More than a million people in the UK are living with heart failure — a condition that occurs when your heart is not able to pump blood around your body properly.

In most cases, this happens because the heart has become too weak, or too stiff. This can happen following a heart attack or because of other conditions like cardiomyopathy. Heart failure is categorised according to how severe it is, with 1 being the least severe and 4 being classed as end-stage heart failure.

A ventricular assist device is one treatment that may be recommended for certain people living with heart failure.

What is ventricular assist device (VAD)?

A ventricular assist device, or VAD for short, is an implantable pumping device that takes over some or all of the role of pumping blood around your body.

It requires you to have open heart surgery to place it into your body.

Why would you need a ventricular assist device?

You may be recommended to have a ventricular assist device if:

  • you are waiting for a heart transplant — since donor hearts are not readily available and it can take time to find the right match, you may be offered a ventricular assist device as a life-saving measure until a suitable donor heart is available
  • a heart transplant is not an option — in which case, a VAD can be used as a long-term treatment for your heart failure
  • you have temporary heart failure, and a VAD will help you until your heart recovers
  • you are recovering from heart surgery

How does a ventricular assist device work?

The heart has four chambers, two of which are particularly large and located towards the bottom of the heart. The left ventricle is responsible for pumping blood into your aorta, which is the large artery that leaves your heart and pushes blood around your body. In people with heart failure the left ventricle cannot do this properly without help, a VAD works by taking over this function.

One end of the VAD pump is attached to the left ventricle of your heart, and the other is attached to your aorta. Blood flows from the ventricle into the ventricular assist device which then pumps it back out into the aorta so it can travel to the rest of your body.

This action is driven by a special cable that connects the VAD (which is inside your body) to a controller that is worn outside the body. This controller senses the function of the VAD and controls the power to make it work. The whole device is powered by an external battery pack.

You can decide how you want to wear your controller and batteries. Some people carry them in a backpack or shoulder bag, while others wear them in a pouch on their belt.

Understanding the battery system on a ventricular assist device

Since ventricular assist devices have such a crucial role in keeping you alive, their battery system is extremely reliable. Two batteries are always connected to the controller so that if one runs out, the other can take over and power the device for several hours.

If your battery starts to run low, an alarm will sound to alert you to the fact that it needs changing. There is also additional backup circuitry on the device so that if the initial circuit fails, the backup will automatically take over.

In addition to mains charging, you should also be given an adapter that enables you to plug it into your car cigarette lighter for portable charging.

The average battery life of a VAD battery is 4–6 hours.

A ventricular assist device, or VAD for short, is an implantable pumping device that takes over some or all of the role of pumping blood around your body.

What happens during VAD surgery?

VAD surgery often requires open heart surgery, though it can be carried out in a minimally invasive way. At Harefield Hospital, we offer minimally invasive VAD surgery, setting us apart from other hospitals.

The procedure requires at least three hours and will be carried out under general anaesthetic. This anaesthetic is delivered intravenously, which means that it passes through a needle into your veins. It will put you to sleep and ensure that you do not feel any pain during your surgery.

You will also be connected to a ventilator, which is a machine that helps you to breathe while you are having surgery. You will also have a catheter inserted into your bladder to drain it during your procedure and to ensure you can continue to pass urine without having to regularly get up while you recover.

Your surgeon will stop your heart temporarily during the surgery, and you will be connected to a heart-lung bypass machine that makes sure that blood and oxygen continue to circulate around your body while your heart is paused.

There are four main steps involved in VAD surgery:

  1. the main pump of the VAD is inserted into the tip of your heart
  2. the other end of the VAD is attached to your aorta
  3. a tube is connected between them that is used to transport the blood from your VAD to your aorta
  4. a cord is inserted through an opening in your skin that connects the pump to the control unit and battery pack

Once your surgery is complete, you will be taken to a recovery area so that you can wake up gradually as the anaesthetic wears off. Our teams will continue to monitor you while this happens.

How to prepare for VAD surgery

A ventricular assist device can only be implanted during open heart surgery. As it is such a big procedure, preparation is essential.

Before your surgery, our expert team will talk to you about what to expect, explain the possible risks and answer any questions that you have.

They will also tell you what practical steps you need to take ahead of your surgery, and what you need to know about your recovery. This will include things like:

  • when you should stop eating and drinking ahead of your surgery (as the procedure will be performed under general anaesthetic)
  • bringing a list of all your usual medications and their dosages with you to the hospital on the day of your surgery
  • what to bring to the hospital to keep you comfortable during your stay, such as personal care items and a book or magazine
  • what you should avoid wearing on the day of your surgery, like contact lenses, dentures, jewellery, and nail polish.

Pre-screening diagnostic tests before VAD surgery

You will also need to have a range of tests before your surgery to make sure that getting a VAD is the best treatment for you, and you will be admitted a few days early for these. Some of the tests you can expect to have may include:

  • blood tests to see how well your other organs are working, check your blood count and that your blood can clot properly
  • an electrocardiogram (ECG) to see the rhythm of your heart
  • an echocardiogram which shows our team the structure of your heart, and how blood flows through it
  • a chest x-ray to show the size and shape of your heart
  • an angiogram (cardiac catheterisation), which involves inserting a thin tube into a blood vessel in your neck, which is moved to your heart to check the pressure inside it

If you have any questions at any stage of the preparation for your VAD surgery, your experienced surgical care team will be happy to answer them for you.

After VAD surgery: recovery and aftercare

You will need to stay in hospital for several days or weeks following your ventricular assist device surgery. Exactly how long will depend on how quickly you recover, but initially, our team will want to monitor you closely to make sure that you do not experience any complications.

In addition to your urinary catheter, you will also have tubes to drain fluid and blood from your heart and chest. You will also probably experience some discomfort, so you will be given fluids and medicines by IV, along with antibiotics to prevent infections and blood-thinning medications to prevent blood clots. This is important since it will take you time to recover and get back on your feet.

Before you leave the hospital, our team will show you how you should care for your new VAD, including how to charge and change the battery, how to clean incision sites and what you should do if you have any concerns.

Benefits of VAD treatment at Harefield

What sets Harefield Hospital apart from other hospitals is that it is one of the leaders in VAD technology. Consultants at Harefield have performed the procedure for over 20 years and have amongst the highest success rates in the UK.

As we are a specialist heart and lung centre, we have experience treating extremely complex cases. Our expert specialists have an enormous amount of experience.

A ventricular assist device is a highly effective treatment for people living with end-stage heart failure and can help improve quality of life.

Benefits of a ventricular assist device

Implanting a ventricular assist device requires open heart surgery, so it will only be recommended where the benefits of the treatment considerably outweigh the risks associated with the procedure.

The key benefits of having a ventricular assist device all relate to improving your quality of life and include:

  • less fatigue
  • better breathing
  • more strength
  • a potential return to exercise
  • a potential return to work
  • recovery and healing of the heart
  • longer life

Risks of a ventricular assist device

As with any surgical procedure, there are also risks associated with getting a ventricular assist device. Some of those potential risks and complications include:

  • infection
  • bleeding
  • blood clots
  • issues with the right ventricle of the heart
  • stroke
  • issues affecting the device itself

Our team of heart experts will talk to you about the benefits and risks of getting a ventricular assist device and help you make an informed decision about your care.

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