What is an LVAD and how does it impact the life of a heart failure patient?

I hope you are not getting tired of all the acronyms.  In some of my initial posts, I began to use the acronym ICD, which is shorthand for Implantable Cardioverter Defibrillator(the little device I have in my body that paces my  heart and keeps me from going into cardiac arrest).  In a more recent post, I wrote about NSAIDs, the class of pain relievers that doctors tell patients with certain heart conditions to avoid.

So now I am asking you to get familiar with another acronym known as LVAD.  LVAD may bring to mind the term HVAC, an acronym for heating, ventilation and air conditioning systems.  Indeed, LVADs do bear some similarities to HVAC systems which contain a heat pump.  You see, LVAD means Left Ventricle Assist Device.  According to the St. Jude Medical website, an LVAD is a heart pump, a mechanical device that helps people when their hearts are too weak to pump blood.  So maybe the comparison between LVADs and HVACs isn’t so zany after all!
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So just what is the purpose of an LVAD? The St. Jude Medical website says that the LVAD does not replace the heart.  Rather, it assists the heart in pumping oxygen-rich blood throughout the body so that the organs and muscles can function properly. The LVAD system has parts that work inside and outside the body. Inside, a heart pump is attached to the left side of the heart. Outside, a controller, batteries and driveline help to power and control the heart pump.

Is the LVAD a permanent solution?  The answer is “it depends.”  According to the St. Jude Medical site, in some instances, an advance heart failure patient who is on the list for a heart transplant will use an LVAD.  The device will help the heart pump blood while he or she is awaiting the heart transplant surgery.  This is referred to as a bridge-to-transplantation. Other patients may not be eligible for heart transplant surgery because of age or other reasons but may still benefit from an LVAD. Because these patients will keep their LVADs for the long term, they are engaging in what is known as destination therapy.

In a recent post, I talked about the evolution of the pacemaker, and concluded that I was ecstatic not to be one of the first people who used a pacemaker.  While the first pacemakers saved lives, they were also far more bulky and far less convenient than the current relatively tiny device that resides in my collarbone area. 

Well the same can be said of LVADs.  An article in 2015 on the University of Iowa Hospitals and Clinics website discussed a patient’s recent LVAD implantation.  It said that an LVAD implantation “traditionally meant a lengthy incision to split open the patient’s chest (called a sternotomy) from the collarbone to just above the stomach to gain access to the heart.”  The article also said that a decade earlier, LVADs were considerably larger, and patients typically required a small cart to carry around the power supply attached to the mechanical pump.

Happily, the doctors were able in 2015 to offer the patient a less invasive LVAD implantation procedure.  Additionally, the device implanted in the patient was smaller, and the patient would be able to carry the power pack over his shoulder.
 
Even though the LVAD has become less bulky and intrusive, it still seems a bit daunting to have a device that requires a controller box or power pack that you had to carry around with you.  How do patients adapt to this?  Well believe it or not, Dick Cheney was a trend setter in the heart patient community when it came to living in the public sphere with an LVAD. 

In an interview featured on the ABC News website Dr. Dr. Robert Kormos, director of the Artificial Heart Program at the University of Pittsburgh said:  "The reality is that many patients have come to us asking about the 'Cheney pump,'" he said, referring to the  LVAD that pumped Cheney's blood on behalf of his failing heart. "His positive presentation while on the device has very much been positive for the public impression of the therapy."

There are other celebrities who have relied on LVADs for at least some time in their life.  Rod Carew has been featured on the American Heart Association as a patient who had an LVAD and who hoped to be placed on the heart transplant list.  One article indicated that if the LVAD was a permanent solution, Carew would be okay with that.

In 2013 as doctors were trying to figure out the cause of my fainting spells, Randy Travis was admitted to the hospital for symptoms that were similar to mine.  It turns out that Travis suffered congestive heart failure, a stroke and cardiomyopathy from a virus.  He received an LVAD in 2013. The last articles I found are a bit dated, but it appears that Travis is to still using an LVAD. 

