Treating advanced heart failure with a VAD
Heart failure is a condition where your heart does not pump blood as well as it should. As a result, your body and vital organs don’t get enough blood, oxygen and nutrients. Many people develop heart failure after having a heart attack or because of another heart condition, such as coronary artery disease, heart valve disease or cardiomyopathy.
Lifestyle changes and medications are common treatments in the condition’s early stages, but heart failure can progress to the point where medications and lifestyle changes are no longer effective. In those instances, your cardiologist or cardiovascular surgeon may recommend more intensive treatment with a VAD or, in very severe cases, a heart transplant.
VADs are sometimes referred to as destination therapy, meaning that they can serve as the only treatment you need to manage advanced heart failure. VADs are also used as a bridge-to-transplant treatment, which means they can keep your heart functioning while you wait for a heart transplant.
Ventricular assist device types
Heart failure can affect either or both of your two ventricles, the lower chambers of your heart. The VAD you receive will depend on which ventricle is weakened.
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Left ventricular assist devices (LVADs)
Left ventricular assist devices (LVADs)
The most common type of VAD, LVAD, helps your left ventricle pump blood out of the heart and into the aorta, which carries it to the rest of your body.
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Right ventricular assist devices (RVADs)
Right ventricular assist devices (RVADs)
RVADs help your right ventricle pump blood into the pulmonary artery, which takes blood to the lungs to receive oxygen.
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Biventricular assist devices (BiVADs)
Biventricular assist devices (BiVADs)
Biventricular means both lower chambers of the heart. If both the right and left ventricles need help pumping blood, you may need a BiVAD.
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Total artificial heart
Total artificial heart
Your cardiologist or cardiovascular surgeon may recommend another device called a total artificial heart.
Like a BiVAD, the total artificial heart pumps blood when the left and right ventricles fail. It can essentially replace your natural heart as it has four valves that allow blood to flow from the ventricles to the atria (the upper chambers of the heart). The artificial heart connects to the aorta and pulmonary artery, which carry blood to the rest of your body.
Left ventricular assist devices (LVADs)
The most common type of VAD, LVAD, helps your left ventricle pump blood out of the heart and into the aorta, which carries it to the rest of your body.
Right ventricular assist devices (RVADs)
RVADs help your right ventricle pump blood into the pulmonary artery, which takes blood to the lungs to receive oxygen.
Biventricular assist devices (BiVADs)
Biventricular means both lower chambers of the heart. If both the right and left ventricles need help pumping blood, you may need a BiVAD.
Total artificial heart
Your cardiologist or cardiovascular surgeon may recommend another device called a total artificial heart.
Like a BiVAD, the total artificial heart pumps blood when the left and right ventricles fail. It can essentially replace your natural heart as it has four valves that allow blood to flow from the ventricles to the atria (the upper chambers of the heart). The artificial heart connects to the aorta and pulmonary artery, which carry blood to the rest of your body.
Benefits of VADs
The primary benefit of VAD therapy is that it improves your quality of life and may help you live longer.
Heart failure has no cure, and if standard treatments don’t help you, your heart may grow too weak. A VAD takes over the functions necessary to keep the heart muscle beating and blood flowing regularly, reducing your symptoms and allowing you to continue your daily activities with fewer limitations.
Additionally, if your doctor has recommended a heart transplant, you must wait for a donor heart to become available. A VAD can keep your heart working properly in the interim.
What to expect when receiving a VAD
- Your VAD features a mechanical pump that draws blood away from your ventricle and sends it to major arteries. It will have an external controller and battery pack that connect to the device through a tube inserted through your stomach.
- You’ll need open-heart surgery to have the VAD implanted. While you’re under anesthesia, your cardiothoracic surgeon makes an incision in your chest and opens your breastbone to access your heart. The surgeon attaches the pump under the affected ventricle or ventricles and connects it to your aorta or pulmonary artery, depending on which type of VAD you receive.
- The procedure takes four to six hours.
- You’ll stay in the intensive care unit for a few days after the procedure and then transfer to another unit in the hospital.
Follow-up care after VAD surgery
Before you go home, your care team will explain how your VAD works, how to use the controller and when to change the batteries. They will also teach you how to care for your surgical incision and give you other instructions for your short—and long-term recovery.
After you leave the hospital, you will follow up with your provider regularly. You’ll need to practice good hygiene to protect against infection and ensure your device’s batteries are always charged and in good working order. Contact your provider if you experience issues with your pump.
Your care team may also recommend cardiac rehabilitation as part of your recovery plan. This program, designed to help people recover from heart surgeries and manage chronic heart conditions, is led by a team of expert physical therapists. They will monitor your progress as you learn exercises and other strategies to protect and strengthen your heart, contributing to your overall recovery and health.