Ventricular Assist Device (VAD)
Pre-operative Education Handbook
FHTransplant.com 1
Table of Contents
3 Contact Information
4 Advanced Heart Failure, Cardiac Transplant and Circulatory Assist Device Program
4 Heart Failure
4 End-stage Heart Failure
4 Eligibility
4 Evaluation
5 Meeting the Team
5 Advanced Heart Failure/VAD Team
6 HeartMate II LVAD and HeartWare HVAD
6 A Closer Look at the Components
7 Surgical Procedure
8 VAD Benefits
8 VAD Risks
8 Caring for Your VAD After Surgery
9 Pregnancy
9 Anticoagulants (Blood Thinners)
9 Precautions
9 Trained Caregiver
9 Lifestyle Changes
9 Diet
9 Exercise
9 Smoking
9 Alcohol/Drugs
10 Medication
10 Clinic Appointments
10 Social Support
10 Alternative Treatment Options
10 VAD Data
10 Suggested Internet Resources
11 Notes
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Contact Information
Florida Hospital Orlando
601 East Rollins StreetOrlando, FL 32803
(407) 303-6611
Florida Hospital Transplant Institute
2415 North Orange Avenue, Suite 700
Orlando, FL 32804
(407) 303-2474
(407) 303-0678 FAX
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Advanced Heart Failure, Cardiac Transplant and
Circulatory Assist Device Program
You have been referred to Florida Hospital’s Advanced Heart Failure, Cardiac Transplant and Mechanical
Circulatory Assist Device Program for evaluation and treatment of your advanced heart disease with advanced
therapies that may include a Ventricular Assist Device (VAD). It is important for you to understand these therapies,
the evaluation process, surgical procedure, treatment course and potential risks and benefits of having this type of
device implanted inside your body. If you have any questions, please do not hesitate to ask.
Heart Failure Eligibility
The heart is responsible for pumping blood to To determine whether you are eligible to receive a
all organs in the body. When the heart is unable VAD, several factors must be considered. The first
to pump enough blood throughout your body, step in the process is a thorough medical-records
other vital organs, such as the liver and kidneys, review that we will obtain from your referring
begin to fail. One type of heart disease is known as physician(s). Following this, an insurance verification
cardiomyopathy, which can affect the ventricles of of benefits is completed. If you are accepted into
your heart, weakening its ability to pump blood. This the LVAD Program, an evaluation process begins, to
can cause you to feel tired and short of breath. Some determine if a VAD would be a good option for you.
patients accumulate fluid in their lungs, abdomen
and/or extremities; these symptoms are known Evaluation
as congestive heart failure. When heart failure no The evaluation process begins once you give
longer responds to advanced heart failure treatment consent. Evaluation involves various exams, tests
and medication, this is known as end-stage heart and assessments. Patients who are listed for heart
failure. transplant may become eligible for a VAD device
as a “bridge to transplant”’ — meaning that your
End-stage Heart Failure weakened heart may need temporary support while
There is no cure yet for end-stage heart failure; waiting for a donor heart to become available.
however, there are several therapies available, such Patients who are not candidates for heart transplant
as the insertion of a VAD. A VAD is essentially a may be eligible for a VAD and require a thorough
pump that assists your heart with pumping blood evaluation to determine if this is a viable option.
through your body, allowing your heart’s ventricle
to rest and helping not only to prolong your life but
also improve your quality of life. It does not replace
your own heart. There are several types of VADs that
can be used to support your heart. The two devices
most commonly used at Florida Hospital are the
HeartMate II LVAD and Heartware HVAD.
learn more Call (407) 303-2474
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Meeting the Team
The Advanced Heart Failure/Ventricular Assist Device team is comprised of highly trained and committed
clinicians who are dedicated to providing our patients with the best care available.
Advanced Heart Failure/VAD Team
Heart Transplant/ Performs the heart transplant/VAD surgery and will see you in the hospital and may
VAD Surgeon see you periodically in the clinic for follow up to make sure you are healing properly.
Specializes in advanced heart failure and heart transplantation and manages your
Heart Failure/
medical care, before your implant surgery, while in the hospital and in the clinic
VAD Cardiologist
post-discharge.
