About Your Ventricular Assist Device (VAD) Surgery

Transcription

1 About Your Ventricular Assist Device (VAD) Surgery Why do I need surgery for a Heart Pump or Ventricular Assist Device (VAD)? VAD s may help you live longer. These electric powered heart pumps are put in your chest during surgery They help your heart work better and improve blood flow VAD s are used for two reasons: o For heart failure patients waiting for a heart transplant (Bridge-to- Transplant) o For patients in end stage heart failure who do not qualify for a heart transplant (Destination Therapy). You will have a VAD for the rest of your life How will this VAD be used? Bridge to Transplant (BTT): You will receive an VAD for BTT: YES NO o It may take a few days or months to find a donor heart for transplant. Some people wait for over a year o Sometimes people are so sick that they will need a VAD before we know for sure if they qualify for a heart transplant o Getting the VAD does not mean you will get a heart transplant in the future Destination Therapy (DT): You are receiving an VAD for DT: YES NO What if I do not want VAD Surgery? You have the choice not to have a heart assist device You will still be treated for your heart failure even if you choose not to have surgery You can always choose to have surgery or VAD implant in the future if you qualify Your health may get worse and you may not live as long if you delay your surgery If you wait, you may be too sick for surgery. A pump may not be able to help you Page 1 of 8

2 Who can have VAD Surgery? People who: o Will probably live longer after this surgery o Have end-stage heart (ventricular) failure o Have a hard time exercising because of their heart problems o Have talked about other treatments besides this surgery You may not be able to have VAD surgery if you: o Are using drugs or alcohol o Have untreated depression or other mood disorders o Are unable to follow medical instructions o Have other health problems that may stop you from getting better after surgery What will I need to do before I find out if I can have VAD surgery? We will contact your health insurance to make sure they will pay for your surgery You will have a head to toe exam of your body You will need to tell us about your medical history. This includes information about: o Any surgery you have had in the past o Food and drug allergies o Whether you have ever had a blood transfusion o Whether you have had a flu, pneumonia or tetanus shot o Past or current smoking, alcohol, or drug use You will meet with a social worker to see if you are able to handle this surgery and needed changes to your lifestyle You will meet with someone to talk about your End of Life (Palliative Care) wishes and treatment goals We will look how the right and left side of your heart are working. You may need special x-rays or tests We will look at how your lungs are working. You may need blood tests or special breathing tests. You also may be asked to ride an exercise bike to test your how your lungs are working You will need blood tests to check how your liver, kidneys, heart, and other organs are working We will check your teeth and mouth We will ask if you have had routine exams in the last year o Eye exam within the last six months o Exam of your bowel (Colonoscopy) o Prostate exam for men or a mammogram for women Page 2 of 8

3 What medical conditions will affect my chances to recover after VAD surgery? o Serious Medical Conditions are: Serious Right Heart Failure End stage liver, kidney, or lung disease High blood pressure or history of stroke Hardening of the arteries in your chest, stomach, or legs Unable to exercise due to health Not following medical instructions from your doctor or nurse Body size or shape that will not allow for proper fit of the device o Other Risk Factors Decreased right heart function Heart valve disease Age between 60 and 70 Patients over age 70 will be considered on a case by case basis Being severely overweight or underweight Poor nutrition and/or muscle weakness Diabetes Infection Current or past history of cancer Blood disorders Alzheimer s or dementia No one to care for you when you go home Not able to get dressing supplies, reliable phone or electric service, or rides to appointments Smoking or using tobacco What are the risks of having VAD surgery? o The heart pump or one of the parts of the pump may stop working or malfunction. This is rare. You may need to have more surgery to fix this There may not be a way to fix this. This is very rare o May have problems with memory, attention, and thinking speed after heart surgery o Death o Infection o Bleeding o Blood clots that form and can travel to other parts of the body. This can cause a stroke or loss of a limb or organs Page 3 of 8

4 o Right side of the heart may be weakened and fail to pump blood (Right Heart Failure) o May have trouble getting off the breathing tube and machine o Longer hospital stay o Brain or nerve damage. This may cause you to have a hard time waking up or trouble moving parts of your body o Damage to blood cells o Heart beat may be irregular or may stop beating completely o High blood pressure o Lungs stop sending oxygen to the body o Fainting o Heart attack o Kidney failure o Liver failure o Women of childbearing age must have a negative pregnancy test at the time of surgery. You must agree to use a reliable form of birth control o A growing baby may move the heart pump which may cause pump failure, bleeding, or death What happens before and during the VAD Surgery? o Before Surgery Your VAD surgery should be planned ahead of time. If your health gets worse you may need to have surgery right away If your surgery is planned you will come to the hospital that morning. If your heart failure is serious you may be in the hospital a few days before surgery Your VAD nurse and surgeon will talk to you about the type of heart pump you are likely to get before your surgery One of your doctors will talk to you about the effects and risks of putting you to sleep for your surgery To help stop infection your skin will be cleaned with special cloths before you go to surgery. You will also have antibiotics before your surgery Your family will be allowed to be with you before surgery. Page 4 of 8

