Sometimes our heart can become very weak. The heart muscle can become so tired that it cannot be controlled by medication or other treatments. We call this condition Advanced Heart Failure. So, did you know that in times like these, a little 'helper' can be implanted in the heart and some of the work of the heart can be assigned to it? This device is what we medically call a Ventricular Assist Device, or VAD for short. Today, let's understand this simply, as if we were talking to a friend.
Simply put, what is a VAD?
Think of your heart as a motor that pumps water to a house. When this motor fails, the water doesn't flow to the whole house, right? That's how it is with a weak heart. A VAD is a small mechanical pump that is used to help the weak heart. It takes blood from a ventricle of the heart and pumps it to the rest of the body. It's like adding a small extra motor to the weak motor.
There are several main types of these VADs.
| VAD type | The work being done |
|---|---|
| Left Ventricular Assist Device (LVAD) | This is the most commonly used type. It helps the left side of the heart pump clean, oxygen-rich blood throughout the body. |
| Right Ventricular Assist Device (RVAD) | It helps the right side of the heart pump and send dirty blood to the lungs for purification. |
| Biventricular Assist Device | This supports both sides of the heart (left and right) simultaneously. |
| Pediatric VADs | These are small in size, specifically designed to fit a range of ages from young children to young adults. |
What kind of people need a VAD?
Not everyone with severe heart failure will be fitted with a VAD. It is mainly used for three purposes.
1. As a Bridge to Recovery: Sometimes the heart can become temporarily very weak. In such cases, a VAD is used to give the heart some rest and support it until it can function on its own again.
2. As a Bridge to a Heart Transplant: Some patients need a heart transplant. But they have to wait a while for a compatible heart to become available. During that time, a VAD is used to support the heart to save life.
3. Destination Therapy: For those who are not eligible for a heart transplant due to age or other medical conditions, this VAD is used permanently to provide lifelong heart support. This allows them to live longer and with a better quality of life.
How does this machine work?
There are several parts to this device. Some are connected to the heart inside the body, while others are located outside the body.
- Inflow Cannula: This is the tube that is connected to the heart chamber. It takes blood from the heart and delivers it to the mechanical pump.
- Mechanical Pump: This is the hero of the story. It is the one who does the pumping work of the heart.
- Outflow Cannula: This tube connects the pumped blood back to the body's main blood vessel (aorta) or the tube leading to the lungs.
- Driveline: This is a small, strong cable that connects the pump inside the body to the controller outside the body. It comes out through the skin.
- Controller: This is like the brain of the VAD. A small computer. This is what controls the functioning of the VAD and allows doctors and the patient to view information from it.
- External Battery Pack: These batteries provide the power needed for the VAD. There is a main battery and a backup battery for emergencies.
What happens before the surgery?
Because this is a very serious surgery, a patient is selected for VAD surgery after a series of very extensive tests. The current condition of the heart and other organs of the body (such as kidneys and liver) is carefully examined.
The most important thing is that this is a decision made by a team of doctors. The patient's physical and mental preparation is very important here.
Common tests include:
- Electrocardiogram (ECG)
- Echocardiogram (Echocardiogram)
- CT Scan
- Exercise Testing
- Cardiac Catheterization
Also, the patient and family are best taught how to live with a VAD and how to care for it. It is especially important to have a family member or close friend who can help the patient.
How is the surgery done?
This is open-heart surgery. Simply put, this is what happens:
1. You will be put under general anesthesia. So you won't feel or remember anything.
2. During the surgery, you will be given breathing support by a ventilator .
3. The surgeon makes an incision in the middle of the chest, exposing the heart.
4. You will then be connected to a cardiopulmonary bypass machine . This machine will continue to circulate blood throughout your body even if your heart has stopped during the surgery.
5. Next, the VAD pump is attached to the appropriate location in the heart, and the driveline is removed through the abdominal wall.
6. After activating the VAD and ensuring that it is providing the body with the necessary blood supply, you will be removed from the bypass machine.
7. Finally, the chest bone is reattached with metal wires, and the wound is closed with dissolvable stitches.
What are the benefits and risks?
Like any major surgery, a VAD has both benefits and risks.
| Benefits | Risks |
|---|---|
|
|
Your medical team will monitor you regularly to manage these risks.
What is life like with a VAD?
Living with a VAD means getting used to a new lifestyle.
- Limitations: You can't bathe or swim because the device is not water resistant (but you will be instructed on how to take a shower with a special cover). Also, you should avoid contact sports that have a high risk of injury.
- Maintenance: Always keep the driveline clean where it exits the skin. Change the batteries, and learn to understand the alarms from the controller.
- Medication: You will need to take anticoagulants, such as Warfarin, for the rest of your life. You will also need to take medications to control your blood pressure.
- Medical supervision: You need to see a doctor regularly, have blood tests, and check the VAD data. Although you may have to go to the hospital frequently in the beginning, the frequency will decrease over time.
Do you also need to think about mental health?
Of course, yes. Some people may experience stress, depression, or anxiety when living with such a big change. That's normal. If you're feeling that way, don't suffer alone, but definitely talk to your doctor. It's very important to get help for that.
When you need to talk to the doctor
If you experience the following symptoms or problems, notify your medical team immediately.
| Problem | What to pay attention to |
|---|---|
| Physical symptoms |
|
| Device problems |
|
A VAD is an amazing technological advancement that can give a second life to someone battling a serious heart condition. The life-saving benefits it provides are priceless. But to get the most out of those benefits, it is essential that the patient takes great care of themselves and their device.
Take-Home Message
- A Ventricular Assist Device (VAD) is a mechanical pump that supports a severely weakened heart.
- This is a major life-saving surgery and is used before or as a permanent solution for a heart transplant.
- Living with a VAD requires a lifelong commitment, following medical instructions, and proper maintenance of the device.
- This can significantly improve the quality of life through things like easier breathing and increased physical strength.
- If you notice any abnormality in your body or device, never ignore it. Talk to your medical team immediately.
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