Ventricular assist device (VAD) is a small mechanical pump that is implanted surgically or percutaneously (through a catheter) to help blood circulate into the body. We can compare it with an artificial heart. It effectively helps the heart to push blood in the body (helps the right heart to push blood toward the lungs and the left heart to push blood to the rest of the organs). Sensors implanted in this device “feel” when it is the propper moment to push blood. This will lead to a better oxygenation and an improvement in symptoms and can even save lives in extreme situations. For informational video click here.
Alexandru Mischie, cardiologist, enumerated the indications for implantation of a ventricular assist device:
- Selected patients with heart failure in the final stage of the disease despite optimal medical treatment and despite treatment with other devices, that are otherwise candidates for transplant.
- Selected patients with end-stage heart failure and optimal medical treatment despite treatment with other devices that are not candidates for transplant but have life expectancy > 1 year.
Eligible patients for ventricular assist device: > 2 months of severe symptoms despite therapy optimal medical treatment and other devices plus
At least one of the following:
- LVEF <25% (and VO2max <12ml / kg / min)
- VD function that deteriorates
- ≥ 3 hospitalizations in the last 12 months for HF without a clear precipitating cause
- Dependence on intravenous inotropics
- Progressive organ dysfunction (kidney, liver) due to reduced perfusion (PCWP-capillary pulmonary venous pressure> 20mmHg and systolic blood pressure <80-90 mmHg or clearance <2l / min / m2) and not due to inadequate ventricular filling.
Typically, patients with terminal heart failure that are considered for ventricular assist device are under continuous IV inotropes.
Indications for implantation of ventricular assist device:
- Bridge to decision (implantation until a decision is taken regarding the optimal treatment)
- Bridge to recovery (if expected recovery)
- Bridge to candidacy (implantation to improve organ parameters in order to turn a patient ineligible for transplant into an eligible one)
- Bridge to transplantation (until finding a donor)
- Destination therapy (palliative treatment)
Method of implantation:
Surgical-for a longer period (months / years). Ventricular assist device consists of a pump (heart inplantata surgical sub) and a small computer with a battery that remains outside the body, connected to the pump by one or more cables.
Percutaneous (by catheter) – for a shorter period (days / weeks) : type Impella or TandemHeart. The heart’s work is relieved through these devices; extremely useful for large infarcts of the heart, myocarditis or severe cardiac valvular disease, refractory to treatment. The procedure takes about 1 hour and complications can occur (bleeding at the injection site infections, hemolysis). The Impella device (quote 8000euro) is a catheter (introduced through the femoral approach by cardiac catheterisation technique) with a thick end in the form of tube. At the head of the catheter there are 2 holes at a distance of about 10 centimeters which are separated by a small motor that propels blood: a hole (the tip of the catheter) will be placed into the left ventricle cavity and will “suction” blood from the heart (to ease the workload of the heart); the hole that stands out is positioned in the aorta, the suctioned blood exits through that oriffice.
All data on this site is purely informational and should not be considered medical advice. If you need a medical oppinion consult a physician.