Ventricular assist device

Answer 1

Definition

Ventricular assist devices (VAD) help your heart pump blood from the main pumping chamber of your heart (the left ventricle) to the rest of your body. These pumps may be implanted in your body or connected to a pump outside your body.

Alternative Names

VAD; RVAD; LVAD; BVAD; Right ventricular assist device; Left ventricular assist device; Biventricular assist device; Heart pump; Left ventricular assist system; LVAS; Implantable ventricular assist device

Description

A ventricular assist device has three parts:

• A pump. The pump weighs 1 to 2 pounds. It is placed in your belly if you will need it permanently, or it may also be used outside of your body when you are waiting for a permanent pump or a heart transplant.
• An electronic controller. The controller is like a small computer that controls how the pump works.
• Two batteries. The batteries are carried outside your body. They are connected to the pump with a cable that goes into your belly

You will need general anesthesia when your VAD is implanted. This will make you unconscious and unable to feel pain during the procedure.

During surgery to implant the pump, the heart surgeon opens the middle of your chest with a surgical cut and then separates your breastbone. This allows the surgeon to reach your heart. Next, the surgeon will make space for the pump under your skin and tissue in the upper part of your belly wall. Then, the surgeon will place the pump in this space.

A tube will connect the pump to your heart. Another tube will connect the pump to your aorta or one of your other major arteries. Another tube will be passed through your skin to connect the pump to the controller and batteries.

The VAD will take blood from your left ventricle through the tube that leads to the pump. Then the device will pump the blood back out to one of your arteries and through your body.

Surgery usually lasts 4 to 6 hours.

Why the Procedure Is Performed

You may need a VAD if you have severe heart failure that cannot be controlled with medicine or a special pacemaker. You may be on a waiting list for a heart transplant. Some patients who get a VAD are very ill and may already be on a heart-lung bypass machine.

Not every patient with severe heart failure is a good candidate for this procedure.

Risks

Risks for this surgery are:

• Blood clots in the legs that may travel to the lungs
• Breathing problems
• Heart attack or stroke
• Allergic reactions to the anesthesia medicines used during surgery
• Infections

Before the Procedure

Most people will already be in the hospital for treatment of their heart failure.

After the Procedure

Most people who are put on a VAD spend up to 5 days in the intensive care unit after surgery. You may stay in the hospital anywhere from 2 to 8 weeks after you have had the pump placed. During this time you will learn how to care for the pump.

Outlook

A VAD may help people who have heart failure live longer. It can also help improve quality of life.

References

Naka Y and Rose EA. Assisted circulation in the treatment of heart failure. In: Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 8th ed. St. Louis, Mo; WB Saunders; 2007:chap. 28.

Slaughter MS, Rogers JG, Milano CA, et al. Advanced heart failure treated with continuous-flow left ventricular assist device. N Engl J Med. 2009 Dec 3;361(23):2241-51.