Heart failure is a condition that can initially be managed with medications. But
if it progresses to an advanced stage, medications and other treatments may not
be as effective. When your heart reaches this stage, a ventricular assist device,
which we call a VAD, may be the best option to support the pumping function
of your heart. A VAD will not cure heart failure but it can help relieve your
physical symptoms like shortness of breath and fatigue. The decision to get a
VAD is not an easy one. While the VAD may be able to extend your
life it requires a complex open heart surgery, commitment to complex aftercare
and your adjustment to a new normal. Once it is implanted, the bad becomes a part
of you and you will always have it. A VAD is a mechanical pump that is surgically
attached to your heart and helps pump blood throughout your body. The pump is
attached to your heart and connected with a drive line that exits the body at
the abdomen. Outside the body the drive line is connected to a controller and a
power source. A battery pack or a wall outlet the battery pack lasts six to
twelve hours and weighs seven pounds. About the weight of a gallon of milk.
When you're stationary or sleeping, the VAD should be connected to a wall outlet.
The VAD must always be connected to a power source so when you leave your home
you must take your backup controller and batteries. Life with a VAD requires
serious commitment to care from both the patient and their caregiver or
caregiving team. You will require a caregivers care around the clock for the
first three months after hospital discharge. Thereafter, you will rely on
your caregiver to help you with medication, frequent clinic visits and
blood draws, equipment maintenance, responding to equipment alarms and
bandage changing. Driveline site care is exceedingly important to prevent
infections and complications. Your caregiver must clean the site, check for
signs of infection and change bandages at least once a week. We recommend that
you do not shower because we believe it increases your risk of
at the driveline site. We recognize though that many patients with VAD's do
choose to shower. If you make the decision to shower, please let us know
prior. You will need to obtain the manufacturers equipment to reduce the
risk of showering. We can provide you with the equipment and instructions on
how to use the equipment. Being constantly connected to wall power or a
battery pack, is also a huge adjustment for patients. The batteries weigh about
as much as a gallon of milk. A patient can wear them on a belt or in a vest and
must have an additional battery pack on hand at all times. Before the VAD, back in
the Fall, my health was going down hill rapidly and I couldn't walk up steps, I
couldn't sleep. I go three days straight and not be able to sleep a wink.
I really couldn't do everyday chores, I basically laid on the couch and was
unable to do really any functions whatsoever. Now, I can do anything that I
used to do, you know, a year ago. Now that I had the VAD installed, it just totally
brought my life back to me. So it really have a staging area in our bedroom for
getting up in the morning. I mean, we have the battery charger and then there's a
tablet that I report every morning to, Hershey Medical Center, all my stats from
my control. Batteries give me a lot of flexibility. I
can do whatever I want. I use the AC or a plug-in at night when I sleep. The
wire on it gives you 20 feet or whatever walking space. So, batteries really
give you a lot of flexibility to do what you need to do. For me, the vest
gives me flexibility because I can free up both my arms. When I do go to the
grocery store or whatever I'm going to do, I already have the bag with
my backup supplies in it and I didn't want to have two bags to carry so I you
know, I opted for the vest. You adjust to a new normal it took me several months.
But now, it's second nature to me. After you get dressed, you know, you
buckle your belt and then you put your vest on and you put your equipment on and
off you go for the rest of the day. No two VAD patients are the same but the
most successful patients are those who engage in planning for their recovery
with the VAD team, their caregivers and their families. The Heart and Vascular
Institute will help you to develop a comprehensive plan for recovery and
aftercare. You and your family should consult the decision tool booklet that
includes questions you'll want to consider. We encourage you to write down
your questions and concerns and discuss them with members of the care team while
you're in the hospital, at appointments or via phone call. We're here to assist
you as you make this decision. If you make the decision to move forward with
VAD implementation, you will undergo a series of tests to ensure that a VAD is
the right treatment choice for you. Once approved, you and your family will meet
with many members of the Penn State support network to plan for your VAD
surgery. You'll meet with a cardiothoracic surgeon to discuss which
VAD pump is right for you. The surgery and post-operative care.
Under the direction of a surgeon are VAD coordinators, registered nurses who will
teach you and your caregiver about your VAD before and after surgery. They'll
also assist with post surgical care and clinical visits. VAD coordinators will
evaluate your support system and your ability to cope with the treatment plan.
