Dr Ajay Kaul
Innovative headway has brought a standard shift in the way complex heart treatment is being done, and this is critical given that heart ailments have alarmingly replaced communicable diseases as biggest killers.
Most of the heart diseases untreated or inappropriately treated result in end stage cardiac failure in which till recently there was no hope except transplant. Unfortunately, worldwide, about 3,500 heart transplants are performed annually.
Now with the modern technology, it is possible to implant a miniature pump device called Left Ventricular Assist device (LVAD) or an artificial heart than can work in place of the failing heart. This not only supports patients till a transplant is possible but can go on for over 10 years.
What is LVAD
A LVAD (Left ventricular assist device) is a surgically implanted mechanical pump that is attached to the heart however; a LVAD is different from an artificial heart. An artificial heart replaces the failing heart completely whereas an LVAD works with the heart to help it pump more blood with less work. It does this by continuously taking blood from the left ventricle and moving it to the aorta (main artery of the body), which then delivers oxygen-rich blood throughout the body.
How does it work
The LVAD has both internal and external components. The actual pump sits on or next to the heart’s left ventricle with a tube attached that routes the blood to your aorta. A cable called driveline extends from the pump, out through the skin, and connects the pump to a controller and power sources worn outside the body.
The driveline must be connected to the controller, and the controller must be connected to power at all times to keep the pump working properly. The pump is powered by batteries or electricity. Some LVADs have an adaptor that also allows them to run off the car battery. Each device has specific carrying cases to allow patient to move about freely with the equipment.
When does one require an LVAD
When the patient is not a good candidate for a heart transplant: Increasingly, LVADs are being used for long-term treatment of patients who have heart failure but for one reason or another, aren’t good candidates for a heart transplant. Heart patients with an LVAD can do many routine activities and it can improve quality of life.
When a heart can function normally again: If the heart failure is temporary, physician may recommend implanting an LVAD to help the heart while it heals and becomes healthy enough to pump blood on its own.
When the patient is waiting for a heart transplant: Temporary LVAD implantation may make sense when the patient is waiting for a donor heart. An LVAD can keep blood flowing even with a diseased heart and can be removed when a new heart becomes available and is implanted.
Benefits of LVAD
Help needed to close the transplant shortfall: LVAD is used as a bridge to transplantation, in which LVAD implantation is deemed necessary to provide stability to a patient on the national heart transplant waiting list until a donor heart can be obtained.
Alternative to death: An LVAD is too often considered only when heart failure is much more severe, perhaps after it lands the patient in the ICU. When heart transplant is contraindicated in such patients, they typically view an LVAD as their only alternative to death.
Extending life for almost all patients: LVAD therapy means for patients is extended life and dramatically improved quality of life. All LVAD recipients including bridge-to-transplant patients and destination therapy patients who receive LVADs as essentially a last resort, survival rates are considerably high. The patients have lived with LVAD support for five years or more. Mechanical failure of LVAD pumps is very rare. Theoretically, these devices are good to last for at least 10 to 15 years.
In India, around 5-6 lakh patients die every year because of heart failure. Even in United States, where the awareness is very good and people donate organs, still not more than 1500 operation are performed every year. Over 2,00,000 patients all over the world are on waiting list because of availability of the donors. In Delhi, not more than 5-6 LVADS implants have been performed in last 2 years.
(The author is Chairman & HOD, Cardiothoracic and Vascular Surgery, BLK Heart Centre, BLK Super Speciality Hospital, New Delhi.)
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