Ventricular Assist Device Procedure

Overview

A ventricular assist device (VAD) helps the heart pump blood when it becomes too weak. Several types of VADs exist, including those that support the left ventricle (LVAD), right ventricle (RVAD), or both (BiVAD). Most often, an LVAD supports the left side of the heart. Doctors may use these devices while someone waits for a heart transplant or as a long-term solution if a transplant is not possible.

Key Types of VADs:

Device Type	Area Supported	Common Term
LVAD	Left ventricle	Left ventricular assist device
RVAD	Right ventricle	Right ventricular assist device
BiVAD	Both left and right	Biventricular assist device

Many refer to VADs as mechanical circulatory support devices. Most modern LVADs provide a continuous flow of blood rather than a pulsing flow, which is why they are called continuous flow devices. Surgeons usually implant these devices during open-heart surgery, which carries risks.

In many serious heart conditions, devices like LVADs and other VADs support life and help with symptoms. Some hospitals run special programs, such as an LVAD program, to focus on caring for people with these devices.

Reasons for Using a Ventricular Assist Device

Doctors use a ventricular assist device (VAD), such as a left ventricular assist device (LVAD), to help people whose hearts can no longer pump blood well enough on their own. Main reasons for choosing a VAD for heart failure patients include:

Support While Awaiting Heart Transplant

People who need a heart transplant sometimes must wait until a suitable donor organ is ready.
A VAD acts as a “bridge to transplant” by keeping blood moving and supporting organ function during this waiting period.
In some cases, using a VAD can help reduce high blood pressure in the lungs, making a person a better candidate for a heart transplant.

As a Permanent Therapy

Not everyone can receive a heart transplant due to age, certain health problems, or other reasons.
For these people, a VAD can serve as a long-term treatment, called destination therapy.
It helps the heart maintain blood flow, which may improve day-to-day life and help the person feel better.

Helping the Heart Recover

Sometimes, heart failure is not permanent.
A VAD can serve as a “bridge to recovery” while the heart heals and regains strength.
When the heart improves, doctors may remove the device.

Key Factors in Deciding on a VAD

When doctors consider using a VAD, they look at several important points:

Factor	Why It Matters
Severity of Heart Failure	Shows how much help the heart needs.
Other Serious Illnesses	Health problems can affect safety and outcomes.
Heart Function	Helps choose the type of device.
Ability to Use Blood Thinners	Blood thinners lower blood clot risks.
Support from Family and Friends	Extra help may be needed after surgery.
Mental and Self-Care Abilities	Taking care of the device requires attention.

A VAD is not for every patient, but it can be a helpful option for those with severe heart problems who meet certain criteria.

Possible Problems

Ventricular assist devices (VADs) can help people with weak hearts, but they may also cause different health problems. One of the most common risks is bleeding, which can happen during or after the surgery. Medicine to prevent blood clots can increase this risk.

Blood clots can form as blood passes through the device. If a clot travels to the brain, it can cause a stroke. Other times, clots might block the device or smaller blood vessels. Infection is a main risk because the VAD connects to an external power source through the skin.

Bacteria can enter the body at this opening, leading to infections at the site or even in the bloodstream (sepsis). Device trouble may happen if the VAD stops working or parts wear out. This can lead to dangerous drops in blood flow, and may require urgent help or device replacement.

Heart rhythm problems (arrhythmia) and right-side heart weakness can also happen. If the right side of the heart can’t pump as fast as the device, doctors may provide extra support or medicine.

Table: Main Risks Linked to VADs

Risk	Details
Bleeding	During surgery or from blood thinners
Blood clots	May cause pump issues or stroke
Infection	At device site or in the blood
Device malfunction	Can lead to emergency situations
Arrhythmia	Irregular heartbeat
Right heart failure	Right side struggles to keep up
Sepsis	Severe blood infection due to bacteria
Death	In rare and severe cases

Steps to Get Ready

What to Eat and Take Before Surgery

Patients should make a list of all their current medicines and any allergies, especially to drugs. This list should include any blood thinners or drugs that affect blood pressure. Patients should bring this list to the hospital for safety.

Most people will be told not to eat or drink for several hours before the operation. The healthcare team from Healthnile will give specific instructions on when to stop eating and which medications to keep taking. Following these directions can lower the risk of problems during and after surgery.

Key Actions	Details
List all medications	Include prescription, over-the-counter, and vitamins.
Note allergies	Mention all known drug and food allergies.
Blood thinners	Tell the team if taking aspirin, warfarin, or others.
Food and drink	Stop as directed, usually hours before arrival.

What to Bring and Wear

A few personal items are helpful for comfort and care during a hospital stay. Patients should bring their advance directive, if they have one, as well as daily-use items like eyeglasses, hearing devices, and toiletries (such as toothbrush, hairbrush, or shaving supplies).

Clothes should be loose and comfortable. It is best to leave valuables at home. Avoid wearing jewelry, nail polish, or contact lenses. Books or music can help pass the time and ease stress before surgery.

