Ventricular Assist Devices

1. What is a ventricular assist device (VAD)?

A ventricular assist device (VAD) is a mechanical device implanted in the chest or abdomen to assist a weakened or failing heart in pumping blood to the rest of the body. VADs are sometimes called “heart pumps” because they help the heart pump blood more effectively, relieving the workload on the heart muscle and improving circulation. These devices can be used as a bridge to transplant, as destination therapy for individuals who are not eligible for heart transplantation, or as a means of recovery for individuals with reversible heart conditions.
Ventricular assist devices have significantly improved the prognosis and quality of life for many individuals with severe heart conditions. They are an essential tool in managing advanced heart failure and can be used in various clinical scenarios based on individual patient needs. The decision to implant a VAD is made on a case-by-case basis by a multidisciplinary team of heart specialists.

How many types of ventricular assist devices?

Several types of ventricular assist devices (VADs) are designed to support the heart’s function and circulation. These devices can be categorized based on their intended use and location of implantation. The main types of VADs include:

Left Ventricular Assist Device (LVAD):

– An LVAD is the most common type of VAD and is used to support the left ventricle, the heart’s main pumping chamber. It assists the heart in pumping oxygen-rich blood to the rest of the body.

– LVADs are often used as a bridge to heart transplantation for individuals awaiting a suitable donor heart.

– Some LVADs are also used as destination therapy for individuals who are not eligible for heart transplantation and require long-term support.

Right Ventricular Assist Device (RVAD):

– An RVAD supports the right ventricle, which pumps blood to the lungs to be oxygenated.

– RVADs are typically used with LVADs (BiVAD) when the right ventricle is weakened or failing.

Biventricular Assist Device (BiVAD):

– A BiVAD supports both the left and right ventricles. It is used when both ventricles are severely compromised and need assistance.

– BiVADs are used for more complex cases of heart failure.

Total Artificial Heart (TAH):

– A TAH is a device that replaces both the left and right ventricles, essentially serving as a complete mechanical replacement for the heart.

– TAHs are used as a bridge to transplantation for individuals with end-stage heart failure who are waiting for a donor’s heart.

Extracorporeal Membrane Oxygenation (ECMO):

– While not a traditional VAD, ECMO is a temporary mechanical circulatory support system that provides oxygenation and circulation for individuals with severe heart and lung failure.

– ECMO can be used in emergencies or as a bridge to more permanent VAD implantation or heart transplantation.

Implantable VADs: These devices are implanted inside the body and are connected to an external power source. They can be partially or fully invested, with some components placed externally. The HeartMate II and HeartWare HVAD are examples of implantable LVADs.
Transcutaneous VADs: These devices are fully implanted inside the body and do not have any external components or wires passing through the skin. The SynCardia Total Artificial Heart (TAH) is an example of a transcutaneous VAD.

The choice of VAD depends on the patient’s specific needs, the condition of their heart, and whether the device is being used as a bridge to transplant, destination therapy, or recovery. A multidisciplinary team decides to implant a VAD of heart specialists based on individual patient assessment and eligibility criteria. Each type of VAD has advantages, limitations, and considerations, and the choice is tailored to the patient’s unique clinical situation.

3. Why might I need a ventricular assist device?

You might need a ventricular assist device (VAD) for several reasons, primarily related to severe heart dysfunction or failure. VADs support the heart’s pumping function and improve blood circulation when the heart cannot perform its regular role effectively. Here are some common reasons why you might need a VAD:

