Ventricular assist devices (VADs)
The ventricular assist device (VAD) helps to pump the blood from the heart’s chambers to rest of the body. VAD can be used as a long-term or temporary cardiac support.
Advancements in the field of continuous flow technology have resulted in enhancements in efficiency, dimensions, implantation capabilities, prolonged support, and holistic patient results. Consequently, there has been a broadened scope in the clinical utilization and implementation of ventricular assist devices (VADs).
Types of Ventricular assist devices
Ventricular assist devices are two main types, such as left ventricular assist device and the right ventricular assist device. Additionally, when the situation demands using both the devices, they are referred to as biventricular assist device (BIVAD). Below is the brief description of each type.
Left Ventricular Assist Device (LVAD): The LVAD is the most common type of VAD that assist left ventricle to pump the blood to the aorta, which is the major artery that travel throughout the body carrying oxygen-rich blood from the heart to the rest of the body. The device is most used in patients with severe heart failure or end-stage cardiac failure or individual who is not a right candidate for transplantation.
Right Ventricular Assist Device (RVAD): The RVAD assist the right ventricle pump blood to the pulmonary artery, which transports blood to the lungs to receive oxygen. RVADs are typically used for short-term support, especially following LVAD surgery or other heart surgeries where the right ventricle needs temporary assistance to function properly.
Biventricular Assist Device (BIVAD):
When both the left and right ventricles need help, they can be used together with an LVAD and RVAD, which is called a BIVAD. This configuration allows for effective blood pumping on both sides of the heart. Such a combination is utilized in cases where neither of both ventricles meet the body’s needs, often used a heart transplant or in serious cases of biventricular heart failure.
VAD designs
Transcutaneous VADs: These are devices with their pump and power source outside the body. They’re connected to the heart through small tubes. They’re usually used for short-term support after heart surgery. They’re easier to manage and replace, but they have a higher risk of infection.
Implantable VADs: These devices are completely placed inside the body. They’re powered by a driveline that connects to an external battery pack and often used for long-term support in patients with chronic heart failure. The device has a lower risk of infection and are better for long-term use, but the surgery to implant them is more complex.
Pulsatile-Flow VADs: These devices work like the natural heart by filling and ejecting blood rhythmically. They were used in early VAD designs but are now rarely used due to advancements in technology. They’re larger and bulkier and have more mechanical parts that can wear out.
Continuous-Flow VADs: These devices use rotary or centrifugal pumps to provide a constant blood flow. They’re the most used VADs today. This device is smaller, more durable, and quieter, but it can complicate the measurement of blood pressure and pulse.
Centrifugal-Flow VADs: These devices use a spinning rotor to move blood from the heart to the body. They’re efficient and effective at providing stable blood flow and have a compact design, but they require careful management to prevent blood clotting and other complications.
Axial-Flow VADs: These devices use a spinning impeller within a cylindrical tube to propel blood forward. They’re often used for long-term support in patients with severe heart failure. They provide continuous and reliable blood flow and are smaller in size, but they can cause the destruction of red blood cells and require precise placement and management.
Risk
- Using Ventricular Assist Devices (VADs) can indeed have some risks. Here are the main ones:
- Like any surgery, the procedure to implant a VAD can increase your risk of bleeding.
- As blood moves through the device, there may be the chance of forming blood clots which can slow or block blood flow, causing problems with the device or even a stroke.
- There’s a risk of infection, especially where the driveline exits the body.
- Device Malfunction: There’s a chance that the device could malfunction24.
- Right-sided Heart Failure: This is a potential complication associated with the surgical VAD implantation.
- Arrhythmias: Irregular heartbeats, or arrhythmias, are another potential risk.
- Stroke: There’s a risk of stroke with VAD implantation.
It’s important to note that these risks need to be balanced against the benefits of using a VAD, which can be lifesaving for people with severe heart failure. Always consult a cardiac surgeon or healthcare provider to understand the about the associated risks and benefits in your specific situation. They can provide the most accurate information based on your health condition and the specific type of VAD being considered.
Life after VAD implantation
There are several lifestyle changes that may be needed after getting a Ventricular Assist Device (VAD):
- One should continue to take your heart failure medication after you have your VAD. The dosage and frequency of these medications may modify based on the vital signs while on VAD support.
- Living with a VAD is a new way of life. One will have to adjust some of the daily activities depending on now having additional connections and needing a constant power source.
- Physical activity will have to start slowing because you have been in the hospital for some time and your muscles are probably out of shape.
- The VAD exit site will require daily sterile dressing changes.
- One may need to adjust fluid intake and get more fluid intake, since the VAD is circulating blood through your body at a set speed.
- Travelling with a VAD should be planned to ensure that one will always have an adequate electrical supply.
Future trends in VAD
Future trends in VAD design include wireless power transmission, the use of biocompatible materials, and the integration of sensors and smart technology to monitor device function and patient health in real time. These advancements aim to reduce the infection risk, increase patient mobility and comfort, enhance patient safety, and improve the management of heart failure.
Conclusion
VAD plays an important role to supporting blood supply at the end stage of cardiac failure. If one has VAD implantation it is important to maintain healthy lifestyle, including quitting smoking and eating nutritious food in the diet. Consult with healthcare providers for personalized advice as they provide the most appropriate information based on health conditions and specific types of VAD being considered.