What is it?
A ventricular assist device (VAD) is a small mechanical pump implanted in the chest to help a weakened or failed heart circulate blood throughout the body. VADs ensure that adequate blood flow and pressure is maintained.
A VAD is a life-sustaining device. VADs that support the left ventricle of the heart are known as LVADs, while VADs that support the right ventricle of the heart are known as RVADs. There are also VADs that support both ventricles of the heart simultaneously, known as BIVADs.
At the CHF/Transplant/VAD Center of Excellence at St.Vincent Heart Center of Indiana, our ultimate goal is to do whatever we can to help patients keep the heart they have, which is especially important as the supply of donor hearts continues to diminish. And the ventricular assist device, or VAD, enables us to do just that. For patients with temporary heart failure, the assistance of a VAD can help the heart recover. For patients who are not good candidates for a heart transplant, a VAD is often their only option for long-term heart failure treatment. And for patients awaiting a heart transplant, a VAD give can them the strength they need until a new heart becomes available.
Who is a candidate for a VAD?
While one in five people suffer left side ventricular failure, only a minority are candidates for VADs. Examples of patients who may be candidates for a VAD include:
- Patients who have suffered a massive heart attack
- Patients who cannot be weaned from a heart-lung bypass machine after treatment with intravenous fluids, medications, and the insertion of a balloon pump in the aorta
- Patients who have an infection in the heart wall that does not respond to conventional treatment
- Patients waiting for a heart transplant who are unresponsive to drug therapy and intravenous fluids
- Patients with the following conditions:
- Congenital heart defects
- Coronary artery disease
- Heart valve disease
- Life-threatening arrhythmia
- Patients who are poor candidates for VADs include those with:
- Severe disease of the vascular system of the brain
- Cancer that has spread (metastasized)
- Severe liver disease
- Blood clotting disorders
- Severe lung disease
- Infections that don’t respond well to antibiotics
- Extreme youth or age
How are VADs implanted?
The technology has improved over the years, and today’s VADs are smaller, more reliable, and easier to implant. Surgery to implant a VAD is performed under general anesthesia. An incision is made in the chest, and catheters are inserted into the heart and proper artery. The surgeon sutures the catheters in place, and attaches tubing to connect the catheters to the pump. Once it’s turned on, blood flows out of the diseased ventricle and into the pump, where it’s returned to the correct blood vessel leaving the heart.
In many cases, patients who have received a VAD implant will require intensive inpatient rehabilitation. While patient circumstances vary, total length of stay at both St.Vincent and the rehabilitation center can range between two weeks and three months. Patients also receive in-depth education on how to properly care for his or her new VAD.
As the technology continues to advance, VADs are being considered more and more as a treatment for heart failure and heart disease.