A weak heart that doesn’t pump enough blood to the body’s tissues and organs can lead to chest discomfort, pressure, fatigue, shortness of breath, and a host of other symptoms that can bring the simplest daily routines to a halt. Known as heart failure, this is a serious condition. But there are solutions, and doctors are getting better at using them to improve quality of life and even prolong life. In the most severe cases, a doctor may recommend a ventricular assist device (VAD), a small mechanical pump that is surgically implanted inside the chest to help the heart pump blood to the body.
VADs are sometimes called “bridge to transplant” devices, because they can stabilize a person’s heart and improve quality of life while they are waiting for a heart transplant—a process that can take months or longer. Other times, VADs are permanent solutions for patients who have severe heart failure, but who also have other medical conditions that make them ineligible for heart transplants.
“In addition to currently available left ventricular assist devices, we offer access to innovative and investigational devices which are smaller, more durable, and have been shown to improve survival and symptoms in patients with heart failure,” says Yale Medicine cardiac surgeon Robert Davis, MD, PhD.
How can heart failure and other heart issues occur?
The heart is a fist-sized, muscular organ that pumps blood to the lungs and around the body. As the heart beats, blood moves through its four chambers. Its two lower chambers are known as the right and left ventricles, and when the muscular walls of these chambers contract, blood gets pumped out of the heart. The right ventricle pumps blood to the lungs, where oxygen is added to it. The left ventricle pumps oxygen-rich blood to the rest of the body.
If the right or left ventricle—or both ventricles—are unable to pump enough blood to meet the needs of the body (as can happen in people with severe heart failure), serious health problems can arise. In these cases, a doctor may recommend that a VAD be surgically implanted.
What is a ventricular assist device (VAD)?
A VAD is a portable, battery-powered mechanical pump that helps the right or left ventricle (or both ventricles) pump blood out of the heart. Tubes connect the pump to the heart and blood vessels. They transport blood from the ventricle to the pump and from the pump to the aorta (the largest artery in the body, responsible for carrying blood from the heart to the rest of the body) or to the lungs.
A cable is fed through a small hole in the abdomen to a power source (for instance, a battery pack) and a computerized controller (to monitor VAD function and provide low battery warnings). This equipment is worn outside the body.
VADs may be a temporary treatment and remain in place while a patient waits for a heart transplant. Sometimes, though, the device is kept in place permanently.
What types of ventricular assist devices are available?
There are a few different types of VADS, each of which is used to treat a different heart condition:
- Left ventricular assist devices (LVAD). The most commonly used VAD, this helps the left ventricle pump blood to the aorta—and to the rest of the body.
- Right ventricular assist devices (RVAD). This device helps the right ventricle pump blood to the lungs. RVADs are often used for short-term support following an LVAD implantation procedure or another type of heart surgery.
Biventricular assist devices (BiVAD). This type of VAD helps both the left and right ventricles pump blood.
- Percutaneous ventricular assist devices. VADS are usually implanted through an open-heart surgical procedure. A percutaneous VAD, however, is not surgically implanted. Instead, the device is kept outside the body and is connected to the heart via a thin tube that is inserted percutaneously (through the skin) into an artery or vein. Percutaneous VADs can provide temporary heart support following heart surgery, heart attack, or other heart injury that impairs the ability of the ventricles to pump blood.
How are ventricular assist devices implanted?
With the exception of percutaneous VADs, they are implanted through open-heart surgery. During the procedure, a surgeon will make an incision down the center of the chest and separate the breastbone, allowing access to the heart. The surgeon will then implant the VAD and use tubes to connect it to the heart and blood vessels. They will also run a cable from the device to the power source and system controller through an incision in the abdomen.
Open-heart surgery is a major procedure. After having a VAD implanted, people usually spend several days in the intensive care unit and a week or more in the hospital. Recovery typically involves a cardiac rehabilitation program that includes education about lifestyle changes and exercises to help improve heart health.
What are the risks of ventricular assist device surgery?
Just as there is with any surgery, there are risks to VAD implantation. They include blood clots, breathing problems, heart attack, infection, device malfunction, and stroke. The risk of infection can be reduced by following your doctor’s instructions on care of the pump and the hole in the abdomen where it connects to the control panel. People with a VAD need to take a blood thinner like aspirin or warfarin to lower the chances of blood clots.
How do you care for a VAD after surgery?
A VAD requires special care. People will have a cable that runs out of the body through a hole in the abdomen, connecting the pump to a power source and system controller. Meticulous hygiene, including proper care of the device and the opening in the body is critical to preventing infection. Care must also be taken to minimize wear on the cable. This involves sleeping on one’s side or back. It is important to learn how the VAD works, how to bathe and shower with it, how to travel, and how respond to alarms designed to warn about signal malfunction or low power.
What is the outlook for people who have a ventricular assist device?
VADs can substantially improve people’s lives. Not only can the devices reduce or eliminate symptoms of heart failure and allow people to live longer, but many people who have a VAD implanted are able once again participate in routine activities.
Having a VAD requires making lifestyle changes and learning to live with and maintain the device. It is also important for anyone who has a VAD to see their doctor regularly to monitor how well their heart and the device are working.
How is Yale Medicine unique in the use of ventricular assist devices?
Yale Medicine is one of the most experienced VAD services in the Northeast and throughout the United States. Our heart failure cardiologists and cardiothoracic surgeons are experts in the implantation of VADs and the long-term care of people who have them. Our specialists can evaluate your condition and recommend the best treatment approach and type of pump for you.
While some patients may have a VAD as a temporary treatment while they wait for a heart transplant, Yale New Haven Hospital is certified by the Joint Commission, the nation’s predominant standards-setting and accrediting body in health care, to implant LVADs into patients with end-stage heart failure as a permanent therapy.