What is a Ventricular Assist Device? Purpose, Procedure & Results

A ventricular assist device (VAD) is a mechanical pump that helps your heart circulate blood throughout your body when your heart muscle becomes too weak to do this job effectively on its own. Think of it as a supportive partner for your heart, stepping in to ensure your organs receive the oxygen-rich blood they need to function properly.

This life-saving technology has helped thousands of people live fuller, more active lives while managing severe heart failure. Whether you're exploring treatment options for yourself or a loved one, understanding how VADs work can help you feel more confident about this important medical decision.

What is a ventricular assist device?

A ventricular assist device is a battery-powered mechanical pump that's surgically placed inside or outside your chest to help pump blood from your heart's lower chambers (ventricles) to the rest of your body. The device works alongside your natural heart, not replacing it entirely.

Most VADs support the left ventricle, which is your heart's main pumping chamber responsible for sending oxygen-rich blood throughout your body. These are called left ventricular assist devices (LVADs). Some people may need support for their right ventricle (RVAD) or both sides (BiVAD), depending on their specific heart condition.

The device consists of several key components that work together seamlessly. You'll have a small pump, flexible tubes called cannulas that connect to your heart, a driveline that exits through your skin, and an external controller with batteries that you'll wear or carry with you.

Why is a ventricular assist device done?

VADs are recommended when your heart becomes severely weakened by heart failure and other treatments haven't provided enough improvement. Your doctor might suggest this option when medications, lifestyle changes, and other procedures can no longer keep your symptoms manageable or your organs functioning properly.

The device serves different purposes depending on your individual situation and long-term treatment goals. Some people use a VAD as a bridge to heart transplant, helping them stay stable and healthy while waiting for a donor heart to become available. This waiting period can sometimes last months or even years.

Others receive a VAD as destination therapy, meaning it becomes a permanent treatment when a heart transplant isn't suitable due to age, other health conditions, or personal choice. Many people in this situation find they can return to activities they enjoy and spend quality time with family and friends.

Less commonly, VADs can serve as a bridge to recovery for people whose hearts might heal with time and support. This approach is sometimes used after heart attacks, certain infections, or during recovery from heart surgery when doctors believe the heart muscle may regain some of its strength.

What is the procedure for ventricular assist device implantation?

VAD implantation is a major heart surgery that typically takes 4 to 6 hours and requires careful planning and preparation. You'll receive general anesthesia and be connected to a heart-lung machine that takes over your heart and lung function during the procedure.

Your surgeon will make an incision down the center of your chest and carefully connect the device to your heart. The pump is usually placed in your upper abdomen, just below your diaphragm, where it sits comfortably without interfering with your daily movements.

Here's what happens during the surgery, step by step:

1. Your surgeon opens your chest and may need to separate some scar tissue if you've had previous heart surgery
2. The heart-lung machine takes over pumping blood while your surgeon works
3. A small tube (inflow cannula) is sewn into your left ventricle to draw blood into the device
4. Another tube (outflow cannula) is connected to your aorta to return blood to your circulation
5. The pump is positioned in your abdomen and tested to ensure proper function
6. The driveline is tunneled under your skin and exits through your abdomen
7. Your chest is closed and you're taken to the intensive care unit for monitoring

Recovery in the hospital typically takes 2 to 3 weeks, though this varies based on your overall health and how quickly you heal. You'll work closely with a specialized team that includes heart surgeons, cardiologists, nurses, and other specialists who understand VAD care.

How to prepare for your ventricular assist device surgery?

Preparing for VAD surgery involves both physical and emotional preparation, and your medical team will guide you through each step to help you feel as ready as possible. You'll undergo several tests to make sure you're healthy enough for surgery and that a VAD is the right choice for your situation.

Your preparation will likely include blood tests, imaging studies of your heart and other organs, and consultations with different specialists. These appointments help your team understand your overall health and plan the safest approach for your surgery.

In the weeks before surgery, focus on taking good care of yourself with these important steps:

• Take all prescribed medications exactly as directed, especially heart medications
• Eat nutritious foods to give your body strength for healing
• Get adequate rest and sleep when possible
• Stay as active as your doctor recommends within your current limitations
• Avoid smoking and limit alcohol, as these can interfere with healing
• Practice good dental hygiene and address any dental problems
• Learn about VAD care and lifestyle changes you'll need to make

Don't hesitate to ask questions or express concerns during your pre-surgery appointments. Your team wants you to feel informed and comfortable, and they're there to support you through this important decision and process.

How to read your ventricular assist device results?

After your VAD is implanted, you'll learn to monitor several important measurements that tell you and your medical team how well the device is working. Your VAD controller displays information about pump speed, power consumption, and flow, which are key indicators of your device's performance.

The pump speed, measured in revolutions per minute (RPM), is typically set between 2,400 and 3,200 RPM, though your specific target range will be determined by your doctor based on your individual needs. This speed can be adjusted during follow-up appointments to optimize your blood flow and symptom relief.

