When state-of-the-art medications are no longer effective for patients with advanced heart failure, a ventricular assist device (VAD), or heart pump, can restore normal blood flow by pumping blood from the left ventricle to the aorta. In rare cases, a VAD can be used to supplement the right ventricle, but the great majority of patients require assistance for the left ventricle, the main pumping chamber of the heart.
The usage of ventricular assist devices falls into three main categories:
Bridge to transplant
Many times patients who are already on the heart transplant list deteriorate during their long wait. For these patients, the heart pump assists their ailing heart, giving patients hope for survival until a donor heart becomes available. In most instances patients recover fully and are able to leave the hospital to await heart transplantation at home.
Bridge to recovery
There are conditions (infections, alcohol abuse) that can lead to severe heart failure requiring placement of a VAD. In some instances, the heart will recover its normal function allowing removal of the device.
Also known as long-term or permanent therapy, destination therapy is used for patients who need a new heart, but are ineligible for the national heart transplant list because of their advanced age or the existence of a disease or condition that disqualifies their candidacy.
During the surgery to implant a VAD, a surgeon creates a pocket in the muscle of the patient's abdominal wall. The main pump is tucked into this pocket. These tubes are then connected from the failing left ventricle to the pump and from the pump to the aorta. Once the device is activated, blood is pumped out of the left ventricle and injected into the aorta.
The pump is also connected to a drive line, or cable, that exits the body through the right side of the abdomen. The drive line is connected to the computer that controls the pump and batteries that the patient must change regularly.
Until recently, patients with small body sizes simply didn't have enough surface area to accommodate pumps, but now the Montefiore Einstein Center for Heart and Vascular Care offers the latest generation of miniaturized heart pumps. Where the large pumps are roughly the size of a palm, the smaller pumps are the size of the thumb. Alternatively, small patients can be supported with external devices where the only internal hardware are the tubes connecting to the heart.
Ventricular assist devices are a state-of the art technology that have saved the lives of thousands of patients. Obviously, complications may arise following placement of these complex pumps into very ill patients. Infections involving the drive-line exit wound, the drive-line itself, and/or the abdominal pocket where the pump is housed are of particular concern and require aggressive treatment.
The development of smaller devices has lessened the risk by allowing for smaller abdominal pouches and cables with thinner diameters. Still, patients with VAD must be vigilant about care of their wounds and devices. At the first sign of infection in the exit wound or fever, VAD patients must seek medical attention.
Other complications, including device malfunction, can occur. Despite this, 70 percent of patients who receive VADs and would otherwise have died survive to transplant. For patients waiting for a heart transplant whose heart function has deteriorated to life-threatening levels, the VAD is a risk they're willing to take.
Montefiore leads the nation in clinical trials for ventricular assist devices including several funded by the National Institutes of Health. By staying on the pulse of innovation, Montefiore is able to pass on lifesaving advances to patients.