Ventricular Assist Devices (VAD)

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Ventricular assist devices (VAD) support the function of the left, right, or both heart ventricles. Heart ventricles are the lower chambers of your heart. The ventricular assist device (VAD) includes tubes to carry blood out of your heart and to your blood vessels, a power source, and a control unit to monitor the device’s function. This device may be used to support your heart until it recovers, to support your heart while you are waiting for a heart transplant, or to help your heart work better if you are not eligible for a heart transplant.

Surgery is required to connect the VAD to your heart. The surgery will be carried out in the hospital. You will be given general anesthesia and will not be awake or feel pain during the operation. You will receive anti-clotting medicine through an intravenous (IV) line in your arm. A breathing tube connected to a ventilator will help you breathe. Your surgeon will open your chest and connect your heart’s arteries and veins to the heart-lung bypass machine. Then, the pump will be placed on the top of your abdominal wall and connected to your heart with a tube. Another tube will connect the pump to one of your main arteries. The VAD will be connected to a control unit and a power source outside your body. When the heart-lung machine is turned off, the VAD will support blood flow and take over the pumping ability of your heart.

After your surgery, you will recover in the intensive care room (ICU) and may stay in the hospital for two to eight weeks. The hospital staff will help you gradually increase your activity to gain strength. You may start a cardiac rehabilitation program. Your healthcare team will watch for signs of infection. To prevent infection, it is important to practice good hygiene, get regular vaccines, and properly clean and care for your device and the hole in your stomach. You will be given instructions on what to do if the device alerts you that it is not working properly. If you are on the waiting list for a heart transplant, you will remain in close contact with the transplant centre.

Having a VAD involves serious risks such as blood clots and bleeding from surgery or caused by anti-clotting medicines. Other risks include infection, broken device, and right-sided heart failure if a left VAD was used. Since blood tends to clot more when in contact with the VAD, you may need to take anti-clotting medicine while you are using the device. It is important to take your medicine exactly as your doctor prescribes to prevent blood clots.

What is a Ventricular Assist Device (VAD)?

A ventricular assist device (VAD) is a mechanical pump used to support heart function and blood flow in people who have weakened hearts.

This device takes blood from a lower chamber of the heart and helps pump it to the body and vital organs —  similar to a healthy heart.

Overview

You may benefit from a VAD if one or both of your ventricles do not work well due to heart disease. Ventricles are the lower chambers of your heart.  

A VAD can help support your heart:

  • During or after surgery, until your heart recovers.
  • While you’re waiting for a heart transplant.

If you are not eligible for a heart transplant. (A VAD can be a long-term solution to help your heart work better.)

The VAD has several basic parts. The first one is a small tube that carries blood out of your heart into a pum; then, another tube carries blood from the pump to your veins, which deliver the blood to your body; and a power source. 

The VAD’s power source is connected to a control unit. The control unit monitors the VAD’s functions. This unit gives warnings, or alarms, if the power is low or the device is not working properly.

Some VADs pump blood as the heart does, with a pumping action. Other VADs maintain a continuous blood flow. With a continuous flow of VAD, you may not have a normal pulse, but your body is getting the blood it needs.

Research has shown that, compared to other VADs, continued VAD flow can reduce length of hospital stays, complications, and increase survival rate. However, more research is needed.

Types of Ventricular Assist Devices

The two basic types of VAD are a left ventricular assist device (LVAD) and a right ventricular assist device (RVAD). When used at the same time, both types are called a biventricular assist device (BIVAD).

The LVAD is the most common type of VAD. This helps the left ventricle pump blood to the aorta. The aorta is the main artery that carries oxygen-rich blood from your heart to your body.

Meanwhile, RVAD is usually only used for short-term right ventricular support after LVAD surgery or other heart surgery. An RVAD helps the right ventricle pump blood to the pulmonary artery. This is the artery that carries blood from the heart to the lungs to pick up oxygen.

BIVAD may be used if the two ventricles are not functioning well enough to meet the body’s needs. Another treatment option for this condition is called a total artificial heart (TAH). TAH is a device that replaces the ventricle.

VAD has two basic designs. The first one is a transcutaneous VAD —  it has a pump and power source located outside the body. Tubes connect the pump to the heart through small holes in the abdomen. This type of VAD may be used for short-term support during or after surgery.

The implanted VAD has a pump that is located in the body and its source of power is located outside the body. The cable connects the pump to the power source through a small hole in the stomach.

