Ventricular Assist Devices

What is a ventricular assist device (VAD)?

A ventricular assist device (VAD) circulates blood from a chamber of your heart (ventricle) to the rest of your body.

There are many types of VADs:

• Left ventricular assist device (LVAD) is the most common. It helps the left side of your heart pump oxygen-rich blood from the heart out to your body.
• Right ventricular assist device (RVAD) pumps oxygen-poor blood from the right side of your heart to your lungs.
• Biventricular assist device assists both sides of your heart.
• Pediatric VADs are smaller devices that include smaller cannulas and pumps. They can be customized to fit people ranging from newborns to young adults.

Why might I need a ventricular assist device?

You might need a VAD if you have advanced heart failure and are either waiting for a transplant or require permanent help for your heart to circulate enough blood to your body.

Ventricular assist devices can help you in many ways:

• Bridge to recovery provides cardiac support over time while your heart recovers from being too weak.
• Bridge to transplant is for people who are eligible for a heart transplant. The VAD can provide the necessary support while you are waiting for a donor heart to become available.
• Destination therapy is for people who are not eligible for a heart transplant and can provide permanent cardiac support that will enable them to live longer and with a better quality of life.

How do ventricular assist devices work?

The device has several components. Some are implanted and connected to your heart. Others stay outside your body.

• Inflow cannula is the part of the VAD that connects to the tip of the ventricle. It enables blood to flow from your heart into the mechanical pump.
• Mechanical pump is the component that takes over your heart’s pumping action.
• Outflow cannula is the part of the VAD connecting the mechanical pump to the aorta (LVAD), pulmonary artery (RVAD) or both (biventricular assist device).
• Driveline is a thin, sturdy cable that runs from the VAD through your skin to the external control device (controller).
• Controller is a small computer that enables you and your healthcare providers to check VAD functioning.
• External battery pack includes the main battery that powers the device and a backup. The controller connects the VAD to the battery.

What happens before VAD implant surgery?

Not everyone with severe heart failure is eligible for a ventricular assist device. Once you’re diagnosed with advanced heart failure, you have comprehensive medical and psychological evaluations. This may include assessing current heart and end-organ function. Healthcare providers screen for complex health issues such as breast cancer, prostate issues and infectious diseases. Additional tests include:

• Electrocardiogram.
• Echocardiogram.
• Computed tomography (CT) scan.
• Exercise testing.
• Both left and right cardiac catheterizations.

Evaluations also include discussions about living with a VAD as well as detailed education for basic day-to-day tasks of caring for the VAD. Your care team will also work with you to identify loved ones or a support system that you may live close to who will be able to help you, if necessary.

What happens during ventricular assist device implant surgery?

Here’s what happens during VAD implant surgery:

1. You will receive general anesthesia, which puts you to sleep and temporarily blocks sensation. You will also have no memory of the procedure. A ventilator will take over your breathing for the duration of the surgery and initially postoperatively in the intensive care unit (ICU).
2. Your surgeon makes an incision in the midline of your chest through your sternum and opens the sac (pericardium) around your heart.
3. After administering heparin, your surgeons place you on the cardiopulmonary bypass machine to keep blood flowing through your body and prevent blood from flowing through your heart during the operation.
4. They then tunnel the VAD driveline through your abdominal wall.
5. Your surgeon then inserts the VAD into the appropriate areas of your heart. For an LVAD, the inflow cannula connects to the apex of your left ventricle and the outflow graft typically connects to your aorta, but many different configurations exist.
6. Once inserted, your surgeon starts the VAD you’re weaned off the bypass machine while they speed up the VAD to support your circulatory needs.
7. Once the function of the VAD is stable, your surgeon reverses the heparin with a drug called protamine to help your blood start to clot again. Your surgeon then brings your sternum back together with metal wires. They close the more superficial layers with absorbable sutures and apply a sterile dressing.

What are the benefits of ventricular assist devices?

Many people notice:

• Improved breathing and organ function.
• Less fatigue.
• More energy.

What risks are associated with ventricular assist devices?

Potential complications associated with the surgical implantation of a VAD as well as the lifelong usage of the VAD include:

• Arrhythmias.
• Bleeding.
• Blood clots.
• Infection.
• Device malfunction.
• Right-sided heart failure.
• Cerebrovascular accident.

Which patients are not eligible for ventricular assist devices?

