Purpose
A ventricular assist device (VAD) is an artificial pump used in people with severe heart failure. An implantable device can be used for left ventricular assist (LVAD). A controller and batteries are located outside the body. This device takes over the heart's pumping action until a donor heart is available for heart transplantation (as a “bridge to transplant”).
A thoratec paracorporeal ventricular assist device uses pumps that remain outside the body that are connected to the heart with tubes. This device takes some of the burden of pumping the blood and essentially assists with the function of the left, right, or both ventricles of the heart.
Implantable temporary VADs can be put in place during surgery or percutaneously (under the skin) through an artery in the leg. These devices are used as a “bridge to decision.” This means they are used to assist the heart until it has had time to recover or while other options, such as a longer-term device or transplant, are considered.
All VADs have several features in common:
- A tube that takes blood from one or both of the heart’s ventricles to one or both of the VAD’s pumps
- A pump for each ventricle needing assistance to pump the blood out
- A tube taking the pumped blood to the artery from the heart (aorta)
- A power source for the pump
A patient with a VAD can become well enough to move and attend physical rehabilitation sessions. Ideally, VAD therapy can aid in the recovery of other organs that have been affected by the weakened heart’s poor blood flow (such as the kidneys and liver).
VAD therapy can have side effects, including infection, major bleeding, or stroke. However, a VAD can offer hope of recovery or survival for patients who need emergency assistance with the functioning of their hearts.
Description
- Blood tests, radiographs of the chest and assessment of heart function are done in the hospital before the procedure.
- The doctor explains the procedure and obtains consent. This consent is required before the procedure can be performed.
- You will be taken to the operating room.
- You will be placed under general anesthesia and remains unconscious for the entire operation.
- For surgical procedures (steps 5 to 9), incisions (cuts) are made through the chest, breastbone, and abdomen to allow the surgeons access to the heart and the space immediately beneath the heart.
- The heart’s blood vessels are connected to a heart-lung machine (also called a heart-lung bypass machine), which pumps the blood through the patients’ body during the surgery.
- Once the heart-lung machine is pumping blood, the patient’s heart is stopped.
- The VAD is positioned in the upper part of the patient’s abdomen and sewn in place.
- A tube is connected from the end of the ventricle to the pump. A second tube runs from the pump to the aorta (for a left ventricular assist device) or to the pulmonary artery (for a right ventricular assist device). For a bi-ventricular assist device, tubes are run from the pump to both the aorta and pulmonary artery.
- For percutaneous procedures, the device is inserted through the femoral artery in the leg.
- The pump is connected to a power source (battery) which is placed outside the body.
- The pump is started and the heart is restarted.
- All incisions are closed, and the patient is awakened.
- You will stay in the Cardiac Surgery Intensive Care Unit (CSICU) for several days following the surgical procedure. For percutaneous procedures, patients must remain in the CSICU until a decision is made for either removing the device or until a longer-term device is inserted.
- You will be moved to a regular hospital room once intensive care is no longer needed. The average hospital stay is 14 to 30 days.
Patient instructions
Patients should bring all medications (including non-prescription drugs and supplements) with them to the hospital.
Patients should not eat or drink after midnight before surgery.