Dr Arvind Kohli
Heart failure
When heart muscle is damaged, it can’t pump enough blood to the rest of the body. A weak heart leads to sluggish circulation (congestion) and symptoms such as fatigue, shortness of breath, swelling in the feet and ankles and irregular heart beats. Common causes of heart failure are coronary artery disease, heart attack, high blood pressure, valve problems, heart muscle disease (such as cardiomyopathy), and heart irregularities. Medications and cardiac rehabilitation programs can reduce symptoms, but if patient has advanced heart failure, Cardiac surgeon may recommend surgery. Surgery is aimed at stopping further damage to the heart and improving the heart’s function.
Ventricular Assist Devices
A ventricular Assist Device (VAD) is a mechanical pump that’s used to support heart function and blood flow in people who have weekend hearts presenting with heart failure. The device takes blood from a lower chamber of the heart and helps pump to the body and vital organs, just as a healthy heart would.
A VAD can help support failing heart:
* During or after surgery, until heart recovers.
* Bridge to Cardiac Transplantation.
* Destination Therapy Unsuitable for heart transplant. (A VAD can be a long-term solution to help heart work better).
A VAD has several basic parts. A small tube carries blood out of your heart into a pump. Another tube carries blood from the pump to your blood vessels, which deliver the blood to your body.
A VAD also has a power source that connects to a control unit. This unit monitors the VAD’s functions. It gives warnings, or alarms, if the power is low or the device isn’t working well.
Some VADs pump blood like the heart does, with a pumping action. Other VADs keep up a continuous flow of blood. With a continuous flow VAD, you might not have a normal pulse, but your body is getting the blood it needs.
Types of Ventricular Assist Devices
The two basic types of VADs are a left ventricular assist device (LVAD) and a right ventricular assist device (RVAD). If both types are used at the same time, they’re called a biventricular assist device (BIVAD).
The LVAD is the most common type of VAD. It helps the left ventricle pump blood the aorta. The aorta is the main artery that carries oxygen-rich blood from your heart to your body.
RVADs usually are used only for short-term support of the right ventricle after LVAD surgery or other heart surgery. An RVAD helps the right ventricle pump blood to the pulmonary artery. This is the artery that carries blood from the heart to the lungs to pick up oxygen.
A BIVAD might be used if both ventricles don’t work well enough to meet the body’s needs. Another treatment option for this condition is a total artificial heart (TAH). A TAH is a device that replaces the ventricles.
VADs have two basic designs
A transcutaneous VAD has its pump and power source located outside of the body. Tubes connect the pump to the heart through small holes in the abdomen. This type of VAD might be used for short-term support during or after surgery.
An implantable VAD has its pump located inside of the body and its power source located outside of the body. A cable connects the pump to the power source through a small hole in the abdomen.
Implantable VADs are used mainly for the people who are waiting for heart transplants or as a long-term solution for people who can’t have heart transplants.
Total Artificial Heart
* For extremely sick patients waiting for a heart transplant, the Total Artificial Heart may be an option. It is used as a temporary replacement for wait-listed patients with signs of severe damaged in both heart chambers (biventricular failure). These are patients who cannot wait any longer for donor heart.
* The mechanical heart replaces both ventricles and all four heart valves. The plastic device takes over completely for the patient’s own dying heart, which is removed when the artificial heart is implanted. It is powered by pulses of air delivered from a small portable pump that is worn like a shoulder bag. After the surgery to implant the artificial heart, many patients can return home to a more active lifestyle as they wait for a permanent donor heart. Clinical trials have shown that nearly 8 of 10 patients receiving the artificial heart survive the wait for a heart transplant.
Heart Transplantation
* For patients with end-stage heart failure, a heart transplant may be an option. “End-stage” means that the heart is severely damaged and cannot be helped with other standard procedures or surgeries. Older patients or those with serious medical conditions may not be good candidates for transplant; they may need a special treatment such as a VAD.
* In transplantation, the failing heart is removed and replaced with a healthy heart from a deceased donor. This operation requires a median strenotomy (splitting of the breastbone) and cardiopulmonary bypass (heart-lung machine) and lasts four to five hours or more.
* In addition to the risks of the surgery itself, patients considering transplantation must also know that this option requires a careful selection process, a pre-transplant “wait list” period, a long post-transplant recovery (A week or two in the hospital followed by months of frequent tests and biopsies), and a lifetime commitment to cardiac rehabilitation, lifestyle changes, and follow-up counseling, monitoring, and ongoing treatment (e.g. powerful immunosuppressants to prevent rejection).
* The good news is that many patients who receive a transplant can eventually start enjoying many of their favorite activities again- walking, sports outings, vacations or even a resumption of their career. Transplantation can be truly life-saving-leading to a longer life and a better quality of daily living.
Cardiac Rehabilitation
Health care team may recommend cardiac rehabilitation (rehab). Cardiac rehab is a medically supervised program that helps improve the health and well-being of people who have heart problems.
Rehab programs include exercise training, education on heart healthy living, and counseling to reduce stress and help you return to a more active life.
Nutrition and exercise
While recovering from VAD surgery, getting good nutrition is important. Supervised exercise also is important to give body the strength it needs to recover. During the time when heart wasn’t working well (before surgery), the muscles in the body weakened. Building up the muscles again will allow patients to do more activities and feel less tired.
(The author is a heart surgeon at CAMC Jammu)
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