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Royal Brompton & Harefield NHS Foundation Trust Left ventricular assist device (LVAD) Information for patients Contents What is a left ventricular assist device? The types of LVADs at Harefield Hospital Is an LVAD a suitable treatment for me? What are the benefits of the LVAD operation? Are there any alternatives to the operation? What will happen if I don’t have the operation? What are the risks of the operation? The operation Where can my family wait during the operation? Recovery in hospital after the operation What will I feel like when I’m in intensive care? Can my friends and family visit me while I am in the ITU? What else will happen when I am in intensive care? What will happen when I move back to the transplant ward? What is the transplant unit like? How will I feel emotionally after the operation? Going home Wound care What if I have problems when I am at home? What should I do in the event of an emergency? Lifestyle Who can I contact for further information? 2 3 4 7 10 11 11 11 15 17 17 18 19 19 20 20 21 22 25 26 27 27 30 This booklet is a general guide about having a left ventricular assist device (LVAD) fitted as a treatment for heart failure. It does not replace the information and individual advice we give you in person. Please ask if you have any questions about this booklet. What is a left ventricular assist device? A left ventricular assist device (LVAD) is a pump that is attached to the heart helping it to circulate blood around the body. It works by sucking the blood from the main pumping chamber of the heart (the left ventricle) and pumping it into the main artery (aorta), which carries blood to all parts of the body. An LVAD can help where a patient’s heart is not working well enough to pump blood through the body. What are LVADs used for? LVADs can extend the lives and improve the health of patients with advanced heart failure. Most patients find that they have fewer symptoms, find exercising easier and that their quality of life improves. An LVAD can be used: • as a bridge to transplantation – so we can try to make sure the patient is well enough for heart transplant surgery in the future, or • as a bridge to recovery for some patients with certain types of heart disease. An LVAD can help the heart to rest and recover enough so that a transplant is no longer needed and the LVAD can be removed. However, it is not possible to predict or guarantee that the heart can recover. 3 Unfortunately, it is not possible to guarantee that an LVAD can be removed once it has been fitted. Even if we suggest that the patient should have a heart transplant, we cannot guarantee that a suitable heart will become available. The patient may also develop a complication that can make a transplant very difficult or risky. Patients should understand and accept that the LVAD could become a long term therapy. The types of LVADs at Harefield Hospital At the time of writing (February 2011), we are using two types of LVAD: the HeartMate II and the HeartWare HVAD. However, other devices are likely to become available in the near future. Please note that most of these devices work in a similar way. If you need more information about a specific device that has been suggested for your treatment, please ask your VAD nurse or surgeon. The HeartMate II The image below shows how the HeartMate II will be placed in your body. 4 The HeartMate II pump has a propeller that spins around to circulate the blood. The pump is connected to wires, called a driveline, which exits through a small cut in the skin of the abdomen. The driveline connects to a system controller that is worn on a belt. The system is powered by a pair of rechargeable batteries or by a mains electricity appliance for night time use. The HeartMate II Power module The HeartMate II Power module provides power to the device while you are sleeping (A/C mains electrical power). It also provides power to a display screen to show you how the pump is working. The power module amplifies the alarms when you are sleeping and it contains a back up battery in case of a power cut. The HeartMate II battery charger The HeartMate II battery charger is designed to charge the batteries that are used to power your device. It can charge up to four batteries in approximately four hours. You will have at least four batteries to take home with you. 5 HeartWare HVAD The HeartWare pump rests inside your chest and two small motors inside the pump move the propeller that circulates the blood. The pump is connected to wires, called a driveline, which exits through a small cut in the skin of the abdomen. The driveline connects to a system controller and batteries that are worn on a belt or in a bag (see image below). HeartWare controller The controller operates your pump and makes sure that it is working correctly. The controller is connected to your driveline and must have two power supplies, either two batteries or mains power and a battery. The display on the controller gives information about how the pump is performing. This includes the blood flow through the pump (L/min), speed of the propeller (rpm) and the amount of power used (watts). The controller also warns you if there is a problem with your pump or with the power supply. 