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Left Ventricular Assist Device (LVAD) What You Should Know What is a left ventricular assist device (LVAD)? Who can have an LVAD? An LVAD (blood pump) is a device that helps your heart pump blood throughout your body. It assists or replaces the work of your left ventricle, the heart’s main blood chamber. An LVAD is used to prolong life and improve quality of life. After receiving an LVAD, many people are able to return to a normal, active life within three months. The LVAD is placed below the heart during surgery. Blood flows from the heart into the LVAD. A motor in the LVAD pumps the blood to the aorta (the body’s main artery) and out to the rest of your body. LVADs are used in patients with end-stage heart disease who: An LVAD includes several parts: t $BOFYQFDUUPMJWFUXPZFBSTPSMFTTXJUIPVU the LVAD. t ɨFQVNQNPUPS XIJDIXFJNQMBOUCFMPXUIF heart. It attaches to the heart’s left ventricle. t 8PVMEOPUCFIFMQFECZPUIFSIFBSUTVSHFSZ (bypass surgery, heart valve replacement) or have had surgery but still have poor quality of life. t 5VCFTUIBUBUUBDIUPZPVSIFBSUBOEBPSUB t .BZPSNBZOPURVBMJGZGPSBIFBSUUSBOTQMBOU t ɨFTZTUFNDPOUSPMMFSTNBMMDPNQVUFS ɨJT makes sure that your pump is working correctly. It connects to the pump and to a power source (battery or wall outlet). Patients who are seeking a transplant sometimes need the short-term support of an LVAD. These are called bridge-to-transplant (BTT) patients. Some of these patients will receive the device before they complete their evaluation for heart transplant. t ɨFESJWFMJOFUIFMJOFUIBUDPNFTPVUPGUIF skin). This connects the pump to the system controller. t "QPXFSTPVSDFCBUUFSJFTBXBMMPVUMFUPSBO emergency power pack). Patients who do not qualify for transplant may be helped by the long-term support of an LVAD. These are called destination-therapy (DT) patients. If you are deaf or hard of hearing, please let us know. We provide many free services including sign language interpreters, oral interpreters, TTYs, telephone amplifiers, note takers and written materials. What is an LVAD evaluation? Before you have LVAD surgery, we must make sure that you have no medical problems that might make the surgery difficult. If you have cancer or kidney problems, you may not qualify for an LVAD. :PVSFWBMVBUJPOXJMMJODMVEFBTFSJFTPGFYBNTBOE meetings. You will have X-rays, lab tests and other tests to check your organs. If you have already completed some of the tests, we may not need to repeat them. You will meet with a heart doctor (cardiologist), heart surgeon, dietician and other specialists. You will also meet with a psychologist and a social worker to discuss: The support group meets every Thursday from 12 noon to 1 p.m. Go to the Bridges Board Room, on the 8th floor of the main hospital. If you cannot attend this group, our social worker may help you find another group in your area. Are there different kinds of LVADs? :FT"U6OJWFSTJUZPG.JOOFTPUB.FEJDBM$FOUFSXF use two devices: t Thoratec HeartMate II. This is FDA-approved for patients awaiting heart transplant. It is in DMJOJDBMUSJBMTGPS%5QBUJFOUTɨFQVNQTIPVME last about 8 to 10 years. For more information, go to www.Thoratec.com. t )PXXFMMZPVBSFDPQJOHXJUIZPVSIFBSUEJTFBTF t "OZTUSFTTZPVNBZIBWFSFMBUFEUPNPOFZ and finances t :PVSDVSSFOUTVQQPSUTZTUFNGBNJMZBOEGSJFOET 8FXBOUUPNBLFTVSFZPVIBWFFOPVHITVQQPSU after surgery, so you will have a good outcome. When will I know if I qualify for an LVAD? After your evaluation, the LVAD team will discuss ZPVSDBTFɨFUFBNNFFUTFWFSZXFFL8FXJMMDBMM you when a decision has been made. What is the Transplant / LVAD Support Group? This support group is open to anyone who: t JTCFJOHFWBMVBUFEGPSBO-7"%PSIFBSU transplant, t JTXBJUJOHGPSBO-7"%PSIFBSUUSBOTQMBOUPS t IBTSFDFJWFEBO-7"%PSIFBSUUSBOTQMBOU 8FVSHFZPVBOEZPVSGBNJMZUPBUUFOEɨFHSPVQ provides a chance for patients and families to share UIFJSFYQFSJFODFTBOETVQQPSUPOFBOPUIFS t HeartWare. This is in clinical trials for patients awaiting heart transplant. For more information, go to XXX)FBSU8BSFDPm. If you receive a device that is in clinical trials, you will need to come to the clinic more often for checkups. If you receive an FDA-approved device, we will ask you to add your name to a national registry. t 5VCFTUPESBJOCMPPEGSPNUIFDIFTUDBMMFE drainage tubes). As with any mechanical device, the LVAD will need to be replaced at some point. This will require another LVAD surgery. t ɨF-7"%TESJWFMJOFɨJTDPNFTPVUPG your abdomen (belly) and connects to your system controller. What happens when the device is implanted? You will need to have open-heart surgery. Surgery may last 4 to 6 hours. During this time, you will be on a heart-lung bypass machine. This machine will take over the function of your