So there are a number of factors that I think are making the LVADs more acceptable.  The first is the continued improvement in size as demonstrated in the 2015 University of Iowa article.  Additionally, I have recently noticed commercials for a device known as an Impella.  I have googled Impella and it looks like a very small and compact device, maybe even more compact than the device implanted in the patient who was featured in the 2015 University of Iowa article. 

The second is seeing people in the news who are equipped with these life-saving devices and who seem to be doing well.  Dick Cheney was indeed a good poster person for an LVAD.  As I recall, he was active and functional while he waited for a more permanent solution and so this is another good selling point for LVADs.    

But Cheney was using the LVAD as a temporary solution as he waited in the queue for a heart transplant.  He did not have to live with his LVAD for the rest of his life.  So your question may be how does one learn to manage when the LVAD might be a permanent solution?  How do these patients feel about potentially using this device for the rest of their lives?  Well, as we have seen many times with heart devices, technology may improve and the device and its controller may continue to get smaller and more manageable for those patients who use the LVAD as destination therapy. 

But there is another factor that is really important and it has to do with the patient's motivation.  There is something that I have come to realize as my heart failure and I become reluctant allies.  If you feel that there are things left for you to do on this earth, you will adapt to just about anything. 

You might want to take a look at the “Go Boldly” website.  Here is what it says about a recent commercial that features a poem that may be familiar to you:  “The iconic Dylan Thomas poem, “Do not go gentle into that good night,” inspires biopharmaceutical scientists who have an indomitable will to find the unfindable and cure the incurable.”  The commercial is about 60 seconds long and recites the Dylan Thomas poem while it shows researchers working on breakthroughs in drugs and therapies for stubborn patients who refuse to go gentle while they still have a purpose to fulfill. 

This commercial says it all for me and I am sure for other heart failure patients who are invested in their treatment and breakthroughs.  While we have a breath and a will to live, we will adapt.  We have had to adapt ever since the doctor delivered a diagnosis of heart failure.  Some things were just small, maybe inconvenient adjustments like giving up salt, carefully tracking fluid intake each day, or juggling the intake and side effects of new drugs.  Some were much bigger adjustments, like implanting a spooky device into your body that would pace your heart, and at some point perhaps prevent your heart from going into cardiac arrest.  Whether inconvenient, or intrusive or just plain scary, each adaptation certainly was better than the alternative of experiencing more damage to the heart or even death.

I want to emphasize that even though I am starting to get familiar with the process of implanting LVADs and the process of heart transplants, the doctors have not told me that I am in line for these procedures any time soon.  In fact, I may not ever need those.  But I also know that my heart is damaged and that we watch it very closely.  There have been a number of days in the last four years when I have feared what might happen if my heart weakens and the medications and diets are not enough.  It helped when the heart failure doctor told me that a person is eligible for a heart transplant until the age of 70 and is also eligible for an LVAD until the age of 80.  

Since that conversation, I have found that comfort in learning about organ transplants and heart pumps.  When I have a fear of something, it is usually because I do not understand it.   So that is why I have started to look at heart transplants and LVADs from the viewpoint of an objective bystander.  Armed with facts, the processes have begun to look less daunting and more comforting in the event that I ever need to travel down those roads.  

I guess the bottom line for me is that if life begins to slip away before I am ready, I will adapt to just about anything to afford more time for dedicated researchers and doctors to find a cure or a advances that will keep me going with a decent quality of life.  So don’t expect me to go gentle.  Indeed, I will rage, I will make noise, I will do whatever it takes to keep blood pumping and breath flowing through my body because I have things that God intended for me to do on this earth.

​But because I am curious I now have a lot of pesky new questions for my doctors.  And because  my way of handling the unknown is with humor, I will continue to insert some zany questions into the mix.  So I am jotting down my list of potential LVAD questions:  Hey doc, will the LVAD be compatible with the ICD that is currently in my body?  What’s the protocol when two different devices control your heart?  Does one take precedence over the other?  God forbid – is it like government agencies trying to figure out who has jurisdiction and control during a crisis.  (If that is the case, I may be toast!)  Would the devices talk to each other without my knowledge?  Would they conspire to take over my body for ulterior motives?  Hey doc, I I think I see the beginnings of a good sci fi novel!