2IntroductionA VAD is one of the treatment options for advanced Heart FailureStanford invented the first VAD - NovacorIt was the first VAD implanted and the first Bridge to transplant in 1984You and your loved ones play an active role in the VAD implant processBeyond the implant surgery, we have a multidisciplinary team that has lifelong relationship with our VAD patients offering support, education and medical management
35 million Americans have heart failure Heart failure is when the heart muscle becomes impairedThe weak heart cannot keep up with the body’s need to pump out bloodThis can be sudden, or may occur over time
4What is a VADA Ventricular Assist Device is a mechanical pump that helps a weakened heart pump blood throughout the body.The VAD device does not replace the heart. It assists the heart to pump blood, decreasing the workload of the heart.There are both short and long term VADs, single or biventricular devices as well as VADs that must stay in the hospital or that you can go home with.
5Bridge to Transplant vs. Destination therapy The team had decided to place you on the transplant listYou will be eligible for transplant when the team feels you are readyThe VAD will be removed and you will have a new heart implantedYou can resume a normal and active lifestyleThis is a designation that may change depending on patient statusDestination TherapyThe team has decided that you are not a candidate for transplantYou will live out your life with the VADYou can resume a normal and active lifestyleThis is a designation that may change depending on patient status
6VAD Evaluation Echocardiogram. Ultrasound of your heart Exercise (VO2) test. Shows the amount of oxygen your heart and lungs can provide to your musclesRight Heart Catheterization. Measures pressures in your heartLeft Heart Catheterization. Uses a dye to look at your coronary arteriesEKG. Evaluates your heart rhythmLaboratory Tests. Determine blood type, other organ function and exposure to certain diseasesChest Xray. Images heart and lungsPulmonary Function Test. Determines lung function if you are/were a smokerCarotid and peripheral ultrasounds. Looks for blockages in certain blood vesselsColonoscopy. To ensure you do not have colon cancerMammogram. To ensure you do not have breast cancerDental exam. To evaluate your oral healthEye examPsychosocial evaluationInsurance clearance. This includes covering the cost of the surgery as well as testing and medications after transplantYour doctors may decide if other studies are needed to ensure you are a good candidate for heart transplant
7Psychosocial/Psychiatric Evaluation A specialized VAD/transplant social worker will perform a detailed psychosocial evaluation of your candidacy as a VAD recipientSome of the things that will be assessedYour understanding of the VAD processAvailability of caregivers before and after implantCoping and stress management barriers/challengesYour compliance with previous medical regimenMental health historySubstance use history
8SelectionOnce all testing and psychosocial evaluation is complete the entire VAD/transplant team comprised of surgeons, cardiologists, nurses, social workers, psychiatrists, financial counselors, and more meet to review your case.The team carefully reviews all of the your information in order to determine if VAD therapy is safe and appropriate for you.Your cardiologist will inform you of the committee’s decision and of alternate therapies in the event that you are not deemed a VAD candidate.
9The Surgery An incision is made in the midline of your chest A heart-lung bypass machine will take over the work of the heart and lungsYour VAD will be implanted into your diseased heart to help support it.