6 HeartWare battery charger The battery charger is used to charge up to four batteries and it takes around four to five hours to charge them fully. You will have at least four batteries to take home with you. Is an LVAD a suitable treatment for me? We have to do a number of tests before we can decide if you need an LVAD. Some of these tests may be repeated after you have received your LVAD to help monitor your progress. Tests are also needed to decide whether LVAD surgery is likely to be successful and if a heart transplant is likely to be possible in the future. You can read about tests for transplantation in our booklet Heart failure and transplantation. Here are some of the tests we commonly use: Electrocardiogram (ECG) This painless test only takes a few minutes and shows the rhythm and electrical activity of your heart. It involves placing small sticky patches (electrodes) on your arms, leg and chest that are connected by leads to an ECG recorder. 7 Echocardiogram (ECHO) This is a simple and painless ultrasound scan of the heart that takes up to 30 minutes to complete. It allows us to learn more about the structure and function of your heart valves and heart chambers. After the LVAD has been fitted, we may carry out several ultrasound scans with the pump speed set lower than normal. This means that your heart has to pump more blood and allows us to test how well your heart is working. Chest x-ray This is a simple test that provides an image of your lungs and heart. Cardiac catheterisation (also known as an angiogram) A cardiac catheterisation is a special x-ray investigation. It involves making a small needle hole (under local anaesthetic) in your groin or neck through which a small, hollow, flexible tube called a catheter is inserted. The catheter is guided into the artery or vein and then through the blood vessels into the heart. Once the catheter is in the correct place pressures will be measured. Contrast may be injected through it into the heart and a series of x-ray pictures are taken. We have a separate leaflet on cardiac catheterisation. If you would like a copy, please just ask a member of staff. Some patients who have a high blood pressure in their lungs may need a longer cardiac catheterisation procedure, where drugs are given intravenously, to determine whether the pressure can be reduced. 8 Multiple gated acquisition (MUGA) scan This scan takes about 45 minutes and looks at how much blood your heart is pumping out. We will give you two injections before the scan. The first injection contains a substance that identifies your red blood cells. The second injection is the tracer, a substance with a small amount of radioactivity. It attaches to the red blood cells and enables us to see the blood flowing through the heart using a special camera. The amount of radioactivity used in MUGA scans is kept to an absolute minimum and we strongly believe that the benefits of the scan outweigh any risks. We have a separate leaflet available on having a MUGA scan. Please ask if you would like a copy. Blood tests We use blood tests regularly as they give us a lot of necessary information. If you are not sure why a blood sample is needed, please ask one of the staff members responsible for your care. Respiratory function test This test measures how well your lungs are working. It is quick and painless and involves blowing into a tube as quickly as you can. Cardiopulmonary exercise test We use this test during the assessment for an LVAD and again after the device has been fitted. This is so we can understand how well your natural heart can handle exercise. We will ask you to walk on a treadmill for as long as possible while we monitor your heart rhythm and your breathing. 9 After the LVAD has been fitted, the first part of the test is carried out with the LVAD turned on at full speed. The same test is then carried out a few hours later with the LVAD speed turned down. This lets us see how well your heart can work with less help from the LVAD. Cardiac magnetic resonance (CMR) scan A CMR scan is used when we want detailed pictures of the heart and blood vessels and how they are working. You will be asked to lie on a bed that will move slowly through the scanner. The scan uses strong magnetic fields and radio waves to produce the images. If you have any metallic devices or implants you cannot have this scan as the scanner contains a large magnet. Computed tomography (CT) scan A CT scan is a special kind of x-ray where several beams are sent at the same time from different angles to produce the scan. CT scans are more detailed than a normal x-ray and can produce 3D images of your body. We may have to give you a tracer injection before a scan where we need to make the blood vessels easier to see. You will be lying flat on a bed that will move slowly through the scanner. You may be asked to hold your breath for a few seconds while the scans are taken. This scan may be done again after an LVAD has been fitted so that we can see the position of your device, helping us to plan any future surgery. What are the benefits of the LVAD operation? An LVAD takes over the function of pumping blood from the left side of a heart that is failing to work properly. 10 After the procedure, you should find that the symptoms of heart failure (such as feeling breathless, coughing, swelling in your ankles and feeling tired) either go away or become much less troublesome. Most patients find they can return to many normal daily activities. Modern LVADs are quite small and function almost silently, so there are only a few restrictions on what you can do. Are there any alternatives to the operation? If we are discussing an LVAD with you it is because your heart failure is serious and we believe that drugs alone cannot give your heart the help it needs. There are two reasons why we may be considering an LVAD for you. This is either because your heart failure has made your current medical condition unsuitable for a transplant or because we do not think that you will be able to wait long enough for a heart transplant to become available. What will happen if I don’t have the operation? This depends on your current condition and how severe it is. However, without surgery, your heart failure and health may get worse. Ultimately, your heart condition may get to the point where your heart is no longer able to keep you alive. What are the risks of the operation? It is important to know that all surgical procedures carry some risk and that the risks for LVAD implantation are greater than for most other kinds of heart surgery. 