Advanced Heart Failure: VADs are often used in cases of advanced heart failure, where the heart’s pumping capacity is severely compromised. Heart failure can result from various underlying conditions, such as cardiomyopathy, ischemic heart disease (coronary artery disease), valvular heart disease, or viral infections that weaken the heart muscle.
Bridge to Heart Transplant: If you are awaiting a heart transplant and your heart function is deteriorating, a VAD can serve as a “bridge” to keep you alive and relatively stable until a suitable donor heart becomes available. It helps maintain your overall health and organ function while on the transplant waiting list.
Destination Therapy: In some cases, VADs are used as a long-term or permanent solution for individuals not eligible for heart transplantation. This is known as destination therapy, intended to improve quality of life and prolong survival.
Recovery from Heart Injury or Surgery: VADs can be used as a means of recovery for individuals who have experienced severe heart injuries, such as post-heart attack complications, or after complex heart surgeries. The device assists the heart during retrieval, allowing the heart muscle to heal and regain strength.
Temporary Support: VADs can provide temporary support for individuals with reversible heart conditions. For example, they may be used in acute myocarditis (heart muscle inflammation) until the inflammation resolves and the heart recovers.
Bridge to Decision: In some situations where the prognosis is uncertain or when a more definitive treatment plan is being determined, VADs can be used as a bridge to a decision. They can stabilize the patient’s condition while healthcare providers gather additional diagnostic information or explore treatment options.
Inoperable Heart Disease: VADs may be considered a less invasive alternative for individuals who are not candidates for heart surgery due to their overall health or the complexity of their condition.
Refractory Heart Failure: In cases of refractory heart failure, where conventional treatments such as medications and lifestyle modifications are not adequately managing the condition, a VAD can offer additional support to improve heart function.

The decision to implant a VAD is made by a team of healthcare providers, including cardiologists, cardiac surgeons, and heart failure specialists, based on a thorough evaluation of your medical history, current health status, and eligibility criteria. VADs have significantly improved the prognosis and quality of life for many individuals with severe heart conditions and have become an essential therapeutic option in managing advanced heart failure.

4. How do ventricular assist devices work?

Ventricular assist devices (VADs) are mechanical devices designed to assist the heart in pumping blood when the heart’s pumping capacity is compromised due to heart failure or other cardiac conditions. These devices work by taking over the pumping function of one or both of the heart’s ventricles (the lower chambers), thereby improving blood circulation throughout the body. Here’s how VADs work:

Implantation: A VAD is surgically implanted inside the chest or abdomen, typically on the left side. The specific location may vary depending on the type and design of the VAD.
Connection to Heart and Blood Vessels: The VAD connects the heart and major blood vessels through tubing or cannulas. The connection is established by sewing the inflow and outflow cannulas to the heart’s chambers and blood vessels.
Blood Flow Regulation: The VAD has a pump mechanism that regulates blood flow. It can assist either the left ventricle (LVAD), right ventricle (RVAD), or both (BiVAD), depending on the patient’s needs. LVADs are the most common and assist the left ventricle in pumping oxygen-rich blood to the body.
Power Source: VADs require a power source to operate. This power source can be external or implanted within the body. In some cases, VADs are connected to an external controller and batteries that patients can carry in a wearable device, allowing them to move around.
Blood Flow Monitoring: The VAD constantly monitors the patient’s blood flow and adjusts its pumping rate to meet the body’s needs. Sensors within the VAD provide real-time feedback on factors such as blood pressure and flow velocity.
External Control Unit: In cases where the power source is external, an external control unit is used to manage and adjust the VAD’s settings. Healthcare providers can modify the device’s parameters to optimize its performance based on the patient’s condition.
Improved Blood Circulation: As the VAD pumps blood effectively, it relieves the workload on the weakened or failing ventricle(s). This improved blood circulation helps ensure that vital organs receive an adequate supply of oxygenated blood.
Monitoring and Follow-Up: Patients with VADs require close monitoring by a healthcare team to ensure that the device is functioning correctly, to manage any complications, and to make necessary adjustments to optimize the device’s performance.
Recovery or Bridge to Transplant: VADs can serve different purposes depending on the patient’s situation. They can act as a bridge to heart transplantation, allowing patients to survive and remain stable while awaiting a donor’s heart. VADs can also serve as destination therapy for individuals not eligible for transplantation, providing long-term support.
Patient Education: Individuals with VADs and their caregivers receive extensive education on how to care for the device, recognize warning signs of complications, and manage the daily challenges associated with living with a VAD.

Ventricular assist devices have revolutionized the management of advanced heart failure, offering a lifeline to individuals with severe cardiac conditions. While they can be life-saving, they require ongoing medical supervision and a significant lifestyle adjustment. Close collaboration between patients, caregivers, and healthcare providers is essential to ensure the successful use of VADs and to optimize patient outcomes.

