Management of End Stage Heart Failure: Ventricular Assist Devices (VAD)

In light of PPMD’s Cardiac Webinar Series, our Director of Care, Kathi Kinnett answers questions/concerns about Ventricular Assist Devices (VAD).

 

There has been recent discussion worldwide regarding the use of ventricular assist device therapy in patients with Duchenne/Becker muscular dystrophy (Duchenne/Becker). This discussion is in its infancy; very few patients to date have had a device inserted. Ventricular assist device therapy has potential benefit in a select group of people, including patients with Duchenne/Becker, but it is not without significant risk.

 

A “ventricular assist device (VAD)” is a mechanical pump that is connected to the heart in order to support its function. The type of device that would be considered in individuals with Duchenne/Becker is a “left ventricular assist device (LVAD)”. It works by assisting the ill heart in pumping blood from the left ventricle to the body. 

 

Generally VAD therapy is used as a “bridge to transplant” (after the heart is too weak to support the body and until a donor heart for transplant is found). In some patients, a VAD could be used as “destination therapy.” What this means is that the device is implanted in an individual who is not a transplant candidate with the intent that the device will be in place for the remainder of their life. Not all people are good candidates for a device. Previous abdominal surgery, liver, kidney, or lung disease may be contraindications. Given the risks associated with the use of the device (outlined below) this option should ONLY be considered when the individual is experiencing significant symptoms and ONLY after all other options (such as medications) have been thoroughly exhausted.

 

Insertion of a VAD is a major surgical procedure requiring general anesthesia and requires recovery in the intensive care unit. The patient and the family will need significant education as to how to care for the device once it is in place. 

 

VAD therapy remains associated with significant risks. Complications of VAD placement may include:

  • Bleeding – this may require re-operation and is a common occurrence
  • Stroke (both hemorrhagic and ischemic)
  • Infection
  • Arrhythmia
  • Respiratory failure
  • Kidney failure
  • Liver failure
  • Hemolysis (break down of red blood vessels)
  • Blood clots within the pump
  • Re-hospitalizations
  • Development of right sided heart failure or air embolism during surgery

 

Following VAD placement, the patient will be managed on numerous medications. These medications will help support heart function and help reduce clotting.

 

There may be unique issues regarding VAD use in the patient with Duchenne/Becker that are currently unknown. Both the upcoming cardiology webinars and the cardiology workshop will address the use of VAD therapy in Duchenne, as well as many other issues. We will keep the community informed as more information becomes available. 

 

Learn more



 


Kathi Kinnett, Director of Clinical Care
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