The VAD Program at St. Francis Hospital

Advanced congestive heart failure can be an extremely debilitating disease. The Ventricular Assist  Device (VAD) Program at St. Francis Hospital is dedicated to improving our patients’ survival and quality of life. Whether they are currently candidates for a heart transplant or not - the device offers patients with late stage heart failure a new lease on life. Our team is with each patient every step of the way, providing medical, surgical, and emotional support. If you have any questions about whether you may qualify, please contact us (631) 689-3330. Someone is available to take your call 24 hours a day, 7 days a week. 

- Edward F. Lundy, M.D., Ph.D., Surgical Director
                       

LVAD Program Overview

The Ventricular Assist Device (VAD) Program at St. Francis Hospital provides both medical/surgical evaluation and treatment for patients with end-stage heart failure. Our VAD program is supported by a successful team of cardiothoracic surgeons, cardiologists, nurse practitioners, social workers, physical therapists and dietitians, offering the full spectrum of cardiovascular services for adult patients.

Started in 2016, the VAD Program at St. Francis Hospital provides state-of-the-art mechanical circulatory support to improve patient survival as well as the patient’s quality of life. These services consist of long-term devices used as a Bridge-to-Transplantation, as well as Destination Therapy. The VAD team manages the patient along a continuum of care spanning pre-operative evaluation, perioperative, and post-operative phases.

The VAD Program at St. Francis is committed to providing advanced life sustaining devices to treat patients with acute and end-stage chronic heart failure utilizing a holistic approach in support of the mission and vision of the Hospital. We incorporate medical, surgical, emotional, and social support using a multidisciplinary team of specialists to assure the best possible care to each of our patients.

What is a Ventricular Assist Device?

Commonly referred to as an “LVAD”, a left ventricular assist device is an implantable mechanical heart pump that helps pump blood from the weakened heart to the rest of the body. It is used to support the failing left ventricle in patients with end-stage heart failure. The device is implanted directly into the heart through the chest. A driveline connects the internal pump to the external controller and power source. 

Who benefits from LVAD therapy?

LVAD therapy is a treatment option for certain patients with end-stage heart failure. There are two indications: Destination Therapy and Bridge to Transplant. Destination Therapy is for patients who are not actively listed for heart transplant. Their life will be prolonged with use of the device. Bridge to Transplant means that the patient is actively listed for a heart transplant. The patient is placed on the device while they await a donor heart. Patients who are implanted as Destination Therapy can later go on to be Bridge to Transplant. Your indication will be communicated to you by the VAD team. 

LVAD therapy may not be appropriate for all patients. Patients who are excluded include those with bleeding or blood clotting disorders, kidney, or liver failure, severe lung disease, failure of the right ventricle, and infections that cannot be successfully treated with antibiotics. 

What should I expect?

If you and your doctor decide that an LVAD is the right choice for you, you will undergo an extensive evaluation process that includes laboratory assessment, imaging, social work assessment, neurocognitive assessment by a neurologist, physical therapy assessment and palliative care assessment. Patients are referred for heart transplant if eligible.

What is the surgery like?

LVAD surgery involves open-heart surgery under general anesthesia and a breathing tube. A cardiopulmonary bypass machine is also used.  The surgery typically takes six hours.  An incision is made down the middle of the chest. The LVAD is placed in the left ventricle of the heart and connected to the aorta.  A driveline is placed through the skin of the abdomen and contains the power cable to power the LVAD. This power cable is connected to a small controller on the outside of the body and connected to a power source. The power source consists of either batteries or a power unit, which is plugged into an AC wall outlet. Once the device is implanted, the cardiopulmonary bypass machine is stopped and the LVAD works with the heart to resume pumping of the blood through the body.

What happens during the hospitalization? 

Patients are taken from the operating room to the Cardiothoracic Intensive Care Unit (CT-ICU) to recover.  Over the course of a few days in the CT-ICU, the breathing tube is removed, intravenous medications are discontinued, and invasive lines are removed. You will work with different members of the multidisciplinary team including nurses, physical therapy, occupational therapy, respiratory therapy and a nutritionist. Your VAD team will be with you every step of the way.

From the CT-ICU, you will be transferred to a Step-Down Unit when cleared by the VAD team. Your ongoing focus will be on preparation for discharge from the hospital including learning about the LVAD, medications, and participating in your normal daily activities.

