Ventricular Assist Device (VAD) Clinic

The Ventricular Assist Device (VAD) Clinic cares for outpatients after the implantation of a durable VAD, a surgically implanted pump that is attached to the left ventricle of the heart. The device helps the heart circulate blood in patients with advanced heart failure. A surgeon will implant a durable VAD to support the heart for one of the following reasons:

• Bridge to transplant: To help keep you stable while waiting for a heart transplant.
• Bridge to candidacy: To improve your condition and increase your chances of being listed for a heart transplant.
• Destination therapy: To improve your quality of life if a heart transplant is not an option.

The Heart Function Clinic will evaluate patients referred for a VAD evaluation. During this evaluation, patients are assessed to determine if they need a VAD and to confirm there are no contraindications for a VAD.

Being referred for evaluation does not automatically mean you will proceed to VAD implantation. You must first undergo numerous tests. A multidisciplinary team will review your results to determine if you are a candidate for a VAD.

The VAD Clinic assigns a nurse coordinator to patients who have received an implanted VAD. Patients and family can contact the coordinator with any health concerns or questions about their upcoming appointments. We encourage patients to sign up for MyChart so they can access information about their upcoming appointments and test results.

The VAD Clinic uses a shared care model. This means any one of our VAD cardiologists may see you in the clinic.

Referrals

Physicians may send patient referrals for VAD evaluation to the Heart Function Clinic at the Ottawa Heart Institute. Physicians should include your complete medical history, an updated medication list, and any relevant testing. Your physician’s office may fax the referral to the Heart Function Clinic at 613-696-7159.

• Advanced Heart Failure Therapies Referral Form (PDF)

What to expect

For VAD evaluation

If we evaluate you for a VAD, you must complete several tests and assessments. Depending on your medical situation, you may complete these tests and assessments as an inpatient or as an outpatient.

Some examples of tests you may need to complete:

• Cardiopulmonary stress test
• Echocardiogram
• Carotid Doppler ultrasound
• Computed tomography (CT) scan of your chest and abdomen
• Flow studies of your legs
• Bloodwork
• Electrocardiogram (ECG)
• Right heart catheterization
• Referrals to a psychologist, social worker, dietitian, physiotherapist, and other specialists

Once your testing is complete, our multidisciplinary committee of cardiologists, surgeons, registered nurses, psychologists, social workers, and other allied healthcare professionals will review your case. The committee will discuss whether you require a VAD implantation, if you have any contraindications to receiving a VAD, and whether a VAD is in your best interest. The committee relays its review to you and your referring physician and informs you whether you are a candidate for a VAD. If the committee decides to proceed with a VAD implantation, we will provide you with more education about the implantation process before we schedule your surgery.

For patients with a VAD

Every person’s experience and recovery with a VAD is different, and the care is tailored to you. Depending on your medical condition before surgery and your recovery afterward, you may stay in the hospital for a minimum of two weeks or as long as needed for you to go home safely. While in the hospital you will start your recovery with physical rehabilitation and training on the VAD and its equipment, including passing a written and practical test. Once you are confident in caring for the VAD and medically stable, we will discharge you from the hospital, and you may return home.

You will need to monitor your health, adjust your lifestyle and complete regular testing after your VAD implantation surgery. This often includes the following:

Bloodwork

You will require frequent blood tests (up to twice a week). The goal is to reduce this to once every two weeks once you are stable. We will give you a standing order for bloodwork when you leave the hospital. Blood tests can be completed at the Heart Institute or at an outside laboratory. If you’re doing your blood tests at the Heart Institute, you may find the order in your electronic chart.

Echocardiograms

You will have echocardiograms once or twice a year. This may be completed as a regular echo or as a speed optimization echo where we adjust the speed of your VAD.

Daily monitoring

Check and record your weight, temperature, mean arterial pressure (MAP) and VAD numbers at the same time every day. Email or fax your log sheets to the VAD coordinator once a week or input your recordings in MyChart.

Support person

Your support person should stay with you consistently for the first month once you arrive home. After this, your support needs can be discussed with your care team. This is to support you and assist you in getting to your appointments and testing.

Back up equipment

Never leave the house without a backup controller, batteries and clips. Always have this equipment accessible to you or your support person.

Cardiovascular Rehabilitation

After getting your VAD, patients are required to attend Cardiovascular rehabilitation to learn about exercising safely. The goal is to increase your strength and endurance so you can become more independent and enjoy a healthier lifestyle. Rehabilitation is free at the Heart Institute. It starts six to eight weeks after your surgery. If you live outside Ottawa, rehabilitation can be arranged closer to home or virtually through the Heart Institute.

The VAD coordinator will review your results and any medication changes with you.

Approximately a month after your hospital discharge you will come to your first VAD clinic appointment to meet with a VAD cardiologist. After this your visits will be scheduled based on your medical condition, every one to six months.

What to expect at VAD clinic visits:

• Clinic visits take about one hour. Please arrive early to allow time for parking and to complete testing.
• Bring your list of medications.
• We may ask you to bring some of your equipment for maintenance checks.
• You will have an ECG before your appointment.
• Your driveline dressing will be changed.
• You may need to have a blood sample drawn.
• Your VAD will be attached to a monitor so we can review your numbers and alarm history.

Within approximately two months of your VAD implantation, you will have a follow-up appointment with your surgeon. They will review the healing of your sternum and driveline. If there are no concerns at this appointment, your surgeon will not book a follow-up meeting. If a surgical concern arises anytime during your time with a VAD, we will refer you to the surgeon for review.

What to expect at your surgeon clinic visit:

• Clinic visits take about one hour. Please arrive early to allow time for parking and to complete testing.
• Bring your list of medications.
• You will have an ECG before your appointment.
• You will have a chest x-ray before your appointment.
• Your driveline dressing may be changed.

If you had a VAD implanted as a bridge to transplant or bridge to candidacy, it usually takes approximately six months for you to recover before your cardiologist will start the evaluation for heart transplant. Please see Heart Transplant Clinic for more information.

Patient Resources

At the Heart Institute

• Coming for a Clinic Visit
• Ventricular Assist Device Patient Guide
• Heart Transplant Patient Guide
• Cardiovascular Rehabilitation Program
• Living Well as a Caregiver

Other organizations

• Considering a Left Ventricular Assist Device - CorHealth Ontario (PDF)