Heart Failure Treatments
TAVI/TFVI (transcatheter aortic valve implantation)
Transcatheter aortic valve implantation is a procedure used to treat severe aortic stenosis, a condition where the aortic valve is narrowed or damaged. The TAVI procedure is used as an alternative to aortic valve surgery for patients who are considered to be at high risk for complications. It is implanted using three different approaches:
- Transapical, which is through a direct apical puncture
- Retrograde transfemoral, which is through the femoral artery
- Antegrade transfemoral, which is through a femoral vein.
The catheter is specially designed to hold compressed replacement tissue and to fix it tightly over the failed valve. The new valve is stuck to the artery wall with pressure from a balloon that is inflated at the end of the catheter.
TAVI was part of a trial study that ended in 2010 to access its success rates in patients with severe aortic stenosis, but who were ineligible for traditional surgery. The trial revealed that TAVI could reduce mortality rates in inoperable patients by 20%.
LVAD (left ventricular assist device)
A left ventricular assist device is a mechanical pump that is surgically implanted in a patient who has a weakened heart or heart failure. Its purpose is to help the left ventricle pump blood to the rest of the body.
An LVAD may be implanted for short-term use in patients waiting for a heart transplant or for the heart muscle to become strong enough to pump on its own. It can also be implanted as long-term treatment for patients with end-stage heart failure who may not be surgical candidates. In either case, the purpose is the same: to assist the weakened left ventricle and maintain its pumping ability.
While you are fitted with LVAD, you will have regular check-up appointments at your doctor’s office or at The Heart Institute. You may be referred for cardiac rehabilitation to strengthen your heart tissue.
How does an LVAD work?
The LVAD pump is placed in the upper part of the abdomen. It functions by pulling the blood from the left ventricle through a tube, out to the pump and then to the aorta before pumping blood out to the body. The battery and device controls are fitted externally and held in place with an abdomen belt. The internal device is regulated through a drive wire that is fed through the abdominal wall from the external device.
The implantation of the device is done under general anesthesia and may take several hours.
Who needs an LVAD?
LVAD devices may be issued to patients waiting for heart transplant surgery, to support their weakened heart muscle while they wait for a replacement. The device will effectively pump blood from a diseased heart, when it has lost the capacity to do so itself. When an LVAD is used to support heart function before a transplant, it is often referred to as a bridge transplant.
Patients having major heart surgery will often have an LVAD implanted for a couple of weeks to a couple of months after surgery, until their heart is strong enough to function on its own.
The device is also used to prolong the lives of patients with end-stage heart failure, who are ineligible for transplant or corrective surgery. LVAD can last roughly 6-30 months.
How do I prepare for receiving an LVAD?
Before implanting an LVAD, your doctor may run several tests to make sure you are healthy enough to undergo the procedure. Your doctor may even admit you to a hospital to perform some of these tests, which may include:
- Cardiac catheterization — done to check pressures in your heart and to determine if you are a candidate for an LVAD
- Blood tests — to check for infection, kidney and liver function, and other possible health issues such as diabetes and thyroid disease
- Echocardiogram — to check the heart valves and pumping function
- Electrocardiogram – to check the heart rhythm
- Chest X-ray — to check the size and shape of the heart and lungs
What are the risks?
As with any heart surgery, the LVAD procedure carries some risk. The most common risk associated with the procedure is infection at the drive wire site. If infection occurs it is most commonly treated with antibiotics. Because of the moving parts, mechanical failure is also a risk, but is less common in newer devices. There is also a low risk of blood clots forming within the device, which can lead to stroke if they do not break-up readily. General risks include:
- Device malfunction
- Blood clotting
- Heart failure, if the device cannot support the heart sufficiently
- Respiratory or kidney failure
What happens after the procedure?
The procedure usually takes about six hours and you will recover in the ICU for a couple of days. Immediately following surgery, you will be connected to a machine that helps you breathe. It will be removed when you are able to breathe on your own. Additionally, you will have:
- A tube in your bladder to drain your urine and a tube your chest for drainage of blood and fluid.
- An intravenous line for the administration of medications.
- Antibiotics and blood thinners prescribed to prevent infection and other complications.
The amount of time in ICU varies and depends on how quickly you recover. You will gradually increase your activity while in the hospital and the nurses and physical therapists will assist you. You will learn how the LVAD works and how to take care of it. The nurses will instruct you on all you need to know before you are discharged.
Once you are discharged, you will be able to resume all your daily activities. Some people will even be able to return to work quickly and start driving. Your doctor will tell you which activities are appropriate.
What are the benefits?
The device will take away the heart failure symptoms such as shortness of breath, fluid retention and fatigue, thus making for a more comfortable lifestyle. It has also been known to be more beneficial than aggressive medical therapy, especially in the end stages of heart failure.
Who cannot receive an LVAD?
Many patients may not be deemed fit for cardiovascular surgery because of the risk associated with operation. Patients ineligible for LVAD may have a combination of:
- Irreversible renal failure
- Peripheral vascular disease
- Brain damage
- Widespread cancer
- Liver or lung disease
- Elevated blood clotting risk
- Advanced age
Please note: LVAD is not offered at The Heart Institute at the present time and we are working to offer this procedure in the near future.