Frequently Asked Questions
When faced with a complex diagnosis, it is natural to have questions and concerns much like other patients with advanced heart failure and VAD therapy. While your doctor is the best person to advise your treatment decisions and lifestyle changes, these questions and answers can offer you important information to assist your discussions.
- It seems like I am getting sicker. Do I have other options?
- I have never heard of a ventricular assist device. Is it new?
- I don't feel that bad. Do I really need this?
- Will I need to take any medications?
- How will the VAD affect my daily routine?
- How about taking a bath or swimming?
- Can I exercise with a VAD?
- Can I travel with a VAD?
- What other things should I keep in mind with a VAD?
- What is the benefit of having a ventricular assist device?
- If you refer me to someone else, who will that be? I am comfortable with you; why can't you be my doctor for this?
- What part of this is covered by insurance?
- Can I meet a patient who has a ventricular assist device?
- What happens if the ventricular assist device fails? (After all, it is a machine.)
Only a physician can determine whether a lifestyle or medication adjustment might help or if the time has come to refer you for a ventricular assist device (VAD)/cardiac transplantation evaluation. However, if you have symptoms that are clearly getting worse, we will work with you to explore all the available options.
VADs have been used in advanced heart failure patients for well over a decade. They have been proven as both bridge-to-transplantation and long-term therapy, improving survival and quality of life for advanced heart failure patients. Newer devices are smaller, quieter, and more durable, providing better quality of life.
Examine the ways that you may currently be compensating for your worsening condition, such as limiting your activities, avoiding certain household chores, or sleeping in a sitting position. Explore whether you may have begun to lose sight of the fact that you could have a better quality of life, convincing yourself that your condition is not that bad. While an adjustment or change of medical strategy could also provide you with a significant improvement in your quality of life, you should always keep in mind what your doctor advises. He or she is referring you for an evaluation at a time when they hope to maximize your potential for a good outcome and improved quality of life.
Other than post-surgery pain medication and your current prescription of heart failure medications, you may require only a low dose of blood-thinning drugs. Immunosuppressive drugs commonly prescribed after a transplant are not necessary with VAD therapy. Also, many times the medications that you have been taking for heart failure can be reduced or discontinued after you receive a VAD. Your physician will reevaluate your medications before you leave the hospital and after you go home.
VADs are designed to restore blood flow throughout your body and oxygen and nutrients to vital organs and tissues. This should make you feel better overall, less light-headed, less tired, and less short of breath. Your kidney function, a major concern for many advanced heart failure patients, will likely improve as well. You should be able to resume most of your normal activities. However, VAD system components are not waterproof and must not be directly exposed to moisture.
Once the surgery site has healed, you may be allowed to shower. Because VAD system components are not waterproof, you will need to protect the external parts of the system from water with a specially-designed shower kit. Ask your health care provider for more specific instructions on showering. Swimming and taking a bath, however, are not allowed with a VAD because of increased infection risk and water damage to the pump and external components.
Generally, your only activity restrictions will be swimming or contact sports. Physical exercise is essential to help prevent the unhealthy effects of bed rest and inactivity. Your physician can discuss exercise goals and guidelines with you.
Due to the small, streamlined design of VADs used today, most people can move around with very little limitation, go on excursions away from home, and even travel. Many VAD patients are excited about their post-implant ability to travel to visit friends and family.
Tell your dentist and other doctors that you have a VAD. Ask your doctor if you should take antibiotics before and after any dental work or invasive procedure to prevent possible infections. Do not have magnetic resonance imaging (also called MRI). MRI uses large magnets that could cause you injury and could cause the pump to stop.
It is important to remember that while VAD implantation carry some risks, for many the potential benefits far outweigh them. Family members may express concerns about putting their loved one through more; but if you are awaiting transplantation or being considered for long-term VAD therapy, a VAD can give you real hope of extending and improving your life. Make a list of questions to ask your doctor, and ask your family to bring questions to your provider as well.
Your physician will remain your primary care physician, and if you receive a VAD or transplant, you can return to them for follow-up visits, as they usually provide all post-operative patient care (that is not device-related) once you are discharged from the hospital. The reason your physician is referring you to another care center is that most hospitals cannot provide cardiac mechanical support or heart transplantations. Members of your care team at this center may include a heart failure cardiologist, a cardiac surgeon, a VAD coordinator, and others.
New reimbursement codes established by the Centers for Medicare and Medicaid Services (CMS) have established appropriate payment levels for MCS therapy, encouraging more medical centers to offer it to patients and providing more complete insurance coverage for expenses. Since policies may vary, your insurance provider can supply more specific information.
There are many support groups available for patients and caregivers. We can make some recommendations to fit your needs.
VADs are designed to function reliably for long periods of time. Before leaving the hospital, you and your family will be trained in the proper function and management of the device. A staff member (likely the VAD coordinator) will thoroughly discuss device operation and its accessories. The device will also be checked at follow-up visits. In the event of a problem, the device will alert you so that immediate action can be taken.