Implanting Biventricular Assist Device for Heart Failure Treatment

Table of Content

Summary

Biventricular Assist Devices are a type of mechanical circulatory support devices that will be required for persons with Congestive Heart Failure. This condition causes heart and heart-function to weaken progressively with time. The device includes a set of pumps that will be implanted in the person’s body during an open-heart surgery. It will take over the functioning of the entire heart and the full circuit of blood-circulation on a continuous basis.

Introduction to CHF and VADs

In earlier articles, we have covered Mechanical Circulatory Support (MCS) devices (also called Ventricular Assist Devices – VAD, or Cardiac Assist Devices) for people with Congestive Heart Failure (CHF). CHF is a progressive condition in which the heart function keeps deteriorating over time until total failure one day. Heart transplantation is the best option for such people but there is always a shortage of cadaver hearts. Further, some people are not suited for heart transplant. Then there are some people who can recover heart function with some external support. An MCS device is then required for all these three kinds of people. Again, MCS devices are of two types – ‘temporary’ for short-term use, and ‘durable’ for long-term use. A Bi Ventricular Assist Device is an example of a durable MCS device.

Also Read: Significance of Ventricular Assist Devices in Cardiac Support

What is a Bi Ventricular Assist Device?

In the normal blood-circulation cycle, impure blood from all over the body comes to the right ventricle, from where it goes to the lungs for purification. Purified or oxygenated blood comes to the left ventricle from where it is pumped to the rest of the body. According to cardiologists, people with CHF may have a weak left ventricle, which is the most common occurrence. Such people require a Left Ventricle Assist Device or LVAD. While people whose right ventricle is weak will require a Right Ventricle Assist Device or RVAD.

But there is the third category of people in whom both ventricles are weak. Does it mean, they require two devices? No. They have the option of a Bi Ventricular Assist Device (BVAD) which can take over the work of both ventricles and manage the complete cycle of blood-circulation, on a continuous basis.

Technically speaking, the BiVAD is an implantable, battery-operated, electromechanical pump that can take over the entire blood-circulation. It can relieve the pressure on a weak or failing heart, in people with CHF. The device is implanted by surgeons during an open-heart surgery.

Why is BiVAD required?

A BiVAD is critical for people with CHF, in order:

To keep the heart working during or after heart surgery and until full recovery
To keep the heart working while the person is waiting for a heart transplant
As a permanent treatment for people for whom neither restorative surgery, nor transplant is an option

Preparing for the Implant procedure

The first step is an assessment of the person’s mental and physical health to determine if he/she is a right candidate for implant and how soon the implant can be done. This will be achieved through a series of diagnostic tests such as electrocardiogram, exercise testing, CT scan and echocardiogram.
The above tests will not give the complete picture, so the next step is cardiac catheterizations for both left and right ventricles. In this, a catheter is introduced through an artery in the arm, groin, upper thigh or neck, and threaded all the way to the heart. This helps examine the circulation in the arteries, evaluate the performance of the heart muscle and measure the quantum of pressure inside the heart’s chambers and lungs.
After the above steps, the next step would be to finalize the date of the procedure. In case of a pregnant woman, the doctors will arrive at the right date after more tests, or more consultation.
The person will have to sign a consent form, and will be explained about the procedure in detail by the case doctors.
If the person is a smoker, he/she should stop smoking for some time.
If he/she is taking any prescription or over-the-counter drugs, he/she should inform the doctors.
If he/she has any bleeding disorder, is taking aspirin or anti-coagulants (blood-thinners), or any medication that may affect blood-clotting, he must inform the doctor about the same. He/she may be advised to stop the same for some time.
If he/she is allergic to iodine, anaesthesia, latex or tape, the doctors must be informed of the same as all these may be used during the procedure.
The person must follow specific instructions on what to consume the previous night of the surgery.

Also Read: Guideline-Directed Medical Treatment (GDMT) of Heart Failure at Kauvery Hospitals: A clinical audit

