Ventricular Assist Device (VAD) is a variant of the auxiliary circulation system. This device, which is used to maintain heart function and blood flow in people with a weakened heart muscle. It receives blood from the lower chambers of the heart and helps to pump it to other vital organs.
VAD artificial ventricles of the heart
These devices are used when one or both of the lower chambers (ventricles) are not functioning due to illness. VAD device helps maintain heart:
- During or after the operation, until the body is restored.
- The waiting period for heart transplantation.
- If the person is not suitable for the transplant procedure (mechanism may be a long term solution to improve the body of the work).
This device has several basic parts. By a small tube blood travels from the heart to pump, on the other - from the pump to the blood vessels, delivering it to the rest of the bodies.
The device also has a power supply that is connected to the control unit and it controls all the functions. It gives alarm if the battery power is too low or not the device is working properly.
Some Ventricular Assist Device pump blood like the heart, others - maintain a continuous flow of blood. In the latter case, the patient will not be a normal heart rhythm, but the body will get the blood they need.
According to research supported by the device reduces the period of hospitalization, decrease the risk of complications and improve survival. However, additional clinical trials.
types of device
There are two main types - the artificial left ventricle (LVAD) and right (RVAD). If both types are used at the same time, they are called biventricular support device (BIVAD) or double.
LVAD - left ventricular assist device circulation, the most common type. It assists the left ventricle to pump blood to the aorta - the main artery carrying oxygen-rich blood from the heart to the body.
RVAD usually used in the short term to support the right ventricle after implantation of LVAD or other cardiac surgery. It helps the right ventricle to pump blood to the pulmonary artery that carries blood from the heart to the lungs, where it picks up oxygen.
BIVAD used if both ventricles does not work well enough to meet the body's needs. Another option is the transplantation of artificial heart - the device for substituting the ventricles.
There are two basic constructions of the device. Percutaneous VAD unit has a pump and a power source located outside the body. Tubes connect the pump to the heart, passing through small holes in the abdomen. This type of device is used as a short-term support during or after surgery.
Implantable circulatory system VAD has a pump and a power source located inside the body. The cable connects the pump to a power source through a small hole in the abdominal cavity. This type of instrument is mainly used for people who are waiting for a heart transplant or as a long-term solution for patients who do not have the possibility of transplantation.
Design and the type of VAD apparatus in which a doctor can recommend Assuta will depend on the general health; the time for which you need a device, and other factors.
Until recently, the VAD of the circulatory system were too bulky to fit inside the chest most people, especially women and children. Only patients with a large chest can get them.
However, recent advances have allowed to create a device smaller and have higher reliability. As a result, the ventricles of the heart become VAD option for most patients.
The researchers also have been successful in that the improved device performance and increased with their help the quality of life of people. In the past, this unit is mainly used in end-stage heart failure. Now it is used also in the early stages of heart failure.
Children with the aforementioned disorders are also considered as candidates for this procedure. VAD ventricles of the heart that are approved for use in adults, are sometimes used for children if their chest is large enough to accommodate the device. Moreover, recently, the FDA approved the device circulatory support the VAD, designed for young children.
Indications for artificial ventricles of the heart VAD
This device can benefit if the heart does not work well due to illness. Cardiovascular disease is prevented adequately pump blood to the heart, the body needs.
This circulatory system can support the body:
- During or after the operation, until the heart recovers.
- The waiting period for heart transplantation.
- If a person is not able to receive the donor organ.
Artificial ventricles of short-term appointments
These devices can support heart function and blood flow a short period of time, until the heart recovers. The doctor may recommend it if the patient has a serious illness - heart failure, ventricular fibrillation or cardiogenic shock.
This device is used for heart failure, when doctors need more time in order to plan treatment.
circulatory support system of long-term VAD destination
When the diagnosis of heart failure awaiting heart transplant, your doctor may recommend this product to a patient. If the drugs do not have the desired effect, VAD will help save lives and improve the quality of waiting for a donor organ.
In the case where there is no possibility to make transplantation a ventricle can be long-term treatment option, while also improving the quality of life and allowing to engage in everyday activities.
Contraindications for this unit
The device is not considered as an option for people with serious illnesses:
- in severe renal insufficiency;
- in serious brain injuries;
- in severe infections and other life-threatening disorders.
Preparation for surgery for implantation of an artificial heart ventricle VAD in Assuta
The training process will take some time, which will be needed in the clinic. Doctors will tell in detail about the product and about the life of him. Before and after surgery, the patient will provide information:
- How does the device.
- How to safely handle the device.
- How to interpret and respond to alarms (the unit informs if the power does not work or low device battery properly).
- How to provide care in an emergency.
- How to take a shower with the device.
- As VAD can affect any trips or travel.
