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Ventricular Assist Devices

stethescopePhysicians who perform this treatment

Welcome to the Johns Hopkins Ventricular Assist Device Program. Ventricular assist devices are mechanical heart assist pumps that prolong a patient's life while waiting for a heart transplant. This is known as a bridge to heart transplantation.

About us
What is ventricular assist device (VAD)?
Who could benefit from this device?
What is heart failure?
What should I expect?
What types of devices are available?
Are there any studies ongoing?
Who are the VAD team members and what are their roles?
Patient testimonials
How do I learn more?

About Us

Image of HeartMateII, Ventricular Assist Device.

The Johns Hopkins Hospital Ventricular Assist Device (VAD) Program began in 1986 and has resulted in the survival of many patients. These devices are also used as a means of improving quality of life for end stage heart failure patients who do not qualify for a heart transplant. This is referred to as destination therapy.

The program offers a variety of ventricular assist devices. Each one is designed to address specific patient conditions. Our physicians will discuss with each patient the options and select the device that is most suited for that patient.

Our VAD team consists of highly trained and committed clinicians who are dedicated to providing our patients with the best care available. The team includes cardiologists, cardiac surgeons, operating room clinicians, cardiac surgical intensive care unit (CSICU) team, cardiac progressive care unit (CPCU) team, physical therapists, occupational therapists, nurses, social workers, transport personnel, and VAD coordinators.

Our approach to caring for a patient with a VAD implant is different in many areas. We fully believe in developing a relationship with you and your family so that you may have a comfortable and trusting group of care givers around you at all times. We remain active in your care throughout the pre-operative evaluation phase, during the surgery, while recovering from surgery in the hospital, and after discharge while adjusting to a new life at home with the VAD.

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What is a Ventricular Assist Device?
A ventricular assist device (VAD) is a pump that assists the heart by pumping blood to the body. It aids the failing ventricle by taking some of the work load from the heart.

The surgeon connects the pump to the heart by using a tube that is made for this specific use. The blood travels from the heart, down the inflow tube, and into the VAD. The VAD then pumps the blood into the outflow tube and delivers the blood to a major blood vessel. The pump is usually placed in the upper abdomen and cannot be seen.

The computer for the pump is outside the body and can be worn with a fanny pack or a belt clip. The pump and the computer are connected by a small cord that exits the body via a small opening on the side of the abdomen. The system can be powered by using batteries or by using an AC power adapter. The batteries enable the patient to resume most daily living activities.

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Who could benefit from this device?
Patients who have end stage heart failure who are no longer responding to medical management could benefit from a ventricular assist device. They may be transplant candidates who would receive a device as a bridge to transplantation, or if they are not candidates for heart transplantation, they may receive a device as a bridge to destination. The goal in both cases is to improve the quality of life as well as to prolong it. If you think you or someone you know might be a candidate for a VAD, contact the VAD Program at Johns Hopkins.

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What is heart failure?
To learn more what heart failure is, click here.

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What should I expect?
The first stage of the process is to schedule an evaluation with our team. You will meet with a cardiologist who will discuss your current condition and will discuss all possible options to improve your health. If your cardiologist recommends a VAD, you will meet with a cardiac surgeon who will discuss the various assist devices available and discuss the surgical aspects of the procedure. A VAD coordinator will meet with you and your family to go over in detail the ventricular assist devices and all related patient care issues. After this meeting, you and your family may decide if this treatment therapy is right for you.

Once the decision is made to embark on this journey, a series of medical tests are necessary to determine what must be addressed prior to implanting the VAD. These tests include cardiac catherizations, blood tests, and additional family meetings. The tests may be performed at Johns Hopkins Hospital or may be performed at your local hospital.

However, some tests do require being performed at Johns Hopkins Hospital. Every effort will be made to ease this process for you. After all test results are completed, your VAD implant surgery date may be scheduled. The night before surgery, an anesthesiologist will meet with you, discuss the plan for the next day, and answer any questions. The morning of surgery a team will escort you from your room to a cardiac surgery operating suite, where the VAD will be implanted.

What to expect for surgery

Day of Surgery

Once in the operating room, a nurse will greet you and be available to address any of your concerns during the procedure. A nurse will provide you with a warm blanket and will also update your progress to your family during the surgery. A second nurse in the room will be preparing the sterile area for the surgery, the heart lung specialists (perfusionists) will be preparing the heart lung machine and VAD, and the anesthesia technologists will be assisting the anesthesiologist. A VAD coordinator will also be checking on your progress and will be available for your family throughout the day. During your surgery, a representative from the OR will keep your family updated on your progress. The average VAD implant surgery takes 5 to 6 hours.

