A ventricular assist device (VAD) is a medical device that takes over for a weakened heart to pump blood. These devices move blood from one or both ventricles of the heart to the aorta or a major artery. The most common type is a left ventricular assist device (LVAD), but it is also possible to see RVADs that handle the right ventricle and BiVADs that pump for both ventricles. Connecting a ventricular assist device is a surgical procedure that requires the skills of a cardiothoracic surgeon.
There are three main reasons why a physician might recommend that a patient consider one of these devices. Patients waiting for transplant sometimes receive a ventricular assist device to handle the pumping for their hearts while they wait, out of concern that the heart may fail before a suitable transplant organ becomes available. These devices can also be used as a "bridge to recovery" to support a patient's heart while he or she is recovering, with the goal of weaning off the ventricular assist device and allowing the heart to function independently.
Finally, some patients are not good candidates for transplant, but have severely weakened hearts. These patients would die without a ventricular assist device and one may be implanted in an approach known as "destination therapy" to keep the patient comfortable. The device can improve quality of life, as well as give the patient more time before the heart finally fails and the ventricular assist device is no longer able to do the work.
Continuous flow and pulsatile flow pumps are both available. A surgeon can discuss the pump and placement options with the patient before the procedure takes place. On the day of the surgery, the patient will be placed under general anesthesia so that the surgeon can place the pump, battery, tubing, and leads. Once the ventricular assist device is in place, the patient can be taken into recovery and allowed to wake up.
Risks of these procedure include traveling blood clots, heart attack, stroke, and infections. Patients can also react poorly to the anesthesia, especially if they are in failing health and their hearts and lungs are already struggling. Working with a skilled surgical team can reduce the risks and patients may also benefit from staying in a hospital or clinic with facilities designed specifically for heart patients. Experienced clinicians can identify early warning signs of complications and intervene rapidly.
