How Are LVAD Pumps Used for Heart Failure?

If you have heart failure—which occurs when your heart is weakened and can’t pump enough blood for your body, per the National Heart, Lung, and Blood Institute (NHLBI)—you’re part of a large and growing group. According to the Journal of Cardiac Failure, 6.7 million American adults are currently living with this condition; by 2030 that number is estimated to grow to 8.5 million. Alarmingly, one in four people will develop heart failure in their lifetime.

As the NHLBI points out, having heart failure doesn’t actually mean that your heart has “failed” or stopped working, but that the organ needs help functioning well. As this condition advances to late stages, some folks will need a heart transplant. It’s those patients who may be told by their doctors that they could benefit from a device called an LVAD pump.

LVAD stands for left ventricular assist device. This device picks up the work that the heart can’t do. “LVAD is a battery-operated, mechanical pump that is implanted into the heart and takes over the function of the left ventricle, which is the main chamber of the heart,” explains Karishma Patwa, M.D., a board-certified cardiologist with Manhattan Cardiology in New York City. (Heart failure can also affect the right ventricle.)

The device, which weighs between about a half pound to a pound and measures about 2 inches by 2 inches, is implanted into the chest, running from the left ventricle up to the aorta. A wire connects from the pump through your skin and into an external power source and controller that you wear on your body.

How Does an LVAD Pump Work?

The left ventricle of your heart is the chamber that pumps blood to the rest of the body. If this chamber is weak, blood can’t effectively flow to your vital organs. An LVAD pump can be implanted to help with this problem. “The LVAD works by pulling blood from the left ventricle and pushing it into the aorta, which is the main artery of the body. From the aorta, oxygenated blood is delivered to the rest of the body,” says Dr. Patwa.

An LVAD is needed in specific circumstances—not every individual with heart failure requires one of these devices. Heart failure can be caused by “problems with the heart not squeezing or relaxing well, or it can be caused by valve problems,” explains Jeffrey Teuteberg, M.D., a professor of medicine and the section chief of heart failure, cardiac transplantation, and mechanical circulatory support at Stanford Health Care in California. An LVAD helps when the heart has trouble pumping.

In 2022, more than 2,500 LVAD pumps were implanted in the United States, according to The Annals of Thoracic Surgery. A heart failure specialist may recommend an LVAD pump for people who have end-stage heart failure, the most advanced stage of the disease where someone experiences symptoms at rest.

As noted, LVAD pumps are appropriate only for the type of heart failure that involves trouble with squeezing blood from the left ventricle into the aorta. “LVAD is used in systolic heart failure where there is something wrong with the muscle of the heart so that it doesn’t squeeze as well,” says Dr. Teuteberg. For these individuals, an LVAD pump may be recommended in one of two instances, he says:

• You are a candidate for a heart transplant but are currently too sick to wait for a transplant on your own. An LVAD pump can act as a bridge as you are awaiting a transplant.

• You have heart failure that would make you a candidate for a heart transplant, but you aren’t eligible for one due to other factors, like underlying medical problems. In this case, you can get an LVAD pump in lieu of a transplant. This is called destination therapy.

If a person’s heart failure is caused by the heart muscle’s trouble relaxing, known as diastolic heart failure, LVAD pumps are not as effective, Dr. Teuteberg adds.

After implantation, an LVAD pump takes the strain off your heart because it doesn’t have to work as hard to pump. “For a minority of people, resting of the heart alone allows the heart to recover to a point where the pump can be taken out,” says Dr. Teuteberg, adding that this is a “small but real” group of people.

For everyone else, an LVAD pump is either a bridge until a heart transplant or a lifelong decision—but one that can make a large difference in your quality of life. “Prior to the procedure, patients are breathless at rest and struggle to do anything. Six months later, most have no or mild breathlessness when they get around. It’s a huge change in their symptoms and exertional tolerance,” he says. At one year post-surgery, 82% of people who received an LVAD from 2015 to 2019 were still alive, with a median survival time of at least 4.5 years, reports to research in the Journal of the American College of Cardiology.

You’ll need surgery to get an LVAD pump implanted into your heart. “It’s typically implanted through a sternotomy,” says Dr. Teuteberg. This is considered major surgery and involves cutting the breastbone open in order to access the heart, according to Cleveland Clinic. Risks from the surgery include abnormal heart rhythm, bleeding, infection, and swelling, and recovery can take a couple of months.

The Journal of the American College of Cardiology study notes that within the year of implantation, 41% of patients with an LVAD had an infection, 33% had major bleeding, 13% had a stroke, and 72% needed to be hospitalized again. It’s important to talk to your heart surgeon about these risks and what to expect after surgery. Complication rates have decreased with the newest generation of heart pumps.

When you have heart failure, it benefits you to open up this conversation with your doctor before an LVAD pump may be needed, suggests Dr. Teuteberg. “What happens is that people with systolic heart failure can get sicker over time despite medications and other devices and become more limited and breathless,” he explains. At that point, there’s more of a risk of having surgical complications, or it may be too risky to have this surgery altogether. “We often see patients too late when they are super sick, frail, or have lost a lot of muscle mass, and then they’re at a higher risk of complications when having surgery,” says Dr. Teuteberg.

If you’ve tried medications and devices but still cannot tolerate walking a block, moving from one room to the next, or have been hospitalized multiple times over the past year because of heart failure, these are warning signs that your condition is advancing, he says. These are all signals that it is time to talk to your cardiologist about getting a referral to a heart surgeon, so you can discuss the benefits and risks of an LVAD pump for your situation, as well as the timing of when one may be needed.

An LVAD pump is a potentially life-changing procedure, but it’s not without risks. “I would recommend ensuring that you completely understand the process of having and caring for an LVAD, including the frequent follow-up appointments,” says Dr. Patwa. Your doctor should talk to you about what caring for your device means, including any indication that the device isn’t working properly, signs of infection where the wire comes out of your skin, and more.

Because it can sometimes feel overwhelming to tackle these large medical decisions on your own, you can ask for help from a trusted person. “It would also be great to have a loved one with you [in the appointment] to also understand and help you care for the device,” she adds. That person can help you come up with questions to ask prior to the appointment, help ensure that you ask them, and take notes for you.

An LVAD, or left ventricular assist device, is a pump that’s implanted in the heart as a treatment for a certain type of advanced heart failure. It’s used as a bridge while a patient waits for a heart transplant or those who are not candidates for heart transplant but whose condition is not adequately controlled with medication or other devices, or who are not otherwise eligible for a transplant. As a patient, it’s important to have support from a loved one who can help you in the shared decision-making process alongside your doctor, especially if you are really ill. Together, you can weigh the benefits and risks for your specific case of having a major surgery like this.