Heart transplant has long been the mainstay of end stage heart failure patients before the advent of high quality LVAD. The lower number of donor hearts is insufficient to fulfill the existing demands. The procedure involves open heart surgery in which the patient under general anesthesia is plugged into the heart lung machine through which the blood circulation is maintained.
The donor heart comes from the cadaver. The diseased heart is isolated from the main arteries and veins and then removed and the blood vessels are ligated. The donor heart is placed in the cavity and the blood vessels are reconnected to the new heart. Once the heart resumes pumping and the blood pressure is restored, the patient is disconnected from the heart lung machine. The patient is put on lifelong medications to avoid rejection and regular check-ups are advised. The procedure takes several hours. A significant number of recipients survive more than 10 years after the procedure.
During the cardiac transplantation procedure, the ventricles are excised, leaving the great vessels, right atrium, and left atrium of the recipient. The donor heart is then sewn to these areas. A cardiac allograft can be sewn in either a heterotopic or an orthotopic position.
Left Ventricular Assist Device or Ventricular Assist Device was once considered as a stop gap arrangement or a bridge to transplant in patients for end stage heart failure who were waiting for heart transplant. With advancement in medical technology, the quality of LVAD has improved to such an extent that patients have shown improvement in quality of life to a great extent.
The LVAD is surgically implanted just below the heart. One end is attached to the left ventricle — that’s the lower chamber of the heart that pumps blood out of the lungs and into the body. The other end is attached to the aorta, the body’s main artery. Blood flows from the ventricles into the pump which passively fills up. When the sensors indicate it is full, the blood is ejected out of the device to the aorta.
A tube passes from the device through the skin. This tube, called the driveline, connects the pump to the external controller and power source.
The pump and its connections are implanted during open-heart surgery. A computer controller, a power pack, and a reserve power pack remain outside the body. Some models let a person wear these external units on a belt or harness outside.
The power pack has to be recharged at night.
Side effects include infection, internal bleeding, heart failure, kidney failure, stroke, device failure, blood clot and respiratory failure.
Ventricular Assist Devices (VADs) are implantable mechanical heart pumps. They have been used in recent times to sustain patients who are candidates for heart transplant as they await a donor heart and are increasingly being used as a substitute for transplantation. Emerging research shows that VAD patients find that their hearts actually improve with help from these mechanical pumps.
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