When is a VAD needed?
Ventricular assist devices are considered when the heart can no longer work well and you’re at risk of dying. Reasons that a person may need to be considered for VAD include:
- Inoperable coronary artery disease
- Dilated cardiomyopathy (enlarged heart)
- Congestive heart failure with recurrent hospital admissions
- Unstable angina
- Ventricular arrhythmias that medication or a defibrillator cannot control
- Adult congenital heart disease
- Hypertropic or restrictive cardiomyopathy
- Inoperable valvular heart disease
The heart may be irreversibly damaged by multiple heart attacks or a viral illness that affects the heart muscle. Regardless of the reason, implantation of mechanical circulatory support can dramatically improve a person’s life expectancy and quality of life.
What tests are part of the VAD evaluation?
The VAD team will review all of your previous medical records, as well as cardiac catheterization films and operative reports. They may request:
- Echocardiogram
- Catheterization of the right heart
- Cardiopulmonary stress test
- Pulmonary function tests
- Blood tests
- Carotid and peripheral vascular testing
- CT scan of chest
Once all tests are completed and you’ve met with all team members, the team will review your results and decide whether you’re a candidate. You will be notified that you’ve been accepted, denied, or deferred. If you’re accepted for VAD, the coordinator will work with you for an implant date.
How are candidates for VAD determined?
For a destination therapy VAD, heart transplantation has been ruled out as an option. Through the evaluation process, patients who have the best chance at long-term survival and doing well are selected. The evaluation is performed by a variety of specialists to determine whether VAD is the best treatment. Following the implant and your discharge, you must have an identified caregiver who can be with you until it is safe for you to manage on your own.
What happens during the operation?
The surgical procedure to implant the VAD will be done using standard surgical procedures and care. The procedure will take on average between four and six hours to perform. The anesthesiologist will see you before your surgery to talk about risks, possible complications, and benefits of anesthesia.
After you are taken to the operating room, it will take about half an hour until you are given general anesthesia. This half hour will be spent getting you ready to receive your VAD. You will have a breathing tube (endotracheal tube) and be under general anesthesia for the duration of the operation. After you are asleep, the VAD team starts your surgery.
- An incision is made down the center of your chest and abdomen and the breastbone is opened.
- You will be placed on the heart-lung machine.
- Connections for an LVAD will be sewn onto your aorta.
- They will then be attached to the VAD or brought out through your skin to be attached to the VAD.
- If you require a right ventricular assist device (RVAD), the device will be attached to your pulmonary artery.
- During your surgery, your family will be updated about your progress. It will be about an hour before the nurse will call your family to come see you.
What happens after the operation?
Once the surgery is complete, you will recover in the Cardiovascular ICU for two to three days. When you’re ready, you’ll be transferred to another unit called a step-down unit. The usual length of stay is 14 to 18 days. If you experience complications, you may be there longer.
Learning how to care for your VAD begins as soon as you have recovered from the anesthesia. You will learn how to monitor your blood pressure, pulse, and weight. You will also learn the signs and symptoms of infection, and when to call your transplant team.
It is important that your family participate with you in learning about your VAD.
What complications could happen after receiving a VAD?
The two most common complications are infection and bleeding.
What happens when I go home?
VAD patients need follow-up medical care for the rest of their lives. Stay in touch with your Saint Luke’s VAD team; it’s critical to your long-term success. Before you leave the hospital, you’ll be scheduled for an appointment with our clinic.
Why do I need a caregiver?
You will need a 24-hour caregiver following discharge from the hospital. You may not stay alone after you have received a VAD until you are deemed independent by the Saint Luke’s Hospital VAD team. You may need indefinite, ongoing support from your caregiver, including dressing changes and care for you and your device.
Your caregiver(s) will be required to attend training sessions at Saint Luke’s Hospital of Kansas City, which will occur during—and possibly prior to—your hospitalization. These sessions occur on weekdays.
You will not be allowed to drive until you are deemed safe to do so by the Saint Luke’s Hospital VAD team.
Does Saint Luke’s offer support services?
Saint Luke's provides various support group meetings throughout the year for our VAD patients waiting for transplant, as well as those who’ve already undergone the procedure.
Educational opportunities and support gatherings are scheduled periodically throughout the year.
Financial Questions
What should I do if my insurance changes?
Call us before the changes happen. We can help you make decisions that may affect your coverage. And call us any time you have questions or concerns regarding disability or overall financial coverage.
What do I do if I don’t have medical coverage?
It’s critical that you never lose your medical and prescription coverage.
When should I apply for Social Security?
In most cases, you’ll want to apply for Social Security when you become disabled. However, contact your financial specialist before applying. For those receiving Social Security for disability, Medicare will not begin for two years after the qualifying date of coverage.
When is Medicare my primary insurance coverage?
For those patients who are covered for disability, Medicare will remain secondary if you’re enrolled in a large, active group employer plan through yourself, a spouse, or a parent. Medicare will be your primary coverage if you’re covered by an individual, small group, retired, or COBRA plan.
How much does a VAD cost?
We’ll help you determine how much is covered by insurance and how much is your responsibility. We’ll work closely with your insurance case manager to coordinate your benefits.