They will collaborate with a VAD nurse practitioner to oversee other aspects of
your care including, follow-up with you and your family with results of tests
and procedures. A social worker will support you and your caregiver with
resources, counseling and assistance with insurance. They will evaluate your
support system and your ability to cope with the treatment plan. A financial
counselor will help you plan for the financial aspects of your treatment plan.
From evaluation through post-operative care. They'll work with your insurance
company and identify out-of-pocket expenses. Chaplains offer you and your
family spiritual care, emotional support and coping and healing resources. You'll
meet with the palliative care team to discuss your care goals before you're
approved for a VAD. The team is also available after the VAD has been
implanted. The VAD team is here to support you from this moment forward. You
can contact us anytime you have questions or need support.
Depending on the complexity of the operation it can take anything
between four and six hours and that includes the time before starting with
the surgery with the anesthesiologists. The operation is done under general
anaesthesia and typically it involves a midline incision in the chest and
dividing the breastbone, the sternum. So we have access to the heart and
are able to place the pump in the appropriate position, we connect the
patient to a device called the heart-lung machine which essentially
does the work of the heart and the lungs and allows us to open the heart and
implant the pump into the heart. And once the pump is implanted and assembled the
cable that delivers electricity to the pump, called the drive line, is tunneled
and passed through the side of the abdominal wall and connected to the
power supply. So once the pump is connected and powered up, we gradually
wean the patient from the heart-lung machine as the pump takes over the
function of the heart. Anesthesia isn't reversed at the end of these operations
because the first few hours after surgery, patients are in critical
condition and we have to keep a close eye on them and we will not wake
patients up until we're satisfied that everything is functioning well and there
is no bleeding or any other reason to concern us. I would like to explain to
you what you can expect postoperatively, after you have your left ventricular
assist device implanted. You will come into the ICU directly from the
operating room. Besides having the new controller for your VAD at your bedside,
you will have a breathing tube down your throat until you're awake and alert
enough to have it removed. You will also have an IV
in your neck as well as IV's in your arms. You will have drains in your chest, known as
chest tubes. We will try to minimize your pain as much as possible. And within the
next couple days, we will be getting you out of bed with the assistance of
physical therapy as well as occupational therapy. The care team at your bedside
will be going over all of the new medications that you will be on
postoperatively and the MCS team will be spending several hours with you,
educating you on the new LVAD and what you can expect when you go home. If you are
considering this therapy as an option, please know that myself and the VAD team
are here to ensure the smoothest transition to a new normal. Oftentimes
this is a bumpy road and isn't easy for everyone but we are here to help you
through that. The complications after an LVAD surgery can be divided into two
phases. There are immediate complications which are related to the operation
itself and then there are long-term complications which are related to
living with a left ventricular assist device. The immediate complications are
things like bleeding and sometimes the bleeding requires a return visit to the
operating room to deal with the potential causes of that. Infection which
can occur early post-operative period as well as as a late complication and this
can occur in the any of the surgical incisions or at the sides of the
driveline exiting the body. Failure of the right ventricle is sometimes seen
after an LVAD operation. Long-term, when patients have recovered from the
operation, infection is a risk. Again, long-term, there is a balance between the
blood being too thin, causing bleeding and that can occur within the
gastrointestinal tract. Or, the blood being too thick
and forming clots within the pump or within the heart which again can cause
complications such as stroke. With the aid of a stethoscope, you can hear a
hum generated by these pumps. They are very quiet. Depending on the design of
the pump and where it's located, some of them are within the chest cavity and
some of them are actually in the abdominal wall. They can be aware of
fullness in their abdominal wall, abdominal cavity. The pumps that are
within the chest typically, individuals are not conscious of them. The drive line
clearly is a part of life. I have not come across many patients who are
uncomfortable necessarily by the pump itself and I think if it weren't for the
driveline, most patients would probably not be aware of what's
on the inside. As imperfect as this treatment, this therapy may be, it
has been a life-changing and life-saving experience for thousands of patients
that would not be alive today if it wasn't for these devices. No two patients
recover the same way. You may be discharged into the care of your
personal in-home caregiver, into the care of visiting nurses or into a
rehabilitation facility. Regardless of your discharge details, you will require
round-the-clock care for at least the first three months after hospital
discharge. You'll be prescribed blood thinner medications known as
anticoagulants that prevent clots from forming in the VAD pump. These
anticoagulants will require twice weekly blood draws to monitor your level of
anticoagulation.
