What is Ventricular Assist Device?

Ventricular Assist Devices (VADs) are devices that help pump blood from your heart’s lower chambers toward the rest of your body. They are used as a treatment for heart failure or a weakened heart. VADs can help your heart work while you wait for other treatments such as heart transplants. In some cases, VADs are used to help your heart pump blood permanently. Another name for VADs is Durable Mechanical Circulatory Support Device (DMRD). VADs are most commonly placed in your left lower heart chambers, which are called left ventricles. LVADs are referred to as “left ventricular assist devices” (LVADs). In this article, we’ll focus on the current LVADs that provide constant blood flow from your heart to your body, also known as continuous flow devices (CFDs). LVADs are often obtained through open heart surgery and have serious risks, but they can be life-saving for severe heart failure patients.

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Why it's done?

An LVAD may be recommended by your health care provider if:

You are awaiting a heart transplant: This is known as a bridge to transplant treatment.

You have a damaged heart and need an LVAD to keep blood flowing through your body. The LVAD will be removed when your new heart is available.

The LVAD may help other organs function better while you wait for your heart transplant. For example, LVADs may lower pressures in your lungs, which can prevent you from receiving a heart transplant if you have high lung pressures.

You are too old or too ill to undergo a heart transplant: In these cases, an LVAD can be used as permanent treatment. This type of ventricular assist device treatment is known as destination therapy.

If you have heart failure

Your heart is temporarily unable to pump blood: Your heart doctor may suggest an LVAD for you until your heart is able to pump on its own. This is known as a “bridge to recovery” LVAD.

Your heart doctor will evaluate your condition and recommend the best LVAD for you based on the following factors:

• How severe is your heart failure

• Your other serious medical conditions

• How well your main pumping chambers are working

• How well you are taking blood thinners safely

• Your social support

• Your mental state and your ability to care for a VAD

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How you prepare

If you are planning to have an LVAD implanted in your body, you will need to have surgery to do so. Your health care provider will provide you with the following information prior to your LVAD surgery:

• What to expect in terms of pre, during and post-surgery care

• What are the potential risks associated with VAD surgery

• What are your concerns?

• Do you have a pre-surgery advance directive?

• What are the specific recovery instructions you will need to follow at home?

How can you prepare for your LVAD surgery?

One of the best ways to prepare for an LVAD surgery is to talk to your loved ones about your planned hospital stay. Talk about how much help you will need at home during your recovery.

What you can expect

Before the procedure:

You may be hospitalized for a few days prior to receiving an LVAD. During your hospital stay, you may receive other treatments for your heart weakness or heart failure. During this time, you may undergo tests to determine if an LVAD is the right treatment for you. These tests may include:

• Blood tests to measure the health of your heart, liver, kidney and other organs

• Complete blood count

• Blood clotting studies to determine if your blood is too thin for surgery

• EKG (electrocardiogram) - This rapid, painless test records electrical signals in your heart. It shows the rhythm of your heart, and how fast or slow your heart is beating

• Chest X-Ray - A chest x-ray shows the shape and size of your heart and can indicate certain problems with your lungs

• ECHO CARDIOGRAPHY - This test uses sound waves to create images of your heart in motion. It shows the structure of your heart and heart valves, as well as the blood flow through your heart

• Catheterization of the heart is a procedure in which a catheter (a thin flexible tube) is inserted into a blood vessel, typically in the neck. The catheter is then transferred to the heart using an X-ray as a guide. Cardiac catheterization tests measure the pressures and blood flow within the heart. This test can be used to determine whether an LVAD (long-term artificial heart) or other treatment is necessary.

During The Procedure:

Open-heart surgery is the most common type of LVAD procedure. The procedure usually takes three hours or more. During the surgery,:

• You will have all hair removed from the area of your chest.

• You will receive medicines through an intravenous line to help you sleep and feel less pain

• During the procedure. You will be connected to an oxygen-rich ventilator that will help you breathe during the procedure.

• Your heart may stop taking medicines during the procedure. If this is the case, you will also be connected to an artificial heart.

During the procedure, the heart will be bypassed and oxygen-filled blood will be pumped through the body. The surgeon will make a cut in the center of your chest to view the heart better and then place the LVAD device.

An LVAD is made up of several components:

• The main pump is placed in the tip of your heart.

• The blood is pumped through a flexible, plastic tube to your heart’s main artery (the aorta).

• The aorta then sends blood to other parts of your body.

• A cord is inserted through a hole in your skin to connect the main pump to a remote control unit and a battery pack outside of your body.

Once the LVAD is installed and functioning correctly, you’ll be removed from the heart and lung bypass machine, allowing your LVAD to begin pumping blood.

After the procedure: After LVAD surgery, you will be admitted to the hospital. The length of your hospital stay depends on your condition prior to the surgery and your recovery time. Your health care team will monitor you for complications while you are in the hospital.

Tubes are used to drain urine from the bladder, as well as draining fluid and draining blood from the heart and the chest.

You will be given:

• Fluids and medicines administered by an intravenous line.

• Antibiotics are used to prevent infection.

• Blood-thinning drugs are used to prevent blood clotting.

For a few days, you may be placed on a respiratory machine or ventilator.

Your health care team will help you become more physically active and stronger as you recover. They will assist you in sitting up, getting out of bed, and walking.

If you require more time to recover, you may be referred to a rehabilitation center for a short stay.

Before you are discharged from the hospital, the health care team will discuss with you and your loved ones the best way to live with an LVAD and how to properly care for it. Some things you will learn include:

• How to Clean the Skin Where the LVAD Was Installed

• What to Do If You Have Symptoms of Infection (Fever and Pain, Redness, or Drainage)

• How to Keep the LVAD Charged (Always Have Spare Batteries With You)

• How to Check the Controller for Dirt and the Batteries for Damage

• What to Do When the LVAD Isn’t Working Well

• How to Wash Without Damage to the LVAD

• What to Do if the device’s Alarm Goes Off

When You Can Return to Daily Life Activities (Driving, Exercise, Going to Work or Being Sexually Active). Tips on How to Travel With an LVAD

Talk to Your Health Care Team If You Have Any Concerns About Living With a Ventricular Assist Device

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Risks

Risks and complications associated with a VAD include:

Bleeding: Any type of surgery increases the risk of bleeding

Blood Clots: As blood flows through the VAD, it is possible for blood clots to form. If a blood clot forms, it can slow or stop blood flow, which can affect the functioning of the device or lead to a stroke

Infections: The power source/controller of an LVAD is located outside of the body and is connected via a wire via a tiny opening in the skin. This area can be infected by germs, which can lead to an infection at or in the site of implantation.

Device Problems: An LVAD may sometimes stop working properly after implantation. For instance, if the wires are damaged, the device might not pump blood correctly. This may require immediate medical attention and may require the replacement of the pump.

Right Heart Failure: If you have a VAD, your lower left chamber will be pumping more blood than before. Your lower right chamber is too weak to cope with the increased blood volume. In some cases, a temporary pump may be necessary. In the long term, medication or other therapies can help your lower right chamber to pump better.

Results

After LVAD implantation, you will receive regular medical checkups to monitor for complications and to improve your overall health. The LVAD is monitored by a health care professional to ensure that the device is performing as expected. You may also receive special blood pressure tests.

A blood thinning drug will be prescribed to help reduce the risk of blood clotting. You will require routine blood tests to monitor the effects of the blood thinning drug.