Ventricular Assisted Device (VAD)

A ventricular assist device (VAD) is a mechanical pump that supports people with weakened hearts to maintain the heart's function and blood flow.

The device, like a healthy heart, takes blood from the heart's lower chamber and helps pump it to other parts of the body and vital organs. If one or both of the heart's lower chambers, i.e., the ventricles, fail to function correctly, a VAD is beneficial.

A VAD may be indicated,

During or after surgery until the heart recovers.
During the period of waiting for a heart transplant.
When a heart transplant is contraindicated.

The components of a VAD include

A tube that transports blood from your heart to a pump.
Another tube transports blood from the pump to your blood vessels, delivering it to your body.
A power source: The power source is connected to a control unit that monitors the functions of the VAD. The control unit will give warnings or alarms if the power is low or the device is not working correctly.

Types of VAD:

VADs are classified into two types: left ventricular assist devices (LVAD) and right ventricular assist devices (RVAD). When both are used together simultaneously, they are referred to as a biventricular assist device (BIVAD).

The most common type of VAD is LVAD, which helps pump blood to the aorta from the left ventricle. The aorta is the most significant main artery that transports oxygen-rich blood from the heart to the remaining parts of your body.

RVAD is typically used only for short-term right ventricle support following LVAD surgery or other heart surgery. An RVAD device assists the right ventricle in pumping blood to the pulmonary artery, and this is the artery that transports blood to the lungs to absorb oxygen.

LVAD and RVAD (also called BIVAD) are used together if both the heart's lower chambers do not work efficiently to meet the body's needs.The basic designs of VAD are:

A transcutaneous VAD pump and power source are located outside the body. Small tubes connect the pump to the heart through small holes in the abdomen. This type of VAD can provide temporary support during or after surgery.
An implantable VAD pump is inside the body, while the power source is outside. A cable will connect the pump to the power source through a small opening in the abdomen. Implantable VADs are most commonly used while waiting for a heart transplant or as a long-term solution if you are not eligible for a transplant.

Procedure

Before the procedure

There will be a few tests before the surgery. These tests may include:

Blood tests: These tests are used to assess the general health and functioning of the liver and kidneys. Blood tests are also used to determine the concentrations of blood count and essential components in the blood.
Chest x ray: Imaging test that uses X-rays to look at the structures and organs in your chest.
Electrocardiogram: It determines the heart function before the surgery.
Echocardiography(echo): It generates an image of your heart. Echo measures the size and shape of your heart and the function of its chambers and valves.

During the procedure

General anesthesia is given, so you will not be aware of the procedure and do not move or feel pain during the surgery. The anesthesiologist monitors your heart rate, blood pressure, oxygen levels, and breathing during surgery. Through your throat, a breathing tube is inserted into your lungs. This tube leads to a ventilator (a machine that helps you breathe).
A cut is made along the center of your chest. The rib cage is opened to allow the surgeon to access the heart by cutting the chest bone(sternum).
Medications are typically used to stop your heart during surgery. This allows the surgeon to operate on your heart while it is not beating.
During surgery, a heart-lung bypass machine keeps oxygen-rich blood flowing through your body.
When the device is attached correctly, the heart-lung machine is turned off and the ventricular-assist device begins to function. It promotes continuous blood circulation and takes over the heart's pumping function.

After the procedure

After the surgery, you will be shifted to the Intensive Care Unit. Your doctor will closely monitor you and take precautions to prevent any immediate infections or clots. Antibiotics and anti clotting medications will be administered via the intravenous tube. Tubes in the bladder to drain urine and blood and fluids from the chest and heart are placed.
The staff will shift you to the cardiac ward. A team of nurses will monitor and help with your recovery. In a few days, you will no longer need any tubes attached. They will demonstrate how to move around and shower with your VAD when ready.
When you are fit to be discharged, which is usually after one week, you will be educated to take care of VAD.
Your doctor will continue to assist you in adjusting to your new way of life with VAD after you have returned home. You will be able to return to your normal regular activities gradually.
You will be required to attend appointments so your doctor can ensure that you are recovering well and that your device is functioning properly.
Strictly follow your doctor's prescriptions and lifestyle modifications after surgery, and keep all your scheduled appointments.

Benefits

A better quality of life involves less fatigue, more strength, better breathing and more prolonged survival.

Risks

As with any surgery, some risks are involved with having a VAD. The more common risks factors are:

Blood clots: Because the device is not a natural part of the body, blood clots are more likely. VADs increase the likelihood of blood clots.
Bleeding: This is a possible side effect of your anti-clotting medication, but taking your medicines exactly as prescribed will help to avoid it.
Infection: Your risk of disease is increased because the device is attached through holes made in your skin. The medical team will teach you how to manage your VAD to reduce the risk of infection.
Device failure: The device may not function due to power failure, incorrect pump action, or component problems. You will be taught how to manage any VAD alarms in the event of a device failure.