Implantable ventricular assist device (VAD)
(also called ventricular assist system or VAS)

A ventricular assist device (VAD) is a mechanical pump that helps a weakened heart pump blood throughout the body. It is used as a "bridge-to-transplant" for those whose medical therapy has failed and are hospitalized with end-stage systolic heart failure. More recently, the VAD device is providing an alternative to transplant or "destination therapy."

• CCF is one of the few institutions worldwide who have access to many FDA approved mechanical ventricular assist systems including the Heartmate, Novacor, Thoratec, Debakey, and SynCardia CardioWest™ Total Artificial Heart devices. This allows us to choose the device that will best suit each patient's clinical needs.

• As one of the most experienced VAD programs in the United States, The Cleveland Clinic Heart Center has implanted over 500 devices. In 2007, 24 patients were supported with five different ventricular assist devices.

• In the critically ill patient awaiting cardiac transplantation, the VAD provides effective hemodynamic support, and maintains or improves other organ function. In the critically-ill patient awaiting cardiac transplantation, the VAD provides effective hemodynamic support and maintains or improves other organ function. Patients who receive VAD therapy in the Kaufman Center for Heart Failure are able to participate in cardiac rehabilitation -- improving exercise performance and rehabilitation. Most importantly, these patients can be discharged to an outpatient setting until an organ becomes available for transplant.

• The benefit of this therapy is reflected in a survival of 84%, 74%, 64%, and 55% at 30 days, 3 months, 1 year, and 4 years after embarking on the strategy of VAD bridge to transplant. This includes mortality during VAD support as well as that after transplant.

• Lessons learned with the bridge to transplant experience have resulted in our ability to provide VAD as permanent or “destination” therapy. For selected individuals with severe, refractory heart failure, the Kaufman Center has been approved by the Centers for Medicare and Medicaid Services and FDA to offer this life saving therapy.
  

The VAD consists of:

• A pump unit, implanted in the abdomen (location of placement is based on the patient's past medical history, anatomy and surgeon preference)
• An inflow tube (or conduit), attached to the bottom of the left ventricle (apex)
• An outflow tube, attached to the aorta (the large artery that carries blood away from your heart)
• Internal valves that allow for one-way blood flow through the system
• Power leads, that pass from the internal device through the skin, and outside your body. The outside of the tube is covered with a special material so that skin cells grow into the material and aids healing.
• External controller and power base unit or battery pack that attaches to the power leads/cables. The controller is programmed to maintain a specific pump spread. It displays the status of the system and any alarm messages, and also sounds alarms if needed. The batteries are rechargeable and changed daily.
• The controller and batteries can be worn in a belted waist pack or a holster under the arm. Or, it may be connected to a power base unit and plugged into a wall outlet.

The type of pump and other components depends on the specific device used.

How the VAD works:

The VAD device does not replace the heart. It assists the patient's own heart to pump blood, decreasing the work of the left ventricle. During surgery, the surgeon attaches the VAD to the apex of the left ventricle and to the aorta. When the left ventricle (the major pumping chamber of the heart) contracts (systole), blood flows into the VAD pump. When the heart relaxes (diastole), the left ventricle fills with blood, and the blood in the device is pumped into the aorta.

When is a VAD used?

• A VAD is used to assist the pumping action of a severely weakened heart
• It may be used when medical therapy has failed and the patient is hospitalized with end-stage systolic heart failure, until a donor heart becomes available.
• The VAD may be used for long-term destination therapy in those patients with end-stage heart failure who are not candidates for transplant.

When should a VAD not be used?

VADs should not be used in patients with:

• Very low body surface areas (very short or very thin)
• Blood clotting disorders

Other considerations include patients with irreversible kidney failure, severe liver disease, severe lung disease, and infections that do not respond to antibiotics

Mobility and freedom

The VAD allows patients to be mobile, and return home. A detailed education program is provided to the patient and family, or patient support system, to ensure safety and proper use of each of the components. The patient must demonstrate independence with self care, and management of the device and potential emergency situations before leaving the hospital.

Patients are also provided with education regarding activity, medications, diet, and when to call the doctor. To enhance quality of life, patients must follow the guidelines provided by their health care team.

Patients with a VAD need to have a medical team member available by pager 24 hours/day.

The VAD procedure is performed in high-risk patients with end-stage heart failure. There are risks involved. Your doctor will discuss the risks and benefits of this procedure.

For more information:

• Click here to see pictures and learn more about VAD devices at the Cleveland Clinic.
• Ventricular Assist Device, FDA, http://www.fda.gov/hearthealth/treatments/medicaldevices/vad.html *

For more information, call the Heart Center Resource Nurse at 216/445-9288 or toll-free 866/289-6911 or e-mail us using the Contact Us form. We would be happy to answer your questions.

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