Ventricular assist device
Definition A ventricular assist device (VAD) is a pump that helps a failing heart deliver blood to the rest of body. Alternative Names VAD; RVAD; LVAD; BVAD; Right ventricular assist device; Left ventricular assist device; Biventricular assist device; Heart pump Description A VAD is grouped according to the area of the heart it helps: - Left ventricular assist devices (LVAD) help the left side of the heart push blood to the aorta, the body's main blood vessel. They are the most common type of heart pump and may also be called a left ventricular assist system (LVAS).
- Right ventricular assist devices (RVAD) pull blood from the right side of the heart and send it to the lungs.
- Bi-ventricular assist devices (BVAD) help both sides of the heart pump blood.
All VADs require surgery to be implanted into the body. The VAD pump can either be placed outside the body (external) or inside the body (implantable). - An external VAD has a pump outside the body. This type of VAD is usually a short-term solution, and is most frequently used if your heart is weak due to recent heart surgery or if you are waiting to have a more permanent pump implanted. However, they may be used for longer periods of time, such as while waiting for a heart transplant. Some types of external VADs require you to stay in the hospital while the pump is needed.
- An implantable ventricular assist device (IVAD) has a pump that is usually placed under the skin in the upper stomach area.
All VADs use a hollow tube, which connects the pump to the heart. Blood that leaves the heart flows through this tube and into the pump, so your heart doesn't have to work as hard. The pump then sends the blood to a major artery, such as the aorta or pulmonary artery. Both external and implantable VADs are attached to a computer that controls the pumping. You can often wear the computer around your waist, attached to your belt. If you have an IVAD, the wire coming from the implanted heart pump will run through a tiny opening in your skin and then to a computer outside the body. Most VADs can run on batteries, so you can go home and resume some of your regular activities. Indications You may need a VAD if you have severe heart failure that cannot be controlled with medicine or a special pacemaker, or if you are waiting for a heart transplant. You may not be considered a good candidate for a heart pump if you have: - Kidney failure
- Liver disease
- Severe lung problems
- Blood clotting or other bleeding disorders
- Infections that do not go away with treatment
If you can not have a heart transplant, a VAD may also be used for the rest of your life. Risks Risks for VAD implantation include: - Bleeding
- Infection
- Stroke
- Blood clots
- Allergic reactions to the medicines (anesthesia) used during surgery
- Organ failure
- Death
Expectations after surgery It takes several hours to place an IVAD into the body. After surgery, your blood pressure, heart rate, and the device will be regularly checked to make sure you are doing well. You will be connected to a breathing machine until you are able to breathe by yourself. Convalescence A VAD may help a person with heart failure live longer, and help improve their quality of life. References Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 7th ed. St. Louis, Mo; WB Saunders; 2005: 627-638. Marx J. Rosen's Emergency Medicine: Concepts and Clinical Practice. 5th ed. St. Louis, Mo: Mosby; 2002:1099-1110. Hirsch DJ. Cardiac failure and left ventricular assist devices. Anesthesiol Clin. Sep 2003: 21(3): 625-38. Yager JE. Left ventricular assist devices as destination therapy for end-stage heart failure. Am Heart J. Aug 2004; 148(2): 252-3. Review date: 7/26/2006 Reviewed By: Glenn Gandelman, MD, MPH, Assistant Clinical Professor of Medicine, New York Medical College, Valhalla, NY. Review provided by VeriMed Healthcare Network. Also reviewed by Steven W. Boyce, MD, Surgical Director, Heart Failure and VAD Program, Washington Hospital Center.
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