Ventricular Assist Device

A ventricular assist device (VAD) is a mechanical device (“heart pump”) that circulates blood throughout the body when the heart is too weak to pump blood on its own. A small electric motor inside the VAD drives the pump. A left ventricular assist device (LVAD or LVAS) receives blood from the left ventricle and delivers the blood to the aorta. A right ventricular assist device (RVAD) receives blood from either the right atrium or right ventricle and delivers the blood to the pulmonary artery. Some VAD can perform the functions of either LVAD or RVAD, or both (BiVAD).

VAD Experience at Northwestern Memorial

Offering the latest in VAD technology and surgical implantation, the Bluhm Cardiovascular Institute of Northwestern Memorial is one of only five hospitals in Illinois offering a Medicare Destination Therapy Ventricular Assist Device Program certified by The Joint Commission. VAD management is directed by Edwin C. McGee, Jr., MD, cardiac surgeon and surgical director, Heart Transplantation and Mechanical Assistance.

VAD implantation at Northwestern Memorial is performed by highly skilled cardiac surgeons who have tremendous depth and breadth of experience in this specialty. Surgical expertise is complemented by a highly trained team of cardiologists, nurses and ancillary staff who skillfully coordinate in-hospital care and outpatient management. Outpatient VAD management is coordinated through a dedicated VAD clinic.

The expertise of this team and their involvement in advanced clinical research trials distinguishes this program as a "front runner" in the management of the advanced heart failure patients.

VAD Description

A ventricular assist device has three parts:

• A small pump that usually weighs around one pound and is a few inches in diameter. Most commonly, it is attached to your heart and the aorta (the large blood vessel that carries blood from your heart to the rest of your body). Blood from your heart flows into the VAD and then is pumped into the aorta and, from there, to the rest of your body.
• An electronic controller is a small computer that controls how the pump works.
• Batteries, carried outside your body, are connected to the pump with a cable (“driveline”) that goes into your body. The wearable system is either worn under or on top of clothing.

The VAD is designed to restore blood flow throughout the body, enabling the patient to breathe more easily and feel less fatigued. The patient’s organs will receive more blood than they did before receiving the VAD, and this will likely improve their function. After receiving a VAD, patients generally feel more energetic and are able to resume normal activities that they were unable to do prior to receiving the device. Many patients are able to return to work and resume hobbies that they haven’t been able to do for years.

VAD Eligibility

A VAD may be used to support patients whose medical therapy has failed and who have end-stage (stage D) systolic heart failure with an enlarged heart and an ejection fraction less than 25 percent.

A VAD can be used to improve patients’ quality of life while they wait for a donor heart to become available for heart transplantation. This is known as “bridge to transplantation.”

A VAD may also be used to improve patients’ quality of life and survival as a permanent option for those who are not eligible for heart transplantation due to advanced age or other medical conditions. Use of the VAD in this manner is known as “destination therapy.”

In rare situations, a VAD can be used as “bridge to recovery” in those patients whose hearts may eventually recover, allowing for removal of the pump.

VAD Implantation

VADs are implanted by a cardiac surgeon under general anesthesia. The surgery usually lasts 4 to 6 hours. As with any surgical procedure, there are risks. Your doctor will talk with you about the specific risks of this procedure.

After the VAD is implanted, most patients spend up to five days in the intensive care unit. You may stay in the hospital anywhere from 2 to 8 weeks after you have had the pump implanted. During this time you and your family will learn how to care for the pump.

VAD Implantation length of time

The amount of time you can receive support from a VAD is variable, depending on the type of system you receive, whether the VAD was implanted for bridge to transplant or destination therapy, and your medical condition. Usually, patients can live with the current generation of VADs for a number of years.

Caring for your VAD

After the implantation procedure, a detailed education program is provided to you and your caregivers to ensure safety and proper use of the device. You’ll learn how to manage the device and trouble shoot potential emergency situations.

What to expect at home

The length of the recovery period is highly variable, but it generally takes a few weeks to recuperate from the implantation procedure. To some extent, recovery will depend on your physical condition before surgery. Patients will need to maintain a healthy diet and a program of exercise approved by your doctor. You will also have to attend regular clinic appointments.

Types of VAD available at Northwestern Memorial

Heartware®
The Heartware® is a small centrifugal implantable VAD, which uses magnetic forces to spin a rotor and create blood flow. This design is expected to provide long-term support. Similar to other implantable continuous flow devices, it has a small electrical lead that exits the skin and attaches to an external controller and AC or DC power. The Heartware® provides patients with a high degree of mobility, being implanted above the diaphragm. It is currently in clinical investigations for use in bridge to transplantation and destination therapy. This VAD is the smallest, full support device available and can be configured to support both ventricles (BiVAD).

HeartMate® II
The Heartmate® II is a continuous flow small implanted pump, about the size of a “D” battery, used as an LVAD. The Heartmate II® is FDA approved as a bridge to transplantation and destination therapy. It is the smallest FDA approved LVAD and is suitable for women and patients with smaller body size.

Contact

Patients with advanced heart failure that have exhausted the limitations of medical therapies may be candidates to receive a VAD. For more information, please contact the Bluhm Cardiovascular Institute at 1-866-662-8467 or request a first time appointment online.