11 However, it is important to remember that we would not recommend this operation if we did not believe the likely benefits to your health would outweigh these risks. Your surgeon will explain the risks that apply to you, but some of the most common risks of LVAD surgery include: Bleeding All heart operations carry a risk of bleeding. The risk of bleeding after the LVAD has been fitted is high compared to other heart operations. Occasionally a second operation is needed to eliminate the source of bleeding. You are also more at risk of bleeding immediately after the operation as we will give you anti-coagulant medicine to reduce the risk of you developing blood clots inside the LVAD. We keep a close eye on this by giving you regular blood tests to make sure your blood is not too thin. These tests will continue once you are back at home. LVAD patients also have an increased risk of internal bleeding into the digestive system and elsewhere. Kidney problems There is a risk of kidney failure because of your underlying heart failure and the complex LVAD operation. If this happens, you may need support from a type of kidney dialysis machine (haemofiltration), which is usually only temporary. Infection When you have an LVAD in place, it is possible for bacteria to get into your body where the driveline lead comes out through your skin. If you do get an infection here, it can be treated with antibiotics but it can be difficult to cure completely. Occasionally an infection can spread to the LVAD itself and this may need to be treated with further surgery. 12 Infection is one of the most serious complications of LVAD therapy. Although infection can be treated, it is usually not possible to cure a deep seated infection while the LVAD is in place. Driveline care is extremely important to reduce the risk of infection. There is more detailed information about wound care on page 25 of this booklet. You will need to keep a dressing over the exit site to protect you from infection. We will always keep a close eye out for signs of infection and encourage you to do the same. If you develop an infection, we will treat it with antibiotics. Stroke A stroke is an uncommon, but serious complication of LVAD treatment. It occurs when the supply of oxygen to the brain is interrupted, causing the brain cells to become damaged or die. Occasionally the damage is minor and the effect is temporary but in some cases, the damage can be permanent. Similar problems may be caused by bleeding into the brain tissue. Death Having an LVAD fitted is a major operation and it does carry a risk of death. According to our experience there is a 15% risk of death within 30 days of the procedure. Our survival rates are described at the end of this booklet. The risk will vary from patient to patient and your surgeon will discuss your anticipated risk with you when he or she asks you to sign the consent form for the operation. The need for a right ventricular assist device (RVAD) The LVAD only provides direct assistance to the left side of your heart. Occasionally it is necessary to support the right side of the heart with an RVAD in addition to LVAD support. 13 If it is likely that you may need an RVAD, your surgeon will discuss this with you. Sometimes the need for an RVAD only becomes apparent during your operation. In the majority of cases, this would be a temporary measure and the RVAD would be removed once the right side of your heart has stabilised. In the event that you need long term right sided support, your surgeon will discuss the options with you. The need for right sided support increases the overall risk of the operation. Unfortunately, there is not always a satisfactory solution to the problems caused by right ventricular failure. The short term device that we use for right sided support is called a Levitronix. This is an external device and the lines containing the blood will be outside your body. A propeller, which is suspended by a magnet, then pulls your blood through these lines. A patient with a Levitronix device 14 The operation What happens before the operation? Before the operation, different members of our team will visit you to discuss their specialist areas of the procedure. Your consultant cardiologist will explain more about your condition and how the LVAD is expected to help you. The anaesthetist will talk to you about what happens during the anaesthetics procedure for the operation and will ask you about any previous anaesthetics you may have had. The anaesthetist will make sure you are doing well during the procedure and will manage any pain you may experience. Your surgeon will explain what is going to happen during the procedure and answer any questions you may have. They will then ask you to sign a consent (agreement) form, which shows that you agree to have the operation. One of the artificial heart team will talk to you in more detail about the LVAD device that has been selected for you and will give you advice about living with an LVAD. You will have a chance to ask our specialist staff any questions you may have. Immediately before the operation, we will take you to the anaesthetic room where the anaesthetist will give you a general anaesthetic. This will ensure that you are unconscious and pain free during the operation. Once you are fully asleep and attached to the monitoring equipment, we will move you into the operating theatre for the procedure. 