Dr. Yuji Kaku, MD

There are several different kinds of VAD. While the controller and power source are always outside of the body, the pump itself can be internal or external. Most pump blood with a rhythm, like a human heart does, but some pump blood continuously. A VAD is usually placed in the left ventricle (to move blood to the body) but can be placed in the right ventricle (to move blood to the lungs) or on both sides of the heart.

VADs with external pumps are for short-term use and can be inserted in different ways. Some are mounted on a catheter (a thin, flexible tube) that is attached to the external pump and motor. This requires minor surgery to thread the catheter through a vein in the groin. Other VADs with external pumps require a larger incision on the chest, where inflow and outflow tubes are inserted. These tubes are connected to the external pump and power source. The chest remains open but covered with sterile material until the patient receives his or her heart transplant, which usually occurs within ten days. The patient must remain in the hospital during this period.

Implantable VADs have pumps that are placed within the chest cavity during open heart surgery. Two tubes are attached to the pump, which is implanted in the upper part of the abdomen. One of the tubes is inserted into the heart, pulling blood into the pump, which then sends the blood into the aorta. The other tube goes out of the abdominal wall to the outside of the body and is connected to the power source, which is worn around the waist. Since placing an implantable VAD requires open heart surgery, both the surgery and recovery are longer and more difficult than for VADs with external pumps. However, implantable VADs have a huge benefit in that they are not hooked up to a large machine -- patients are free to move around after being fitted with one. For this reason, they are more common when heart support is needed long-term. They may be used for patients who are waiting for a heart transplant, or as a permanent treatment for those who do not qualify for a transplant.

VADs come with their set of challenges. For instance, placement of the device can take several hours, and recovery can take as long as two months. Often, people who need VADs have experienced heart failure, and their weakened heart and lungs need careful monitoring and support. Patients with VADs that have external pumps need to sacrifice their mobility, while those who have implantable VADs must learn how to keep their device clean, safe, and working properly. Despite any difficulties of adjusting to life with a VAD, they can be lifesaving devices for those who need them.