ventricular assist device

Insertion of a Ventricular assist device

Introduction 

The ventricular assist device (VAD) helps to pump blood through the lower chambers of a person’s heart to the other parts of his body. It has been referred to as a mechanically circulatory assist device. This device is inserted in a patient’s chest under the heart and requires surgery. Commonly, LVAD has been inserted in a patient’s left ventricle. It regulates the heart’s pumping capacity, which is very fragile to work.

Explanation

VAD is used for heart failure patients who don’t improve with medicines and are waiting for a heart transplant. After inserting VAD, patients may experience more power, less fatigue, improved breathing, and a longer survival rate. In the U.S, it is estimated that around 50,000-100,000 heart failure persons take advantage of the VAD. Currently, LVADs supply a constant blood flow through the heart to the body and refer to as continuous flow devices. Furthermore, VAD is lifesaving when a person faces heart failure in severe conditions. 

Why do we need VAD?

The doctor recommends a VAD in certain conditions, such as:

  • Bridge towards transplant: A VAD is temporarily used when a patient is waiting for the donor’s heart to be available. The VAD may retain blood pumping from the body instead of the damaged heart. It is removed when a person receives his new donor heart. A VAD can also assist the body’s other organs for better working if a patient is waiting for a heart transplant.
  • Destination therapy: VADs are significantly used if a patient cannot get a heart transplant due to age and other factors. This treatment has been permanently used for these patients and is referred to as destination therapy. Long-term VAD treatment may improve the life quality of a person having advanced heart failure. Moreover, a VAD can rarely improve the patient’s existing condition and make him eligible to take a heart transplant. The time duration with a VAD during this condition depends on the patient’s body size, blood type, and medical condition. 
  • Bridge towards recovery: If a patient has temporary heart failure, a doctor suggests inserting a VAD until his heart becomes healthy for heart pumping. 

The specialist considers certain conditions to decide on a VAD treatment, which may include: 

  • The severity of a person’s heart failure.
  • Additional medical conditions of a patient.
  • The working of pumping chambers of a patient’s heart.
  • The patient’s capacity for taking blood thinners.
  • The capability and mental health of a patient to manage the VAD.
  • The social support of a patient’s friends and family. 

How to prepare for VAD?

Before insertion of a VAD, a doctor offers the patient some instructions to prepare for surgery, including:

  • Explain the possible complications and risk factors of a VAD surgery.
  • Discuss every detail about VAD.
  • Give specific guidelines to follow throughout the recovery phase at home.
  • A patient may prepare for this surgery by discussing related hospital stays and treatment with his family.
  • Stop drinking and eating for some hours before a VAD surgery.
  • Before the surgery, a doctor prescribes medications taken and brought to the hospital. 
  • Other items, such as loose-fitting clothing, eyeglasses, hairbrushes, and toothbrushes, must be brought to the hospital. 

What is the mechanism of VAD? 

Before the surgery

For a VAD insertion, a patient requires to admit to the hospital before surgery for several tests. The specialist suggests these tests to determine that a VAD is the best treatment, such as:

  • Blood tests: Blood tests, such as complete blood count (CBC), are done to examine the presence of blood clots. The doctor recommends blood tests to evaluate the heart, kidneys, and liver before VAD insertion. 
  • Electrocardiogram (ECG): It checks electrical activity and heart rhythm. Electrodes are attached to the chest at different spots to examine the heartbeats. 
  • Echocardiogram: Echocardiogram is used to check heart conditions. It creates images of the heart by using sound waves and shows the heart structure and blood flow from the heart.
  • Chest X-Ray: It is an imaging test that uses X-rays to evaluate the organs and structures of the heart and lungs.
  • Cardiac catheterization: During this procedure, a thin tube (catheter) is inserted into the blood vessels and transferred to the heart by X-ray to calculate the pressure in the heart. This test may assist in determining whether a VAD treatment is suitable for the patient or if another surgery is required. 

During the surgery:

The insertion of a VAD needs open heart surgery that takes 4-6 hours. These are the steps of surgery, which may include:

  • The patient must remove the jewelry because it interferes with the VAD surgery. A gown is given to a person to wear. 
  • The specialist applies a local anesthetic spray with the medications to make him sleepy during a VAD surgery. 
  • The patient is attached to the machine, which assists him in breathing during his surgery.
  •  A patient is attached to the bypass machine that retains oxygen-rich blood flow from the body during the procedure. 
  • The surgeon inserts a VAD in the chest. Then he separated the sternum to evaluate the heart and inserted the device. 

A VAD has different parts. The heart pump connects to the heart’s tip and transfers blood through the heart to the other body parts. The cords from the skin attach the mechanical pump to the battery pack and control unit outside the body. Once the LVAD is inserted and worked correctly, a person removes it from the bypass machine. Therefore a person’s VAD may start blood pumping. 

After the surgery

A patient needs to stay in the ICU after the VAD insertion so his treatment team may manage heart treatments and monitor him for potential complications. The patient receives particular objects in the ICU. Examples are antibiotics, blood thinning medications to stop blood clots and infections, and tubes draining urine and blood from the chest and heart. After several days, a patient is transferred to a private hospital room. Before discharge from the hospital, physical therapists, nurses, and doctors assist the patient in becoming stronger and more active. 

After inserting a VAD, the patient requires weekly checkups with the specialist to confirm that it is working effectively. The specialist will listen to his heart with the stethoscope and check his blood pressure. He may suggest thinning blood medicines like warfarin to stop blood clots. Furthermore, he may prescribe cardiac rehabilitation, personalized education, and exercise that improves a patient’s heart health after surgery. 

What are the risk factors of VAD?

These are the possible risk factors associated with using a VAD, such as:

    • Blood clots: When a person’s blood transfers from his VAD, blood clots can develop. These blood clots through a VAD may slow the blood flow and cause heart attack, stroke, or device problems. 
    • Bleeding: Bleeding is a common risk factor after VAD insertion. A VAD treatment may increase bleeding risk factors because of hemostasis modification. 
    • Infection: The control unit and power source for a patient’s VAD are placed outside his body and connected from a wire through the small opening in his skin. It is enhanced the possibility of germs entering the site, causing infection. 
  • Right heart failure: If a person has VAD insertion, his heart’s left ventricle may pump additional blood than usual. The patient’s right ventricle can become more fragile to manage the blood-enhanced amount. Occasionally, it needs a temporary pump to assist a right ventricle. Different therapies and medications can help a right ventricle with a long-term pump. 
  • Device problems: Rarely a VAD treatment cannot work effectively after insertion. For example, the power supply may fail, or a VAD device cannot pump sufficient blood. These conditions need medical attention immediately. 

Healthy lifestyle changes

A doctor recommends a healthy lifestyle to the patients before and after inserting a VAD. These are the preventive measures, which may include: 

  • Take a nutritious diet
  • Quit smoking
  • Daily exercise or physical activity
  • Stop using alcohol
  • Avoid usage of illegal drugs 
  • Managing stress

References

  • https://www.mayoclinic.org/tests-procedures/ventricular-assist-device/about/pac-20384529# 
  • https://ctsurgerypatients.org/adult-heart-disease/left-ventricular-assist-device-lvad 
  • https://www.ucsfhealth.org/treatments/ventricular-assist-device 
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