Accessible Search Form           Advanced Search


National Heart Lung and Blood Institute Logo

For more information, visit http://www.nhlbi.nih.gov/health/health-topics/topics/vad/


What Is a Ventricular Assist Device?

A ventricular assist device (VAD) is a mechanical pump that's used to support heart function and blood flow in people who have weakened hearts.

The device takes blood from a lower chamber of the heart and helps pump it to the body and vital organs, just as a healthy heart would. (For more information about how the heart pumps blood, go to the Health Topics How the Heart Works article.)

Overview

You may benefit from a VAD if one or both of your ventricles (VEN-trih-kuls) don't work well because of heart disease. Ventricles are the lower chambers of your heart.

A VAD can help support your heart:

  • During or after surgery, until your heart recovers.
  • While you're waiting for a heart transplant.
  • If you're not eligible for a heart transplant. (A VAD can be a long-term solution to help your heart work better.)

A VAD has several basic parts. A small tube carries blood out of your heart into a pump. Another tube carries blood from the pump to your blood vessels, which deliver the blood to your body.

A VAD also has a power source that connects to a control unit. This unit monitors the VAD's functions. It gives warnings, or alarms, if the power is low or the device isn't working well.

Some VADs pump blood like the heart does, with a pumping action. Other VADs keep up a continuous flow of blood. With a continuous flow VAD, you might not have a normal pulse, but your body is getting the blood it needs.

Research has shown that, compared with other VADs, continuous flow VADs may decrease hospital stays and complications and improve survival. However, more research is needed.

Types of Ventricular Assist Devices

The two basic types of VADs are a left ventricular assist device (LVAD) and a right ventricular assist device (RVAD). If both types are used at the same time, they're called a biventricular assist device (BIVAD).

The LVAD is the most common type of VAD. It helps the left ventricle pump blood to the aorta. The aorta is the main artery that carries oxygen-rich blood from your heart to your body.

RVADs usually are used only for short-term support of the right ventricle after LVAD surgery or other heart surgery. An RVAD helps the right ventricle pump blood to the pulmonary (PULL-mun-ary) artery. This is the artery that carries blood from the heart to the lungs to pick up oxygen.

A BIVAD might be used if both ventricles don't work well enough to meet the body's needs. Another treatment option for this condition is a total artificial heart (TAH). A TAH is a device that replaces the ventricles.

VADs have two basic designs. A transcutaneous (tranz-ku-TA-ne-us) VAD has its pump and power source located outside of the body. Tubes connect the pump to the heart through small holes in the abdomen. This type of VAD might be used for short-term support during or after surgery.

Transcutaneous Ventricular Assist Device

The image shows a transcutaneous BIVAD and how it's connected to the heart. 

The image shows a transcutaneous BIVAD and how it's connected to the heart.

An implantable VAD has its pump located inside of the body and its power source located outside of the body. A cable connects the pump to the power source through a small hole in the abdomen.

Implantable VADs are used mainly for people who are waiting for heart transplants or as a long-term solution for people who can't have heart transplants.

Implantable Ventricular Assist Device

 Figure A shows the location of the heart and the typical equipment needed for an implantable LVAD. Figure B shows how the LVAD is connected to the heart.

Figure A shows the location of the heart and the typical equipment needed for an implantable LVAD. Figure B shows how the LVAD is connected to the heart.

The design and type of VAD your doctor recommends will depend on your overall health, how long you'll likely need the device, and other factors.

Outlook

Until recently, VADs were too big to fit in many people's chests, especially women and children. Only people who had large chests could get them.

However, recent advances have resulted in smaller, more reliable devices. This now makes treatment with VADs an option for more people.

Researchers also have made advances in how well VADs work and how much they improve people's quality of life. In the past, VADs mostly were used for people who had end-stage heart failure. Now VADs also can help people who have earlier stages of heart failure.

Children who have heart failure also can be treated with VADs. VADs approved for use in adults sometimes are used in children if the children are large enough for the device. Also, the Food and Drug Administration recently approved a VAD designed for smaller children.




Other Names for a Ventricular Assist Device

  • Heart pump
  • Left ventricular assist device, or LVAD
  • Right ventricular assist device, or RVAD
  • Biventricular assist device, or BIVAD (the term for both an LVAD and RVAD used together)



Who Needs a Ventricular Assist Device?

You may benefit from a ventricular assist device (VAD) if your heart doesn't work well because of heart disease. Heart disease can prevent your heart from pumping enough blood to your body.

A VAD can help support your heart:

  • During or after surgery, until your heart recovers.
  • While you're waiting for a heart transplant.
  • If you're not eligible for a heart transplant. (A VAD can be a long-term solution to help your heart work better.)