15 What happens during the operation? To insert the LVAD, the surgeon makes a cut from your breastbone to your abdomen. The chest is then opened to reveal the heart. The surgeon connects one tube from the LVAD to your left ventricle and the other to your aorta. Once they are both in place, the power lead is passed out of your body through a small hole made in the skin of your abdomen. Most patients will be on a special heart-lung bypass machine during the operation. This takes over the job of your heart and lungs and pumps blood around your body. The bypass machine is necessary as your surgeon usually has to stop your heart to connect the LVAD. During your operation and immediately afterwards, you will be attached to some essential medical monitoring equipment that normally includes: • a probe on your finger to measure your pulse and the amount of oxygen in your blood • sticky patches (electrodes) on your chest to monitor your heart rhythm • a catheter in your bladder to measure how much urine your kidneys are producing • several tubes coming out of your chest and abdomen, known as drains to ensure that fluid is not collecting inside your body and to check if you are bleeding • an arterial line (tube in one of your arteries usually at the wrist) to check your blood pressure • a central line (a tube placed into a vein in the neck) to give you medication and check your fluid levels • an endotracheal tube (a tube inserted in your windpipe) to ensure that air reaches your lungs when you are connected to the mechanical ventilator. 16 Where can my family wait during the operation? Your friends and family are welcome to stay in the hospital while you are having your operation. They can wait in the relatives’ area just outside the intensive care unit (also known as ITU) or in the hospital restaurant. It is important that they know the procedure usually takes between five to eight hours and can sometimes take longer. The nurse looking after you can contact your relatives when the operation has finished. Recovery in hospital after the operation What happens after the operation? After the operation, we will take you to the ITU where you will stay until you are well enough to go back to the transplant ward. The time it takes varies for each patient. Some patients stay in the ITU for a few days, while others can stay for a few weeks before they are well enough to move back to the transplant ward. Help with breathing At first you will be asleep or very drowsy. You will be attached to a ventilator, a machine that helps you to breathe. The ventilator tube is placed in your mouth and down your windpipe. You will not be able to talk, eat or drink while on the ventilator. As soon as your condition is stable, we will reduce the sleep medication and remove the breathing tube so you can start breathing for yourself. You will soon be able to speak and in time, you will be able to drink. Help with feeding Until you are well enough to drink for yourself, we will give you water through a drip in one of the large veins in your neck. We will give you food by nasogastric tube, which is inserted into your nostril and passed down into your stomach. We can also use these tubes to give you medication. 17 Help with passing urine You will have a catheter in place to drain the urine from your bladder. This means that you do not have to worry about going to the toilet and also lets us check how much urine you are producing. Help with draining excess blood from the surgical site There will be at least two drains from your chest helping to remove the blood and fluid that collects within your chest after surgery. One end of a tube is placed in your chest and the other end into the chest drain bottle. The tube is held in place with a stitch (suture) and is placed between the ribcage and the lung. We will remove the drains once any bleeding has slowed down. Help with controlling your heart rate Sometimes the heart beats slowly after an LVAD has been fitted. When this happens, we can regulate the heartbeat using a pacemaker. This means you may have thin wires coming from your chest for the first few days after your operation. We will remove these as soon as your heart beats normally again. What will I feel like when I’m in intensive care? It is worth knowing that most patients do not remember much about their time spent in intensive care. This is because of the medication we give you to keep you drowsy and free from pain after the operation. We will help you to manage your pain after the operation. You will initially receive intravenous (directly into the vein) pain medication, which will change to tablet painkillers once you are fully awake. Some patients may suffer from hallucinations during this time. The hallucinations will become less frequent and less vivid over time. If you experience hallucinations, please let us know. 18 Can my friends and family visit me while I am in the ITU? We ask that only immediate family visit you in the ITU and that you only have two visitors at a time. This is to allow medical and nursing staff to carry out your care and treatment. Your friends and family are welcome to use the nearby waiting rooms. We recommend that you choose one key person in your family to share information on your progress with other family members and friends. This will provide us with a clear channel of communication. What else will happen when I am in intensive care? A physiotherapist will visit you regularly while you are in the ITU. The physiotherapist will make sure your lungs are working well and check the movement in all your joints. Once you come off the ventilator, you will learn techniques to help you take deep breaths and clear any phlegm (thick mucus) that you may have on your chest. As soon as you are well enough, the physiotherapist will help you to get out of bed and sit in a chair. Even though you may still have lines and drains in place, this will not stop you from getting out of bed. Getting up will help your muscles work more normally and help your lungs work more effectively. Once you are able to get out of bed safely, your physiotherapist will give you some exercises to do. These will stop your joints from becoming stiff and help your muscles work properly. 