Has your doctor told you that your heart is so weak that it can't pump blood properly? Or does someone in your family have this condition? Today we're talking about a special device that is used to help the heart in cases of advanced heart failure. This is called a Ventricular Assist Device, or VAD for short.
Simply put, what is this VAD?
Think of your heart as a small motor that pumps blood throughout your body. Sometimes this motor becomes weak. Then it can't work properly. At that time, a VAD is a mechanical device that helps the heart pump blood from the heart to the rest of the body. It's like adding another small motor to help the weak motor.
There are several types of VADs. Let's look at the main types.
| VAD type | What are you doing? |
|---|---|
| Left Ventricular Assist Device (LVAD) | This is the most commonly used type. It works on the left side of the heart (the left ventricle). It helps pump clean, oxygenated blood from the heart to the rest of the body. |
| Right Ventricular Assist Device (RVAD) | This helps the right side of the heart. It helps to purify the body's impure blood (blood lacking oxygen) by sending it to the lungs. |
| Biventricular Assist Device | This helps both sides of the heart. That is, both the left and right sides. |
| Pediatric VADs | These are small VADs designed specifically for young children. They can be used from a newborn to a young child. |
Why do I need a VAD?
If you have advanced heart failure and your heart can't pump enough blood to your body on its own, you may need a VAD. It has three main uses.
- Bridge to transplant: Some people are eligible for a heart transplant. But they have to wait a while for a matching heart to become available. During that time, this VAD is used to help your weakened heart. It's like a bridge.
- A bridge to recovery: Sometimes the heart can become temporarily weak. With proper treatment, the heart can eventually recover. Until that heart recovers, this VAD can be used to help.
- Destination therapy: Some patients may not be able to have a heart transplant due to age or other medical conditions. For such patients, this VAD can be used as a lifelong heart support device. This allows them to live longer with a better quality of life.
How does this VAD machine work?
This device has several parts. Some are surgically attached to the heart and are inside the body. Other parts are outside the body.
| Part of the device | Simple explanation |
|---|---|
| Inflow cannula | This is a small tube that connects the heart chamber. The blood in the heart goes into the mechanical pump through this tube. |
| Mechanical pump | This is the main part of the VAD. This pump does the pumping work of your heart. |
| Outflow cannula | This is also a tube. It carries blood from the mechanical pump to the body's main blood vessel (aorta) or to the blood vessel that goes to the lungs (pulmonary artery). |
| Driveline | This is a strong wire that comes out of the VAD inside your body and through your skin. This is where the VAD is connected to the controller outside. |
| Controller | This is like a small computer. It controls the functioning of the VAD. You and your doctor can look at it to see if the VAD is working properly. |
| External battery pack | This is the battery pack that supplies the power needed for the VAD. There is a main battery and a backup battery. The VAD is connected to these batteries through the controller. |
What happens before the surgery?
Not everyone with severe heart failure can have a VAD. To determine if you are a good candidate, you will undergo a thorough medical and psychological evaluation. This will include a thorough examination of your heart and other vital organs (such as your kidneys and liver). They will also check for other medical conditions. Some of the tests that may be done include:
- Electrocardiogram (ECG)
- Echocardiogram (Echo)
- Computed tomography (CT) scan
- Exercise testing
- Cardiac catheterization (tests performed by inserting a catheter into the heart)
Also, you and your family will be well-informed about living with a VAD and how to care for it on a daily basis. It is very important to involve someone who can support you, whether it is a family member or someone close to you, in this process.
What happens during the surgery?
This is a major surgery. In simple terms, what happens during it is as follows:
1. Anesthesia: First, you will be put completely to sleep (general anesthesia). So you will not feel anything and will have no memory of the surgery.
2. Breathing assistance: After the operation , and during the first few days in the intensive care unit (ICU), a ventilator will breathe for you.
3. Surgery: The surgeon makes an incision in the middle of your chest and goes to where your heart is.
4. Heart-lung bypass machine: Next, you will be connected to a special machine. It is called a `Cardiopulmonary Bypass Machine`. During the surgery, the work of the heart and lungs is temporarily done by this machine. You will also be given a medicine called `Heparin` to prevent blood clotting.
5. Implantation of the VAD: The surgeon then attaches the VAD device to the appropriate locations in the heart. The driveline is then removed through the skin of the abdomen.
6. Turning on the machine: Once the VAD is connected, it is turned on and you are removed from the special machine.
7. Completion of the surgery: Once the VAD is working stably, a drug called `Protamine` is given to help blood clot normally again, the chest bone is reattached with wires, and the skin wound is sutured.
What are the benefits of using a VAD?
Many people begin to experience these things while living with a VAD:
- Ease of breathing: Fatigue and shortness of breath are greatly reduced.
- Improved organ function: Other organs in the body receive better blood flow, so their function improves.
- Revitalization: The excessive fatigue that was present before is gone, and the body feels good energy.
Simply put, a VAD can greatly improve your quality of life.
What are the risks associated with this?
Like any major surgery, there are risks involved, and even with lifelong use of this device, some complications may occur.
- Irregular heartbeats (Arrhythmias)
- Bleeding
- Blood clots
- Infection
- Device malfunction
- Right-sided heart failure
- Cerebrovascular accident ( stroke )
Don't be afraid of these risks. Your medical team is always on the lookout to prevent them and manage them if they occur.
Things to consider when living with a VAD
After the surgery, you will have to stay in the intensive care unit (ICU) for a few days. Then you will be transferred to a regular ward. During your stay in the hospital, you will be trained to live with this equipment.
When you go home, take care of these things:
- Take your medication exactly: It is extremely important to take blood thinners like Warfarin, which is given to prevent blood clots, exactly and on time. You should also take other medications for high blood pressure and heart rate control exactly.
- Device Care: You will be instructed on how to keep the device, battery, and driveline clean. Follow these instructions carefully.
- Lifestyle changes:
- The device should never be submerged in water. This means you can't take a bath or swim with it. However, we will show you how to take a shower with the device carefully covered.
- Contact sports should be avoided because, if you are taking blood-thinning medication, even a small injury can cause significant bleeding.
- You always need to be connected to batteries or a plug in the wall.
- A heart-healthy lifestyle: Avoid smoking completely. Eat a nutritious diet. Engage in appropriate exercise as advised by your doctor.
When to see the doctor
Living with a VAD means you will need to go for regular medical check-ups. Although you may have to go more often at first, the frequency will decrease as your condition improves.
If you have any of these symptoms, call your doctor immediately:
| Symptoms in the body | Equipment problems |
|---|---|
| - Chest pain - Bleeding - Dark urine - Fever or chills - Joint pain - Redness, swelling, and pain where the incisions or driveline come out - Sudden weight gain or swelling of the hands and feet | - If the controller, driveline, or battery appears to be damaged - If the controller is displaying error messages - If an alarm is going off and you don't know how to stop it |
Think about mental health too
It's normal to feel depressed and anxious at times when you're living with such a big change. But don't keep those feelings to yourself. It's nothing to be ashamed of. If you're feeling this way, definitely talk to your doctor about it.
Take-Home Message
- A Ventricular Assist Device (VAD) is a mechanical device that helps a severely weakened heart pump blood.
- This can be used as a support until a heart transplant, until the heart heals, or throughout life.
- Although this is a major surgery, it will greatly help extend your life and improve your quality of life.
- When living with a VAD, it is extremely important to take proper care of the device, take the medication correctly, and follow your doctor's instructions.
- If you notice anything unusual in your body or equipment, seek medical advice immediately. Also take care of your mental health.
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