What Are The Benefits And Complications Of LVADs For Heart Failure?

Question: What are the benefits and complications of LVADs for heart failure?

Answer: So, LVADs are implantable mechanical pumps that substitute for the function of the main pumping chamber of the heart, the left ventricle. The devices have been clearly shown in several studies now to improve the quality of life for patients dramatically. The pumps when they work take away the heart failure symptoms. So, patients who are short of breath, having difficulty with fluid retention, fatigue to the point where you can't get out of the house or do anything -- these symptoms are all relieved very effectively by the device and you no longer have the symptoms of heart failure. In addition, the devices have been shown to keep people alive longer than aggressive medical therapy when the heart is in its very last end-stages.

However, there is a tradeoff. There are substantial risks with these devices. All LVADs have a power supply that is external to the body. And so, there is what's called a drive line that exits the abdomen from the device which is internal to the power supply which is external. And that line that goes into the abdominal wall is a source of potential infection that can get into the body and into the pump. And infections are the number one complication of these devices. Some of these infections can be treated with antibiotics and controlled, but some of these infections are in fact life-threatening and very serious.

The second complication of VADs is a mechanical dysfunction of the device. These are mechanical devices with moving parts and they are subject to mechanical failure. They've had extensive testing and they are in fact very reliable. But some of the VADs have a known life expectancy of a year and a half to two and a half years, and some of the VADs have moving parts that can fail. And so, mechanical complications can occur with the devices. The newer generation devices and the newest technology seem to less prone to mechanical failure, but we're still in early testing of those devices and we don't know yet how long these devices are going to be able to last.

And finally, the third complication that's significant with these devices is the formation of blood clots within the device that can then break off and move to parts of the body most significantly causing strokes when the blood clot moves to the brain. Some of the devices require you to be on blood thinners to address this risk, and then there's a risk of bleeding with the blood thinners, and again, most significantly, if the bleeding in the brain, it can cause a different form of stroke. So infections, mechanical failures of the device and stroke are significant risks with this procedure.