Responsible for evaluation and coordinating the implant surgery, providing
VAD Coordinator
VAD education and managing your follow-up care after discharge.
VAD/Heart Failure Works with the transplant physicians in the hospital, coordinating and assisting with
Nurse Practitioner needed medical care.
Transplant Monitors your medications and educates you and your caregiver(s) about your
Pharmacist medication.
Evaluates psychosocial and emotional needs, including financial, housing,
Social Worker
medications and caregiver needs.
Registered Instructs you and your family about healthy nutrition prior to and after
Dietician VAD implantation
Financial Reviews your insurance coverage and all costs associated with your transplant. It is
Coordinator important that you understand the costs that may not be covered by insurance.
The physical therapist meets with you to evaluate your exercise capacity. They will
Physical Therapist recommend and teach you specific exercises to maintain optimal health pre and
post VAD Implant.
Respiratory Teaches deep-breathing exercises and use of incentive spirometer; performs chest
Therapist physiotherapy and pulmonary function tests.
Cardiac Rehab Will help design a cardiac rehab program during the pre-transplant, hospitalization
Specialist and post-transplant phases.
Primary Care Works with the transplant team to continue to care for you after transplant.
Physician
Will help address your spiritual needs and are available 24 hours a day, seven days a
Pastoral Care Staff
week. They will also consult with members of your church, as requested.
Provides consultation services to help you face the complex physical, psychological,
Palliative Care
social and spiritual problems that often accompany advanced illness.
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HeartMate II LVAD and
HeartWare HVAD
HeartWare HVAD A Closer Look at the Components
Implanted heart pump: The pump is designed to support the left
HVAD Pump ventricle of your heart, which is responsible for pumping blood
throughout your body via arteries.
Driveline The pump is surgically implanted inside your chest, below your heart,
and is attached to both the left ventricle and the ascending aorta (the
large blood vessel that carries blood to the rest of your body).
Battery
Blood travels through your left ventricle into the heart pump,
Power cord which then ejects the blood into your aorta, and from there, the rest
Controller of your body.
Cannulas (tubes): The cannulas/ tubes are inserted in your chest,
HeartMate II LVAD connecting your heart to the blood pump. There are different ways to
connect the tubing to your heart, and the surgeon will decide which
way is the best for you.
Driveline
Driveline: The driveline (cable) passes through the skin and connects
LVAD
Pump the pump inside your chest to the system controller, and power source
outside of the body.
Battery
Controller
The driveline exits the skin of your abdomen. The exit site is covered
Power by a sterile dressing. This dressing needs to be changed initially every
cord day, until the skin shows signs of healing, and then may be done less
frequently, as directed by your doctor.
You and your support person will learn how to change the dressing and
will be responsible for dressing changes after discharge.
System controller: The system controller is a small computer that tells
the pump how to run and continually monitors the pump to alert you
if there are any problems.
Power source: The VAD can be powered by portable lithium batteries
or AC electricity by connecting to a power module.
The wall outlet must be grounded and NOT connected to a wall
switch. You connect to the power module at night for sleeping.
Two portable batteries that power the pump can be worn in a holster,
vest, pants pockets or shoulder bag to allow great mobility for
activities.
The batteries are rechargeable and can provide power to the pump for
eight to 10 hours.
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Surgical Procedure
The VAD is implanted during open-heart surgery, is removed, you will not be able to talk but can
which can take up to six hours. An incision is made communicate by writing or other means. You will
through your sternum (breast bone) in the middle of receive medicine for pain while you recover.
your chest that extends down to your abdomen. You
will be placed onto a heart/lung bypass machine that Nitric oxide, a form of inhaled gas, or epoprostenol
will support your circulation so that your heart can (Flolan ®), may be used during surgery, along with
be stopped for a short period of time while the pump oxygen in your breathing tube. They dilate blood
is implanted. vessels in your lungs to allow the right side of your
heart to pump blood to your lungs more efficiently
One part of the mechanical pump will be attached and help prevent right heart failure. They may be
to your left ventricle, and the other end attached to used for about 24 to 48 hours after surgery, until
your aorta. The driveline will be placed through your your vital signs are stable, and then are weaned off
skin on the chosen abdominal site. (similar to the oxygen weaning from your breathing
tube before it is removed).
