Heart failure is one of the most difficult diseases to treat. The left ventricle of your heart is the main pump that pushes blood throughout your body. If there is damage to your left ventricle or a general stiffness in the muscles of your heart, your heart will need help to pump blood through your body.
Progress is being made to develop new technology to help a failing heart pump sufficiently. Developments in smaller, more efficient mechanical pumps have resulted in advanced ventricular assist devices (VADs). These VADs have given new hope to people with damaged ventricles. A VAD, either connected outside your body or implanted within your body, can be connected to your heart and help your left ventricle move blood through your body.
In the past, only people with enough space in their chest cavity could be treated with a VAD. However, recent advances in the design of VADs have made them smaller. Now, many men, women and even older children with enough space in the chest area can be treated with this method.
A VAD may help you to feel better and have better quality of life if you have significant heart failure. If the lower chambers of your heart, called ventricles, are no longer pumping blood efficiently, your heart needs help pumping.
You may have tried medication or had a pacemaker (a small device implanted into the chest that helps correct abnormal heart rhythms) installed. If these do not work sufficiently, there are few options for treatment. In the past, the only option to treat this kind of heart failure was a heart transplant. However, today there are very long waiting lists for heart transplants. The use of a VAD can help patients live longer.
A VAD is typically used in people who are in the end stages of heart failure, and may be implanted if you’re waiting for a heart transplant. If you are not eligible for a heart transplant, a VAD will help extend your life. Alternatively, a VAD may be used temporarily if you need additional heart support before or after surgery.
Unfortunately, not everyone with heart failure can be treated with a VAD. According to the Cleveland Clinic, people with blood clotting disorders, severe liver or lung disease, kidney disease, or people who suffer from antibiotic-resistant infections may not be eligible for this type of treatment (Cleveland Clinic, 2009).
You will likely already be in the hospital if you are ill enough to require a VAD. Your care team will perform thorough health checks and an assessment of your ability to withstand surgery.
The VAD is a complex machine requiring several parts to work correctly. A tube carries blood out of your heart to a pump. Another tube carries blood from your pump into a large blood vessel that leads to the rest of your body. A control unit monitors the performance of the VAD and sends out alarms if there are problems. A power source tethered to a machine or attached to a battery pack will allow you to move around.
Some VAD models work by pumping as the heart does, with short breaks on and off. Other types pump continuously, without any breaks or changes. There are also left ventricle assist devices (LVAD) and right ventricle assist devices (RVAD), for each chamber of the lower heart. If both are used at the same time, it is called a biventricular assist device (BIVAD).
VAD implantation is a long and complex surgery. You will be given general anesthesia so that you are asleep and pain-free during the procedure. VAD implantation requires open-heart surgery, so the doctors will open up your breastbone and separate your ribs to reach your heart. The surgeon then makes a pocket under the skin and tissue of your belly wall to hold the pump. A tube is attached from the pump to your heart. Another tube is attached from the pump to your aorta, which carries blood to the rest of your body.
Surgery lasts from four to six hours. You will spend up to five days in the intensive care unit (ICU or CCU) of your hospital. You may have to spend two to eight weeks in the hospital in order to recover. During this time, your condition will be monitored and you will be given guidelines on how to use and care for the pump.
Potential problems can arise during any surgery, including:
- blood clots in the legs
- breathing problems
- allergic reactions to anesthesia
- heart attack
Your doctor and care team will work hard to prevent any of these problems.
Heart failure is a very serious condition, and your outlook depends on your unique situation.
A VAD can help lengthen the life of those in end-stage heart failure and keep them healthy enough for a transplant procedure. A VAD can also be used earlier in the progression of heart failure, which can significantly improve recovery time and increase quality of life for longer.