Gregory Egnaczyk, M.D., cardiologist, Medical Director of Advanced Heart Failure at The Christ Hospital
—As told to Kevin Schultz
LVADs, which stands for Left Ventricular Assist Devices, are surgically implanted pumps that take over the heart’s pumping function. They are for patients suffering from advanced heart failure, a chronic condition in which the heart can no longer keep up with the body’s circulatory demands.
When we think about the heart, there are electrical systems, plumbing systems, and valves. All those things are very important in how the heart functions and we can intervene on all of those things: optimize medications, optimize different pacemakers, see if patients are candidates for high-risk stenting or valve procedures. Sometimes we’ve exhausted all those possibilities and at the end of the day the heart as a pump just doesn’t work, and we are left with two options: heart transplants and these pumps.
Heart transplants are a very effective way to treat heart failure, but the supply does not meet the demand. With that supply-demand mismatch, LVADs have really risen up and taken over in terms of how many people receive them each year. We can also use the LVAD as a bridge to a heart transplant—at least half the people in the U.S. [who get a heart transplant] end up getting an LVAD as a pathway to a transplant.
The left ventricle is the heart’s main pumping chamber. When that is diseased, enlarged, and/or weakened, it doesn’t function as well as it should. With this LVAD, blood comes out of the heart to a pump that sits right next to the heart and then on to the aorta, where it can restore circulation to the body. It’s almost like a bypass of the left ventricle. It creates force to allow circulation pressure to the rest of the body.
A drawback is that patients can’t bathe—they can’t submerse themselves in a bath or a hot tub. They can take showers after a certain length of time. That’s probably the main restriction. They can golf, exercise, have relations, they can do all those things [unless] it requires them to be submersed in water.
No one ever really wants an LVAD. When you first mention this to people they are like, “No way!” I tell my team that though patients may not want one, they have to do their best to predict the future a little bit. You don’t want patients to be thinking about this when they are at death’s door. You want them when they can still get through the surgery. So we have to, as providers, do our best to predict the future for our heart failure patients.