Once the VAD pump is in place, the heart/lung
machine will be stopped and the pump will assist your Throughout the procedure, surgeons will monitor your
own heart to pump blood throughout your body. heart function using an echocardiogram via a tube
placed down your esophagus. By recording your heart’s
Following surgery, you will be taken to the Intensive pumping action and movement of the heart valves,
Care Unit (ICU) for recovery. You will have a tube this ultrasound test allows the surgical team to monitor
in your throat connected to a ventilator (breathing your heart during surgery and shows the placement of
machine) until you wake up from anesthesia and the ventricular assist device, allowing the physicians
begin breathing on your own. At that time, the to optimize the pump settings after implantation.
breathing tube will be removed. Until the tube The tube is removed at the end of the procedure.
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VAD Benefits • Esophageal (swallowing tube) perforation from
transesophageal echocardiogram
The device can help your heart function and pump
more blood to your body. This increase in blood • Kidney failure
supply or cardiac output can improve other vital organ • Thromboembolic event (blood clot that breaks
function such as kidney and liver, and give you more loose and plugs a blood vessel)
energy which, in turn, may improve your quality of life.
• Myocardial infarction (heart attack)
In some cases, VAD implantation can help • Liver dysfunction and/or failure
candidates become more suitable for heart
• Device malfunction and/or failure
transplantation and prolong life.
• Hemolysis (destruction of red blood cells)
VAD Risks • Increased antibodies that may prolong waiting
The success of the device implantation depends on time for heart transplant
several factors, including your physical condition at the
Caring for Your VAD After Surgery
time of surgery, and other underlying medical conditions.
You and your caregiver will receive detailed
Right heart failure can sometimes occur during or instructions on VAD care and receive training on
after the VAD surgery and may require the use of a the system controller, power module and battery
temporary right-sided ventricular assist device (RVAD). operations in preparation for going home.
There are also potential psychosocial risks that may You will be required to come to the clinic for frequent
include, but are not limited to, depression, post- appointments to assess the VAD function, driveline
traumatic stress disorder (PTSD), generalized anxiety, exit site, tests and/or procedures, and have weekly
anxiety regarding dependence on others and feelings blood draws for laboratory testing. We will explain how
of guilt. to care for the surgical site and review other topics,
such as personal hygiene, activity and hydration.
Other potential complications that may occur during
this surgery include, but are not limited to, the following: Your home environment must be able to support your
VAD equipment with constant and reliable electricity
• Bleeding/hemorrhage
and telephone services. The electric outlets that
• Damage to red blood cells support your power module must be three-pronged,
• Blood clots in veins or lungs grounded and not controlled by a wall switch.
• Blood clotting problems You will be able to return to a fairly normal lifestyle
• Respiratory failure with some limitations.
• Neurological dysfunction • VAD equipment is electrical and cannot be
• Stroke immersed in water.
• Partial or permanent disability • You may resume taking showers once your driveline
has healed and with surgeon’s permission. The
• Need for additional surgery
equipment is placed in a specially designed, water-
• Driveline or pocket infection resistant shower bag, keeping equipment safe and dry.
• Sepsis (severe blood infection) • You must not participate in contact sports or
• Psychiatric episodes engage in activities that can cause impact to the
area where the VAD connects to your heart, this
• Infection
can cause damage to the pump or the driveline or
• Cardiac arrest cause bleeding. Damage to the cannulas, driveline
• Death or pump may require re-operation to replace the
damaged part.
• Pleural effusions (extra fluid in lungs)
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Pregnancy Lifestyle Changes
If you are a woman of childbearing age, you must not Diet
become pregnant. The growing fetus can dislodge
the pump, causing catastrophic bleeding and death. A balanced diet is essential for good health. The
Required medication can cause birth defects. key to a healthful diet is eating sensibly. A well-
balanced diet includes foods that have protein, fats
and carbohydrates. A nutritionist is available to
Anticoagulants make suggestions and teach the patient and family
members how this can be achieved.
(Blood Thinners)
Eating healthy, nutritious meals will help you
To prevent blood clot formation inside the pump maintain a recommended weight and may help you
or other areas of the body, the long-term use of lose extra weight. Drink plenty of fluids. You need
blood thinners, such as warfarin (Coumadin®) will an optimal blood volume for the VAD to adequately
be necessary. Frequent blood tests are required to pump blood to your body.
monitor for potential clot formation.