Implantable VADs are used primarily for people waiting for a heart transplant or as a long-term solution for people who are unable to have a heart transplant.

The design and type of VAD your doctor recommends depends on your overall health, how long you will need the device, and other factors.

Until recently, VADs were too large to fit in many people’s chests, especially women and children. Only people who have large chests could get one.

However, recent advances have resulted in smaller and more reliable devices. Now, VADs have become more accessible for more people.

Researchers have also made advances in how well VADs work and how much they improve people’s quality of life. In the past, VADs were mostly used for people with end-stage heart failure. Now VADs can also help people who have early-stage heart failure.

Children who have heart failure can also be treated with VAD. VADs for adults may be used in paediatric patients (as long as the children are old enough to use the device). Moreover, the Food and Drug Administration recently approved a VAD designed for younger children.

Who Needs A Ventricular Assist Device (VAD)?

You may benefit from a ventricular assist device (VAD) if your heart isn’t functioning properly because of heart disease. Heart disease can prevent your heart from pumping enough blood to your body.

A VAD can help support your heart:

  • During or after surgery, until your heart recovers.
  • While you are waiting for a heart transplant.
  • If you are not qualified for a heart transplant. (A VAD can be a long-term solution to help your heart work better.)

Short-Term Ventricular Assist Devices

A VAD can help support the heart’s function and blood flow for a short time before, during, and/or after heart surgery until your heart recovers. Your doctor may recommend a short-term VAD if you have severe heart conditions, such as heart failure, ventricular arrhythmias, or cardiogenic shock.

You may also use a VAD if you have heart failure and your doctor needs more time to plan your treatment.

Long-Term Ventricular Assist Devices

If you have heart failure and are waiting for a heart transplant, your doctor may recommend a VAD. If heart failure medications are not working well, a VAD can keep you alive and improve your quality of life while you wait for a donor’s heart.

If you are not a candidate for a heart transplant, a VAD can be a long-term treatment solution. It can improve your quality of life and allow you to do many of your daily activities.

When Is a Ventricular Assist Device Not Recommended?

VAD may not be a treatment option for people who have certain serious health conditions. Examples of these conditions include severe kidney failure, serious brain injuries, severe infections, and other life-threatening conditions.

What Are The Risks of Ventricular Assist Devices (VAD)? 

Risks of Ventricular Assist Devices

Using a ventricular assist device (VAD) involves some serious risks. These risks include:

  • Blood clots
  • Bleeding
  • Infection
  • Device malfunction
  • Right heart failure (possible risk of LVAD)

However, newer VAD models have reduced some of the most serious risks. 

As with any other surgical procedures involving the heart, complications may be fatal. However, survival rates for VAD surgery have improved over the years.

Blood clots

When coming into contact with something that is not a natural part of your body, such as a VAD, your blood tends to clot more than usual. Blood clots can disrupt blood flow and block blood vessels — even important organs in the body, such as the brain.

Blood clots can cause serious complications or even death. Thus, you may need to take anti-clotting medications as long as you have a VAD.

Bleeding

The surgery to implant a VAD is complex, and bleeding may occur during and after surgery. Anti-clotting medications also increase the risk of bleeding.

Balancing the anti-clotting medicines with the risk of bleeding can be difficult. Make sure to take your medication exactly as your doctor prescribes.

Infection

In implantable VADs, a pump inside your body is attached to a power source outside your body. Meanwhile, transcutaneous VADs attach a pump outside your body to your heart.

For both types of VADs, the parts inside your body are attached to the parts outside your body through a hole or holes in the skin. Whenever you have a hole in your skin, it increases the risk of bacteria entering and causing infection.

There is a risk of serious infection if the permanent tubes are connected to the outside through your skin. Your healthcare team will need to watch you closely if you have signs of infection, such as soreness over the VAD site, fluid drainage, or fever

Device malfunction

The VAD can malfunction (not work properly) in different ways

  • The VAD’s pumping action may not be right
  • The VAD’s power may fail
  • Some of the parts may stop working properly

Newer continuous flow VADs can reduce the risk of device malfunction.

Right Heart Failure

Right heart failure means the heart’s right ventricle is too weak to pump enough blood to the lungs. This condition can occur as a result of getting an LVAD, which solely supports the left ventricle.

