Chairman, Cardiac Sciences, Fortis Hospital, Noida
Part 6 of 8 in Transforming Cardiac Care: Advances in Diagnosis, Surgery and Management
The Artificial Heart (LVAD): A Bridge to Transplant
December 1, 2024
When a patient is on the transplant waiting list and their heart cannot wait for a donor organ to become available, an artificial heart device, a left ventricular assist device or LVAD, is the intervening option. Dr. Ajay Kaul, Chairman of Cardiac Sciences at Fortis Hospital, Noida, explained how the device works and where it fits into treatment during a Jivo Healthcare masterclass for doctors across Africa.
The Heart Is Just a Pump, and So Is the Device
Dr. Kaul's explanation started from first principles: the heart's actual job is to receive blood returning from the body, push it to the lungs to be purified, and push it back out to the body. An LVAD replicates that same basic pump function. The engineering difficulty was never the pumping itself, it was building a pump that blood could pass through for years without clotting, a problem that took roughly 50 years to solve.
Magnetic Levitation, the Same Technology as a Bullet Train
The solution Dr. Kaul described is a rotor that runs on magnetic levitation, the same principle used in Japan's high-speed trains, which run above the rails without touching them. Inside the LVAD, the rotor never physically contacts the blood it moves, which is what allows the device to function for years without destroying blood cells.
A Real Case: Eight Months on the Waiting List
Dr. Kaul described a patient who had traveled to India from Iraq for treatment. No donor heart was available, and after eight months on the waiting list with his condition deteriorating, he was offered an LVAD, accepted it, and was still doing well at follow-up years later.
Three Complications, and Why It Is Meant to Be Temporary
An LVAD carries three main risks, according to Dr. Kaul: the blood thinners required to prevent clotting create a bleeding risk, the device carries an infection risk, and the device itself is only built to function for about five to seven years, so it should ideally be converted to a transplant before that window closes rather than treated as a permanent solution. In practice, some patients have gone 10, 12, even 15 years on the device without a transplant. The other major barrier is cost: in India, a single artificial heart device costs around 1.5 crore rupees.
This guide is based on a live Jivo Masterclass: Dr. Ajay Kaul taught doctors across Africa on December 1, 2024.
FROM THE LIVE Q&A
Moderator
Are there any techniques available for treating tetralogy of Fallot?
Dr. Ajay Kaul
Tetralogy of Fallot is very well treatable, and children who are operated on go on to lead a normal life. I have patients who are now 25 to 30 years old and doing very well. Depending on the exact type of tetralogy, the results are very good.
Frequently Asked Questions
How does an artificial heart actually work?▼
The heart is essentially a pump: blood comes in from the body, is pushed to the lungs to be purified, and is then pushed back out to the body. Building an artificial pump that does not damage or clot the blood took nearly 50 years to perfect. The device is based on magnetic levitation technology, similar to Japan's high-speed trains that run without touching the rails, so the pump's rotor never actually makes contact with the blood it is moving. In India, one artificial heart costs around 1.5 crore rupees, which is the major cost barrier.
Is heterozygous (mismatched donor-recipient) heart transplantation possible?▼
It is technically possible, but very few doctors would attempt it. A heart is a precious, scarce organ with a long waiting list of patients, so we always give it to the best-matching recipient rather than risk it in a less compatible match where rejection is more likely.
What happens to the donor in a heart transplant?▼
The donor is already dead by the time of donation. It is not a live donation, so nothing happens to the donor.
What can someone who is currently healthy do in everyday life to keep their heart healthy?▼
Some factors cannot be changed: genetics (a family history of coronary artery disease, hypertension or diabetes), age, and sex. Some factors are partially avoidable, like living in a polluted city or staying in a highly stressful job or relationship. The fully preventable factors are the most important: smoking or chewing tobacco has no offsetting benefit and damages the heart, lungs or mouth; alcohol should be limited to two or three drinks, two or three times a week; walking at least 10,000 steps a day and taking the stairs down instead of the lift helps; and the single best exercise is a 3-kilometer walk in 30 minutes, twice a day. On checkups: if there is a family history of heart disease or diabetes, get a cardiac checkup from age 20; if there is no family history, get one by age 40. And before starting any strenuous new exercise routine, such as joining a gym, get a cardiac checkup first, because the heart often gives no warning symptoms until it fails outright, the same way a car needs servicing even when it seems to be running fine.
Does a transplant recipient have to stay on rejection-suppression therapy, and what is the average monthly cost?▼
Yes, anyone who has had an organ transplant, whether liver, lung, or heart, has to remain on anti-rejection therapy. In India, that costs on average about 25,000 to 35,000 rupees a month, and can range from about 20,000 up to 50,000. I'm not able to speak to what it costs in other countries.
What technology allows an LVAD to avoid damaging blood cells?▼
The device's rotor runs on magnetic levitation, the same principle used in Japan's high-speed trains, so it never physically touches the blood it pumps.
How long is an LVAD designed to function?▼
About five to seven years, though Dr. Kaul has seen patients go 10 to 15 years on the device without needing a transplant.
What does an artificial heart device cost in India?▼
Around 1.5 crore rupees, which remains the major barrier to wider use.
In This Series: Transforming Cardiac Care: Advances in Diagnosis, Surgery and Management
- 1.Transforming Cardiac Care
- 2.Minimally Invasive Cardiac Surgery: A New Standard for Heart Operations
- 3.Valve Replacement and Coronary Bypass Surgery Without a Full Sternotomy
- 4.Treating Aortic and Carotid Aneurysms With a Minimally Invasive Stent
- 5.Heart Failure and the Case for Heart Transplantation
- 6.The Artificial Heart (LVAD): A Bridge to Transplant
- 7.Tetralogy of Fallot and Eisenmenger Syndrome: Two Very Different Outcomes
- 8.A Cardiac Surgeon's Guide to Preventing Heart Disease