The patient may show what it looks like such a circulatory system and how it will be attached inside the body. There will also be an opportunity to meet with those who have already gone through a similar operation. When communicating with this person can receive answers to questions about how a person feels from the implanted device and how to live with it.
Doctors Assuta convinced that the body is strong enough to undergo surgery. You may need extra food - intravenously before surgery.
There will also be assigned to the tests in preparation for surgery. These include:
- Blood tests that show how well the liver and kidneys, measure the levels of blood cells and other important chemicals.
- Chest X-ray will create an image of internal structures - the heart and lungs, help the doctor to prepare for surgery.
- EKG records the electrical activity of the heart, helping to assess how well the heart works.
- Echocardiography using sound waves create a detailed picture of the heart, will show the size and shape of the body, the work chambers and valves.
What happens during the implantation of ventricular VAD heart?
Operation takes 4-6 hours. In general, the process is similar to other types of surgical procedures that are performed on an open heart.
Surgical team includes:
- cardiac surgeons;
- surgical department nurses;
- perfusionist responsible for AIC supplying the organism with blood during implantation.
The patient is given anesthesia. During the operation check pulse, blood pressure, oxygen level, respiration.
Through the throat to the lungs lead pipe, which is connected to a ventilator.
The surgeon makes an incision in the middle of the sternum, cut the breastbone and opening the chest, gaining access to the heart.
To stop the heart using a special drug that allows the surgeon to operate on a fixed body. AIC functions, providing the body with blood during surgery.
Once the ventricles are implanted VAD, AIC switched off and the device begins to operate. The device supports the blood flow and assumes the pumping function of the heart.
Rehabilitation after surgery Assuta
The recovery time is largely due to the state of health before surgery.
If the heart condition was severe, your body may be weakened and lungs were unable to function well. Therefore, a few days may be needed ventilator support respiration. It may be necessary probe, which will provide the power.
After implantation, the artificial ventricles of the patient regains consciousness in the intensive care unit. Intravenous fluid will flow and power. To drain urine catheters, drains - to drain excess blood and fluid from the chest and heart.
Several days later, the patient will be transferred to a normal ward. Nurses teach how to deal with circulatory support system. they also help to move around, get out of bed, sit. As the recovery dropper and the catheter is removed.
With the patient will work physiotherapist gradually increasing exercise.
After the operation, it will be necessary to observe whether there are signs of infection. These include:
- tenderness over the area of the device location;
- discharge of liquid at the location where the exit tube from the body;
The patient is prescribed antibiotics preoperatively and for several days thereafter. They reduce the risk of infection.
Doctors also prescribe antiplatelet medications, such as warfarin and aspirin. It helps prevent blood clots. Placing the implanted device increases the risk of thrombosis. These drugs will need to be taken until the inside of the artificial ventricles are. Periodically will need blood tests to make sure that the drugs are working appropriately.
Doctors in Assuta will help to prepare the patient for life in the house. The team may include cardiac surgeon, cardiologist, specially trained nurses, a physiotherapist, a nutritionist. The patient will teach how to live with an artificial circulatory support device.
After discharge, a person will be able to return to daily activities. He will be able to start to work, continue to engage in a hobby, resume sexual activity, take the wheel. Doctors will advise on the level of activity that will be safe for the patient.
If the patient waits for a heart transplant, you must be available to the appearance of the possibility of 2 hours to get to the transplant center.
If the patient does not expect the transplant surgery, the medical team will introduce in the course of the special measures to be taken if a person wants to travel. People with ventricles VAD can fly on airplanes and other modes of transport.
Nutrition and exercise
During recovery it is important to eat well, so that the body receives all the necessary nutrients. Doctors in Assuta develop proper eating plan that will facilitate rehabilitation.
Physical activity is also important to give the body the strength needed for the recovery process. Due to the poor performance of the heart muscle in the body is likely to have weakened before the operation. It is therefore important to strengthen the body and build muscle mass, it will feel less tired.
Weekly during the first month will need to visit the doctor, and then once a month for a certain period of time.
If the patient is in the waiting list for a heart transplant, he will have to remain in close contact with the transplant center. In most cases, the donor heart is transplanted within 4 hours after preparation.
Emotional problems and support
Implantation of artificial ventricles may cause fear, anxiety and stress. A person can be in a depressed state.
All these feelings are normal for anyone who passes through such a serious operation. Communicate with team doctors and a psychologist will help.
They can be assigned to drugs or other treatments that improve quality of life. Family and friends can help relieve stress and anxiety.
implantation risks the auxiliary circulation system VAD
Transplanting this device carries serious risks:
- Blood clots.
- The occurrence of infection.
- Breakage of the device.
- The development of right ventricular failure in transplant LVAD.
With more new models of artificial ventricles of some of the most serious risks have decreased significantly.
As with any heart surgery complications are sometimes fatal. However, survival rates with VAD implantation in recent years, seriously improved.