What You Should Know About the Procedure

Getting Ready for Surgery

Before surgery, hospital staff usually admit patients a few days ahead of time. This allows the healthcare team to monitor them closely and provide any needed treatment for heart problems before implanting the ventricular assist device. The care team performs several tests to check the condition of the organs and make sure the procedure is safe. These may include:

Blood Tests: Check how the heart, liver, and kidneys are working. Doctors also look at how well the blood clots to avoid any problems during surgery.
Heart Rhythm Test (ECG): This test shows if the heart is beating normally or if there are irregular rhythms.
Chest X-ray: Helps doctors look at the size and shape of the heart and check the lungs for any issues.
Heart Ultrasound (Echocardiogram): Provides images of the heart’s chambers and valves, and shows the flow of blood through the heart.
Cardiac Catheterization: A thin tube is placed into a blood vessel, often the neck, and guided to the heart. This allows the care team to measure blood pressure inside the heart and look at blood flow, including in the pulmonary artery.

Doctors use the results of these tests to decide if a ventricular assist device is the best choice. Common preparations before surgery include:

Step	What Happens
1	Shaving the chest area
2	IV line placed for medicines
3	Breathing tube put in place

Staff also explain what to expect and answer any questions. Family members receive information on how they can help after surgery.

What Happens in the Operating Room

Surgeons implant a ventricular assist device during open-heart surgery. The patient receives general anesthesia and sleeps through the procedure. Steps during the operation:

Preparing for Surgery: The chest area is cleaned and any hair is removed. Medicines are given through an IV to keep the patient comfortable.
Breathing Support: A ventilator (breathing machine) helps the patient breathe during surgery.
Accessing the Heart: The surgeon makes a cut along the middle of the chest and gently spreads the breastbone open for a clear view of the heart.
Using Support Machines: Sometimes, doctors pause the heart using special medicines. If this happens, a heart-lung bypass machine takes over, moving blood through the body and sending oxygen to the organs.
Placing the Device: The surgeon attaches the main pump of the ventricular assist device to the heart (often the tip of the left ventricle).
- A tube carries blood from the heart to the aorta.
- The aorta is the artery that sends blood to the rest of the body.
- A cable runs from the device through the skin to connect with a controller and battery pack that stays outside the body.
Restarting the Heart: After the ventricular assist device is in place and working well, doctors take the patient off the heart-lung bypass machine. The device begins pumping blood instead of the heart.

Table: Surgery Highlights

Step	Tool or Machine	Purpose
Anesthesia	IV medicine	Keeps patient pain-free/asleep
Breathing	Ventilator	Supports breathing during surgery
Heart Pause/Support	Heart-lung bypass machine	Circulates oxygen-rich blood
Implantation	Surgical instruments, VAD	Places device and tubes
Monitoring	Monitors for vital signs	Tracks heart rate and blood flow

The entire surgery can last three or more hours depending on the patient and any unexpected issues.

Recovery and Life After Surgery

After surgeons implant the ventricular assist device, patients remain in the hospital for recovery. The length of time in the hospital depends on their health before the procedure and how quickly they heal.

Immediate Care

The care team watches patients closely for problems.
Tubes help drain fluid or blood from the heart and chest.
A tube drains urine from the bladder.
IV lines give fluids, medicines, and sometimes antibiotics to lower the risk of infection.

Doctors work to prevent common issues:

Infection: Antibiotics help prevent infection.
Blood Clots: Blood-thinning medicine lowers the risk of clots.

A ventilator may support breathing for the first days after surgery until the patient can breathe on their own.

Physical Recovery

The healthcare team encourages movement as soon as it is safe. This may include sitting up and short walks to build strength.
If needed, a short stay in a rehab center is suggested for extra help.

Learning to Manage the Device

Before leaving the hospital, patients learn:

How to keep the skin around the device clean.
Warning signs of infection, like redness, pain, swelling, or fever.
How to charge and look after the battery pack and controller.
How to react if there are device alarms or problems.
How to shower safely without damaging the equipment.

Daily Life and Activities

Doctors and nurses talk with patients and their families about returning to daily life, such as going back to work, driving, being physically active, or even traveling. They offer advice about safely living with the device.

Patients should stay in touch with their care team and discuss any concerns. The team provides support and education on caring for the ventricular assist device so patients know how to handle every situation and live as safely as possible with the device.

Findings

Heart Recovery Programs

Patients with an LVAD often join a customized recovery program. This program, sometimes called cardiac rehab, combines safe exercise, nutrition guidance, and emotional care. Professionals supervise the activities to help improve heart strength and health.

They provide education on a heart-healthy diet and how to handle emotions after surgery. Many find these programs useful in rebuilding their confidence and daily routines.

LVADs as Pathways to Advanced Treatment

LVADs serve as both permanent solutions (destination therapy) and as a bridge to transplantation. When a person is waiting for a heart transplant, they may use an LVAD to keep their heart working.

Patients on the transplant list often stay close to their treatment center, so they are prepared if a donor organ becomes available. Frequent checkups and careful monitoring help ensure safe waiting and timely readiness for a transplant.

LVAD Uses Table

Reason for LVAD	Description
Bridge to transplant	Supports patient until heart transplant.
Destination therapy	Long-term support without transplant.

Emotional Well-being and Social Connections

Living with an LVAD can be stressful or overwhelming at times. Team members encourage patients to reach out for counseling or support services. Support groups help individuals connect and share experiences. These groups let people learn from others who face similar challenges, which reduces feelings of isolation or worry and helps patients adapt to new routines.