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Heart Assist System Implantation(Ventricular Assist Device; VAD)
Definition

A heart assist system implantation is an artificial heart. It is also called a ventricular assist device (VAD). This single-chamber artificial heart works by compressed air or battery power. The device boosts the function of a failing heart ventricle.

Left Ventricular Assist Device

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Reasons for Procedure

Heart failure occurs when the heart is too weak to pump all the blood it receives and blood begins to back up. Blood can back up into the lungs and into the lower parts of the body. This can cause trouble breathing, cough, and swelling of the legs and ankles.

Getting a VAD is a way to improve the heart's ability to pump without having a heart transplant. A VAD is sometimes referred to as a bridge to transplant, since it can be used while a person is waiting for a heart transplant. This device can also be used for permanent treatment in people who:

  • Are not candidates for transplant
  • Do not respond to standard treatment
  • Have a low risk of surviving one year
Possible Complications

If you are planning to have VAD implantation, your doctor will review a list of possible complications, which may include:

  • Bleeding
  • Blood clots
  • Infection
  • Device failure
  • Adverse reaction to the anesthesia
  • Kidney, lung, or heart damage

Factors that may increase the risk of complications include:

  • A serious infectious disease
  • Advanced disease of vital organs other than the heart
  • Blood clotting disorder
  • Excessive alcohol consumption
  • Smoking

Also, if you have a small stature, you may not be able to get a VAD due to the size of the device.

Be sure to discuss these risks with your doctor before the surgery.

What to Expect
Prior to Procedure

If you need a VAD, it is because your heart is failing. Most likely, you will be on a list to receive a heart transplant. You may already be in the hospital. Your doctor will do many tests, including:

Leading up to the procedure, your doctor will instruct you to:

  • Avoid eating for 8 hours before the procedure
  • Stop taking certain medications for one week before surgery. Medications often stopped include:
    • Anti-inflammatory medications, such as ibuprofen
    • Blood thinners
    • Anti-platelet medications
Anesthesia

General anesthesia will be used. It will block any pain and keep you asleep through the surgery.

Description of the Procedure

This procedure involves open heart surgery. The doctor will make an incision down the length of your breast bone. The breast bone will then be split and separated. You will be placed on a heart-lung machine. This machine will take the place of your heart and lungs during the surgery. The doctor will place the VAD into a pocket on the inside of the abdominal wall. Tubes will be sewn to your heart. Tubes may also be sewn to your aorta, depending on the type of device.

Immediately After Procedure

You will be in the intensive care unit (ICU) after the procedure. You will be connected to many tubes. The medical staff will monitor you.

How Long Will It Take?

About 4-8 hours

How Much Will It Hurt?

You will have pain from the surgery. Ask your doctor about medications to help with the pain.

Average Hospital Stay
  • 2-5 days in the ICU
  • 2-4 weeks in a regular hospital room
Postoperative Care
At Home

When you return home, do the following to help ensure a smooth recovery:

  • Stay in contact with the heart center. You may be waiting for a heart transplant.
  • Slowly increase your activity as instructed. Ask your doctor if you will be able to return to work.
  • Take blood thinners as advised by your doctor. These will prevent blood clots.
  • Be sure to follow your doctor’s instructions. Instructions will include:
    • How to take care of your VAD
    • When to contact the hospital—Make sure that you know how to call your doctor if you have an emergency.

Ask your doctor about when it is safe to shower, bathe, or soak in water.

Call Your Doctor

After you leave the hospital, contact your doctor if any of the following occurs:

  • Signs of infection, including fever and chills
  • Redness, swelling, excessive bleeding, or any discharge from the incision site
  • Increasing pain
  • One-sided weakness, blurry vision, or inability to talk
  • A cold, pale or blue, numb, or painful extremity
  • Cough, difficulty breathing, or chest pain
  • Nausea, vomiting
  • Problems with urination or bowel movements
  • Redness or swelling in legs.
  • Warning indications from the device

In case of an emergency, call for medical help right away.

RESOURCES:

American Heart Association
http://www.heart.org

United States Food and Drug Administration
http://www.fda.gov

CANADIAN RESOURCES:

Health Canada
http://www.hc-sc.gc.ca

Heart and Stroke Foundation of Canada
http://ww2.heartandstroke.ca

References:

The Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure (REMATCH) trial. NEJM. 2001 Volume345:1435-1443

Slaughter M, Milano C, et al. Advanced heart failure treated with continuous-flow ventricular assist device. N Engl J Med. 2009; DOI:101056/NEJMoa0909938.

Ventricular assist devices (VAD). Cleveland Clinic website. Available at: http://my.clevelandclinic.org/heart/disorders/heartfailure/lvad_devices.aspx. Updated December 2009. Accessed August 9, 2013.

3/6/2013 DynaMed's Systematic Literature Surveillance http://dynamed.ebscohost.com/about/about-us: Peura JL, Colvin-Adams M, Francis GS, et al. Recommendations for the use of mechanical circulatory support: device strategies and patient selection: a scientific statement from the American Heart Association. Circulation. 2012;126(22):2648-2667.



Last reviewed August 2013 by Michael J. Fucci, DO; Michael Woods, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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