Short-Term Ventricular Assist Devices

A VAD can support heart function and blood flow for a short time before, during, and/or after heart surgery until your heart recovers. Your doctor may recommend a short-term VAD if you have a severe heart condition, such as heart failure, a ventricular arrhythmia, or cardiogenic shock.

You also might use a VAD if you have heart failure and your doctors need more time to plan your treatment.

Long-Term Ventricular Assist Devices

If you have heart failure and are waiting for a heart transplant, your doctor may recommend a VAD. If heart failure medicines aren't working well, a VAD can keep you alive and improve your quality of life while you wait for a donor heart.

If you're not eligible for a heart transplant, a VAD might be a long-term treatment option. It can improve your quality of life and allow you to do many daily activities.

When Are Ventricular Assist Devices Not Recommended?

VADs might not be a treatment option for people who have certain serious health conditions. Examples of these conditions include severe kidney failure, serious brain injuries, severe infections, and other life-threatening conditions.




What To Expect Before Ventricular Assist Device Surgery

Before you get a ventricular assist device (VAD), you'll spend some time in the hospital to prepare for the surgery. You might already be in the hospital getting treatment for heart failure.

During this time, you'll learn about the VAD and how to live with it. You and your caregivers will spend time with your surgeon, cardiologist (heart specialist), and nurses to make sure you have all the information you need about the VAD.

Before and after the surgery, you and your caregivers will learn:

  • How the VAD works.
  • How to safely handle the VAD.
  • How to interpret and respond to alarms. (The device gives warnings, or alarms, if the power is low or if it isn't working right.)
  • How to provide care in case of emergency, such as the loss of electrical power.
  • How you should wash and shower.
  • How the VAD may affect travel.

You can ask to see what the device looks like and how it will be attached inside your body. You also may meet with someone who already has a VAD. This person can answer questions about what it feels like to have a VAD and how to live with the device.

Your doctors will make sure that your body is strong enough for the surgery. If your doctors think your body is too weak, you may need to get extra nutrition through a feeding tube before surgery.

You also may have tests to make sure you're ready for surgery. These tests include:

  • Blood tests. Blood tests can check how well your liver and kidneys are working. Blood tests also can check the levels of blood cells and important chemicals in your blood.
  • Chest x ray. This test creates a picture of the structures inside your chest, such as your heart and lungs. A chest x ray can help your doctor prepare for surgery.
  • EKG (electrocardiogram). This test can check how well your heart is working before the VAD surgery. An EKG records the heart's electrical activity.
  • Echocardiography (echo). This test uses sound waves to create a detailed picture of your heart. Echo shows the size and shape of your heart and how well your heart's chambers and valves are working.



What To Expect During Ventricular Assist Device Surgery

Ventricular assist device (VAD) surgery usually takes between 4 and 6 hours. The process is similar to that of other types of open-heart surgery.

The team for VAD surgery includes:

  • Surgeons who do the operation.
  • Surgical nurses who assist the surgeons.
  • Anesthesiologists who are in charge of the medicine that makes you sleep during surgery.
  • Perfusionists who are in charge of the heart-lung bypass machine. This machine keeps blood flowing through your body while the VAD is put in your chest.

Before the surgery, you'll be given medicine to make you sleep so you won't feel any pain. Your vital signs—such as your heartbeat, blood pressure, oxygen level, and breathing—will be checked throughout the surgery.

A breathing tube will be guided down your throat into your lungs. This tube will connect to a ventilator (a machine that supports breathing).

The surgeon will make a cut down the center of your chest. Then, he or she will cut your breastbone and open your rib cage to reach your heart.

You may be given medicine to stop your heart during the surgery. The medicine will allow your surgeon to operate on a still heart.  A heart-lung bypass machine will keep oxygen-rich blood moving through your body during the surgery. (Some LVAD surgeries have been done without stopping the heart and using a heart-lung bypass machine.)

For more information about heart-lung bypass machines, including an illustration, go to "What To Expect During Heart Surgery."

Once the surgeon has properly attached the VAD, the heart-lung machine is switched off and the VAD starts working. The device supports blood flow and takes over the heart's pumping function.




What To Expect After Ventricular Assist Device Surgery

Recovery in the Hospital

Recovery time after ventricular assist device (VAD) surgery depends a lot on your condition before the surgery.

If you had severe heart disease for a while before getting the VAD, your body might be weak and your lungs may not work very well. Thus, you may still need a ventilator (a machine that supports breathing) for several days after surgery. You also may need to continue getting nutrition through a feeding tube.

When you first wake up from VAD surgery, you'll be in the hospital's intensive care unit (ICU). An intravenous (IV) tube will provide you with fluid and nutrition. You'll have a tube in your bladder to drain urine and tubes to drain blood and fluid from your chest and heart.