The LVAD pumps a lot more blood than your weak left ventricle. This puts more pressure on the right ventricle to pump the same amount of blood. The right ventricle may be too weak to match the pumping ability of the LVAD.

Thus, you may need extra support for the right ventricle. Usually, you only need this support until your right ventricle has recovered or until you have a heart transplant (if you are a candidate).

Medicines may improve the function of the right side of your heart. However, some people may require a right ventricular assist device (RVAD) for short-term support of the right ventricle

What to Expect Before Ventricular Assist Device Surgery?

Before you get a ventricular assist device (VAD), you will spend some time in the hospital preparing for surgery. You may already be in the hospital receiving treatment for heart failure.

During this time, you will learn about the VAD and how to live with it. You and your caregivers will spend time with the surgeon and cardiologist to make sure you have all the information you need about VAD.

Before and after surgery, here are some things that you will learn:

  • How the VAD works.
  • How to safely handle VAD.
  • How to interpret and respond to alarms. (The device gives warnings, alarms, if the power is low or if it is not functioning properly.)
  • How to provide care in an emergency, such as the loss of electrical power.
  • How to wash and shower.
  • How the VAD may affect travel.

You can ask to see what the device looks like and how it will be attached inside your body. You may also meet someone who already has a VAD. This person can answer questions about what it is like to use the VAD and how to live with it.

Your doctor will make sure that your body is strong enough for surgery. If your doctor thinks your body is too weak, you may need to get additional nutrition through a feeding tube before surgery.

You may also have tests to make sure you are ready for surgery. These tests include:

  • Blood tests. Blood tests are done to check how well your heart and kidneys are working. Blood tests can also check the levels of blood cells and important chemicals in your blood.
  • Chest x-ray. This test creates images of the structures inside your chest, such as your heart and lungs. Chest X-rays can help your doctor prepare for surgery.
  • EKG (electrocardiogram). This test can check how well your heart is working before the VAD surgery. The EKG records your heart’s electrical activity
  • Echocardiography (echo). This test uses sound waves to create detailed images of your heart. The echo shows the size and shape of your heart and how well your heart chambers and valves are working

What to Expect During Ventricular Assist Device Surgery? 

A ventricular assist device (VAD) surgery usually takes between 4 and 6 hours. The process is similar to other types of open heart surgery.

The team for VAD surgery includes:

  • The surgeon who performs the surgery.
  • Surgical nurses who assist surgeons.
  • Anesthetists who are in charge of medications that put you to sleep during surgery.
  • Perfusionist who are in charge of the heart-lung bypass machine. This machine keeps blood flowing through your body while the VAD is placed on your chest.

Before the surgery, you will be given medicine to put you to sleep so that you will not feel sick. Your vital signs — such as heart rate, blood pressure, oxygen level, and breathing — will be examined throughout the surgery.

A breathing tube will be inserted into your lungs through your throat. This tube will be connected to a ventilator (a machine that helps you breathe).

You may be given medicine to stop your heart during the surgery. The medicines will allow your surgeon to operate on your heart. A heart-lung bypass machine will keep oxygen-rich blood moving through your body during the surgery. (Several LVAD surgeries have been performed without stopping the heart and using a heart-lung bypass machine.)

After the surgeon has properly placed the VAD, the heart-lung machine is turned off and the VAD starts working. This device supports blood flow and takes over the pumping function of the heart.

A cut is made down the center of your chest. The chest bone is then cut and your ribcage is opened so that the surgeon can get to your heart.

The surgeon will cut the center of your chest. Then, your chest bone is cut and your ribcage is open so that your surgeon can get to your heart.

What to Expect After Ventricular Assist Device Surgery? 

Apa yang Diharapkan Sesudah Operasi Alat Bantu Ventrikel. Sumber: Hellerhoff

Hospital Recovery

Recovery time after ventricular assist device (VAD) surgery highly depends on your condition before the surgery.

If you had severe heart disease before getting the VAD, your body may be weak and your lungs may not function properly. Thus, you may still need a ventilator (a machine that helps you breathe) for a few days after surgery. You may also need to continue getting nutrition through a feeding tube.

When you first wake up from VAD surgery, you will be in the hospital’s intensive care unit (ICU). The intravenous (IV) tube will provide you with fluids and nutrition. A tube is also placed in your bladder to drain urine. You will also have other tubes to drain blood and fluids from your chest and heart.

After a few days or so, depending on how quickly your body recovers, you will move to the usual hospital ward. A nurse who has experience with VAD will look after you.

