Ventricular Assists Devices - "VADS"

A Ventricular Assist Device, also known as a VAD, is a mechanical pump that helps your heart to pump blood throughout your body.

What is a VAD?

A Ventricular Assist Device, also known as a VAD, is a mechanical pump that helps your heart to pump blood throughout your body. If your heart is very weak, you need a little help recovering from surgery or are on a heart transplant waiting list, a VAD may be recommended for you.
The diagram below shows you what a VAD looks like:

Interestingly, a VAD keeps your blood flowing in a continuous stream, as opposed to a rhythm - so, you might not be able to feel your pulse when you have a VAD.

Why do I need a VAD?

Your doctor may recommend a VAD for you if one or both of the chambers in your heart, also called ventricles, become very weak and aren’t able to pump blood effectively. The three most common scenarios in which VADs are recommended are:

  1. During or after heart surgery or a procedure – a VAD can be attached temporarily to help your heart work effectively while you’re recovering from surgery
  2. While waiting for a heart transplant – a “bridge to transplant”, a VAD can help to improve your quality of life, make you stronger and, in some cases, save your life while you’re waiting for a donor heart 
  3. As a long term treatment option – used as “destination therapy” for those who aren’t able to have a heart transplant 

A VAD is made up of:

  • A pump or LVAD - which has a spinning part inside, called an impeller. This moves blood from your heart to the rest of your body
  • One controller – this operates your pump and makes sure it is working correctly
  • A power source – the controller receives power from two batteries, or electricity from a wall or car outlet 

The image below shows the parts of a VAD

What are the risks of having a VAD?

As with any surgery, there are some risks involved with having a VAD. Some of the more common risks can include:

  • Blood clots - as the device isn't a natural part of your body, you're more likely to experience blood clots VADs increase the risk of blood clots (you will be given medication to help prevent this from happening) 
  • Bleeding - this can be a side effect from your anti-clotting medication, but taking your medicines exactly as prescribed will help to prevent this
  • Infection – because VADs are attached through holes in your skin, your risk of infection is increased; your medical team will teach you how you can manage your VAD to reduce your risk of infection
  • Device failure – a VAD may not work properly due to power failure, incorrect pump action or problems with parts; you will be taught how to manage any alarms from the VAD in the event of a device failure

How do I prepare for a VAD?

Your VAD is a very sophisticated device – and both you and your family (or support network) will be taught how to use it so that you’re comfortable with:

  • How your VAD works – and how to safely handle it
  • What the alarms mean – and how to respond to them
  • What to do in case of emergency – for example, a power failure
  • How to take care of your VAD – including washing, showering and cleaning your ‘exit site’
  • Certain activities – such as travelling and exercising

Before your surgery, you’ll need to have tests such as: 

On the day before surgery, you’ll need to:

  • Ensure your bowels are opened – ask for a laxative, if required
  • Pack a small bag of essentials, like toiletries and glasses – these will be taken to the Intensive Care Unit after your surgery
  • Stop eating and drinking – from midnight before your surgery

On the day of surgery:

  • Remember not to eat or drink anything 
  • A member of staff will clip off any hair from your chest, arms, legs, groins – to reduce the potential of infection
  • Wash with antibacterial soap which will be provided by the hospital
  • Wear a hospital gown and remove any makeup, nail polish and jewellery (dentures can be left in)

What happens during the VAD procedure?

Your surgery is performed under general anaesthetic, which means you will be given medications to help you relax and fall asleep. As soon as you fall asleep:

  • A breathing tube is put down your throat to the lungs
  • A urinary catheter is passed up into your bladder so that you do not need to get to the toilet and the amount of urine can be assessed

Your doctor will:

  • Connect you to a heart lung bypass machine, so that blood circulation is maintained throughout your body during the surgery
  • Access your heart by a cut through your breastbone (sternum)
  • Attach the VAD
  • Close your chest with wires and continuous dissolvable stitches
  • Restart your heart and take you off the heart-lung machine, allowing blood to flow back to heart

The surgery usually takes 4-6 hours.

What happens after the VAD procedure?

As soon as your surgery has finished, you’ll be transferred from the operating theatre to the Intensive Care Unit (ICU). There, your medical team will watch you carefully and take steps to reduce the chance of any immediate infections and clots. You’ll be given antibiotics and anticlotting medicines, and tubes in your bladder and chest will drain fluid from your chest and heart.

After a few days, if all is going well, you’ll be transferred to the cardiac ward. There, a team of experienced VAD nurses will care for you and monitor you, helping you to continue to recover well. In a few days, you’ll become stronger and will no longer need your tubes attached. When you’re feeling well, your team will show you how to move around and shower with your VAD.

When it’s time for you to leave the hospital, which is usually after one week, you’ll be given education and resources to help you take care of your VAD - so you know exactly how to look after it and what to do in case something happens.

After you’ve returned home, your medical team will continue to help you to adjust to your new way of living with your VAD. They’ll be checking in to make sure you understand how the device works and how to care for it. Being healthy enough to come home also means you’ll be able to return to your normal activities, like driving, hobbies, socializing and intimacy in your relationship. You’ll be required to attend regular medical appointments so that your medical team can ensure you’re recovering well and that your device is working as well as it should be. 

Remember to follow your doctor’s advice about medications and any recommended lifestyle changes after your surgery, and attend your regular appointments. If you start to feel unwell or would like to discuss your follow-up care at any time, make an appointment with your doctor.

For more information about VADS, you can visit the HeartWare Patients and Caregivers page.

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