Ventricular assist device (VAD)
Date Updated: 12/21/2021
A ventricular assist device (VAD) — also known as a mechanical circulatory support device — is a device that helps pump blood from the lower chambers of your heart (ventricles) to the rest of your body. You may need surgery to implant a VAD while you wait for a heart transplant or to permanently help your heart produce enough blood flow.
Although a VAD can be placed (implanted) in one or both ventricles of your heart, it is most frequently implanted in the left ventricle. When placed in the left ventricle, it's called a left ventricular assist device (LVAD).
Current LVADs provide a constant flow of blood from your heart to your body. Such LVADs are called continuous flow devices.
The procedure to implant a VAD often requires open-heart surgery and has serious risks. However, a VAD can be lifesaving if you have severe heart failure.
Why it's done
Your doctor may recommend that you get a VAD if:
- You're waiting for a heart transplant (bridge to transplant). A VAD may be temporarily used while you wait for a donor heart to become available. A VAD can keep blood pumping through your body despite a damaged heart. It will be removed when you receive your new heart. A VAD may also help other organs in the body work better while you're waiting for a heart transplant.
- You can't have a heart transplant because of age or other factors (destination therapy). VADs are increasingly being used as a permanent treatment for people who have heart failure but who aren't good candidates for a heart transplant. This type of treatment is called destination therapy. If you have heart failure, long-term VAD therapy can improve your quality of life. Rarely, a VAD may improve existing conditions so that you can be eligible for a heart transplant.
- You have temporary heart failure (bridge to recovery). If your heart failure is temporary, your doctor may recommend implanting a VAD until your heart is healthy enough to pump blood on its own again.
To decide if a VAD is the right treatment for your condition, and to select which device is best for you, your doctor will consider:
- The severity of your heart failure
- Other serious medical conditions you have
- How well the main pumping chambers of the heart are working
- Your ability to safely take blood thinners
- How much social support you have from your family and friends
- Your mental health and ability to take care of a VAD
Possible risks and complications associated with implanting and using a ventricular assist device (VAD) include:
- Bleeding. Any surgery can increase your risk of bleeding.
- Blood clots. As your blood moves through your VAD, blood clots may form. A blood clot from a VAD can slow or block blood flow, causing stroke, heart attack or problems with the device.
- Infection. Because the power source and control unit for your VAD are located outside your body and are connected through a wire (line) through a small opening (port) in your skin, there's an increased risk of germs getting into the area. This can cause an infection at the site or in your blood.
- Device problems. Sometimes a VAD may stop working properly after it's implanted. For example, the device may not pump blood properly or the power supply could fail. Each of these problems requires immediate medical attention and may require the pump to be replaced.
- Right heart failure. If you have an LVAD implanted, the left ventricle of your heart will pump more blood than it used to. Your right ventricle may be too weak to handle the increased amount of blood. Sometimes this requires a temporary pump to help the right ventricle. Medications or other therapies may help the right ventricle pump better in the long term.
How you prepare
Before you get a ventricular assist device (VAD) implanted, your doctor and treatment team will:
- Tell you what to expect before, during and after the surgery
- Explain the possible risks of VAD surgery
- Discuss any concerns you have
- Ask if you have an advance directive
- Give you specific instructions to follow during your recovery at home
You can prepare for VAD surgery by talking to your family about your upcoming hospital stay and the type of help you'll need at home as you recover.
Food and medications
You'll need to stop eating or drinking for several hours before surgery. Your treatment team will tell you the specific time to do this.
Your doctor or nurse will review your current medications and tell you which, if any, you can take on the day of your VAD surgery. It's helpful if you make a list of all the medications you take and bring it with you to the hospital. Your treatment team will also note if you have any drug allergies.
Clothing and personal items
In addition to a list of your medications, your treatment team may ask that you bring several other items to the hospital, including:
- A copy of your advance directive
- Eyeglasses, hearing aids or dentures
- Personal care items, such as a toothbrush, a hairbrush or comb, and shaving equipment
- Loosefitting, comfortable clothing
- Items that may help you relax, such as portable music players or books
You'll likely be asked to avoid wearing:
- Contact lenses
- Nail polish
What you can expect
Before the procedure
If you're getting a VAD, you'll need surgery to implant the device. You'll usually be admitted to the hospital a few days before the surgery so tests can be done to make sure a VAD is still your best treatment option. Tests done before VAD implantation may include:
- Blood tests. Before your VAD surgery, your doctor will order blood tests to see how well the heart and other organs, particularly the liver and kidneys, are working. A complete blood count and blood clotting studies are done to make sure the your blood isn't too thin for surgery.
- Electrocardiogram (ECG). This quick and painless test records the electrical signals in the heart. It can show the timing and length of heartbeats.
