Ventricular Assist Device Implantation (VAD)

A ventricular assist device (VAD), also known as a mechanical circulatory support device, is a mechanical pump that supports heart function and blood flow in people who have weakened hearts. It does so by taking blood from a ventricle (heart’s lower chamber) and pumping it to the rest of the body, just as a healthy heart would. The device allows a weakened heart to rest and sometimes recover by lightening its workload.

A VAD can assist one or both of the heart’s ventricles. The most common type of VAD is a left ventricular assist device (LVAD), which helps the left ventricle pump blood to the aorta, the main artery that delivers oxygenated blood to the organs. A right ventricular assist device (RVAD) supports the heart’s right ventricle, helping it pump blood to the pulmonary artery and ultimately the lungs. When both devices are implanted at the same time, they are sometimes called a biventricular assist device (BIVAD).

VADs are recommended when advanced heart failure cannot be controlled by medication, pacemakers or other treatments. VADs provide a temporary solution for patients waiting a heart transplant (bridge to transplant), when heart failure is temporary due to an infection or another acute condition (bridge to recovery), or when individuals are not qualified for a heart transplant (long-term therapy). The device is implanted via open-heart surgery.

Do you have a question? Request more information and we will connect you with an RWJBarnabas Health cardiovascular expert.

How to Prepare for the Procedure

Before the procedure, your doctor and treatment team will explain to you what to expect before, during and after the procedure and potential risks of the procedure. Talk to your doctor about:

• All medications, herbal products and dietary supplements you are currently taking and ask for their recommendations about each.
• Diabetes and how to adjust your medicine on the day of the procedure.
• Radiation exposure, especially for those that are pregnant.
• Any allergies to medicines, latex, tape, iodine, and anesthetic agents.
• Any history of bleeding disorders.
• Any implanted device (e.g. pacemaker or ICD).
• Any body piercings on your chest or abdomen.

Other recommendations include:

• Eat a normal meal the evening before the procedure. However, do not eat, drink or chew anything after midnight before your procedure. If you must take medications, only take them with sips of water.
• Leave all jewelry at home.
• Remove all makeup and nail polish.
• Wear comfortable clothing when you come to the hospital.

What to Expect Before the Procedure

Before the procedure, your doctor may perform a variety of diagnostic tests, including:

• Blood tests
• Cardiac Catheterization
• X-Rays
• Ultrasound
• Echocardiogram (ECHO)
• Electrocardiogram (EKG/ECG)
• Stress test
• Urinalysis

What to Expect During the Procedure

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VAD implantation usually takes 3 to 4 hours, but the preparation and recovery add several hours. The procedure is usually performed in the cardiothoracic operating room (OR). Check with your doctor about the details of your procedure. In general:

• You will change into a hospital gown.
• Prior to starting the procedure, you will receive a local anesthetic. Once you are sedated, your doctor may insert a breathing tube through your throat into your lungs and connect you to a ventilator. This will breathe for you during surgery.
• Your doctor will administer general anesthesia (will make you feel sleepy).
• The procedure begins when your doctor exposes your heart by dividing the breastbone (sternum) in half. Your doctor then spreads both halves to gain access to your heart (open-heart surgery).
• For this type of surgery, your heart must be still. Prior to doing so, your doctor will place tubes into your heart so that blood can be pumped through your body by use of a heart-lung machine. This machine takes over for the heart by replacing the heart’s pumping action and the lungs by adding oxygen to the blood.
• Once the blood has been diverted into the bypass machine for pumping, your doctor will then stop the heart by injecting it with a cold solution.
• When the heart has been stopped, your doctor will insert the VAD device and make sure is working properly. Once checked, the doctor will let the blood circulating through the bypass machine back into your heart.
• If your heart is not restarting after the procedure is complete, a mild electric shock may be used to restart it.
• Your doctor may also put temporary wires for pacing into your heart. These wires can be attached to a pacemaker, if needed, during the initial recovery period.
• Once the procedure is complete, the machine will be turned off. The tubes will be removed and the sternum will be sewn together with the use or sutures or surgical staples.

What to Expect After the Procedure

After the procedure, you will be taken to the cardiothoracic intensive care unit (CTICU) for further observation for several days. This procedure requires a hospital stay of 7 to 14 days, or even longer. Other recommendations include:

General Guidelines

• The breathing tube is removed when you wake up from anesthesia.
• Diet is started the day after surgery with liquids, and quickly advanced to solids as tolerated.
• Ambulation is started on the first or second day of surgery.
• Urine catheters and drainage tubes (chest tubes) are removed after 24 to 48 hours.
• If you have pacing wires in your heart, he or she will remove those too.
• Nurses, respiratory therapists, and physical therapists will work with you as you begin physical therapy and breathing exercises.
• Your doctor will give you instructions to follow during your recovery.
• A cardiac rehabilitation program may also be suggested.

Do you have a question? Request more information and we will connect you with an RWJBarnabas Health cardiovascular expert.