A mechanical heart device is a man-made pump that takes over the pumping action of the heart, to help maintain blood circulation.

What is a ventricular assist device (VAD)?
A VAD is normally used when the heart is severely weakened, such as in severe or end-stage congestive heart failure, and medicines fail to maintain enough circulation. The blood pressure remains low and the patient has difficulty breathing and is confined to bed. Most of the patients require assistance for the left ventricle, the main pumping chamber of the heart to restore normal blood flow.

The Left Ventricular Assist Device (LVAD) pumps blood from the left ventricle to the aorta. In some patients, a Right Ventricular Assist Device (RVAD) is needed to supplement the right ventricle. There are also Bi-Ventricular Assist Devices (biVAD) which assist both ventricles.

When do we need a VAD?
The use of the device falls into 3 main categories:

• Bridge to transplant - Patients who are already on the heart transplant list may deteriorate during their long wait. For these patients, the heart pump assists their failing heart, supporting them until a donor heart becomes available.

• Bridge to recovery - There are conditions (infections, alcohol abuse) that can lead to severe heart failure requiring placement of a VAD. In some instances, the heart recovers enough of its normal function after resting for some time and the device can be removed.

• Destination therapy - Also known as long-term or chronic therapy, destination therapy is used for patients who need a new heart, but are not eligible for transplant because of their advanced age or another disease or condition, such as cancer, which makes them unsuitable for heart transplant.

VADs cannot be used for people with serious renal (kidney), liver or lung disease, blood clotting disorders, or infections that do not respond to antibiotics.

The surgery
During the surgery to implant a VAD, a surgeon creates a pocket in the muscle under the heart. The main pump is tucked into this pocket. Tubes are then connected from the failing left ventricle to the pump and from the pump to the aorta. Once the device is activated, blood is pumped out of the left ventricle and injected into the aorta.

The pump is also connected to a drive line, or cable, that exits the body through the right side of the abdomen. The drive line links to the computer that controls the pump and batteries that the patient must charge regularly.

Until recently, patients with small body sizes simply didn't have enough space to accommodate the older big-pump models. But with better technology, we can now offer these patients new miniaturised heart pumps. Small-built patients can also be supported with external devices where the only internal hardware is the tubes connecting to the heart.

Implantation of a VAD involves open-heart surgery. A general anesthetic is given so you will sleep through the entire operation. The heart will be stopped so the surgeons can attach the pump to it. In the mean time, you will be connected to a heart-lung machine, which will take over the pumping action of the heart and ensures your body continues to receive a flow of oxygen-rich blood.

The surgery can take several hours. You will wake up in an intensive care unit (ICU) and can expect to stay in the hospital for a few weeks. How quickly you recover from surgery will depend in large part on how healthy you were before the surgery. During this time, tests will be conducted to assess and monitor your condition. You and your family will also learn how to manage and care for the VAD and yourself, so that you can return to your normal life and routine after discharge from the hospital.