Ventricular assist devices

Ventricular assist devices are battery-operated mechanical pumps implanted in the lower heart chambers (the left or right ventricles) to help the heart pump blood to the rest of the body. Also known as mechanical circulatory support devices, VADs are used to treat people with end-stage heart failure or those expecting a heart transplant. Cardiac surgeons implant most VADs through open-heart surgery, though some people are eligible for minimally invasive procedures.

Penn Medicine’s implant specialists in our Mechanical Circulatory Support program are among the most experienced in the nation. We have a team of cardiac surgeons and cardiologists who specialize in advanced heart failure and heart transplants. Our proven expertise, along with state-of-the-art technology and access to clinical trials, provides you with the latest techniques to successfully treat even the most challenging heart conditions.

Heart surgeons place VADs into the heart chamber that needs support. The devices may be placed in either the left or right heart chamber (or both), though they are most frequently placed in the left ventricle (LVAD). Once implanted, the VAD pumps a continuous flow of blood from the heart chamber into a tube connected to the main artery of the body (aorta), which pushes blood to the rest of the body.

The internal VAD pump is connected to an external computer (controller) through a small cable that passes through the skin on your abdomen. The controller, which is worn as a harness, on a belt, or in a bag, runs the pump using external rechargeable batteries. The controller displays usage information, provides alerts, and enables healthcare providers to adjust settings.

If you have severe heart failure and cannot pump blood to your body on your own, you may be eligible for a VAD implant. If you meet one of these criteria, your cardiologist may recommend VAD treatment:

• You are waiting for a heart transplant and need temporary support while waiting for a donor.
• You need short-term assistance to recover more fully from a heart ailment or procedure.
• You have end-stage heart failure and are not a candidate for heart transplant surgery.
• Medications can’t control your heart failure symptoms.

Your cardiologist or cardiac surgeon will advise you on whether you’re eligible for VAD surgery and what type of VAD device is best for you.

LVAD or RVAD implant surgery is typically a complex, open-heart surgery that can take four to eight hours. In some cases, minimally invasive surgery, called a thoracotomy, may be possible.

Your cardiology team will provide instructions on how to prepare for VAD surgery. For example, you may need to adjust your medications and diet and avoid alcohol and smoking. You’ll have pre-operative exams, including blood tests, stress tests, chest x-rays, electrocardiograms (EKGs), or echocardiograms, to be sure you are ready to receive a VAD implant.

While each surgery is individualized to your specific case, VAD procedures follow these general steps:

• An intravenous (IV) line will be inserted to provide anesthesia to help you fall asleep and deliver other recommended medications.
• You’ll be connected to certain devices to support you throughout surgery, such as a ventilator for breathing and a catheter to remove urine.
• For open-heart surgery, your surgeon will make a large incision in your chest and divide the breastbone to access the heart. Minimally invasive surgeries may access the heart through smaller incisions in the ribs.
• The VAD implant will be placed in your heart chamber and connected via tubes to the aorta to pump blood through the body.
• The pump apparatus will be threaded through your abdomen and connected to a small external controller on the outside of your body.
• Your surgeon will be sure the device is functioning properly and close the incisions.

You’ll typically recover in an intensive care unit (ICU) unit for a few days where you’ll be closely monitored and supported. You’ll then be moved to a hospital room to complete your recovery.

While the VAD recovery time is different for each patient depending on the type of surgery and your overall health, you’ll typically progress through these steps:

• Any tubes, devices, or wires that provided support during surgery, like those to help you breathe or keep a normal heart rhythm, will be removed after you’ve stabilized.
• You’ll receive inpatient care for your wound and for pain management to keep you as comfortable as possible.
• You’ll begin taking medications, such as blood thinners to avoid the risk of developing blood clots.
• You’ll start a cardiac rehabilitation and physical therapy program while you are in the hospital to begin walking and start regaining strength.
• Once you are ready to leave the hospital, you’ll receive at-home instructions for wound care, pain management, and continued rehabilitation. Your care team will provide instructions on how to use and maintain your external VAD controller.
• You’ll have outpatient cardiac rehabilitation to help with exercise, lifestyle changes, and counseling to regain your energy and improve your quality of life.

You’ll have follow-up appointments with your cardiology team to assess how well the VAD is working and to monitor your symptoms. They’ll provide additional support if needed to be sure you are comfortable and progressing toward your optimal heart health.

All surgeries carry some risks, and your doctor will discuss the risks associated with VAD surgery, which may include:

• Blood clots
• Infection
• Bleeding
• A device malfunction
• Stroke
• Kidney issues
• Arrhythmias
• Issues with the right heart chamber, after an LVAD implantation

Penn Medicine’s VAD implant specialists are among the most experienced in the country. We perform a large number of VAD procedures each year, far exceeding the national average, giving us the expertise to successfully treat people with advanced heart failure.

When you choose Penn Medicine for VAD treatment, you’ll benefit from:

• Extensive VAD options: We’re the only center in the southeastern Pennsylvania and New Jersey regions to offer every type of VAD implant approved by the U.S. Food and Drug Administration (FDA). We match the right device to each person to provide the care you need.
• Minimally invasive surgery: We’re one of a few programs in the United States to offer eligible people a minimally invasive approach for implanting certain VADs. This technique helps reduce recovery time and improve post-operative results.
• Full support for your recovery: We take a collaborative approach to your long-term health using a multidisciplinary approach that includes physical therapists, cardiac rehabilitation specialists, nutritionists, and counselors.
• High-quality care: We have a reputation for excellence in cardiac care with a track record of successful outcomes for people with severe heart failure. We understand what it takes to support your healing and improve your quality of life.