Kids Health Info

Ventricular Assist Device VAD

  • The Ventricular Assist Device (VAD) is designed to provide short-term or long-term support for children whose hearts are too damaged or diseased to provide enough blood flow. It is usually used as a bridge-to-heart transplantation for children on a waiting list to receive a donor heart. 

    There are two main types of VADs used at RCH: the Thoratec and the Berlin Heart. 

    There are 3 major parts to the system:

    1. Blood pump- this is the artificial ventricle (a chamber of the heart where blood is pumped out).
    2. Cannula (tubes)- which connect the blood pump to the heart and vessels.
    3. Console- this is what powers the VAD. Also known as the 'driver'.

    How does it work?

    The VAD is used to help support the right side, left side, or both sides of your/your child's heart. When you/your child have a VAD that is helping to support only the left side of your heart, this is called a LVAD (left ventricular assist device). A VAD that helps to support only the right side of your heart, is called a RVAD (right ventricular assist device). When you have two VADs helping to support both sides of your heart, this is called a BiVAD (biventricular assist device). 

    What are the risks?

    While VAD is a life saving procedure that will improve blood flow and allow you/your child to breathe easier and feel less tired, there are certain risks. It is important to prevent blood in the VAD from clotting. To do this, you/your child will need to have a medicine called Heparin. Once you/your child are more stable, you/they will need to take a combination of medicines called anti-coagulants. These include aspirin, warfarin  dipyridamole, and sometimes clopidogrel. 

    These medicines prevent the blood from clotting but also increase the risk of bleeding. Blood tests that measure clotting times are done regularly to monitor and reduce the risk of bleeding. Although anti-coagulants are used, there is still the risk of clots which could potentially cause thromboembolic events such as a stroke.

    Another important risk is infection. Dressings around the cannula sites are changed every second day using a sterile technique. If the cannula sites have healed well over time then the dressing can be changed two or three times a week.

    What to expect?

    After surgery, you/your child will be taken to the Paediatric Intensive Care Unit (PICU) where you/they will receive special, one-on-one care and monitoring until you/they wake up. As soon as you/your child improves and stabilises, you/they will need less intensive care and will move to the cardiac ward. Once you/they can walk fairly well, you/your child will be transferred to a portable driver, which enables them to take longer walks and be more independent.

    If you/your child has a Berlin Heart VAD, you/they will remain on the same driver because there is no portable driver available.

    If you/your child has a Thoratec VAD, you/your child will also be fitted for a Holster belt which is designed to fit around the VAD to help relieve the weight of the device and keep it secure once they are moving about.

    Your child can take a shower or bath as soon as the cannula sites are healed. This will be on the cardiac ward.

    Pain relief

    Your child may have some pain and discomfort around the cannula sites. Your child will be given medication for pain relief. The Holster belt will also help relieve some of the pain. If you are concerned about any aspect of your child's pain, please talk to your child's nurse or doctor. They can refer you to the pain management team if needed.     

    Physiotherapy

    You/your child will start getting physiotherapy very soon after the operation. Physiotherapists will help to get your child out of bed and start walking. For the first few days, you/your child may just get out of bed and sit in a chair. As you/they recover, you/they will go to the physiotherapy department for more intensive physiotherapy.

    What happens if the machine stops?

    There will be an alarm to alert you. There is always a back-up machine ready to go in case the machine stops. Even when you/your child goes home, you will be given another machine as a back-up. Also, it is easy to pump the machine by hand.

    Living with a VAD while waiting heart transplantation

    During your/your child's time on the VAD, you and your child will be taught more about the system and be involved in caring for it. Exercise is an important part of therapy as this helps your/your child's body get into the best condition while waiting for a heart transplant. Eating regular nutritious meals and drinking plenty of fluids is also important. Finally, it is our goal to discharge your child home or to hospital accommodation so you and your child are free from the hospital environment while waiting for your child's heart transplant.

    Key points to remember

    • A VAD (Ventricular Assist Device) is for short-term or long-term support while waiting for a heart transplant.
    • Physiotherapists will help your child get up and about soon after the operation.
    • There are risks of bleeding and clotting from the operation and medicines. You/your child will need regular blood tests to watch for these risks.
    • If the machine stops working you will always have a back-up. Also, it is easy to pump the machine by hand.

    For more information

    Individual instructions

    Your child's doctor's name and contact number:

     

     

    Developed by the RCH Cardiology Department. First published in May 2007. Updated October 2010.

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Disclaimer 
This information is intended to support, not replace, discussion with your doctor or healthcare professionals. The authors of these consumer health information handouts have made a considerable effort to ensure the information is accurate, up to date and easy to understand. The Royal Children's Hospital, Melbourne accepts no responsibility for any inaccuracies, information perceived as misleading, or the success of any treatment regimen detailed in these handouts. Information contained in the handouts is updated regularly and therefore you should always check you are referring to the most recent version of the handout. The onus is on you, the user, to ensure that you have downloaded the most up-to-date version of a consumer health information handout.