Overview

What Is a Ventricular Assist Device (VAD)?

What Is a Ventricular Assist Device (VAD)?

VAD

A ventricular assist device (VAD) is a mechanical device that is used to take over the pumping function for one or both of the heart’s ventricles. Patients may need a VAD when heart failure progresses to the point that medications and other treatments are no longer effective.

For persons with severe or end-stage heart failure, ventricular assist devices (VADs) may be required to support the heart to ensure that enough blood is pumped out by the heart per minute to meet the body’s needs.

Heart Failure & Heart Transplant Surgery

Heart transplantation is an option for some patients with severe heart failure (HF). But during this late stage of HF, over 50 percent of people on a waiting list for heart transplantation will die before they receive a donor heart. Organ donors are in short supply and don't meet the demand for patients waiting for heart transplant.

The wait time for heart transplantation may often be longer than 200 days.

Long wait times and decreased availability of donors strengthens the need to find other ways to support patients whose hearts are failing. Patients may die waiting for a heart transplant, or their other important organs, like their liver and kidney, may become permanently damaged before a donor heart is available.

Fortunately, using a VAD can prevent organ failure in other organs like the liver and kidney. VADs have been shown to help the body circulate enough blood to support the liver and kidney, even for patients with severe heart failure.

VAD Devices

Some VADs are designed to support the right heart alone (right ventricular assist device or RVAD) or both ventricles (biventricular assist device or BiVAD). But most types of VADS support the left ventricle (left ventricular support device or LVAD).

VADs are usually implanted during an open-heart surgical procedure.

VADs can be used for just a few hours or days of support or as a longer-term support, months to years.

Read more about the types of VAD devices.

Why Choose a Ventricular Assist Device?

Reasons to Use a VAD

There are commonly three main reasons that a ventricular assist device (VAD) might be used:

  1. As a bridge to transplant
  2. As a bridge to recovery
  3. For destination therapy

Bridge to Transplant

Some patients with advanced heart failure are candidates for a heart transplant, which can dramatically improve survival and quality of life. Unfortunately, donor hearts are not always available. A patient may wait several years before a suitable donor heart is found. While waiting the condition of the heart may continue to worsen. A VAD is most often used to sustain severe heart failure patients until a donor heart becomes available, and the patient can receive a transplant.

Supporting Research

Researchers have studied and documented how patients with ventricular assist devices fare before and after the heart transplant.* Several devices are available at University of Utah Heath for help in supporting the failing heart while a patient awaits a donor heart. These VADs are designed to allow patients full mobility to participate in physical strengthening as well as live outside the hospital while they wait for a donor heart.

Bridge to Recovery

In some patients with reversible forms of heart failure, a ventricular assist device (VAD) can be implanted with the hope that it will allow the heart to recover. Once the heart has recovered sufficiently, the VAD may be removed. The temporary VAD can also allow time for decisions to be made regarding the need for a more permanent VAD or heart transplant.

Destination Therapy

For some patients who are not good candidates for heart transplantation, a VAD may be used to provide support for a failing heart over the course of several years. Newer VAD pumps have been designed to provide patients with greater mobility and out-of hospital use so that they may return home after the device has been implanted. The goal of VADs for destination therapy is to help patients live a good quality of life that they would otherwise not have with their severe heart failure.

*The Impact of Bridge to Transplant VAD Support on Long Term Survival Following Cardiac Transplantation: Analysis of a Single Center Experience with over 1000 Heart Transplants
 by David A Bull, Craig H Selzman, Amit N Patel, Reza Khodaverdian, Dale G Renlund, John A Hawkins

Frequently Asked Questions About VADs

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?

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.

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

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.

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

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.

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Will I need to take any medications?

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.

How will the VAD affect my daily routine?

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.

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 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.

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.

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.

What is the benefit of having a ventricular assist device?

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.

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?

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.

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What part of this is covered by insurance?

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.

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

There are many support groups available for patients and caregivers. We can make some recommendations to fit your needs.

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, 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.

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