Preparing for Your Visit
If you or someone you care about has been referred for a ventricular assist device (VAD) – also called a heart pump – you may have a lot of questions about how the process works and what to expect along the way. Our Mechanical Circulatory Support Team will help guide you through the process – from initial evaluation to implantation and postoperative care.
It's important to remember our team understands that going through the evaluation process can be overwhelming and frightening. We are here for you and your support team to answer any questions or concerns and help guide you through the process.
If you are just getting started, this page will provide an overview of what to expect.
Step 1: Initial Evaluation for Ventricular Assist Device
An evaluation is done to determine if your heart failure requires a heart pump and whether you're medically, surgically, emotionally and mentally well enough to receive a heart pump.
Our team of specialists will discuss the risks and benefits of the evaluation process, surgical procedure and postoperative care so you can make an informed decision. If you wish to proceed with the evaluation for a heart pump, you must sign a consent form.
During the evaluation process, you will be educated about the heart pump and the care you would require if you receive one. After the evaluation, our team will decide if you meet the criteria to have a VAD implanted.
The evaluation process will involve consultations with the following specialists:
- Heart failure cardiologist
- Heart surgeon
- Mechanical circulatory support coordinator
- Mechanical circulatory support social worker
- Financial coordinator
- Nutritionist, pharmacist, psychologist or psychiatrist
- Other specialists when necessary
Step 2: Testing and Review
You will also need to undergo several tests in order to be evaluated. Examples of these tests include blood work, urine tests, chest X-ray, electrocardiogram (EKG), heart catheterization, echocardiogram, dental evaluation and stool tests.
Not every potential VAD candidate will need all of these tests. Completion of the testing may be performed after implantation of the device to manage complications or to evaluate a patient for heart transplantation, if that is an option.
During your evaluation process, unknown health issues may be discovered. These newly diagnosed problems may change your ability to get a heart pump and will require treatment before proceeding any further.
The Mechanical Circulatory Support Team will discuss the results of your evaluation. As part of this discussion, we determine if you need a heart pump and if you are a suitable candidate. If more testing or more time is needed prior to a decision being made, you will be made aware of this.
Additional testing may be performed including stress test, CT scans, lung tests, colonoscopy, neurocognitive testing and ultrasounds.
Step 3: Types of Mechanical Support
There are several different types of mechanical circulatory support devices:
- Left ventricular assist device (LVAD): This device helps the left side of the heart pump blood to the largest artery of the body, the aorta, and then to all of the organs.
- Right ventricular assist device (RVAD): This device helps the right side of the heart pump blood to the lungs.
- Bi-ventricular assist devices (BiVAD): These devices help both sides of the heart pump.
- Total artificial heart (TAH): This device replaces the entire heart and pumps blood to the lungs and body.
These devices can also be categorized into short- and long-term therapies. When patients need help to pump blood for a few short hours to a few days or weeks, short-term devices are considered. Sometimes, after a period of rest, the heart can recover and the short-term device can be removed. Short-term devices are usually placed in emergencies and there is no time to complete an extensive evaluation.
Long-term devices can support patients for months to years. Some patients may receive a short-term device to stabilize them prior to implantation of a long-term device.
Step 4: Surgical Procedure for VAD Devices
The surgical procedure to implant the heart pump requires open-heart surgery and can take several hours. The surgeon will need to make an incision to place the device. This is most commonly down the front of the chest to reach the heart, although an incision in the left side of the chest between the ribs is used in a small number of patients.
You will have a breathing tube and will be under general anesthesia. The VAD is connected to the heart. Once the pump is in place, the VAD will help the natural heart pump blood through the body. In the case an artificial heart is recommended, the total artificial heart will completely replace the heart and will pump all of the blood. After the surgery is completed, you will be taken to the intensive care unit.
As with any surgery, there are risks involved. Your team of specialists will discuss the risks associated with the surgery and the device.
More details of what to expect in your postsurgical course will be explained to you when you meet with the members of the Mechanical Circulatory Support Team during the evaluation.
