What is a LVAD?
A left ventricular assist device (LVAD) is a mechanical pump implanted inside a patient’s chest to help the heart to pump blood around the body. It helps to bear the stress of the heart by circulating the blood to the rest of the body, allowing the heart to rest while other organ functions are sustained by the pump. The LVAD helps patients with advanced heart failure by relieving their symptoms such as shortness of breath and weakness, improving their exercise capacity and prolonging their survival.
How does the LVAD work?
The LVAD is implanted via an open heart surgery, with one end attached to the tip of the left ventricle (main pumping chamber of the heart) and the other end to the aorta (main artery of the body). Blood is pumped out of the left ventricle into the aorta by the LVAD. An insulated electrical cable (driveline) passes from the device, through the skin, to connect the pump to an external controller and electrical power source (two battery packs) outside of the patient’s body. The controller and battery packs are usually carried in a pouch that is slung on the shoulder or worn around the waist. The batteries are rechargeable.
Which patients require LVAD?
Patients with advanced heart failure have a poor quality of life and a one-year survival rate of less than 50%. Those who should consider an LVAD surgery include patients who have severely impaired left heart function AND:
a. have frequent disabling heart failure symptoms like breathlessness at rest or on mild exertion despite being treated with oral medications, OR
b. have frequent hospital admissions for heart failure, OR
c. have critically low blood pressure and require intravenous medications or mechanical devices to boost the blood pressure. These patients are usually confined to the Intensive Care Units (ICUs).
After a successful LVAD implantation, majority of patients experience markedly improved exercise capacity and reduced hospital readmissions. In Singapore, the 5-year survival rate of patients on LVAD support is more than 80%.
The LVAD can be implanted to temporarily support patients while they await a heart transplant (Bridge-to-Transplant) or as a permanent support (Destination Therapy).
Consult your cardiologist about LVAD if you continue to experience heart failure symptoms not controlled by your medications.
Here are some publications from Abbott, of the Momentum 3 Trial involving their Heartmate III LVAD, sharing from their website:
https://www.cardiovascular.abbott/us/en/momentum3publications.html
The MOMENTUM 3 (Multicenter Study of MagLev™ Technology in Patients Undergoing Mechanical Circulatory Support Therapy with HeartMate 3™) investigational device exemption (IDE) clinical study was designed to evaluate the safety and effectiveness of HeartMate 3™ Left Ventricular Assist System (LVAS) by demonstrating non-inferiority to the HeartMate II™ LVAS when used for the treatment of advanced refractory left ventricular heart failure.
Final Report of the Two-year Principal Outcomes in the MOMENTUM 3 Full Cohort
https://www.nejm.org/doi/full/10.1056/NEJMoa1900486
Mehra, M.R., Uriel, N., Naka, Y., Cleveland, J.C., Yuzefpolskaya, M., …Goldstein, D.J., for the MOMENTUM 3 Investigators. (2019). A Fully Magnetically Levitated Left Ventricular Assist Device – Final Report. N Engl J Med. https://www.doi.org/10.1056/NEJMoa1900486
The data from two-year followup of the MOMENTUM 3 full cohort demonstrates:
- Clinical superiority of the HeartMate 3 LVAS when compared to the HeartMate II LVAS
- Less frequent need for pump replacement with HeartMate 3 LVAS
- Lower rate of stroke and disabling stroke with HeartMate 3 LVAS
- Lower rate of gastrointestinal bleeding with HeartMate 3 LVAS
Other Publications:
2 Year Primary Outcomes in the MOMENTUM 3 Long-term Cohort
https://www.nejm.org/doi/full/10.1056/NEJMoa1800866
Quality of Life and Functional Capacity Outcomes at 6 months in the MOMENTUM 3 Short-term cohort
https://www.jhltonline.org/article/S1053-2498(17)32085-5/fulltext
