Insertion of Ventricular Assist Devices

Insertion of Ventricular Assist Devices is a surgical procedure for the implantation of ventricular assist device (VAD) to help pump blood from the lower chambers of your heart to the rest of your body.

Some facts about Insertion of Ventricular Assist Devices:

• Ventricular Assist Devices is a mechanical circulatory support device that can be used in people who have weakened hearts or heart failure.
• Although a VAD can be implanted in the left, right or both ventricles of your heart, it is most frequently used in the left ventricle.
• It is called a left ventricular assist device (LVAD) when placed in the left ventricle.
• VAD can be implanted when you wait for a heart transplant or for your heart to become strong enough to effectively pump blood on its own.
• VAD can also be implanted as a long term treatment if you have heart failure and you are not eligible for a heart transplant.
• An open-heart surgery is often required in the procedure to implant a VAD.

Necessity of Insertion of Ventricular Assist Devices:

• The lower left heart chamber, the lower right heart chamber or both lower heart chambers can be supported by a VAD.
• VAD is called as left ventricular assist device, or LVAD when it is used for the lower left heart chamber, as right ventricular assist device, or RVAD when used for the lower right heart chamber, and biventricular assist device, or BIVAD when used for both lower heart chambers.
• You can have a VAD implanted if you're waiting for a heart transplant, not eligible for a heart transplant because of age or other conditions or there is a chance or your heart's function become normal again.
• VAD can be implanted temporarily till you get a donor for a heart transplant. It can keep blood pumping despite a diseased heart and will be removed when your new heart is implanted.
• The function of other organs in your body that may not be working properly and other medical conditions can be improved by implanting a VAD.
• It is referred to as a 'bridge to transplant' when a VAD is implanted while you are waiting for a heart transplant.
• It is referred to as a 'destination therapy' when a VAD is implanted in case of heart failure, but you are not eligible for a heart transplant due to age or other medical conditions.
• You can become eligible for a heart transplant candidate if your other medical conditions improves because of VAD implantation or you may need to keep the VAD as a permanent treatment.
• VAD can be implanted as therapy for heart failure for  people who have heart failure but aren't an eligible candidate for a heart transplant as it can enhance your quality of life.
• It is referred to as 'bridge to recovery' when a VAD is implanted in case of temporary heart failure  until your heart is healthy enough to pump blood on its own again.
• A VAD can also be implanted for a few weeks or months during or after having heart surgery.
• A total artificial heart can be implanted as a treatment option if a VAD can't help your heart.

Preparation of Insertion of Ventricular Assist Devices:

• You need to spend at least a week in the hospital to prepare for the VAD surgery.
• During this time, you will continue to take any heart medicines given by your doctor and will learn about the VAD that you are getting and how to live with it.
• You may need to get extra nutrition through a feeding tube to make your body is strong enough for the surgery.
• Some blood tests, CT scan of your chest, MRI and X-Ray of chest, Electrocardiogram, Echocardiogram and Pulmonary function tests are done before the surgery to evaluate your condition and ensure that you are healthy enough for surgery to implant a VAD.
• Several factors will be reviewed to decide if a VAD is the most appropriate treatment for your condition and to the most appropriate type of VAD will be determined for you.
• The factors to be riviewed are if the severity of your heart failure is appropriate for a VAD, you have other serious medical conditions that may affect your health or quality of life with a VAD, whether you need support for the left ventricle, the right ventricle or both ventricles and you will be able to take blood thinning medications for a long period of time.

Procedure of Insertion of Ventricular Assist Devices:

• The procedure to implant a ventricular assist device (VAD) generally takes four to six hours.
• The surgical team include surgeon, Surgical nurses, Anesthesiologists, Perfusionists and Engineers.
• Local anesthesia will be given by an anesthesiologist to make you sleep before the surgery. The anesthesiologist will check your heart rate, blood pressure, oxygen levels, and breathing uring the surgery.
• A breathing tube will be placed in your windpipe through your mouth which is connected to a ventilator machine to support your breathing during the surgery.
• Medicines are used to stop your heart so that the surgeons can operate on your heart while it is not moving.
• Oxygen-rich blood will keep moving through your body during the surgery through a heart-lung bypass machine.
• Your surgeons will cut into your chest bone to perform the surgery. After cutting the chest bone, your ribcage will be opened so that the surgeon can operate on your heart so that the surgeon can operate on your heart.
• A VAD will be implanted by the  surgical team.
• An implanted left ventricular assist device (LVAD) consist of a tube that carries blood from the left ventricle of your heart to a pump, a pump that delivers blood through another tube to the aorta and the artery that leads out to the body from the heart which then delivers blood to the body.
• The pump is connected through a cable inserted through the skin to the control unit and battery pack outside your body.
• Your doctors will take you off the heart-lung bypass machine after your VAD is implanted and working properly so that the VAD can begin pumping blood through your heart.
• A pumping action is used by certain types of VADs to pump blood in the way similar to your heart does as they help pump blood from one or both lower chambers of your heart and on to the rest of your body.
• Other types of VADs are continuous flow devices which are smaller and allow a continuous stream of blood to flow through your heart.

Recovery from Insertion of Ventricular Assist Devices:

• The duration to stay in hospital after surgery can be a month or more and the recovery time will depend on your health condition before the surgery.
• You will be moved to the intensive care unit right after surgery.
• Fluids and medications will be given through intravenous (IV) lines.
• Urine from your bladder and fluid and blood from your chest can be drained by other tubes.
• Oxygen can be given through a mask or nasal prongs in your nose.
• Your condition will be monitored and the signs of infection in your incision sites will be watched by your treatment team.
• The pain you have after surgery can be managed by your treatment team.
• You may need to remain connected to a ventilator for several days after surgery until you are able to breathe on your own as your lungs may not work properly immediately after your surgery.
• Antibiotics and blood-thinning medications will be prescribed to prevent infection and other complications while you are in the hospital.
• Blood-thinning medications, including aspirin and warfarin should be continued during the time you have a VAD to prevent blood clots.