You and your caregiver will also attend a series of follow-up appointments.
Including a seven-day post-operative visit and monthly clinic appointments
with a VAD nurse and cardiologist. On an ongoing daily basis, you must record the
numbers from your pump, your blood pressure, weight and temperature. You will
rely on your caregiver to help you with medication, equipment maintenance,
responding to equipment alarms, driveline sight cleaning and bandaging and some
personal care. You may also experience complications with the VAD that may
require rehospitalization or repeat surgeries. Complications may include
device malfunction, driveline site infection, gastrointestinal bleeding,
renal failure and stroke. When I first got out of the hospital, I thought, oh man,
I hope this isn't the rest of my life because I didn't have energy, I didn't
feel that well and everything else but I don't know, after what, four or five weeks, About a month
and a half. I'm kicking in and I'm back to doing my flea markets and cutting
firewood and all that good stuff. So you know it didn't take that long really. The
whole scope of things, to get back to somewhat of a normal. You know, the
LVAD, it did change me but not drastically. I can still do a lot of the
stuff that I used to do but maybe not as fast. You know, I've got to take my time
and also you're going to think things out a little bit because you do have
batteries and you do have a controller so you guys be careful the cables and
so sometimes, you just got to stop and think a minute, well you know, what
could happen if I do this? You know, first they give you these things you
wear on your sides and they didn't work. So I ended up buying pants with deep pockets and I
set by batteries in my pockets and I have a little belt pouch for my other things.
So, you know, it took a couple weeks to figure out how I wanted to wear them.
Caregivers are just, for me, they were so important and I probably
have to two of the best. It was hard going through it before but
once he had it, the transition was easier than I
thought just to get back to everything and now, I don't even think about it much.
It didn't take long for everything to become normal again. Minus, going to the beach
which, he really didn't like the hot sand any way. It was hard because it was a
time when I was going to school and kind of moving out and actually on my own. So
before I wasn't spending as much time but now I spend the nights a lot
more, come and cook dinner and spend a lot more quality time I guess. I kind of
realized you need that quality time after something like that to. [Giggle]
It was just going through motions I feel, when I look back.
I felt like I just knew I had to do. The one thing that I learned
towards, well shortly before he was discharged, one of the nurses said, he's
actually doing very well. Well that part really startled me because he looked so
awful. Accept offers of help, ask for help, don't be afraid because it takes a lot.
It takes a lot to really get your strength. For me to reach
my new normal, it took several weeks. For me, being his daughter it was a little
different transitioning into a caregiver because I always relied on him for
everything. Support that I needed was always coming from him. So it was a
little different to transition into me giving the support to him and him
relying on me. So with that being said, I think our relationship has actually
gotten closer and better because we have a whole new dynamic to it and a whole
new appreciation for each other to. So we have appreciation for life,
appreciation for each other and things are going great with it.
I don't know, I wasn't really in a frame of mind to think about what you're going to
do to me. All I cared about is if you could do
something to keep me alive, you just go ahead and do it and I don't want to know
what you're going to do but if something is going to keep me alive for another
week, another year, just go ahead and do it. And what else could I say?
You know, if you give me a choice of maybe not making it or getting an
LVAD. You take it! Every day that I've lived after that has been a gift. So you
know, I don;t know what else to say. His girlfriend and I basically just talked
about how we wanted him in our life in any way possible
that could happen. If that's what has to happen, so with the LVAD, I don't know
if there's ever a chance when you really fully get to decide because it's not
like you get to decide to have heart issues or anything like that it's
just, decide to live and that's what we all decided.
The VAD team here at the Hershey Medical Center are here to support you while you
make a consideration for a ventricular assist device. We know that it requires a
lot of commitment from you, your family and your caregivers. We encourage you to
take time and reflect, speak with your VAD coordinators and your family. If you
decide that a VAD is a right decision for you and your family, we'll move
forward with a VAD evaluation; a series of tests and visits from the VAD
multidisciplinary team, Whatever decision you and your family make, understand that
myself and the rest of the team are here to help you along the way.
you