USE OF VENTRICULAR

ASSISTED DEVICES
MARIA THELMA ASUNCION
PRINCESS JOY SUSTIGUER

OVERVIEW

A ventricular assist device (VAD) is a

mechanical pump that's used to
support heart function and blood flow
in people who have weakened hearts.
The device takes blood from a lower
chamber of the heart and helps pump it
to the body and vital organs, just as a
healthy heart would.

TYPES OF VENTRICULAR ASSIST DEVICES

The basic types of VADs :

Left ventricular assist device (LVAD)

Right ventricular assist device (RVAD)

Biventricular assist device (BIVAD).

TWO BASIC DESIGNS

1. A
transcutaneous
VAD has its
pump and
power source
located outside
of the body.

2. An
implantable
VAD has its
pump located
inside of the
body and its
power source
located
outside of the
body

CANDIDATES FOR THE PROCEDURE

Examples of patients who may be candidates for a
VAD include:

Patients who have suffered a massive heart attack

Patients who cannot be weaned from a heart-lung
bypass machine after treatment with intravenous
fluids, medications, and the insertion of a balloon
pump in the aorta
Patients who have an infection in the heart wall
that does not respond to conventional treatment

Patients waiting for a heart transplant

who are unresponsive to drug therapy
and intravenous fluids
Patients with the following conditions:

Cardiomyopathy
Congenital heart defects
Coronary artery disease
Heart valve disease
Life-threatening arrhythmia

PREPARATION OF THE PATIENT FOR THE PROCEDURE

Pre-implantation
Informed consent is obtained from the patient with the risks
and benefits of the procedure explained in detail by
cardiologist, surgeon and VAD personnel.
Patients and relatives anticipating implantation may fear it
will result in a dependence on the device (and loss of
independence), financial hardship, changes in body image, a
loss of control and that he or she will become a burden to
the family (McCafferty et al, 2002). It is critical that these
issues are addressed before the implant is undertaken. The
artificial heart nurse specialist takes an active role in
supporting patients and carers to accept the ventricular
assist device implant.

Before your VAD is implanted, it's likely

you'll stay in the hospital for some time
preparing for surgery. While you're in
the hospital, you may have other
treatments for your weakened heart or
heart failure. Your doctors will make
sure you're healthy enough to have
surgery to implant a VAD. You may
need many tests or other procedures
before the surgery, including:

Echocardiogram.helps your doctor

determine the pumping function of your
heart, check your heart valves and help
determine the cause of your heart failure.
This can help your doctor decide if you're a
candidate for a VAD and if there are any
other treatment options available.
Chest X-ray.Your doctor uses a chest X-ray
to see the size and shape of your heart and
lungs.

Blood tests.Your doctor will order

blood tests to see if your liver and
kidneys are working properly before the
surgery to implant your VAD. Your
doctor might also check for other
chemicals in your blood that show how
well your heart is working. Blood tests
are commonly used to check for
diabetes, thyroid problems or
symptoms of infection, which will need

Cardiac catheterization.This test

checks the pressures in your heart and
may be used to determine if you are a
candidate for a VAD and if you may
need additional devices.

THE IMPLANTATION PROCEDURE

Surgery to implant a VAD is performed

by a cardiothoracic surgeon under
general anesthesia. The surgery to
implant a VAD is considered openheart surgery, and usually takes
between 4 to 6 hours.

The surgeon makes an incision down the

front of the chest. The sternum (breastbone)
is opened so the surgeon can access the
heart.
Tubes are inserted to connect the patient to
the heart-lung bypass machine. The bypass
machine performs the function of the heart
and lungs. By diverting blood away from the
heart, the surgeon can operate on the heart
much more safely.

The surgeon will then sew in the tubes which will

connect to the blood pump(s) of the VAD. The
locations of these tubes depend on the type of
VAD being implanted. For an LVAD, the surgeon
will core out a hole in the bottom of the left
ventricle and insert the inflow cannula (tube) of
the VAD. The cannula is secured with sutures.
The outflow cannula for the LVAD is then sewn
to the aorta. For an RVAD, cannula are sewn into
the right atrium and pulmonary artery.

Depending on the type of VAD being

implanted, the blood pump may be on
the inside or outside of the body. When
the pump is inside of the body, the
surgeon will create a pocket for the
pump in the abdominal wall just below
the heart. If the pump is outside the
body, the tubes attached to the heart
will be tunneled out of the body
through incisions in the skin.

Next, the surgeon attaches the tubes to

the VAD pump and turns on the pump.
Blood begins to flow out of the heart
into the VAD. Your surgeon will adjust
the settings on the pump to ensure it is
appropriately supporting your heart.
Finally, the breastbone and chest
incision are closed.

COMPLICATIONS:

Blood clots.As your blood moves

through your VAD, blood clots may
form. Blood clots can slow or block
normal blood flow through your heart,
which can lead to stroke or heart
attack, or cause your VAD to stop
working.

Bleeding.Implanting a VAD requires

open-heart surgery. Having open-heart
surgery can increase your risk of
bleeding after your operation. Taking
blood-thinning medications to reduce
your risk of clotting also increases your
risk of dangerous bleeding into the
gastrointestinal track and the brain.

Infection.Because the power source

and control unit for your VAD are
outside your body and connected
through a port in your skin, there's an
increased risk of germs getting in the
port and causing a serious infection.
You and your medical team should
watch for signs of infection, such as
soreness or redness near the port, fluid
draining from the site, or a fever.

Right heart failure.If you have an

LVAD implanted, it will pump more
blood from the left ventricle of your
heart than what your heart might have
been used to. Your right ventricle may
be too weak to pump the increased
amount of blood.

CARE

Assist patient in his/her activities

of daily living
Activity Level

AFTER SURGERY

Patient might be able to return to work,

engage in hobbies and sexual activity, and
drive.

Medicines

Antibiotics
Anti- clotting medicines

Travel

. People who have VADs can fly in airplanes

and use all other forms of transportation.

Nutrition and exercise

Supervised exercise also is important to

give your body the strength it needs to
recover.
Talk to your medical team about following
a proper eating plan for recovery.

Cardiac Rehab

Rehab programs include exercise training,

education on heart healthy living, and counseling
to reduce stress and help you return to a more
active life.

Ongoing Care

After you leave the hospital, your doctor may

advise you to visit an outpatient clinic weekly for
the first month. After that, you may go every
other week and then every other month for a
certain amount of time.

Emotional Issues and Support

Talk about how you feel with your health

care team. Talking to a professional
counselor also might help.