19 What will happen when I move back to the transplant ward? We will move you from the ITU to the transplant ward when you are well enough. You will still be attached to a cardiac monitor to check your heart rate and rhythm, have a urinary catheter in place and may still have chest drains and/or drips. We will start to remove these as your condition improves. The VAD team and ward nurses will look after all your LVAD equipment. As you get better, we will show you and your family how to look after the device and deal with any problems. You and your family members/friends will need to complete a quiz to make sure you know how to look after your LVAD and how to deal with emergency situations. The VAD team will explain this to you and will go through the questions with you. If you are unable to complete the quiz or perform the emergency procedures, you will need to have someone with you 24 hours a day who has been trained to help you. What is the transplant unit like? While you are in the ITU, a single nurse will care for you. However on the transplant unit, each nurse cares for several patients. This may take some getting used to, but please remember that being back on the transplant unit is a sign that you are beginning to recover from your operation. All the rooms in the transplant unit are single rooms with TVs, phones, fridges and washbasins. Showers and toilets are in a central section of the ward. 20 Will I still see the physiotherapist? Physiotherapy is a very important part of your recovery and a physiotherapist will continue to see you regularly once you are back on the ward. Once most of your lines and drains have been removed, they will help you to start walking. You will start with very short distances at first and as your confidence grows, you will be able to walk further. Your physiotherapist will also design a personal exercise programme for you. This will help to make you as independent as possible and fit enough to go home safely. How will I feel emotionally after the operation? Every patient reacts differently to having an LVAD operation. There is no right or wrong way to feel. Many patients feel very happy and relieved after surgery but some may have periods of feeling low or down. Most patients experience a time where they feel worried about their recovery, have concerns about looking after their LVADs or have practical worries about going home. Your emotional wellbeing is as important as your physical recovery and we will support you through these mixed emotions. Do not hesitate to talk to us. We are always on hand to help and can refer you to our health psychologists if you need extra help. As a general rule, you should find that you are having more good days than difficult days as your health improves. Please talk to your nurse if this is not the case. 21 Going home When will I be ready to go home? Having an LVAD fitted is a big operation and it can take from two to six weeks before you are ready to go home. Some patients can take longer than six weeks to recover, particularly if they have been sick for a long time before surgery or if there have been complications. You and your family or carer will be given specific training in the care and use of your LVAD. What happens before I leave hospital? One of our VAD nurses will visit your local hospital, GP surgery and ambulance service to explain to staff that you have an LVAD and how it works. This will allow your local healthcare staff to be fully prepared to help should you have any problems with the device. When you leave hospital, we will give you medication that will last for two weeks. Your GP can give you more medication so please make an appointment with him or her well before your medication runs out. We will train a family member or carer to regularly clean the area where the driveline leaves your body. If the area remains free of infection, it may be cleaned as little as once a week. We will give you a two week supply of dressings and your GP can give you more. If your GP cannot replace some of these items, you can contact the VAD team to request more. We will discuss all of this with you before you go home. It is important to realise that you must keep your LVAD running at all times and this means you must carry spare equipment wherever you go. 22 This includes the following: • a spare controller • spare batteries that are fully charged • a mobile phone to call for help if needed • a letter explaining your specific device, why and when it was fitted as well as the contact details for the VAD team at Harefield to give to ambulance crews or other healthcare professionals. How will I feel when I get ready to go back home? Most patients feel happy about going home but may also have a few concerns. In order to increase your confidence about going home, we will gradually get you ready to leave hospital. This is called a progressive discharge. Trips outside the hospital with your family member or carer will help you to get ready to go home. Some patients are concerned about feeling embarrassed in public with the LVAD fitted. These trips will help you to get used to any questions people may ask and help you realise that most people do not