Before the procedure
Before your ventricular assist device (VAD) is implanted, you'll likely need to stay in the hospital for several days preparing for your surgery. While you're in the hospital, you may have other treatments for your weakened heart or heart failure.
Your doctor may review several factors to decide if a VAD is the most appropriate treatment for your condition and to determine which VAD may be most appropriate for you, including whether:
- The severity of your heart failure is appropriate for a VAD.
- You have other serious medical conditions that may affect your health or quality of life with a VAD.
- You need support for the left ventricle, the right ventricle or both ventricles.
- You're able to take blood-thinning medications for a long period of time.
- You have appropriate social support from your family and friends.
- You are mentally and emotionally able to take care of a VAD.
Your doctor will also evaluate your condition and ensure that you're healthy enough for surgery to implant a VAD. Your doctor may order several tests, including:
- Echocardiogram. In an echocardiogram, sound waves are used to produce a video image of the heart. Your doctor uses an echocardiogram to determine the pumping function of your heart, check your heart valves and help determine the cause of your heart failure. This can help your doctor decide if you're a candidate for a VAD or if another treatment option may be appropriate.
- Chest X-ray. An X-ray image helps your doctor to see the size and shape of your heart and lungs.
- Blood tests. Your doctor may order blood tests to check your liver, kidney and thyroid function before surgery to implant a VAD. Your doctor might also test for other chemicals in your blood that show how well your heart is working. Blood tests may also be used to check for symptoms of infection, which need to be treated before surgery.
- Electrocardiogram (ECG). An electrocardiogram records the electrical activity of your heart. An ECG measures the timing and duration of each electrical phase in your heartbeat.
- Cardiac catheterization. In this test, a doctor inserts a thin, flexible tube (catheter) into a vein or artery in your upper leg (groin), arm or neck and guides it to your heart using X-ray imaging. Doctors may use this test to measure the pressure and blood flow in your heart. This test may help your doctor determine if you're a candidate for a VAD or if you may need alternative devices.
While you're in the hospital before your surgery to implant a VAD and after the VAD has been implanted, your treatment team will educate you and your family about how your VAD works and how to live with a VAD, including:
- How your VAD works to support your heart
- Safety precautions
- What to do if your control unit signals a problem with your VAD
- How to respond to emergencies, such as a failed battery or other loss of power to your VAD
- How to care for your VAD, such as how to clean and check the equipment
- How to shower without damaging your device
- How to monitor for infections or complications after surgery
- How to travel with your VAD
- How you and your family can manage stress and anxiety regarding your device, and how you can adjust to your new lifestyle
During the procedure
A surgical team of heart (cardiac) surgeons, surgical nurses, doctors trained in giving medication that causes you to sleep during surgery (anesthesiologists) and others work together to perform your surgery.
The procedure to implant a ventricular assist device (VAD) is an open-heart surgery that generally takes four to six hours. You'll be asleep during the procedure, so you shouldn't feel any pain during the procedure.
You'll be connected to a machine that helps you breathe (ventilator) during your surgery. A tube will be run down your throat to your lungs and connected to the ventilator. You may need to remain connected to the ventilator for several days after your surgery.
In this procedure, your surgeon will make an incision down the center of your chest. Your surgeon will separate your chest bone (sternum) and open your rib cage so that he or she can operate on your heart.
Your heart may be stopped using medications during the surgery. You'll be connected to a heart-lung bypass machine that keeps oxygenated blood flowing through your body during surgery if your heart is stopped during surgery.
Your surgical team will implant your VAD during surgery. An implanted left ventricular assist device (LVAD) has many parts. A tube carries blood from the left ventricle of your heart to a pump. The pump delivers blood through another tube to the aorta — the artery that leads out to the body from the heart — which then delivers blood to the body. A cable inserted through the skin connects the pump to the control unit and battery pack outside your body.
After your VAD is implanted and working properly, your doctors will take you off the heart-lung bypass machine so that the VAD can begin pumping blood through your heart.
Certain types of VADs pump blood similar to the way your heart does, using a pumping action. They help pump blood from one or both lower chambers of your heart (ventricles) and on to the rest of your body.
Other types of VADs — continuous flow devices — are smaller and quieter. These devices allow a continuous stream of blood to flow through your heart. If you have a continuous stream of blood flowing through your LVAD, you or your doctor may not be able to check your pulse or your blood pressure using standard methods. Doctors may use other tests to check your heart rate and rhythm and to measure your blood pressure.
Certain types of VADs have pumps located outside of the body. These VADs may have external pumps connecting to a large console, while some have smaller external pumps located next to the body that are connected to portable devices. These VADs may be used for a temporary period of time, such as during or after heart surgery, but some may be used while waiting for a heart transplant or a longer-term VAD.
In one type of short-term VAD, the pump is inserted through a catheter in the leg, which doctors guide through the arteries to the heart. Another type uses catheters to access the heart, but the pump is located outside the body.
After the procedure
After surgery to implant a VAD, you'll stay in the intensive care unit (ICU). You'll be given fluids, nutrition and medications through intravenous (IV) lines. Other tubes will drain urine from your bladder and drain fluid and blood from your heart and chest. Your treatment team will monitor you for signs of infection or other complications.
Your lungs may not work properly immediately after your surgery, so you may need to remain connected to a ventilator for a few days after surgery until you're able to breathe on your own.
After a few days in the ICU, you'll generally be moved to a regular hospital room. The amount of time you'll spend in the ICU and in the hospital can vary, depending on your condition before the procedure and how well you recover after your VAD is placed.
As you recover, your nurses and other members of your treatment team will help you become increasingly active. They may help you sit up, get out of bed and walk in the hallways of the hospital. You may have visits with a physical therapist to help you continue to increase your strength and get used to performing daily life activities.
Your treatment team will work with you to help you gain strength and prepare you for going home. They may explain how to live with a VAD and care for your VAD after you go home, and they can help answer your questions about the VAD. Your treatment team may also discuss with you nutrition and cardiac rehabilitation plans they may recommend during your recovery after you return home.
Your doctor will likely prescribe antibiotics and blood-thinning medications to prevent infection and other complications while you're in the hospital. You'll usually need to continue to take blood-thinning medications such as aspirin or warfarin (Coumadin, Jantoven) during the time you have a VAD to prevent blood clots.
It's very important to follow the instructions for taking these medications carefully. You'll need to have regular blood tests to monitor the effects of warfarin. Contact your doctor if you have any questions about your medications or if you experience any side effects. You'll also need to continue to take any medications you're taking for other conditions.
Your treatment team may encourage you to have visitors, such as family and friends, while you're recovering in the hospital. Visitors may be able to help you perform some physical activities. Your nurses and treatment team will also educate your family about many aspects of your care, such as how to care for your VAD, how to watch for signs of infection after surgery, how to respond to emergencies related to the VAD and how they can assist you at home.
Once you have recovered and gained your strength, your treatment team will determine when you're healthy enough to be released from the hospital. If you need more time to recover your strength before returning home, you may stay at a special care facility, such as a nursing home, for a period of time after leaving the hospital.