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Definition
A heart assist system implantation, or VAD, is a compressed air or battery-operated, single chamber, artificial heart that boosts the function of a failing ventricle (the pumping chambers of your heart).
Because the left ventricle does the most work, it is usually the chamber that fails first. Instead of replacing the entire heart with a transplant or a mechanical heart, a VAD can improve the performance of the heart with an operation of lesser magnitude. These devices are most often used while awaiting a transplant.
Left Ventricular Assist Device
2008 Nucleus Medical Art, Inc.
Parts of the Body Involved
- The heartMost often it is the left ventricle that needs assistance, but occasionally a VAD will assist the right ventricle.
Reasons for Procedure
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.
Risk Factors for Complications During the Procedure
If you have a blood clotting disorder or are very small, you may not qualify for a VAD; the device is bulky. If you have a serious infectious disease or advanced disease of vital organs other than the heart, your risk is higher, and you may not qualify for the procedure.
What to Expect Prior to Procedure You will be very ill with a failing heart and most likely on the list to receive a heart transplant when one becomes available. You will probably be in the hospital already when the decision is made to implant a VAD. Therefore, you will have been evaluated extensively, including an echocardiogram and possibly contrast x-rays. Anesthesia You will be put to sleep with a general anesthetic . Description of the ProcedureThis is open heart surgery. An incision will be made down the length of your breast bone, which will then be split and separated so that your chest is wide open. You will be placed on a heart-lung machine that will take the place of your heart and lungs during the surgery. The device will be placed into a pocket in your abdominal wall and sewn into your heart and possibly your aorta (depending upon the particular device used). After ProcedureUpon awakening you will be in an intensive care unit (ICU) with multiple tubes and medical personnel surrounding you. You will spend 2-5 days in the ICU and 2-4 weeks in a regular hospital room before going home. After discharge, you will be in continuous touch with the heart center and will most likely be awaiting a heart transplant. As you recover, your permitted activity will increase; you may even be able to return to work.
How Long Will It Take?Approximately 4-8 hours Will It Hurt?You will be asleep during the procedure. Afterward, there will be the usual incisional pain and general discomfort of having been through major surgery. Possible ComplicationsSurgery does not get more major than this. Bleeding, infection, blood clots, medication reactions, kidney, and lung problemsall of these and more are potential complications. Preventing problems is a principal reason for the long stay in the hospital. Average Hospital StayYou will spend 2-5 days in the ICU and 2-4 weeks in a regular hospital room. Postoperative CareA VAD will allow you to live at home. There will be a list of instructions on what you can do and what you must do that includes activities, a menu, return visits to the heart center, and reasons to call for help. You will most likely be prescribed blood thinners to prevent blood clots. You will probably be required to have a means of contacting a heart center, such as a pager or a panic button connected to your phone, immediately available 24 hours a day. OutcomeBarring complications and depending upon your overall health status, you may be able to return to full activity. Call Your Doctor If Any of the Following Occurs You will receive extensive instructions for taking care of your VAD and for reporting to the heart center. Among the events you will need to report are:
BleedingIncreasing or unremitting painFeverDrainage from an incisionStroke symptoms A cold, pale or blue, numb, or painful extremityDifficulty breathingProblems with urination or bowel movementsNausea, vomitingWarning indications from the device RESOURCES: American Heart Associationhttp://www.americanheart.org Mount Sinai School of Medicinehttp://www.mssm.edu Cleveland Clinichttp://www.clevelandclinic.org US Food and Drug Administrationhttp://www.fda.gov CANADIAN RESOURCES: Heart and Stroke Foundation of Canadahttp://ww2.heartandstroke.ca University Health Networkhttp://www.uhn.ca References: Cleveland Clinic website. Available at: http://www.clevelandclinic.org/heartcenter/pub/guide/disease/heartfailure/lvad.htm . Accessed August 26, 2005. The Michael E. DeBakey Department of Surgery. Baylor College of Medicine website. Available at: http://www.debakeydepartmentofsurgery.org/ . Accessed August 26, 2005. Last reviewed November 2007 by J. Peter Oettgen, MDPlease 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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