Download Ventricular Assist Device (VAD)

Ventricular Assist Device (VAD)
Information for patients with heart failure and their families
Read this booklet to learn about:
• what heart failure is
• how a VAD can help
• what to expect
• living with your VAD
• who to call if you have any questions
Please visit the UHN Patient Education website for more health information: www.uhnpatienteducation.ca
© 2013 University Health Network. All rights reserved.
This information is to be used for informational purposes only and is not intended as a substitute for professional
medical advice, diagnosis or treatment. Please consult your health care provider for advice about a specific
medical condition. A single copy of these materials may be reprinted for non-commercial personal use only.
Author: Jane MacIver, Morgan Zych, Alexander To and Vivek Rao
Created: 04/2006
Form: D-5330 (02/2014)
What is heart failure?
In Canada, about 500 000 people live with heart failure. Heart failure happens when the
heart doesn’t pump enough blood to meet the needs of your body. This causes fluid to
build up in the lungs and body.
Even with excellent care, the heart sometimes becomes so weak that medicine cannot
improve the symptoms.
Sometimes, the only choices are a heart transplant or a ventricular assist device (VAD).
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What is a VAD?
VADs are mechanical pumps that are implanted in (put inside) your chest. They take over
the pumping action of the area of the heart called the ventricle. An LVAD takes over the
pumping action of the left ventricle and an RVAD takes over the pumping action of the
right ventricle.
A VAD helps your heart pump so that you become stronger.
The HeartMate II and Heartware pumps are long-term LVADs. Patients can go home
and live with either a Heartmate II or Heartware device.
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Parts of the VAD
1. Blood pump
A surgeon puts the blood pump below your heart and attaches it to your heart and aorta. It
makes the blood flow in only one direction: from the ventricle, through the pump, and out
to the body.
A driveline is a cable with electrical wires that connects the blood pump to the system
controller and a power source. The driveline exits your body just above your waist on the
right or left side.
HeartMate II Blood Pump
HeartWare Blood Pump
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2. System controller
The system controller is a small computer that attaches to the blood pump and tells it
what to do. It also lets you know if there are any problems by showing warning lights and
making sounds. You can check to see how the VAD is working by pressing a button.
You wear the controller outside your body, either in a bag or on your belt.
HeartMate II System Controller
HeartWare System Controller
3. Power sources
VADs must always have power, either from batteries or electricity from the
wall outlet.
A power module (for the HeartMate II), an AC adapter (for the HeartWare) or a set of
rechargeable batteries supply power to the VAD.
The power module or AC adapter is used when you are not active, like when you are
watching TV. It must be used when you are sleeping.
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The power module gives continuous
power to the HeartMate II VAD.
The AC adapter gives continuous
power to the HeartWare VAD.
Batteries:
You can get up and do things away from the power unit by using a pair of rechargeable
batteries. You wear the batteries in a vest or carry them in a bag. You will have a special
battery charger to recharge the batteries.
HeartMate II Battery
HeartWare Battery
• Batteries can fully charge in about 4 hours.
• A green light will let you know when the battery is fully charged and ready to use.
• When you are doing regular activities like reading a book or walking at a normal
pace, the fully charged batteries last about:
▪▪ 8 to 10 hours for the HeartMate II
▪▪ 4 to 6 hours for the HeartWare
An indicator on the controller will tell you how much battery power is left. When the
battery power is low, you can either change the batteries or switch to the power module or
AC adapter.
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HeartMate II Battery Charger
HeartWare Battery Charger
Remember to keep your batteries charged.
Who decides if I need a VAD?
Your cardiologist may refer you to the Toronto General Hospital (TGH) Heart Function
Program to see if you need further treatment for your heart failure. This may include
changes to your medicines, pacemakers, a heart transplant or a VAD.
The members of the TGH Heart Function Program are:
• cardiologists
• cardiac Surgeons
• nurses
• social workers
• perfusionists (professionals trained to use heart-lung machines)
You will have many medical tests to see if a VAD is right for you. These tests may
include:
• blood tests
• CT scans (take pictures of your body)
• ultrasounds or any other necessary tests
These tests help the team members decide if your other organs are healthy enough to get
through the surgery and live with the VAD.
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What happens in the hospital?
The day before surgery:
• You are admitted to the Coronary Intensive Care Unit (CICU) at the TGH.
• The nurses and doctors who are part of your care team visit you and answer your
questions.
Don’t eat or drink anything after midnight the night before your surgery You
cannot have candy or chew gum.
The day of your surgery:
1. Once you are under anaesthesia, the cardiac surgeon makes 2 incisions (cuts):
• from the top center of your chest down into your abdomen (stomach area)
• in your abdomen where the driveline exits your body
2. The surgeon places the VAD in the upper-left part of your abdomen. Then a
heart-lung bypass machine does the work of your heart and lungs while the
surgeon puts in the VAD.
3. After the VAD is connected to the system controller, the heart-lung bypass
machine is stopped.
4. The surgeon closes the incision and covers it with a bandage.
While you are in surgery, a member of the surgical team visits your family in the waiting
room to let them know how you are doing.
The surgery usually lasts 3 to 6 hours.
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After Your Surgery:
Cardiovascular Intensive Care Unit (CVICU)
After your surgery, you recover in the Cardiovascular Intensive Care Unit (CVICU). This
is a special unit just for patients who had heart surgery.
