A Ventricular assist device, or VAD, is a mechanical circulatory device that is used to partially or completely replace the function of a failing heart. Some VADs are intended for short term use, typically for patients recovering from heart attacks or heart surgery, while others are intended for long term use (months to years and in some cases for life), typically for patients suffering from congestive heart failure.
VADs need to be clearly distinguished from artificial hearts, which are designed to completely take over cardiac function and generally require the removal of the patient’s heart.
VADs are designed to assist either the right (RVAD) or left (LVAD) ventricle, or both at once (BiVAD). Which of these types is used depends primarily on the underlying heart disease and the pulmonary arterial resistance that determines the load on the right ventricle.
LVADs are most commonly used, but when pulmonary arterial resistance is high, right ventricular assistance becomes necessary. Long term VADs are normally used to keep patients alive with a good quality of life while they wait for a heart transplantation (known as a “bridge to transplantation”). However, LVADs are sometimes used as destination therapy and sometimes as a bridge to recovery. In the last few years, VADs have improved significantly in terms of providing survival and quality of life among recipients
Ventricular assist devices are an important option in the management of patients with heart failure condition. They provide life-saving temporary treatment for patients awaiting heart transplantation or heart recovery, and they significantly improve mortality among patients who are ineligible for heart transplantation. However, VAD therapy poses significant risks for complications that may disturb the course of treatment and compromise patient’s health. Complication are divided into two types Acute and Long term.
ACUTE COMPLICATIONS
The development
of the VADs opened the possibility for survival for many patients whose hearts are not able to function on their own. Ventricular assist devices improved the quality of life for patients with heart failure condition and gave them independence and a chance to return to normal functioning. However, despite the life-saving capabilities of the VADs, there are also negative consequences of their therapy. The devices pose risk of multiple complications that can be debilitating for patients and their families. They can also be very challenging for the critical care nurses who manage these patients. Many of the complications occur in acute care setting, shortly after the device implantation. Among these complications are altered immune response, thromboembolism, hemorrhage, right ventricular failure, and multisystem organ failure. However, some complications can also occur later, frequently after a patient is discharged home. The critical care nurse should assess and monitor patients with VADs in an effort to be proactive to decrease the incidence of complications.
Thromboembolism
Thromboembolism is one of the main concerns in patients with VADs. The reported incidence of thromboembolic events ranges from 10% to 25%. The risk for the development of thromboembolism depends on the patient’s condition such as presence of infection, the pump design, and the anticoagulation regimen used. Most thromboembolic events are cerebrovascular, but frequently, they are accompanied by other events such as peripheral embolization of the spleen, kidneys, extremities, or visceral arteries.
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