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Transplant Programs

Circulatory Assist Devices

Heart Failure Syndrome and How the Heart Works.

The heart is a crucial organ in our body responsible entirely for pumping blood to all organs. When the heart fails as a pump all vital organs are affected and our body develops heart failure syndrome. There are many diseases that can cause heart function to fail - few most common are coronary artery disease, hypertension, cardiomyopathies. The patient affected by heart failure syndrome can experience many different nonspecific symptoms such as tiredness, shortness of breath, cough, syncope, difficulty to concentrate, nausea, abdominal pain. All these symptoms are caused by decreased blood flow to vital organs, such as the brain, lungs, liver, and kidneys. With progression of heart failure syndrome the symptoms become more severe and clinical signs of water retention, swelling, wheezing, weight gain, an abdominal distention become easily noticeable.

How a VAD works

The artificial devices designed to support the pumping function of heart chambers (ventricles) are called VAD.  The devices are surgically implanted and can support cardiac function for a short or long time.  The pumps are designed to unload the blood from heart ventricles and flow effectively through the body's circulation in order to keep flow through all vital organs.  With the development of new technologies, the long term implantable devices with electrical support allow patients to continue therapy at home. 

Are you a VAD candidate?

The evaluation for advanced therapy involves a comprehensive multidisciplinary review of clinical and psychosocial variables to assure the true benefits of this procedure.  Your doctor can refer you for evaluation.   It is required that you and your proposed caregiver(s) understand and agree with the treatment plan and are willing to be an active participant in all advanced therapies.

Types of VADs

The HeartMate II (HM II) is the most commonly used VAD at Florida Hospital.

The HM II has 4 main parts:

  • The implantable heart pump
  • The cannulas (tubes) connect your heart to the blood pump
  • A percutaneous driveline passes through the skin and connects to the pump inside your body, the system controller, and power source outside of the body.
  • A system controller, which is a small computer that controls the pump. It is powered by a power base module that plugs into the wall outlet or by rechargeable batteries.

PVAD

This type of device is known as a Paracorporeal (meaning outside of the body cavity) Ventricular Assist Device, or PVAD. (Pictured to the right).

The PVAD has 4 main parts:

  • The external blood pump designed to support the left, right, or
    both sides of your heart by pumping blood throughout your body via arteries.
  • Cannulas, tubes, or percutaneous drive line that passes through the skin of your chest
  • Electric and pneumatic leads
  • An external driver and power source; either the Dual Drive Console or the TLC II portable Driver that is powered by electricity or by rechargeable batteries.

The Implantation Procedure

The LVAD is implanted during open heart surgery.  An incision is made through your chest bone (sternum) that extends down to your abdomen. You will be placed onto a heart/lung bypass machine that will support your circulation so that your heart can be stopped for a short period of time while the pump is implanted.

Once the LVAD pump is in place, the heart/lung machine will be stopped and the HM II pump will assist your own heart to pump blood to your body.

After the Surgery

Following the LVAD implantation surgery you will be taken to the intensive care unit for recovery. You will have a tube in your throat connected to a breathing machine (ventilator) after surgery until you wake up from anesthesia and begin breathing on your own. This tube is removed as your lungs are able to take over the work of breathing. You won't be able to talk until the breathing tube is out. The nursing staff will take care of all your needs and will medicate you for pain on a regular basis.

Caring for your LVAD

After surgery you and your caregiver will receive detailed instructions on LVAD care in preparation for going home, including care for the surgical site, personal hygiene, diet, activity, and training on your LVAD equipment.

  • To prepare you for discharge, your home environment must be able to support LVAD equipment. You must have consistent electricity and telephone services.
  • You will be required to return for frequent appointments to assess the LVAD function and your driveline exit site.
  • You will be able to return to a fairly normal lifestyle; however, you will have some limitations. Because the equipment associated with an LVAD is electrical and is outside the body, you must avoid immersing in water (swimming and bathing). You may only resume showering once your driveline has healed and your surgeon gives you permission to do so.
  • Contact sports should be avoided due to the risk of damage to the pump and the driveline. Damage to the cannulas, driveline, or pump may require re-operation to replace the damaged part.

 Anticoagulants (Blood Thinners):

  • Patients with LVADs may be prescribed long-term use of blood thinners, such as Coumadin (warfarin) to prevent blood clot formation inside the pump or other areas of the body. If you are on Coumadin (warfarin), you will be required to be monitored with frequent blood tests.
  • One of the main risks of blood thinners is bleeding. The other risk is clotting. Even after a minor accident you may need to be checked by a health care provider for signs of bleeding that may not initially be visible, but still could lead to serious complications and even death.

Trained Caregiver:

You and your caregiver(s) will receive instructions and training on the use and care of your LVAD and associated equipment. It is essential that you have a trained caregiver within visual or hearing distance of you for the first few weeks after discharge from the hospital.

Lifestyle Changes:

The improved circulation of blood after LVAD implantation may enable you to return to your daily life with some restrictions on activity. Having the LVAD requires some lifestyle changes as you will be attached to a power source at all times. With time and after extensive teaching you should become comfortable with all aspects of living with an LVAD. Keep in mind a few good habits for a healthy LVAD lifestyle:

Diet
Eating healthy nutritious meals will help to maintain a recommended weight and may help you lose extra weight. Drink plenty of fluids. You need an adequate blood volume for the VAD to adequately pump blood to your body.

Exercise
Exercise regularly under your physician's supervision

Smoking
Smoking constricts blood vessels and is a major risk factor in coronary artery disease. All patients must stop smoking prior to VAD surgery and maintain abstinence afterward. 

Alcohol/Drugs
VAD patients must abstain from alcohol and illicit drug use including Marijuana.

Medication
You must adhere strictly to your medication regimen with no alteration in the schedule unless prescribed by a physician.

Clinic Appointments
There are many clinic appointments and evaluations.  It is your responsibility to attend all appointments, unless they are changed with the VAD coordinator's approval. 

All VAD patients must be prepared to attend frequent follow-up visits as needed at Florida Hospital Orlando. In addition, you may need to come to the VAD clinic if there is a change in your condition. You are responsible for arranging reliable transportation. 
 
Family Support
It is essential for caregivers and friends to agree to support VAD patients, emotionally, with rides to the clinic, assistance with diet, medications, and VAD care. Family support can make a big difference in the long-term success of the VAD.