Purpose
A ventricular assist device (VAD) is a mechanical pump used in people with advanced heart failure. Advanced heart failure can be caused by many diseases and disorders, including congenital heart disease, coronary artery disease, heart attack, and cardiomyopathy. A VAD assist over the heart's pumping action. VADs can be placed to support the right side of the heart, the left side of the heart, or both sides of the heart. These devices can be placed as a durable (long-term) device that you can be discharged home with or a temporary (short-term) device.
All VADs have several features in common:
- Inflow Cannula: that takes blood from the heart’s ventricle.
- Pump: that moves the blood forward.
- Outflow Cannula: that takes the blood from the pump to the artery.
- Power source: for powering the pump
A VAD will be inserted to support your heart for one of the following reasons:
- Bridge to Transplant (BTT): To help keep you stable while you wait for a heart transplant.
- Bridge to Candidacy (BTC): To improve your condition and increase your chances of being listed for a heart transplant.
- Bridge to Recovery (BTR): To help keep you stable until your heart is able to recover.
- Bridge to Decision (BTD): To help keep you stable until a plan is made.
- Destination therapy (DT): To improve your quality of life if a heart transplant is not an option.
Durable LVAD
A durable VAD is a pump the is surgically implanted in the left ventricle of the heart. The device helps the heart to circulate blood in patients with advanced heart failure. The pump is attached to its external components via a driveline that exits the body from the upper abdomen. The driveline is attached to a system controller and power source to run the pump.
Every person’s experience and recovery with a VAD is different, and the care is tailored to you. While in hospital you will start your recovery with physical rehabilitation and training on the VAD and its equipment, including passing a written and practical test. You will be discharged home once you are confident in managing the VAD and medically stable.
Your cardiac care will be managed by the VAD Clinic post discharge.
Patients who receive a durable VAD must take anticoagulant medications to prevent blood clots.
Temporary VAD
Temporary VADs are short-term heart support devices used in acute or advanced heart failure, when the heart is suddenly too weak to pump blood to the body.
Just like a durable VAD, a temporary VAD helps the heart to rest, improve blood flow to vital organs, and stabilize patients while you and your care team decide on the next steps (i.e. recovery, surgery, durable LVAD, or heart transplantation). These devices can also be used to support patients during high-risk procedures (i.e., coronary artery stenting). A temporary VAD can sometimes be inserted in an emergency situation.
Unlike a durable VAD, a temporary VAD is only meant to support a patient for days to weeks, not long-term.
Patients who receive a temporary VAD will be on anticoagulation medications to prevent blood clotting.
There are two temporary VADs used at the University of Ottawa Heart Institute: Impellas and CentriMags. The type of temporary VAD you receive will be decided by a team of doctors depending on the nature, progression, and severity of your heart failure.
Impella:
The Impella is a small internal pump inserted through an artery, usually in the groin or sometimes in the shoulder area. It sits inside the heart and helps to pump blood from the left ventricle into the aorta. It can only be used to help the left side of the heart. It is connected to an external console that monitors performance and provides power.
CentriMag:
The CentriMag is an external pump that sits outside of the body. This pump is connected to tubes (cannulas) that are placed in the heart and large blood vessels. The pump helps move the patient’s blood from the heart and into their circulation via these tubes. A CentriMag device can support the left side of the heart, the right side of the heart, or both.
Description
Procedure for Durable VAD:
- Blood tests, radiographs of the chest, and assessments of heart function are done in the hospital before the procedure.
- The doctor explains the procedure, risks, and obtains consent. This consent is required before the procedure can be performed.
- You will be taken to the operating room.
- You will be placed under general anesthesia and remain unconscious for the entire operation. You will have a breathing tube inserted and be connected to a ventilator.
- For the surgical procedure (steps 5 to 9), incisions (cuts) are made through the chest, breastbone, and abdomen to allow the surgeons access to the heart and the space immediately beneath the heart.
- The heart’s blood vessels are connected to a heart-lung machine (also called a heart-lung bypass machine), which pumps the blood through the patients’ body during the surgery.
- Once the heart-lung machine is pumping blood, the patient’s heart is stopped.
- The inflow cannula is positioned in the left ventricle and the pump is then attached to the left ventricle.
- The outflow cannula is attached to the pump and sewn onto the aorta (the large artery exiting the heart
- The pump and communication line (known as the driveline) is placed and exits the body in the upper abdomen.
- The pump is connected to a power source which is outside the body.
- The pump starts and the heart is restarted.
- All incisions are closed, and then you will be transferred to CSICU
- You will have the breathing tube removed as early as possible to facilitate physiotherapy and rehabilitation.
- You will stay in the Cardiac Surgery Intensive Care Unit (CSICU) for several days or longer following the surgical procedure.
- You will be moved to a regular hospital room once intensive care is no longer needed. The average hospital stay is 14 to 30 days, but depending on your medical status, the stay may be longer.
Procedure for Impella or CentriMag:
- The doctor will explain the procedure and risks and obtain your consent. If you are unable to provide consent due to the emergency nature of the procedure, your substitute decision maker will consent on your behalf.
- You will be taken to the cardiac operating room, or the cardiac catheterization lab.
- You will be placed under general anesthesia and will remain unconscious for the entire procedure. You will have a breathing tube inserted and connected to a ventilator.
- The Impella or CentriMag device will either be placed surgically (via an incision), or percutaneously (via needle puncture of the skin).
- Once the procedure is completed, you will be transferred to the ICCU (Intensive Coronary Care Unit) or the CSICU (Cardiac Surgical Intensive Care Unit) with the device in place.
- You will have the breathing tube removed as early as possible to facilitate physiotherapy and rehabilitation.
- Several teams of health care professionals (i.e. Advanced heart failure cardiologists, critical care intensivists, cardiac surgeons, anesthesiologists, physiotherapists). will discuss your care and collaborate on the next steps daily.
- You will have frequent blood tests, x-rays, and cardiac echocardiograms to help determine when the temporary VAD can be removed.
- You will stay in one of the intensive care units while you have the temporary VAD device in, and for several days to weeks after it is removed.
- You will be moved to a regular hospital room once intensive care is no longer needed.
Patient instructions
Patients should bring all medications (including non-prescription drugs and supplements) with them to the hospital.
Patients should not eat or drink after midnight before surgery.