The implantation of a Left Ventricular Assist Device (LVAD) is a major cardiac procedure. An LVAD is a mechanical pump surgically placed inside the chest that takes over the function of the left ventricle, the heart’s main pumping chamber, which is failing due to advanced heart disease. The total time a patient spends under surgical care extends far beyond the actual moments of device placement. Understanding the timeline involves breaking down the distinct phases, from initial preparation to final stabilization.
Preparation Before the Incision
The preparation phase begins when the patient enters the operating room and involves a highly coordinated effort by the surgical team. A significant portion of this time is dedicated to safely inducing general anesthesia, which requires careful management in patients with severe heart failure.
Once the patient is asleep, the anesthesia team places extensive monitoring lines to track the patient’s condition with precision. These placements often include an arterial line for continuous blood pressure monitoring, a central venous catheter, and sometimes a pulmonary artery catheter. This instrumentation process can take up to an hour or more to complete safely.
After monitoring is set up, the surgical site must be meticulously sterilized and draped to prevent infection. This entire pre-incision phase—encompassing anesthesia, line placement, and sterile preparation—typically adds 1.5 to 3 hours before the operation officially begins.
The Duration of the Core Procedure
The surgical implantation of the Left Ventricular Assist Device, measured from the initial incision to the final closure, generally takes between 4 and 6 hours for an uncomplicated case. This timeframe involves several highly technical steps to place the mechanical pump and its associated components precisely.
The procedure typically begins with a median sternotomy to gain full access to the heart. The patient is often connected to a heart-lung bypass machine, which temporarily takes over the function of the heart and lungs, though some LVADs are implanted using an off-pump technique. The surgeon secures the LVAD’s inflow cannula to the apex of the left ventricle and connects the outflow graft to the aorta, ensuring proper alignment.
The final step involves tunneling the driveline—the insulated electrical cable connecting the internal pump to the external controller and battery pack—through the patient’s skin. This tunneling must be done carefully to prevent kinks and ensure a clean exit site.
Variables That Extend Operating Room Time
The 4 to 6-hour range for the core procedure can be significantly extended by several patient-specific and procedural variables. These factors increase complexity and operating room time:
- Prior cardiac surgeries: A history of previous operations necessitates a “redo” sternotomy. Dissection through existing scar tissue (adhesions) is time-consuming and can add one or more hours.
- Patient anatomy: Challenges like severe calcification of the aorta or unusual anatomical variations complicate the connection of the outflow graft.
- Unexpected bleeding: This serious complication requires meticulous control and demands additional time to achieve hemostasis.
- Concomitant procedures: Surgeons may elect to perform a second procedure, such as a tricuspid valve repair, simultaneously, which can add 1 to 3 hours to the overall operating time.
These conditions and surgical decisions are the primary reasons why the total duration of the core implantation procedure can vary widely, sometimes pushing the total time closer to eight hours.
Immediate Post-Surgical Stabilization
The time in the operating room continues after the final incision closure with immediate post-surgical stabilization. If the heart-lung machine was used, the patient is slowly weaned off bypass while the surgical team ensures the newly implanted LVAD is functioning optimally and achieving necessary flow rates.
Achieving hemodynamic stability is a primary focus, involving the stabilization of blood pressure and cardiac output using medications. The effects of anesthesia are reversed, though the patient typically remains intubated and sedated for transfer to the Intensive Care Unit (ICU). Temporary pacing wires are often placed on the heart’s surface, and chest tubes are inserted to drain fluid from the chest cavity.
This stabilization and transfer preparation phase requires an additional 1 to 2 hours after the surgical closure is complete. Once the team confirms the LVAD is supporting the patient and immediate risks are managed, the patient is transported to the ICU. This final stage concludes the patient’s total time in the operating room environment, which can total anywhere from 6.5 to 13 hours or more.