After a few days or more, depending on how quickly your body recovers, you'll move to a regular hospital room. Nurses who have experience with VADs will take care of you.

The nurses will help you get out of bed, sit, and walk around. As you get stronger, you'll be able to go to the bathroom on your own and have a regular diet. The feeding and urine tubes will be removed. You'll also be able to take a shower. You'll learn how to care for your VAD while bathing.

In the hospital, nurses and physical therapists will help you gain your strength through a gradual increase in activity. You'll also learn how to care for your VAD at home.

Having family or friends visit you at the hospital can be very helpful. They can assist you with many activities. They also can learn about caring for the VAD so they can help you at home.

Medicines

After VAD surgery, you'll need to watch for signs of infection. These signs might include soreness over the VAD site, fluid draining from the site where the tubes or cable exit the skin, or fever. If you have these signs, tell your doctor right away.

You may take antibiotics before the surgery and for a few days after the surgery. Antibiotics can lower your risk for infection.

With most VADs, doctors also prescribe anticlotting medicines, such as warfarin (Coumadin®) and aspirin. These medicines help prevent blood clots from forming in your heart or the VAD.

When you have a device implanted in your body, the risk of blood clots increases. You'll likely need to take anticlotting medicines for as long as you have the VAD. You'll also have periodic blood tests to make sure the medicines are working well.

Take all of your medicines as your doctor prescribes. Let your doctor know whether you have any side effects.

Going Home

After the initial recovery from VAD surgery, you'll begin to get ready to go home. Your health care team will help prepare you for the transition.

The team may include a heart surgeon, cardiologist (heart specialist), critical care nurse, physical therapist, dietitian, and social worker.

The team will help you gradually adjust to living at home with the VAD. You'll leave the hospital and go home for a few hours and then come back. Next, you may go home for a whole day and come back to the hospital to sleep.

If these trips go well, your doctor might discharge you from the hospital. If you haven't recovered your strength enough, you might go to a special care facility for up to 2 weeks. This allows your medical team to make sure you're ready to go home.

Your medical team also will teach you how to live with a VAD. You may get some of this information before your surgery. You'll learn how to care for the VAD, what to do in case the device gives a warning that it's not working well, and how to do normal daily activities like bathing.

For more information, go to "What To Expect Before Ventricular Assist Device Surgery."

Activity Level

When you go home after VAD surgery, you'll likely be able to return to most of your normal daily activities. You might be able to return to work, engage in hobbies and sexual activity, and drive. Your medical team will advise you on the level of activity that's safe for you.

Travel

If you're waiting for a heart transplant, you'll need to stay within 2 hours of the hospital in case a donor heart becomes available.

If you're not waiting for a transplant and want to travel, your medical team can advise you about any special steps you need to take. People who have VADs can fly in airplanes and use all other forms of transportation.

Nutrition and Exercise

While you recover from VAD surgery, getting good nutrition is important. Talk to your medical team about following a proper eating plan for recovery.

Supervised exercise also is important to give your body the strength it needs to recover. During the time when your heart wasn't working well (before surgery), the muscles in your body weakened. Building up the muscles again will allow you to do more activities and feel less tired.

Cardiac Rehab

Your health care team may recommend cardiac rehabilitation (rehab). Cardiac rehab is a medically supervised program that helps improve the health and well-being of people who have heart problems.

Rehab programs include exercise training, education on heart healthy living, and counseling to reduce stress and help you return to a more active life.

Ongoing Care

You and your doctor will schedule followup medical visits. This will help your doctor track how you're doing.

After you leave the hospital, your doctor may advise you to visit an outpatient clinic weekly for the first month. After that, you may go every other week and then every other month for a certain amount of time.

If you're on the waiting list for a heart transplant, you'll stay in close contact with the transplant center. Most donor hearts must be transplanted within 4 hours after removal from the donor.

Some heart transplant centers give you a pager so the center can contact you at any time. You need to be prepared to arrive at the hospital within 2 hours of being notified about a donor heart.

Emotional Issues and Support

Getting a VAD may cause fear, anxiety, and stress. If you're waiting for a heart transplant, you may worry that the VAD won't keep you alive long enough to get a new heart. You may feel overwhelmed or depressed.

All of these feelings are normal for someone going through major heart surgery. Talk about how you feel with your health care team. Talking to a professional counselor also might help.

If you're very depressed, your doctor may recommend medicines or other treatments that can improve your quality of life.

Having family and friends around for support also can help relieve stress and anxiety. Let your loved ones know how you feel and what they can do to help you. They can play an important role in caring for you after you go home.




What Are the Risks of a Ventricular Assist Device?

