Ventricular assist device (VAD) placement is surgery to treat advanced heart failure. In advanced heart failure, the heart is too weak to pump enough blood to meet your body’s needs. A VAD helps your heart pump. Your surgeon places the pump component inside your chest and connects it to a power source and computer controller that remains outside your body. VAD placement can improve your quality of life and reduce or resolve your symptoms. A VAD has a few basic parts. The size and specific components will vary depending on the specific device. In general, VADs have a pumping unit that is inside the body, and a power source and computer controller outside the body. Tubes carry blood to the pump. The external components typically connect to the pump inside the body through a cable. The cable usually enters the body through a small hole in the abdomen. VAD placement is major surgery that has risks and potential complications. You may have less invasive treatment options. Consider getting a second opinion about all of your treatment choices before having VAD placement. Types of VADs The types of VADs include: Left ventricular assist device (LVAD) helps the left ventricle pump blood to the aorta and out to the body. This is the most common type of VAD. Right ventricular assist device (RVAD) helps the right ventricle pump blood to the lungs. This type of VAD is usually for temporary use. Biventricular assist device (BIVAD) helps both the left and right ventricles pump blood. Your doctor may recommend ventricular assist device (VAD) placement to treat advanced heart failure. Your doctor may only consider a VAD for you if other treatment options that involve less risk of complications have been ineffective. Ask your doctor about all of your treatment options and consider getting a second opinion. Your doctor may recommend VAD placement in the following situations: As a temporary support for your heart following an injury, such as a severe heart attack or heart infection. In this case, it allows your heart time to recover and regain function. This is sometimes called a “bridge to recovery.” As a temporary support for your heart while you await transplantation. This is the most common reason for having VAD placement and is sometimes called a “bridge to transplant.” As a permanent support for your heart if you are not eligible for a transplant. This is sometimes called “destination therapy.” In some cases, VAD placement helps people improve enough to become eligible for a heart transplant. Cardiac surgeons perform ventricular assist device placements. Cardiac surgeons specialize in the surgical treatment of conditions of the heart and its blood vessels. Cardiac surgeons may also be known as cardiothoracic surgeons. Your surgeon will perform your ventricular assist device (VAD) placement in a hospital. Your surgeon will make an incision in your chest and through your breastbone (sternum) to access your heart. A heart-lung machine is usually necessary for VAD placement. Your surgical team will stop your heart with medicine and the heart-lung machine will pump blood to the body. When the surgery is complete, your surgeon will start your heart and take your heart off the machine. Types of anesthesia Your surgeon will perform your VAD placement using general anesthesia. General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the surgery and do not feel any pain. What to expect the day of your VAD placement You may already be in the hospital because of your condition or your surgeon may admit you to the hospital the day before your VAD placement. The day of your surgery, you can expect to: Talk with a preoperative nurse. The nurse will perform an exam and ensure that all needed tests are in order. The nurse can also answer questions and will make sure you understand and sign the surgical consent form. Remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member. The surgical team will give you blankets for modesty and warmth. Talk with the anesthesiologist or nurse anesthetist about your medical history. A surgical team member will start an IV. The anesthesiologist or nurse anesthetist will start your anesthesia. A tube will be placed in your windpipe to protect and control breathing during general anesthesia. You will not feel or remember this or the surgical procedure as they happen. The surgical team will monitor your vital signs and other critical body functions. This occurs throughout the procedure and during your recovery until you are alert, breathing effectively, and your vital signs are stable. As with all surgeries, ventricular assist device (VAD) placement involves risks and complications. Complications may become serious and life threatening in some cases. Complications can develop during surgery or recovery. General risks of surgery The general risks of surgery include: Anesthesia reaction, such as an allergic reaction and problems with breathing Bleeding, which can lead to shock Blood clot, in particular a deep vein thrombosis that develops in the leg or pelvis. A blood clot can travel to your lungs causing a pulmonary embolism. Infection Potential complications of VAD placement Problems with VAD placement are not common, but can be serious and include: Death Device malfunction Heart arrhythmias Heart attack Kidney failure and other organ failure Stroke Reducing your risk of complications You can reduce the risk of certain complications by following your treatment plan including: Following activity, dietary and lifestyle restrictions and recommendations before surgery and during recovery. This may include cardiac rehabilitation. Informing your doctor if you are nursing or there is any possibility of pregnancy Notifying your doctor immediately of any concerns, such as bleeding, fever, increase in pain, or wound