In cases of improper heart functioning or heart failure, a Ventricular Assist Device (VAD) is implanted inside the person's body to help the heart in pumping blood to the rest of the body. VADs are placed in the bottom sections of the heart known as ventricles. The device used in the right ventricle is termed as Right Ventricular Assist Device (RVAD) or if used in the left ventricle is termed as Left Ventricular Assist Device (LVAD). However, in severe cases, a doctor might use both the RVAD and LVAD and it is then called the Bi-Ventricular Assist Device (BIVAD). A transplantable VAD generally has its pump inside the body, but the power source remains outside.
What is the need of VADs?
The doctor may recommend the VAD implantation to the patient in the following conditions:
- When the patient is waiting for a heart transplant: VAD implantation may be implanted temporarily while the patient is waiting for a donor heart to become available.
- The patient's heart's function can become normal again: If the heart failure is temporary, the doctor may recommend implanting a VAD until the patient's heart is healthy enough to pump blood on its own again. This is referred to as "bridge to recovery."
- During or after having heart surgery: It's also possible that the doctor may recommend a VAD implantation for a short time during or after having heart surgery. The patient may have a VAD implanted for a few weeks to months.
If a VAD can't help the heart, then the doctor may consider a total artificial heart as a treatment option. This device replaces the two lower heart chambers of the patient's heart. This option can be considered only in people with severe heart failure whose conditions haven't improved through other treatments.
Test and Diagnosis for VAD Implantation
Before going for the VSD Implantation, the doctor will make sure that the patient's body is strong enough for the surgery. If the doctors think the patient is not fit for the surgery, he/she may need to get extra nutrition through a feeding tube.
The patient also may have the following tests to make sure he/she is ready for surgery. These tests may include:
- Blood tests: Blood tests are done to check how well the liver and kidneys of the patient are working. Blood test results also help the doctor to understand the levels of blood cells and important chemicals in the blood.
- Chest x-ray: This test is done to create pictures of the inside of the chest that help the doctor prepare for surgery.
- ECG (electrocardiogram): This test is used to check how well the patient's heart is working before the VAD surgery.
- Echocardiography (echo): This test is done to create a detailed picture of the patient's heart. Echo provides information about the size and shape of the heart and how well the heart's chambers and valves are working.
VAD Surgery Procedure
Before Ventricular Assist Device Surgery
Before the patient get a ventricular assist device (VAD), he/she will spend some time in the hospital to prepare for the surgery.
During this time, the patient will learn about the VAD and how to live with it. The patient and caregivers will spend time with the surgeon, cardiologist and nurses to make sure he/she has all the required information about the VAD.
Before and/or after the surgery, the patient and their caregivers will learn:
- How does the Ventricular Assist Device work?
- Required safety precautions
- How to interpret and respond to alarms. (The device gives warnings, if the power is low or if it senses that it isn't working properly.)
- How to wash and shower
- How to care in case of emergency, such as the loss of electrical power
- How the VAD may affect travel
During Ventricular Assist Device (VAD) Surgery
- Ventricular assist device surgery is performed under general anesthesia and usually takes between 4 to 6 hours. The VAD surgery procedure is similar to that of other types of open-heart surgery.
- During the surgery, the anesthesiologist checks the patient's heartbeat, blood pressure, oxygen levels and breathing.
- A breathing tube is placed in the lungs through your throat. This tube is connected to a machine that helps the patient breathe known as a ventilator.
- An incision is made down the center of the chest. The chest bone is then cut and the ribcage is opened so that the surgeon can reach the heart.
- Medicines are used to stop the heart during surgery. This allows the surgeon to operate on the heart while it's not functioning.
- A heart-lung bypass machine is attached to keep the oxygen-rich blood moving through the body. However, in some cases, LVAD surgeries may have been done without using a heart-lung bypass machine.
- When the Ventricular assist device is attached properly, the heart-lung machine is switched off.
Recovery in the Hospital
- Recovery time after VAD (ventricular assist device) surgery depends on the condition of the patient before the surgery.
- If the patient had severe heart disease for a while before getting the VAD, the body might be weak, and the lungs may not work very well. Thus, the patient may still need a ventilator for several days after surgery. The patient continues getting nutrition through a feeding tube.
- The patient will have an intravenous (IV) tube to give the fluid and nutrition and also have a tube in the bladder to drain urine. In addition to this, the patient may have other tubes to drain blood and fluid from the chest and heart.
- In the hospital, physical therapists and nurses will help the patient gain strength through gradual increase inactivity.