Mechanical Heart Assist Device/ Ventricular Assist Device

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Post-Surgery

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What is - Mechanical Heart Assist Device/ Ventricular Assist Device

What is a mechanical heart device?

A mechanical heart device is a man-made artificial pump that takes over the pumping action of the heart, to help maintain blood circulation.

What is a ventricular assist device (VAD)?

A VAD is normally used when the heart is severely weakened, such as in severe or end-stage congestive heart failure, and medicines fail to maintain enough circulation. The blood pressure remains low and the patient has difficulty breathing and is confined to bed. Most of the patients require assistance for the left ventricle, the main pumping chamber of the heart to restore normal blood flow.

The Left Ventricular Assist Device (LVAD) pumps blood from the left ventricle to the aorta. In some patients, a Right Ventricular Assist Device (RVAD) is needed to supplement the right ventricle. There are also Bi-Ventricular Assist Devices (biVAD) which assist both ventricles.

Diagnosis of Mechanical Heart Assist Device/ Ventricular Assist Device

When do we need a VAD?

The use of the device falls into 3 main categories:

Bridge to transplant - Patients who are already on the heart transplant list may deteriorate during their long wait, due to the scarcity of donor organs For these patients, the heart pump assists their failing heart, supporting them until a donor heart becomes available.
Bridge to recovery - There are conditions (infections, alcohol abuse) that can lead to severe heart failure requiring placement of a VAD. In some instances, the heart recovers enough of its normal function after resting for some time and the device can be removed.
Destination therapy - Also known as long-term or chronic therapy, destination therapy is used for patients who need a new heart, but are not eligible for transplant because of their advanced age or another disease or condition, such as cancer, which makes them unsuitable for heart transplant.

VADs cannot be used for people with serious renal (kidney), liver or lung disease, blood clotting disorders, or infections that do not respond to antibiotics.

Treatment for Mechanical Heart Assist Device/ Ventricular Assist Device

The surgery

During the surgery to implant a VAD, depending on the choice of the device, a surgeon may create a pocket in the muscle under the heart. The main pump is tucked into this pocket. Tubes are then connected from the failing left ventricle to the pump and from the pump to the aorta. Once the device is activated, blood is pumped out of the left ventricle and flows into the aorta.

The pump is also connected to a drive line, or cable, that exits the body through the right side of the abdomen. The drive line links to the computer that controls the pump and batteries that the patient must charge regularly.

Until recently, patients with small body sizes did not have enough space to accommodate the older pump models which are larger. With better technology, we can now offer these patients newer, miniaturised heart pumps. Small-built patients can also be supported with external devices where the only internal hardware is the tubes connecting to the heart.

Implantation of a VAD involves open-heart surgery. A general anaesthetic is given so that the patient will sleep through the entire operation. The patient will be connected to a heart-lung machine, which will take over the pumping action of the heart and ensures the body continues to receive a flow of oxygen-rich blood during the surgery.

Post-Surgery Care for Mechanical Heart Assist Device/ Ventricular Assist Device

The surgery can take several hours. The patient will wake up in an intensive care unit (ICU) and can expect to stay in the hospital for a few weeks. How quickly one recovers from surgery will depend largely on how healthy he was before the surgery. During this time, tests will be conducted to assess and monitor the patient’s condition. The patient and his family will also learn how to manage and care for the VAD and himself/herself, so that he/she can return to his/her normal life and routine after discharge from the hospital.