Immediately after surgery, you will be taken to the Cardiac Surgical Intensive Care Unit (CSICU). Your family may visit approximately one hour after your arrival. The CSICU team is a group of highly skilled professionals comprising physicians, nurses, nurse practitioners, respiratory therapists, pharmacists, and VAD coordinators who will care for you.

You will be attached to a breathing machine (ventilator) until you are fully awake and able to breathe on your own. At that point the physician will remove the tube and he will have you put on a small green plastic mask to give you additional oxygen if needed. You will also have wires attached to you that will monitor heart rate, blood pressure, intravenous medication lines, and other monitoring equipment.

Visitors after surgery
Even though family visiting is limited on the day of your surgery, the CSICU team tries to make accommodations as much as possible. The length of stay in the CSICU after your surgery is variable. When you are considered stable enough you will be transferred to the Cardiac Progressive Care Unit (CPCU) for more extensive rehabilitation. You and your family will be encouraged to participate in care and learn about the ventricular assist device. This process usually begins in the CSICU and increases as you are cared for in CPCU.

While you are in the CPCU, you will continue to be monitored and will require less monitoring as you become stronger. This will allow you the ability to move around more. The important aspects of care on this unit are related to improving your state of health and increasing your level of activity. One of these aspects is respiratory care. You will be using an insentive spirometer and flutter valve to help keep your lungs clear.

Also while in the CPCU, you will be getting out of bed and walking. Your nurse and physical therapist will help you with this activity. You will start with sitting in a chair and progress to taking short walks. As you get stronger, you will walk longer distances, ride a bike and begin balance exercises. The main goal of physical therapy is to make you as independent as possible to allow you to return to work, your hobbies and an active lifestyle. Some patients will achieve these goals while in the hospital and go home walking without any assistance. Others will need to attend outpatient physical therapy to achieve these goals. It will be a lot of work but the rewards will make it worth while.

You will stay in the CPCU until discharge. Family and close friends may visit at any time. One adult family member may stay in the room with you. Each room is equipped with a chair that changes into a bed. You will also be given important information about your care and the services that are available to you while on the CPCU.

While you are in the CPCU, the VAD team will provide you and your primary care givers training about your new device. Primary caregivers may be family members or friends. These individuals agree to come to the hospital to learn about the device, how to handle emergencies, and will be available to assist with your VAD care once discharged.

All patients and caregivers must pass a written test and demonstrate a strong knowledge base regarding the operation of the VAD prior to discharge. Two trips out of the hospital will be planned to allow you and your care givers an opportunity to gradually navigate in the community before discharge. The first trip is supervised by one of the VAD coordinators and the second trip is unsupervised by a VAD coordinator.

After discharge, you will return to the hospital periodically for clinic visits. During these visits, you will have basic blood work drawn, meet with a VAD coordinator, and visit with your surgeon. The clinic visits usually last one hour. The frequency of clinic visits will depend on your progress and the amount of time since your discharge.

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What types of devices are available?
The Johns Hopkins Hospital Ventricular Assist Device Program offers a wide array of devices. The specific device that is best for you will be determined by your cardiologist and surgeon. Here are some of the options that are available to you at Johns Hopkins:

  • ABIOMED® AB5000 Ventricle
  • HeartMate® XVE
  • HeartMate® II
  • Heartware
  • Impella
ABIOMED AB5000 Ventricle

Photo is courtesy of ABIOMED®

ABIOMED® AB5000 Ventricle

The ABIOMED® AB5000 Ventricle is another short term, external device that is used to support the heart. It can be used as a bridge to a longer term support device, or as a cardiac assist device to allow time for the heart to rest after surgery or other reversible heart dysfunction. The ABIOMED® AB5000 Ventricle is approved by the FDA for use as a bridge to recovery for patients with potentially reversible heart failure. Patients on this device must remain in the hospital during the support phase. This device can provide right, left, or bi-ventricular cardiac support.

Dr. Ashish Shah with the Impella device
Dr. Ashish Shah shows the Impella device.

