Ventricular Assist Devices (VADs)

Ventricular assist devices (VADs) are mechanical devices that are implanted in an open heart surgical procedure in the chest or upper part of the abdomen or connected to a pump outside of the body. VADs help the heart pump blood from the ventricles (the lower chambers of the heart) to the rest of the body. VADs may be necessary as a long-term treatment for patients who have heart failure or temporarily by patients waiting for a heart transplant or heart recovery from injury.

A ventricular assist device has three parts:

  • A pump placed inside or outside of the body
  • An electronic controller similar to a computer
  • A power supply

A left ventricular assist device (LVAD) is the most commonly used VAD. It supports the pumping action of the left ventricle of the heart. A right ventricular assist device (RVAD) supports the function of the right ventricle, and a biventricular assist device (BiVAD) supports the function of both the right and left ventricles. A total artificial heart (TAH) completely replaces the right and left ventricles.

At the Brigham and Women's Hospital (BWH) Heart & Vascular Center, a team of multidisciplinary cardiovascular specialists in the Mechanical Circulatory Support and Heart Transplant Program collaborate, leveraging their specialized training in VAD technology, enabling our cardiac specialists to handle the most complicated cases.

In 1999, BWH performed the first left ventricular assist device (LVAD) implantation for long-term treatment in New England, and was the only New England site to participate in the landmark REMATCH (Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure) trial. The trial compared outcomes for patients managed with LVAD plus medical therapy with outcomes for patients on optimal medical therapy alone, and demonstrated a better survival rate among the LVAD group. We are currently leading a national pivotal trial of 3rd generation LVAD technology as bridge-to-transplant or lifetime (destination) therapy.

With 47,000 outpatient visits each year, the Heart & Vascular Center is one of the largest in the United States, treating over 7,000 inpatients and performing more than 8,000 procedures annually at our state-of-the-art Shapiro Cardiovascular Center.

Ventricular Assist Devices (VADs)

Ventricular Assist Device Implantation Procedure

Cardiac surgeons and cardiologists in the BWH Heart & Vascular Center are highly skilled in VAD surgery and in choosing the correct device for each patient, based on individual needs.

Our devices include:

  • HeartMate II, HeartMate 3, and HeartWare VADs, small, durable and quiet devices used as a bridge to transplantation or destination therapy.
  • Thoratec Paracorporeal Ventricular Assist Device (PVAD), a larger, durable, pulsating device that can be used to support the right, left, or both ventricles while awaiting transplantation.
  • SynCardia Total Artificial Heart, a potential bridge-to-transplantation option for patients with severe biventricular heart failure requiring total cardiac replacement.
  • Abiomed's Impella 2.5 and Impella CP, the world's smallest ventricular assist devices, designed to be used as partial circulatory support during high-risk stenting, radiofrequency ablation or as bridge to durable LVAD therapy.
  • CardiacAssist Tandem Heart, used as a bridge to recovery or as a transition to a longer-term device.
  • CentriMag, a surgically implanted continuous flow pump that can be used to support the left ventricle, right ventricle or both ventricles for days-weeks.

In 2011, BWH became the first and only program in New England to participate in a new study of a portable driver (SynCardia Freedom® Driver) that enables total artificial heart (TAH) patients to return home while awaiting a donor heart.

Read this article about a BWH cardiac nurse's experience with a VAD patient.

Read this article about living with a VAD in the American Heart Association's Circulation journal.

Why Have Ventricular Assist Device Surgery?

Our cardiac specialists use VADs for three main purposes:

  • As a bridge to transplantation, temporarily supporting a patient who is waiting for a heart transplant.
  • As a bridge to recovery, for a patient with a potentially reversible form of cardiac failure. The device is implanted to assist the heart while it recovers, and is removed if the recovery is successful.
  • For a patient who has irreversible heart failure but is not an ideal candidate for a heart transplant, a VAD may be used as destination therapy, helping to support circulation for many years.
What You Should Expect

The Heart & Vascular Center is located in the Shapiro Cardiovascular Center, across the street from BWH's main 75 Francis Street entrance. The Heart & Vascular Center brings together the full range of services in one location, fostering seamless and coordinated care for all cardiovascular patients.

Prior to your procedure, you will be admitted to the Shapiro Cardiovascular Center for preoperative management and additional tests as needed.

The day of the procedure, your care will be provided by surgeons, anesthesiologists and nurses who specialize in ventricular assist device surgery. The Heart & Vascular Center is home to one of the most advanced hybrid operating rooms in the country. You will recover in the post-surgical care unit where you will receive comprehensive care by an experienced surgical and nursing staff. After you transition out of the intensive care unit, you will receive comprehensive care on a multidisciplinary, combined medical-surgical unit.

During your procedure, family and friends can wait in the Shapiro Family Center where staff members will provide surgery updates.

Multidisciplinary Care

In addition to our cardiac surgeons and cardiologists, patients also benefit from the teamwork of interventional cardiologists, cardiovascular imaging experts and radiologists, and anesthesiologists, all experts in cardiovascular disease. They work alongside nurses, physician assistants, physical therapists, dietitians and social workers to achieve outstanding outcomes for our patients.

Resources

Learn more about heart failure in our health library.

Visit the Kessler Health Education Library in the Bretholtz Center for Patients and Families.

Access a complete directory of patient and family services.

Learn about the Watkins Clinic in the Shapiro Cardiovascular Center.

Download Cardiac Surgery: A Guide for Patients in English or Spanish.

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