Heart Assist System Implantation
(Ventricular Assist Device; VAD)
A heart assist system implantation (also called a ventricular assist device, or VAD) is an artificial heart. This single-chamber artificial heart works by compressed air or battery power. The device boosts the function of a failing ventricle.
Left Ventricular Assist Device
Reasons for Procedure
VADs are used for people with end-stage refractory congestive heart failure that has not responded to medicine. In the heart, the left ventricle does most of the work. It is usually the chamber that fails first. VADs can be used to support the left ventricle, right ventricle, or both. Getting a VAD is a way to improve the heart's ability to pump without having a heart transplant]]>.
A VAD is used most often while you are waiting for a heart transplant. This is known as a bridge to transplant. Newer devices are being studied for long-term support of a failing heart. This is known as destination therapy. Depending on your overall health, you may be able to return to normal activities after you recover.
Heart failure occurs when the heart is too weak to pump all the blood it receives. Blood begins to back up, first into the lungs (if it is the left ventricle that is failing), then into the lower parts of the body so that ankle swelling develops.
If you are planning to have VAD implantation, your doctor will review a list of possible complications, which may include:
- Blood clots
- Device failure
- Adverse reaction to the anesthesia
- Kidney, lung, or heart damage
Factors that may increase the risk of complications include having:
- A serious infectious disease
- Advanced disease of vital organs other than the heart
- Blood clotting disorder
Also, if you have a small stature, you may not be able to get a VAD. The device is bulky. Newer generation continuous flow devices, which are much smaller, are being studied.
Be sure to discuss these risks with your doctor before the surgery.
What to Expect
Prior to Procedure
If you need a VAD, it is because your heart is failing. Most likely, you will be on a list to receive a heart transplant. You may already be in the hospital. Your doctor will do many tests, for example:
- Echocardiogram]]>—size, shape, and motion of the heart are examined using sound waves
- ]]>X-ray]]>—uses radiation to take a picture of structures inside the body
- ]]>Cardiac Catheterization]]>—to look for ]]>coronary artery disease]]>
- Psychological and social system evaluations to make sure you are prepared to manage the device outside of the hospital
Leading up to the procedure, your doctor will instruct you to:
]]>General anesthesia]]> will be used. It will block any pain and keep you asleep through the surgery.
Description of the Procedure
This is open heart surgery. The doctor will make an incision down the length of your breast bone. The breast bone will then be split and separated. You will be placed on a heart-lung machine. This machine will take the place of your heart and lungs during the surgery. The doctor will place the VAD into a pocket on the inside of the abdominal wall. The device will be sewn into your heart. It may also be sewn into your aorta, depending on the type of device.
Immediately After Procedure
You will be in the intensive care unit (ICU). You will be connected to many tubes. The medical staff will monitor you.
How Long Will It Take?
About 4-8 hours
How Much Will It Hurt?
You will have pain from the surgery. Ask your doctor about medicine to help with the pain.
Average Hospital Stay
- 2-5 days in the ICU
- 2-4 weeks in a regular hospital room
When you return home, do the following to help ensure a smooth recovery:
- Stay in contact with the heart center. You may be waiting for a heart transplant.
- Slowly increase your activity. Ask your doctor if you will be able to return to work.
- As prescribed by your doctor, take blood thinners. These will prevent blood clots.
- Be sure to follow your doctor’s instructions. She will tell you:
- How to take care of your VAD
- When to contact the hospital—Make sure that you know how to call your doctor if you have an emergency.
Call Your Doctor
After you leave the hospital, contact your doctor if any of the following occurs:
- Signs of infection, including fever and chills
- Redness, swelling, increasing pain, excessive bleeding, or any discharge from the incision site
- Increasing pain
- One-sided weakness, blurry vision, or inability to talk
- A cold, pale or blue, numb, or painful extremity
- Cough, difficulty breathing, or chest pain
- Nausea, vomiting
- Problems with urination or bowel movements
- Redness or swelling in legs.
- Warning indications from the device
American Heart Association
US Food and Drug Administration
Heart and Stroke Foundation of Canada
HFSA 2006 Comprehensive Heart Failure Practice Guideline
The Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure (REMATCH) trial. NEJM. 2001 Volume345:1435-1443
Slaughter M, Milano C, Russel S, et al. Advanced heart failure treated with continuous-flow ventricular assist device. N Engl J Med. 2009; DOI:101056/NEJMoa0909938. Available at: http://www.nejm.org.
Implantable ventricular assist device (VAD). Cleveland Clinic website. Available at: http://www.clevelandclinic.org/heartcenter/pub/guide/disease/heartfailure/lvad.htm. Accessed September 4, 2009.
The Michael E. DeBakey Department of Surgery, Baylor College of Medicine website. Available at: http://www.debakeydepartmentofsurgery.org/. Accessed September 4, 2009.
Last reviewed November 2009 by ]]>Craig Clark, DO, FACC, FAHA, FASE]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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