Getting a ventricular assist device (VAD) involves some serious risks. These risks include:

  • Blood clots
  • Bleeding
  • Infection
  • Device malfunctions
  • Right heart failure (a possible risk of LVADs)

Thanks to newer VAD models, some of the most serious risks have decreased.

As with any surgery involving the heart, complications can sometimes be fatal. However, survival rates for VAD surgery have improved over the years.

Blood Clots

When your blood comes in contact with something that isn't a natural part of your body, such as a VAD, it tends to clot more than normal. Blood clots can disrupt blood flow and block blood vessels leading to important organs in the body, such as the brain.

Blood clots can lead to serious complications (such as stroke) or even death. Thus, you'll likely need to take anticlotting medicines for as long as you have a VAD.

Bleeding

The surgery to implant a VAD is complex, and bleeding may occur during and after surgery. Anticlotting medicines also raise the risk of bleeding.

Balancing the anticlotting medicines with the risk of bleeding can be hard. Make sure to take your medicines exactly as your doctor prescribes.

Infection

With implantable VADs, a pump inside your body is attached to a power source outside of your body. With transcutaneous VADs, a pump outside of your body is attached to your heart.

For both types of VADs, the parts inside your body are attached to the parts outside of your body through a hole or holes in the skin. Holes in the skin increase the risk of bacteria getting in and causing an infection.

With permanent tubes going through your skin, the risk of infection is serious. Your medical team will need to closely watch you if you have any signs of infection, such as soreness over the site of the VAD, fluid drainage, or fever.

Device Malfunctions

VADs can malfunction (not work properly) in different ways. A VAD's:

  • Pumping action may not be exactly right
  • Power may fail
  • Parts may stop working properly

Newer continuous flow VADs might reduce the risk of device malfunctions.

Right Heart Failure

Right heart failure means that the heart's right ventricle is too weak to pump enough blood to the lungs. This condition can happen as a result of getting an LVAD, which only supports the left ventricle.

The LVAD pumps a lot more blood than your weak left ventricle did. This puts more pressure on the right ventricle to pump the same amount of blood. The right ventricle might be too weak to match the LVAD's pumping ability.

Thus, you may need extra support for your right ventricle. Usually, you only need this support until your right ventricle recovers or until you get a heart transplant (if you're a candidate).

Medicines might improve the function of the right side of your heart. However, some people need a right ventricle assist device (RVAD) for short-term support of the right ventricle.




Clinical Trials

The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.

NHLBI-supported research has led to many advances in medical knowledge and care. For example, this research has helped evaluate various methods and devices for treating heart problems.

The NHLBI continues to support research on various heart treatments, including ventricular assist devices (VADs). For example, NHLBI-sponsored research includes studies that:

  • Explore whether injecting a type of cell found in the bone marrow into the heart during LVAD surgery can improve heart function
  • Use data from patients who have had LVAD surgery to better assess heart recovery and to determine which patients no longer need LVAD support
  • Compare a ventricular assist system with standard medical therapy in patients with advanced heart failure who are not candidates for a heart transplant or a permanent LVAD

Much of this research depends on the willingness of volunteers to take part in clinical trials. Clinical trials test new ways to prevent, diagnose, or treat various diseases and conditions.

For example, new treatments for a disease or condition (such as medicines, medical devices, surgeries, or procedures) are tested in volunteers who have the illness. Testing shows whether a treatment is safe and effective in humans before it is made available for widespread use.

By taking part in a clinical trial, you may gain access to new treatments before they're widely available. You also will have the support of a team of health care providers, who will likely monitor your health closely. Even if you don't directly benefit from the results of a clinical trial, the information gathered can help others and add to scientific knowledge.

If you volunteer for a clinical trial, the research will be explained to you in detail. You'll learn about treatments and tests you may receive, and the benefits and risks they may pose. You'll also be given a chance to ask questions about the research. This process is called informed consent.

If you agree to take part in the trial, you'll be asked to sign an informed consent form. This form is not a contract. You have the right to withdraw from a study at any time, for any reason. Also, you have the right to learn about new risks or findings that emerge during the trial.

For more information about clinical trials related to VADs, talk with your doctor. You also can visit the following Web sites to learn more about clinical research and to search for clinical trials:

For more information about clinical trials for children, visit the NHLBI's Children and Clinical Studies Web page.




Links to Other Information About Ventricular Assist Devices

NHLBI Resources

Non-NHLBI Resources

Clinical Trials

 
March 31, 2012 Last Updated Icon

The NHLBI updates Health Topics articles on a biennial cycle based on a thorough review of research findings and new literature. The articles also are updated as needed if important new research is published. The date on each Health Topics article reflects when the content was originally posted or last revised.