1. VAD Resource Team University of Washington Medical Center
HeartMate XVE LVAD
VAD Resource Team University of Washington Medical Center

2. VAD Resource Team Pager/Phone Email Cardiac Surgery Shauna Andrus
sandrus
5NE/5SE Sheryl Greco
sagreco
5NE Kristina Green
kegreen
5SE Nicola Kaye
kiwi
5SE Janie Shively
janie
5NE Eileen Suver
esuver
5SE Teddy Villamarin
pinoy

3. Heart Failure
Heart failure is defined as the inability of the heart to effectively pump oxygenated blood to meet the metabolic demands of the body.
This devastating condition affects 4.7 million people a year in the United States alone.
When conventional medical therapies are unsuccessful, cardiac transplantation is an option for treatment and to prolong life.
Unfortunately, only 2300 patients each year receive heart transplants, because the number of patients awaiting transplants far exceeds the number of organs available.

4. HeartMate Candidates Transplant candidate:
dependent on vasopressor support OR
incomplete response to continued vasopressor support
Approved for ‘Destination Therapy’
BSA of 1.5 or greater

9. Pump Percutaneous Tube Vent Adapter
Weight: 3.74 lbs
Pump volume: 83 ml
Rate: Up to 120
Flow: Up to 10 L/min
Titatanium
Motor with 2 bearings
Vent port
Two tissue valves:
Inflow & Outflow

10. Inside surface of pump housing

11. Pump weighs 2.63 pounds
Titanium case
Inside surfaces textured to encourage natural formation of a lining that mimics intima
Clot formation inside the pump not a concern because of the lining
Coumadin not used
ASA daily to prevent platelet aggregation which helps to prevent antibody formation
Pump stroke volume is 83 ml
Normal volume of blood pumped each cycle is about 90% of the 83 ml
Typical stroke volume for a patient is in the low 70s
Pump works via microprocessing chip that runs a motor encased inside the pump. Motor drives a pusher plate up, forcing blood out of the pump
Percutaneous lead is tunneled under the skin from the pump on the left side to the exit site on the right
This helps prevent infection at the exit site from traveling to the pocket where the actual pump is
More comfortable for the patient
Allows easier activity

12. Percutaneous Tube & Vent Adapter
AVOID:
WATER & POWDER AROUND FILTER
Percutaneous lead
Tunneled from pump to the surface of the skin
Contains an electrical cable and an air tube
Once the lead emerges from the body, it separates at the Y-connector into an electric connector and an air vent
Our patients have had problems with broken Y-connectors
The company has developed a new Y-connector that will be introduced sometime this year
Air Vent
Purpose is to allow free moving air in the system
Without free air movement, a vacuum would be created in the pump, causing malfunction
The motor causes the pusher plate to move up, pushing blood into the aorta
Air moves in under the pusher plate to fill the space
When the pusher plate returns to its starting pooint, it pushes the air out of the way
If the air didn’t move in and out, a vacuum would be created in the empty space and the pusher plate would not be able to return to its starting place
Because this is an open line directly into the pump, it is vital that no fluids enter this line!!!
Could cause the pump to seize and stoop working
Like any piece of metal equipment, a little bit of fluid sitting in a motor can cause corrosion resulting in a malfunction
Either way, this creates a major problem and can result in needing to emergently replace the implanted pump at high risk to the patient and a cost of $65,000!
NO FLUID SHOULD EVER BE NEAR THE PORT!
A simple filter is attached to the end of the port
Non-occlusive to allow the air to flow
Should never have an occlusive cap of any sort
Will not prevent fluids from entering the line
Collects dust
Change weekly
Electrical connector attaches to a cable on the system controller and provides transmission of information between the controller and the pump

13. System Controller
“Quick” Connector

14. System Controller Cables

15. System Controller ‘Brains’ of system (computer)
Alarms: Audible & Visual
Two cables: connect to power source
‘Quick connect’ to percutaneous lead

