Ventricular Assist Device

ExitCare ImageA ventricular assist device (VAD) is a mechanical pump that helps the two lower chambers of your heart (ventricles) pump blood. A person may need a VAD due to:

  • Heart failure.

  • A heart attack (myocardial infarction, MI).

  • An infection or medical condition that affects the heart muscle.

PURPOSES OF A VAD

  • A bridge to recovery. A VAD can provide support until your heart function improves sufficiently. If heart function improves, the VAD can be removed.

  • A bridge to transplantation. A VAD can provide support until a heart transplant becomes available.

  • A bridge to destination therapy. A VAD can provide support to individuals who have end-stage heart failure and are not candidates for a heart transplant.

TYPES OF VADS

There are different types of VADs. Most VADs are implanted into your heart. Your caregiver will determine which type of device you need based on your type of heart failure and medical condition. Types of VADs include:

  • Left Ventricular Assist Device(LVAD). This is the most common type of VAD. It helps the left ventricle pump blood to the aorta.

  • Right Ventricular Assist Device (RVAD). This type of VAD helps pump blood from the right ventricle to the lungs. An RVAD is used if you have right-sided heart failure. It may only be used for a short time.

  • Biventricular Assist Device(BIVAD). This type of VAD combines an LVAD and an RVAD. The two are used together to help the right and left ventricle pump blood.

  • Transcutaneous VAD (Bedside VAD). This type of VAD is used in emergency or short-term situations. The pump is located outside the body (transcutaneous).

PARTS OF A VAD

A VAD consists of the following parts:

  • Inflow tube. This tube carries oxygenated blood from the left ventricle to the VAD pump.

  • Outflow tube. This tube carries blood from the VAD pump to the aorta. The aorta is a large artery that carries oxygenated blood from your heart to the rest of your body.

  • Pump. The VAD pump is implanted inside the body.

  • Drive line (percutaneous lead). This tube connects the VAD pump to the system controller.

  • System controller. The controller consists of batteries and electronics which control the VAD.

The VAD is powered by either batteries or an electrical wall outlet.

BLOOD FLOW THROUGH A VAD

Blood flows through a VAD in one of two methods.

  • Pulse flow. Blood is pumped or pulses through the VAD.

  • Continuous flow. Blood is continuously cycled through the VAD. You may not feel a pulse when your blood is continuously ran through the VAD.

RISKS AND COMPLICATIONS OF A VAD

With any type of VAD, problems can occur during implantation, after implantation, or when living at home with the VAD. Complications can include:

  • Infection.

  • Bacteria can get into the VAD tubing and cause an infection.

  • After implantation of a VAD, an infection can also affect different body organs such as the lungs and kidneys.

  • You may be on antibiotic medicine.

  • Bleeding.

  • You will need to take blood thinning medicines (anticoagulants) to prevent blood clots in the VAD tubing. Bleeding can occur because of the anticoagulant use.

  • You will need frequent blood samples to measure the clotting time of your blood.

  • Blood clots.

  • Even with anticoagulants, there is still a risk for blood clots.

  • Blood clots can clog the VAD and prevent the VAD from working properly.

  • Stroke.

  • A stroke caused by a clot (ischemic stroke).

  • A stroke caused by bleeding into the brain (hemorrhagic stroke). This type of stroke can be caused by anticoagulant use.

  • VAD malfunction.

  • Mechanical complications can occur with a VAD. It is important to understand the VAD functions and alarms.

IMPLANTING A VAD

  • Open heart surgery is needed to implant a VAD.

  • After the VAD is implanted, you will go to an intensive care unit (ICU). Expect the following:

  • You will be on a breathing machine (ventilator). You will be weaned off the ventilator when you are strong enough to breathe on your own.

  • You will have a lot of tubes after the surgery. A tube will drain urine from your bladder (catheter). A tube in your chest (chest tube) will drain fluid from around your heart. Intravenous (IV) lines will allow for the administration of fluids and medicines.

  • Pain relieving medicine will be given to keep you comfortable.

VAD SUPPORT

The care and support you will need with a VAD will vary. This depends on the type of VAD you have and your medical condition. You can expect the following:

  • You may need a continuous hospital stay with a VAD.

  • You will receive support from different health care professionals such as:

  • A heart specialist (cardiologist).

  • A VAD coordinator.

  • A dietitian.

  • A social worker.

  • You must be able to live independently if discharged home with a VAD.

  • If you are discharged home with a VAD, it is important to live near the hospital where the VAD was implanted. Individuals who are discharged home with a VAD will need close follow-up care and support.