Implantation of an artificial ventricular assist device is a surgical procedure in which a mechanical device is implanted to replace or support the function of one or both cardiac ventricles. Such devices are known as a left ventricular assist device (LVAD), right ventricular assist device (RVAD), biventricular assist device (BiVAD), or a total artificial heart (TAH). These systems help pump blood throughout the body when the patient’s own heart is unable to maintain adequate circulation.
The procedure is most commonly performed in patients with advanced heart failure when other treatment options, such as optimized medical therapy, are no longer effective.
Main goals of implantation
- Bridge to transplantation. Temporary circulatory support for patients awaiting heart transplantation.
- Destination therapy. Long-term or permanent treatment for patients who are not candidates for heart transplantation.
- Bridge to recovery. Temporary support in selected cases (for example, after acute myocardial infarction or myocarditis) while native cardiac function recovers.
Indications for artificial ventricular assist device implantation in Belarus
- End-stage heart failure. New York Heart Association (NYHA) class IV, when even minimal physical activity causes severe dyspnea and fatigue.
- Cardiomyopathy. Including dilated and ischemic cardiomyopathy with severe impairment of myocardial contractility.
- Acute cardiogenic shock. A life-threatening condition in which the heart is unable to pump sufficient blood to maintain organ perfusion.
- Failure of other treatment options. Ineffectiveness of pharmacological therapy, coronary stenting, or other interventional procedures.
Types of artificial ventricular support devices
LVAD (Left Ventricular Assist Device), RVAD (Right Ventricular Assist Device), BiVAD (Biventricular Assist Device); Total Artificial Heart (TAH) — a system that completely replaces both ventricles when the native heart cannot be preserved.
How is the procedure performed?
Preoperative assessment
The patient undergoes a comprehensive evaluation, including:
- Echocardiography to assess cardiac structure and function.
- Cardiac catheterization to measure intracardiac pressures and hemodynamics.
- Blood tests to evaluate overall health status and organ function.
- Targeted medical therapy to stabilize the patient before surgery, if required.
Surgical procedure
- The operation is performed under general anesthesia.
- A median sternotomy is performed to access the heart.
- The device is implanted to pump blood from the cardiac chamber (for example, the left ventricle) into the main arterial circulation (most commonly the aorta).
- In most cases, cardiopulmonary bypass is used during implantation.
Device connection
- The mechanical pump is connected to an external power source via a driveline exiting through the skin, or to an implantable power system, depending on the device type.
Recovery after artificial ventricular assist device implantation
- Postoperative monitoring. The patient is cared for in an intensive care unit to closely monitor cardiac function and prevent complications.
- Patient education. Patients and their families are trained in device management, including battery handling and care of the driveline exit site.
- Rehabilitation. Gradual return to physical activity under medical supervision, with adherence to dietary and lifestyle recommendations.
Advantages of artificial ventricular assist device implantation
- Prolongation of life. These devices can significantly extend survival in patients with terminal heart failure.
- Improved quality of life. Many patients experience marked reduction in symptoms such as dyspnea and fatigue.
- Support until transplantation. Maintenance of adequate circulation while awaiting a donor heart.
Limitations and risks
- Device dependence. Patients must continuously carry external components such as batteries and controllers.
- Lifestyle restrictions. Special precautions are required, including limitations on water exposure and activities that may damage the device.
- Need for regular follow-up. Ongoing medical supervision is essential to monitor device function and patient health.
Artificial ventricular assist device implantation in Belarus is a life-saving treatment option for patients with severe heart failure. Modern mechanical circulatory support systems allow significant prolongation of life and improvement in its quality. However, successful outcomes require careful patient selection, strict medical follow-up, and adherence to lifestyle modifications. Advances in biomedical engineering continue to improve the safety, durability, and availability of these technologies.