Power consumption shows how much energy your device is using and usually ranges from 3 to 8 watts. Changes in power consumption can sometimes indicate issues like blood clots or changes in how well your heart is working alongside the device.

Flow measurements estimate how much blood your VAD is pumping per minute, typically ranging from 3 to 6 liters. Higher flows generally mean better circulation to your organs, while lower flows might suggest the need for adjustments.

You'll also learn to recognize alarm sounds and messages that alert you to situations requiring attention. Most alarms are related to battery issues, connection problems, or temporary changes that can be easily addressed, but your team will teach you when to seek immediate help.

How to manage life with your ventricular assist device?

Living with a VAD requires some adjustments to your daily routine, but most people find they can return to many activities they enjoy once they've healed from surgery. The key is learning to incorporate device care into your life while staying active and engaged with family and friends.

Your daily routine will include checking your equipment, keeping your driveline site clean and dry, and managing your batteries to ensure your device never loses power. You'll carry backup batteries and learn to change them smoothly so your activities aren't interrupted.

Taking care of your driveline exit site is crucial for preventing infections, which are one of the most serious complications. You'll clean the area daily with special supplies and watch for signs of redness, drainage, or tenderness that might indicate a problem.

Here are the essential daily management tasks you'll master:

• Check your controller display for normal readings and any alarms
• Clean your driveline exit site with sterile technique
• Change and charge batteries according to your schedule
• Take prescribed medications, especially blood thinners
• Monitor your weight and report significant changes
• Stay hydrated and eat a heart-healthy diet
• Get adequate rest and manage stress

Most people with VADs can gradually return to work, travel, and recreational activities with proper planning and precautions. Your team will help you understand which activities are safe and how to adapt others to accommodate your device.

What are the risk factors for VAD complications?

While VADs are life-saving devices, like any major medical intervention, they do carry some risks that you should understand before making your decision. Your medical team will discuss these risks honestly with you and explain how they work to minimize them.

Infection is one of the most common complications, particularly around the driveline exit site where the cable comes through your skin. This creates a permanent opening that requires careful daily care to prevent bacteria from entering your body.

Several factors can increase your risk of complications, and understanding these helps your team provide the best possible care:

• Previous heart surgeries that create scar tissue
• Diabetes or other conditions that affect healing
• Kidney or liver problems that impact your overall health
• Poor nutrition or being significantly underweight or overweight
• Active infections anywhere in your body
• Difficulty following complex medication schedules
• Limited social support for learning device care
• Severe lung disease or other organ problems

Your team carefully evaluates these factors before recommending a VAD to ensure you're likely to benefit from the device while minimizing potential risks. They'll work with you to optimize your health before surgery whenever possible.

What are the possible complications of ventricular assist devices?

Understanding potential complications helps you make an informed decision and know what symptoms to watch for after your VAD is implanted. While complications can occur, many people live successfully with VADs for years with proper care and monitoring.

The most common complications include bleeding, blood clots, and infections, each requiring different prevention strategies and treatments. Your medical team will teach you how to recognize early signs of these problems so they can be addressed quickly.

Here are the complications you should be aware of, organized from most common to less frequent:

• Driveline infections around the exit site, causing redness, pain, or drainage
• Bleeding issues due to blood-thinning medications required with VADs
• Blood clots that can form in the device or travel to other organs
• Right heart failure if your right ventricle can't keep up with increased blood flow
• Stroke from blood clots or changes in blood flow patterns
• Device malfunction requiring repair or replacement surgery
• Kidney problems from changes in blood flow or medications
• Gastrointestinal bleeding, which can be more common with certain types of VADs

Less common but serious complications include device failure, severe infections that spread throughout your body, and complications related to blood thinning medications. Your team monitors you closely for these issues and has protocols in place to address them quickly if they occur.

Remember that while this list might seem concerning, your medical team has extensive experience managing these complications, and many can be prevented or treated successfully when caught early.

When should I see a doctor for VAD-related concerns?

After receiving your VAD, you'll have regular follow-up appointments to monitor your device and overall health, but you should also know when to seek immediate medical attention. Learning to recognize warning signs helps ensure you get prompt care when needed.

You should contact your VAD team immediately if you experience device alarms that don't resolve with basic troubleshooting, any signs of infection around your driveline, or symptoms that might indicate complications like stroke or heart problems.

Seek immediate emergency care for these serious warning signs:

• Continuous device alarms that won't stop or reset
• Complete device failure or power loss
• Sudden severe chest pain or difficulty breathing
• Signs of stroke like sudden weakness, confusion, or speech problems
• Severe bleeding that won't stop with pressure
• High fever with chills or feeling very unwell
• Driveline that's been pulled or damaged
• Sudden severe dizziness or fainting

Contact your VAD team within 24 hours for these concerning but less urgent symptoms: drainage or increasing redness around your driveline site, weight gain of more than 3 pounds in a day, persistent nausea or vomiting, or any new symptoms that worry you.

Don't hesitate to call with questions or concerns, especially during your first few months with the device. Your team would rather hear from you about something minor than have you wait too long to address a potentially serious problem.