood from the left ventricle of your heart than what your heart might have been used to. Your right ventricle may be too weak to pump the increased amount of blood. If you develop right heart failure, medications or other therapies may help improve the pumping ability of the right ventricle.

Preparations

Food and medications

Discuss with the doctor

• When you can take your regular medications and whether you can take them before your surgery
• When you should stop eating or drinking the night before the surgery

Precautions regarding medications and allergies

Talk to your doctor about:

• Any medications you have brought to the hospital and when you should take medications on the day of the procedure
• Allergies or reactions you have had to medications

Before the procedure

Before your ventricular assist device (VAD) is implanted, you'll likely need to stay in the hospital for several days preparing for your surgery. While you're in the hospital, you may have other treatments for your weakened heart or heart failure. Doctor may review several factors to decide if a VAD is the most appropriate treatment for your condition and to determine which VAD may be most appropriate for you, including whether:

• The severity of your heart failure is appropriate for a VAD.
• You have other serious medical conditions that may affect your health or quality of life with a VAD.
• You need support for the left ventricle, the right ventricle or both ventricles.
• You're able to take blood-thinning medications for a long period of time.
• You have appropriate social support from your family and friends.
• You are mentally and emotionally able to take care of a VAD.

Your doctor will also evaluate your condition and ensure that you're healthy enough for surgery to implant a VAD. Your doctor may order several tests, including:

• Echocardiogram. In an echocardiogram, sound waves are used to produce a video image of the heart. Your doctor uses an echocardiogram to determine the pumping function of your heart, check your heart valves and help determine the cause of your heart failure.
• Chest X-ray. An X-ray image helps your doctor to see the size and shape of your heart and lungs.
• Blood tests. Your doctor may order blood tests to check your liver, kidney and thyroid function before surgery to implant a VAD. Your doctor might also test for other chemicals in your blood that show how well your heart is working. Blood tests may also be used to check for symptoms of infection, which need to be treated before surgery.
• Electrocardiogram (ECG). An electrocardiogram records the electrical activity of your heart. An ECG measures the timing and duration of each electrical phase in your heartbeat.
• Cardiac catheterization. In this test, a doctor inserts a thin, flexible tube (catheter) into a vein or artery in your upper leg (groin), arm or neck and guides it to your heart using X-ray imaging. Doctors may use this test to measure the pressure and blood flow in your heart. This test may help your doctor determine if you're a candidate for a VAD or if you may need alternative devices.

During the Procedure

A surgical team of heart (cardiac) surgeons, surgical nurses, doctors trained in giving medication that causes you to sleep during surgery (anesthesiologists) and others work together to perform your surgery. The procedure to implant a ventricular assist device (VAD) is typically an open-heart surgery that generally takes four to six hours. You'll be connected to a machine that helps you breathe (ventilator) during your surgery. A tube will be run down your throat to your lungs and connected to the ventilator. You may need to remain connected to the ventilator for several days after your surgery. In this procedure, your surgeon will make an incision down the center of your chest. Your surgeon will separate your chest bone (sternum) and open your rib cage so that he or she can operate on your heart. Your heart may be stopped using medications during the surgery. You'll be connected to a heart-lung bypass machine that keeps oxygenated blood flowing through your body during surgery if your heart is stopped during surgery.

Your surgical team will implant your VAD during surgery. An implanted left ventricular assist device (LVAD) has many parts. A tube carries blood from the left ventricle of your heart to a pump. The pump delivers blood through another tube to the aorta — the artery that leads out to the body from the heart — which then delivers blood to the body. A cable inserted through the skin connects the pump to the control unit and battery pack outside your body. After your VAD is implanted and working properly, your doctors will take you off the heart-lung bypass machine so that the VAD can begin pumping blood through your heart. Certain types of VAD pump blood similar to the way your heart does, using a pumping action. They help pump blood from one or both lower chambers of your heart (ventricles) and on to the rest of your body. Other types of VAD — continuous flow devices — are smaller. These devices allow a continuous stream of blood to flow through your heart. If you have a continuous stream of blood flowing through your LVAD, you or your doctor may not be able to check your pulse or your blood pressure using standard methods. Doctors may use other tests to check your heart rate and rhythm and to measure your blood pressure. Certain types of VADs have pumps located outside of the body. These VADs may have external pumps connecting to a large console, while some have smaller external pumps located next to the body that are connected to portable devices. These VADs may be used for a temporary period of time, such as during or after heart surgery, but some may be used while waiting for a heart transplant or a longer-term VAD. In one type of short-term VAD, the pump is inserted through a catheter in the leg, neck or armpit, which doctors guide through the arteries to the heart. Another type uses catheters to access the heart, but the pump is located outside the body.

After the procedure

After surgery to implant a VAD, you'll stay in the intensive care unit (ICU). You'll be given fluids, nutrition and medications through intravenous (IV) lines. Other tubes will drain urine from your bladder and drain fluid and blood from your heart and chest. Your treatment team will monitor you for signs of infection or other complications. Your lungs may not work properly immediately after your surgery, so you may need to remain connected to a ventilator for a few days after surgery until you're able to breathe on your own.

After a few days in the ICU, you'll generally be moved to a regular hospital room. Your treatment team will work with you to help you gain strength and prepare you for going home. They may explain how to live with a VAD and care for your VAD after you go home, and they can help answer your questions about the VAD. Your treatment team may also discuss with you nutrition and cardiac rehabilitation plans they may recommend during your recovery after you return home.

Your doctor will likely prescribe antibiotics and blood-thinning medications to prevent infection and other complications while you're in the hospital. It's very important to follow the instructions for taking these medications carefully. Once you have recovered and gained your strength, your treatment team will determine when you're healthy enough to be released from the hospital. If you need more time to recover your strength before returning home, you may stay at a special care facility, such as a nursing home, for a period of time after leaving the hospital.

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