redness, swelling or drainage Taking your medications exactly as directed Telling all members of your care team if you have any allergies You are an important member of your own healthcare team. The steps you take before surgery can improve your comfort and outcome. You can prepare for ventricular assist device (VAD) placement by: Answering all questions about your medical history, allergies, and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times. Getting preoperative testing as directed. Testing will vary depending on your age, health, and specific procedure. Preoperative testing may include a chest X-ray, EKG (electrocardiogram), blood tests, and other tests as needed. Following dietary guidelines as directed Losing excess weight before the surgery through a healthy diet and exercise plan Not eating or drinking before surgery as directed. Your surgery may be cancelled if you eat or drink too close to the start of surgery because you can choke on stomach contents during anesthesia. Stopping smoking as soon as possible. Even quitting for just a few days can be beneficial and can help the healing process. Taking or stopping medications exactly as directed. This may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners. Your doctor will give you instructions for taking your specific medications and supplements. Questions to ask your doctor Facing surgery can be stressful. It is common for patients to forget some of their questions during a doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before surgery and between appointments. It is also a good idea to bring a list of questions to your preoperative appointments. Questions can include: Why do I need a VAD? Are there any other options for treating my condition? How long will the surgery take? When can I go home? What restrictions will I have after the surgery? When can I return to work and other activities? When will I start cardiac rehabilitation and where do I go for it? What kind of assistance will I need at home? What medications will I need before and after the surgery? How will you treat my pain? When should I follow up with you? How should I contact you? Ask for numbers to call during and after regular hours. Knowing what to expect can help make your road to recovery after ventricular assist device (VAD) placement as smooth as possible. How long will it take to recover? You will stay in the recovery room after surgery until your vital signs are stable. Your care team will then move you to an intensive care unit (ICU). ICUs provide 24-hour specialized monitoring and care. It may take a few hours until the major effects of anesthesia wear off and you are alert. When you wake up, you may have a breathing tube in your mouth and tubes and wires attached to your body. These allow your team to monitor your vital signs, drain bodily fluids, take blood, and give medications and fluids. You will not be able to talk if you have a breathing tube. However, the care team usually removes it within 24 hours. You may have a sore throat from the tube. This is usually temporary, but tell your care team if you are uncomfortable. As you recover, you may move to a hospital room outside the ICU. This room will have equipment to monitor your heart rhythm and vital signs. Hospital stays after VAD placement typically range from one to two weeks. Recovery after surgery is a gradual process. How long it will take for you to recover and return to normal activities varies depending on your general health, your age, and other factors. Your doctor will likely refer you to a cardiac rehabilitation program to help you recover. Full recovery takes several months. Will I feel pain? Pain control is important for healing and a smooth recovery. There will be discomfort after your surgery. Your doctor will treat your pain so you are comfortable and can get the rest you need. Call your doctor if your pain gets worse or changes because it may be a sign of a complication. When should I call my doctor? It is important to keep your follow-up and cardiac rehabilitation appointments after VAD placement. Contact your doctor for questions and concerns between appointments. Call your doctor right away or seek immediate medical care if you have: Bleeding Breathing problems, such as shortness of breath, difficulty breathing, labored breathing, or wheezing Change in alertness, such as passing out, unresponsiveness, or confusion Chest pain, chest tightness, chest pressure, or palpitations Dizziness Fever. A low-grade fever (lower than 101 degrees Fahrenheit) is common for a couple of days after surgery and not necessarily a sign of a surgical infection. However, you should follow your doctor's specific instructions about when to call for a fever. Inability to urinate or have a bowel movement Leg pain, redness or swelling, especially in the calf, which may indicate a blood clot Leg swelling Pain that is not controlled by your pain medication Unexpected drainage, pus, redness or swelling of your incision How might VAD placement affect my everyday life? VAD placement can save your life if you are in the final stages of heart failure. It can also improve your quality of life, and reduce or resolve your heart failure symptoms. VAD placement can allow you to return to work or school, and resume activities, such as hobbies, exercise, travel, and outdoor activities. VAD placement can give your heart time to recover and get stronger as a bridge to recovery after heart attack or other heart injury. It can also support heart function until a heart transplant can be done. You will need to understand how to trouble-shoot your VAD and handle emergency situations that may arise. Your care team will teach you how to manage your device and give you instructions for caring for your device before you leave the hospital.