A heart assist device (also called a ventricular assist device or VAD) is a mechanical pump surgically implanted to supplement or replace the pumping function of a failing heart. These devices are used when the heart can no longer maintain adequate circulation despite optimal medical therapy.
The most commonly used type is the left ventricular assist device (LVAD), which draws blood from the left ventricle and pumps it into the aorta, bypassing the weakened heart muscle. LVADs are used in three clinical contexts: as a bridge to transplant, supporting a patient with severe heart failure who is waiting for a heart transplant when without support they would not survive the wait; as destination therapy, a long-term solution for patients with end-stage heart failure who are not eligible for transplantation; and as a bridge to recovery, supporting the heart after an acute insult such as cardiogenic shock following cardiac arrest or a large heart attack, allowing time for the heart muscle to recover.
Modern LVADs are small, implantable centrifugal or axial flow pumps that run continuously. They require an external controller worn by the patient and a power source (batteries or mains power). Patients with LVADs have a specific set of precautions and need to avoid water immersion around the drive-line exit site.
LVADs also have implications for ICD management, as the haemodynamic support they provide changes the threshold at which arrhythmias are dangerous. Specialist centre follow-up is required.
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