You are attached to a breathing machine until you can breathe on your own. You will
also notice tubes and IV lines that were put in during the surgery. As you get better, we
remove them.
Physiotherapists and nurses help you get out of bed to sit in a chair and help you start
walking around your room.
Your family can visit you for short times in the CVICU. We encourage families to visit.
Talk to the nurses about visiting times or any special requests such as having young
children or home clergy visit too.
Most patients stay in the CVICU for 3 to 7 days. How long you stay depends on how well
you do after the surgery. The doctors and nurses will let you and your family know when
you are ready to be transferred to the Cardiovascular Surgical Ward.
Cardiovascular Surgical Ward
During your time in the Cardiovascular Surgical Ward we teach you about your VAD.
You and your family learn:
• how to care for your VAD system
• how to change the batteries
• about the alarm settings
• how to use the shower bag to take a shower once your exit site has healed
• what to do in an emergency
Here is a link to our patient education videos that you can find on YouTube:
http://www.youtube.com/playlist?list=PLeaL_GAHxKLT5jqMtpCSK9SSufbTneb9d
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Doing rehabilitation and preventing infections from happening are also very important
after VAD surgery.
Rehabilitation:
• Physiotherapists and nurses help you to walk and do deep breathing and coughing
exercises.
• For the first few days after your surgery, you eat smaller meals more often
instead of a few large meals. This can help with your poor appetite and a feeling
of fullness after eating. These symptoms happen because the pump is close to
your stomach.
To prevent infection:
• We give you antibiotics through an intravenous line (IV) for the first few days after
surgery.
• The nurses change the dressings over the incision and the driveline exit sites.
• We teach you how to change your driveline dressing and check for signs
of infection.
When can I go home?
You and the VAD team decide when you are ready to go home. Most patients go home
2 to 4 weeks after surgery. After you recover from your surgery and you complete your
VAD training, you can go home. It’s important that you are very comfortable with the
care of the VAD.
Before you leave the hospital, the VAD team makes sure you have all the equipment
you need to care for your device. We write down the equipment you are taking with you
and ask you to sign an agreement form. This form says that you agree to return the
equipment in good working order.
Remember: This equipment is on loan to you. It is still the property of Toronto
General Hospital. Please take good care of your equipment. We want to use our
funds to buy new equipment instead of replacing lost or broken equipment.
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Living with your VAD
With the changes in your life, you will feel many different emotions. It is important that
you and your family talk about your concerns with the doctors and nurses. Your health
care team includes:
• dieticians
• physiotherapist
• social workers
• and the psychosocial team
These professionals are available to help you and your family get used to your new
lifestyle.
The VAD lets your blood flow better. It helps your liver and kidneys work better too. This
will help you become stronger. Most patients tell us they are able to do many activities
that they were not able to do when they were very sick with heart failure.
How long can a VAD support me?
A single VAD can support patients for almost 4 years. In very rare cases, a second VAD
has supported patients for up to 7 years.
Will I take new medicines after getting the VAD?
After VAD surgery, you will probably take less medicine than you did before surgery.
But, you will need to take blood thinners, such as Aspirin® and Coumadin®.
Your doctor will let you know which medicines you need. The nurses and pharmacist
who are part of your health care team will make sure you know each of your pills, what
they do and when to take them.
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Will I be able to shower with the VAD?
Once your nurse practitioner thinks that your incision is healed, you will be able to
shower. They will show you how to cover and protect the electrical connections with
shower kits. To be safe, you must put the system controller in a shower bag that keeps it
dry during the shower.
The VAD is an electrical device. You cannot take a bath, swim or go under water with a
VAD.
Will I have to be on a special diet?
When you are eating well and without discomfort, you can eat what you did before your
VAD surgery. Avoid foods high in vitamin K, such as dark leafy vegetables. Vitamin K
affects how well the Coumadin® (blood thinner medicine) you are taking works.
What about sex?
Once your surgical wound is healed, you can have sex. Female patients must use birth
control. Blood thinners, which are prescribed to VAD patients, can cause birth defects.
What kinds of activities can I do?
You can do your regular daily activities when you get home. To exercise, you can do
things like walk, jog, or ride a bike. You can also play golf or tennis.
Avoid contact sports (like hockey, football, or soccer) because they could cause bleeding
or damage to the VAD. Stop any activity that makes you feel uncomfortable or pushes
your body too much. You make the final decision for what level of activity you are
comfortable with.
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Who can I contact if I have any questions?
The members of the VAD Team are available to support you and answer your questions:
Cardiac Surgeons
Dr. Vivek Rao, Surgical Director 416 340 3562
Dr. R.J. Cusimano
416 340 4928
Dr. Terry Yau
Cardiologists
416 340 4074
Dr. Heather Ross, Medical Director 416 340 3482
Dr. Diego Delgado
416 340 3940
Dr. Michael McDonald
416 340 6805
Dr. Phyllis Billia
Nurse Practitioners 416 340 8596
Dr. Jane MacIver (Outpatients)
416 340 4622
Marnie Rodger (Inpatients)
Social Work 416 340 3129
Danielle Millar (Cardiac Surgery)
416 340 2637
Brigitte Talevski (Transplantation)
416 340 3629
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