5. What happens before VAD implant surgery?

Before undergoing ventricular assist device (VAD) implant surgery, several necessary steps and assessments are typically carried out to ensure the procedure is appropriate and prepare the patient for surgery and postoperative care. Here’s an overview of what happens before VAD implant surgery:

Comprehensive Evaluation: You will undergo a comprehensive evaluation by a team of healthcare providers, including cardiologists, cardiac surgeons, and heart failure specialists. This evaluation involves a thorough assessment of your medical history, current health status, and the severity of your heart condition.
Diagnostic Tests: Various diagnostic tests may be conducted to gather information about your heart’s function and overall health. These tests may include echocardiography, cardiac catheterization, blood tests, and imaging studies.
Psychosocial Assessment: Given the significant impact of VAD implantation on your lifestyle and emotional well-being, a psychosocial assessment is often performed. This assessment helps identify any psychological, social, or support-related factors that may influence your ability to cope with the surgery and its aftermath.
Patient Education: You and your caregivers will receive extensive education about VADs, the surgical procedure, and what to expect during recovery. This education is essential for making informed decisions and preparing for life with a VAD.
Discussion of Treatment Options: Based on the evaluation results, your healthcare team will discuss the most appropriate treatment options for your condition. This may include VAD implantation, heart transplantation, or other medical therapies.
Informed Consent: You will be asked to provide informed consent for the surgery. This involves a detailed discussion with your healthcare provider about the risks, benefits, and potential complications associated with VAD implantation.
VAD Selection: If VAD implantation is deemed appropriate, your healthcare team will select the type of VAD that best suits your needs, such as LVAD, RVAD, or BiVAD. The choice depends on the specific characteristics of your heart failure.
Preoperative Medical Optimization: In the weeks leading up to the surgery, efforts are made to optimize your overall health. This may include medication adjustments, management of existing medical conditions, and nutritional support to ensure you are in the best possible need for surgery.
Blood Type and Crossmatching: If you are being considered for heart transplantation in the future, your blood type and crossmatching will be performed to determine compatibility with potential donor hearts.

VAD implantation is complex, and thorough preparation is crucial for success. Your healthcare team will guide you through every step of the process, answer your questions, and provide the necessary support to ensure you are well-prepared physically and emotionally for the surgery. Open communication with your healthcare providers and active participation in your care plan is essential during this preoperative phase.

6. What happens during ventricular assist device implant surgery?

Ventricular assist device (VAD) implant surgery is a complex procedure that involves placing the VAD inside your chest or abdomen to assist your heart in pumping blood more effectively. A team of skilled cardiac surgeons and healthcare professionals performs the surgery. Here is an overview of what happens during VAD implant surgery:

Anesthesia: You will be taken to the operating room, where you will be given anaesthesia to ensure you are unconscious and pain-free throughout the procedure. The type of anaesthesia used may vary depending on your medical condition and the specific details of the surgery.
Incision: The surgeon will make one or more incisions in your chest or abdomen, depending on the type of implanted VAD. The incisions are carefully planned to provide access to the heart and blood vessels.
Surgical Access: The surgical team will carefully access your heart and blood vessels. In the case of a left ventricular assist device (LVAD), the surgeon will typically access the left side of the heart.
Cannulation: Cannulas (tubes) are inserted into the heart and blood vessels. These tubes are connected to the VAD, allowing blood to be drawn from the heart and pumped back into circulation.
VAD Placement: The VAD is implanted inside your body and connected to the cannulas. The specific location of the VAD depends on the type of device and your unique anatomy. For LVADs, it is commonly implanted in the upper part of the abdomen and connected to the left ventricle and the aorta.
Connection to Power Source: The VAD is connected to its power source. This may involve placing external components, such as cables, that pass through the skin. Some VADs have internal power sources.
Testing and Adjustment: The surgical team will test the VAD to ensure it functions correctly. They will also make any necessary adjustments to optimize its performance.
Closure: The surgeon will close the incisions with sutures or staples once the VAD is in place and functioning well. Sterile dressings and bandages are applied to the incisions.

