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Ventricular assist devices (VAD) or ventricular assist systems (VAS) is a surgically implanted pump that helps the weakened lower two chambers of the heart (ventricles) pump blood out to the body and lungs. VADs can be used as a bridge to therapy, sustaining patients until a heart can be located for transplant. This approach is often used for patient who are not responding to other treatments or who have end-stage systolic heart failure. Some patients with a VAD who are waiting for a transplant are able to leave the hospital and continue care as an outpatient—meaning they come to the office or clinic for checkups but won’t require additional hospitalization for the VAD.
Some patients receive a VAD as an alternative to a heart transplant. For patients who do not meet the criteria for a heart transplant, or simply choose not to have a transplant, a VAD can provide long-term management and an improved quality of life. VADs can help patients improve exercise and activity tolerances, cardiac output (the amount of blood the heart is able to pump out), organ function, and hemodynamic function.
No part of the heart is removed to place a ventricular assist device. Instead the device is placed where the patient needs it most—in the left or right ventricle of the heart, or in some cases both ventricles. Depending on which side of the heart the device is located in, the VAD helps the ventricles pump blood out and eases demand on the muscle. A left ventricular assist device (LVAD) receives blood from the left ventricle and delivers it to the aorta for delivery to the body. The right ventricular assist device (RVAD) gathers blood from the right atria (top chamber of the heart) or right ventricle and sends it to the pulmonary artery where it travels to the lungs for oxygenation.
The type of VAD placed will depend on the patient’s heart failure and need. All VADs have three main parts: a pump that may be implanted in the abdomen or be outside the body, a control system and a power supply that plugs in our uses batteries. Patients can be mobile with an VAD, but must remember to charge batteries regularly or use the main power when not ambulating.
Ventricular assist devices are not right for every patient and your doctor will talk with you to decide if you are a candidate. Those who may not be right for a VAD include irreversible kidney failure, some types of clotting disorders, and severe lung or liver diseases. If you are selected for VAD placement, there are a few risks you should know about. Your doctor will talk with you more about them, but the most common include bleeding, blood clots, stroke, and failure of the device.
After VAD placement, you will receive extensive training about caring for your device, including management of emergencies and maintenance of your unit. Diet, activity and when to call the doctor will all be reviewed and patients should be prepared to demonstrate independence with daily activities like bathing, walking and dressing before leaving the hospital.