The LVAD explained

  

  Here in Rochester, New York we are fortunate to have two accredited heart hospitals: Strong Memorial Hospital and Rochester General Hospital. I have been blessed with the opportunity to work with both hospitals already in my now twelve year history as a nurse. Strong Memorial Hospital is now know as the University of Rochester Medical Center (URMC). This is the only hospital in Rochester that does heart transplant. As a part of that heart transplant program, URMC uses VAD (ventricular assist device) to treat a patient awaiting a heart transplant, or it can be used as what is known as destination therapy. Why would a patient require a heart transplant, you ask. Transplant is a last-resort surgery for hearts (in this case) that are too diseased to continue to carry on an effective life. Transplant is a major surgery, and not all survive. VAD therapy has been shown to show improved outcomes after transplant. Sometimes, even transplant is not an option for patients with hearts that are so diseased, they are in the end stages of life.These patients are only eligible for destination therapy.

     This is where the VAD therapy comes in. Most often, the VAD is implanted into the left ventricle of the heart to give the blood flow through the rest of the body (commonly referred to as systemic circulation). This is then the LVAD (left ventricular assist device). There is also the RVAD (right ventricular assist device), and the BiVAD (bi-ventricular assist device). The BiVAD will be further explained in next week's post. VAD therapy increases cardiac output by decreasing the workload, thereby  giving the patient fewer CHF symptoms, and giving them a better quality of life as they either await transplant or continue on their destination therapy.  For patients awaiting transplant, not only are they less symptomatic and have a higher quality of life, if they are hospitalized for any reason, these patients are then moved up on the priority list for transplantation.

As you can see from the pictures and videos, the VAD has decreased in size as time has gone on. Competition has made this possible. Abiomed and Thoratec are the two leading companies in this technology. Often, the surgeon implanting the device decides which manufacturer they will be using, but I have linked these two companies so that the reader can make an informed decision if needed.
     While VAD therapy has its benefits, as with any invasive medical procedure, it is not without its risks. As it is meant to do, the human body tends to fight off any intruders, including ones that were put there on purpose. That is why special care is given to patients on VAD therapy. The body wants to clot of where a foreign object enters the blood stream. For that reason, these patients have their clotting factors monitored very carefully. They are often given aspirin as a means for keeping the platelets in the blood from aggregating (collecting). As you can see from the video, the drive line enters through the abdominal wall. Special care is given here to avoid infection, so daily sterile dressing changes are done around the the drive line insertion point. Constant daily monitoring of the dressing and any appearance of drainage, foul smell, pain, or increase in white blood cell count could be a sign of a drive line or pocket infection. This condition is very serious and needs to be brought to the attention of a medical practitioner right away.