Ventricular assist devices (VADs) are pumps that are designed to help support a failing heart. They are implanted by a surgeon and either used to provide support while awaiting a heart transplant, or as a permanent support for patients who are not transplant candidates. You may need a VAD if you have severe heart failure that is characterized by:

• Progressive increase in the amount of diuretics (water pills) needed to prevent fluid build-up
• Inability to take heart failure medications due to side effects such as low blood pressure
• Lack of response to medications or devices such as a biventricular pacemaker (also known as cardiac resynchronization therapy, or CRT)
• Multiple hospitalizations for heart failure
• Dissatisfaction with your quality of life due to heart failure

Although VADs have been studied for decades, their use increased substantially in the 1990s and the University of Minnesota Medical Center, Fairview was among the first medical centers to offer this option to patients. The Advanced Heart Failure team at University of Minnesota Physicians has one of the busiest and most successful mechanical circulatory support programs in the world, implanting over 50 devices per year. Following this type of procedure, the average hospital stay is approximately 2 weeks.

Since 1995, the Advanced Heart Failure team has implanted nearly 500 ventricular assist devices; our substantial experience has impacted the lives of many patients and helped train many leaders in the field. We also provide training for hospitals and programs that are developing VAD implant programs, including both temporary and permanent devices. Furthermore, the University of Minnesota has been a leader in studying factors that predict outcome following implant and optimizing timing of implant prior to the development of severe cardiogenic shock. We have played a major role in several landmark trials demonstrating the benefits of VAD therapy, including REMATCH (2001), the HeartMate II bridge to transplant trial (2007), and the recently published HeartMate II destination therapy trial (2009).

Originally used exclusively as a “bridge to transplantation” in patients not expected to survive the wait for a suitable donor organ to become available, VADs are now also used in patients for whom heart transplantation is not an option due to advanced age, medical contraindications, or patient wishes. In these patients, VADs are considered “destination therapy,” and are used to improve heart-failure symptoms and survival. Medical therapy with inotropes for advanced heart failure has been consistently shown to have a
50% mortality rate at 6 months. In contrast, contemporary LVADs have dramatically extended this 50% mortality rate to over 2 years. There is no absolute age cutoff for LVAD as destination therapy, but it is less common in patients over the age of 80.

Compared to first- and second-generation VADs, currently available devices are smaller, quieter, more durable, and result in significantly lower rates of complications and improved survival. They can also be implanted in patients who have left-sided heart failure and pulmonary hypertension, and have been demonstrated to reverse severe pulmonary hypertension in many cases. Patients with kidney or liver dysfunction as a consequence of their heart failure may also experience improvement in function of these organs following VAD implant. As VAD pumps become smaller, more durable, and safer, their use in patients with severe heart failure is likely to increase, particularly as availability of organs for transplant is unlikely to increase.

Powered by small battery packs worn outside the body, all VADs have power “drivelines” that exit through an opening in the skin, and are therefore subject to risk of infection.  Anticoagulation therapy with warfarin is recommended to reduce the risk of developing a blood clot in the pump.  Due to multiple factors, excessive bleeding can also occur.  Overall, however, patients with VADs feel much better with the devices and in most circumstances, return home within a few weeks of implant and engage in almost any activities, the one major exception being swimming.

To learn more about VAD therapy, and determine if this might be an option for you or someone you love, contact us at LVAD@umn.edu for more information or to schedule an appointment with a member of our Advanced Heart Failure team.

External sites:

• Heart Hope
• Thoratec Corporation
• Heartware, Inc.
• Video overview and cartoon closeup of the Heartmate II (over 135 implanted at the
  University of Minnesota Medical Center, Fairview).
• LVAD Patient Stories: (Features 3 patients from the University of Minnesota Medical Center, Fairview)
• Advanced Heart Failure Support