16. System Controller Change Mode Alarm Reset
Has three functions
Controls the motor of the pump
Assures that the pump is working correctly
Provides a warning when things are not working correctly
Worn at the waist on the right side of the body
Three cables
Single cable attaches to the electric cable of the percutaneous lead, allowing information to be passed back and forth
Two cables are used to attach to the power source
Two buttons
Mode button (lower left corner of the controller)
Selects auto and fixed modes of operation
1 beep = Fixed (one syllable)
Present rate that VAD pumps at regardless of activity
Used when the controller is unable to get information from the pump (switches into fixed mode automatically)
When you want to control the pump rate to keep it from pumping too fast or too slow
When the batteries are low
2 beeps = Auto (two syllables)
Normal mode of operation
Pump will adjust the rate to meet the demands of the patient, just like the normal heart rate adjusts
Systems Check: Done daily and charted in CIS
Press and hold the Mode button for 3 seconds
Yellow wrench, red heart, red battery and fuel gauge lights will come on and a steady alarm will sound
After 3 seconds, release the mode button. Lights remain lit and the alarm will sound for another 3 seconds
All warning lights will turn off except for the yellow wrench. Warning lights will turn back on in less than 5 seconds and will stay on for another 5 seconds. The alarms continue to sound.
If lights and alarms turn off after 5 seconds it means the controller cell needs to be replaced
Courtesy dictates shutting the patient’s door and letting those around you know what is going on.
Alarm Reset Button
Resets alarms
5 minutes for yellow wrench
2 minutes for red heart
Check battery life
Press and hold while looking at the number of green battery lights showing
Amount of battery life is approximate, since the amount of power used is based on pump workload and the age and condition of the batteries
At < 25% available battery power, you should change to another power source!
Battery Symbols
If < 15 minutes of power remains, yellow battery symbol lights with audible beep 1/sec
If < 5 minutes of power remains, red battery symbol will appear and a steady tone will sound
Controller initiates Power Saver Mode, telling the pump to beat at 50 bpm
This uses less battery energy and allows time to immediately switch to another power source
A patient with a sudden decrease in HR may be symptomatic!
Change Mode Alarm Reset
System Check Battery Power Check

17. Power Base Unit (PBU) & System Monitor

18. Power Base Unit PBU Internal battery Battery charger AC Fail Low Batt
Alarm reset

19. Screen of System Monitor
Pump Rate:
Rate PUMP is beating
Flow:
Cardiac
output
Stroke
volume:
ml/beat
FUNCTION BUTTONS
Auto/Fixed Fixed Rate  Fixed Rate 

20. FIXED vs. AUTO MODE
FIXED MODE is a set rate the pump will beat at regardless of other conditions. This rate can be adjusted by using the system monitor, and should always be set at a rate close to the patient’s baseline.
AUTO MODE is responsive to the filling and emptying of the LVAD pump. The pump fills to a fixed volume at a variable rate depending on the patient’s activity and volume status.
NO RELATIONSHIP TO RATE OR RHYTHM OF HEART

21. Display Module
DISPLAY
Provides information ONLY
No button interface

22. Components:Tethered
Quick Connect: percutaneous tube to system controller
Power Base Unit Cable: connecting cable from PBU to system controller
Twist together connection: system controller to power base unit cable
VE LVAD
Percutaneous lead
Y-connector
External air vent
Electrical connection
System Controller
PBU cable
Power base unit
System monitor
Power cord
Rear panel of PBU
Display Module
Hand Pump
Emergency Power Pack
Stroke Volume Limiter
Pneumatic console

23. Components: Battery Powered
Requires 2
batteries
4-6 hours of
power/set
Worn in holster
Quick Connect
Twist together connect: system controller to battery

24. Hand Pump: Goes with patient EVERYWHERE
Emergency Power Pack

25. Battery Clips & Batteries

26. Changing Power Sources

27. YELLOW WRENCH: ADVISORIES
1 beep per second
May be silenced for 24 hours
RED HEART: HAZARD ALARMS
Steady tone alarm
Preceded and accompanied by a Yellow Wrench alarm
YELLOW WRENCH ALERTS
1 beep per second
May be silenced
RED HEART ALARMS
Steady tone alarm
Preceded and accompanied by a yellow wrench alarm
May be reset for 2 minutes
May be reset for 2 minutes

28. YELLOW WRENCH Power Cable Disconnect
MOST COMMON
Routine alarm that sounds when power
source (battery or outlet) is changed
or only one power source connected
Check the connections to the power source

29. YELLOW WRENCH 2. Controller Malfunction Caused by a malfunction in the
2nd MOST COMMON
Caused by a malfunction in the
system controller
*Inoperative Controller = ½ wrench*
Change the system controller

30. Occurs when pump has higher than normal pressure to pump against
YELLOW WRENCH
3. Power Limit Advisory
RARE
Occurs when pump has higher than
normal pressure to pump against
Kinked or occluded vent line
 replace the extension
High blood pressure to pump against
 lower blood pressure
Outflow obstruction  requires surgery
Kink or obstruction at vent line  check for and remove kinks or obstructions, change the vent filter

