Cardiac | Ventricular Assist Devices
A ventricular assist device is a mechanical circulatory device that is used to partially or completely replace the function of a failing heart. Some VADs are intended for short term use, typically for patients recovering from heart attacks or heart surgery, while others are intended for long term use (months to years and in some cases for life), typically for patients suffering from congestive heart failure.
In the last few years, VADs have improved significantly in terms of providing survival and quality of life among recipients at St. Vincent’s.
Ventricular Support for Heart Failure Management
At St. Vincent’s one of the most exciting procedures we are able to provide patients is a ventricular support device for heart failure management. An alternative to heart transplantation, this device can allow the most damaged heart to recover and heal.
LVADs are most commonly used, but when pulmonary arterial resistance is high, right ventricular assistance becomes necessary. Long term VADs are normally used to keep patients alive with a good quality of life while they wait for a heart transplantation (known as a "bridge to transplantation"). However, LVADs are sometimes used as destination therapy and sometimes as a bridge to recovery.
VADs need to be clearly distinguished from artificial hearts, which are designed to completely take over cardiac function and generally require the removal of the patient's heart. VADs are designed to assist either the right (RVAD) or left (LVAD) ventricle, or both at once (BiVAD). Which of these types is used depends primarily on the underlying heart disease and the pulmonary arterial resistance that determines the load on the right ventricle.
Circulatory Assist Devices
St. Vincent’s was the first in the region to introduce the Impella 2.5, a non-surgical finely engineered circulatory-assist device used to take over the blood circulating duties of the heart during high risk angioplasty and open heart surgery. We also offer Tandem Heart Circulatory Assist Device, which is being used in the Hybrid-OR for high-risk cardiac procedures.
High Risk Angioplasty
High risk angioplasty involving complex stenting of clogged arteries has traditionally not been an available option for elderly patients with advanced cardiovascular disease, especially those with other serious conditions such as kidney disease. The procedure typically called for a sternotomy, which is opening the chest. The blood loss and invasive nature of the surgery would place an intolerable strain on such a patient’s heart.
As an alternative for certain individuals who are deemed to be candidates, a minimally invasive angioplasty in the Cardiac Cath Lab can now be performed with the guidance of a tiny camera, which is threaded along with the heart-assist device itself up through the femoral artery starting at the groin area.
Relieving the Heart’s Stress
The small motor located at the tip of the device allows it to circulate the blood during the procedure. It takes the blood out of the ventricle pumping it to the rest of the body, therefore protecting the heart. Because of this heart assist, the cardiologist has more time to position the stents, and patients can be stabilized faster. And because the device has allowed the heart to rest, patients recover more quickly and can be discharged sooner.
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