even notice the LVAD. If you are very concerned about going home, please tell us. We can arrange for you to see a health psychologist who will help you to address your concerns. How will I keep in contact with the hospital when I am back at home? We will ask you to come back to Harefield Hospital for regular follow-up appointments as an outpatient to see how you are doing. Your first appointment is usually two weeks after you have left hospital and we will book this before you leave. Please call us each week to let us know how you are doing, unless you have an outpatient appointment that week. 23 You will need to have regular blood tests to check that the level of blood thinning (anticoagulant) medicine is correct. Your GP normally organises this once you have left hospital. What happens if I need further help or advice when I am at home? Some patients may need extra support when they are back at home. This could be help with practical issues around care or advice on financial matters. If you need extra support, we can put you in touch with social workers and/or welfare rights advisers. Are there any symptoms I should watch out for when I am at home? It is important that you check your temperature each day. If it goes above 37.5 degrees, you should contact your GP and let the VAD team know immediately. You may have an infection and this is usually treated with antibiotics. Your GP may take a swab, a urine sample and/or a blood sample to confirm whether or not you have an infection. You should also weigh yourself each day and let us know if you lose or gain weight quickly. Weight gain over a short period of time can be a symptom of fluid retention or heart failure and needs to be investigated. Weight loss over a short period of time can be a sign of dehydration. How do I care for my LVAD at home? It is important to follow the advice we have given you. Remember to keep the equipment clean and take care not to damage it. If it does become damaged, please contact the VAD team immediately. If you accidentally drop any batteries, please do not use them until we have checked that they are still working properly. 24 What medication will I use when I am back at home? You will be on a variety of medication when you are back at home. Medication may be slightly different for each patient. You will definitely be on aspirin and warfarin tablets once a day to help thin your blood. You will need to have your blood tested regularly to make sure that you are still on the right warfarin dose. We will also show you how to inject yourself with a fast acting blood thinner should your warfarin levels be too low. You may also be on heart failure medication and water tablets. Nurses and pharmacists will explain these to you before you leave the hospital. Wound care After your VAD has been fitted, you will have a permanent wound where the driveline exits your abdomen. The wound will need further dressing and ongoing care. We will train a family member, carer or nurse on how to care for your driveline. In order to prevent infection, you should not take a shower until the skin around your driveline has completely grown onto the driveline. The VAD team will check your driveline when you come in to the outpatient follow-up clinic and issue you with a shower kit once this has happened. Trauma to the driveline exit site can lead to an increased risk of infection. In order to minimise trauma, be careful with the driveline and ensure it is immobilised (fixed in place) at all times. Try not to pull, twist or bend the driveline. Take care not to drop the controller or place unnecessary strain on the controller’s electrical leads. 25 Please contact the VAD team immediately if: • you have a temperature of 37.5 or above • you experience increased tenderness or pain around the driveline • your wound feels hot or looks red and inflamed • a new swelling or bruising appears • the wound begins to ooze or there is an increase in oozing since the previous dressing change • the wound starts to smell It can sometimes be difficult to get some of the items needed to take care of the driveline. The VAD team can provide essential items if your GP is unable to get them. To order supplies, please contact the VAD team on 01895 823 737 or email [email protected] at least four working days before your outpatient clinic appointment. Each time your driveline dressing is being changed at home, we ask that your carer takes a digital photo and emails it to us. This creates an electronic record of the condition of your driveline exit site and helps us pick up potential problems early. If you have any concerns regarding the wound, please contact the VAD team. What if I have problems when I am at home? If you have problems or worries once you are back at home, please call Harefield Hospital on 01895 823737 and ask for the VAD team. Non urgent enquiries can be emailed to [email protected] 26 What should I do in the event of an emergency? You should go to your nearest A&E or dial 999. If possible, also contact Harefield Hospital switchboard on 01895 823 737 and ask for the transplant registrar. If it is a problem with the LVAD, ask for a member of the VAD team. Lifestyle Can I take a bath or shower? It is important that you protect the external parts of your LVAD from water. It will not be possible for you to take a bath. You will be able to take a shower once your driveline has fully healed. We will check this when you are ready to go home and in the follow-up clinics as an outpatient. You should change your driveline dressing after each shower as this helps minimise the risk of infection. We ask patients not to have more than two showers a week. Can I have sex? Many patients have been able to resume sexual relations after having an LVAD fitted. If you are a female patient, please remember that you should not get pregnant because of your medical condition and the drug therapy that you are receiving. Will having an LVAD interrupt my periods? Sometimes women find that their periods stop immediately after the procedure. This can happen after any major illness or major surgery. In these cases, periods may not restart for many months. If your periods have stopped, please discuss this with your doctor or your nurse. Not having any periods after surgery does not guarantee that you cannot get pregnant (see section on sex above). Once your periods have restarted, they may be heavier than before because of the anticoagulant medicines (warfarin) that you are taking. 