heart and lungs. The surgeon will make an incision (cut) down your sternum (breastbone). The cut runs down the center of your chest, from the top of your chest to the bottom of your ribs. Incision What can I expect after surgery? "GUFSTVSHFSZZPVXJMMCFJOUIF*$6JOUFOTJWFDBSF unit). You may or may not be awake during this time. You will have: t "CSFBUIJOHUVCFEPXOZPVSUISPBUɨFUVCFJT connected to a breathing machine (ventilator). t *7JOUSBWFOPVT MJOFTJOZPVSOFDLBTXFMMBT your arms or hands. t "UVCFJOZPVSCMBEEFSDBMMFEB'PMFZDBUIFUFS You will receive pain medicine to keep you DPNGPSUBCMF8FXJMMMJLFMZSFNPWFZPVSCSFBUIJOH tube within the first day or so after surgery. After that, we will move you to a regular hospital room. You will likely stay in the hospital for two to three weeks. Your stay may be shorter or longer depending on your health before the surgery. As you recover, we will teach you and your family how to change your bandages and manage your equipment. You will have several teaching sessions. 8FXJMMHJWFZPVBXSJUUFOUFTUCFGPSFZPVMFBWF the hospital. After you leave, you will return to the clinic $BSEJPWBTDVMBS$FOUFS JOPOFUPUXPXFFLT*GZPV MJWFPVUTJEFPGUIF5XJO$JUJFTBSFBZPVXJMMTUBZJO a local motel or apartment for two weeks. If needed, a social worker will help you find a place to stay. Your LVAD team will decide when you can go back home again. Back at home, you will need the help of a caregiver 24 hours a day. Plan on having a caregiver for at one to three months. As you heal, you should need less care over time. What problems might occur after surgery? t Infection around the driveline or at your surgery site. You must do all that you can to prevent JOGFDUJPOT8FXJMMUFBDIZPVIPX#FTVSFUP check your driveline and surgery sites each day. Signs of infection include redness, swelling, warmth, draining fluid and increasing pain. t Bleeding. You may need to take blood-thinning medicine (warfarin) to prevent blood clots. This increases your risk of bleeding. If you take warfarin, you will have regular blood tests to make sure you have a safe level of medicine in your blood. t Heart rhythm problems. After surgery, you may notice irregular heartbeats. This is common. If it happens, call your LVAD team. *GZPVIBWFBIFBSUEFmCSJMMBUPS"*$% JUXJMM not interfere with your LVAD. t Blood clots. A clot can cause a stroke, heart BUUBDLPSTVEEFOTIPSUOFTTPGCSFBUI5PSFEVDF your risk of blood clots, you will need to take a blood thinner and aspirin each day. t Pump failure. In rare cases, the pump may fail. If this occurs, you will need surgery to replace the pump. What medicines will I need to take after surgery? You will keep taking medicines for heart failure, but your doses may decrease. You may also start bloodthinning medicines such as warfarin and aspirin. How often will I come back to the clinic? This depends on the type of device you have and whether you are waiting for a heart transplant. If waiting for a transplant (BTT patients): t *GZPVIBWFB)FBSU.BUF**-7"%ZPVSDBSF team will decide how often you should return to the clinic. For most patients, this is every 3 to 6 months. t *GZPVIBWFB)FBSU8BSF-7"%ZPVXJMMSFUVSO – at weeks 2, 3, 4, 6 and 8, then – each month for one year, then – every other month until transplant. For those who will not have a transplant (DT patients): :PVXJMMIBWFB)FBSU.BUF**-7"%:PV will need to return every month for two years. During clinic visits, you will see your heart doctor or surgeon and your LVAD coordinator. You will IBWFMBCUFTUTBUFBDIWJTJU8FXJMMBMTPBTTFTTZPVS driveline and how well your LVAD is working. What else should I know about LVADs? If you have an LVAD, you cannot bathe or swim. It will damage your LVAD and may cause it to stop. You should also avoid boating—if the boat tips over, the water will put you at risk. You may shower only after we show you how to protect your LVAD. :PVNBZIBWFTPNFPVUPGQPDLFUFYQFOTFTTVDIBT bandage supplies and getting to and from the clinic. 5PEJTDVTTJOTVSBODFBOEPUIFSNPOFZNBUUFST please speak with our financial representative or Social Services department. Once you return home, you will need to see your family doctor on a regular basis. Who should I call with questions? Mechanical Circulatory Support Program Mayo C652, MMC 811 420 Delaware Street SE Minneapolis, MN 55455 Fax: 612-273-4779 www.fairview.org Your LVAD team will answer any questions you may have. If you have any problems, you may contact an on-call coordinator 24 hours a day. $BMMBOEBTLGPSQBHFS For informational purposes only. Not to replace the advice of your health care provider. Text copyright © 2009 Fairview Health Services. All rights reserved. HeartMate II art © Thoratec Corporation; HeartWare image © HeartWare International, Inc. Used with permission. SMARTworks 521047 – 11/09.