A ventricular assist device, or VAD, is a device that helps a failing heart pump blood to the rest of the body. The device can be used to keep heart failure patients alive while they wait for a heart transplant. Because modern VADs are portable, transplant patients may return home while they wait for a donor heart to become available. For patients who aren't good candidates for a heart transplant, a VAD may be used to help them live longer, with a better quality of life. VADS can also be used as short-term support following heart surgery.

There are several different VADs approved by the Food and Drug Administration (FDA). Some support the left ventricle or the right ventricle — the two pumping chambers of the heart — and some, known as biventricular assist devices, support both. UCSF Medical Center has several different types of VADs. Our team will determine which is the best option for your particular case.

All VADs consist of a pump, a control system and a power source. The power source and control system are always outside the body, but the pump may be external or implanted inside the body. The blood flows from the heart's ventricle into the device, flows through the pump, and is returned to the aorta, the major blood vessel that carries blood to the arteries. The external parts of the device are connected to the internal parts via a tube through the side of your abdomen.

Aside from prolonging life, the benefits of a VAD include more energy and relief of breathlessness. Patients may be able to exercise and return to work. In some patients, by relieving the heart's workload the VAD actually allows the heart to recover. These patients may eventually be able to have the VAD removed and avoid a heart transplant.

VADs do come with risks, including the risks associated with any major surgery, as well as the risk of stroke, bleeding or infection at the incision or in the heart.

Evaluation

Our team will evaluate your case to determine if you might benefit from a VAD. In general, good candidates for a VAD meet all of the following conditions:

• Have heart failure that can't be managed by medication
• Are physically capable of undergoing the implant procedure
• Other organs have not failed

During the evaluation we will discuss the various types of VADs available and which may be the best choice for you. You will have the chance to ask any questions you have about the device and procedure.

Procedure

Implanting the VAD requires open heart surgery under general anesthesia. You will be asleep for the procedure and will not feel anything. The surgery takes about four to six hours. Afterward, you will be transferred to the intensive care unit for recovery. You will be on a respirator, or breathing machine, until you are awake and able to breathe on your own.

During your hospital stay we will instruct you and a family member or friend you've chosen as your caregiver on the device, including how to maintain and protect it and what to do in case of emergency. By the time you leave the hospital, you and your caregiver will be experts on your VAD.

We will communicate with your primary care doctor and emergency services — such as the ambulance service or fire department — in the town where you live, to alert them that you have a VAD and to explain what this means for your care.

Recovery

Once you're home you'll need to do a daily check to make sure the device is working properly. This takes just a few seconds and all you need do is press a button that cues the device to run a self-test. Your caregiver will also need to change the dressing covering the site where the device exits your body. This takes 15 to 30 minutes. Depending on the type of VAD used, you may need to take a blood thinner medication.

You won't be able to swim or take baths, but once the exit site has healed you'll be able to take showers with a special covering that protects the device from getting wet. It's possible to damage your VAD by touching certain electronic equipment, so your health care team will instruct you about handling electronic equipment before you're discharged from the hospital.

When you're discharged, you will be given contact information for the Mechanical Circulatory Support Program team. If you have any problems with your VAD, you will be able to reach your support person 24 hours a day, seven days a week.

Reviewed by health care specialists at UCSF Medical Center.