VAD implant surgery is a significant undertaking, and the recovery process can vary from person to person. It’s important to follow your healthcare provider’s instructions carefully and attend all follow-up appointments to ensure the VAD functions optimally and monitor for potential complications. A strong support system and close collaboration with your healthcare team are critical to a successful outcome after VAD implantation.

7. What are the benefits of ventricular assist devices?

Ventricular assist devices (VADs) benefit individuals with severe heart failure or other cardiac conditions. These devices improve heart function and circulation, ultimately enhancing the patient’s quality of life and prognosis. Here are some key benefits of VADs:

Improved Circulation: VADs assist the heart in pumping blood more effectively. They can significantly increase cardiac output, which means more oxygen-rich blood is delivered to vital organs and tissues throughout the body.
Symptom Relief: VADs can alleviate symptoms of heart failure, such as shortness of breath, fatigue, fluid retention (oedema), and exercise intolerance. This improvement in symptoms can lead to a better overall quality of life.
Bridge to Transplant: VADs serve as a bridge to heart transplantation for individuals awaiting a suitable donor heart. They help maintain the patient’s health and stability while on the transplant waiting list, increasing the chances of receiving a transplant.
Destination Therapy: In cases where heart transplantation is not an option for medical reasons or patient preferences, VADs can be used as destination therapy, providing long-term support to improve survival and quality of life.
Recovery: For some patients, VADs can be used as a means of recovery. They assist the heart temporarily, allowing the weakened heart muscle to rest and heal. Sometimes, the heart may regain enough function to remove the VAD.
Bridge to Decision: VADs can serve as a bridge to a decision for patients whose prognosis is uncertain or when a more definitive treatment plan is being determined. They provide stability while healthcare providers gather additional information and evaluate the best course of action.
Improved Exercise Capacity: Many VAD recipients experience an improvement in exercise capacity, allowing them to engage in physical activities they could not previously participate in.

It’s important to note that while VADs offer significant benefits, they have risks and considerations. VAD-related complications can include bleeding, infection, blood clots, and device malfunction. Close monitoring and follow-up care by a specialized healthcare team are essential to manage and mitigate these risks.
The decision to implant a VAD is made based on a thorough evaluation of the patient’s medical condition and needs. The goal is to optimize the balance between improved circulation and heart function benefits and the potential risks and challenges associated with VAD therapy.

8. What risks are associated with ventricular assist devices?

While ventricular assist devices (VADs) offer significant benefits for individuals with severe heart failure, they are not without risks and potential complications. The decision to implant a VAD is made based on an individual’s specific medical condition, heart failure severity, and overall health. Healthcare providers carefully weigh the benefits against the risks. Here are some of the risks and potential complications associated with VADs:

Bleeding
Infection
Blood Clots
Device Malfunction
Driveline Infections
Right Heart Failure
Stroke
Pump Thrombosis
Device-Related Complications
Medication Side Effects

It’s essential for patients and their caregivers to receive thorough education and training on VAD management, including infection prevention, driveline care, and recognition of warning signs. Close monitoring and follow-up care with a specialized healthcare team are critical to identify and address potential complications early. Despite these risks, VADs have significantly improved the prognosis and quality of life for many individuals with advanced heart failure. The decision to implant a VAD is made carefully, considering the patient’s unique circumstances and pursuing the best possible outcomes.

9. Which patients are not eligible for ventricular assist devices?

Ventricular assist devices (VADs) can be a life-saving and life-enhancing treatment for many individuals with advanced heart failure, but not all patients are eligible for VAD implantation. Eligibility is determined based on medical, psychological, and logistical factors. Here are some scenarios in which a patient may not be suitable for VAD placement:

Medical Ineligibility: Patients with certain medical conditions or factors may not be suitable candidates for VAD implantation. These factors include:

– Severe Organ Dysfunction: Individuals with severe dysfunction or failure of other major organs, such as the kidneys, liver, or lungs, may not be eligible for VAD placement because the benefits of the device may be limited in the presence of multi-organ failure.

