Ventricular Assist Device (VAD) Implantation: Indications, Preparation and Procedure
The Ventricular Assist Device (VAD) is an important innovation in heart care, providing hope for people with severe heart failure. It is a mechanical pump that helps the heart pump blood, reducing the strain on the weakened heart muscles. This device has changed the way heart failure is treated, helping many patients live longer and better lives when other options are limited. In some cases, an artificial heart pumping machine may be used as a temporary solution while waiting for a heart transplant.
Advantages of Ventricular Assist Device (VAD) Surgery
- Improved Heart Function: VADs help in pumping blood effectively, enhancing circulation and ensuring vital organs receive the necessary blood supply.
- Bridge to Transplant: VADs are often used as a temporary solution for patients awaiting a heart transplant, maintaining heart function while waiting for a donor.
- Long-term Heart Support: For patients who are not candidates for a heart transplant, a VAD can be used as long-term support to manage severe heart failure.
- Better Quality of Life: Many patients experience reduced symptoms like shortness of breath, fatigue, and swelling, allowing them to engage in daily activities with improved energy levels.
- Reduced Hospitalization: By stabilizing the heart, a VAD can lower the frequency of hospital visits and improve overall stability, reducing the risk of further complications.
Types of Ventricular Assist Device (VAD) Surgery
- Left Ventricular Assist Device (LVAD): The most common type, this device helps pump blood from the left ventricle to the rest of the body, especially in cases of left-sided heart failure.
- Right Ventricular Assist Device (RVAD): Used to support the right side of the heart, often in cases where the right ventricle is weakened.
- Biventricular Assist Device (BIVAD): This type supports both the left and right ventricles when both sides of the heart are severely compromised.
- Total Artificial Heart (TAH): An advanced option, the TAH completely replaces both ventricles in patients with severe heart failure, offering a full replacement for the heart’s pumping function.
What are the Indications for LVAD?
Your heart doctor might suggest a ventricular assist device (LVAD) in the following situations:
- If you’re awaiting a heart donor for transplant.
- If you’re ineligible for a heart transplant due to factors such as age or other considerations.
- If you’re currently experiencing temporary heart failure.
Who will treat Ventricular Assist Device?
Implanting a VAD (Ventricular Assist Device) involves a team of medical experts, including cardiac surgeons, cardiologists, cardiac nurses, and VAD coordinators. The process begins with a detailed assessment to determine if the patient is a good candidate for the device. Typically, cardiologists start the process by referring patients to specialized heart failure centers for further evaluation. The use of cardiac assist devices such as a VAD can significantly support heart function for patients with severe heart failure.
For anyone seeking information about heart pump machines or considering the procedure, it’s advisable to contact a reputable heart failure centre or a cardiologist to begin the assessment process.
How to Prepare for Ventricular Assist Device?
Your healthcare team explains the procedure, discusses risks, addresses concerns, and reviews advance directives. Discuss hospital stay and home support needs with family. Here are some of the points to consider to get prepared for VAD Implantation:
- Pre-surgery Assessments: Review medical history, optimize therapy, conduct tests (blood, echocardiogram, etc.), assess fluid status and device compliance.
- Pre-surgery Tests: Blood tests, ECG , chest X-ray, and echocardiogram are done.
- Day Before Surgery: Ensure bowel movement, pack essentials, and refrain from eating/drinking after midnight.
- Day of Surgery: Continue fasting, undergo hair clipping, wash with antibacterial soap, and wear hospital gown, removing makeup, nail polish, and jewelry.
What Happens During Ventricular Assist Device Implantation?
VAD implantation is a major surgical procedure typically performed under general anesthesia. Here are the steps involved in the Ventricular Assist Device Implantation procedure:
- First, you receive local anesthesia, followed by general anesthesia to induce sleepiness.
- Next, a tube may be inserted into your throat to assist with breathing during surgery.
- The surgery takes place in a cardiothoracic room dedicated to heart and chest operations.
- The surgeon incises the breastbone to access the heart and exposes it.
- A heart-lung machine assumes the role of pumping the heart and enriches the blood with oxygen.
- Blood is diverted into a bypass machine to aid in its circulation.
- The surgeon halts the heart’s function by administering a cold solution.
- The VAD (Ventricular Assist Device) is inserted and evaluated for functionality.
- Finally, the blood is returned to the heart via the machine.
Recovery after Ventricular Assist Device Implantation
The recovery period post-VAD implantation can vary from patient to patient, but it generally involves a hospital stay of several weeks.
- Medical teams monitor progress, adjust settings, and administer medications.
- Physical therapy aids strength and mobility recovery.
- Training on VAD management, maintenance, and complication recognition is crucial for patients and caregivers.
Risks of Ventricular Assist Device Surgery
- Infection: As with any surgery, there is a risk of infection around the device or surgical site.
- Blood Clots: Blood clots can form in the VAD, potentially causing complications like strokes or device malfunction.
- Bleeding: Since patients are often on blood thinners, there is a risk of excessive bleeding during or after the surgery.
- Device Malfunction: If the VAD experiences mechanical failure or malfunctions, it could cause complications that need prompt attention.
- Arrhythmias: After surgery, irregular heart rhythms may develop and may require further treatment.
- Organ Damage: Long-term use of a VAD or complications from the device can cause damage to other organs, such as the kidneys or liver.
Lifestyle Changes after Ventricular Assist Device
Living with a VAD (Ventricular Assist Device) can bring about major changes, but it can also give patients a chance for a better quality of life. It’s important for patients to follow a heart-healthy diet, engage in light physical activity as advised by their healthcare team, and manage stress. Regular check-ups are necessary to track the device’s performance and the patient’s health.
Patients may need to make some lifestyle changes, such as limiting certain physical activities, avoiding water-based activities that could harm the device, and performing daily maintenance routines for the device.