- Chest X-ray. A chest X-ray shows the size and shape of the heart and can show certain problems with the lungs.
- Echocardiogram. Sound waves are used to produce images of the heart in motion. This test shows the structure of the heart and heart valves and blood flow through the heart. An echocardiogram can help determine whether a VAD is the right treatment option.
- Cardiac catheterization. A doctor inserts a thin, flexible tube (catheter) into a blood vessel and moves it to the heart using X-rays as a guide to measure the pressures and flow in the heart. This test can help determine if someone is still a good candidate for a VAD or if other treatment is needed.
While you're in the hospital preparing for VAD surgery, you may have other treatments for your weakened heart or heart failure. Before the your procedure, a nurse or technician will shave any hair on your chest where the surgery will take place.
During the procedure
A team of doctors and nurses works together to perform VAD surgery. Members of this team will include:
- Heart surgeons (cardiovascular surgeons)
- Nurses trained in surgery (surgical nurses)
- Doctors trained in giving medication to make you sleep during surgery (anesthesiologists)
Getting a ventricular assist device (VAD) often requires open-heart surgery. VAD surgery usually takes three or more hours. You can expect the following:
- You'll receive medicines through an IV to make you sleepy and pain-free during the surgery.
- You'll be connected to a machine that helps you breathe (ventilator) during your surgery.
- Your heart may be stopped using medications during the surgery. If so, you'll be connected to a heart-lung bypass machine, which keeps oxygen-rich blood flowing through your body during surgery.
To implant an LVAD, the surgeon makes an incision down the center of the chest. The surgeon then separates the chest bone (sternum) to better view the heart and place the device.
An LVAD has several parts. The main pump is inserted into the tip of the heart. The blood is pumped out through a flexible plastic tube to the body's main artery (aorta). The aorta sends blood to the rest of the body. A cord inserted through the skin connects the mechanical pump to a control unit (controller) and battery pack outside your body.
After your VAD is implanted and working properly, you'll be taken off the heart-lung bypass machine so your VAD can start pumping blood.
After the procedure
After surgery to implant a VAD, you'll stay in the intensive care unit (ICU) so your treatment team can adjust heart treatments, as needed, and monitor you for complications. While in the ICU, you'll have or receive:
- Fluids and medications given by IV
- Tubes to drain urine from your bladder
- Tubes to drain fluid and blood from your heart and chest
- Antibiotics to prevent infections
- Blood-thinning medicine to prevent blood clots
Your lungs may not work properly immediately after your surgery, so you may need to remain on a breathing machine (ventilator) for a few days until you can breathe on your own.
After a number of days in the ICU, you'll likely be moved to a regular hospital room. How long you stay in the hospital depends on your health before the procedure and how quickly you recover afterward.
Before you go home, your nurses, physical therapist and other medical specialists will help you become more active and stronger. They'll help you sit up, get out of bed and walk. If you need more time to recover your strength, your doctor may recommend a short stay at a rehabilitation facility.
After VAD surgery, your doctor or nurse will talk to you and your family about how to live with and properly care for a VAD. You and your family will learn:
- The signs or symptoms of infection, including fever and pain, redness, or oozing near the incision site
- What to do if the VAD isn't working properly
- How to keep the incision site and VAD cord clean
- How to shower without damaging the device
- Tips for traveling with your VAD
- Ways to decrease stress and anxiety while living with a VAD
- When you can safely return to daily life activities such as driving, exercising, going to work or being sexually active
You'll likely have weekly checkups with your doctor for the first month after getting your VAD to make sure it's working properly and to check for complications. Your doctor will listen to your heart with a stethoscope and check your blood pressure. You may need special tests to check your blood pressure and heartbeat.
As you recover from surgery, you'll generally need fewer follow-up appointments. Your doctor will prescribe a blood-thinning medication such as warfarin (Jantoven) to help prevent blood clots. You'll need regular blood tests to monitor the drug's effects.
After getting a VAD, your doctor may recommend cardiac rehabilitation. Cardiac rehabilitation is a personalized exercise and education program that teaches you ways to improve your heart health after heart surgery. Cardiac rehabilitation helps you add healthy lifestyle changes — such as exercise, a heart-healthy diet and stress management — into your life.
VADs and heart transplants
If you have a VAD implanted to help your heart pump blood while you wait for a heart transplant, you'll remain in close contact with your doctor and transplant center while you're on the waiting list. It's likely that you'll have some restrictions on how far away you should be from the hospital in case a donor heart becomes available.
Coping and support
If you're feeling anxious or frustrated about living with a VAD, consider sharing your thoughts and feelings with your doctors, family or professional counselor. Some people also find it helpful to join a support group with others who are going through or have gone through similar experiences. A support group gives you the opportunity to talk about personal experiences and feelings and coping strategies.