During the procedure

On the day of the surgery, the person will be admitted into the hospital.
He/she must remove jewellery and all accessories.
He/she must remove clothing and wear a gown given by the nurses. He/she must empty the bladder now.
The person must then lie on a bed on his/her back, after which he/she will be wheeled into the operating theatre.
An IV line will be started in the arm or hand. Catheters will be inserted into the neck and wrist, and these are required to monitor the heart-rate, pulse, and blood-pressure.
The person will be sedated using general anaesthesia. An anaesthesiologist will continuously monitor the person’s heart-rate, blood-oxygen, breathing and pulse, throughout the surgery.
A breathing tube will be inserted into the throat and from there to the lungs. The other end is connected to a ventilator. Together, these two will help the person breathe during the procedure.
A catheter will be inserted into the groin to help drain urine during the procedure.
The skin over the chest region will be shaved, and cleaned using an antiseptic solution.
An incision is made on the skin right through the chest well, to access the heart. Tubes will be inserted into the heart and connected to a heart-and-lung machine. This will keep the circulation going during the surgery.
One end of an inlet tube is connected to the right ventricle and the other end to a pump. One end of an outlet tube is connected to the pump and the other end to the pulmonary artery. This takes care of the heart to lung cycle of blood-circulation.
In the same way, one end of an inlet tube is connected to the left ventricle and the other end to a pump. One end of an outlet tube is connected to the pump and the other end to the aorta. This takes care of the heart to rest-of-the-body cycle of blood-circulation.
The two pumps are then implanted either inside the body, near the belly, or outside the body, on the belly. This decision will be discussed with the patient before the procedure.
A cable going out of the body through the skin will connect the two pumps implanted inside, with a power-source and a system controller outside the body. The power-source and controller must be worn on the body at all times.
The pumps will be turned on, to take care of both circuits of blood-flow.
The blood circulating through the heart-and-lung machine will be allowed to enter the heart and the connections to this machine will be removed.
The cuts or incisions on the skin will be closed with surgical staples or stitches. A sterile bandage or dressing is applied on the spot.
One end of a tube will be inserted into the chest to drain away blood and fluids from around the heart. The other end is connected to a suction machine to enable this.
Similarly, a tube will be inserted into the stomach, through the nose or mouth, to drain fluids from there.

Also Read: Heart Failure – Cause, Symptoms, Types and Stages

After the procedure

At the hospital

From the OT, the person will be wheeled into an ICU where he/she will remain for a few days. Doctors in the ICU will closely monitor the person’s vitals until they have stabilized.
All the tubes that have been inserted to introduce food and water, to help in breathing, and to drain away fluids, will be removed one by one, gradually.
There are temporary pacing wires that are inserted during the surgery. These are there to ensure the heart rhythm is stable. Once stable, these wires will be removed.
Cardiac rehabilitation, physiotherapy and pulmonary rehabilitation are all required for long-term recovery. This will be started in a step-wise manner. That is, the intensity of activity and time spent will be gradually increased till the day the person is discharged.
The person will be given an incentive spirometer (IS) device to use as often as possible. This will help expand his/her lungs which is required to prevent pneumonia after the procedure.
Throughout this stay, the person’s dressing will be changed regularly and pain-killers may be given to manage pain.
The cardiologist will instruct the person on how to take care of the BiVAD. This includes how to travel with it, how to keep the controller and battery dry while bathing, what to do if the power goes off and what to do in case of an alarm.
The doctors will instruct the patient on diet, exercise, activity, medication and wound-care, all of which must be followed strictly by the person as per the schedules given.
Then the person is discharged. He/she must not drive home and must be driven there by a friend or family-member.

Also Read: Holter Monitors – Heart Monitoring for continuous insights

At home

The person must avoid lifting heavy objects. He/she must walk as much as possible to prevent blood-clots.
He/she must gradually resume all activities, other than work, driving, intense exercise and sex. There will be restrictions on these activities to help the breastbone and muscles of the chest heal properly.
The person must constantly watch the wounds for any sign of redness, bleeding, swelling or discharge and report them if found, to the case doctors immediately.
So also, if there is any fever, pain in the body, chest pain and shortness of breath, he/she must inform the doctors right away.
The person must consume a heart-healthy diet as instructed by the doctors, to maintain a healthy weight. He/she must consume a diet low in fat, cholesterol and salt and high in fresh fruits, fresh vegetables and lean meat.
He/she must not smoke cigarettes or electronic cigarettes, must avoid all tobacco products, and avoid exposure to second-hand smoke.

At Kauvery Hospital, with branches in Chennai, Hosur, Salem, Tirunelveli, and Trichy, we strive to provide personalized and comprehensive care to our patients. With a team of highly skilled cardiologists and state-of-the-art facilities, our commitment is to help our patients navigate their journey towards better heart health. Trust our expertise in heart failure treatments including the advanced Biventricular Assist Device implantation. Visit us today and take the first step to a healthier heart.

Kauvery Hospital is globally known for its multidisciplinary services at all its Centers of Excellence, and for its comprehensive, Avant-Grade technology, especially in diagnostics and remedial care in heart diseases, transplantation, vascular and neurosciences medicine. Located in the heart of Trichy (Tennur, Royal Road and Alexandria Road (Cantonment), Chennai (Alwarpet & Vadapalani), Hosur, Salem, Tirunelveli and Bengaluru, the hospital also renders adult and pediatric trauma care.

Chennai Alwarpet – 044 4000 6000 • Chennai Vadapalani – 044 4000 6000 • Trichy – Cantonment – 0431 4077777 • Trichy – Heartcity – 0431 4003500 • Trichy – Tennur – 0431 4022555 • Hosur – 04344 272727 • Salem – 0427 2677777 • Tirunelveli – 0462 4006000 • Bengaluru – 080 6801 6801