The typical hospital stay is about two to three weeks.  This depends on how well you progress medically and in learning about your LVAD. The VAD team will communicate your expected hospital stay.    

What types of devices are available?

The device St. Francis Hospital uses is the Heartmate II LVAD, made by Abbott.  It was approved by the Food and Drug Administration in 2008. There are other devices on the market, however, the Heartmate II is the most widely used device in the world and the only device that is approved for both Destination Therapy and Bridge to Transplant. You can learn more about the device by visiting www.thoratec.com.

How long can I live with a LVAD?

According to current data, patients can live approximately five years on the device. There is a small chance of device malfunction. This is dependent upon different factors. If you take care of the device, it will take care of you. 

Who is the VAD Team?

Successful utilization of LVAD therapy requires a multidisciplinary health care approach. The VAD team works in close collaboration with the patient and caregiver(s) during the process. Each member of the team practices within his or her scope of practice, while remaining consistent with the mission, goals, and objectives of the VAD Program.

Our team consists of:

  • Cardiothoracic Surgeons
  • Heart Failure Cardiologists
  • VAD Coordinator (Nurse Practitioner)
  • Social Worker
  • Palliative Care Consultants
  • Physical Therapy/Occupational Therapy
  • Nursing – CT-ICU, IMCU
  • Support Services – Respiratory Therapy, Dietary, Critical Care

The VAD team will assess patient readiness, willingness, and ability to provide or support self-management activities that are required as part of follow-up after the LVAD surgery. Developing a strong social support system, along with the patient’s strong willingness to actively and responsibly participate in the care, are essential to the success of LVAD therapy. The team will continue to assess these factors during treatment and evaluation.

How do I contact the VAD team?

To make an appointment to discuss your need for an LVAD, please call (631) 689-3330.  Someone is available to take your call 24 hours a day, 7 days a week.

What are the risks?

As with any surgical procedure, LVAD surgery has many risks. Every effort is made to minimize the risks. All risks will be discussed with you prior to surgery by your team of doctors.

Some of the possible risks include:

  • Blood clots: These clots can lead to heart attack and stroke. All patients with an LVAD are placed on Warfarin (Coumadin) to help minimize the possibility of blood clot.
  • Bleeding: Some patients are at risk of bleeding. Bleeding can occur from the open heart surgery, because of blood thinners (Warfarin), and bleeding in the gastrointestinal tract or brain.
  • Infection: The driveline which exits the abdomen is susceptible to infection. Patients and their caregiver are taught how to minimize the risk of infection.
  • Device Malfunction: The risk of device malfunction is small. Proper care to the device can ensure good device function.
  • Right heart failure: Because the right side of the heart is not supported by a device, it must keep up with the device on the left side of the heart. Sometimes the right side of the heart becomes weakened.
  • Other risks are possible and will be discussed with you prior to your surgery.

How to prepare for surgery?

The VAD team will explain what is expected before, during and after the surgical procedure. Some of the topics that will be discussed include:

  • Advance directives (Health Care Proxy, Living Will)
  • Admission to the hospital before the surgery to have treatments for heart failure and further testing including Echocardiogram, X-Rays, Labs, Electrocardiogram.
  • Operating Room Prep
  • Nothing to eat or drink after midnight of the procedure

How am I prepared to go home with the device?

The VAD coordinator develops a detailed education plan that teaches you about the device. You will be well educated as to how the device works, safety precautions, how to care for the device every day and what to do in an emergency.  You will also learn about your daily care, including guidelines about daily activities, medications, and diet. That also includes getting a thermometer and scale to help prepare for your after care.  

What happens after I am discharged from the hospital?

Most patients go home after the surgical procedure, however some patients may require subacute or acute inpatient rehab for approximately 10 to 14 days. You will be continuously evaluated for the best discharge plan during your hospitalization. The VAD team will follow up with you within one week to see how you are feeling and how well the device is working as well as check for complications. Frequent follow up visits are required, but will become less frequent over time. When you are ready, outpatient cardiac rehab will be recommended. You may eventually return to work, driving, sexual activity, hobbies, exercise, and traveling. 

Can I be listed for heart transplant after the LVAD?

Yes. Many patients who are implanted as Destination Therapy can go on to get successfully listed for heart transplant. You should discuss this with your doctor at follow up visits to see if you are a candidate.

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