– Advanced Age: Advanced age alone is not a strict contraindication for VAD implantation, but the overall health and medical condition of elderly patients are carefully assessed to determine eligibility.

– Active Infections: Active infections, particularly systemic infections or infections at the surgical site, are a contraindication for VAD placement. Conditions can increase the risk of complications.

– Irreversible Neurological Dysfunction: Individuals with severe and irreversible neurological conditions may not be eligible for VAD implantation, as the benefits of the device may be limited in these cases.

Lack of Adequate Social Support: Patients who lack a sufficient support system or caregivers may need help managing a VAD. Adequate social support is crucial for device management, driveline care, and coping with the lifestyle changes associated with VADs.
Significant Psychosocial Issues: Psychological and emotional stability is essential for VAD recipients. Patients with untreated or severe mental health issues, substance abuse problems, or cognitive impairments may not be eligible.

It’s important to note that VAD eligibility is determined on a case-by-case basis, and a multidisciplinary team decides to implant a VAD of healthcare providers, including cardiologists, cardiac surgeons, heart failure specialists, and psychologists. The group considers the patient’s medical condition, overall health, psychosocial factors, and individual circumstances.
Patients who are deemed ineligible for VAD placement may still have other treatment options, and their healthcare team will work to explore alternative therapies and supportive care approaches to manage their heart failure and optimize their quality of life.

10. What is recovery from VAD implant surgery like?

Recovery from ventricular assist device (VAD) implant surgery is a critical phase that requires careful monitoring and support. The recovery process can vary from person to person, depending on several factors, including the type of VAD implanted, the patient’s overall health, and any complications that may arise. Here’s an overview of what to expect during the recovery period:

Immediate Postoperative Care: After VAD implant surgery, you will be transferred to an intensive care unit (ICU) or a specialized cardiac care unit for close monitoring. During this phase:

– You will be connected to various monitors to track your vital signs, heart function, and the performance of the VAD.

– Healthcare providers will manage pain and ensure your comfort.

– Intravenous medications, including medications to prevent infection and blood clots, will be administered.

– You will receive breathing support if necessary, such as mechanical ventilation.

Monitoring and Device Optimization: Your healthcare team will closely monitor your recovery and the performance of the VAD. They will make any necessary adjustments to optimize the VAD settings and ensure they function correctly.
Mobilization and Rehabilitation: As your condition stabilizes, you will gradually become more mobile. Physical therapists may work with you to help you regain strength and mobility. Early mobilization is essential for preventing complications such as blood clots and muscle weakness.
Driveline Care and Infection Prevention: You and your caregivers will receive training on driveline care. The driveline is the cable that connects the VAD to the external power source. Maintaining good hygiene and preventing driveline infections are essential aspects of VAD care.
Medication Management: You will be prescribed medications to manage various aspects of your care, including:

– Anticoagulants (blood thinners) to prevent blood clots and strokes.

– Immunoprotection medications to suppress the immune system and prevent device rejection.

– Medications to manage heart function and blood pressure.

– Prophylactic antibiotics to prevent infections.

Recovery from VAD implant surgery is an ongoing process, and it can take several weeks to months to fully adjust to life with the device. The level of independence and quality of life you can achieve will depend on your circumstances and the support you receive from your healthcare team, caregivers, and loved ones. Regular communication with your healthcare providers, adherence to the prescribed care plan, and a positive mindset are essential for a successful recovery and improved quality of life.

11. Will there be any restrictions after I recover from surgery?

After recovering from ventricular assist device (VAD) implant surgery, there are typically some restrictions and guidelines you will need to follow to ensure your safety and the device’s proper functioning. These restrictions can vary depending on your medical condition, the type of VAD implanted, and your healthcare provider’s recommendations. Here are some common restrictions and guidelines:

Driving Restrictions
Physical Activity
Avoiding High-Risk Activities
Medication Adherence
Infection Prevention
Follow-Up Appointments
Power Sources

Remember that your specific restrictions and guidelines may be customized based on your unique medical condition and VAD type. It’s essential to follow your healthcare provider’s recommendations closely and seek clarification on any restrictions or concerns you may have. Compliance with these guidelines is crucial for your safety and well-being as a VAD recipient.

