What is ventricular assist device placement?

Ventricular assist device (VAD) placement is surgery to treat advanced heart failure. In advanced heart failure, the heart is too weak to pump enough blood to meet your body’s needs. A VAD helps your heart pump. Your surgeon places the pump component inside your chest and connects it to a power source and computer controller that remains outside your body. VAD placement can improve your quality of life and reduce or resolve your symptoms.

A VAD has a few basic parts. The size and specific components will vary depending on the specific device. In general, VADs have a pumping unit that is inside the body, and a power source and computer controller outside the body. Tubes carry blood to the pump. The external components typically connect to the pump inside the body through a cable. The cable usually enters the body through a small hole in the abdomen.

VAD placement is major surgery that has risks and potential complications. You may have less invasive treatment options. Consider getting a second opinion about all of your treatment choices before having VAD placement. 

Types of VADs

The types of VADs include:

  • Left ventricular assist device (LVAD) helps the left ventricle pump blood to the aorta and out to the body. This is the most common type of VAD. 
  • Right ventricular assist device (RVAD) helps the right ventricle pump blood to the lungs. This type of VAD is usually for temporary use.
  • Biventricular assist device (BIVAD) helps both the left and right ventricles pump blood.

Why is ventricular assist device placement performed? 

Your doctor may recommend ventricular assist device (VAD) placement to treat advanced heart failure. Your doctor may only consider a VAD for you if other treatment options that involve less risk of complications have been ineffective. Ask your doctor about all of your treatment options and consider getting a second opinion.

Your doctor may recommend VAD placement in the following situations: 

  • As a temporary support for your heart following an injury, such as a severe heart attack or heart infection. In this case, it allows your heart time to recover and regain function. This is sometimes called a “bridge to recovery.”
  • As a temporary support for your heart while you await transplantation. This is the most common reason for having VAD placement and is sometimes called a “bridge to transplant.”
  • As a permanent support for your heart if you are not eligible for a transplant. This is sometimes called “destination therapy.” In some cases, VAD placement helps people improve enough to become eligible for a heart transplant.

Who performs ventricular assist device placement?

Cardiac surgeons perform ventricular assist device placements. Cardiac surgeons specialize in the surgical treatment of conditions of the heart and its blood vessels. Cardiac surgeons may also be known as cardiothoracic surgeons. 

How is ventricular assist device placement performed?

Your surgeon will perform your ventricular assist device (VAD) placement in a hospital. Your surgeon will make an incision in your chest and through your breastbone (sternum) to access your heart. A heart-lung machine is usually necessary for VAD placement. Your surgical team will stop your heart with medicine and the heart-lung machine will pump blood to the body. When the surgery is complete, your surgeon will start your heart and take your heart off the machine.

Types of anesthesia 

Your surgeon will perform your VAD placement using general anesthesia. General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the surgery and do not feel any pain. 

What to expect the day of your VAD placement

You may already be in the hospital because of your condition or your surgeon may admit you to the hospital the day before your VAD placement. The day of your surgery, you can expect to:

  • Talk with a preoperative nurse. The nurse will perform an exam and ensure that all needed tests are in order. The nurse can also answer questions and will make sure you understand and sign the surgical consent form.
  • Remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member. The surgical team will give you blankets for modesty and warmth.
  • Talk with the anesthesiologist or nurse anesthetist about your medical history.
  • A surgical team member will start an IV.
  • The anesthesiologist or nurse anesthetist will start your anesthesia.
  • A tube will be placed in your windpipe to protect and control breathing during general anesthesia. You will not feel or remember this or the surgical procedure as they happen.
  • The surgical team will monitor your vital signs and other critical body functions. This occurs throughout the procedure and during your recovery until you are alert, breathing effectively, and your vital signs are stable.