Insertion of Ventricular Assist Device (VAD)

DIAGNOSIS

Not everyone with severe heart failure is eligible for a ventricular assist device. Once you’re diagnosed with advanced heart failure, you have comprehensive medical and psychological evaluations. This may include assessing current heart and end-organ function. Healthcare providers screen for complex health issues such as breast cancer, prostate issues and infectious diseases. Additional tests include:

• Electrocardiogram : This quick test records the electrical activity of the heart. It shows how the heart beats.

• Echocardiogram: An echocardiogram uses sound waves to create pictures of the beating heart.

• Computed tomography (CT) scan : A cardiac CT scan uses a series of X-rays to create detailed images of the heart and heart valves

• Exercise testing

• Both left and right cardiac catheterizations: A long, thin flexible tube called a catheter is inserted in a blood vessel, usually in the neck. It's moved to the heart using X-rays as a guide. During this test, pressures and blood flow in the heart can be checked. This test can help determine if an LVAD or other treatment is needed.

Evaluations also include discussions about living with a VAD as well as detailed education for basic day-to-day tasks of caring for the VAD.

PREPARING FOR SURGERY

If you're getting an LVAD, you'll need surgery to implant the device. Before surgery, your health care 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.

Food and medications Bring a list of all the medicines you take with you to the hospital. Also note if you have any allergies to medicines. Your health care team reviews your medicines before surgery. You'll likely need to stop eating or drinking for several hours before surgery. Your health care team gives you specific instructions.

Clothing and personal items

• Bring these items with you to the hospital:
• A copy of your advance directive, if you have one.
• Eyeglasses, hearing aids or dentures.
• Personal care items, such as a toothbrush, a hairbrush or comb, and shaving equipment.
• Loose fitting, 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.
• Dentures.
• Eyeglasses.
• Jewelry.
• Nail polish.

Before the procedure You may be admitted to the hospital a few days before getting an LVAD. While you're in the hospital, you may have other treatments for your weakened heart or heart failure. Certain tests will also be performed like:

• Electrocardiogram
• Echocardiogram
• CT scan
• Catheterization

During the procedure Getting an LVAD often requires open-heart surgery. The surgery usually takes three or more hours. You can expect the following:

• Any hair on the chest is shaved from the area where surgery will take place.
• You'll get 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 during your surgery. This machine is called a ventilator.
• Your heart may be stopped using medicines during the surgery. If so, you'll be connected to a heart-lung bypass machine. The machine keeps oxygen-rich blood flowing through your body during surgery.

An LVAD has several parts.

• The main pump is inserted into the tip of the heart.
• The blood pumps through a flexible plastic tube to the body's main artery, called the aorta.
• The aorta sends blood to the rest of the body.
• A cord inserted through an opening in the skin connects the pump to a control unit and battery pack outside the body.

After the procedure You usually receive:

• Fluids and medicines given by IV.
• Antibiotics to prevent infections.
• Blood-thinning medicine to prevent blood clots.