A ventricular assist device (VAD) - also known as a mechanical circulatory support device - is an implantable mechanical pump that helps pump blood from the lower chambers of your heart (the ventricles) to the rest of your body. A VAD is used in people who have weakened hearts or heart failure.
Although a VAD can be placed in the left, right or both ventricles of your heart, it is most frequently used in the left ventricle. When placed in the left ventricle it is called a left ventricular assist device (LVAD).
You may have a VAD implanted while you wait for a heart transplant or for your heart to become strong enough to effectively pump blood on its own. Your doctor may also recommend having a VAD implanted as a long-term treatment if you have heart failure and you're not a good candidate for a heart transplant.
The procedure to implant a VAD requires open-heart surgery and has serious risks. However, a VAD can be lifesaving if you have severe heart failure.
Why a ventricular assist device procedure is performed?
A ventricular assist device (VAD) is a mechanical device that supports the lower left heart chamber (left ventricular assist device, or LVAD), the lower right heart chamber (right ventricular assist device, or RVAD) or both lower heart chambers (biventricular assist device, or BIVAD). Your doctor may recommend you have a VAD implanted if:
Risks associated with ventricular assist device procedure
- You're waiting for a heart transplant. You may have a VAD implanted temporarily while you wait for a donor heart to become available.
- You're not currently eligible for a heart transplant because of other conditions. A VAD may sometimes be implanted if you have heart failure, but you're not yet eligible for a heart transplant due to other medical conditions. Your doctor may not have decided whether you're eligible for a heart transplant or a VAD as a permanent treatment.
- Your heart's function can become normal again. If your heart failure is temporary, your doctor may recommend implanting a VAD until your heart is healthy enough to pump blood on its own again. This is referred to as "bridge to recovery."
- You're not a good candidate for a heart transplant. VADs are increasingly being used as a long-term treatment for people who have heart failure but aren't good candidates for a heart transplant. Generally if you're older than age 65, you may not be eligible for heart transplantation. In that situation the VAD would be implanted as therapy for heart failure. A VAD can enhance your quality of life.
Implanting and using a ventricular assist device (VAD) involves risks that may include:
Diagnostic lab tests before a ventricular assist device procedure
- Blood clots. As your blood moves through your VAD, blood clots may form. Blood clots can slow or block normal blood flow through your heart, which can lead to stroke or heart attack, or cause your VAD to stop working.
- Bleeding. Implanting a VAD requires open-heart surgery. Having open-heart surgery can increase your risk of bleeding during or after your procedure. Taking blood-thinning medications to reduce your risk of blood clotting also increases your risk of dangerous bleeding into the gastrointestinal tract and the brain.
- Infection. Because the power source and control unit for your VAD are located outside your body and are connected through a port in your skin, there's an increased risk of germs getting in the port and causing a serious infection.
- Device malfunctions. It's possible that your VAD may stop working properly after it's implanted. The pumping action of the device might not work correctly, making it so not enough blood pumps through your heart. The power supply to the device could also fail, or other parts of the device may quit working properly. Each of these problems requires immediate medical attention.
- Right heart failure. If you have an LVAD implanted, it will pump more blood from the left ventricle of your heart than what your heart might have been used to. Your right ventricle may be too weak to pump the increased amount of blood.
Your doctor will also evaluate your condition and ensure that you're healthy enough for surgery to implant a VAD. Your doctor may order several tests, including:
Results of a ventricular assist device procedure
- Echocardiogram. In an echocardiogram, sound waves are used to produce a video image of the heart. Your doctor uses an echocardiogram to determine the pumping function of your heart, check your heart valves and help determine the cause of your heart failure. This can help your doctor decide if you're a candidate for a VAD or if another treatment option may be appropriate.
- Chest X-ray. An X-ray image helps your doctor to see the size and shape of your heart and lungs.
- Blood tests. Your doctor may order blood tests to check your liver, kidney and thyroid function before surgery to implant a VAD. Your doctor might also test for other chemicals in your blood that show how well your heart is working. Blood tests may also be used to check for symptoms of infection, which need to be treated before surgery.
- Electrocardiogram (ECG). An electrocardiogram records the electrical activity of your heart. An ECG measures the timing and duration of each electrical phase in your heartbeat.
- Cardiac catheterization. In this test, a doctor inserts a thin, flexible tube (catheter) into a vein or artery in your upper leg (groin), arm or neck and guides it to your heart using X-ray imaging. Doctors may use this test to measure the pressure and blood flow in your heart. This test may help your doctor determine if you're a candidate for a VAD or if you may need alternative devices.
You'll likely have follow-up appointments with your doctor once a week for the first month after your procedure to check how well your ventricular assist device (VAD) is working and to check for complications.
Follow-up appointments may include a physical examination, several tests and an evaluation of the device's function. You'll generally need follow-up appointments less frequently over a period of time, as you continue to recover.
Your doctor may also recommend that you participate in a cardiac rehabilitation program. Cardiac rehabilitation is a customised program of exercise and education, designed to help you improve your health and recover from a heart attack, other forms of heart disease or surgery to treat heart disease.