One of the main risks of blood thinners is
Exercise
bleeding. The other risk is clotting. Even after a Follow the exercise program that was prescribed by
minor accident, you may need to be checked by a your physician.
healthcare provider for signs of bleeding that may
not initially be visible, but could still lead to serious Smoking
complications and even death. Smoking constricts blood vessels and is an
independent risk factor in coronary artery disease.
Precautions All patients must stop smoking prior to VAD surgery
and maintain abstinence afterwards. Cigarette
VAD patients MUST NEVER have magnetic withdrawal at the time of surgery is an undue stress.
resonance imaging (MRI) testing. MRI uses large
Your home must be a smoke-free environment,
magnets that will damage the pump, cause the pump
and family members must support a smoke-free
to stop and could lead to death.
environment around you.
Do not touch tube television or computer screens or
Smoking cessation resources are available for you
engage in activities that may create static electricity,
and your caregiver(s).
such as vacuuming. Strong electrical shocks can
cause the pump to stop and could lead to death.
Alcohol/Drugs
VAD patients must not drink alcohol or take illicit
Trained Caregiver drugs, including marijuana. Alcohol interferes with
the absorption of some medications.
You and your caregiver will receive instructions
and training on the use and care of your VAD Use of prescription medications, including narcotics,
components. It is required that you have a trained must only be taken in the prescribed amounts
caregiver within visual or hearing distance of you for indicated by the physician.
the first few weeks after discharge from the hospital.
Those identified by the team with alcohol or illicit
drug use issues must regularly attend a chemical
dependency group, such as Alcoholics Anonymous
or Narcotics Anonymous, and will be subjected to
random drug screening.
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Medication VAD Data
You must adhere strictly to your medication regimen,
with no alteration in the schedule, unless prescribed Your VAD device may be registered with
by a physician. You must take all medications on INTERMACS, a registry that tracks all
time as directed. If you have side effects from the mechanical assist device implants. The purpose
medication, discuss this with your physician so he/she of the registry is to collect and analyze clinical
can attempt to minimize any negative effects. data from patients who are receiving ventricular
assist devices.
Clinic Appointments
There are many clinic appointments, consults and
testing for evaluation. It is your responsibility to
attend all appointments.
You must also be prepared to attend frequent
follow-up visits, as needed, at the Florida Hospital
Transplant Institute. You may need to come to the
VAD clinic more frequently if there is a change in
your condition.
You are responsible for arranging reliable Suggested
transportation.
Internet Resources
Social Support • Thoratec Device Information:
Family and persons of support can make a big Thoratec.com
difference in the long-term success of VAD therapy.
• American Heart Association:
It is necessary to enlist the assistance of available
Heart.org
family and friends to support you following VAD
surgery. You may need help with: • American Diabetes Association:
Diabetes.org
• Transportation to the clinic
• Nutrition:
• Diet and medications Nutrition.gov
• Encouragement and emotional support • United Network for Organ Sharing (UNOS):
• Chemical dependency and smoking cessation UNOS.org
treatment (if needed) • Organ Procurement and
Transplantation Network (OPTN):
Alternative OPTN.Transplant.HRSA.gov
• Scientific Registry of
Treatment Options Transplant Recipients (SRTR):
SRTR.org
If you decide that a VAD is not the best option for
you or you are not a candidate for VAD therapy, • National Institutes of Health:
you will continue to receive medical care. Medical NIH.gov
treatments are available to reduce symptoms and
For more information,
other complications of heart disease. Heart failure
call (407) 303-2474
therapies, such as cardiac medications, may increase
your quality of life. However, these interventions will
not cure your underlying heart disease.
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Notes
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IDA HOSPI
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F L L
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The Florida Hospital Transplant Institute is a trusted
member of one of America’s largest, not-for-profit
healthcare systems.
Advanced Heart Failure, Cardiac Transplant and Circulatory Assist Device Program
17-TRANSPLA-03137
2415 North Orange Avenue, Suite 700 | Orlando, FL 32804
(407) 303-2474 | (407) 303 0678 FAX | FHTransplant.com
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