Ventricular Assist Device (VAD)

A ventricular assist device, or VAD, is a mechanical pump used to support heart

function and blood flow in people with weak or failing hearts. The device is
implanted in the chest and pumps blood from the lower chambers of the heart to
the rest of the body. A VAD can be used to temporarily help your heart or as
permanent support. By relieving the heart's workload, a VAD can prolong life and
relieve symptoms such as lack of energy and breathlessness. Patients may be
able to exercise and return to work. In some patients, the VAD actually allows the
heart to recover. These patients may eventually be able to have the VAD
removed and avoid a heart transplant.

There are several different types of VADs approved by the Food and Drug
Administration (FDA) and used by UCSF. The most common type, known as an
LVAD, supports the left ventricle, or pumping chamber, of the heart. But there are
also devices that support the right ventricle (RVADs) and biventricular assist
devices (BiVADS), which support both chambers. Our team will determine which
 is the best option for your particular case.
A VAD may be used to support your heart:
• During or after surgery, until your heart recovers.
• While you're waiting for a heart transplant.
• If you're not eligible for a heart transplant because of age or other medical
conditions.
All VADs consist of several parts. A small tube is connected to the heart and
carries blood to the pump, which may be external or implanted in either the
abdomen or chest. Another tube carries blood from the pump back to your aorta,
the major blood vessel, which distributes blood to the arteries throughout your
body. There is also a control system that is worn externally and a power source,
consisting of batteries that are worn either around the waist or over the shoulder.
The VAD's external parts are connected to the internal parts via a tube through
the side of your abdomen.
Until recently VADs were too big to fit into many people's chests, especially
women and children. But thanks to new smaller, more reliable devices, VADs are
now an option for most people who need them.
Evaluation
Our team will evaluate your case to determine if you might benefit from a VAD.
During the evaluation we will discuss the various types of VADs available and
which may be the best choice for you. You will have the chance to ask any
questions you have about the device and procedure.
Your doctor may recommend a VAD if:
• You're waiting for a heart transplant. The VAD will be implanted temporarily
and you can return home while you wait for a donor heart to become
available. When you receive your new heart, the VAD will be removed.
This temporary use of a VAD is called "bridge therapy." UCSF has begun
using a newly approved device, the HeartWare Ventricular Assist
System, which is smaller and lighter that conventional LVADs. It is
compact enough to implant in the chest, next to the heart, rather than in
the abdomen, and it can be used in smaller patients. The HeartWare VAD
also has a mechanical system that is more durable and less prone to
complications than existing VADs. Unlike conventional VADS that pump in
the same way as your heart, the HeartWare device allows a continuous
stream of blood to flow through your heart, so you do not have a normal
pulse, even though your body is getting the blood it needs.
•
• You're not a good candidate for a heart transplant. A VAD can be a long-
term solution to help your heart work better when medication isn't helping
but you are not eligible for a transplant. In this case, the VAD will be
permanently implanted, a treatment known as "destination therapy." It
can significantly improve your quality of life. Currently only the larger
VADs are approved for destination therapy, but clinical studies are
underway exploring the use of the smaller HeartWare VAD for long-term
treatment.
•
•
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• Your heart's function can become normal again. If you are recovering from
heart surgery, a heart attack or other illness that has temporarily
weakened your heart, a VAD can give your heart a rest until it's healthy
enough to pump blood on its own. In this case, you may only need the
VAD a few weeks or months. Once you are better, it will be removed.
VADs do come with risks, including the risks associated with any major surgery,
as well as the risk of stroke, bleeding or infection at the incision or in the heart.
There is also an ongoing risk of infection at the wound site where tubing
connects the internal pump to the external power source.
Procedure
Before getting a VAD, you will undergo tests to assess your heart function and
ensure you're healthy enough to undergo surgery. These may include: a chest x-
ray, an echocardiogram, an electrocardiogram (EKG), blood tests or cardiac
 catheterization.
Implanting the VAD requires open-heart surgery under general anesthesia. You
will be asleep for the procedure and will not feel anything. The surgery takes
about four to six hours. Afterward, you will be transferred to the intensive care
unit for recovery. You will be on a respirator, or breathing machine, until you are
awake and able to breathe on your own.
During your hospital stay we will instruct you and a family member or friend
you've chosen as your caregiver on the device, including how to maintain and
protect it and what to do in case of emergency. By the time you leave the
hospital, you and your caregiver will be experts on your VAD.
We will communicate with your primary care doctor and emergency services —
such as the ambulance service or fire department — in the town where you live,
to alert them that you have a VAD and to explain what this means for your care.
Recovery
Once you're home you'll need to do a daily check to make sure the device is
working properly. This takes just a few seconds and all you need do is press a
button that cues the device to run a self-test. Your caregiver will also need to
change the dressing covering the site where the device exits your body. This
takes 15 to 30 minutes. Depending on the type of VAD used, you may need to
take a blood thinner medication.
You won't be able to swim or take baths, but once the exit site has healed you'll
be able to take showers using a special covering that protects the device from
getting wet. It's possible to damage your VAD by touching certain electronic
equipment, so your health care team will instruct you about handling electronic
equipment before you're discharged from the hospital.
When you're discharged, you will be given contact information for the
Mechanical Circulatory Support Program team. If you have any problems with
your VAD, you will be able to reach your support person 24 hours a day, seven
days a week.

Reviewed by health care specialists at UCSF Medical Center.

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UCSF Clinics & Centers
Heart & Vascular Center
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