LVAD implantation is an open-heart surgery that takes from 4 to 6 hours to perform. The recovery process following surgery varies from patient to patient. The hospital length of stay can range anywhere from 2 to 4 weeks but may change based on your specific needs. Each hospital follows slightly different procedures, but the information below will give you a general sense of what to expect.
Preparing for Your Surgery
Most LVAD candidates are admitted to the hospital several days before their surgery. In many cases, patients are already in the hospital for heart-failure-related complications when the decision is made to implant an LVAD.
Before the surgery is performed, your doctor will conduct an extensive medical evaluation and talk you through the details of your operation. An LVAD coordinator or other members of the LVAD team will also provide details about your LVAD, including information about living with an LVAD and about your post-operative care and recovery plan. It may also be possible for you to meet another patient who is currently or was previously on an LVAD.
Depending on your health status and the timing of your surgery, your doctor may admit you to a specialized hospital unit where you can be monitored more closely and receive stronger medications to help your heart before your surgery. The purpose of this extra care is to improve your clinical condition, so that you're as healthy as possible before surgery. It's sometimes called preoperative tune-up.
Before your surgery you may meet:
- An LVAD Coordinator, who will introduce you to your LVAD pump and its external components. In most institutions, the LVAD Coordinators are responsible for training you to manage and care for the pump and the driveline that exits your body.
- A hospital social worker, who will help identify the support systems and resources available to you at home, for any outstanding needs. The social worker will also discuss the details of post-operative home life, as well as the network of social and psychological services available to you once you leave the hospital.
- A hospital financial representative, who will work with you and your insurance company to discuss your medical coverage and all the financial details of your surgery, including your post-operative care and other costs related to the ongoing maintenance of your LVAD.
The Day of Your Surgery
LVAD surgery is performed under general anesthesia, which means you'll be asleep for the entire operation. Before your surgery begins, an anesthesiologist will start an IV (intravenous line) to give you medicines to put you to sleep.
Once you're asleep, you'll be connected to a ventilator to help you breathe. A breathing tube, connected to the ventilator, will be passed through your mouth to your airway to deliver air to your lungs.
Next, an incision will be made through your breastbone (also called the sternum) to expose your heart. The blood running through your heart will be rerouted to a heart-lung machine that essentially takes over the work of your heart and lungs for the length of the surgery.
The type of LVAD that you receive will determine how it is implanted. Some pumps are placed right next to the heart in the chest, while others sit in a space made by the surgeon called called a pump pocket. It is in the left upper abdomen, right below the heart and diaphragm. The cable from the pump (the driveline) will exit your body through an incision in your abdomen, where it will connect to the controller and power sources.
Once your LVAD is implanted and connected to the controller, you will be weaned off the heart-lung machine and blood will begin to pump through your heart and your new LVAD.
After Your Surgery
Once your surgery is over, you will be taken to an intensive care unit (ICU). This is where you will be when you awake from anesthesia. You'll be connected to several tubes bringing fluids to and from your body. You may need to remain connected to a ventilator for a few days until you are able to breathe on your own.
After your stay in the ICU, you'll be moved to a cardiac step-down floor where you'll stay until you recover from the surgery and are able to take care of and get around with your LVAD.