Left ventricular assist devices (LVAD): your questions answered 

What is an LVAD and how does it treat heart failure?

An implantable LVAD, or left ventricular assist device, is a mechanical device that’s used to pump blood around the body when the heart is too weak to pump blood on its own.

An LVAD does not replace your heart, and it is not an artificial heart. It helps the left ventricle – the main pumping chamber of the heart – pump blood around your body.

I’m going to talk here about long-term implantable left ventricular assist devices, to treat people with advanced heart failure who are waiting for a heart transplant. (There are also short-term LVADs, which are just used for a few days or weeks while someone is in hospital – those are a different type of device.)

Who can benefit from an LVAD?

There are 2 main reasons people may be considered for an LVAD in the UK:

1. To support their heart while on the heart transplant waiting list, if they’re at high risk of deteriorating or dying before a donor heart becomes available. This is called ‘bridge to transplant’.
2. To reverse certain conditions that would prevent them going on the heart transplant waiting list, such as high blood pressure in the lungs. This may enable them to become eligible for a heart transplant and is called ‘bridging to transplant candidacy’.

LVADs help do the work of the left ventricle, so if someone has failure of both the left and right ventricles of their heart, they may need a different type of mechanical circulatory support.

Can you have an LVAD instead of a heart transplant?

In some countries, LVADs are used as a final, long-term treatment for advanced heart failure, especially for people who cannot have a heart transplant due to other health issues. This is called ‘destination therapy’.

This is rare in the UK because long-term LVADs for advanced heart failure are not recommended for routine commissioning by NHS England.

But not everyone who receives an LVAD in the UK will ultimately have a heart transplant, either because of the shortage of donor hearts or because adverse events while they have the LVAD mean that heart transplantation is no longer sensible.

So, for some people, an LVAD becomes a long-term treatment for their heart failure.

What happens when an LVAD is put in?

This is a major operation performed under general anaesthetic.

A heart-lung bypass machine takes over the heart and lung function during the surgery. A hole is created in the bottom tip of the left ventricle, and the LVAD is inserted. A pipe is placed to connect the LVAD to the body’s main artery (the aorta).

Once the LVAD is in place, the patient is weaned off the heart-lung bypass machine, and the LVAD starts assisting the heart by pumping blood into the aorta.

Afterwards, you will have a scar down your breastbone and a small ‘exit site’ near your belly button where the power cable emerges.

What’s it like living with an LVAD?

For most people, receiving an LVAD can be life-changing.

Many people who were previously very limited in what they could do find they can return to a more active life. People often go back to work, enjoy hobbies, and spend more quality time with their families.

However, living with an LVAD has its challenges. It can be a bit daunting at first, incorporating LVAD care into daily life.

One patient described it as like taking home a new baby – something precious and important that needs constant care and attention.

While LVADs are transformative, they are not forgettable devices. You will always be aware of it being there.

One of the main things people need to adapt to is the ‘driveline’. This is an electrical power cable that comes out through the skin of your abdomen, near the belly button.

This connects the pump inside your body to the system’s controller and batteries, which are worn outside the body. You also need to keep the exit site clean and dry to prevent infection.

This means you cannot swim, and even showering requires careful planning to protect the electrical components and the driveline exit site from water.

Many people with an LVAD say that one of the things they look forward to most when they get their heart transplant is simply being able to have a bath or swim freely again!

You always need to be connected to a power source – there are usually 2 batteries that you carry in a shoulder bag or backpack. You need to be aware of battery levels and be prepared to swap them when needed.

Battery technology has improved significantly, and modern LVAD batteries can now last for around 12 hours, meaning most people can go about their day without needing to recharge during work or social activities.

What problems can arise with LVADs?

Modern LVADs are much more reliable than earlier models, but like any medical device, some issues can arise. The most common problem is infection at the driveline exit site.

Heart rhythm disturbances, such as ventricular arrhythmias, can sometimes affect the pump's efficiency.

Becoming dehydrated can also impact pump function, especially during travel to hotter climates or if you experience illness causing dehydration.

More serious mechanical problems with the pump itself are rare. Stroke and pump thrombosis (blood clots in the pump), which were concerns with older LVADs, are now much less common with the latest devices.

Can you have an LVAD if you live alone?

While living alone is not a barrier to receiving an LVAD, having a support network of family, friends, or community services is essential for managing life with the device successfully.

Having good support is critical for doing well with an LVAD. It's important to have someone who can help you day-to-day, especially in the initial weeks and months after implantation.

This could involve help with dressings, battery changes, and transport to hospital appointments as you will not be able to drive initially.

For people who live alone, especially if you’re the kind of person who does not like to ask for help, it's important to have a frank discussion with the LVAD team about what support you’ll need and how it can be arranged.

Can you fly with an LVAD?

Yes – many people with LVADs enjoy holidays and travel, including long-distance trips. However, good planning is essential.

You need to inform your airline well in advance that you have an implantable LVAD and will be travelling with medical equipment, including batteries.

It's also crucial to ensure your travel insurance covers you for travelling with an LVAD and to consider what medical facilities are available at your destination should any issues arise with your device.

While LVAD expertise is common in developed countries like the United States of America and across Europe, access to specialist care might be more limited in very remote or less developed regions.

Can you be defibrillated with an LVAD?

Yes, absolutely. LVADs are designed to be safe to use alongside defibrillators. Many people who need LVADs already have an implanted defibrillator (ICD).

If you have an ICD, it will be programmed carefully to avoid interference with the LVAD and to ensure it only delivers a shock when needed. 

External defibrillation, such as that used in emergencies by paramedics or in hospitals, is also safe for people with LVADs.

Interestingly, because LVADs continuously pump blood regardless of the heart’s rhythm, it's less common for someone with an LVAD to require defibrillation, even in serious heart rhythm disturbances.

In fact, some people with LVADs can be in ventricular fibrillation (a life-threatening heart rhythm) and still be conscious and relatively stable, because the LVAD is maintaining blood flow.

How long can people live with an LVAD?

The average length of time people live with an LVAD has been increasing.

Years ago, it might have been around 2 years, but now, with advances in technology, it's more commonly in the region of 3 to 5 years, and sometimes much longer. We have one patient who has lived with their LVADs for almost 15 years.

What does the future hold for LVAD technology?

One major focus is developing wireless power transfer, similar to that used for charging mobile phones wirelessly. The idea is to implant a charging mat inside the abdomen, with the system controller placed externally over the skin.

This would significantly reduce the risk of driveline infections and make showering and bathing much easier. Another area of development is making pumps smaller and easier to implant.

The most potentially game-changing development is pumps that can support both the left and right ventricles, essentially acting as a ‘total artificial heart’.

These are in the early stages of testing in humans. They could be suitable for people with complex heart conditions or right-sided heart failure, who cannot be helped by current LVADs.

The British Heart Foundation is funding many groundbreaking pieces of research into heart failure.

• Take a look at the trials currently taking place via our research page.

Where can I find more information and support?

• Call our Heart Helpline to speak to a cardiac nurse for free.
• If you’re making the big decision to have an LVAD, LVAD Decision Aid has useful resources – bear in mind that it’s a US website so not all the information will apply.
• Get more support with our guide to heart failure booklet.

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