The nurses will help you get out of bed, sit down, and walk around. As you get stronger, you will be able to go to the bathroom yourself and have a regular diet. The feeding and urine tubes will be removed. You can also take a shower. You will learn how to care for your VAD while taking a shower.

In the hospital, nurses and physical therapists will help you gain your strength through a gradual increase in activity. You will also learn how to care for your VAD at home.

You can have your family or friends visit you at the hospital. They can help you with many activities. They can also learn about caring for the VAD so they can help you when you get to go home.

Medications

After VAD surgery, you should watch for signs of infection. These signs may include soreness over the site of the VAD, fluid draining from where the tube or cable exits the skin or fever. If you have any of these signs, tell your doctor right away.

You may take antibiotics before and for a few days after the surgery. Antibiotics can lower your risk of getting an infection.

With most VADs, doctors also prescribe anti-clotting drugs, such as warfarin (Coumadin®) and aspirin. These medicines help prevent blood clots in your heart or VAD.

When you have a device implanted in your body, the risk of blood clots increases. You may need to take anti-clotting medicines for as long as you have the VAD. You will also have regular blood tests to make sure the medicines are working properly.

Take all of your medications as prescribed by your doctor. Let your doctor know if you experience any side effects.

Returning Home

After your initial recovery from VAD surgery, you will start preparing to go home. Your health care team will help prepare you for the transition.

The team may include a heart surgeon, cardiologist, critical care nurse, physical therapist, dietitian, and social worker.

The team will help you gradually adjust to living at home with the VAD. You will leave the hospital and go home for a few hours and then come back. Then, you may go home for a whole day and come back to the hospital to sleep.

If these trips go well, your doctor may discharge you from the hospital. If you have not recovered enough strength, you may be transferred to a special care facility for up to 2 weeks. This allows your medical team to make sure you are ready to go home.

Your medical team will also teach you how to live with VAD. You may get some of this information before your surgery. You will learn how to care for the VAD, what to do if the device warns you that the VAD is not working right, and how to perform everyday activities such as taking a shower.

Activity Level

When you go home after VAD surgery, you will likely be able to return to most of your normal daily activities. You may be able to return to work, engage in hobbies and sexual activities, and drive. Your medical team will advise you on the level of activity that is safe for you.

Travel

If you are waiting to get a heart transplant, you will need to stay within 2 hours in the hospital in case a donor heart is available.

If you are not waiting for a transplant and want to travel, your medical team can advise you on any special arrangements required. People who have VAD can fly in aeroplanes and use all other forms of transportation.

Nutrition and Exercise

While you recover from VAD surgery, it is vital to get good nutrition. Talk to your medical team about following a proper meal plan for recovery.

Supervised exercise is also important to give your body the strength it needs to recover. During times when your heart was not working right (before surgery), the muscles in your body weakened. Rebuilding muscle will allow you to do more activities and feel less tired.

Cardiac Rehab

Your health care team may recommend cardiac rehabilitation (rehab). Heart rehabilitation is a medically supervised program that helps improve the health and well-being of people who have heart problems.

Rehabilitation programs include exercise training, education for living a healthy heart life, and counseling to reduce stress and help you return to a more active life.

Continuous Care

You and your doctor will schedule follow-up medical visits. This will help the doctor keep track of how you are doing.

After you leave the hospital, your doctor may recommend that you visit an outpatient clinic every week for the first month. After that, you may go every other week and then every other month for a certain time.

If you are on the waiting list for a heart transplant, you may have to remain in close contact with the transplant center. Most donor hearts must be transplanted within 4 hours after removal from the donor.

Some heart transplant centers provide you with a pager so that the center can contact you at any time. You should be ready to arrive at the hospital within 2 hours of being notified about a donor heart.

Emotional Issues and Support

Getting a VAD may cause fear, anxiety, and stress. If you are waiting for a heart transplant, you may worry that a VAD will not keep you alive long enough to get a new heart. 

All of these feelings are normal for people who are going to have major heart surgery. You should talk about how you feel with your health care team. Talking to a professional counselor can also help.

If you are feeling very depressed, your doctor may prescribe medications or suggest other treatments that can help improve your quality of life.

Having family and friends around for support can also help relieve stress and anxiety. Let your loved ones know how you feel and what they can do to help you. They can play an important role in caring for you the moment you return home. 

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