Ventricular Assist Device (VAD) for Heart Failure
Medically reviewed by Christopher Lee, MDMedically reviewed by Christopher Lee, MDA ventricular assist device (VAD) is a mechanical pump implanted in the heart to help the heart pump blood throughout the body. Healthcare providers use it as a treatment in people with severe (stage D) heart failure who are waiting for a heart transplant or when a transplant is not an option.Stage D heart failure is the most serious type, resulting in impaired blood flow—despite interventions—and significantly impacting quality of life. When a person reaches stage D heart failure, there are only a few treatment options, such as a heart transplant or a ventricular assist device.
Photo composite by Michela Buttignol for Verywell Health; Getty Images
Functions of Ventricular Assist DevicesHealthcare providers use VADs when treatments are no longer effective in controlling heart failure symptoms. A VAD is a mechanical heart pump that can relieve symptoms associated with advanced heart failure, but it does have risks, such as infection, stroke, and bleeding.A VAD is a motorized pump a specialized surgeon implants into the tip of the heart to act as one or both ventricles or lower heart chambers. It has a power cord—the driveline cord—that connects the VAD to an external controller. The driveline cord usually exits the body through a surgical opening, called a driveline site, often in the abdominal area.The driveline cord connects to a controller box that most people with VADs wear on a belt around their waist. The controller box operates the pump, monitors for problems with the VAD, and sends alerts and alarms if any issues arise. The controller is connected to a portable battery pack or an electrical cable plugged into an outlet.Left VADThe most common type of VAD is a left ventricular assist device (LVAD) used to support the heart's left ventricle function. The heart's left ventricle pumps nutrient- and oxygen-rich blood out of the heart and into the body.Right VADRight ventricular assist devices are less common but are often considered a lifesaving option. The heart's right ventricle pumps blood from the heart into the lungs to oxygenate the blood.
Related: All Parts of Heart Anatomy
VADs vs. PacemakersThe VAD and pacemaker are both implanted devices, but have some key differences:VADA VAD is a mechanical pump designed to keep one or both of the heart's ventricles working. It is used when the heart becomes too weak to pump blood effectively and is often the last treatment option before a heart transplant. In some cases, the VAD works well enough to eliminate the need for a heart transplant.PacemakerA pacemaker is an implantable device to help regulate the heart's electrical system. A healthcare provider may opt for a pacemaker to help conduct electrical impulses in the heart and keep it beating regularly if the heart's sinoatrial node (natural pacemaker) is damaged or not working correctly.Complexity of SurgeryThe surgery for VAD placement is complex and is performed by specialized healthcare providers known as cardiothoracic surgeons and a team of highly skilled nurses, anesthesiologists, and other specialists.VAD surgery is a type of open-heart surgery that typically takes between four and six hours. During the surgery, you can expect the following:An anesthesiologist will administer medications to put you to sleep so you are unaware of your surroundings and cannot feel pain during the surgery. They closely monitor you throughout the surgery.The cardiothoracic surgeon will make a large incision down the center of your chest, cut open the sternum (breastbone), and spread the rib cage to visualize and operate on the heart.The surgical team will place you on a heart-lung bypass machine, which will continue to pump nutrient- and oxygen-rich blood throughout the body but allow the heart to remain still so the surgeon can perform the delicate surgery.Once the cardiothoracic surgeon completes implanting the VAD, the heart resumes pumping, and the surgical team removes you from the heart-lung machine. They closely monitor you during this period to ensure the heart resumes beating correctly.
VAD Surgery RisksOpen heart surgery is a complex operation which has risks such as:BleedingInfectionPotential for additional surgeryStroke
Life Expectancy After SurgeryHealthcare providers initially intended to use VADs as a short-term treatment for severe heart failure until a viable heart was available for transplant.However, with a lack of available hearts for transplant, people with stage D heart failure depend on VADs for much longer than initially intended. A 2020 study found that long-term survival with VAD is as high as 51% at the seven-year point, which supports the long-term use of VADs as an appropriate treatment option for severe heart failure.
VAD and Comorbid ConditionsThe vast majority of people who undergo a VAD surgery have co-occurring, or comorbid, conditions, the most common of which include:Chronic kidney diseaseDiabetesOverweight or experiencing obesityPulmonary hypertension
Life With LVADAfter recovering from VAD surgery, people often express relief from weakness, tiredness, and shortness of breath associated with heart failure. Usually, they can perform their activities of daily living much more easily than before surgery. As recovery progresses, some people can return to work or travel, something they lacked the energy and physical ability to do before the VAD surgery.A VAD can impact your life in a positive way, but there are certain adjustments to consider.Consistent Power AccessA VAD is a mechanical pump that requires power to operate. Its battery packs allow mobility and last up to 17 hours. You should plug the battery packs into an electrical outlet while you sleep so they can recharge.Driveline CareThe VAD is implanted near the heart but has a power cable that exits the body to connect to a power source. The driveline site requires proper cleaning and special bandages to prevent infection.Regular Medication ChecksPeople with VADs need to take blood thinners to prevent blood clots. People taking blood thinners require regular checkups with a healthcare provider.Contact With WaterOnce a VAD is placed, you cannot submerge yourself in water due to the power supply and driveline site. You can use protective devices for the power source while you shower, but you cannot bathe or swim.Emotional ChallengesMany people with a VAD appreciate experiencing an improvement in how they feel and performing normal activities of daily living. However, caring for the VAD and adapting your lifestyle to accommodate the VAD can cause feelings of anxiety, worry, or stress.Sex Life ChangesGenerally, it is safe to have sex once you have recovered from surgery. But living with a VAD might change your sex life. It is important to share any sex life concerns with your sexual partner(s) and talk to a healthcare provider.
Costs Associated With VADVAD surgery can cost around $175,000, depending on hospital and professional costs and any additional testing required. Medicare and Medicaid and most commercial insurance carriers cover VAD surgery costs.If you do not have insurance, nonprofit hospitals must provide financial assistance to eligible patients who cannot afford the medical costs. It is important you work with your insurance provider and/or the hospital where you will be receiving VAD surgery to be fully informed about the associated costs and your potential out-of-pocket expenses.
Caretaker SupportWhen determining eligibility for VAD surgery, healthcare providers consider whether the individual has access to a reliable caregiver. Recovery from VAD surgery can require minimal to significant support. As part of the VAD process, healthcare providers encourage caregivers to participate in preoperative and postoperative education. Caregiver support is crucial to long-term recovery for people living with VADs.SummaryA ventricular assist device (VAD) is a treatment option for people with stage D heart failure. It is a mechanical pump that performs the functions of the left or right ventricles of the heart. Healthcare providers initially intended to use VADs as a short-term option for people awaiting a heart transplant. Still, because of the lack of available hearts for transplant, VADs can be used for long-term treatment of heart failure as well. Read the original article on Verywell Health.
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