Implantable Ventricular Assist Device (VAD)

Overview

A ventricular assist device, also known as a mechanical circulatory support device, is a device used in heart failure patients to help their heart pump blood from the heart’s lower chambers to the rest of the body.

• A VAD can be placed in either the left or right ventricle but is more frequently used in the left ventricle. When the device is placed in the left ventricle, it is called a left ventricular assist device (LVAD).
• Your doctor may implant a VAD while you are waiting for a heart transplant or as long-term therapy for heart failure in patients who are not candidates for a heart transplant.
• Your doctor will perform open-heart surgery to implant the VAD. Open heart surgery is serious surgery.

Candidates for a ventricular assist device

Your doctor may recommend you have a VAD in the following cases:

• You are on the heart transplant list waiting for a transplant. A VAD will keep the blood pumping through your body and will be removed when a new heart is transplanted. In many cases, it improves the function of other organs that may not be working correctly.  This is called bridge to transplant therapy.
• If you are not eligible for a heart transplant due to other medical conditions or age. The VAD can help improve the function of other organs to potentially improve your overall health, so you can eventually get a heart transplant.

In some cases, a VAD becomes a permanent treatment. Patients over 65 generally are not good candidates for a heart transplant. This is called destination therapy.

• Your heart failure is temporary. Your doctor may implant a VAD until your heart is healthy enough to pump blood on its own. This is called bridge to recovery.
• You had heart surgery and need a short-term option to pump your blood pump through the body efficiently. The VAD may be implanted for a few weeks or months.

Preparing for a ventricular assist device

• Prepare your home for you to easily move around and perform daily activities when you return home after surgery.
• Your doctor will give you specific instructions about medication usage as well as when to stop eating and drinking the night before surgery.
• Because you will be in the hospital several days, bring a list of your medications, personal care items, comfortable clothing, a copy of your advance directive, and any other items to help you relax.
• Inform your care team about any allergies you have or any medications you have at the hospital.

Expectations during ventricular assist device implantation

• A team of cardiac specialists, including cardiac surgeons, surgical nurses, and anesthesiologists, will work together to perform a VAD implant surgery.
• VAD implant surgery is typically an open-heart procedure performed under general anesthesia that takes approximately four to six hours. 
• You will be connected to a ventilator to help you breathe during surgery and for a few days after surgery.
• During the procedure, your surgeon will make an incision in the center of your chest, separate the chest bone, and open the rib cage to access the heart.
• You will likely be connected to a heart-lung bypass machine to keep your blood flowing during surgery. 
• Once the device is implanted and pumping correctly, you will be taken off the heart-lung bypass machine. Your surgeon will close your chest, and you will go to an intensive care unit (ICU) for monitoring.

Duration of ventricular assist device implantation

VAD implant surgery will take between four and six hours.

Recovery from ventricular device surgery

In the ICU unit, your care team will closely monitor you to ensure you are recovering appropriately, and there are no signs of infection or other complications. Your length of stay in the ICU varies depending on how well your recovery is going.

• If your lungs are not working properly, you will remain on the ventilator until you can breathe independently.
• After a period in the ICU, you will be moved to a regular hospital room where your care team will help you begin a light activity routine.
• You will likely need medications such as antibiotics and blood-thinning medications to prevent infection and complications while in the hospital. Take these medications exactly as prescribed.
• You will be discharged when you have recovered and gained strength. In some cases, patients are moved to a special nursing facility after leaving the hospital.
• Your care team will schedule regular follow-up visits and cardiac rehabilitation after you leave the hospital.
• Many people can return to work, driving, hobbies, and exercise after recovering from a VAD implant. Discuss what activities may not be recommended after a VAD implant with your doctor.

When to Seek Care

If you think you may need VAD surgery, start by voicing your concerns and symptoms to your primary care provider. From there, your doctor may suggest seeing a cardiologist for more specialized treatment.