Ventricular Assist Devices (VADs)

A ventricular assist device is a mechanical heart pump that is inserted into your heart to help it distribute blood throughout your body. VADs are often used as a “bridge” to a heart transplant to support your failing heart and your body while you wait for transplant. Thanks to advances in VAD technology, the devices are now smaller and more portable and are also used as a long-term treatment for people who aren’t candidates for a heart transplant. This long-term option is called “destination" or "chronic" therapy, and it can add years to your life. Many people with VADs report noticeable improvements in heart failure symptoms like shortness of breath, swelling, and energy levels.

Parts of a VAD
VADs have four main parts. 

• During open heart surgery, a small mechanical pump is attached to the left or right ventricle (the left is most common), the heart’s chamber that is responsible for most of the pumping action. The pump is also attached to the aorta, which is the main artery that delivers blood to the body. The attachment to the left ventricle is the reason these devices are often called left ventricular assist devices or LVADs. 
• A thin tube called a driveline directs wires from the pump inside the body through a small hole in the abdomen. The wires are connected to a controller outside the body.
• The controller is a small computer (about the size of three stacked cell phones) that operates the pump and displays messages and alarms.
• Either batteries or a unit attached to an electrical outlet powers the device and is connected to the controller.

^{Parts of a VAD system include batteries that provide power, a pump that moves blood from the heart's left ventricle to the rest of the body, a controller that controls the VAD, and a driveline that connects the internal and external parts of the device.}

Possible Complications
There are risks associated with VAD support, including hospital readmission, stroke, infection, and bleeding. If complications occur, you may need another surgery or a new VAD. Duke is dedicated to reducing your risk of these complications.

If you are a candidate for a VAD, you will undergo an in-depth evaluation conducted by a team of specialists that includes an advanced heart failure specialist and a heart surgeon. This team works together to determine whether a VAD is the best treatment option for you based on your age, condition, and test results. In addition to a standard physical exam and medical history, you may undergo the following tests:

Blood Tests
These help your doctors evaluate your overall health. They show how well certain organs are functioning, including your heart. Blood tests can also help identify whether you have any infections that need to be treated before surgery.

Advanced Imaging
These imaging techniques help your doctors learn more about your heart’s function and structure. 

• Cardiac catheterization: This minimally invasive procedure measures the pressure and blood flow in your heart. While you are sedated, an interventional cardiologist inserts a thin, flexible tube called a catheter into a large blood vessel (usually in your groin, neck, or arm) and threads it through your veins to your heart. 
• Chest X-ray: This shows the shape and size of your lungs and heart.
• Echocardiography: Also called an echo, this specialized ultrasound captures images and videos of the heart as it pumps. 
• Electrocardiography (ECG): This quick, noninvasive test records your heart’s electrical activity.

Other imaging scans, like a head or chest CT, may be ordered if needed.

Personal and Caregiver Preparation
Because getting a VAD is a big life change and requires major surgery, it’s critical that you have caregivers who are committed to helping you recover and adjust. Your primary caregiver will need to come to the hospital to learn how to help you take care of your VAD -- for example, how to change driveline dressings. They will also need to complete a home assessment. This may include checking for tripping and water hazards and identifying a reliable power source. You’ll need to have someone stay with you 24/7 for your first few weeks at home, in case of an emergency.

Depending on your condition, you may need to be admitted to the hospital ahead of surgery to ensure you are as healthy and as strong as possible. This leads to better outcomes after surgery. The procedure takes about four to six hours and requires general anesthesia. It also usually requires a large chest incision, although you may be eligible for a less invasive option.

After Surgery
You’ll need to stay in the hospital for two weeks or longer to recover after surgery. After you go home, you’re encouraged to complete a cardiac rehab program. You will also need to return to the hospital for follow-up visits. These visits will be weekly at first but will gradually decrease to a few times a year.

Life with a VAD takes some getting used to. 

• Together, the controller and battery packs weigh about five pounds, which can be burdensome. Fortunately, there are many options for wearing and storing your controller and batteries. Your VAD coordinator will show you how to wear and use your VAD. 
• You will always need to bring back-up batteries with you when you leave home. Without power, the pump will stop working, which could lead to death.
• You’ll need to clean the driveline regularly and monitor it for infection. 
• Although you can shower with a VAD with special precautions, you won’t be able to swim or take a bath, since a VAD can’t be submerged. 
• You’ll likely need to take blood-thinning medication to avoid blood clots, so you may need to see your doctor often or do at-home finger-prick testing to monitor your medication levels.
• You may need to adjust how you sleep so you aren’t lying on the device. You’ll need to plug in your controller to an electrical outlet during the night rather than use batteries. 

While it can be difficult to adjust to life with a VAD, most people are able to return to many of the activities that they enjoy.

Highly Experienced and Recognized for Excellence
Research shows that hospitals and surgeons who perform more surgeries tend to have better outcomes. On average, our team implants around 150 VADs each year, which makes Duke’s Mechanical Circulatory Support Program one of the busiest in the country. According to internal data, 90 people received "durable" VADs (those meant for long-term use) at Duke in 2022, one of the highest volumes in the world. The Joint Commission has recognized Duke for its high standards and positive outcomes for long-term VAD therapy.

Comprehensive Care
At Duke, an entire team of experts is devoted to caring for people with VADs. Heart failure specialists, heart surgeons, physical therapists, psychiatrists, psychologists, infectious disease experts, pharmacists, social workers, financial coordinators, and more all join together to provide you with the highest-quality care possible. 

A Built-In Network of Support
Our group of VAD coordinators are a built-in network of support for you and your caregivers. VAD coordinators help facilitate your care by setting up appointments and referrals, assisting with paperwork, and being the primary point of contact for your VAD care at Duke. We are committed to ensuring you have the information you need to understand every aspect of treatment and life after VAD implantation. Every step of the way, our team of experts is available 24/7 to answer your questions and offer hands-on support to you and your caregivers.

Pioneers in VAD Technology
Duke was the first center in North Carolina and one of the first in the Southeast to offer VADs as a temporary therapy for people awaiting a transplant and as long-term therapy for people who are not heart transplant candidates. To this day, we work with device companies to make VADs smaller, more effective, and more feasible to implant. We aim to improve the technology as well as best practices.

Partnerships with Other Centers
Through our Shared Care program, we collaborate with hospitals throughout the Southeast to bring joint VAD care closer to your home.

Community Education and Emergency Communication
Before you are discharged from the hospital after VAD surgery, our VAD coordinators will communicate with your local emergency medical services (EMS), fire department, power company, primary care physician, and emergency room to let them know about your VAD and how they can best support you in case of an emergency. In the event of potential severe weather and power outages, we contact all of our VAD patients to let you know about the risk, and we’ll work to make sure you have an emergency backup power source.

Clinical Research
Duke researchers have been involved in nearly all of the clinical trials that have led to FDA approval of modern VADs. Our doctors and scientists are working to learn how best to care for the heart during VAD support, which surgical techniques are best, which drugs can optimize VAD therapy, how to further reduce risk of complications, and more. You may be eligible to participate in clinical trials that could give you access to advanced therapies and techniques before they are widely available.