5 o During Surgery Surgery for a VAD implant can take 6 to -12 hours. If you have had a heart surgery or problems with bleeding in the past your surgery may take longer Surgery time also depends on the type of pump you will have For most VADs, the surgeon will make an incision in your chest and through your breast bone. The VAD will be attached to the heart through this opening For most devices the pump will be inside the body with a power cord or driveline coming out of the skin, usually through the abdomen Some pumps are outside the body. They are connected to the heart with tubes that run through your skin During the surgery you will be placed on a machine (cardiopulmonary bypass) that will push oxygen into your blood and then send the blood around (bypass) your heart and lungs during the surgery o After Surgery When the VAD surgery is over, two to four tubes will be put in your chest to let the fluids drain out. This will help you heal after surgery You will have a tube in your throat to help you breathe You will get medicine for pain You will be attached to a power module or driver. The type of power source depends on the type of VAD This power source plugs into the wall and helps power the VAD It also monitors how the pump is working You will be using power sources like this when you go home Page 5 of 8

6 o Living with a VAD Many people are active with some rules to live by Support person You need at least one person to learn how to take care of the VAD. If you cannot take care of the VAD yourself, you will always need a trained person with you Your support person usually changes the dressing at the power cord exit site Home Safety You need grounded (3 prong) outlets for your VAD Use wall power when sleeping You need working phone and electric service Driving and Travel Take your VAD equipment with you We recommend that you Do Not drive after your surgery If you will travel long distance, we can give you a contact number for the VAD center near you Other rules No putting your whole body or VAD in water. For example, you cannot sit in a tub of water or hot tub. You cannot swim No contact sports No showering unless your VAD team says this is OK o End of life with VAD We will have you talk to a End of Life Care team before surgery to help learn your goals If you become very sick and do not have a chance to survive, we may talk about stopping the pump. The doctor would talk to you or your family about what is right for you It is helpful to talk to your family about your goals before surgery so they know what your wishes are. o If you have more questions Call and press option 3. This is the heart transplant and VAD nurse line. We are here from 8:00 am to 4:30 pm Monday through Friday. We will call you within the next work day. For emergencies call the hospital operator at or Ask them to page 3833 or A nurse will answer 24 hours a day. Page 6 of 8

7 Acknowledgement of Understanding: I know that not caring for my VAD and driveline or not following my medical instructions may cause: o Pump failure o Pump or driveline infection o My health to get worse. o All of these can cause serious health problems including having to return to the hospital and/or death Changes in lifestyle and body image have been discussed with me o I have seen VAD pump models and have a basic understanding of the device pieces, including batteries, power module, driveline, and controller o I have seen a picture of a patient wearing the controller and batteries o I have seen a picture of where the device exits the body on the abdomen (driveline exit site) I know I will need someone to care for me 24-hours a day after I am sent home from the hospital. I cannot stay alone after I receive a VAD until my treatment team approves this I know I cannot drive after surgery I have met with a current VAD patient and was able to ask questions in private about the VAD surgery, treatment, and home going instructions I know it is important to tell my support persons, family, and the VAD team about my treatment goals and desires in case of serious illness or device failure I know that if the device is not meeting my goals, I have the right to have the device turned off or to refuse another surgery I have made my decisions about end-of-life care (advance directives) to make sure my goals for treatment are met Page 7 of 8

8 My signature below confirms that I have been given education on Ventricular Assist Devices (VAD). I have also met with a doctor and nurse from the University of Iowa Cardiomyopathy team to discuss: Type of heart pump I will get during surgery What to expect before, during, and after surgery Information about needed lifestyle changes All of my questions about my condition, tests, risks or problems with surgery, lifestyle/body image changes, or other treatment options have been answered. Patient Signature: Date: Caregiver Signature: Date: The above signed Patient and Caregiver have verbalized understanding of the above information regarding VAD Therapy, and have had the opportunity to ask questions and have those questions answered. VAD Coordinator Signature: Date: Page 8 of 8