• Heart Assist System Implantation

    (Ventricular Assist Device; VAD)

    Definition

    A heart assist system implantation (also called a ventricular assist device, or VAD) is an artificial heart. This single-chamber artificial heart works by compressed air or battery power. The device boosts the function of a failing heart ventricle.
    Left Ventricular Assist Device
    Nucleus image
    Copyright © Nucleus Medical Media, Inc.

    Reasons for Procedure

    Heart failure occurs when the heart is too weak to pump all the blood it receives and blood begins to back up. Blood can back up into the lungs and into the lower parts of the body. This can trouble breathing, cough, and swelling of the legs and ankles.
    Getting a VAD is a way to improve the heart's ability to pump without having a heart transplant. A VAD is sometimes referred to as a bridge to transplant, since it can be used to maintain people awaiting a heart transplant. This device can also be used for permanent treatment in people who:
    • Are not candidates for transplant
    • Do not respond to standard treatment
    • Have a low risk of surviving one year

    Possible Complications

    If you are planning to have VAD implantation, your doctor will review a list of possible complications, which may include:
    • Bleeding
    • Blood clots
    • Infection
    • Device failure
    • Adverse reaction to the anesthesia
    • Kidney, lung, or heart damage
    Factors that may increase the risk of complications include having:
    • A serious infectious disease
    • Advanced disease of vital organs other than the heart
    • Blood clotting disorder
    Also, if you have a small stature, you may not be able to get a VAD. The device is bulky. Newer generation continuous flow devices, which are much smaller, are being studied.
    Be sure to discuss these risks with your doctor before the surgery.

    What to Expect

    Prior to Procedure

    If you need a VAD, it is because your heart is failing. Most likely, you will be on a list to receive a heart transplant. You may already be in the hospital. Your doctor will do many tests, for example:
    • Echocardiogram —size, shape, and motion of the heart are examined using sound waves
    • X-ray —uses radiation to take a picture of structures inside the body
    • Cardiac Catheterization —to look for coronary artery disease
    • Psychological and social system evaluations to make sure you are prepared to manage the device outside of the hospital
    Leading up to the procedure, your doctor will instruct you to:
    • Avoid eating for 8 hours before the procedure
    • Stop taking aspirin or other anti-inflammatory drugs for one week before surgery. You may also need to stop taking blood-thinning medicines, such as:
      • Clopidogrel (Plavix)
      • Warfarin (Coumadin)

    Anesthesia

    General anesthesia will be used. It will block any pain and keep you asleep through the surgery.

    Description of the Procedure

    This procedure involves open heart surgery. The doctor will make an incision down the length of your breast bone. The breast bone will then be split and separated. You will be placed on a heart-lung machine. This machine will take the place of your heart and lungs during the surgery. The doctor will place the VAD into a pocket on the inside of the abdominal wall. The device will be sewn into your heart. It may also be sewn into your aorta, depending on the type of device.

    Immediately After Procedure

    You will be in the intensive care unit (ICU) after the procedure. You will be connected to many tubes. The medical staff will monitor you.

    How Long Will It Take?

    About 4-8 hours

    How Much Will It Hurt?

    You will have pain from the surgery. Ask your doctor about medicine to help with the pain.

    Average Hospital Stay

    • 2-5 days in the ICU
    • 2-4 weeks in a regular hospital room

    Postoperative Care

    At Home
    When you return home, do the following to help ensure a smooth recovery:
    • Stay in contact with the heart center. You may be waiting for a heart transplant.
    • Slowly increase your activity as instructed. Ask your doctor if you will be able to return to work.
    • As prescribed by your doctor, take blood thinners. These will prevent blood clots.
    • Be sure to follow your doctor’s instructions. She will tell you:
      • How to take care of your VAD
      • When to contact the hospital—Make sure that you know how to call your doctor if you have an emergency.
    Ask your doctor about when it is safe to shower, bathe, or soak in water.

    Call Your Doctor

    After you leave the hospital, contact your doctor if any of the following occurs:
    • Signs of infection, including fever and chills
    • Redness, swelling, increasing pain, excessive bleeding, or any discharge from the incision site
    • Increasing pain
    • One-sided weakness, blurry vision, or inability to talk
    • A cold, pale or blue, numb, or painful extremity
    • Cough, difficulty breathing, or chest pain
    • Nausea, vomiting
    • Problems with urination or bowel movements
    • Redness or swelling in legs.
    • Warning indications from the device
    In case of an emergency, call for medical help right away.

    RESOURCES

    American Heart Association http://www.americanheart.org

    United States Food and Drug Administration http://www.fda.gov

    CANADIAN RESOURCES

    Health Canada http://www.hc-sc.gc.ca/index%5Fe.html

    Heart and Stroke Foundation of Canada http://ww2.heartandstroke.ca/splash

    References

    HFSA 2006 Comprehensive Heart Failure Practice Guideline

    Implantable ventricular assist device (VAD). Cleveland Clinic website. Available at: http://www.clevelandclinic.org/heartcenter/pub/guide/disease/heartfailure/lvad.htm . Accessed September 4, 2009.

    The Michael E. DeBakey Department of Surgery, Baylor College of Medicine website. Available at: http://www.debakeydepartmentofsurgery.org/ . Accessed September 4, 2009.

    The Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure (REMATCH) trial. NEJM. 2001 Volume345:1435-1443

    Slaughter M, Milano C, Russel S, et al. Advanced heart failure treated with continuous-flow ventricular assist device. N Engl J Med. 2009; DOI:101056/NEJMoa0909938. Available at: http://www.nejm.org .

    3/6/2013 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php: Peura JL, Colvin-Adams M, Francis GS, et al. Recommendations for the use of mechanical circulatory support: device strategies and patient selection: a scientific statement from the American Heart Association. Circulation. 2012;126(22):2648-2667.

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