Now for the BiVAD

     When I first started working on the Heart Transplant Unit at Strong Memorial Hospital, I had no idea how much I was going to learn in an incredibly short time. I remember the day like it happened just last week. I was told to get report from the ICU nurse about a patient that was awaiting transplant after his heart took what I was told was a "morbid blow" from his cocaine use. I got report and was told he was on Biventricular support. At this point I knew what left ventricular support was and so did my unit, but we had no idea what BiVentricular support was going to look like. We all agreed that we were about to find out very soon.


      We found out sooner than we anticipated. Our new patient was arriving on our patient ten minutes from the time that I had hung up with the ICU. He had two nurses, the nurse practitioner, and the Nurse Manager of the ICU with him, not to mention his wife and his toddler son. He walked most of the way from unit to unit, but he was immediately ready to be in bed. Once he was in bed, I did my complete assessment on him. At that time, I couldn't believe what I saw. There was no way this was going to work, I thought. He had on an abdominal binder that kept the two pumps in place. Each one of the pumps (one on his left, one on his right) was supported by a pouch that was usually used to carry our portable patient telemetry. Where each pump entered his upper abdominal wall there was a dressing setup covered by two large abdominal dressings. Each one of the pumps was red and made a large clicking sound around an average of 80 times per minute, representing his heartbeat. Each one of his pumps were hooked up to a computer that showed his pulse and stroke volume continuously. With the click of a button, the computer also showed several pressure readings that were taken every few minutes. These pressure readings basically showed how well the pump vacuumed in the blood and how well the pump evacuated the blood. This patient also had to be on continuous telemetry, so we were able to monitor his heart's electrical activity since all this equipment was helping us monitor his heart's pumping effectiveness.

     This gentleman stayed with us for a long time before he got his heart. He became a fixture on the unit. After a while, he was able to ambulate around the unit using a portable computer in what looked like an airline luggage carrier. Early on, he required frequent dosing of pain medication. As time went on, he needed it less and less. He gradually began to smile more often (as compared to never smiling early on). During the time that he was implanted with this device, he required high doses of Coumadin (a anti-coagulant) to slow his clotting time to quite extended (INR needed to be around 3-4). He was eventually able to get his heart transplanted. Even though rehabilitation after transplant can be extensive, he seemed to handle it quite well. At first it seemed like we were going to go back down that long road of pain and depression with him again, but he bounced back quickly. He even gave me a hug when he left.

     While this was a great success story, at the time of his implantation, there were still complications and disadvantages. One complication that I noticed early on was that the outer casing of one of his pumps had cracked. This was highly concerning to me at the time because I was afraid we were either going to develop a vacuum leak, or an integrity of the pump problem. Luckily, we only developed a very small vacuum leak, and there was an inner casing that was still completely intact. The fact that his clotting time was so extended was also very concerning. I spent extra care ensuring that he did not shave using a regular razor and when he was ambulating, someone was always next to him, to be sure he didn't fall. All those lies coming from him made a great trip hazard. As with the LVAD, the same potential complications also exist: risk for stroke, device failure and line infection are the major considerations. During this time, the patient was not allowed to be discharged to home with a BiVAD in place. Some changes in the devices are now allowing for patients to be discharged from the hospital as they await transplant.

     After the holiday break we can discuss the total artificial heart.