31. Occurs when pump is changed to Fixed Mode and the preset rate is:
YELLOW WRENCH
4. Rate Control Fault
RARE
Occurs when pump is changed to
Fixed Mode and the preset rate is:
Less than 50 or
Greater than 120
Pump defaults to 72 beats per minute
 correct by attaching the system monitor and changing the backup rate

32. YELLOW WRENCH: ADVISORIES
1 beep per second
May be silenced for 24 hours
RED HEART: HAZARD ALARMS
Steady tone alarm
Preceded and accompanied by a yellow wrench alarm
YELLOW WRENCH: ADVISORIES
1 beep per second
May be silenced for 24 hours
RED HEART: HAZARD ALARM
Steady tone alarm
Preceded and accompanied by a yellow wrench alarm
May be reset for 2 minutes
May be reset for 2 minutes

33. THIS IS A CRITICAL ALARM
RED HEART
Low Beat Rate or No Op
Low Beat Rate:
Pump slows to < 30 bpm
No Op: may be stopped
THIS IS A CRITICAL ALARM
AND CANNOT BE RESET

34. Check connections
most likely culprit is the percutaneous tube
connection to the system controller
Check your patient
 you may need to hand pump
Check the vent port to insure it is not occluded
Try changing the power source
Try changing the system controller

35. If pumping does not resume immediately, remove all power sources and start hand pumping
STAT page the perfusionist on call
STAT page Surg C Attending or Fellow
Call for pneumatic console (5NE) with Stroke Volume Limiter (SVL)
Do NOT restart the pump if it has been off > 5 minutes except with order from Attending or Fellow

36. 2. Low Stroke Volume: < 25 ml
RED HEART
2. Low Stroke Volume: < 25 ml
3. Low Flow: < 1.5 L/min
STAT page perfusion
STAT page Surg C Attending or Fellow
Consider changing to Fixed Mode to  flow
Assess whether this is a patient or equipment
problem

37. RED HEART CAUSES Severe RV failure  consider inotropes
Extreme low blood volume  assess for
bleeding or fluid loss, replace fluids
VT, VF or Asystole  ACLS protocols
EXCEPTION: NO chest compressions
(may dislodge outflow conduit)
LV inflow cannula obstruction
 requires surgical intervention

38. disconnected from the percutaneous tube
FLASHING YELLOW BATTERY RED HEART YELLOW WRENCH Steady tone CANNOT BE SILENCED
XVE System Controller
disconnected from the percutaneous tube
Check system controller cable connection
to percutaneous tube

39. BATTERY ALARMS Flashing Yellow Battery No tone Yellow Battery
Once-per-second
Red Battery
Continuous Audio Tone

40. FLASHING YELLOW BATTERY No tone
Battery Module
The battery that controls the alarm lights and tones on the system controller is low
This battery controls ONLY the alarm tones and lights, NOT the pump
Change the battery, then do a controller self-test to clear the alarm

41. YELLOW BATTERY Once-per-second BEEP
Low Voltage Advisory
Less than 15 min of battery power remain
Change to alternate power source

42. RED BATTERY: Steady tone
Low Voltage Alarm
Less than 5 minutes of battery power remains
Pump defaults to POWER SAVER MODE: 50 bpm
Patient may be this rate if used
to faster rate
Immediately switch to an alternate power source or prepare to hand pump

43. EMERGENCIES VT/VF BLOOD FROM EXIT SITE RED HEART
Monitor BP; Flows; Cardiovert/Defibrillate
BLOOD FROM EXIT SITE
STAT page CT surgeon &/or fellow
RED HEART
Trouble shoot; be prepared to hand pump

44. IF LVAD MOTOR STOPS < 5 minutes > 5 minutes
Troubleshoot and get it working again
Try hand pumping
Replace system controller
Try pneumatic console (with SVL)
> 5 minutes
DO NOT attempt to restart motor
STAT page perfusionist
STAT page Surg C Attending/Fellow

45. Pneumatic Console Can drive XVE HeartMate if pump failure Must use STROKE VOLUME LIMITER Pneumatic tubing with flutter diaphragm FIXED only available mode No electric connections to provide pump information Consider transfer to 5SE No alarms on IP console

46. Three months after implant

47. University of Washington Medical Center 1997-2006
Device
Total TX
Waiting/
Current
IP HeartMate 19 17
VE HeartMate 22 20
XVE HeartMate 26 23 1
Thoratec PVAD 24 5
Thoratec IVAD 2
XVE HeartMate DT/HM II DT 4
HM II 7
TOTAL
102* 66
*4 Combo HeartMate + Thoratec