Left Ventricular Assist Device (LVAD)

For patients diagnosed with end-stage heart failure, UCI Health now is the first health system in Orange County to offer the life-saving left ventricular assist device (LVAD).

LVAD is an implantable pump that can help circulate blood through the body while a patient awaits a heart transplant. In some patients, it may eliminate the need for a transplant altogether.

What is an LVAD?

LVADs are mechanical pumps that are attached directly to the heart. One end of the pump is attached to the left chamber (left ventricle) which helps pump blood out of the ventricle to the aorta and then to the rest of the body.

They take over most of the work of the heart and help people with advanced heart failure return to a more normal life.

LVADs have two primary uses in heart-failure patients:

• Bridge to transplant therapy — LVAD takes over the pumping action for the heart muscle, enabling the patients’ survival while they wait for a heart transplant. The LVAD sometimes may be able to restore the failing heart and eliminate the need for a transplant.
• Destination therapy — Not all heart-failure patients are candidates for transplants. LVAD is used as a long-term treatment in such cases because it can prolong and improve patients' lives.

To learn more about LVAD or our Cardiothoracic Surgery team, please call 714-824-3278.

Procedure

The LVAD is implanted through open-heart surgery. The surgery lasts about four to six hours but may vary depending on the patient's cardiac health and history.

Generally, there are four basic parts to the LVAD:

• The pump unit is placed in the chest and attached to the apex of the heart where it receives blood.
• A tube then delivers this blood from the device to the aorta.
• A driveline (cable) passes from the device through the skin on the abdomen to the controller on the outside of your body. 
• A controller (computerized control system) runs the pump and provides messages to help operate the system. A power supply of two rechargeable batteries keeps the LVAD running and allows the patient to be mobile for up to 20 hours without recharging.

Learn more about living with an LVAD device ›

How LVAD works

Eligibility

LVADs are designed for people who have advanced heart failure with evidence of end-organ dysfunction. Often kidney function has begun to be compromised, or there are worsening symptoms despite continued medical therapy. Patients who have continued symptoms or worsening organ function despite medical therapy should be considered for either heart transplant or LVAD.

In many cases, a heart transplant is not an immediate option and LVADs can be used as a bridge to heart transplant. For patients who are ineligible for heart transplants because of advanced age (typically age 65), severe kidney disease, obesity, tobacco use, or diabetes requiring insulin, LVADs have been shown to extend and improve the quality of life, and alleviate symptoms when compared to medication alone.

Referral

For providers caring for heart-failure patients, timing is critical. People who should be considered for LVAD include:

• Patients whose symptoms are getting worse, particularly within the same year
• Patients who are intolerant to optimal heart failure medications because of hypotension, side-effects or other clinical reasons
• Patients who are in class III or class IV heart failure with evidence of end-organ dysfunction, especially rising levels of the waste product creatinine and decreasing muscle mass and serum protein

Physician's referral criteria are:

• EF < 25% or less
• Creatinine >2 baseline
• >1 HF hospitalization in the last year
• NYHA class III-IV
• Intolerant of an optimal dose of any guideline-directed medical therapy drug

Evaluation services

As a designated LVAD center, UCI Health provides LVAD evaluations (both in-patient and outpatient), LVAD surgery, management of LVAD complications (medical and surgical), partnership with designated heart transplant centers. We are committed to forming partnerships with physicians in Orange County and the region. We welcome them to present their patients at our open-selection committee meeting, which is held on Thursday afternoons.

This is a wonderful opportunity to collaborate and offer patients the latest in advanced heart-failure care. We also provide training to assist in the transition back to the care of primary cardiologists.

We will always be available to help manage ongoing LVAD issues, but we value and protect the relationships that are developed between patients and their primary cardiologists.

The degree of post LVAD-implant involvement of referring cardiologists will be at their discretion.

The LVAD team

Why choose us

The UCI Health Cardiovascular Center now offers Orange County residents a range of cardiac care not available anywhere else. As Orange County’s only academic medical system, our nationally recognized specialists also are leaders in research and clinical trials for heart failure and cardiomyopathy.

Our goal is to develop new treatment approaches through a large, active research program. Our patients benefit from this research, often gaining access to therapies long before they are available elsewhere.

UCI Health Heart Failure Services is the first such program in Southern California to earn the Gold Seal of Approval™ certification by The Joint Commission, the nation’s predominant, standards-setting and accrediting body in healthcare.

In each of the last four years, the program also received the American Heart Association's Gold Plus Award for meeting the highest standard of care for heart failure patients according to prevention guidelines recommended by the American Heart Association/American College of Cardiology.