How LVAD addresses the complexities of severe heart failure

Written by: Mr Espeed Khoshbin
Published:
Edited by: Kate Forristal

In the realm of cardiac care, the Left Ventricular Assist Device (LVAD) stands out as a remarkable technological innovation designed to address the complexities of severe heart failure. Serving as an artificial heart pump, the LVAD plays a pivotal role in supporting individuals whose weakened hearts struggle to pump an adequate amount of blood, thereby offering a lifeline to those facing uncertain survival while awaiting a heart transplant. In his latest online article, Mr Espeed Khoshbin delves into the intricacies of why certain individuals require an LVAD, its function, impact on patients' lives, and the evolving landscape of LVAD technology.

Man who requires the LVAD, holding his chest

Why do certain individuals require a left ventricular assist device (LVAD)?

An LVAD serves as an artificial heart pump, specifically designed to address severe heart failure. It is occasionally implanted in individuals awaiting a heart transplant. This is called bridging to transplantation. An LVAD may also be used as a definitive treatment so-called destination therapy. In normal circumstances, the left ventricle, one of the heart's four chambers, pumps blood into the aorta, facilitating its circulation throughout the body. However, in cases of severe heart failure, the weakened heart struggles to pump an adequate amount of blood, necessitating intervention. If their survival until a suitable donor heart becomes available is uncertain, patients being considered for a heart transplant may be candidates for an LVAD.The device supports the failing heart, aiming to restore normal blood flow.

 

 

Is an LVAD recommended for everyone with heart failure?

While not all individuals with heart failure are candidates for an LVAD, the device can be a life-saving measure, providing crucial time for patients until a suitable donor heart is found. Heart failure often arises from conditions such as a heart attack or cardiomyopathy, where the heart muscle is diseased. For patients with severe heart failure that cannot be managed through medications or other treatments, a heart transplant may be considered. However, for those at risk of deteriorating while awaiting a donor heart, implanting an LVAD can be a life-saving interim solution. In patients that are not candidates for heart transplantation LVAD may be used as destination therapy (DT). LVAD could potentially be a good option which would restore cardiac output and improve both prognosis and quality of life. DT therapy is a proven treatment for advanced heart failure. Current median survival following LVAD therapy is more than 5 years survival (MOMENTUM III study).

 

 

How does the LVAD function?

Implanting an LVAD involves a significant open-heart surgery, wherein one end of the LVAD pump is attached to the left ventricle, and the other end is connected to the aorta. Blood flows from the ventricle into the LVAD, which then pumps the blood into the aorta, facilitating its distribution throughout the body. The device is connected to an external controller through a fine cable called the driveline, and the controller, in turn, links to an external battery pack.

 

 

How reliable is the LVAD's battery power?

Due to the critical nature of the device, LVADs are designed to be extremely reliable, incorporating built-in safety systems. In case of a low battery, an alarm signals the need for a replacement. Additionally, a backup battery is always connected to the controller, ensuring continued LVAD functionality. With backup circuitry in place, modern LVADs offer high reliability, supporting patients for years. Users can choose different ways to carry the controller and batteries, enhancing flexibility and convenience in their daily lives.

 

 

How do LVADs impact patients' lives?

Patients considered for an LVAD typically experience a significantly compromised quality of life before the procedure, marked by fatigue, weakness, and breathlessness. Following implantation, normal blood supply is restored, alleviating heart failure symptoms. Many patients regain the ability to engage in daily activities, including walking, driving, and even returning to work.

 

 

How do LVADs serve as a bridge to transplant?

Given the prolonged wait for a heart donor, an LVAD may be employed to sustain an individual until a suitable match is found. Paradoxically, some patients improve to the extent that they become lower priorities on the transplant list, as they are deemed less urgent than those without the device. Notably, LVADs have supported patients for extended periods, with survival rates reaching 80–85 per cent after one year and 70–75 per cent after two years.

 

 

What lies ahead for LVAD technology?

Advancements in technology over the past decade have led to more sophisticated LVADs. Anticipated improvements in this technology holds promise for enhanced convenience and reduced risks associated with external components. Looking ahead, having an LVAD fitted could emerge as a viable alternative to a heart transplant.

 

 

 

Mr Espeed Khoshbin is an esteemed consultant cardiac surgeon. You can schedule an appointment with him via his Top Doctors profile.

By Mr Espeed Khoshbin
Cardiothoracic surgery

Mr Espeed Khoshbin is a leading consultant cardiac surgeon in London. He specialises in coronary bypass surgery, heart valve surgery including aortic valve and aortic root replacement. He is a super specialist performing a high volume of heart and lung transplant in London. He conducts surgery for heart failure through mechanical circulatory support and is one of the few transplant surgeons performing left ventricular assist device (LVAD) surgery in the United Kingdom. Additionally, he holds an honorary clinical senior lecturer position at Imperial College and The National Heart and Lung Institute (NHLI) in London.
 
Graduating from Aberdeen Medical School with an MB ChB, Mr Khoshbin obtained a postgraduate research doctorate (MD) from the University of Leicester. He initiated his cardiac surgery training at St Mary's Hospital in London, part of the East Thames rotation. As a national trainee in cardiac surgery, he achieved the intercollegiate fellowship of The Surgical Royal Colleges of Great Britain and Ireland (FRCS CTh) and secured a position in the UK’s prestigious National Peri-CCT Fellowship in cardiothoracic transplantation and mechanical support. Mr Khoshbin achieved a traveling scholarship from the International Society of Heart and Lung Transplantation to the University College of Los Angeles, California.
 
In his professional roles, Mr Khoshbin is the national lead for heart and lung transplant education, the London deanery appointed lead for cardiac surgical training at Harefield Hospital, and an examiner for the board of examiners of European and UKs Intercollegiate examination board in cardiac surgery. Recently, two of his intercalate BSc students achieved first class honours in transplantation at the Imperial College London. He is the director of Harefield core thoracic transplantation course. He also serves as the NHS lead for organ utilisation at Royal Brompton and Harefield Hospitals.
 
With a research focus on mechanical circulatory support, Mr Khoshbin has a research doctorate (MD) and experience in both clinical and laboratory research. He has conducted Cochrane systematic reviews, randomised controlled trials in cardiac surgery and metanalysis of randomised trials. He has an interest in education research and artificial intelligence applications. He is a supervisor for doctoral research students. He is also the Director of Harefield Hospital core thoracic transplant course.
 
Mr Khoshbin has contributed extensively to medical literature, with publications in peer-reviewed journals such as the British Medical Journal, Circulation, Journal of Heart and Lung Transplantation, Annals of Cardiothoracic Surgery, European Journal of Cardiothoracic Surgery and Journal of Robotic Surgery. He is an elected trustree on the SCTS board of representatives at Royal Brompton and Harefield Hospital. He is an expert reviewer for The National Institute of Health Research (NIHR), European Journal of Cardio-Thoracic Surgery. The Journal of Cardiovascular Surgery, Journal of Heart and Lung Transplantation, Journal of Robotic Surgery, and the Annals of Robotics and Automation.

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