Transplant Center

Frequently Asked Questions

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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.

It seems like I am getting sicker. Do I have other options?

A range of interventions can be initiated to improve the advanced heart failure patient's condition.

Only a physician can determine whether a lifestyle or medication adjustment is warranted, or if the time has come to refer the patient for a ventricular assist device (VAD)/cardiac transplantation evaluation. However, a patient who has exhibited a worsening of symptoms should receive an introduction to options that may be appropriate in the future.

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I have never heart of a ventricular assist device. Is it new?

Many patients will not know that VADs have been used in advanced heart failure patients for well over a decade. They may have concerns that VADs are experimental and unproven. Ventricular assist devices 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.

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I don't feel that bad. Do I really need this?

Discuss the ways that the patient may currently be compensating for their worsening condition, such as limiting their activities, avoiding certain household chores, or sleeping in a sitting position. Help them understand that they may have begun to lose sight of the fact that they are not really living with good quality of life, and may have begun to deceive themselves into thinking their condition is "not that bad."

When clinically indicated, an adjustment or change of medical strategy can provide patients with a significant improvement in their NYHA functional class and improvement in quality of life.

Though patients should not be bogged down with selection criteria, they should understand that you are referring them for an evaluation at a time when you hope to maximize their potential for a good outcome and improved quality of life.

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Will I need to take any medications?

Other than post-surgery pain medication and your current regimen 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. 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.

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How will the VAD affect my daily routine?

VADs are designed to restore blood flow throughout your body, restoring 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.

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How about taking a bath or swimming?

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 healthcare provider for more specific instructions on showering.

Swimming and taking a bath are not allowed with a VAD becuase of increased infection risk and water damage to the pump and external components.

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Can I exercise with a VAD?

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.

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Can I travel with a VAD?

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.

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What other things should I keep in mind with a VAD?

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.

If you've recently been diagnosed with advanced heart failure or are considering therapy options, you're probably hearing a lot of new terms. Talk to your doctor.

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What is the benefit of having a ventricular assist device?

It is important to reassure patients that, while VAD implantation carries some risks, for many the potential benefits far outweigh them. Family members, especially the primary caregiver, may express concerns about putting their loved one through "more." Whether the patient is awaiting transplantation or being considered for long-term VAD therapy, a VAD can give patients real hope of extending and improving their lives.

A separate conversation with family members may allow them to ask you questions that they might avoid in front of the patient. Help them understand that post-implantation, the patient will be cared for in the hospital; though there will be a device to manage once the patient returns home, the impact on their lifestyle will be largely positive.

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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?

Help patients understand that you will remain their physician, and in the event that they receive a VAD or transplant, they can return to your care for follow-up visits. Managing physicians routinely provide all post-operative patient care that is not device-related once patients are discharged from the hospital.

Explain that you are referring them to a leading center that offers advanced technologies to provide them with very specialized treatment options, and that most hospitals cannot provide MCS and cardiac transplantation procedures. Printed materials about the center may also be helpful. If patients understand that you're referring them because you believe this is the best option for their care at the present time, you will help them feel more comfortable about the process. Most importantly, the patient can take comfort in knowing that there is solid communication and an atmosphere of collaboration among all members of the healthcare team.

The following are some lay descriptions of specialists that a patient may see at the tertiary care center:

Heart failure cardiologist: Heart failure specialists with similar background to yours who have chosen to focus their careers on therapies for advanced heart failure. Some have helped create the current treatment guidelines for advanced heart failure. They often practice at academic medical centers, and may have access to procedures, devices, and medicines that are being studied in clinical trials and are funded through large grants.

Cardiac surgeon: These surgeons have completed training in surgery of the heart. Many of these surgeons focus their practices specifically on surgeries that help to restore or improve the pumping function of a diseased heart, or to replace the heart altogether with a transplant.

VAD coordinator: A specially-trained staff member, usually a nurse, at the implanting center who helps coordinate the hospital team of physicians, nutritionists, therapists, social workers and nurses who work together to ensure the best care for patients before, during and after VAD implantation.

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What part of this is covered by insurance?

Today, people of all ages and socioeconomic groups comprise the spectrum of advanced heart failure patients benefiting from mechanical circulatory support therapy.

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, the patient's insurance provider can supply more specific information.

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Can I meet a patient who has a ventricular assist device?

There are many support groups available for patients and caregivers. Patients may also be able to meet a VAD patient through the tertiary care center where you refer them.

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What happens if the ventricular assist device fails? After all, it is a machine.

VADs are designed to function reliably for long periods of time. Before leaving the hospital, the patient and 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 the patient so that immediate action can be taken.

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Feras M. Bader, M.D.

Locations

University Hospital	(801) 585-3693
University Hospital	(801) 585-5122

Specialties: Cardiology, Echocardiography, Heart Failure, Heart Transplant

David A. Bull, M.D.

Locations

University Hospital

(801) 581-5311

Specialties: Cardiac Mechanical Support, Cardiothoracic Surgery, Coronary Revascularization, Esophageal Surgery, Heart Transplant, Lung Cancer, Lung Transplant, Valvular Heart Disease

Georges Desjardins, M.D.

Specialties: Anesthesiology, Heart Transplant

Stavros G. Drakos, M.D., Ph.D.

Locations

University Hospital

(801) 585-5122

Specialties: Cardiac Mechanical Support, Cardiology, Heart Failure, Heart Transplant

Aaron W. Eckhauser, M.D., M.S.C.I

Specialties: Cardiac Mechanical Support, Cardiothoracic Surgery, Heart Transplant, Pediatric Cardiothoracic Surgery

Edward Michael Gilbert, M.D.

Locations

Saint Alphonsus Regional Medical Center	(208) 367-4278
University Hospital	(801) 585-3693
University Hospital	(801) 585-5122

Specialties: Cardiology, Echocardiography, Heart Failure, Heart Transplant

Peter J. Gruber, M.D., Ph.D.

Locations

Primary Children's Medical Center

(801) 662-5566

Specialties: Cardiac Mechanical Support, Cardiothoracic Surgery, Heart Transplant, Pediatric Cardiothoracic Surgery

Aditya K. Kaza, M.D.

Locations

Primary Children's Medical Center

(801) 662-5566

Specialties: Cardiac Mechanical Support, Cardiothoracic Surgery, Heart Transplant, Pediatric Cardiothoracic Surgery

Stephen McKellar, M.D., M.Sc.

Specialties: Cardiac Mechanical Support, Cardiothoracic Surgery, Coronary Revascularization, Heart Failure, Heart Transplant, Lung Transplant, Minimally Invasive Heart Surgery, Minimally Invasive Lung & Esophageal Surgery, Valvular Heart Disease

Kimberly M. Molina, M.D.

Locations

Primary Children's Medical Center

(801) 662-5400

Specialties: Echocardiography, Heart Failure, Heart Transplant, Pediatric Cardiology

Amit N. Patel, M.D., B.S., M.S.

Locations

University Hospital

(801) 587-7946

Specialties: Cardiothoracic Surgery, Heart Failure, Heart Stem Cell Therapy, Heart Transplant, Lung Transplant, Valvular Heart Disease

Craig H. Selzman, M.D.

Locations

University Hospital

(801) 587-9348

Specialties: Adult Congenital Heart Disease, Cardiac Mechanical Support, Cardiothoracic Surgery, Coronary Revascularization, Heart Failure, Heart Stem Cell Therapy, Heart Transplant, Lung Transplant, Minimally Invasive Heart Surgery, Surgical Ventricular Restoration, Valvular Heart Disease