VAD Education

Consider referral when a patient has systolic heart failure (ejection fraction <30 percent) and two or more of the following:

• Class III-IV symptoms despite optimal medical therapy
• Unable to tolerate or titrate heart failure drugs due to hypotension or renal insufficiency
• Cardiorenal syndrome
• Hospitalization for heart failure within the past six months
• Hyponatremia
• Ventricular arrhythmias or defibrillator firings
• Onset of cardiac cachexia
• Being considered for or on inotropes

Mechanical circulatory support with a VAD is increasingly a realistic therapy for improving survival and quality of life in select patients with medically-refractory heart failure. Recent results with the HeartMate II LVAD demonstrate one-year survival of 90 percent in transplant-eligible patients, which is comparable to survival with transplant.¹ In the growing population of older patients for whom a VAD is destination therapy, one-year survival approaches 70 percent. ^{2, 3}

Thousands of patients worldwide have had marked improvements in quality-of-life and survival following implantation of a VAD.⁴ Selecting the right patient and the right time for surgery is key to good outcomes. In evaluating patients, co-morbid conditions need to be carefully considered.

In general, patients with severe and irreversible end-organ dysfunction (e.g. hemodialysis, oxygen-dependent lung disease, cirrhosis) or other non-cardiac illness that limits life expectancy to fewer than two years are not good candidates. Patients with frailty and musculoskeletal or neurologic impairments that significantly limit mobility are also unlikely to benefit.

After VAD surgery, a patient will require treatment with aspirin and warfarin (goal INR 1.5-2.5). Thus, individuals at high risk of bleeding, particularly gastrointestinal bleeding, may be poor candidates for a VAD.

Importantly, excellent outcomes have been achieved in carefully selected elderly patients. While there is no absolute age cutoff for VAD therapy, candidates under 75 years old are usually appropriate for destination therapy. All patients must have adequate psychosocial support and a stable home environment.

Your patient will be evaluated by an experienced multidisciplinary team that includes a heart failure cardiologist, cardiac surgeon, social worker and palliative care providers. The standardized assessment includes imaging, right heart catheterization, routine laboratory and physiologic testing (e.g., pulmonary function testing, cardiopulmonary exercise testing, etc.) as indicated.

In addition, we perform a thorough psychosocial evaluation involving the patient and his or her loved ones. A home safety evaluation may be recommended to assess the physical environment of the patient's home. An electrical inspection of the patient's home is also required.

Most patients spend two to three weeks in the hospital before discharge. Once out of the intensive care unit, usually after four to seven days, your patient will receive intense physical and occupational therapy.

Our VAD coordinators and nurses will educate your patient and his or her loved ones on changing power sources, caring for the driveline, dressing changes, device alarms and living with a VAD.

After hospital discharge, patients are seen weekly for close follow-up. Additional follow-up visits are scheduled based on your patient's progress. Cardiac rehabilitation is strongly encouraged. Patients and families who live outside the Portland metro area are invited to stay at the Providence St. Vincent Medical Center Guest Housing Center near the hospital for a few days until their first clinic appointment.

• Most patients feel dramatically better within weeks of surgery and have sustained improvements in functional class and end-organ function.
• Most patients are New York Heart Association functional class I-II.
• A patient must always bring two spare batteries when using battery-power. A fully-charged pair of batteries can provide 10 hours of support.
• A VAD-supported patient can shower using a specially-adapted shower kit, but immersion in water such as bathing or swimming is not possible.
• Patients are also advised not to drive.
• Patients should not become pregnant.