12Immediately after your VAD implant You will be taken to a bed in North ICU to recover immediately after the implantYou will be connected to a ventilator to help you breathe while you awaken from your surgery. This will be discontinued when you can breathe independentlyYou may need a special catheter in one of the big veins in your neck that will monitor the pressure in your heartYou will have many IVs and IV pumps delivering medicationsChest Tubes will be present to drain fluids from your chestYou will have a catheter in your bladder to drain your urineMost patients are in the ICU for 4-5 days after your VAD implant depending on the pace of your recoveryYou will have a procedure called an Echocardiogram to evaluate how your heart and VAD are working together
14Once stable you will be transferred to the step down ICU You will most likely be in a private room once on the step down unit so family can visit, or even spend the night in your room with youYou will receive your own set of VAD equipment, and the VAD coordinator will start to teach you and your caregiver about the equipment, how to recognize complications and how to contact the VAD team.Physical and occupational therapists will work with you to build up your strengthA dietician will meet with you to discuss a heart healthy diet now that you have a VADYou will continue with blood draws and chest x-rays that monitor response to medications and your recovery
15DischargeYou will generally be in the hospital for weeks after implantation.Once you are doing well medically and have learned your equipment, you will be discharged to an apartment/motel located very near Stanford hospital.You will stay in that apartment/motel for a minimum of 2 weeksSometimes it becomes necessary for you to stay in the area longer if you are experiencing any complications or if your provider deems it necessaryYou must have a caregiver/support person staying with you for the entire 2 week durationPlease ensure you have an alternate person available should your primary caregiver become sickOur social workers will work with you to find accommodations that are affordable for you
16Home MonitoringYou will need a scale, upper arm blood pressure cuff and thermometer when you are dischargedYou will chart your weight, blood pressure, temperature and VAD data daily and report these findings to the VAD team at clinic or if there are any changes.It is important that you take these measurements at the same time every dayMake sure when doing your daily weight that you have the same amount of clothes on or no clothes on
17Clinic Follow UpAs a new VAD patient you will be seen very frequently by the VAD teamWeekly for 1 monthEvery 2 weeks for 2 monthsAnd monthly thereafter or as needed depending on your statusAt each clinic visit, you will get lab work doneWe may ask you to come in for an extra clinic visit if you are not feeling well or we are concerned about your heart function in any way.
18VAD ComplicationsSometimes patients experience complications related to VAD therapyBleedingGutBrainClotStrokeInfectionRight heart dysfunctionHemolysisDamage to blood cells due to the pump
19Lifestyle changeYou may not have a palpable pulse or blood pressure by conventional methodsYou must always wear your VAD equipment!Plan ahead to ensure you will always have an adequate electrical supplyCarry a bag with extra supplies with you at all timesThe VAD exit site will require daily sterile dressing changesStatic may interfere with your pump functionModified activity for sternal precautions for 6-8 weeks after surgery
20Restrictions No swimming, bath tubs or hot tubs No activities that you run the risk of submersing yourself in water.No jumpingNo contact sportsNo MRI
22AnticoagulationWhile on the VAD you will need to take blood thinning medication called Warfarin to decrease your chance of getting a blood clotThis medication requires frequent blood draws a few times a weekYou will also need to take Aspirin, this also thins your bloodYou will need to take precautions to ensure your safetyProtect yourself from injury, you are at an increased risk for bleedingWatch for increased or abnormal bleeding or bruisingUse an electric razorYou should not take medications containing IbuprofenYou may need to modify your dietThere are multiple medication interactions with Warfarin
23Precautions Protect your driveline at all times Protect cables connected to your system controllerMust always have a power source
24ComplianceThe VAD is a device that requires commitment to living healthily and safelyTake all drugs as prescribedMonitor vital signs, weights and VAD data dailyAttend all clinic visitsRegular exerciseHealthy eatingHealth care maintenanceThe Stanford VAD team has a lifelong commitment to you to get you through this process by providing information and support.
25Routine Health CareIt is essential that you have a primary care provider before implantYou will continue to have other health needs outside of your VAD that you will need to see a general internist forYou will need to keep up regular health maintenance screenings such as colonoscopy, mammogram, prostate exam, pap smear, skin checksIf you live a long distance from Stanford, it may be in your best interest to have a cardiologist closer to home. We can often communicate with the cardiologist to help guide careDental health is important to avoid infection.Ensure you have regular dental check ups and you may need antibiotics before any dental work
26General PointsYou will likely be discharged on 5-10 medications that you will take one or multiple times a dayYour list of medications will likely change through out the time you have the VADNEVER stop or change the doses of your medications unless instructed by the VAD teamTake all your medications exactly as directedYou will have an individualized regimenYour medications will be reviewed at every clinic visit. Make sure you bring an updated list with youDo not take any new medications or supplements without the VAD teams approvalReport any adverse effects of your medicationsNotify the VAD team if there is any reason you are unable to take your medicationsREMEMBER – The VAD and medications keep your heart functioning!!