Ventricular Assist Device
A Ventricular Assist Device is a mechanical pump that pumps blood from the lower chambers of the heart to the rest of the body.The pump then sends blood into the aorta, helping a weakened ventricle by taking over its pumping action. The pump is placed in the chest and the wires for the battery and controller exit from the upper part of the abdomen into the outside of the body, where they are attached to the pump battery and control system. While the VAD could be placed in the left, right, or both sides of the heart, most often it is used in the left ventricle – hence the term LVAD (Left Ventricular Assist Device).
Your doctors recommend this procedure
As a temporary measure if you are awaiting heart transplant
As a step to managing your heart failure condition in the long term and a step or bridge towards a heart transplant.
VADs are now portable and can be used for many years. Patients with LVADs can be discharged from the hospital, return to their normal activities and enjoy a good quality of life while waiting for a donor heart to become available. Patients who are not transplant candidates also enjoy a high quality of life for years after implantation.
Device Operations
The parts of the LVAD may vary based on the type of device but there are four basic parts:
The pump unit is placed in the chest. It is implanted into the apex of the heart where it receives blood. A tube then delivers this blood from the device to the aorta (the large artery that takes blood from the heart to the rest of the body). It works by pumping blood by continuous flow from the left ventricle to the aorta.
The pump is attached to a driveline (cable) and a control system (controller). The driveline passes from the device through the skin on your belly (abdomen) to the controller (a small computer) on the outside of your body. The controller runs the pump and provides messages and alarms to help you operate the system. A power supply (rechargeable batteries or cord that plugs into an electrical socket) keeps the LVAD running.
Securing an VAD
For a patient to receive an VAD, they need to have a heart that’s sick enough to need one, but not be too sick overall—otherwise, the VAD is too risky. A number of objective tests are performed to assess your heart as well as your overall suitability for this procedure.
The evaluation process is designed to help decide if a VAD is the best choice for you. The process involves a series of blood work, other tests, and consultations. The evaluation will assess the patient’s past medical history, previous medical compliance, mental preparedness, and existing support system. We will also work with you to help you understand the financial implications, insurance details, and long-term self-care requirements.
Even if you are being considered for a bridge to heart transplantation, this is subject to change pending the results from your evaluation and the transplant team’s decisions. After the evaluation, the Advanced Heart Failure/VAD/Transplant Team will decide if you meet the criteria to have a heart pump implanted. If the evaluation results in the need to address other medical conditions, then we will proceed with addressing those conditions before VAD implantation is taken up.
If you are considered medically reasonable for VAD implantation, we work with you and your family so that they could arrive at the decision themselves. If you decide that this may not be the best option, we will re-evaluate the condition later as and when the need arises. Every time the tests need to be repeated to be considered medically fit for the procedure.
When the evaluation is finished, your cardiologist will present your case to the LVAD selection committee for approval.
Benefits of a VAD
The overall goal of VAD implantation is improved health and quality of life. The VAD may not make all your symptoms go away, or directly fix the heart failure. However, patients see a marked improvement in symptoms of heart failure. In most cases, blood flow improves, you can expect to have more energy and decreased shortness of breath and fatigue.
Since successful VAD surgery helps deliver more oxygen-rich blood, you may feel well enough to resume many of the activities and hobbies. The improved blood flow may also prolong life. Research studies that have shown, on average, LVAD patients live longer than similar patients with advanced heart failure who are treated with medications alone.
VAD Implantation Surgery
The surgery to implant the VAD will be open-heart surgery and can take between 6-12 hours. The surgeon will make an incision (cut) down the front of your chest to reach the heart. You will have a breathing tube and be under general anesthesia. In all cases, you will be on a heart/lung machine during the surgery. The VAD is placed below the heart and the surgeon will connect the pump to the heart and secure it in place. Once the pump is in place, the VAD and the heart will together pump blood through your body. After the surgery is completed, you will return to the intensive care unit.
Post operation, you will receive close monitoring and support. You will have a breathing tube, drainage tubes (chest tubes), and a catheter in your bladder. You will receive medications for sedation and pain control. You will also be on intravenous (IV) medications until your blood pressure is stable. Your length of stay in the ICU will depend on how fast you recover. Once you are breathing on your own and more stable, you will be transferred to a general care unit where you can expect to stay for another 1-3 weeks. On average, patients spend about three weeks in the hospital after the VAD surgery, but this can vary depending on how sick you were before the surgery and if there are any complications after the surgery. Most patients can return home after VAD surgery. You will need additional rehabilitation and recovery at an inpatient rehabilitation facility.
After you are discharged, you will follow up in the clinic with your medical team. They will work together to care for you and make decisions about your treatment. Typically, your first visit will be every alternate day for the first week after discharge. As your health improves, visits may be further apart. Once you are considered stable, your doctors may decide that you can follow-up every 2-3 months. Along with seeing a cardiologist for your heart failure, you will need tests regularly to monitor and maintain your health. The types of testing that you may need will be decided by you’re the medical team but the most common tests include blood tests, electrocardiogram (EKGs), echocardiogram (ECG), an implantable cardioverter-defibrillator (ICD) checks.
On average, about 8-12 weeks after surgery you can expect to be able to do most activities, with the permission of your doctors.