VADs are not appropriate for some people, including if you:

• Aren’t capable of performing ongoing self-care tasks, like VAD maintenance.
• Can’t tolerate lifelong blood thinner therapy (anticoagulants).
• Have co-existing severe end-organ dysfunction that makes having surgery high risk.

What is recovery from VAD implant surgery like?

After implant surgery, you’ll spend at least a few days in the ICU. Once you’re healthy enough to not need ICU-level care, you’ll transfer to the cardiac step-down unit for the rest of your hospital stay.

During your postoperative stay, healthcare providers will monitor your organ functions including your heart, kidneys, brain, lungs and liver. You’ll also work with physical and occupational therapists and other specialists as you learn to live with the new device. Your providers will prescribe a blood-thinning medication called warfarin sodium (Coumadin®) to take to keep your blood from clotting inside the VAD.

What else happens before I leave the hospital?

A nurse or VAD coordinator teaches you how to take care of your ventricular assist device. This includes how to:

• Clean the equipment and driveline.
• Monitor the incisions including the driveline exit site to make sure they stay healthy and are healing well.
• Change the batteries and how to troubleshoot the different alarms that you may experience from the device.
• And who to contact if you have questions.

Will there be any restrictions after I recover from surgery?

Living with a VAD does come with some limitations, including:

• Being connected to a power source either via batteries or to a wall socket.
• You’ll take blood thinners and need occasional laboratory tests to monitor the therapeutic effect of this medicine.
• You'll have to abstain from activities that may risk the device getting wet including taking a bath or swimming. Your providers will teach you how to safely shower with the device after covering it appropriately.
• Not participating in contact activities that would place you at risk of excessive bleeding if an injury were to occur.

What is daily life like with a ventricular assist device?

Living with a VAD may include responsibilities such as:

• Taking medications: In addition to the blood thinner, you may also need to take various other cardiovascular medications that help control high blood pressure and prevent abnormal rhythms.
• Living a heart-healthy lifestyle: Adopting healthy habits can help you feel your best and get the most out of your VAD. These include quitting smoking and using tobacco products, eating a nutritious diet and getting regular physical activity.
• Going to rehabilitation: After receiving a VAD, it takes time to regain your strength. Cardiac rehabilitation is a medically supervised exercise program that helps you safely transition back to daily activities and gives you the strength and confidence needed to do well when at home.
• Performing VAD maintenance: It’s essential to take good care of your ventricular assist device. The VAD team will provide all the necessary education and are available around the clock to help triage any issues that may arise.

Can being on a VAD affect my mental health?

Some people on ventricular assist devices experience depression and anxiety. You don’t have to deal with these feelings on your own. If you are struggling with these issues, it’s important to let your healthcare provider know.

How often will I need to see my healthcare provider after VAD implant surgery?

Living with a ventricular assist device requires lifelong follow-up care. After discharge, you’ll visit your provider routinely. These visits will be more frequent at first. As you continue to improve and start to become more independent, your visits will become less frequent. Follow-up appointments enable your team to optimize your care by preventing, screening for and treating complications.

These visits may include:

• Monitoring and managing your blood pressure. It’s common for those with VAD to develop high blood pressure.
• Checking medications, especially anticoagulants, to make sure they are the proper dose for your needs.
• Downloading VAD data to assess for any alarms or issues with the function of the VAD.
• Adjusting ventricular assist device settings, if necessary.
• Discussing your progress with lifestyle changes and providing helpful tips and recommendations.

When should I contact my healthcare provider about potential complications?

Contact your healthcare provider if you have any questions or concerns or experience complications, such as:

• Chest pain.
• Coughing up blood.
• Dark-colored urine.
• Fever or chills.
• Joint pain.
• Redness, tenderness or unusual warmth near incisions or where the driveline exits your body.
• Sudden weight gain or swelling in your hands or feet.

You should also contact your healthcare provider if you notice issues with your VAD, such as:

• Signs of damage to the controller, driveline or battery pack.
• Error messages on the controller or an alarm sounding and you don’t know how to address it.

A note from Cleveland Clinic

Ventricular assist devices are mechanical pumps that take over your heart’s pumping action. They are for people whose hearts are too weak to meet their needs. A VAD can bring notable positive changes to your life including an increase in survival and an improved quality of life. For the best results, it’s essential to take good care of yourself and the device.