Left ventricular assist devices

There is a growing population of patients in the UK with advanced heart failure who are receiving a left ventricular assist device (LVAD) as a bridge to transplant. This is due to the plateauing number of heart transplantations and the increasing evidence of the effectiveness of these devices. It is, therefore, important that all clinicians working in an intensive care setting have an understanding of how LVADs work, whether as a district general physician referring a patient for consideration of implantation or a tertiary centre healthcare professional managing the complications.

This case study describes the journey of a patient presenting with decompensated heart failure who failed to improve despite maximal medical intervention. The patient was not eligible for a heart transplant at the time, so an LVAD was inserted as a bridge to recovery of organ dysfunction and then eventual cardiac transplantation.

This article will focus on providing an overview of the indications and anatomy of LVADs as well as the evidence behind their use so that intensive care professionals are aware of the potential of these devices. There will also be further discussion around complications of these devices and practical points to consider when managing a patient who has an LVAD in situ.