Ventricular circulatory assist devices (VADs) now almost rival heart transplantation in terms of impact on patient survival and quality of life. VADs are becoming smaller and risks are declining.
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What are Ventricular-assist Devices?
Ventricular assist devices (VADs) are a type of mechanical circulatory support (MCS) that aid the pumping ability of hearts in patients with advanced-stage heart failure. In eligible patients, a small device is implanted next to their heart, pumping up to 10 liters of blood per minute—covering the full output of a healthy heart.
The Massachusetts General Hospital Mechanical Circulatory Support (MCS) Program comprises leading cardiologists and cardiac surgeons who provide comprehensive evaluation to patients requiring a VAD to determine their eligibility and recommend the best VAD option for them.
There are three types of VADs:
- Left ventricular assist device (LVAD)
- Right ventricular assist device (RVAD)
- Biventricular assist device (BVAD), which uses both ventricles
In most cases, an LVAD may be recommended. The left ventricle is the heart chamber responsible for pumping oxygen-rich blood to other organs. LVADs help to reduce the workload of the ventricle and assist in delivering adequate blood supply to all organ systems.
Candidates for LVAD
- Bridge to Transplant: For patients who require additional support while waiting for a heart transplant, an LVAD can be used due to the rising demand of organs and low supply of available donations. The LVAD allows for the patient to have more time to wait until an organ becomes available, which can sometimes take two years or longer
- Destination Therapy: For patients who either do not meet the criteria for heart transplant or choose not to under go it, LVAD therapy helps these individuals both increase quality of life and return to daily activities, as it mitigates the symptoms of advanced heart failure
- Those in need of temporary support after a heart attack or during high-risk cardiac intervention
Preparing for an LVAD
Patients preparing to receive an LVAD will need to undergo a full evaluation of their heart function as well as other organ function that may impact their overall health status when the LVAD is in place. Patients and their support networks will work with their care team to learn how to perform dressing changes, battery changes and other LVAD-related issues that may arise. In addition, prospective candidates for LVAD implantation are given the opportunity to meet with other patients who currently have an LVAD in place to learn more about their experience and how Mass General handles their care.
Learn more about the Heart Failure and Cardiac Transplant Program >
What to Expect During an LVAD Procedure
During the implantation of an LVAD, the mechanical pump is implanted next to the heart, typically through a midline incision through the chest bone (sternum). A cylindrical core of tissue from the bottom portion of the heart is removed so that the LVAD inflow cannula, a special tube that connects the heart to the LVAD, can be sewn on to the left side of the heart. An outflow graft, or tube, is also sewn on to the aorta, which is the largest artery in the body. These tubes allow blood to flow from inside the dysfunctional left ventricle into the LVAD, and then out to the aorta, so that it can be circulated throughout the body.
The LVAD is run by a small external computer called a controller. Both the LVAD and controller are connected by a small cable (driveline) that passes through the skin of the upper abdomen. The controller runs the pump and provides audible alarms to help you manage the operation of the system. The controller is powered by two batteries, or one battery and electricity from a wall.
The total duration of the surgery is approximately four to six hours but can vary based on whether a patient has had previous cardiac surgery and other technical considerations.
Recovery Time for LVAD Procedures
Patients should expect to remain in the hospital for 10-14 days. Because of the overall medical complexity and advanced nature of heart disease in patients who undergo LVAD surgery, patients are advised to prepare for potentially longer overall hospital stays. The post-operative hospital care involves pain management, physical therapy (PT), occupational therapy (OT) and extensive ducation involving care and safety of the LVAD. The Mass General MCS Program has partnered with Spaulding Rehabilitation Hospital for specialized LVAD-related rehabilitation care in order to help patients gain strength and conditioning after their surgery.
Discharge to home or a rehabilitation hospital occurs once the patient is considered stable and safe by the medical, PT and OT services, and the patient and caregiver are fully educated on the use of the LVAD and potential emergency situations.
What Can Affect Outcomes?
Patients and their support networks are active partners with the Mass General MCS team in helping to ensure that the LVAD implantation is healthy and successful. It is expected that patients and their support systems will follow the LVAD education and training while closely adhering to the medication and lifestyle recommendations from the MCS team.
Frequently Asked Questions
How often do I have to come to clinic?
Regularly scheduled LVAD clinic appointments occur every four to six weeks. More frequent appointments are possible if you are not feeling well or if the LVAD service is making medication adjustments or more closely monitoring the LVAD for a period of time.
Can I shower?
You can shower after the driveline exit site is fully healed and the VAD team grants permission to shower, which usually takes about three months after LVAD implantation.
Can I swim?
You cannot swim with an LVAD, due to risk of getting an infection at the driveline exit site. You also cannot take baths or submerge your body in water.
Can I travel?
Yes, you can travel anywhere in the United States with an LVAD. Prior to your flight, the LVAD coordinators will draft a TSA (Transportation Security Administration) as well as contact the closest LVAD hospital to your destination, in case of an emergency.
Safety of LVAD Procedures
Compared to medical therapy alone, LVADs dramatically improve long-term survival. In the REMATCH trial, a study to determine the use of LVADS as an alternative to heart transplants, survival was approximately four times longer with the Heartmate II® device in comparison to treatment with medications alone in a similar population of heart failure patients.
There are potential complications related to being supported with an LVAD. Patients will need blood thinners to avoid clotting of the device or thromboembolic stroke, a type of stroke caused by the interruption of blood flow to a part of the brain from a blood clot in an artery. Blood thinners, however, increase the risk of bleeding. Additionally, the presence of an implanted device and a driveline puts patients at risk of infections. As a result, careful monitoring is required.
Survival outcomes at Mass General for LVAD procedures are higher than the national average. Our implant volume continues to grow and our LVAD population continues to be successful. Additionally Mass General is home to one of the largest transplant centers in New England, with about 50% of our LVAD patients progressing to transplant.
Highly Experienced, Personalized Care
The Mass General MCS Program consists of highly experienced practitioners who have a very successful track record of working in close collaboration with patients and their families to achieve excellent long-term outcomes. Mass General patients supported with MCS also achieve long-term survival rates that significantly exceed national and international averages.
Devices used at Mass General are designed for patient-specific needs. In addition to currently available devices, our team uses innovative and investigational devices. These state-of-the-art devices are smaller, more durable, quieter and have been shown to improve survival and quality of life.
Meet Our Team
The Mass General LVAD Program consists of cardiologists, surgeons and Ventricular Assist Device (VAD) coordinators.
- Medical Director, Mechanical Cardiac Support Program
- Surgical Director, Heart Transplantation and Ventricular Assist Devices
- Member of Faculty, Harvard Medical School
- Medical Director, MGH Cardiac ECMO Program
- Co-Director, Resynchronization and Advanced Cardiac Therapeutics (ReACT) Program
- Department of Medicine
Alexandra Anthony, RN, BSN
Janice Camuso, RN, BSN
Tara Logan RN, BSN
Katherine Milley, RN, BSN
- Jan | 17 | 2017
Cardiac resynchronization therapy (CRT) is one of the most common treatments for patients with moderate to severe heart failure, and uses a device to aid the contraction of the heart's ventricles.