Step 5: Equipment, Education and Follow-Up Care
The average hospital stay after your surgery will be from two to four weeks unless there are complications that prolong your hospital stay. Your medical condition after the operation, how quickly you and your family are trained to take care of the device, and how quickly you are up and walking significant distances all determine when you are discharged.
Along with the heart pump, you will have a number of external pieces of equipment that will require care and maintenance. The specifics will depend upon the device. Your coordinator will educate you and your family regarding your specific equipment. Most patients will need three or more 2-hour educational sessions.
You and your support person(s) are required to demonstrate competency in your care and management of your device prior to discharge.
Some patients are discharged directly to home after the operation, while others need to go to inpatient rehabilitation to regain their strength before going home. It is difficult to predict who will be able to go directly home, but in general, patients who need to go to rehab tend to be older, have more medical problems before the operation, have more weakness before the operation or have more complications after the operation. For those who require inpatient rehabilitation, the usual stay is one to three weeks.
After discharge from the hospital, your follow-up care will be as follows:
- Office visits weekly for approximately four to six weeks after discharge, then,
- Every two weeks for about four visits, then,
- Monthly visits
- Once considered stable, your team may decide you can follow up every two to three months.
Visits may need to occur more frequently depending on your condition.
In addition to your office visits, you will have laboratory testing and other testing done on a regular basis in order to monitor and maintain your progress and health. The types of testing that you may need and the frequency will be decided by your Mechanical Circulatory Support Team but can include:
- Blood tests
- EKGs (electrocardiograms)
- Right heart catheterizations
- 6-minute walk tests
- Implantable cardioverter defibrillator (ICD) device checks
There may be other testing needed depending on your situation. In addition, you will need blood work at least monthly for the rest of your life. If you have received an investigational device, you may have other testing that will be required for the research study.
Step 6: Lifestyle Changes After VAD Placement
There will be some lifestyle changes after your device placement. Your coordinator will educate you on which activities are prohibited after you receive your device. You will have few limitations and can resume most of your usual activities; however, certain activities are hazardous or fatal after implant. These activities include but are not limited to:
- Showering or Submerging in Water
Persons with implantable heart pumps must not allow their controller/computer or electrical equipment to get wet. There are serious or fatal complications that could occur including the need for re-operation to replace the device and device infection. Swimming and bathing are strictly prohibited. Our team of specialists strongly advises against showering due to the risk of serious infection and the complications that can arise. The one exception is that patients with the Jarvik device may be able to resume showering and swimming. This is possible due to the innovative design of the driveline that may make the risk of infection very low.
- No Activities That Can Cause Trauma
Any activities that could cause trauma to the pump and the pump attachments must be avoided. These activities include contact sports, repetitive jumping, skiing, snowboarding, roller skating, climbing (such as on a ladder) and any other activities that could cause damage.
- No MRIs
You may not have a magnetic resonance imaging (MRI) test because of the magnetic fields.
- No Activities That Can Interfere with the VAD
You may not vacuum or dust a computer or television screen due to the risk of static electricity, which may interfere with your device. You cannot sleep with electric blankets or pads.
- Driving Restrictions
You will only be able to operate a motor vehicle if you are healthy enough to do this safely. This will also depend on what device you have implanted. You will not be permitted to drive (or operate any vehicle) until you meet certain criteria that indicate that it is safe for you to operate a vehicle and the requirements of the Department of Motor Vehicles (DMV). It is ultimately up to the DMV if you are legally able to drive. Your Mechanical Circulatory Support Team cannot guarantee that you will ever be allowed to drive again. In general, if a patient is able to operate a vehicle and meet the requirements, it takes up to six months after operation to get clearance.
You will be provided with more detailed and a comprehensive list of lifestyle changes and restrictions at the time of evaluation. You will also be provided with detailed information and education of the necessary care required for your device and its components, as well as necessary medications that are needed after your device is implanted.