HeartMate®II

The HeartMate® II is a new technology that utilizes rotor flow to propel blood from the left ventricle to the aorta. This device is used primarily as a left ventricular assist device and is a bridge to heart transplantation. The pump is approximately the size of a large candy bar and can be placed in smaller patients due to its smaller size. It is an internal pump and is monitored by an external controller that is approximately the size of an adult's hand. The patient carries the controller in a fanny pack. The patient on this device are discharged from the hospital and can go back to work or school, and resume most daily life activities. The device is powered by an AC unit or by batteries.

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Are there any studies ongoing?
Discovery, innovation, excitement, and application: these are the hallmarks of Johns Hopkins research. Hopkins' clinical scientists and privately supported research studies help develop new knowledge, new techniques and new technologies for patient care. Thanks to their creative research, the Johns Hopkins School of Medicine receives more National Institutes of Health funding than any other medical school.

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Who are the VAD team members and what are their roles?
Hopkins VAD Coordinators come from various medical backgrounds which makes the Hopkins VAD Program unique. This approach creates an excellent patient care environment by creating a think tank of clinicians.

Our VAD Coordinators all hold advanced degrees and have a combined clinical experience of over 90 years. Before surgery the coordinators will meet with you to discuss the pump options that the cardiac surgeon and cardiologist have selected for you. They coordinate your in-patient care from hospital admission to hospital discharge and help manage your care after you leave the hospital with your heart pump.

Dr. John V. Conte currently implants VAD's at Johns Hopkins.

Dr. John ConteDr. John V. Conte joined the Johns Hopkins Division of Cardiac Surgery in 1998 as an Assistant Professor, in 2000 advanced to Associate Professor and later in 2005 was appointed the Associate Chief of the Division of Cardiac Surgery. He is the Director of the Ventricular Assist Device Program and performs adult cardiac surgery, including the implantation of ventricular assist devices.

The Hopkins CSICU and CPCU teams involved with the VAD program will care for you in our state of the art facilities after your implant surgery is complete. These teams include critical care nurses, nurse practitioners, physicians, respiratory therapists, occupational therapists, and our VAD Coordinators.
Hopkins physical therapy and occupational therapy teams involved with the VAD program are the key to your rehabilitation after implant. Physical therapy will begin soon after your surgery and continue through most of your hospital stay. While you are still in the intensive care unit, a physical therapist will begin to work with you on your range of motion and strength. As soon as it is possible they will assist you with standing and walking and other rehabilitation goals.

Hopkins social workers involved with the VAD Program will help you and your family understand the system and assist with personal and social situations. They help find financial resources and housing resources. They help you and your family cope with the important life changing decisions that must occur when choosing to have a device or not.

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Patient Testimonials
AlexAlex was an 18-year-old who arrived at Johns Hopkins Hospital after an acute episode of heart failure. The patient was previously healthy but suddenly found himself in a much different situation. His heart was failing and he needed a heart transplant. To help him survive until a donor heart became available, his doctor decided to implant a HeartMate® XVE left ventricular assist device. Alex went home on the device and resumed his daily routine. Alex got his heart transplant approximately 10 months after his LVAD implant. He is now home finishing high school and planning on going to college. Alex says, "I am grateful to the team at Hopkins who really came through when I needed them".

GabbieGabbie is an 18 year old HeartMate® II patient of Dr. John V. Conte. She developed dilated cardiomyopathy following Adriamycin chemotherapy for leukemia. She was flown to Hopkins after she had a sudden episode of decompensating cardiomyopathy at another hospital. She would not have survived to receive a heart transplant without a heart assist device. Dr. Conte implanted the HeartMate® II device in her January of 2005. Gabbie says, "The VAD Team at Johns Hopkins are cool people, who are very helpful, considerate, and compassionate. They know their stuff like the back of their hand!" She is currently home on the device and just successfully completed her GED program.

Mr. MilberryMr. Millberry is a 57-year-old male who needed a heart transplant. The patient had end-stage heart disease and had been dependent on many heart drugs to keep his failing ventricle functioning. Dr. Conte implanted a HeartMate® II in him. Mr. Millberry worked very hard to rehabilitate in order to go home with the device. But the night before discharge, a heart became available for him and he was successfully transplanted. He is now home. Mr. Millberry says, "The people at Hopkins become like family and I am tickled that we met."

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How do I learn more?
To learn more about the Johns Hopkins Hospital VAD Program, contact one of our team members.

VAD Program Voice Mail
410-502-4757

Dr. John V. Conte
410-955-1753

Dr. Ashish Shah
410-502-3900

VAD Team E-Mail
HopkinsVAD@csurg.jhmi.jhu.edu

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Physicians Who Perform This Treatment:


 

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