There are currently at least 4.8 million people in the United States with congestive heart failure, a condition in which the heart is either unable to properly fill with blood or unable to properly pump it to the rest of the body. Because a heart attack weakens the heart muscle, heart-attack survivors often develop congestive heart failure. As advances in cardiac care save the lives of ever more heart-attack victims, the population of those with congestive heart failure grows—there are 550,000 new cases each year. Many of these patients will survive less than five years, and 287,000 die every year.

Despite improvements in medical therapy and the efficacy of implanted pacemakers, a portion of the population still reaches the end stages of the disease. For these patients, the only available therapies are heart transplantation (which continues to be limited by organ availability) and mechanical-assist devices.

A left ventricular assist device (LVAD) is an instrument that is attached to the heart to replace the heart’s main pumping chamber (the left ventricle). Normally, the left ventricle pumps blood from the heart to the rest of the body. After the implantation, the left ventricle pumps blood into the artificial pumping chamber, which then pumps the blood to the rest of the body. The device is inserted inside the chest cavity, and a power cord comes out of the abdomen and plugs into a battery pack worn on the waist. For some patients, this device serves as a temporary treatment until a heart donor can be found. (This use is called “bridge to transplant.”) For other patients, the device will ease the burden on the heart enough that further therapy is unnecessary (“bridge to recovery”). For patients who are terminal and not eligible for a transplant operation, the device will extend their lifespan from several months to several years (“destination therapy”).

LVAD implantation is a major heart surgery requiring general anesthesia. Most patients remain in the hospital for 10 to 14 days.

The medications taken by patients with LVADs are similar to those taken by most patients with heart disease: blood thinners (to fight clotting), diuretics and beta blockers (to lower blood pressure), and cholesterol-lowering drugs.

To be a candidate for an LVAD, a patient must be in the end stages of congestive heart failure. (Typically, this means he has only a few years to live.) If the patient is deemed appropriate for transplant surgery, he will receive an LVAD to buy him time while an organ donor is found. If he is not appropriate for surgery, he will receive an LVAD to extend his life.

Certain conditions make a patient ineligible to receive an LVAD. These include extreme old age, neurological deficits, non-reversible organ failure, and active infections. 

The vast majority of patients receiving LVADs (about 85 percent) are waiting for a heart transplant. LVADs are now a widely accepted therapy to facilitate transplantation. At the UW Medicine Regional Heart Center and other leading heart centers, bridge-to-transplant patients have an approximate 90 percent chance of survival to transplant.

For those who receive LVADs as “destination therapy” (about 10 percent of recipients), research has shown that they will enjoy a significantly improved two-year survival rate (27 percent vs. 10 percent), improved function, and improved quality of life.

The “bridge-to-recovery” group is 5 percent of the total LVAD population. For these patients, many life-threatening heart conditions can be reversed.

The most common causes of death after LVAD insertion are device failure and infection. Currently, the life of LVADs is three to five years. In the near future, LVADs will likely have an improved durability (over five years) and will carry a lower risk of infection. Once a device is implanted, the patient will receive periodic tests of its function. If the LVAD does fail, many patients retain enough natural heart-function to survive until another LVAD can be implanted.

There is also a small but finite chance of complications due to anesthesia.

Most patients eligible for LVAD implantation have tried other medical treatment without success. Without an LVAD, they would likely die within a few years.

Congestive heart failure is a progressive disease, so LVAD implantation can be scheduled at the patient's convenience