27 Can I drive? You may be allowed to drive after your surgery. This depends on: • how well you are • how dependent your heart and circulation are on the LVAD • any other medical conditions that you may have It is important that you contact the DVLA and your insurance company and explain your situation to them. The DVLA may request a medical report about your case from the hospital. If you are unable to drive and find it difficult getting to your clinic appointments, please let us know. Can I exercise? Most patients find they can exercise well with an LVAD even if they were very unwell before the operation. We advise LVAD patients to do some moderate exercise and build up slowly over a long period. The physiotherapist will give you an appropriate exercise programme to continue with once you are back at home. It is important that you do not swim or take part in contact sports. You should avoid jumping, exercises that cause impact on your torso and abdominal exercises such as sit-ups. You should also avoid activities that are repetitive or cause you to reach over such as decorating or gardening. It is very important that you protect your driveline and LVAD equipment during physical activity. You should always discuss any new form of physical activity with your LVAD nurse before you start. Please ask if you would like your physiotherapist to give you more advice on specific types of exercise. 28 Can I go on holiday? Once you are back home and feeling comfortable with the device, you may want to visit friends and family or spend some time away. We do not recommend that you travel abroad, but you can take holidays in the UK whenever you feel ready. Please let us know if you are planning to spend some time away from home. The VAD team can let the local Accident and Emergency departments and ambulance service know. This will allow them to be better prepared in the event of an emergency. Are there any devices that could interfere with my LVAD? Strong magnetic fields (such as those used for MRI scans) and static electricity can affect your LVAD. You should avoid touching television screens or computer monitors as these can give off static electricity. Mobile phones do not affect LVADs. You should keep a charged mobile on you at all times when you are not in a hospital building. What lifestyle changes can I make to improve my health? If you are a smoker, stop smoking. Try to avoid smoky environments. If you or your friends or relatives need help to quit, call the NHS Smoking Helpline on 0800 022 4332 or visit the website at www.gosmokefree.nhs.uk. Drinking too much alcohol can interfere with your blood-thinning medication. It can also cause your heart to work less well. Alcohol impairs your judgement and reactions and reduces your ability to deal with a problem relating to your LVAD. 29 Remember to eat a healthy, balanced diet and to stick to the right weight for your height. Being overweight is one factor that may reduce your chance of receiving a transplant in the future. Our dietitians can give you advice on this if you need it. Take your prescribed medication regularly. Do not use any other medication (including over-the-counter medication) without checking with your doctor or the VAD team first. Remember to attend your check-up appointments regularly. If you cannot attend for any reason, contact the VAD team. Who can I contact for further information? If you have any questions, please contact us through the main switchboard on 01895 823 737 and ask for the VAD team. If you have a medical problem, please ask for the transplant registrar or the on call transplant SHO. In the event of an emergency, you should go to your nearest A&E or dial 999. Outcome of LVAD surgery The information on the opposite page represents our experiences with LVAD survival at Harefield Hospital. Table 1 shows the survival percentages from Harefield Hospital after having an LVAD fitted in comparison to all UK centres combined. Diagram 1 shows our recent experience at Harefield Hospital from 1 April 2005 to 31 March 2010. Please speak to your VAD nurse if you have any questions. 30 Survival percentages after implant of a long term LVAD (May 2002 to March 2010) Centre Number of patients 30 days 3 months 1 year 2 years 3 years Harefield 110 85% 78% 65% 54% 51% All UK Centres 228 85% 74% 63% 55% 53% Table 1 Harefield LVAD outcome data 1 April 2005 to 31 March 2010 Implanted Patients 80 Deceased Patients 20 Transplanted Patients 15 Explanted (Heart recovered) Patients 20 Ongoing Patients 25 Diagram 1 31 © Royal Brompton & Harefield NHS FoundationTrust Royal Brompton Hospital Sydney Street London SW3 6NP tel: 020 7352 8121 textphone: (18001) 020 7352 8121 Harefield Hospital Hill End Road Harefield Middlesex UB9 6JH tel: 01895 823737 textphone: (18001) 01895 823 737 website: www.rbht.nhs.uk February 2011 Brosürteki bilginin Türkçe tercümesi için tedavi gorüyor oldugunuz bolüme bas vurunuz. Bolüm personeli tercümenin gerçeklesmesini en kisa zamanda ayarlacaktir.