Ventricular Assist Device

Ventricular Assist Devices (VADs) are mechanical devices designed to assist or replace the function of a failing heart. These devices are used in patients with advanced heart failure to improve blood flow, relieve symptoms, and increase survival. VADs are implanted surgically and can be used as a bridge to heart transplantation or as destination therapy for patients who are not eligible for transplantation.

 

Types of VADs

There are different types of VADs available, including:

  • Left Ventricular Assist Devices (LVAD): These devices are implanted to support the left ventricle, which is responsible for pumping oxygenated blood to the body.
  • Right Ventricular Assist Devices (RVAD): These devices are used to support the right ventricle, which pumps deoxygenated blood to the lungs.
  • Biventricular Assist Devices (BiVAD): These devices support both the left and right ventricles and are used when both sides of the heart are failing.

 

Treatments and Conditions

VADs are used in the treatment of end-stage heart failure, a condition where the heart can no longer pump blood effectively to meet the body’s needs. VADs can be used as:

  • Bridge to transplantation: When a patient is awaiting a heart transplant, a VAD can be implanted to support heart function until a suitable donor heart becomes available.
  • Destination therapy: For patients who are not eligible for heart transplantation, VADs can be used as long-term or permanent therapy to improve quality of life and prolong survival.

 

Why it’s needed

VADs are needed to improve survival and quality of life. Our outcomes are better than currently published data, with over 90% survival at one year and over 50% survival at five years. In addition:

  • Improve blood flow: VADs help the heart pump blood effectively throughout the body, improving circulation and relieving symptoms such as fatigue, shortness of breath, and fluid retention.
  • Support heart function: In advanced heart failure, the heart’s pumping ability is severely compromised. VADs provide mechanical support, taking over the pumping function and reducing the workload on the failing heart.
  • Bridge to transplantation: VADs can keep patients alive and stabilize their condition while they wait for a suitable donor heart for transplantation.
  • Provide long-term support: For patients who are not eligible for transplantation, VADs can serve as long-term or destination therapy, improving their quality of life and extending survival.

 

Before the procedure

Before VAD implantation, preparation may include:

  • Medical evaluation: You will undergo a thorough medical assessment, including imaging tests, blood tests, and assessments of heart and lung function.
  • Optimization of medical condition: Your healthcare team may recommend medications or treatments to stabilize your heart failure and other medical conditions before the procedure.
  • Education: You and your caregivers will receive education about the VAD implantation process, including the device, its care, and potential complications.
  • Lifestyle modifications: Your healthcare provider may recommend lifestyle changes, such as quitting smoking or making dietary modifications, to optimize your overall health.

 

During the procedure

During VAD implantation:

  • Anesthesia: General anesthesia is administered to ensure you are asleep and pain-free throughout the procedure.
  • Incision: The surgeon makes an incision in the chest to access the heart.
  • Device implantation: The VAD is implanted, with the inflow and outflow cannulas connected to the appropriate chambers of the heart. The device is then connected to an external controller and power source.
  • Chest closure: The incision is closed using sutures or staples.

 

After the procedure

After VAD implantation:

  • Hospital stay: You will be closely monitored in the intensive care unit (ICU) for several days following surgery. The length of stay may vary depending on your condition and recovery progress, but we aim to get all patients out of hospital within three weeks of the surgery.
  • Recovery and rehabilitation: Once stable, you will be transferred to a regular hospital room for further recovery and rehabilitation. Physical and occupational therapy may be provided to help regain strength and mobility.
  • Device management: Your healthcare team will train you and your caregivers on how to care for the VAD, including driveline exit site care, battery management, and emergency procedures.
  • Follow-up care: Regular follow-up visits will be scheduled to monitor your progress, make adjustments to medications, and evaluate device function.

 

Advantages

  • Improved quality of life: VADs can alleviate symptoms of heart failure, such as shortness of breath and fatigue, allowing for a better quality of life.
  • Bridge to transplantation: VADs can keep patients stable and alive while they await a heart transplant.
  • Destination therapy: For patients who are not eligible for transplantation, VADs offer long-term support, improving survival and quality of life.
  • Compact and portable: Some VAD models are smaller and more portable, allowing for greater mobility and freedom for patients.

 

Risks

VAD implantation carries certain risks and complications, including:

  • Bleeding during or after the procedure
  • Infection at the surgical site or driveline exit site
  • Blood clots or stroke
  • Device malfunction or failure
  • Arrhythmias (abnormal heart rhythms)
  • Right heart failure
  • Kidney or liver dysfunction
  • Gastrointestinal bleeding
  • Complications related to anesthesia

It is important to remember that when the heart is deemed too sick needing an LVAD, this means that it is associated with 90% mortality if left untreated. Such therapy that we offer at UTHealth will dramatically change survival and improve quality of life to all those who need it, despite the risks.

Results and post-procedure care

At home, you will need to follow the instructions provided by your healthcare team for VAD care, including driveline site care, battery management, medication adherence, and regular follow-up appointments.

VADs can significantly improve symptoms, quality of life, and survival in patients with advanced heart failure. However, individual outcomes may vary depending on the underlying condition, overall health, and adherence to post-implantation care.