Ventricular assist device (VAD) for Heart Disease

Overview
In some people with heart failure, the ventricles, or lower chambers of the heart, can no longer pump blood effectively through the heart and body. A ventricular assist device (VAD) is a mechanical system that can take over the pumping function from one or both ventricles. Blood passes through the VAD instead of through your ventricle(s). A VAD may be short-term, while you recover from heart surgery or wait for a heart transplant. In the latter situation, the VAD may be referred to as a “bridge to transplant.” A VAD may also be long-term in cases of end-stage heart failure if a heart transplant is not a possibility. If the VAD is a long-term solution, the VAD may be referred to as “destination therapy.”

A VAD may be used for the left ventricle only (LVAD), the right ventricle only (RVAD), or be biventricular (BIVAD). However, the LVAD is the most common type of VAD. Other terms for a VAD include heart pump, ventricular assist system (VAS), or mechanical circulatory support (MCS).

What does it involve?
There are several types of VAD. Some VADs involve an external pump. The external pump may be small and portable, or connected to a large console at your hospital bedside. External pumps are connected to your heart via catheters that exit your abdomen or leg. Other types of VADs are entirely internal, with the pump placed inside your chest.

Another difference between VADs is the way in which they pump your blood. Some devices pump continuously, with a constant flow. These devices tend to be smaller and quieter, and you would no longer have a normal pulse. Other VADs use a pumping action more like that of your heart.

You may already be in the hospital receiving treatment for heart failure when you receive a VAD.

VAD implantation requires open-heart surgery. You will be under general anesthetic. The surgeon makes a long incision down the chest, cuts the sternum in half, and spreads the rib cage apart. The heart is then temporarily stopped while VAD implant surgery is performed. While the heart is stopped, blood will continue to be pumped through the body by a cardiopulmonary bypass (heart-lung) machine. When the VAD is in place, the heart is restarted, and blood will begin flowing through your heart and the VAD. The surgeon will then close the chest. If you are receiving an external VAD, the surgeon will also make incisions and place catheters to connect the external pump to your heart.

Recovery
Recovery time for VAD placement surgery varies depending on your condition before surgery. After VAD placement surgery, you will spend a few days in the intensive care unit (ICU) where your condition can be monitored regularly. You will continue recovery in another part of the hospital. You may transition to returning home in different ways. You may visit home during the day, but sleep in the hospital for monitoring. Your doctor may recommend you stay for a week or more at a skilled nursing facility where you can continue to receive care before returning home. By the time you return home, you will likely be able to resume your normal activities. Your cardiologist may recommend cardiac rehabilitation after VAD placement.

Results
Ventricular assist devices prolong the lives of people with severe heart failure.

Constraints
Any surgery carries risks including blood clots, blood loss, infection, breathing problems, reactions to medication, heart attack or stroke during the surgery, and death. Complications specific to heart surgery include postpericardiotomy syndrome, which can cause chest pain and low-grade fever lasting several months.

LVADs can compromise the right side of your heart, leading to right heart failure. You may require medication or the implantation of an RVAD to support right ventricular function.

You may need to take blood thinners to prevent blood clots while you have a VAD.

In rare cases, the VAD device may malfunction or fail and require further surgery or replacement.

For more details about this treatment, visit:
What Is a Ventricular Assist Device? – National Heart, Lung, and Blood Institute
https://www.nhlbi.nih.gov/health/health-topics/...

Ventricular assist device – Mayo Clinic
http://www.mayoclinic.org/tests-procedures/vent...

Left Ventricular Assist Devices (Mechanical Circulatory Support MCS) – Cleveland Clinic
http://my.clevelandclinic.org/services/heart/se...