A weak heart that is not functioning properly can cause discomfort, pressure, fatigue, and other symptoms that can bring the simplest daily routines to a halt. Called heart failure, this is a serious condition. But there are solutions, and doctors are getting better at using them to prolong life and even provide better quality of life. In the most serious cases, a doctor may recommend a ventricular assist device (VAD), a small mechanical pump that is surgically implanted inside the chest to help the heart pump blood to the body.
VADs are sometimes called “bridge to transplant” devices, because they can stabilize a person’s heart and allow their bodies to grow stronger while they are waiting for a heart transplant—a process that can take months or longer. Sometimes VADs are permanent solutions for patients who have severe heart failure, but who have other conditions or problems that make them ineligible for heart transplants.
“These devices save countless lives,” says Yale Medicine cardiac surgeon Pramod Bonde, MD, who has helped many patients with his innovative use of the devices. “A few years ago, more people were dying while waiting for a heart. Now, thanks to VADs, they have an option that will help them survive.”
What is a VAD and how does it work?
Your heart is about the size of a clenched adult fist. It has four chambers, and its job is to pump blood into the arteries (or blood vessels) throughout your body. The ventricles are the heart’s two lower chambers, and their job is to collect blood from the atrium (one of two upper chambers) and circulate it to the body and the lungs.
In a weakened heart, a VAD supports the work of the left, right, or both ventricles to keep blood pumping through the heart (it is most frequently placed in the left ventricle, which is the heart’s main pumping chamber). It is a battery-operated mechanical pump, weighing about two pounds, that is surgically implanted. A VAD has tubes that connect to the heart and a major artery such as the aorta. A cable is fed through a hole in the abdomen to machinery outside of the body—the machine includes a power device and a computerized control unit (to monitor VAD function and provide low battery warnings).
A VAD may be used as a temporary treatment to help you recover from heart surgery or to support your heart while you wait for a donor heart to become available. It may also be used if you have a condition, such as ventricular arrhythmia, that can’t be treated with medication.
If you are not eligible for a transplant, VAD may be used as a treatment. VAD as a permanent solution is known as “destination therapy.”
Types of VADs include the following:
Left ventricular assist devices (LVAD): The most commonly used VAD, this helps the left ventricle pump blood to the aorta, the main artery.
Right ventricular assist devices (RVAD): These are used for short-term support of the right ventricle, which pumps blood to the pulmonary artery; it’s typically for patients who have just had heart surgery.
Biventricular assist devices (BVAD): Both an LVAD and an RVAD are used at the same time.
What is it like to have surgery to implant a VAD?
VAD surgery is open heart surgery. Your surgical team will give you general anesthesia and connect you to a ventilator that will help you breathe. Your surgeon will make an incision down the middle of your chest and separate your breastbone, allowing access to the heart. From there, your arteries and veins will be connected to a heart-lung bypass machine that will take over the function of your heart while the VAD is implanted. Then the surgeon will place the VAD near your heart, connecting it to your heart and arteries with tubes.
Monitoring during recovery is important. You may spend several days in the intensive care unit, and anywhere from two to eight weeks in the hospital. From there, you may go straight home or transfer to a rehabilitation center.
What are the risks of VAD?
Just as there is with any surgery, there are risks to VAD. They include blood clots (mainly as a result of blood coming into contact with a foreign object), breathing problems, heart attack, infection, malfunction of the device, and stroke.
You can help avoid infection by following your doctor’s instructions on care of the pump and the hole in the abdomen where it connects to the control panel.
It’s also common to feel anxious, stressed, or overwhelmed If you are getting a VAD—or anticipating any serious heart surgery. These feelings are normal, and it’s important to talk to your doctor and seek support from family and friends, or a professional counselor.
How do you care for a VAD after surgery?
A VAD requires special care. You will have a cord that runs through the chest and out of the body through a hole in the abdomen. Meticulous hygiene, including proper care of the device and the opening in the body is critical to preventing infection. You must shower carefully and sleep on your back or side. You will learn how your VAD works, how to bathe and shower with it, how to travel, and how respond to alarms designed to warn about signal malfunction or low power. You will be at increased risk for blood clots, so your doctor may prescribe warfarin and aspirin to prevent blood clots.
VADs tend to last five to 10 years.
Are there people who are not eligible for a VAD?
A VAD may not be helpful for patients who have an additional serious health concern, such as acute kidney failure or a serious infection, that could impact their long-term survival.
How can a VAD improve life with heart failure?
Not only can a VAD help people with heart failure live longer, it can significantly improve their quality of life, and allow them to perform many of the routine activities—some patients even play golf again—that they weren’t able to do before treatment.
How is Yale Medicine unique in the use of VADs?
Yale Medicine is one of the most experienced VAD services in the Northeast and throughout the United States. Our heart failure cardiologists and cardiothoracic surgeons are experts in the implantation of VADs and the long-term care of people who have them. Our specialists can evaluate your condition and recommend the best treatment approach and type of pump for you.
While some patients may have a VAD as a temporary treatment while they wait for a heart transplant, Yale New Haven Hospital is certified by the Joint Commission, the nation’s predominant standards-setting and accrediting body in health care, to implant LVADs into patients with end-stage heart failure as a permanent therapy.
Because of his research and extensive experience, Dr. Bonde is also a pioneer in the use of LVADs in the care of patients who may be difficult to treat otherwise. “If you are told you have no options because your heart function is poor, we might be able to help you,” Dr. Bonde says.