12. What is daily life like with a ventricular assist device?

Daily life with a ventricular assist device (VAD) can differ significantly from life without one. Still, many VAD recipients can lead fulfilling and active lives with proper care and adaptation. Here are some aspects of daily life with a VAD:

Device Management: A significant portion of your daily routine will involve managing your VAD. This includes caring for the driveline, the cable connecting the VAD to the external power source, and ensuring the device functions properly. You must change dressings, clean the driveline, and monitor for any alarms or issues.
Medication Management: Adherence to your prescribed medication regimen is essential. This often includes anticoagulants (blood thinners) to prevent blood clots, immunosuppressants to manage the immune response, and other medications to support heart function. You must take medicines as directed by your healthcare provider and attend regular medication management appointments.
Hygiene and Infection Prevention: Maintaining good hygiene is crucial to prevent infections, especially around the driveline exit site. Handwashing, dressing changes, and careful wound care are essential to your daily routine.
Physical Activity: Engaging in physical activity within the limits set by your healthcare team is encouraged. Regular walks and light exercise can help maintain cardiovascular health. However, you should avoid strenuous activities and high-impact sports.
Emergency Preparedness: You and your caregivers should be prepared for VAD-related emergencies. This includes knowing how to respond to alarms, understanding emergency power sources, and having an emergency plan.

Daily life with a VAD requires dedication to self-care and adherence to your care plan. Maintaining a positive mindset and being proactive in managing your health is essential. Over time, you will become more accustomed to your new routine, which will become a natural part of your daily life. Open communication with your healthcare team and a strong support system are essential to successfully navigating life with a VAD.

13. Can being on a VAD affect my mental health?

Yes, being on a ventricular assist device (VAD) can significantly impact your mental health. Living with a VAD involves numerous physical, emotional, and lifestyle challenges that can affect your overall well-being. Recognizing and addressing these mental health concerns is essential to ensure your emotional and psychological well-being while living with a VAD.
Remember that it’s entirely normal to experience a wide range of emotions while living with a VAD. Seeking help and support is a sign of strength, and addressing your mental health is essential to your overall well-being and quality of life as a VAD recipient.

14. How often will I need to see my healthcare provider after VAD implant surgery?

The frequency of follow-up appointments with your healthcare provider after ventricular assist device (VAD) implant surgery can vary depending on your circumstances, the type of VAD implanted, and overall health.
It’s important to note that the above schedule is a general guideline, and the actual frequency of follow-up appointments may vary based on your specific medical condition and the preferences of your healthcare provider. Your healthcare team will tailor your follow-up schedule to meet your unique needs.
During these follow-up appointments, your healthcare provider will assess various aspects of your health, including VAD function, medication management, wound care, and any potential complications. They will also address any questions or concerns you may have and provide guidance on maintaining a healthy lifestyle and coping with the challenges of living with a VAD.
Remember that adherence to your follow-up appointments is crucial for your overall well-being and the success of VAD therapy. Regular monitoring allows your healthcare team to make timely adjustments to your care plan, address any issues, and ensure you receive the best possible care as a VAD recipient.

15. When should I contact my healthcare provider about potential complications?

Contact your healthcare provider immediately if you experience any potential complications or concerning symptoms related to your ventricular assist device (VAD). Prompt communication with your healthcare team is crucial for addressing issues and ensuring your safety. Here are some situations in which you should contact your healthcare provider:

VAD Alarms
Chest Pain or Discomfort:
Shortness of Breath
Signs of Infection
Fever
Changes in Device Function

Unusual Symptoms:
Medication Side Effects
Driveline Issues
Device or Equipment Malfunction
Bleeding or Bruising
Changes in Mental Status

It’s important to remember that early detection and intervention can often prevent more serious complications. Do not hesitate to contact your healthcare provider or seek emergency medical attention if you have concerns about your VAD or experience any symptoms that raise suspicion of potential issues. Your healthcare team supports you and ensures your safety while living with a VAD.

Ventricular Assist Devices