The evaluation process is designed to help decide if a VAD is the best choice for you. The process involves a series of blood work, other tests, and consultations. The evaluation will assess the patient’s past medical history, previous medical compliance, mental preparedness, and existing support system. We will also work with you to help you understand the financial implications, insurance details, and long-term self-care requirements.
Even if you are being considered for a bridge to heart transplantation, this is subject to change pending the results from your evaluation and the transplant team’s decisions. After the evaluation, the Advanced Heart Failure/VAD/Transplant Team will decide if you meet the criteria to have a heart pump implanted. If the evaluation results in the need to address other medical conditions, then we will proceed with addressing those conditions before VAD implantation is taken up.
If you are considered medically reasonable for VAD implantation, we work with you and your family so that they could arrive at the decision themselves. If you decide that this may not be the best option, we will re-evaluate the condition later as and when the need arises. Every time the tests need to be repeated to be considered medically fit for the procedure.
MEDICAL REQUIREMENTS FOR VAD IMPLANTATION
VAD improves the blood flow from the heart to the rest of the body. Implantation of VAD is major surgery and hence requires several medical conditions to be tested. The long-term maintenance of VAD also requires a lot of care. Some of the reasons implantation of VAD may not be a good option include the following:
- Certain medical conditions could make the surgery very difficult or dangerous. The risks of a VAD surgery include – excessively high lung artery (PA) pressures and right heart failure, problems with the existing heart valves, a small left ventricle, a damaged aorta, blood clotting disorders, poor food intake, current pregnancy, and high risk of infection. If the medical team evaluates that any of these risks are very high in a patient, they will not be recommended for the surgery.
- Diseases of other parts of the body could also increase risks during the surgery for VAD implantation. Diseases/ conditions such as aggressive cancers, permanent kidney disease, end-stage liver disease, severe emphysema of the lung, blockages of the arteries to the legs or the brain, uncontrolled diabetes, and extreme frailty or extreme obesity, are also considered high risk.
- If the patient is unable to care for the VAD in the long-term, they will also not be considered for VAD implantations. Patients with a severe psychiatric disorder, patients who are habitual users of illicit drugs or alcohol, patients with a history of not following medical recommendations, patients with inadequate social support (patients with VAD must identify a primary caregiver), and those with financial hardship may not be able to follow the self-care required in the long term.
ALTERNATIVES TO LVAD/ VAD
After evaluation, if you are not medically fit for VAD implantation, or if you and your family decide that this is not the best option, you will continue to get standard medical care. However, VAD implantation is suggested when current therapies do not adequately treat heart failure. For patients with advanced heart failure who do not proceed with VAD implantation, we suggest palliative treatment for end of life care.